Balloon Angioplasty Of Aortic Coarctation Research Articles

Balloon Dilatation in the Management of Congenital Obstructive Lesions of the Heart: Review of Author's Experiences and Observations-Part II.

While investigating the outcomes of balloon dilatation procedures in patients with congenital obstructive lesions of the heart, several parallel observations were made. The purpose of this review is to present these observations/phenomena/innovations related to balloon dilatation of pulmonary stenosis (PS), aortic stenosis (AS), and aortic coarctation (AC). In subjects who had balloon pulmonary valvuloplasty (BPV), development of infundibular obstruction, electrocardiographic (ECG) changes, changes in right ventricular filling, role of balloon/annulus ratios on the results of BPV, and double balloon vs. single balloon BPV will be reviewed. In patients who had balloon aortic valvuloplasty (BAV), causes of aortic insufficiency and trans-umbilical venous approach for BAV are tackled. In children who had balloon angioplasty (BA) of AC, aortic remodeling and biophysical response after BA of AC are discussed.

MRI visualization of aortic recoarctation in the long-term period after surgery (case report)

Case study. Aortic coarctation refers to well-known and well-studied congenital malformations of the cardiovascular system. The success of cardiovascular surgery significantly increased the survival rate of patients, but, unfortunately, did not reduce the risks of serious cardiovascular complications in the long-term postoperative period. One of the significant complications remains recoarctation – repeated narrowing in the area of surgery, which can initiate other complications.The purpose of the study: to present the features of blood flow in the aorta in a patient with aortic coarctation in the long-term postoperative period on the clinical example of a complex MR examination.Material and methods. A 12-year-old patient, at the age of 6, she underwent balloon angioplasty of aortic coarctation. Echocardiographic data revealed a residual gradient at the isthmus of the aorta and expansion of the descending aorta. To clarify the diagnosis, MRI angiography of the heart was performed with intravenous contrast and the use of a cardiopackage for 4D flow analysis (4D flow).Results and discussion. According to the MRI study, a narrowing of the distal aortic arch with aortic dilation after the departure of the left subclavian artery was revealed, which is confirmed by the obtained absolute values of blood flow indicators. MR-angiography of the aortic arch made it possible to visually determine the “gothic” shape of the aortic arch and present 3D reconstructions. 4D flow maps showed acceleration of blood flow to the systole in the area of aortic narrowing, additional vortex flow below the area of aortic narrowing and spiral flow in the descending aorta, which persisted throughout the diastole.One explanation for the abnormal spiral flow in the descending thoracic aorta may be the presence of a “gothic” aortic arch. Also, residual hypoplasia of the aortic arch and narrowing of the isthmus are the leading parameters affecting the pathophysiology of changes in blood pressure during exercise.Conclusion. The 4D-flow MR package in vivo makes it possible to study the flow geometry and blood flow parameters in detail, to obtain a detailed picture of the aortic condition, which gives potential advantages in a comprehensive examination of patients with aortic coarctation under dynamic observation.

The efficacy and safety of percutaneous balloon angioplasty for aortic coarctation in children. Acute and mid-term results in a single center experience.

Objectives:To assess the efficacy and safety of balloon angioplasty (BAP) procedure for treatment of coarctation of the aorta (CoA) in children.Methods:A retrospective study included 27 consecutive children, underwent BAP for either native-CoA (Na-CoA) or recoarctation (Re-CoA). Medical records, echocardiographic findings, angiographic and hemodynamic data were collected from the hospital database. Follow-up was scheduled at 1, 3, 6, 12 months after the procedure. The study took place over a period of 4.5 years, from April 2014 to January 2019, in Madinah Cardiac Center, Madinah, Northwest region, Saudi Arabia.Results:The mean age of patients was 11.86±8.96 months. Seven children had Na-CoA and 20 children had Re-CoA. The success rate of the procedure was achieved in 23 children (85%), as BAP reduced the mean systolic pressure gradient across the CoA (Na-CoA: from 45.28± 18.3 to 9.8± 6.57 mm Hg, p=0.0009), and in Re-CoA groups (from 42.48±16.7 to 10.9±8.5 mm Hg, p<0.0001). In mid-term follow-up, the need for re-intervention occurred in 8 children of the cohort (3 children [42.8%] from the Na-CoA group, and 5 children [25%] from the Re-CoA group).Conclusions:Balloon angioplasty is considered a safe procedure for the management of CoA, but its efficacy remains questionable especially for young infants with Na-CoA type. However, it is a reliable option for managing Re-CoA children, with a lower rate of future re-intervention.

Interventional Treatment of Cardiac Emergencies in Children with Congenital Heart Diseases

Abstract Cardiac emergencies in children represent an extremely important issue in medical practice. In general, interventional treatment could be optional in many situations, however it can be indicated in emergency conditions. There are many diseases at pediatric age that can benefit from interventional treatment, thus reducing the surgical risks and subsequent complications. Balloon atrioseptostomy, patent ductus arteriosus (PDA) closure, percutaneous or hybrid closure of a ventricular septal defect, pulmonary or aortic valvuloplasty, balloon angioplasty for aortic coarctation, implantation of a stent for coarctation of the aorta, for severe stenosis of the infundibulum of the right ventricle, or for PDA correction are among the procedures that can be performed in emergency situations. This review aims to present the current state of the art in the field of pediatric interventional cardiology.

Percutaneous Balloon Angioplasty for Aortic Coarctation in Newborns and Infants: Is It Still an Option?

Percutaneous Balloon Angioplasty for Aortic Coarctation in Newborns and Infants: Is It Still an Option?

Rarely Seen Embolic Events Associated with Infective Endocarditis: Case Report

Although infective endocarditis is an uncommon disease during childhood, it has high rates of morbidity and mortality. Congenital heart diseases and rheumatic valve damages are the most important predisposing factors for infective endocarditis and the risk is increased by heart surgery and interventional treatments. The most significant complications of infective endocarditis are congestive heart failure and embolic events. We report a four-year-old boy presented with acute ischemic stroke two months following balloon angioplasty for aortic coarctation diagnosed as infective endocarditis. During follow-up, parotid and intramuscular abscess formation because of septic embolism were observed as complications of infective endocarditis.&nbsp;

Infective endocarditis, thoracic aortitis, and mycotic aneurysm formation complicating balloon angioplasty of aortic coarctation

Coarctation of the aorta is a rare congenital anomaly usually accompanying bicuspid aortic valve. Adult patients with aortic coarctation can be managed either with surgery or percutaneously. Here we present a case of percutaneously treated aortic coarctation complicated with infective endocarditis of the aortic valve, thoracic aortitis, and thoracic mycotic aneurysm.

Interventional treatment of critical coarctation of the aorta in an extremely low birth weight preterm neonate

The authors describe successful balloon angioplasty of aortic coarctation in a preterm neonate weighing 670 grams. The intervention was performed in an open incubator to ensure stable temperature comfort and to minimise the risk of hypothermia during the procedure of obtaining surgical vessel access, performing balloon angioplasty, and closure of the wound.

The comparison a 16-year follow-up results of balloon angioplasty for aortic coarctation in children of different age groups: a single-center experience

Pediatric patients with different age groups who underwent balloon angioplasty for aortic coarctation were evaluated for recoarctation, aneurysm, peripheral arterial injuries and concomitant diseases. From January 1994 to 2010, 80 patients with aortic coarctation (native/recoarctation) were evaluated, retrospectively. According to age at angioplasty, patients were divided into three groups: Group A (0-3 months, n=29, 25 male/4 female, average weight 4±1.2 kg), Group B (3-12 months, n=20, 15 male/5 girls, average weight 6.5±1.9 kg) and Group C (> 1 year, n= 31, 15 male/16 girls, average weight 22.8±16 kg). The patients were followed with echocardiography and clinical signs. The data of the native and recoarcted patients and also those in three different age groups were analyzed by using Chi-square, Kruskal-Wallis, and Student t tests. Peak systolic pressure gradient was reduced from 42±17 mmHg to 6.2±6 mmHg after balloon angioplasty (p<0.001) [n=80, 56 (70%) native, 24 (30%) recoarctation]. There was no difference between groups for early success. None of them did require immediate surgery. There were ventricular septal defect in 23 (28.7%), bicuspid aorta in 18 (22.5%), patent ductus arteriosus in 11 (13.7%) patients. Two patients had Turner's syndrome. Mean follow-up period was 74±56 months. While recoarctation developed in 20 (25%), [12 (60%) in Group A, 5 (25%) in Group B and 3 (15%) in group C, incidence was higher in the 0-3 months age group (p=0.018). Femoral artery occlusion and aneurysm were developed in 6 (7.5%) and 4 (5%) patients, respectively, and all of them were under 1-year-old. Balloon angioplasty can be used a method in treatment of native aortic coarctation and postoperative restenosis. Especially, children under 3 months should be monitored closely after the procedure for recoarctation, aneurysms and peripheral artery problems.

Twenty-two years of follow-up results of balloon angioplasty for discreet native coarctation of the aorta in adolescents and adults

Although the immediate and intermediate-term results of balloon angioplasty (BA) for patients with aortic coarctation (AC) have been encouraging, there is paucity of data on long-term follow-up results. This study evaluated the long-term (up to 22 years) follow-up results of BA in adolescent and adult patients with discrete (shelf-like) coarctation of the aorta. Follow-up data of 58 patients (mean age 24+/-9 years) undergoing BA for discrete AC at median interval of 13.4 years including cardiac catheterization, magnetic resonance imaging, and Doppler echocardiography form the basis of this study. No early deaths occurred. Balloon angioplasty produced immediate reduction in peak AC gradient from 60+/-22 mm Hg to 8.5+/-8 mm Hg (P<.0001). Follow-up catheterization 12 months later revealed a residual gradient of 5+/-6.4 mm Hg (P=.01). Five patients (8%) with suboptimal initial outcome (peak gradient>20 mm Hg) developed restenosis, and 4 of these had successful repeat angioplasty. Aneurysm developed at the site of dilatation in 4 patients (7%). Magnetic resonance imaging follow-up results revealed no new aneurysm. In one patient, the aneurysm increased in size, but no recoarctation or appreciable changes in the Doppler gradient across the AC site was noted. The blood pressure had normalized without medical treatment in 29 (50%) of the 58 patients. Long-term results of BA for discrete AC are excellent and should be considered as first option for treatment of this disease.

Balloon Angioplasty for Native Aortic Coarctation in Different Anatomic Variants

Balloon angioplasty for native coarctation of the aorta in infants and children is gaining acceptance as an alternative to surgery in discrete membranous obstruction. The aim of this study was to assess the immediate and intermediate-term effectiveness and safety of balloon angioplasty in infants and children with discrete membranous obstruction and mild complex arch anomalies. We performed a retrospective study evaluating the immediate and intermediate-term results of balloon angioplasty in 46 consecutive patients with native coarctation of the aorta done between March 1998 and June 2003. Isolated discrete fibromembranous obstruction occurred in 32 patients, and 14 patients had mild complex arch anomalies. Follow-up was obtained in 40 patients. There was no early mortality. The procedure was initially successful in 43 patients (93%). There were three immediate failures. Of the 40 patients who were followed, 32 (80%) had maintained a cuff pressure gradient of 20 mmHg across the dilated area. Four patients developed restenosis, which was successfully treated by repeated balloon angioplasty. The other four patients continued to have mild gradient (20-22 mmHg) with systolic hypertension and without angiographic evidence of restenosis but with isthmus hypoplasia; they received atenolol and captopril. Serial echocardiographic measurement of left ventricular dimension and function revealed significant improvement after balloon angioplasty of aortic coarctation in patients with the echocardiographic picture of hypertensive cardiomyopathy. Balloon angioplasty may be considered as a tool in the armamentarium of management of aortic coarctation in different anatomic variants, taking into consideration the clinical presentation and patient age.

Abstract 1562: Long-term Results (up To 19 Years) Of Balloon Angioplasty Of Coarctation Of The Aorta On Systemic Hypertension And Left Ventricular Hypertrophy.

Aim : To define the long-term effect of balloon angioplasty (BA) of aortic coarctation (AC) on systemic hypertension and left ventricular hypertrophy (LVH) in adolescent and adult patients. Methods : Follow-up data of 53 patients (mean age 24 ± 9 years) undergoing BA for discrete AC at median interval of 12.5 years (range 5–19 years) including cardiac catheterization, MRI and Echocardiography form the basis of this study. Patients were divided into two groups (A&amp;B) based on whether or not long-term antihypertensive therapy was required. Results : No early or late deaths occurred. Fifty-one patients had baseline hypertension, 49 patients had baseline LVH (92%), BA produced an immediate reduction in peak AC gradient from 66 ± 23 mmHg (95% confidence interval [CI]: 59.5 to 72.7) to 10.8 ± 7 mmHg (95% CI: 8.8 to 12.5) (p&lt; 0.0001). Follow-up catheterization 12 months later revealed a residual gradient of 6.2 ± 6 mmHg (95% CI: 4.4 to 7.9) (p&lt;0.001). The Doppler gradient across coarctation decreased from 59.6 ± 17 to 16 ± 8.4 mmHg at one year and 12.0 ± 6.9 mmHg at last follow-up. Left ventricular mass index (LVMI) decreased significantly in 48 patients (98%) from 132 ± 30.7 (95% CI: 122 to 141.9) to 86 ± 19.9 gram/m 2 (95% CI: 79.5 to 92.5)(p&lt;0.0001). The systolic blood pressure decreased from 165 ± 17 mmHg (95% CI: 159 to 171) to 125 ± 10 mmHg (95% CI: 122 to 131, p&lt;0.001) in 40 patients (group A) and from 184 ± 19 mmHg (95% CI: 169 to 198) to 142 ± 22 mmHg (95% CI: 124 to 156, p&lt;0.001) in 11 patients (group B). The blood pressure had normalized without medication in 40 (78%) of the 51 patients (165 ± 17 mmHg to 115 ± 10 mmHg). Conclusion : Long-term results of BA for discrete AC are excellent and should be considered as first option for treatment of this disease; Regression of LVH (≥ 20% reduction in LVMI) occurred in 98% of patients after BA and only 22% of patients required medications for hypertension.

Long‐term effects of balloon angioplasty on left ventricular hypertrophy in adolescent and adult patients with native coarctation of the aorta. Up to 18 years follow‐up results

Little is known regarding the long-term follow-up results of balloon angioplasty (BA) for patients with native aortic coarctation (AC) on left ventricular hypertrophy (LVH) regression. The purpose of this study was to define the long-term effect of BA of AC on LVH in adolescent and adult patients. Follow-up data of 53 patients (36 male) mean age 24 +/- 9 years undergoing BA for discrete AC at median interval of 11.8 years (range 4-18 years) including cardiac catheterization, magnetic resonance imaging, and Echocardiography form the basis of this study. Patients were divided into two groups at 1 year after BA based on absence (group A) or presence (group B) of persistent hypertension and need for medication. Forty-nine patients had baseline LVH, BA produced an immediate reduction in peak AC gradient from 66 +/- 23 mm Hg (95% confidence interval [CI]: 59.5-72.7) to 10.8 +/- 7 mm Hg (95% CI: 8.8-12.5) (P < 0.0001). Follow-up catheterization 12 months later revealed a residual gradient of 6.2 +/- 6 mm Hg (95% CI: 4.4-7.9) (P < 0.001). The blood pressure had normalized without medication in 38 of the 49 patients (165 +/- 17 to 115 +/- 10 mm Hg). Left ventricular mass index (LVMI) decreased significantly (>20% decrease LVMI from baseline) in 48 patients (98%) at median interval 1.4 years (range 0.5-3 years) post BA, group A (38 patients) LVMI decreased from 132 +/- 30.7 g/m(2) (95% CI: 122-141.9) to 86 +/- 19.9 g/m(2) (95% CI: 79.5-92.5) (P < 0.0001). Similarly, in 10 patients (group B) the LVMI decreased from 157 +/- 38.7 g/m(2) (95% CI: 127-185) to 102 +/- 29 g/m(2) (95% CI: 105-151) (P < 0.0001) at follow-up. Mild (<20% decrease in LVMI) regressions were noted in one patient from group B. There was no progression to LVH in the four patients who had normal baseline LVMI. (1) Long-term results of BA for discrete AC are excellent and should be considered as first option for treatment of this disease; (2) Regression of LVH (> or =20% reduction in LVMI) occurred in 98% of patients after BA.

Long‐term results (up to 18 years) of balloon angioplasty on systemic hypertension in adolescent and adult patients with coarctation of the aorta

Little is known regarding the long-term follow-up results of balloon angioplasty (BA) for patients with aortic coarctation (AC) on systemic hypertension. To define the long-term effect of BA of AC on systemic hypertension in adolescent and adult patients. Follow-up data of 53 patients (36 male), mean age 24 +/- 9 years, undergoing BA for discrete AC at median interval of 11.8 years (range, 4-18 years), including cardiac catheterization, magnetic resonance imaging (MRI), and echocardiography. Patients were divided into two groups at 1 year after BA on the basis of absence (group A: 40 patients) or presence (group B: 11 patients) of persistent hypertension and need for medication. Fifty-one patients had baseline hypertension, BA produced an immediate reduction in peak AC gradient from 66 +/- 23 mmHg to 10.8 +/- 7 mmHg (p < 0.0001). The immediate systolic blood pressure (SBP) decreased from 165 +/- 17 mmHg (95% CI: 159 to 171) to 125 +/- 10 mmHg (95% CI: 122 to 131) (p < 0.001) in 40 patients (group A) and from 184 +/- 19 mmHg (95% CI: 169 to 198) to 142 +/- 22 mmHg (95% CI: 124 to 156) (p<0.001) in 11 patients (group B). At 1-year follow-up, SBP decreased further to 115 +/- 10 in group A (95% CI 111-119) and 134 +/- 19 in group B (95% CI 122-142) (p<0.001). The blood pressure had normalized without medication in group A (165 +/- 17 to 115 +/- 10 mmHg). Long-term results of BA for discrete AC are excellent and should be considered as the first option for treatment of this disease. No paradoxical hypertension occurred post angioplasty, and normalization of blood pressure without medication occurred in 78% of the patients after BA.

Magnetic Resonance Imaging-Guided Catheter Interventions in Congenital Heart Disease

Magnetic resonance imaging (MRI) has long been recognized as a useful technique for guiding diagnostic and therapeutic procedures. Biopsies have been guided by MRI since the 1980s1; neurosurgery followed soon thereafter.2 Excellent soft tissue contrast and accurate spatial localization and display in 3 dimensions were particular advantages of MRI over other modalities in neurological and body imaging. The application of MRI to cardiovascular interventions, however, has been much slower because of the technical challenges related mainly to cardiac motion. More recently, experimental work in animal models of acquired and congenital heart disease has demonstrated the feasibility of MRI-guided interventional cardiac catheterization.3–5 In 2003, Razavi et al6 published the first clinical experience with cardiac catheterization aided by MRI in 16 children and adults with congenital heart disease. In this issue of Circulation , Krueger and colleagues7 report on extending this concept to another clinical application: MRI-guided balloon angioplasty of aortic coarctation. Using commercially available catheters filled with a diluted solution of iron oxide particles, a homemade nonmetallic guidewire, and passive catheter tracking, the procedure was judged technically successful in all of the 5 patients in whom it was attempted. Article p 1093 The experience reported by Krueger et al7 highlights a familiar reality for pediatric cardiologists. Because most equipment is designed for adults, pediatric cardiologists frequently operate in a world of imperfect tools, bedside modifications of equipment, and off-label use of devices and diagnostic techniques. Most of the tools used to perform the procedure described in this report were not designed for …

Long-term outcome (up to 15 years) of balloon angioplasty of discrete native coarctation of the aorta in adolescents and adults

ObjectivesThis study evaluated the long-term follow-up results of balloon angioplasty (BA) in adolescent and adult patients with discrete coarctation of the aorta. BackgroundAlthough the immediate and intermediate term results of BA for patients with aortic coarctation (AC) have been encouraging, there is a paucity of data on long-term follow-up results. MethodsThis basis of this study was follow-up of 49 patients (mean age, 22 ± 7 years) undergoing BA for discrete AC at median interval of 10.2 years, including cardiac catheterization, magnetic resonance imaging, and Doppler echocardiography. ResultsNo early or late deaths occurred. Balloon angioplasty produced a reduction in peak AC gradient from 66 ± 23 mm Hg (95% confidence interval [CI]: 59.5 to 72.7) to 10.8 ± 7 mm Hg (95% CI: 8.8 to 12.5) (p < 0.0001). Follow-up catheterization 12 months later revealed a residual gradient of 6.2 ± 6 mm Hg (95% CI: 4.4 to 7.9) (p < 0.001). Four patients (7.5%) with suboptimal initial outcome with peak gradient >20 mm Hg had successful repeat angioplasty. Aneurysm developed at the site of dilation in four patients (7.5%). Magnetic resonance imaging follow-up results revealed no new aneurysm or appreciable changes in the size of pre-existing aneurysms, and no recoarctation was observed. Also, no appreciable changes in the Doppler gradient across the AC site were noted. The blood pressure had normalized without medication in 31 (63%) of the 49 patients. ConclusionsLong-term results of BA for discrete AC are excellent and should be considered as first option for treatment of this disease.

Intraoperative balloon angioplasty for aortic coarctation after Norwood operation

We report intraoperative balloon angioplasty for recurrent aortic coarctation in hypoplastic left heart syndrome. After bidirectional Glenn anastomosis, balloon angioplasty was performed via ascending aorta. Pressure gradient across the coarctation decreased from 45 to 8 mm Hg. Intravascular ultrasound revealed successful splits of thickened intima without any extensive dissection. Intraoperative balloon angioplasty is a safe and favorable procedure for hypoplastic left heart syndrome because balloon inflation before bidirectional Glenn anastomosis could induce serious ventricular collapse or arrhythmias.

Long-term follow-up results after balloon dilatation of pulmonic stenosis, aortic stenosis, and coarctation of the aorta: A review

Although immediate and intermediate-term results after balloon dilatation of congenital stenotic lesions of the heart in children are well studied, long-term results have not been documented. Therefore, we reviewed our experience along with the limited published data to address this issue. Late follow-up after balloon pulmonary and aortic valvuloplasty shows low-residual gradients, reintervention-free rates in the mid-80s for pulmonic and in the mid-50s for aortic stenosis, and an increase in degree and prevalence of similunar valve insufficiency. Balloon angioplasty of aortic coarctation results in low-residual gradients, residual hypertension in a minority of patients, low prevalence of aneurysms, and high rates of recurrence in the neonate and young infant. Overall, balloon dilatation is a useful technique in relieving congenital obstructive lesions of the heart in the pediatric patient, but continued study of (1) late pulmonary and aortic insufficiency after valvuloplasty, (2) recurrence and aneurysms after balloon angioplasty of coarctations and, (3) femoral artery compromise in lesions requiring transfemoral artery approach is warranted. Copyright © 1999 by W.B. Saunders Company Progress in Cardiovascular Diseases, Vol. 42, No. 1 (July/August), 1999: pp 59-74

Long-term effects of balloon angioplasty on systemic hypertension in adolescent and adult patients with coarctation of the aorta.

To define the long-term effect of balloon angioplasty of aortic coarctation on hypertension, in adolescent and adult patients. Balloon angioplasty of discrete, native aortic coarctation was performed on 50 patients (34 male) aged 23+/-8 (mean+/-standard deviation) years. In 42 of these patients cardiac catheterization and angiography were repeated 1 year later, and on the basis of sphygmomanometric blood pressure determination at that time, they were divided into 31 patients (group A) with normalized blood pressure and 11 patients (group B) who still needed antihypertensive medication. Both groups were followed annually thereafter for 12-123 (66+/-37) months. Coarctation gradient values before, immediately after and 1 year after angioplasty were 69+/-24 mmHg, 12+/-8 mmHg (P<0.001) and 7+/-6 mmHg. The corresponding systolic blood pressure values were 165+/-17 mmHg, 128+/-12 mmHg (P<0.001) and 115+/-10 mmHg (P<0.001) in group A; 182+/-21 mmHg, 141+/-24 mmHg (P<0.001) and 134+/-18 mmHg (P<0.001) in group B. Echocardiographic left ventricular mass index before angioplasty and at follow-up was 130+/-31 g x m-2 and 105+/-23 g x m-2 in group A; 157+/-38 g x m-2 and 132+/-35 g x m-2 in group B (P<0.001 for both comparisons). Normalization of blood pressure without medication occurred in 74% of patients after angioplasty for aortic coarctation, with subsequent long-term regression of left ventricular hypertrophy. In comparison to reported surgical results, balloon angioplasty should be considered as first line treatment for native, discrete aortic coarctation in adolescent and adult patients.

Aortic pain

With the exception of the pain of acute aortic dissection, the thoracic aorta is not usually considered as a pain-producing organ. However, nineteenth century clinicians considered the aorta as a source of cardiovascular pain in the presence of autopsy-documented inflammatory aortitis, aortic aneurysms, and arterial hypertension, whereas early in the twentieth century, aortic pain reactions were elicited in experimental studies involving distension of the ascending aorta or the application of stimulating substances to the outer surface of the aorta. More recently, increased attention to aortic elastic properties, and to aortic vascular biology at the molecular level refocused interest on the many facets of aortic function beyond that of a simple conduit. The recognition of pain of thoracic aortic origin now extends to patients with progressive aortic syndromes such as aortic intramural hematoma, aortic intimal tears, aortic penetrating ulcers, aortic root dilatation without dissection in connective tissue disorders, inflammatory aortopathies, and abnormalities of aortic distensibility. The occurrence of pain during balloon inflation at balloon angioplasty of aortic coarctation, which disappears immediately after deflation, is the modern equivalent of the early experimental studies. The authors present a consideration of thoracic aortic pain in light of contemporary concepts in cardiovascular medicine with roots in the rich historical reservoir of information about aortic function and disease.