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Ann Thorac Surg 2002;74:2071
© 2002 The Society of Thoracic Surgeons
a Baltimore, Maryland, USA
Diseases of the Aortarepresents an ambitious endeavor by leading authorities in their fields of specialty to provide the latest advances in aortic pathology, diagnosis, and various modalities of therapy. The book comprises five major sections. Section I covers the basic science section of the aorta. In this section Chapter 1 covers the anatomic and functional aspects of the aorta, Chapter 2 the normal structure of the aorta, Chapter 3 the pathology of aortic aneurysms, and Chapter 4 the normal physiologic processes acting on the aortic wall including blood flow, vascular resistance and impedance, compliance and remodeling. Chapter 5 covers mechanisms and mechanical properties of aneurysms. The concept of the development of aneurysms due to atherosclerosis is challenged and the presence of atherosclerosis in aneurysms is considered incidental. Several animal models of aneurysms are presented to simulate the development of aneurysms in humans. Among these are the atherogenic diet in monkeys, the abnormalities in the X chromosome in the blotchy mouse resulting from abnormality of the copper metabolism, the production of aortic aneurysms in chicks exposed to theophylline in utero, and the mechanical or chemical disruption of the arterial wall of the rat. Chapter 7 discusses the genetic factors in the development of aortic aneurysms. Most of the efforts have been directed toward analyzing candidate genes of biological significance to the aorta. Chapter 8 covers the fibrillin mutations in Marfan syndrome and phenotypes. Microfibrils in fibrillins in association with elastin in elastic fibers confer the biomechanical properties of the aorta. As a result, mutations in fibrillin genes have deleterious effects on the integrity of the aortic wall. In humans, mutations in fibrillins cause Marfan syndrome and congenital contractural arachnodactyly.
Section II (Chapters 9–11) discusses the various modalities of radiologic diagnosis of diseases of the aorta. The sensitivity, specificity, and accuracy of each method in detecting aortic dissection is presented with comparison of the advantages and limitations of each diagnostic method and criteria for choosing between distinct diagnostic techniques.
Section III (Chapters 12–18) discusses the incidence of thoracoabdominal aortic aneurysms and dissection based on autopsy and population screening, the prediction of thoracic aneurysm expansion, and factors that predispose to aortic rupture. It also discusses the etiology, pathogenesis, and clinical aspects of aortic dissection.
Section IV (Chapters 19–22) discusses endoluminal treatment of abdominal aortic aneurysms, the various devices used to repair such aneurysms, and a meta-analysis of clinical studies about endoleaks after stent grafting of abdominal aortic aneurysms and percutaneous interventions for treating ischemic complications of aortic dissection.
Section V presents surgery of the proximal aorta including repair of the aortic root, the ascending aorta and subaortic outflow tract, illustrating the aortic valve sparing operations with excellent diagrams. Separate chapters are devoted to aortic arch repair and surgical treatment of degenerative diseases of the descending aorta and descending aortic dissection. The criteria for differentiation between penetrating atherosclerotic ulcers and intramural hematomas are presented as well as recommendations for surgical treatment. The section also covers the surgical treatment of aortic aneurysms in Marfan syndrome, the use of axillary cannulation in cardiopulmonary bypass for thoracic aortic repair, and the current status and analysis of risk factors for morbidity and mortality in retrograde cerebral perfusion in aortic arch surgery as well as selective antegrade cerebral perfusion.
Diseases of the Aorta is an encyclopedia of information, covering all aspects of anatomy, physiology, molecular biology, genetics, radiological diagnosis, endoluminal, and surgical therapy of diseases of the aorta. It is illustrated with clear pictures of computed tomography scans, magnetic resonance images, angiograms, and operative procedures although some pictures could have been improved by direct labeling. All aspects of degenerative and dissecting aneurysms of the aorta are well covered. However, traumatic rupture of the aorta is mentioned only briefly in the discussion of the diagnosis of aortic diseases by transesophageal echocardiography. Detailed discussions of the clinical presentation, the value of spiral computed tomography, and the surgical management of traumatic aortic rupture are lacking.
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