[Aneurysms of the thoracic aorta].

The purpose of this paper is to review the natural history, surgical management, and clinical and radiographic features of aneurysm of the aorta above the diaphragm. Experience is limited to 40 patients, of whom only nine were women. An operation, the aim of which was to resect the aneurysm, was undertaken in 14 patients; three of these died in the early postoperative period and the others are well. All of the 26 patients in whom an operation was not undertaken have died. The youngest patients were men of 27 and 33 years, respectively, in whom the diagnosis of cystic medial necrosis in association with Marfan's syndrome was confirmed post mortem: five were in the fourth decade, 10 in the fifth, 10 in the sixth, 12 in the seventh, and the two oldest were 70 and 71 years respectively. Most (33) were Bantu and in them age was often an estimate; four were Asiatic and three of Caucasian stock. There was serological evidence of luetic disease in 27; in eight, in three of whom the Wassermann reaction was positive, there was a history of trauma of such severity that it would not have been surprising if the aneurysm had had a traumatic origin, and in four of these traumatic aneurysm was diagnosed with certainty at thoracotomy; in 15 patients, in four of whom the Wassermann reaction was positive, the aneurysm was associated with extensive and severe atherosclerosis of the aorta. The aneurysm was distal to the left subclavian artery in 16 patients-well distal in 10, and barely distal in six. In six, the aneurysm involved the arch; in seven, the ascending aorta, short of the innominate artery; in seven, the innominate artery was aneurysmal-in five of these with aneurysmal dilatation of the ascending aorta; in five of the last-mentioned 14 patients there was aortic incompetence. In three patients, two with cystic medial necrosis, the entire thoracic aorta was aneurysmal, and in the last there were several small aneurysms of the ascending aorta in association with aortic stenosis.