Volume 56, Issue 2, Pages 152-155 (August 1969) The Surgical Treatment of Dissecting Aortic Aneurysm Due to Idiopathic Cystic Medial Necrosis in a Six-Year-Old Child  Mosche Gueron, M.D., Menahem Hirsh, M.D., Wehbi Shahin, M.D, Morris J. Levy, M.D., F.C.C.P.  Diseases of the Chest  Volume 56, Issue 2, Pages 152-155 (August 1969) DOI: 10.1378/chest.56.2.152 Copyright © 1969 The American College of Chest Physicians Terms and Conditions

Figure 1 The electrocardiogram is consistent with left ventricular hypertrophy. The phonocardiogram shows the ejection systolic murmur and the early diastolic murmur recorded at the second right and third left intercostal spaces. The carotid artery pressure curve shows pulsus bisferiens and the dicrotic notch is not distinct. Upper phonocardiogram: second right intercostal space; lower: third left intercostal space. Diseases of the Chest 1969 56, 152-155DOI: (10.1378/chest.56.2.152) Copyright © 1969 The American College of Chest Physicians Terms and Conditions

Figure 2 Moderate left ventricular enlargement. Diseases of the Chest 1969 56, 152-155DOI: (10.1378/chest.56.2.152) Copyright © 1969 The American College of Chest Physicians Terms and Conditions

Figure 3 The retrograde aortogram shows a large irregular aneurysm located anteriorly and to the left of the ascending aorta. There is also marked regurgitation of contrast material into the left ventricle. Diseases of the Chest 1969 56, 152-155DOI: (10.1378/chest.56.2.152) Copyright © 1969 The American College of Chest Physicians Terms and Conditions

Figure 4 Anterior aspect of the heart and the ascending aorta. An aneurysmatic formation arising from the ascending aorta and projecting anteriorly is clearly seen. Diseases of the Chest 1969 56, 152-155DOI: (10.1378/chest.56.2.152) Copyright © 1969 The American College of Chest Physicians Terms and Conditions

Figure 5 Part of the aortic wall removed during operation from the area of the aneurysm shows a zone of loss in continuity of the media (between arrows) with retraction of the elastic tissue from this zone. This area corresponds to the region seen at surgery where the incomplete dissection of the aortic wall began. Small areas of cystic medial necrosis with loss of continuity of the elastica corresponding to the arrow are seen. It is considered that the fundamental weakness of the media due to cystic degeneration was responsible for the gross break in the continuity of the intima–media, which in turn led to the aneurysmatic formation. Diseases of the Chest 1969 56, 152-155DOI: (10.1378/chest.56.2.152) Copyright © 1969 The American College of Chest Physicians Terms and Conditions

Figure 6 The postoperative aortogram shows elongated narrowing of the ascending aorta. Significant regurgitation of contrast into the left ventricle is still present. Diseases of the Chest 1969 56, 152-155DOI: (10.1378/chest.56.2.152) Copyright © 1969 The American College of Chest Physicians Terms and Conditions