Abstract
Aneurysms of the thoracic aorta must be differentiated from pseudoaneurysms, carcinomas of the lung and mediastinal tumors. Although diagnostic technics for delineating pathologic conditions in the aorta have improved in recent years, none is infallible, and frequently the correct diagnosis can be made only at the time of thoracotomy. The therapy of choice is excision with grafting (or direct repair in some cases of traumatic aneurysms), using a bypass to relieve left ventricular pressure and at the same time to nourish the spinal cord and kidneys during aortic crossclamping. Left heart bypass has proved to be a safe procedure in these cases if certain details of technic are followed. These consist of a large catheter in the left atrium, a reservoir in the circuit and proper regulation of proximal aortic pressure during bypass. Experimental data has been presented to show that normal renal blood flow can be assured if the proximal aortic pressure is maintained approximately at 10 mm. Hg below the pre-clamping pressure rather than the higher pressures recommended by other authors.
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