RT Book, Section A1 Wasnick, John D. A1 Hillel, Zak A1 Kramer, David A1 Littwin, Sanford A1 Nicoara, Alina SR Print(0) ID 8550964 T1 Chapter 9. Anesthesia for Repair of Diseases of Thoracic Aorta T2 Cardiac Anesthesia and Transesophageal Echocardiography YR 2011 FD 2011 PB The McGraw-Hill Companies PP New York, NY SN 978-0-07-171798-4 LK accessanesthesiology.mhmedical.com/content.aspx?aid=8550964 RD 2024/03/28 AB With each heartbeat blood is ejected into the aorta exerting multiple mechanical forces on it: pressure, radial and longitudinal stress, tension. Just as diseases of the aorta can affect the heart, diseases of the heart can affect the aorta. Cardiac patients often suffer from both and this makes their clinical care more complex.The aorta ascends in the anterior mediastinum, curves backward into the aortic arch from which emanate the great vessels of the head and the upper extremities, descends into the posterior mediastinum and beyond the diaphragm continues into the abdomen providing blood to the spinal cord, gut, kidneys, ultimately dividing to deliver blood to the lower extremities. Diseases that interfere with the delivery of blood to the tissues (eg, aortic dissections, atherosclerosis, and emboli) place patients at great risk for organ ischemia. Other disease conditions (eg, aneurysms) weaken the wall of the aorta and often result in aortic rupture and sudden death. Many patients with aortic disease present emergently in the setting of acute aortic dissection, contained aneurysmal rupture, or following blunt or penetrating traumatic aortic injury. Others, with long-standing aortic aneurysms, present for elective surgery for repair of progressive dilatation of the thoracic aorta. Irrespective of the nature of their thoracic aorta disease these patients are often quite unstable and their prognosis can be disappointing. Consequently, cardiac surgeons and their anesthesia colleagues are called upon to exert great skill to manage these "high-risk" patients.