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Sample records for aortic arch surgery

  1. Aortic arch malformations

    Energy Technology Data Exchange (ETDEWEB)

    Kellenberger, Christian J. [University Children' s Hospital, Department of Diagnostic Imaging, Zuerich (Switzerland)

    2010-06-15

    Although anomalies of the aortic arch and its branches are relatively uncommon malformations, they are often associated with congenital heart disease. Isolated lesions may be clinically significant when the airways are compromised by a vascular ring. In this article, the development and imaging appearance of the aortic arch system and its various malformations are reviewed. (orig.)

  2. Clinical and biochemical outcomes for additive mesenteric and lower body perfusion during hypothermic circulatory arrest for complex total aortic arch replacement surgery.

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    Fernandes, P; Cleland, A; Adams, C; Chu, M W A

    2012-11-01

    protection strategy for complex aortic arch surgery. This additive perfusion strategy may attenuate visceral and lower body ischemia that normally develops during periods of deep hypothermic circulatory arrest.

  3. Techniques for aortic arch endovascular repair.

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    kHONGKU, Kiattisak; Dias, Nuno; Sonesson, Bjorn; Resch, Timothy

    2016-06-01

    This article reviews endovascular strategies for aortic arch repair. Open repair remains the gold standard particularly for good risk patients. Endovascular treatment potentially offers a less invasive repair. Principles, technical considerations, devices and outcomes of each technique are discussed and summarized. Hybrid repair combines less invasive revascularization options, instead of arch replacement while extending stent-graft into the arch. Outcomes vary with regard to extent of repair and aortic arch pathologies treated. Results of arch chimney and other parallel graft techniques perhaps make it a less preferable choice for elective cases. However, they are very appealing options for urgent or bailout situations. Fenestrated stent-grafting is subjected to many technical challenges in aortic arch due to difficulties in stent-graft orientation and fenestration positioning. In situ fenestration techniques emerge to avoid these problems, but durability of stent-grafts after fenestration and ischemic consequences of temporary carotid arteries coverage raises some concern total arch repair using this technique. Arch branched graft is a new technology. Early outcomes did not meet the expectation; however the results have been improving after its learning curve period. Refining stent-graft technologies and implantation techniques positively impact outcomes of endovascular approaches. PMID:26940011

  4. Recurrent Pneumonia due to Double Aortic Arch

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    I. Sedighi

    2012-04-01

    Full Text Available Introduction: Pneumonia is one of the most common infections during childhood. In children with recurrent bacterial pneumonia complete evaluation for underlying factors is necessary. The most common underlying diseases include: antibody deficiencies , cystic fibrosis , tracheoesophageal fistula and increased pulmonary blood flow. Vascular ring and its pressure effect is a less common cause of stridor and recurrent pneumonia. Congenital abnormalities in aortic arch and main branches which form vascular ring around esophagus and trachea with variable pressure effect cause respiratory symptoms such as stridor , wheezing and recurrent pneumoniaCase Report: A 2 year old boy was admitted in our hospital with respiratory distress and cough . Chest x-Ray demonstrated right lobar pneumonia. He had history of stridor and wheezing from neonatal period and hospitalization due to pneumonia for four times. The patient received appropriate antibiotics. Despite fever and respiratory distress improvement, wheezing continued. Review of his medical documents showed fixed pressure effect on posterior aspect of esophagus in barium swallow. In CT angiography we confirmed double aortic arch.Conclusion: Double aortic arch is one of the causes of persistant respiratory symptom and recurrent pneumonia in children for which fluoroscopic barium swallow is the first non-invasive diagnostic method.(Sci J Hamadan Univ Med Sci 2012;19(1:70-74

  5. Adult presentation with vascular ring due to double aortic arch.

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    Kafka, Henryk; Uebing, Anselm; Mohiaddin, Raad

    2006-11-01

    This is a case report on the use of cardiovascular magnetic resonance imaging to diagnose vascular ring due to double aortic arch in an adult presenting with an abnormal chest X-ray. The experience in this case and the literature review identify the benefits of using cardiovascular magnetic resonance imaging to clarify complex aortic arch anatomy.

  6. Double aortic arch and nasogastric tubes: A fatal combination

    Institute of Scientific and Technical Information of China (English)

    Julia Massaad; Kelly Crawford

    2008-01-01

    Double aortic arch is a common form of complete vascular ring that encircles both the trachea and the esophagus, and presents with various respiratory and esophageal symptoms, usually in the pediatric population.We present a case of double aortic arch in an adult patient that manifested as massive upper gastrointestinal bleeding after prolonged nasogastric intubation.

  7. Aortic arch vessel anomalies associated with persistent trigeminal artery.

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    Lotfi, Mehrzad; Nabavizadeh, Seyed Ali; Foroughi, Amin Abolhasani

    2012-01-01

    Developmental anomalies of the aortic arch vessels and persistent trigeminal artery that is the most common of the four anomalous carotid-basilar anastomoses are repeatedly reported in the literature as separate entities. Herein we report a previously undescribed variant including the coexistence of persistent trigeminal artery, truncus bicaroticus and direct origin of left vertebral artery from aortic arch. PMID:22542381

  8. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

    Gefke, K; Schroeder, T V; Thisted, B;

    1994-01-01

    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems....

  9. Blood flow characteristics in the aortic arch

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    Prahl Wittberg, Lisa; van Wyk, Stevin; Mihaiescu, Mihai; Fuchs, Laszlo; Gutmark, Ephraim; Backeljauw, Philippe; Gutmark-Little, Iris

    2012-11-01

    The purpose with this study is to investigate the flow characteristics of blood in the aortic arch. Cardiovascular diseases are associated with specific locations in the arterial tree. Considering atherogenesis, it is claimed that the Wall Shear Stress (WSS) along with its temporal and spatial gradients play an important role in the development of the disease. The WSS is determined by the local flow characteristics, that in turn depends on the geometry as well as the rheological properties of blood. In this numerical work, the time dependent fluid flow during the entire cardiac cycle is fully resolved. The Quemada model is applied to account for the non-Newtonian properties of blood, an empirical model valid for different Red Blood Cell loading. Data obtained through Cardiac Magnetic Resonance Imaging have been used in order to reconstruct geometries of the the aortic arch. Here, three different geometries are studied out of which two display malformations that can be found in patients having the genetic disorder Turner's syndrome. The simulations show a highly complex flow with regions of secondary flow that is enhanced for the diseased aortas. The financial support from the Swedish Research Council (VR) and the Sweden-America Foundation is gratefully acknowledged.

  10. Bacteroides fragilis aortic arch pseudoaneurysm: case report with review

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    Yang Yu-Jen

    2008-05-01

    Full Text Available Abstract We present a case of 58-year-old woman with underlying diabetes mellitus, hepatitis C virus-related liver cirrhosis, and total hysterectomy for uterine myoma 11 moths ago, who was diagnosed ruptured aortic arch mycotic pseudoaneurysm after a certain period of survey for her unknown fever cause. After emergent surgery with prosthetic graft interposition, all her blood cultures and tissue cultures revealed pathogen with Bacteroides fragilis. Although mycotic aneurysms have been well described in literatures, an aneurysm infected solely with Bacteroides fragilis is unusual, with only eight similar cases in the literature. Here we reported the only female case with her specific clinical and management course and summarized all reported cases of mycotic aneurysm caused by Bacteroides fragilis to clarify their conditions and treatments, alert the difficulty in diagnosis, and importance of highly suspicious.

  11. Giant aortic arch aneurysm complicating Kawasaki′s disease

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    Kaouthar Hakim; Rafik Boussada; Lilia Chaker; Fatma Ouarda

    2014-01-01

    Kawasaki disease (KD) is a common acute vasculitis in pediatric population that usually involves small- and middle-sized arteries, commonly coronary arteries. Although the incidence and natural course of coronary aneurysms after KD are well documented in studies, related reports on peripheral arterial and aortic aneurysms are scarce. We report the occurrence of a giant aortic aneurysm involving the horizontal part of aortic arch in a 28-month-old boy diagnosed with KD. This complication was m...

  12. Temporary extracorporeal bypass modalities during aortic surgery.

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    Bassin, Levi; Bell, David

    2016-09-01

    The key to aortic surgery is protection of the brain, heart, spinal cord, and viscera. For operations involving the aortic arch, the focus is on cerebral protection, while for pathology involving the descending thoracic aorta, the focus is on spinal protection. Optimal cerebral and spinal protection requires an extensive knowledge of the operative steps and an understanding of the cardiopulmonary bypass modalities that are possible. A bloodless field is required when operating on the aorta. As a result, periods of ischemia to the central nervous system and end-organ viscera are often unavoidable. The main techniques to mitigate ischemia include hypothermia and selective perfusion of the ischemic organ in question. This chapter will first briefly review bypass modalities and then describe how they can be used for various aortic scenarios. PMID:27650344

  13. Bare Metal Stenting for Endovascular Exclusion of Aortic Arch Thrombi

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    Mahnken, Andreas H., E-mail: mahnken@med.uni-marburg.de [University Hospital Giessen and Marburg, Philipps University of Marburg, Department of Diagnostic Radiology (Germany); Hoffman, Andras; Autschbach, Ruediger; Damberg, Anneke L. M., E-mail: anneke.damberg@rwth-aachen.de [University Hospital RWTH Aachen, Department of Thoracic, Cardiac and Vascular Surgery (Germany)

    2013-08-01

    BackgroundAortic thrombi in the ascending aorta or aortic arch are rare but are associated with a relevant risk of major stroke or distal embolization. Although stent grafting is commonly used as a treatment option in the descending aorta, only a few case reports discuss stenting of the aortic arch for the treatment of a thrombus. The use of bare metal stents in this setting has not yet been described.MethodsWe report two cases of ascending and aortic arch thrombus that were treated by covering the thrombus with an uncovered stent. Both procedures were performed under local anesthesia via a femoral approach. A femoral cutdown was used in one case, and a total percutaneous insertion was possible in the second case.ResultsBoth procedures were successfully performed without any periprocedural complications. Postoperative recovery was uneventful. In both cases, no late complications or recurrent embolization occurred at midterm follow-up, and control CT angiography at 1 respectively 10 months revealed no stent migration, freely perfused supra-aortic branches, and no thrombus recurrence.ConclusionTreating symptomatic thrombi in the ascending aorta or aortic arch with a bare metal stent is feasible. This technique could constitute a minimally invasive alternative to a surgical intervention or complex endovascular therapy with fenestrated or branched stent grafts.

  14. When and how to replace the aortic arch for type A dissection.

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    Di Bartolomeo, Roberto; Leone, Alessandro; Di Marco, Luca; Pacini, Davide

    2016-07-01

    Acute type A aortic dissection (AAAD) remains one of the most challenging diseases in cardiothoracic surgery and despite numerous innovations in medical and surgical management, early mortality remains high. The standard treatment of AAAD requires emergency surgery of the proximal aorta, preventing rupture and consequent cardiac tamponade. Resection of the primary intimal tear and repair of the aortic root and aortic valve are well-established surgical principles. However, the dissection in the aortic arch and descending untreated aorta remains. This injury is associated with the risk of subsequent false lumen dilatation potentially progressing to rupture, true lumen compression and distal malperfusion. Additionally, the dilatation of the aortic arch, the presence of a tear and retrograde dissection can all be considered indication for a total arch replacement in AAAD. In such cases a more aggressive strategy may be used, from the classic aortic arch operation to a single stage frozen elephant trunk (FET) technique or a two-stage approach such as the classical elephant trunk (ET) or the recent Lupiae technique. Although these are all feasible solutions, they are also complex and time demanding techniques requiring experience and expertise, with an in the length of cardiopulmonary bypass and both myocardial and visceral ischemia. Effective methods of cerebral, myocardial as well visceral protection are necessary to obtain acceptable results in terms of hospital mortality and morbidity. Moreover, a correct assessment of the anatomy of the dissection, through the preoperative angio CT scan, in addition to the clinical condition of the patients, remain the decision points for the best arch repair strategy to use in AAAD. PMID:27563552

  15. Aortic arch in neonates with esophageal atresia: Preoperative assessment using CT

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    Day, D.L.

    1985-04-01

    Preoperative localization of the aortic arch is important in infants with esophageal atresia to prevent morbidity and death from an ipsilateral surgical approach. Computed tomography is an accurate, noninvasive technique for determining the position of the aortic arch.

  16. Management of hypoplastic aortic arch associated with neonatal coarctation.

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    Caspi, J; Ilbawi, M N; Muster, A; Roberson, D; Arcilla, R

    1994-12-01

    Controversy still exists as to whether hypoplastic aortic arch frequently associated with neonatal coarctation, should be enlarged at the time of coarctation repair. To determine the indications for and the outcome of repair of hypoplastic aortic arch, pre- and postoperative angiograms/echocardigraphy of 77 cases with isolated (n = 25, Group 1) or complex (n = 52, Group 2) neonatal coarctation operated upon between 1/80 and 12/89 were reviewed. Age was 5-14 days (mean 8 +/- 1.6). Aortic arch/ascending aorta diameter ratio (AR/AA) as a measure of the degree of aortic arch hypoplasia was 0.39-0.64 (0.52 +/- 0.04) in isolated and 0.15-0.47 (0.34 +/- 0.06) in complex coarctation (p < 0.05). Left subclavian flap aortoplasty was used in 72 patients; alone in 25, in combination with pulmonary artery banding in 43 patients, and simultaneously with intracardiac repair in 4 patients. Extensive reconstruction of aortic arch and coarctation with synthetic patch was performed in the remaining 5 patients (AR/AO = 0.16 +/- 0.03) using cardiopulmonary by-pass at the time of intracardiac repair. Operative mortality was 2/76 (2.5%). Follow-up is 6.6 +/- 1.4 years. Recoarctation occurred in 3 patients (4%). AR/AA increased to 0.86 +/- 0.1 in isolated (p < 0.05 vs preoperative) and to 0.7 +/- 0.1 in complex coarctation (p < 0.05 vs preoperative). In the majority of cases, hypoplastic aortic arch associated with coarctation grows satisfactorily following simple repair of coarctation with no significant residual narrowing.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Computed tomography angiography of hybrid thoracic endovascular aortic repair of the aortic arch.

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    Akhtar, Nila J; Oderich, Gustavo S; Vrtiska, Terri J; Williamson, Eric E; Araoz, Philip A

    2013-05-01

    Endovascular repair of the aorta has traditionally been limited to the abdominal aorta and, more recently, the descending thoracic aorta. However, recently hybrid repairs (a combination of open surgical and endovascular repair) have made endovascular repair of the aortic arch possible. Hybrid repair of the aortic arch typically involves an open surgical debranching procedure that allows for revascularization of the aortic arch vessels and subsequent endovascular stent placement. These approaches avoid the deep hypothermic circulatory arrest required for full, open surgical repair of the aortic arch. In hybrid repairs, the stent landing zone determines which branch vessels will be covered and therefore need revascularization. This article will review the preprocedure assessment with computed tomography angiography, techniques for revascularization and postprocedure complications. PMID:23621141

  18. A Review of Diseases of Aortic Arch: Diagnosis by CTA

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    S. Sabouri

    2007-01-01

    The noninvasive revolution in cardiovascular imaging has altered the diagnostic algorithm for all types of acquired and congenital cardiovascular disease. CT techniques are commonly used in the diagnosis of aortic arch and its major branch vessels as well as thoracic and abdominal aortic diseases. CT angiogra-phy combines with CT scans obtained detailed in-formation on precise morphology and extent of dis-ease. Studies were performed on an MDCT unit (4row GE light speed). In infants and small...

  19. Right-sided aortic arch with anomalous origin of the left subclavian artery: Case report

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    Vučurević Goran

    2011-01-01

    Full Text Available Introduction. A right-sided aortic arch is a rare congenital defect of the aorta with incidence of 0.05% to 0.1% reported in published series. Usually it is associated with congenital heart anomalies and esophageal and tracheal compression symptoms. We present a case of a right-sided aortic arch of anomalous left subclavian artery origin, accidentally revealed during multislice CT (MSCT supraaortic branches angiography. Case Outline. A 53-year-old female patient was examined at the Outpatients’ Unit of the Vascular Surgery University Clinic for vertigo, occasional dizziness and difficulty with swallowing. Physical examination revealed a murmur of the left supraclavicular space, with 15 mmHg lower rate of arterial tension on the left arm. Ultrasound of carotid arteries revealed 60% stenosis of the left subclavian artery and bilateral internal carotid artery elongation. MSCT angiography revealed a right-sided aortic arch with aberrant separation of the left subclavian artery that was narrowed 50%, while internal carotid arteries were marginally elongated. There was no need for surgical treatment or percutaneous interventions, so that conservative treatment was indicated. Conclusion. A right-sided aortic arch is a very rare anomaly of the location and branching of the aorta. Multislice CT angiography is of great importance in the diagnostics of this rare disease.

  20. Double aortic arches, esophageal atresia and tracheal compression

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    Majid Yameen; Warade Monali; Aziz Zarina; Karthik G

    2009-01-01

    We report a case of double aortic arch in a 12-month-old male infant well delineated on 64 slice computed tomography scan. It formed a complete vascular ring around the trachea compressing it. The symptoms resolved after surgical division of the ring.

  1. Branched and fenestrated options to treat aortic arch aneurysms.

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    Maurel, Blandine; Mastracci, Tara M; Spear, Rafaelle; Hertault, Adrien; Azzaoui, Richard; Sobocinski, Jonathan; Haulon, Stephan

    2016-10-01

    Conventional surgical repair of aortic arch aneurysms using cardiopulmonary bypass and hypothermic circulatory arrest remains the gold standard, however it is associated with a substantial mortality and morbidity rate, especially in the elderly. Hybrid techniques avoid aortic cross-clamping and circulatory arrest, but are of limited use and are only applicable to selected patients. The development of new devices to treat aortic arch aneurysms endovascularly has the potential to offer a treatment modality to patients unfit for an open repair. We present the challenges specific to endovascular arch repair based on our experience and the literature available from the first experience in 1999 to the third generation graft currently commonly used. Following an initial learning curve associated with the use of the third generation arch branch device, along with careful patient selection and operator experience, early results are promising. Technical success was achieved in all cases, there was no early mortality and strokes were noted in 11%. As with branched and fenestrated technology for thoracoabdominal aneurysm repair, the use of total endovascular repair for arch pathology will require an evolution in endovascular practice and device design. However, at present, the early use of the latest generation device offers a novel approach to patients who previously had no surgical options. PMID:27332680

  2. Antenatal evaluation of fetal interrupted aortic arch type B

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    Ali Babacan

    2015-06-01

    Full Text Available Interruption of the aortic arch (IAA is a rare, severe form of congenital heart defect characterized by complete anatomical discontinuity between two adjacent segments of the aortic arch. The data on the features and outcomes of fetal IAA are limited. Three anatomical types have been described according to the site of interruption. The current recommendations for screening on the obstetric fetal anomaly scan include identification of a 4-chamber view, all 4 valves, and the outflow tracts, all of which can appear to be normal to the ultrasonographer in fetuses with conotruncal anomalies. Although the identification of IAA on a prenatal echocardiogram can be challenging, a number of anatomic features can facilitate the diagnosis. We aim to present the features and outcome of a case of IAA type B referred to our centre in the light of literatures.

  3. Reoperation on aortic disease in patients with previous aortic valve surgery

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    SUN Xiao-gang; ZHANG Liang; YU Cun-tao; QIAN Xiang-yang; CHANG Qian

    2013-01-01

    Background Aortic valve replacement (AVR) is a safe and effective method in the treatment of aortic valve diseases.This study aimed to increase the understanding on re-treatment of aortic diseases after aortic valve surgery through a retrospective analysis of 47 related cases.Methods Forty-seven patients (38 males and 9 females) with previous aortic valve surgery have received reoperation on aorta from January 2003 to June 2012,and the mean interval time of re-intervention to aortic disease was 6 years ((6.0± 3.8) years).The secondary aortic surgery included aortic root replacement (14 cases),ascending aorta replacement (10 cases),aortic root/ascending aorta plus total arch replacement with stented elephant trunk implantation (21 cases),and total thoracoabdominal aorta replacement (2 cases).All these patients have received outpatient re-exams or follow-up by phone calls.Results After the initial aortic valve replacement,patients suffered from aortic dissection (25 cases,53%),ascending aortic aneurysm (12 cases,26%) or aortic root aneurysm (10 cases,21%).Diameter in ascending aorta increased (5.2±7.1) mm per year and aortic sinus (3.3±3.1) mm per year.The annual growth value of diameter in ascending aorta was higher in patients with rheumatic heart disease than that in Marfan syndrome (P<0.05).All 47 patients have received reoperation on aorta.One patient died in operating room because aortic dissection seriously involved right coronary artery.Seven patients had renal insufficiency after operation; neurological complications occurred in 14 patients including 7 patients with stroke and the others with transient brain dysfunction.All patients were followed up,the mean survival time was (97.25±17.63) months,95% confidence interval was 55.24-73.33 months.Eight cases were died during follow-up and five-year survival rate was 83%.Conclusion To reduce the aortic adverse events after first aortic valve surgery,it is necessary to actively treat and strictly

  4. Congenital aortic arch anomalies: diagnosis using contrast enhanced magnetic resonance angiography

    Institute of Scientific and Technical Information of China (English)

    ZHU Ming; ZHONG Yu-min; LI Yu-hua; SUN Ai-min; JIN Biao

    2005-01-01

    @@ Congenital aortic arch anomalies occur most commonly in children. The disease can be classified into three types: ① obstructive congenital abnormalities, including coarctation of aorta (CoA) and interruption of aortic arch (IAA); ② non-obstructive congenital abnormalities, including double aortic arch and others; ③ congenital shunt abnormalities, including different types of patent ductus arteriosus (PDA). Management of patients with congenital aortic arch anomalies relies on imaging. Routine imaging modalities, such as conventional X-ray plain film and transthoracic echocardiography (TTE), have been recently complemented by magnetic resonance imaging (MRI).

  5. Markedly hypoplastic circumflex retroesophageal right aortic arch: MR imaging and surgical implications

    International Nuclear Information System (INIS)

    Circumflex retroesophageal right aortic arch with a markedly hypoplastic retroesophageal segment is a rare anomaly of the aortic arch. Adequate surgical management relies on precise diagnosis, which might not be feasible with echocardiography. To demonstrate the utility of MR imaging in establishing the diagnosis and to describe potential pitfalls in making the diagnosis. Three patients with a circumflex retroesophageal right aortic arch with a markedly hypoplastic retroesophageal segment were retrospectively evaluated. All patients underwent evaluation by echocardiography and MR imaging. The MR imaging consisted of 3-D MR angiography in two patients and fast gradient recalled echo with cardiac-triggered segmented acquisition in one patient. Surgical confirmation was obtained on all three patients. The arch anatomy was accurately depicted in all three patients by MR imaging and in none of the patients by echocardiography. MR imaging is extremely useful in establishing the diagnosis of markedly hypoplastic retroesophageal circumflex right aortic arch and thus helps in surgical planning. (orig.)

  6. [Minimally invasive cardiac surgery for aortic valve disease].

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    Fujimura, Y; Katoh, T; Hamano, K; Gohra, H; Tsuboi, H; Esato, K

    1998-12-01

    Recent surgical advances leading to good operative results have contributed to the trend to useminimally invasive approaches, even in cardiac surgery. Smaller incisions are clearly more cosmetically acceptable to patients. When using a minimally invasive approach, it is most important to maintain surgical quality without jeopardizing patients. A good operative visual field leads to good surgical results. In the parasternal approach, we use a retractor to harvest an internal thoracic artery in coronary artery bypass surgery. Retracting the sternum upward allows for a good surgical view and permits the use of an arch cannula rather than femoral cannulation. When reoperating for aortic valve repair, the j-sternotomy approach requires less adhesiolysis compared with the traditional full sternotomy. No special technique is necessary to perform aortic valve surgery using the j-sternotomy approach. However, meticulous attention must be paid to avoiding left ventricular air embolisms to prevent postoperative stroke or neurocognitive deficits, especially when utilizing a minimally invasive approach. Transesophageal echo is useful not only for monitoring cardiac function but also for monitoring the persence of air in the left ventricle and atrium. This paper compare as the degree of invasion of minimally invasive cardiac surgery and the traditional full sternotomy. No differences were found in the occurrence of systemic inflammatory response syndrome between patients undergoing minimally invasive cardiac surgery and the traditional technique. Therefore it is concluded that minimally invasive surgery for patients with aortic valve disease may become the standard approach in the near future.

  7. Mycotic aneurysm of the aortic arch presenting with left vocal cord palsy.

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    Tokmaji, George; Gosev, Igor; Kumamaru, Kanako Kunishima; Bolman, Ralph Morton

    2013-07-01

    We report a case of a 71-year-old man with a mycotic aneurysm of the aortic arch who presented with progressive hoarseness. Three weeks prior to this event the patient was admitted to an outside hospital in septic condition and was diagnosed with a mycotic abdominal aortic aneurysm. Resection of the infected abdominal aortic aneurysm with right axillofemoral and femoral-femoral bypass grafts was performed and the patient was discharged home on intravenous antibiotics. At our institution, the aortic arch aneurysm was treated with extensive debridement and replaced with a Dacron prosthesis under circulatory arrest with antegrade cerebral perfusion through the axillofemoral bypass. PMID:23816081

  8. A Review of Diseases of Aortic Arch: Diagnosis by CTA

    Directory of Open Access Journals (Sweden)

    S. Sabouri

    2007-05-01

    Full Text Available The noninvasive revolution in cardiovascular imaging has altered the diagnostic algorithm for all types of acquired and congenital cardiovascular disease. CT techniques are commonly used in the diagnosis of aortic arch and its major branch vessels as well as thoracic and abdominal aortic diseases. CT angiogra-phy combines with CT scans obtained detailed in-formation on precise morphology and extent of dis-ease. Studies were performed on an MDCT unit (4row GE light speed. In infants and small children, the seda-tion rate for CT was lower than that used for patients of similar age undergoing cardiac MR imaging. Seda-tion times ranged between 5 and 10 min, in the pedi-atric population, MDCT was performed with a 1- to 2.5-mm slice thickness in adults, MDCT was per-formed with a 2.5-mm slice thickness with 50% re-construction overlap, pitch 0.75-1.CT angiographic studies were performed with nonionic contrast mate-rial with iodine concentrations of 300 mg/mL admin-istered at a dose of 2-3 mL/kg. Contrast material was injected by power injection, followed by normal sa-line, an automated bolus-tracking technique was used at an injection rate of 2-4 mL/sec. the bolus-tracking device was placed on the ascending aorta. For pa-tients with thoracic outlet syndrome, CT angiogram was performed with neutral position of arm and ab-duction of the arm. Radiologist studied the CT image data in an axial cine paging mode as well as multiplanar reformations. To plan effective management of Aorta disease, CTA is displayed using a combination of 3D images, such as those obtained by multiplanar reformation (MPR, curved planar reformation (CPR, maximum intensity projection (MIP and volume rendering (VR. Case reports include coarctation of aorta, vascular ring, right sided aorta, interrupted aortic arch, abber-ant vessels, paitent ductus arteriosus, subclavian steel syndrome, aneurysm, dissection, thoracic outlet syn-drome, arthritis and atherosclerotic stenosis.

  9. Antegrade Versus Retrograde Cerebral Perfusion in Relation to Postoperative Complications Following Aortic Arch Surgery for Acute Aortic Dissection Type A%双侧顺行与上腔逆行脑灌注在A型主动脉夹层中应用效果对比的临床研究

    Institute of Scientific and Technical Information of China (English)

    吴智勇; 王志维; 夏军; 张遵严; 陈雪芬; 邓宏平; 徐鹏; 李罗成; 王杰

    2011-01-01

    Objective Antegrade or retrograde cerebral perfusion ( RCP) , is a well - established method of brain protection in aortic arch surgery. In this retrospective study, we compard the two methods of brain perfusion. Methods From Oct 2008 to Jan 2011,63 consecutive patients were urgently operated for acute type A aortic dissection and underwent arch replacement under deep hypothermic circulatory arrest (DHCA). Our patient cohort was divided into those protected with antegrade cerebral perfusion ( ACP) (group A, n = 54) and those protected with RCP (group B, n = 9). Results There was no siguificant difference in operative time, cardiopulmonary bypass - time, myocardial blocking time, cerebral - perfusion time between groups B and A, but the incidence of temporary neurologic dysfunction, the mean extubation time,the mean ICU -stay,the hospital -stay increased. Conclusion The antegrade perfusion was related with significantly lower incidence of temporary neurological complications, earlier extubation, shorter ICU - stay, and hospitalization.%目的 深低温停循环(DHCA)的同时顺行或逆行脑灌注,是一种行之有效的脑保护方法.在这个回顾性研究中,我们比较顺行、逆行两种方法的临床疗效.方法 从2008年10月~2011年1月,63例患者行Stanford A型主动脉夹层手术,均在深低温停循环下行全弓置换.其中选择双侧顺行脑灌注的A组病人54例,B组采用上腔静脉逆灌(RCP)脑保护的病人9例.结果 B组与A组比较在手术时间、体外循环时间、心肌阻断时间、脑灌注时间差异不明显,而B组短暂脑神经功能障碍发生率、拔管时间、ICU滞留时间、住院时间有所增加.结论 顺行脑灌注较上腔逆灌降低短暂脑神经功能障碍发生率从而拔管早,缩短ICU及住院时间.

  10. Right aortic arch with aberrant left innominate artery arising from Kommerell's diverticulum*

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    Faistauer, Ângela; Torres, Felipe Soares; Faccin, Carlo Sasso

    2016-01-01

    We report a case of an uncommon thoracic aorta anomaly-right aortic arch with aberrant left innominate artery arising from Kommerell's diverticulum-that went undiagnosed until adulthood. PMID:27777481

  11. Quantification of the aortic arch morphology in 3D CTA images for endovascular aortic repair (EVAR)

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    Wörz, S.; von Tengg-Kobligk, H.; Henninger, V.; Böckler, D.; Kauczor, H.-U.; Rohr, K.

    2008-03-01

    We introduce a new model-based approach for the segmentation and quantification of the aortic arch morphology in 3D CTA images for endovascular aortic repair (EVAR). The approach is based on a 3D analytic intensity model for thick vessels, which is directly fitted to the image. Based on the fitting results we compute the (local) 3D vessel curvature and torsion as well as the relevant lengths not only along the 3D centerline but particularly along the inner and outer contour. These measurements are important for pre-operative planning in EVAR applications. We have successfully applied our approach using ten 3D CTA images and have compared the results with ground truth obtained by a radiologist. It turned out that our approach yields accurate estimation results. We have also performed a comparison with a commercial vascular analysis software.

  12. Technical and Clinical Success and Long-Term Durability of Endovascular Treatment for Atherosclerotic Aortic Arch Branch Origin Obstruction : Evaluation of 144 Procedures

    NARCIS (Netherlands)

    van de Weijer, M. A. J.; Vonken, E. J. P. A.; de Vries, J-P. P. M.; Moll, F. L.; Vos, J. A.; de Borst, G. J.

    2015-01-01

    Objectives: Endovascular treatment of atherosclerotic obstruction of aortic arch branch origins (AABO) has largely replaced open surgery, but long-term outcome data are lacking. This study evaluated mid-term and long-term results of these procedures. Design: Retrospective cohort study. Materials and

  13. Early Results of Chimney Technique for Type B Aortic Dissections Extending to the Aortic Arch

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Chen [Affiliated Hospital of Nantong University, Department of General Surgery (China); Tang, Hanfei; Qiao, Tong; Liu, Changjian; Zhou, Min, E-mail: 813477618@qq.com [The Affiliated Hospital of Nanjing University Medical School, Department of Vascular Surgery, Nanjing Drum Tower Hospital (China)

    2016-01-15

    ObjectiveTo summarize our early experience gained from the chimney technique for type B aortic dissection (TBAD) extending to the aortic arch and to evaluate the aortic remodeling in the follow-up period.MethodsFrom September 2011 to July 2014, 27 consecutive TBAD patients without adequate proximal landing zones were retrograde analyzed. Chimney stent-grafts were deployed parallel to the main endografts to reserve flow to branch vessels while extending the landing zones. In the follow-up period, aortic remodeling was observed with computed tomography angiography.ResultsThe technical success rate was 100 %, and endografts were deployed in zone 0 (n = 3, 11.1 %), zone 1 (n = 18, 66.7 %), and zone 2 (n = 6, 22.2 %). Immediately, proximal endoleaks were detected in 5 patients (18.5 %). During a mean follow-up period of 17.6 months, computed tomography angiography showed all the aortic stent-grafts and chimney grafts to be patent. Favorable remodeling was observed at the level of maximum descending aorta and left subclavian artery with expansion of true lumen (from 18.4 ± 4.8 to 25 ± 0.86 mm, p < 0.001 and 27.1 ± 0.62 to 28.5 ± 0.37 mm, p < 0.001) and depressurization of false lumen (from 23.7 ± 2.7 to 8.7 ± 3.8 mm, p < 0.001, from 5.3 ± 1.2 to 2.1 ± 2.1 mm, p < 0.001). While at the level of maximum abdominal aorta, suboptimal remodeling of the total aorta (from 24.1 ± 0.4 to 23.6 ± 1.5 mm, p = 0.06) and true lumen (from 13.8 ± 0.6 to 14.5 ± 0.4 mm, p = 0.08) was observed.ConclusionBased on our limited experience, the chimney technique with thoracic endovascular repair is demonstrated to be promising for TBAD extending to the arch with favorable aortic remodeling.

  14. Abnormal aortic arch morphology in Turner syndrome patients is a risk factor for hypertension.

    Science.gov (United States)

    De Groote, Katya; Devos, Daniël; Van Herck, Koen; Demulier, Laurent; Buysse, Wesley; De Schepper, Jean; De Wolf, Daniël

    2015-09-01

    Hypertension in Turner syndrome (TS) is a multifactorial, highly prevalent and significant problem that warrants timely diagnosis and rigorous treatment. The objective of this study was to investigate the association between abnormal aortic arch morphology and hypertension in adult TS patients. This was a single centre retrospective study in 74 adult TS patients (age 29.41 ± 8.91 years) who underwent a routine cardiac MRI. Patients were assigned to the hypertensive group (N = 31) if blood pressure exceeded 140/90 mmHg and/or if they were treated with antihypertensive medication. Aortic arch morphology was evaluated on MRI images and initially assigned as normal (N = 54) or abnormal (N = 20), based on the curve of the transverse arch and the distance between the left common carotid-left subclavian artery. We additionally used a new more objective method to describe aortic arch abnormality in TS by determination of the relative position of the highest point of the transverse arch (AoHP). Logistic regression analysis showed that hypertension is significantly and independently associated with age, BMI and abnormal arch morphology, with a larger effect size for the new AoHP method than for the classical method. TS patients with hypertension and abnormal arch morphology more often had dilatation of the ascending aorta. There is a significant association between abnormal arch morphology and hypertension in TS patients, independent of age and BMI, and not related to other structural heart disease. We suggest that aortic arch morphology should be included in the risk stratification for hypertension in TS and propose a new quantitative method to express aortic arch morphology.

  15. Abnormal aortic arch morphology in Turner syndrome patients is a risk factor for hypertension.

    Science.gov (United States)

    De Groote, Katya; Devos, Daniël; Van Herck, Koen; Demulier, Laurent; Buysse, Wesley; De Schepper, Jean; De Wolf, Daniël

    2015-09-01

    Hypertension in Turner syndrome (TS) is a multifactorial, highly prevalent and significant problem that warrants timely diagnosis and rigorous treatment. The objective of this study was to investigate the association between abnormal aortic arch morphology and hypertension in adult TS patients. This was a single centre retrospective study in 74 adult TS patients (age 29.41 ± 8.91 years) who underwent a routine cardiac MRI. Patients were assigned to the hypertensive group (N = 31) if blood pressure exceeded 140/90 mmHg and/or if they were treated with antihypertensive medication. Aortic arch morphology was evaluated on MRI images and initially assigned as normal (N = 54) or abnormal (N = 20), based on the curve of the transverse arch and the distance between the left common carotid-left subclavian artery. We additionally used a new more objective method to describe aortic arch abnormality in TS by determination of the relative position of the highest point of the transverse arch (AoHP). Logistic regression analysis showed that hypertension is significantly and independently associated with age, BMI and abnormal arch morphology, with a larger effect size for the new AoHP method than for the classical method. TS patients with hypertension and abnormal arch morphology more often had dilatation of the ascending aorta. There is a significant association between abnormal arch morphology and hypertension in TS patients, independent of age and BMI, and not related to other structural heart disease. We suggest that aortic arch morphology should be included in the risk stratification for hypertension in TS and propose a new quantitative method to express aortic arch morphology. PMID:24935217

  16. Aortic arch thrombectomy in a 2.8 kilogram neonate--a case report and review of the literature.

    Science.gov (United States)

    Omeje, Ikenna; Ram, Awat; Kostolny, Martin

    2013-02-01

    Aortic arch thrombus is a rare occurrence in neonates. In the few described cases, this has mainly been associated with sepsis or early postnatal interventions, such as insertion of umbilical arterial line. We describe a case of occlusive aortic arch thrombus in a neonate who presented with signs of critical coarctation and successfully underwent surgical thrombectomy on deep hypothermic circulatory arrest. We also present a review of the most recently published cases of aortic arch thrombus in neonates and the treatment options employed.

  17. The origin and significance of secondary flows in the aortic arch.

    Science.gov (United States)

    Black, M M; Hose, D R; Lawford, P V

    1995-01-01

    This paper comprises a study of the secondary flow patterns that can develop in the human aortic arch. Clinical evidence of these secondary flows has been obtained by Kilner et al. using magnetic resonance velocity mapping techniques. Some of their results are presented for comparison in this paper. Four difference parametric models of the aortic arch have been analysed using computational fluid dynamic techniques. Both steady and transient flow conditions have been considered and two different commercially available software packages were used, namely FIDAP and FLOTRAN. A satisfactory comparison of the theoretical analysis with the results, both in vivo and in vitro, obtained by Kilner et al. for their out-of-plane inlet model was found. The theoretical analysis can now be extended to analyse the effect of different configurations and orientations of artificial aortic valves on the resulting aortic arch flow patterns.

  18. Role of aortic arch vascular mechanics in cardiovagal baroreflex sensitivity.

    Science.gov (United States)

    Klassen, Stephen A; Chirico, Daniele; Dempster, Kylie S; Shoemaker, J Kevin; O'Leary, Deborah D

    2016-07-01

    Cardiovagal baroreflex sensitivity (cvBRS) measures the efficiency of the cardiovagal baroreflex to modulate heart rate in response to increases or decreases in systolic blood pressure (SBP). Given that baroreceptors are located in the walls of the carotid sinuses (CS) and aortic arch (AA), the arterial mechanics of these sites are important contributors to cvBRS. However, the relative contribution of CS and AA mechanics to cvBRS remains unclear. This study employed sex differences as a model to test the hypothesis that differences in cvBRS between groups would be explained by the vascular mechanics of the AA but not the CS. Thirty-six young, healthy, normotensive individuals (18 females; 24 ± 2 yr) were recruited. cvBRS was measured using transfer function analysis of the low-frequency region (0.04-0.15 Hz). Ultrasonography was performed at the CS and AA to obtain arterial diameters for the measurement of distensibility. Local pulse pressure (PP) was taken at the CS using a hand-held tonometer, whereas AA PP was estimated using a transfer function of brachial PP. Both cvBRS (25 ± 11 vs. 19 ± 7 ms/mmHg, P = 0.04) and AA distensibility (16.5 ± 6.0 vs. 10.5 ± 3.8 mmHg(-1) × 10(-3), P = 0.02) were greater in females than males. Sex differences in cvBRS were eliminated after controlling for AA distensibility (P = 0.19). There were no sex differences in CS distensibility (5.32 ± 2.3 vs. 4.63 ± 1.3 mmHg(-1) × 10(-3), P = 0.32). The present data demonstrate that AA mechanics are an important contributor to differences in cvBRS.

  19. Endovascular treatment of aortic arch aneurysms Tratamento endovascular dos aneurismas de arco aórtico

    Directory of Open Access Journals (Sweden)

    Roberto Chiesa

    2008-06-01

    Full Text Available BACKGROUND: Endovascular approach to the aortic arch is an appealing solution for selected patients. OBJECTIVE: To compare the technical and clinical success recorded in the different anatomical settings of endografting for aortic arch disease. METHODS: Between June 1999 and October 2006, among 178 patients treated at our institution for thoracic aorta disease with a stent-graft, the aortic arch was involved in 64 cases. According to the classification proposed by Ishimaru, aortic zone 0 was involved in 14 cases, zone 1 in 12 cases and zone 2 in 38 cases. A hybrid surgical procedure of supra-aortic debranching and revascularization was performed in 37 cases. RESULTS: Zone 0. Proximal neck length: 44±6 mm. Initial clinical success was 78.6%: two deaths (stroke, one type Ia endoleak. At a mean follow-up of 16.4±11 months the midterm clinical success was 85.7%. Zone 1. Proximal neck length: 28±5 mm. Initial clinical success was 66.7%: 0 deaths, four type Ia endoleaks. At a mean follow-up of 16.9±17.2 months the midterm clinical success was 75.0%. Zone 2. Proximal neck length: 30±5 mm. Initial clinical success was 84.2%: two deaths (one cardiac arrest, one multiorgan embolization, three type Ia endoleaks, one case of open conversion. Two cases of delayed transitory paraparesis/paraplegia were observed. At a mean follow-up of 28.0±17.2 months the midterm clinical success was 89.5%. CONCLUSIONS: This study and a literature review demonstrated that hybrid procedure for aortic arch pathology is feasible in selected patients at high risk for conventional surgery. Our experience is still limited by the relatively small sample size. We propose to reserve zone 1 for patients unfit for sternotomy or in cases with aortic neck length > 30 mm following left common carotid artery debranching. We recommend to perform complete aortic rerouting of the aortic arch in cases with lesser comorbidities and shorter aortic neck.CONTEXTO: O tratamento endovascular

  20. Canadian Cardiovascular Society/Canadian Society of Cardiac Surgeons/Canadian Society for Vascular Surgery Joint Position Statement on Open and Endovascular Surgery for Thoracic Aortic Disease.

    Science.gov (United States)

    Appoo, Jehangir J; Bozinovski, John; Chu, Michael W A; El-Hamamsy, Ismail; Forbes, Thomas L; Moon, Michael; Ouzounian, Maral; Peterson, Mark D; Tittley, Jacques; Boodhwani, Munir

    2016-06-01

    In 2014, the Canadian Cardiovascular Society (CCS) published a position statement on the management of thoracic aortic disease addressing size thresholds for surgery, imaging modalities, medical therapy, and genetics. It did not address issues related to surgical intervention. This joint Position Statement on behalf of the CCS, Canadian Society of Cardiac Surgeons, and the Canadian Society for Vascular Surgery provides recommendations about thoracic aortic disease interventions, including: aortic valve repair, perfusion strategies for arch repair, extended arch hybrid reconstruction for acute type A dissection, endovascular management of arch and descending aortic aneurysms, and type B dissection. The position statement is constructed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and has been approved by the primary panel, an international secondary panel, and the CCS Guidelines Committee. Advent of endovascular technology has improved aortic surgery safety and extended the indications of minimally invasive thoracic aortic surgery. The combination of safer open surgery with endovascular treatment has improved patient outcomes in this rapidly evolving subspecialty field of cardiovascular surgery.

  1. The role of transesophageal echocardiography in aortic surgery.

    Science.gov (United States)

    Nowak-Machen, Martina

    2016-09-01

    Aortic disease, when left untreated, is still associated with major morbidity and mortality. Aortic dissection and aortic aneurysm are the main reasons for performing aortic surgery procedures in the adult. Imaging techniques such as computed tomography and magnetic resonance imaging play a key role in the preoperative evaluation. Transesophageal echocardiography (TEE) has become a safe and invaluable perioperative imaging tool for aortic disease over the past decade with high sensitivity and specificity. TEE can increase patient safety and improve overall patient outcome in aortic surgery. Especially during endovascular aortic repair, TEE is more sensitive than other imaging modalities in diagnosing complications such as graft endoleaks. Newer echocardiographic techniques such as three-dimensional (3D) TEE and contrast-enhanced TEE are emerging and seem to have a valuable role especially in aortic dissection repair and endovascular aortic stent procedures. In the absence of contraindications, TEE should generally be performed during aortic surgery and endovascular aortic procedures. PMID:27650342

  2. Tracheal compression due to an elongated aortic arch in patients with congenital heart disease: evaluation using multidetector-row CT

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, Noriko; Hayabuchi, Yasunobu; Inoue, Miki; Sakata, Miho; Nabo, Manal Mohamed Helmy; Nakagawa, Ryuji; Saijo, Takahiko; Kagami, Shoji [University of Tokushima, Department of Pediatrics, Tokushima (Japan)

    2009-10-15

    The airway can become obstructed as a result of compression by an elongated aortic arch. In this study we evaluated tracheal compression using multidetector-row CT in patients with congenital heart disease and an elongated aortic arch. The trachea was measured at the level of the aortic arch in 205 children and young adults and then the severity of tracheal compression was determined by measuring the tracheal diameter ratio (short axis diameter/long axis diameter). Patients were divided as follows: group I (normal aortic arch; n=166), group II (transversely running aortic arch; n=22), and group III (elongated aortic arch; n=17). From the viewpoint of the relationship of the great arteries, group II had D-malposition, and group III had L-malposition. Age, height, weight and body surface area were significantly correlated with the short and long axis diameter in group I. There was a negative correlation between tracheal diameter ratio and the physical size parameters. The tracheal diameter ratio in group III was 0.50{+-}0.13, which was significantly lower than in groups I and II (P<0.01 and 0.05, respectively). Even apparently asymptomatic patients with an elongated aortic arch can have tracheal compression. An elongated aortic arch may be a useful predictor of tracheal compression. (orig.)

  3. The future of aortic surgery in Europe

    DEFF Research Database (Denmark)

    Czerny, Martin; Bachet, Jean; Bavaria, Joseph;

    2012-01-01

    At least every ten years, each specialty should reflect upon its past, its present and its future, in order to be able to reconfirm the direction in which it is headed, to adopt suggestions from inside and outside and, consequently, to improve. As such, the aim of this manuscript is to provide th...... in Europe, namely the Vascular Domain of the European Association of Cardio-Thoracic Surgery (EACTS)....... the interested reader with an overview of how aortic surgery and (perhaps more accurately) aortic medicine has evolved in Europe, and its present standing; also to provide a glimpse into the future, trying to disseminate the thoughts of a group of people actively involved in the development of aortic medicine...

  4. Invasive aspergillosis in the aortic arch with infectious Aspergillus lesions in pulmonary bullae

    Directory of Open Access Journals (Sweden)

    Isao Watanabe

    2015-03-01

    Full Text Available A patient with pulmonary bullae died of massive hemoptysis. At autopsy a hole was observed in the aortic wall. A microscopic examination indicated small Aspergillus lesions in pulmonary bullae and extensive necrotic lesions with Aspergillus hyphae in the media of the thoracic aorta. These findings led to a diagnosis of invasive aspergillosis in the aortic arch. This is a rare case in which Aspergillus invaded the aorta in a patient without hematologic neoplasms or neutropenia.

  5. Hybrid Repair of Complex Thoracic Aortic Arch Pathology: Long-Term Outcomes of Extra-anatomic Bypass Grafting of the Supra-aortic Trunk

    Energy Technology Data Exchange (ETDEWEB)

    Lotfi, S., E-mail: shamim.lotfi@kcl.ac.uk; Clough, R. E.; Ali, T. [Guy' s and St. Thomas' NHS Trust, Vascular Surgery (United Kingdom); Salter, R. [Guy' s and St. Thomas' NHS Trust, Interventional Radiology (United Kingdom); Young, C. P. [Guy' s and St. Thomas' NHS Trust, Cardiac Surgery (United Kingdom); Bell, R.; Modarai, B.; Taylor, P., E-mail: peter.taylor@gstt.nhs.uk [Guy' s and St. Thomas' NHS Trust, Vascular Surgery (United Kingdom)

    2013-02-15

    Hybrid repair constitutes supra-aortic debranching before thoracic endovascular aortic repair (TEVAR). It offers improved short-term outcome compared with open surgery; however, longer-term studies are required to assess patient outcomes and patency of the extra-anatomic bypass grafts. A prospectively maintained database of 380 elective and urgent patients who had undergone TEVAR (1997-2011) was analyzed retrospectively. Fifty-one patients (34 males; 17 females) underwent hybrid repair. Median age was 71 (range, 18-90) years with mean follow-up of 15 (range, 0-61) months. Perioperative complications included death: 10 % (5/51), stroke: 12 % (6/51), paraplegia: 6 % (3/51), endoleak: 16 % (8/51), rupture: 4 % (2/51), upper-limb ischemia: 2 % (1/51), bypass graft occlusion: 4 % (2/51), and cardiopulmonary complications in 14 % (7/51). Three patients (6 %) required emergency intervention for retrograde dissection: (2 aortic root repairs; 2 innominate stents). Early reintervention was performed for type 1 endoleak in two patients (2 proximal cuff extensions). One patient underwent innominate stenting and revision of their bypass for symptomatic restenosis. At 48 months, survival was 73 %. Endoleak was detected in three (6 %) patients (type 1 = 2; type 2 = 1) requiring debranching with proximal stent graft (n = 2) and proximal extension cuff (n = 1). One patient had a fatal rupture of a mycotic aneurysm and two arch aneurysms expanded. No bypass graft occluded after the perioperative period. Hybrid operations to treat aortic arch disease can be performed with results comparable to open surgery. The longer-term outcomes demonstrate low rates of reintervention and high rates of graft patency.

  6. Abdominal Aortic Surgery: Anesthetic Implications

    OpenAIRE

    Cunningham, Anthony J.

    1991-01-01

    The objectives of the review are to highlight the clinical characteristics of the patient population; to assess multivariate risk factor analysis and the invasive/non-invasive techniques available for risk factor identification and management in this high-risk surgical population; to assess the major hemodynamic, metabolic, and regional blood flow changes associated with aortic cross-clamping/unclamping procedures and techniques for their modification or attenuation; and to assess the influen...

  7. Total aortic arch replacement: superior ventriculo-arterial coupling with decellularized allografts compared with conventional prostheses.

    Directory of Open Access Journals (Sweden)

    Alexander Weymann

    Full Text Available To date, no experimental or clinical study provides detailed analysis of vascular impedance changes after total aortic arch replacement. This study investigated ventriculoarterial coupling and vascular impedance after replacement of the aortic arch with conventional prostheses vs. decellularized allografts.After preparing decellularized aortic arch allografts, their mechanical, histological and biochemical properties were evaluated and compared to native aortic arches and conventional prostheses in vitro. In open-chest dogs, total aortic arch replacement was performed with conventional prostheses and compared to decellularized allografts (n = 5/group. Aortic flow and pressure were recorded continuously, left ventricular pressure-volume relations were measured by using a pressure-conductance catheter. From the hemodynamic variables end-systolic elastance (Ees, arterial elastance (Ea and ventriculoarterial coupling were calculated. Characteristic impedance (Z was assessed by Fourier analysis.While Ees did not differ between the groups and over time (4.1±1.19 vs. 4.58±1.39 mmHg/mL and 3.21±0.97 vs. 3.96±1.16 mmHg/mL, Ea showed a higher increase in the prosthesis group (4.01±0.67 vs. 6.18±0.20 mmHg/mL, P<0.05 in comparison to decellularized allografts (5.03±0.35 vs. 5.99±1.09 mmHg/mL. This led to impaired ventriculoarterial coupling in the prosthesis group, while it remained unchanged in the allograft group (62.5±50.9 vs. 3.9±23.4%. Z showed a strong increasing tendency in the prosthesis group and it was markedly higher after replacement when compared to decellularized allografts (44.6±8.3 dyn·sec·cm(-5 vs. 32.4±2.0 dyn·sec·cm(-5, P<0.05.Total aortic arch replacement leads to contractility-afterload mismatch by means of increased impedance and invert ventriculoarterial coupling ratio after implantation of conventional prostheses. Implantation of decellularized allografts preserves vascular impedance thereby improving

  8. Chylous complications after abdominal aortic surgery.

    Science.gov (United States)

    Haug, E S; Saether, O D; Odegaard, A; Johnsen, G; Myhre, H O

    1998-12-01

    Two patients developed chylous complications following abdominal aortic aneurysm repair. One patient had chylous ascitis and was successfully treated by a peritoneo-caval shunt. The other patient developed a lymph cyst, which gradually resorbed after puncture. Chylous complications following aortic surgery are rare. Patients in bad a general condition should be treated by initial paracentesis and total parenteral nutrition, supplemented by medium-chain triglyceride and low-fat diet. If no improvement is observed on this regimen, the next step should be implementation of a peritoneo-venous shunt, whereas direct ligation of the leak should be reserved for those who are not responding to this treatment. PMID:10204656

  9. Reconstructive surgery of the aortic valve

    Directory of Open Access Journals (Sweden)

    Mendonça José Teles de

    2003-01-01

    Full Text Available OBJECTIVE: Lacking an ideal valve substitute and motivated by the good results of mitral valve repair since 1990, we faced with determination aortic valve reconstruction surgery. The objective of this paper is to show our experience with this procedure. METHOD: Between January of 1990 and December of 2001; 136 aortic valve repair surgeries were performed. Seventy-five (55.1% of the patients were female and the ages ranged from 4 to 70 years (mean 23.3 ± 1.2 years. Every patient had rheumatic valve disease and insufficiency was the most prevalent type (108 patients - 79.4%, followed by double aortic lesion in 16 (11.7% patients and stenosis in 12 (8.8%. The surgical techniques used were: subcommissural annuloplasty in 74 (54.4% patients, commissurotomy in 38 (27.9%, cusp extension with pericardium in 17 (12.5%, substitution of one cusp in 2 (1.4%, cusp suspension by annuloplasty in 37 (27.2% and Valsalva sinus remodeling in 27 (19.8%. The surgery exclusively involved the aortic valve in 57 (41.9% patients and was associated in 79 (mitral valve replacement in 12, mitral repair in 65, coronary artery bypass grafting in 1 and pulmonary commissurotomy in 1. RESULTS: Hospital mortality was 2.2% and 22 (16.2% patients underwent a new surgery during the follow-up period (57.7 ± 3.5 months. CONCLUSIONS: Aortic valve repair is a safe surgical procedure that can be used in an increasing number of patients with promising results.

  10. Balloon aortic valvuloplasty as a bridge to aortic valve surgery for severe aortic stenosis.

    Science.gov (United States)

    Nwaejike, Nnamdi; Mills, Keith; Stables, Rod; Field, Mark

    2015-03-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, in patients with severe aortic stenosis, can balloon valvuloplasty be used as a bridge to aortic valve replacement? Altogether 463 papers were found using the reported search, of which 11 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that balloon aortic valvuloplasty is recommended as a bridge to aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI) in patients with severe symptomatic aortic stenosis. Institutional practices, local and logistic factors can affect patient selection and management approaches to severe aortic stenosis, but having the facility to offer balloon aortic valvuloplasty (especially in the TAVI era) provides another management option for patients who would otherwise have been considered unacceptably high risk for aortic valve surgery. The increased incidence of balloon aortic valvuloplasty mirrors the increase in the use of TAVI with a sharp increase in activity from 2006. Success rates for bridging from balloon aortic valvuloplasty to definite surgical intervention are in the range 26.3-74%, with AVR or TAVI occurring within 8 weeks to 7 months. Complications from balloon aortic valvuloplasty such as aortic regurgitation (AR) can be managed successfully. Up to 40% of patients selected by balloon aortic valvuloplasty to have TAVI or AVR do not have these procedures within 2 years. While most of these patients are excluded for objective clinical reasons such as terminal disease/malignancy or other persistent contraindication, some patients refuse definitive treatment and others die while on the waiting list. Outcomes in patients bridged to AVR/TAVI are better than in patients treated with balloon aortic valvuloplasty

  11. Double aortic arch as a source of airway obstruction in a child

    Directory of Open Access Journals (Sweden)

    Sambhunath Das

    2015-01-01

    Full Text Available Double aortic arch (DAA is a congenital vascular anomaly. The diagnosis was difficult till the child was symptomatic, and other causes were ruled out. We present the interesting images of a child of respiratory distress because of tracheal compression from DAA.

  12. Prenatal diagnosis of the rare association of common arterial trunk and double aortic arch

    OpenAIRE

    Rock, Andrea; Eltayeb, Osama; Camarda, Joseph; Gotteiner, Nina

    2016-01-01

    Key Clinical Message Common arterial trunk with associated double aortic arch is a very rare constellation of congenital heart disease. Prenatal diagnosis allows for surgical repair prior to development of respiratory morbidity, which is otherwise described in all cases with this association.

  13. [Antegrade unilateral perfusion of the brain through the brachiocephalic trunk in operations on the aortic arch].

    Science.gov (United States)

    Kozlov, B N; Panfilov, D S; Kuznetsov, M S; Ponomarenko, I V; Nasrashvili, G G; Shipulin, V M

    2016-01-01

    Presented herein is a technique of unilateral antegrade perfusion of the brain in operations on the aortic arch. The method makes it possible to perform both systemic artificial circulation and adequate physiological perfusion of the brain, promoting minimization of the number of neurological complications. PMID:27100557

  14. Truncus arteriosus with aortic arch interruption: cardiovascular magnetic resonance findings in the unrepaired adult

    OpenAIRE

    Cook Stephen C; Thavendiranathan Paaladinesh; Arruda Janine; Verhaert David; Raman Subha V

    2010-01-01

    Abstract Truncus arteriosus (TA) is a rare congenital condition defined as a single arterial vessel arising from the heart that gives origin to the systemic, pulmonary and coronary circulations. We discuss the unique case of a 28 year-old female patient with unrepaired TA and interruption of the aortic arch who underwent cardiovascular magnetic resonance (CMR).

  15. Double aortic arch with double aneuploidy-rare anomaly in combined Down and Klinefelter syndrome

    NARCIS (Netherlands)

    M.F. Gerretsen; W. Peelen; L.A.J. Rammeloo; D.R. Koolbergen; J. Hruda

    2009-01-01

    A 14-month-old boy with double aneuploidy and a double aortic arch suffered from frequently recurrent severe feeding and respiratory problems. Chromosomal analysis showed a 48,XXY + 21 karyotype: a double aneuploidy of Down syndrome (DS) and Klinefelter syndrome (KS). Only four cases of double aneup

  16. Aortic Arch Vessel Anomalies Associated with Persistent Trigeminal Artery: (Report of a Case

    Directory of Open Access Journals (Sweden)

    M. Lotfi

    2008-01-01

    Full Text Available Introduction: Developmental anomalies of the aortic arch vessels are well described entities. Persistent trigeminal artery (PTA is the most common type of the four anomalous carotid-basilar anastomoses, and is due to abnormal persistence of what are normal transient communications between the embryonic forebrain and hindbrain arterial systems. Herein we report a previously undescribed variant consisting of coexistence of the PTA, truncus bicaroticus, and di-rect origin of left vertebral artery from aortic arch. "nCase Presentation: A 46 year-old man was admitted in the Namazi hospital with severe nausea, vomiting, severe headache, and decreased level of conscious-ness. Computed tomography scan revealed intraven-tricular hemorrhage with no evidence of subarach-noid hemorrhage. The patient was referred for four-vessel cerebral arteriography to evaluate the entire cerebral vascular anatomy. Arch aortography demon-strated the right subclavian artery as the first branch of the arch. The left vertebral artery arose directly from the arch as the second branch. The third branch consisted of a common trunk giving rise to the right and left common carotid arteries (Truncus Bicaroti-cus. The left subclavian artery arose as the final branch of the aortic arch. Selective angiography con-firmed that left vertebral artery did not arise from the left subclavian artery. Left vertebral artery angiogra-phy revealed a persistent trigeminal artery, with fill-ing of left internal carotid artery and its branches. No aneurysm or any other vascular abnormality was de-tected in this patient. The patient was subsequently managed by evacuation of IVH and ventriculostomy."nDiscussion: The usual configuration of three branches from the aortic arch is found in 60-80% of popula-tion. The left vertebral artery normally originate along the superior portion of the left subclavian ar-tery. However, this artery is subject to a number of variations; among all; the most common

  17. Stenting of Variant Left Carotid Artery Using Brachial Artery Approach in a Patient with Unusual Type of Bovine Aortic Arch

    Directory of Open Access Journals (Sweden)

    Emre Gürel

    2016-01-01

    Full Text Available Bovine aortic arch is the most frequently encountered variation in human aortic arch branching. A 63-year-old Asian male presented with symptomatic severe stenosis of left carotid artery originating from the brachiocephalic trunk. Selective engagement to the left carotid artery was unsuccessful using transfemoral approach. We reported on a successful left carotid artery stenting case using right brachial artery approach in a bovine aortic arch. This paper is worthy of reporting in terms of guiding physicians for interventional procedures in these types of challenging cases.

  18. Rapid prototyping in aortic surgery.

    Science.gov (United States)

    Bangeas, Petros; Voulalas, Grigorios; Ktenidis, Kiriakos

    2016-04-01

    3D printing provides the sequential addition of material layers and, thus, the opportunity to print parts and components made of different materials with variable mechanical and physical properties. It helps us create 3D anatomical models for the better planning of surgical procedures when needed, since it can reveal any complex anatomical feature. Images of abdominal aortic aneurysms received by computed tomographic angiography were converted into 3D images using a Google SketchUp free software and saved in stereolithography format. Using a 3D printer (Makerbot), a model made of polylactic acid material (thermoplastic filament) was printed. A 3D model of an abdominal aorta aneurysm was created in 138 min, while the model was a precise copy of the aorta visualized in the computed tomographic images. The total cost (including the initial cost of the printer) reached 1303.00 euros. 3D imaging and modelling using different materials can be very useful in cases when anatomical difficulties are recognized through the computed tomographic images and a tactile approach is demanded preoperatively. In this way, major complications during abdominal aorta aneurysm management can be predicted and prevented. Furthermore, the model can be used as a mould; the development of new, more biocompatible, less antigenic and individualized can become a challenge in the future. PMID:26803324

  19. One-stage Surgical Correction of Aortic Coarctation Complicated With Aortic Arch Hypoplasia by Autologous Pulmonary Artery Patch%自体肺动脉补片一期矫治主动脉缩窄伴主动脉弓发育不良

    Institute of Scientific and Technical Information of China (English)

    王显悦; 毕生辉; 童光; 董文鹏; 王晓武; 梁爱琼; 徐宇; 张卫达

    2014-01-01

      结论:自体肺动脉补片一期矫治主动脉缩窄伴弓发育不良,病变解除良好,并发症少,手术后早中期效果理想。%Objective: To observe the outcomes of one-stage surgical correction of aortic coarctation (COA) complicated with aortic arch hypoplasia by autologous pulmonary artery patch. Methods: A total of 22 COA with aortic arch hypolasia children treated in our hospital from 2009-05 to 2013-05 were summarized. All patients were clearly diagnosed by CTA. All patients received the one-stage surgical correction of aortic coarctation complicated with aortic arch hypoplasia by autologous pulmonary artery patch. The selective low-lfow cerebral perfusion was used during aortic arch procedure and the concomitant cardiac anomalies were corrected during the same surgery. Results: No peri-operative death. There were 6 patients with the upper arm BP higher than lower arm immediately after the operation and the pressure gradient Conclusion: COA with aortic arch hypoplasia could be treated with one-stage surgical correction using autologous pulmonary artery patch, which had good early and mid term outcomes.

  20. Interrupted aortic arch diagnosed by ECG-gated multi-slice computed tomography angiography: a case report

    Institute of Scientific and Technical Information of China (English)

    ZHOU Yang-yang; HAN Ping; FENG Gan-sheng; LIANG Bo

    2005-01-01

    @@ Interrupted aortic arch (IAA) is a rare congenital cardiovascular disease with major intracardiac defects and always with multisystem non-cardiac malformations. It occurs in 1: 10,000 births, and about 1% of the patients with congenital heart defects.

  1. Pattern-based approach to fetal congenital cardiovascular anomalies using the transverse aortic arch view on prenatal cardiac MRI

    Energy Technology Data Exchange (ETDEWEB)

    Dong, Su-Zhen; Zhu, Ming [Shanghai Jiaotong University School of Medicine, Department of Radiology, Shanghai Children' s Medical Center, Shanghai (China)

    2015-05-01

    Fetal echocardiography is the imaging modality of choice for prenatal diagnosis of congenital cardiovascular anomalies. However, echocardiography has limitations. Fetal cardiac magnetic resonance imaging (MRI) has the potential to complement US in detecting congenital cardiovascular anomalies. This article draws on our experience; it describes the transverse aortic arch view on fetal cardiac MRI and important clues on an abnormal transverse view at the level of the aortic arch to the diagnosis of fetal congenital cardiovascular anomalies. (orig.)

  2. Aortic Arch Atherosclerosis——An Important Potential Source Of Cerebral Embolic Stroke

    Institute of Scientific and Technical Information of China (English)

    Yi Guo; Shao wen Zhang; Si Chen

    2000-01-01

    Background and purpose: Recent years with use of transesophageal echography renew awareness of aortic atherosclerosis. The purpose of this study was to determine the prevalence, clinical significance, and embolic potential of thoracic aortic plaque in patients with cerebral emblism; and further study the correlation aortic plaque with carotid or heart disease. Method: 49 consecutive patients with cerebral embolism was included in this sutdy. We uscd TEE to evaluated potential source of emboli in aortic arch and heart, and duplex in carotid artery. A atherosclerotic lesion of thoracic aorta was defined as normal(O); mild plaque (1); moderate plaque (2); protruding plaque or mobile plaque (3). Result: 31(63%) patients showed evidence of AAA; 7 (14.3%) patients had mild AAA, 9 (18.4%) patients had moderate AAA and 15 (32.7%) patients had severe AAA, In these 15 patients 11 patients neither severe ICAA or embolic heart disease, the AAA may be responsible to the cerebral embolism; 33 patients had internal carotid arterial atherosclerosis(ICAA), 9 patients had embolic heart disease; Age, ICAA had significant correlated with aortic plaque. Conclusion: Aortic atherosclerosis is common in cerebral embolism. Aortic plaque might be not only responsible for some unexplained embolic event, but also for some of the embolic stroke in the group of patient do have carotid artery or heart disease. Age might be important risk factor for the development of atherosclerotic lesion in the thoracic aorta.

  3. Right-Sided Aortic Arch with Aberrant Left Subclavian Artery from Kommerell's Diverticulum

    Directory of Open Access Journals (Sweden)

    M.Y. Mubarak

    2011-06-01

    Full Text Available A previously healthy 52-year-old man had a chest radiograph for medical check-up and found to have a right-sided aortic arch. Computed tomography of the thorax revealed a right-sided aorticarch with aberrant left subclavian artery originated from Kommerell's diverticulum. Barium swallow examination showed compression of the posterior wall of the esophagus. He was asymptomatic and no surgical intervention was performed.

  4. [Interruption of the aortic arch with no patent ductus arteriosus: is survival possible?].

    Science.gov (United States)

    Boukhris, M; Hakim, K; Ouarda, F; M'saad, H; Boussaada, R

    2014-03-01

    Interruption of the aortic arch is a rare congenital disease. It is defined by the complete interruption between the ascending and descending aorta. A patent ductus arteriosus is necessary to maintain flow from the pulmonary to the descending aorta. Its closure leads to a cardiovascular collapse and this malformation is therefore duct-dependent. However, in rare cases, survival remains possible even after ductus arteriosus closure. We report such a case. PMID:24457106

  5. Carbon Dioxide in the Aortic Arch: Coronary Effects and Implications in a Swine Study

    International Nuclear Information System (INIS)

    Purpose: CO2 angiography is considered dangerous in the aortic arch where bubbles may cause critical cerebral and cardiac ischemia. We investigated CO2distribution, physiologic effects in the heart, methods of detection and treatments. Methods: Eight pigs had CO2and iodinated contrast arch angiograms in supine and both lateral decubitus positions. An electrocardiogram, physiologic data and cardiac ultrasound were obtained. Therapies included precordial thumps and rolls to lateral decubitus positions. Results: Supine high descending aorta CO2 injections floated retrograde up the arch during diastole and preferentially filled the right coronary artery (RCA): mean score 3.5 (of 4), in nominate artery 2.4, left coronary artery 1.2; n = 17; p = 0.0001. Aortic root injections preferentially filled the RCA when the animal was supine, left coronary in the right decubitus position, and showed a diffuse pattern in the left decubitus position. Right decubitus rolls filled both coronaries causing several lethal arrhythmias. Precordialthumps successfully cleared CO2. Ultrasound is a sensitive detector of myocardial CO2. Conclusion: Arch distribution of CO2 primarily involves the RCA. Diagnostic ultrasound detects cardiac CO2 well. Precordial thumps are an effective treatment

  6. Multimodal optical measurement in vitro of surface deformations and wall thickness of the pressurized aortic arch.

    Science.gov (United States)

    Genovese, Katia; Humphrey, Jay D

    2015-04-01

    Computational modeling of arterial mechanics continues to progress, even to the point of allowing the study of complex regions such as the aortic arch. Nevertheless, most prior studies assign homogeneous and isotropic material properties and constant wall thickness even when implementing patient-specific luminal geometries obtained from medical imaging. These assumptions are not due to computational limitations, but rather to the lack of spatially dense sets of experimental data that describe regional variations in mechanical properties and wall thickness in such complex arterial regions. In this work, we addressed technical challenges associated with in vitro measurement of overall geometry, full-field surface deformations, and regional wall thickness of the porcine aortic arch in its native anatomical configuration. Specifically, we combined two digital image correlation-based approaches, standard and panoramic, to track surface geometry and finite deformations during pressurization, with a 360-deg fringe projection system to contour the outer and inner geometry. The latter provided, for the first time, information on heterogeneous distributions of wall thickness of the arch and associated branches in the unloaded state. Results showed that mechanical responses vary significantly with orientation and location (e.g., less extensible in the circumferential direction and with increasing distance from the heart) and that the arch exhibits a nearly linear increase in pressure-induced strain up to 40%, consistent with other findings on proximal porcine aortas. Thickness measurements revealed strong regional differences, thus emphasizing the need to include nonuniform thicknesses in theoretical and computational studies of complex arterial geometries.

  7. 小儿主动脉弓手术中深低温停循环和局部脑灌注的应用效果%Applied research of deep hypothermic circulatory arrest and regional cerebral perfusion in pediatric aortic arch surgery

    Institute of Scientific and Technical Information of China (English)

    郭铮; 郑景浩; 王伟; 付惟定; 朱德明

    2014-01-01

    目的 观察并比较深低温停循环(DHCA)和局部脑灌注(RCP)在小儿主动脉弓手术中的应用效果.方法 70例小于3个月的主动脉缩窄和主动脉弓中断合并房间隔缺损、室间隔缺损的手术患儿根据体外循环方法不同分成DHCA组和RCP组.DHCA组35例,男23例,女12例;年龄(1.33±0.80)个月;体质量(4.3±2.9)kg.RCP组35例,男20例,女15例;年龄(1.35±0.90)个月;体质量(4.4±3.2) kg.分析两组体外循环时间、主动脉阻断时间、停循环或脑灌注时间,呼吸机辅助时间、监护室停留时间,术后肾功能不全、低心排血量综合征、肺部炎症、神经系统并发症和院内死亡等情况.结果 神经系统并发症发病率,DHCA组显著高于RCP组(P<0.05).体外循环时间,RCP组显著的长于DHCA组(P<0.05).RCP时间显著长于DHCA时间(P<0.01).在主动脉阻断时间、呼吸机插管时间、监护室停留时间和术后肾功能不全、低心排血量综合征、肺部炎症及院内死亡比例等两组间差异无统计学意义.结论 RCP是一种有效的脑保护技术,同DHCA相比,能更好的对大脑进行持续的脑血流灌注,适用于复杂耗时的小儿主动脉弓手术,在神经系统保护方面较DHCA有着更好的效果.%Objective To observe and evaluate the effects of the deep hypothermic circulatory arrest(DHCA) and regional cerebral perfusion(RCP) in pediatric aortic arch surgery.Methods According to different methods of CPB,70 infants less than 3-month-old with CoA or IAA were undergone corrective surgery with DHCA or RCP.The bypass time,aortic clamp time,DHCA or RCP time,ventilation time,ICU stay time and post-operative complications were recorded and compared between two groups.Results The incidence of neurological complications was significantly higher in DHCA group.The CPB time was significantly longer in the RCP group,and the RCP time was significantly longer than DHCA time.Blocking time,ventilator intubation time

  8. Biomechanical implications of excessive endograft protrusion into the aortic arch after thoracic endovascular repair.

    Science.gov (United States)

    Rinaudo, Antonino; Raffa, Giuseppe Maria; Scardulla, Francesco; Pilato, Michele; Scardulla, Cesare; Pasta, Salvatore

    2015-11-01

    Endografts placed in the aorta for thoracic endovascular aortic repair (TEVAR) may determine malappositioning to the lesser curvature of the aortic wall, thus resulting in a devastating complication known as endograft collapse. This premature device failure commonly occurs in young individuals after TEVAR for traumatic aortic injuries as a result of applications outside the physical conditions for which the endograft was designed. In this study, an experimentally-calibrated fluid-structure interaction (FSI) model was developed to assess the hemodynamic and stress/strain distributions acting on the excessive protrusion extension (PE) of endografts deployed in four young patients underwent TEVAR. Endograft infolding was experimentally measured for different hemodynamic scenarios by perfusion testing and then used to numerically calibrate the mechanical behavior of endograft PE. Results evinced that the extent of endograft can severely alter the hemodynamic and structural loads exerted on the endograft PE. Specifically, PE determined a physiological aortic coarctation into the aortic arch characterized by a helical flow in the distal descending aorta. High device displacement and transmural pressure across the stent-graft wall were found for a PE longer than 21 mm. Finally, marked intramural stress and principal strain distributions on the protruded segment of the endograft wall may suggest failure due to material fatigue. These critical parameters may contribute to the endograft collapse observed clinically and can be used to design new devices more suitable for young individuals to be treated with an endoprosthesis for TEVAR of blunt traumatic aortic injuries.

  9. DSA in detection of morphology and branches variation of aortic arch%DSA检测主动脉弓形态及分支变异

    Institute of Scientific and Technical Information of China (English)

    王金龙; 张鸿祺; 朱凤水; 焦力群; 李慎茂; 吉训明; 凌锋

    2014-01-01

    ).RCCA originated directly from the aortic arch with aberrant right subclavian artery (RSA,35/4272,0.82%).RCCA,LCCA,LSA originated from the aortic arch and RSA originated aorta descendens (10/4272,0.23%).RCCA,LSA originated directly from aortic arch,RSA and LSA had a common trunk arising from aortic arch,and RVA originated directly from RCCA (4/4272,0.10%).The duplicitous origin of RVA originated from RSA (4/4272,0.10%).RVA directly originated from right internal carotid artery (4/4272,0.10%).From right to left RCCA,LCCA,LSA,RSA originated aortic arch,aberration RSA and LVA was absence combined with the persistence primitive trigeminal artery (4/4272,0.10%).The right aortic arch (13/4272,0.30%),and the right aortic arch and LSA originated from Kommecell diverticulum (1/4272,0.02%).Conclusion Assessment of variation of the morphology and branches of the aortic arch with DSA has important guiding significance for vascular interventional therapy and some thoracic surgeries.

  10. [Hybrid surgical intervention in a patient with an aortic arch aneurysm and coronary artery disease].

    Science.gov (United States)

    Charchan, E R; Abugov, S A; Puretsky, M V; Kim, S Yu; Skvortsov, A A; Khachatryan, Z R

    2015-01-01

    Presented herein is a clinical case report regarding the use of hybrid technology in surgical treatment of a patient with an aneurysm of the distal portion of the aortic arch and coronary artery disease. The patient underwent a hybrid operation, i.e. debranching of the aortic arch branches, exoprosthetic repair of the ascending aorta, autovenous prosthetic coronary bypass grafting of the branch of the blunt edge of the anterior interventricular artery, stenting of the ascending portion, arch and descending portion of the aorta (stent graft "Medtronic Valiant"). In doing so, we used a non-standard approach to connecting the artificial circulation unit and to choosing the place for establishing proximal anastomoses of autovenous coronary bypass grafts. The early postoperative period was complicated by the development of respiratory insufficiency requiring continuation artificial pulmonary ventilation. The duration of the hospital stay of the patient amounted to 15 days. The check-up multispiral computed tomography showed normal functioning of the reconstruction zones, the stent graft is expanded, with no leak observed. The conclusion was made that hybrid interventions may be considered as an alternative to the classical surgical treatment associated in patients of older age group with a severe course of the postoperative period and high lethality. PMID:26035581

  11. 主动脉弓部手术中单侧大脑灌注血流变化与神经系统并发症关系的分析%Analysis of the relationship between the hemodynamic changes during selective cerebral perfusion and postoperative neurological complications in aortic arch surgery

    Institute of Scientific and Technical Information of China (English)

    阳晟; 任长伟; 许尚栋; 孙立忠

    2012-01-01

    Objective: This study tries to monitor the hemodynamic changes of middle cerebral artery ( MCA) by transcranial Doppler sonography (TCD) in aortic arch surgery. Analysis of relationship between the hemodynamic changes during selective cerebral perfusion (SCP) and postoperative neurological complications. Methods: From September 2010 to January 2011, 23 patients with aortic dissection undergoing aortic arch operation were included in this study. Every patient underwent profound hypothermia (DHCA) and selective cerebral perfusion. Hemodynamic signals of bilateral MCA were monitored via TCD during operation. Data at 6 time-points were selected for analysis. All the patients were divided into four groups by the decline in the proportion of non-perfusion side flow( 30% ) , and all the postoperative neurological complications and early death after surgery were recorded in each group. Results: During the full flow of CPB, blood flow velocity of MCA at left and right side was no differences ( P = 0. 565 ) . During SCP, blood flow velocity of MCA at perfusion side (right side) was similar with blood flow velocity before SCP; and blood flow velocity of MCA at non-perfusion side (left side) was significant decreased compare with blood flow veloci-ly before SCP (P 30% groups (50% ) ,no permanent neurological dysfunction (PND) and early death was observed. Conclusion; SCP in aortic arch operation can meet the blood supply to the brain; During SCP, blood flow velocity of MCA at perfusion side (right side) was similar to the blood flow velocity before SCP; blood flow velocity of MCA at non-perfusion side (left side) was significant decreased compare with blood flow velocity before SCP. Less than 30% drop of blood flow velocity of MCA at non-perfusion side (left side) may be safe for the patients.%目的:通过经颅多普勒超声(TCD)监测主动脉弓部手术中大脑中动脉(MCA)的血流,评估选择性脑灌注(SCP)期间血流变化与术后神经系统

  12. Calcification at orifices of aortic arch branches is a reliable and significant marker of stenosis at carotid bifurcation and intracranial arteries

    International Nuclear Information System (INIS)

    Purpose: Simple rating scale for calcification in the cervical arteries and the aortic arch on multi-detector computed tomography angiography (MDCTA) was evaluated its reliability and validity. Additionally, we investigated where is the most representative location for evaluating the calcification risk of carotid bifurcation stenosis and atherosclerotic infarction in the overall cervical arteries covering from the aortic arch to the carotid bifurcation. Method: The aortic arch and cervical arteries among 518 patients (292 men, 226 women) were evaluated the extent of calcification using a 4-point grading scale for MDCTA. Reliability, validity and the concomitant risk with vascular stenosis and atherosclerotic infarction were assessed. Results: Calcification was most frequently observed in the aortic arch itself, the orifices from the aortic arch, and the carotid bifurcation. Compared with the bilateral carotid bifurcations, the aortic arch itself had a stronger inter-observer agreement for the calcification score (Fleiss’ kappa coefficients; 0.77), but weaker associations with stenosis and atherosclerotic infarction. Calcification at the orifices of the aortic arch branches had a stronger inter-observer agreement (0.74) and enough associations with carotid bifurcation stenosis and intracranial stenosis. In addition, the extensive calcification at the orifices from the aortic arch was significantly associated with atherosclerotic infarction, similar to the calcification at the bilateral carotid bifurcations. Conclusions: The orifices of the aortic arch branches were the novel representative location of the aortic arch and overall cervical arteries for evaluating the calcification extent. Thus, calcification at the aortic arch should be evaluated with focus on the orifices of 3 main branches

  13. Calcification at orifices of aortic arch branches is a reliable and significant marker of stenosis at carotid bifurcation and intracranial arteries

    Energy Technology Data Exchange (ETDEWEB)

    Yamada, Shigeki, E-mail: shigekiyamada3@gmail.com [Department of Neurosurgery and Stroke Center, Rakuwakai Otowa Hospital, Kyoto (Japan); Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, Tokyo (Japan); Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka (Japan); Hashimoto, Kenji, E-mail: hashiken8022@yahoo.co.jp [Department of Neurosurgery, Kishiwada Municipal Hospital, Osaka (Japan); Ogata, Hideki, E-mail: hidogata@gmail.com [Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka (Japan); Watanabe, Yoshihiko, E-mail: ynabe@magic.odn.ne.jp [Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka (Japan); Oshima, Marie, E-mail: marie@iis.u-tokyo.ac.jp [Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, Tokyo (Japan); Miyake, Hidenori, E-mail: hi-miyake@hamamatsuh.rofuku.go.jp [Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka (Japan)

    2014-02-15

    Purpose: Simple rating scale for calcification in the cervical arteries and the aortic arch on multi-detector computed tomography angiography (MDCTA) was evaluated its reliability and validity. Additionally, we investigated where is the most representative location for evaluating the calcification risk of carotid bifurcation stenosis and atherosclerotic infarction in the overall cervical arteries covering from the aortic arch to the carotid bifurcation. Method: The aortic arch and cervical arteries among 518 patients (292 men, 226 women) were evaluated the extent of calcification using a 4-point grading scale for MDCTA. Reliability, validity and the concomitant risk with vascular stenosis and atherosclerotic infarction were assessed. Results: Calcification was most frequently observed in the aortic arch itself, the orifices from the aortic arch, and the carotid bifurcation. Compared with the bilateral carotid bifurcations, the aortic arch itself had a stronger inter-observer agreement for the calcification score (Fleiss’ kappa coefficients; 0.77), but weaker associations with stenosis and atherosclerotic infarction. Calcification at the orifices of the aortic arch branches had a stronger inter-observer agreement (0.74) and enough associations with carotid bifurcation stenosis and intracranial stenosis. In addition, the extensive calcification at the orifices from the aortic arch was significantly associated with atherosclerotic infarction, similar to the calcification at the bilateral carotid bifurcations. Conclusions: The orifices of the aortic arch branches were the novel representative location of the aortic arch and overall cervical arteries for evaluating the calcification extent. Thus, calcification at the aortic arch should be evaluated with focus on the orifices of 3 main branches.

  14. Prenatal Diagnosis of Down Syndrome Associated with Right Aortic Arch and Dilated Septum Cavi Pellucidi

    Directory of Open Access Journals (Sweden)

    José Morales-Roselló

    2012-01-01

    Full Text Available A 30-year-old woman with a normal first trimester Down syndrome screening attended our ultrasound unit for a 20-week scan. The most remarkable anomalies were the presence of a right aortic arch along with a dilated cavum septi pellucidi. In addition, the scan showed an atrioventricular canal and bilateral choroid plexus cysts. Fetal karyotype showed the existence of trisomy 21. A novel association between Down syndrome and dilated cavum septi pellucidi is reported and the relationship between DS and vascular rings is discussed.

  15. Unexpected difficulty during transcatheter device closure of atrial septal defect associated with right aortic arch

    International Nuclear Information System (INIS)

    Right aortic arch (RAA) associated with isolated atrial septal defect (ASD) is very rare. We report successful closure of ASD associated with RAA using a 26-mm atrial septal occluder in a 30-year-old male patient. The impingement of right descending aorta in RAA caused malposition of the device in the left atrium. Deployment of the device through the right upper pulmonary vein successfully closed the defect. Follow-up evaluation by computerized tomography scan and echocardiogram showed no pulmonary venous obstruction

  16. Aortic arch and intra-/extracranial cerebral arterial atherosclerosis in patients suffering acute ischemic strokes

    Institute of Scientific and Technical Information of China (English)

    郭毅; 姜昕; 陈实; 张少文; 赵宏文; 吴瑛

    2003-01-01

    Objective To determine the distribution of aortic arch and intra/extracranial cerebral arterial atherosclerosis in Chinese patients who had suffered acute ischemic strokes. Methods Eighty-nine patients with acute ischemic strokes were included in this study. Transesophageal echocardiography (TEE) was used to evaluate potential sources of embolisms in the aortic arch and in the heart; duplex ultrasound was used for the carotid artery; and intracranial Doppler (TCD) imaging was used for the middle cerebral artery (MCA), anterior cerebral artery (ACA), posterior cerebral artery (PCA), and basilar artery (BA). An atherosclerotic lesion in the aortic arch was defined as normal (0); mild plaque (1); moderate plaque (2); and protruding plaque or mobile plaque (3). A lesion in the carotid artery was considered a plaque if the maximal carotid plaque thickness was 1.2 mm. TCD results were deemed abnormal if flow velocity was either greater or lower than normal, and, in the case of the MCA, if an asymmetry index above 21% was measured. Results Of the 89 patients, 52 (58.43%) patients showed evidence of aortic arch atherosclerosis (AAA), including 11 (12.36%) patients graded mild, 18 (20.22%) patients graded moderate, and 23 (25.84%) patients graded severe. Of the 23 patients with severe AAA, AAA was determined to be an important potential embolic source in 14 patients. Forty-nine (50.56%) patients had carotid arterial plaques (CAPs). The incidence of carotid plaques was higher among patients with AAA than among patients without AAA (71.15% vs 21.62%, OR=3.291, 95% CI=1.740-6.225, P<0.001). TCD abnormalities affecting the MCA were found in 54 (60.67%) patients. Differences in incidence of TCD abnormalities between patients with AAA and without AAA (69.23% vs 48.65%) were not significant (OR=1.423, 95% CI=0.976-2.076, P=0.05). There was a higher incidence of AAA in older, male patients with a history of diabetes and smoking. Conclusions AAA is an important potential source of

  17. Aortic valve surgery: what is the future?

    Science.gov (United States)

    Hudorović, Narcis

    2008-04-01

    Modern surgical treatment for aortic valve disease has undergone significant improvements in all areas of this procedure. Successful treatment strategies for cardiovascular diseases have often been initiated and driven by surgeons. Radical excision of diseased tissue, repair and replacement strategies lead to long-term successful treatment of the underlying diseases and clearly improved patient outcome. In highly developed nations, valve surgery will be increasing applied in older people, with more co-morbidities and a higher incidence of concomitant coronary artery disease. Cardiovascular surgeons will be facing increased competition from the catheter-based procedures; these are already applied clinically, and their numbers will rise in near future. Right now interventional cardiologists supported by some cardiac surgeons are on their way to transform some conventional open surgical procedures into catheter-based less invasive interventions, such as valve repair and replacement. Cardiovascular surgery is undergoing a rapid transformation; socio-economic factors and recent advances in medical technology contribute to these changes. Further developments will come, and surgeons with all their expertise in the treatment of valvular heart disease need to be part of it. Cardiovascular surgeons have to adapt the exciting new approaches of transapical and transfemoral transcatheter valve implantation techniques. PMID:17573248

  18. Fenestrated endografting of juxtarenal aneurysms after open aortic surgery

    NARCIS (Netherlands)

    Oikonomou, Kyriakos; Katsargyris, Athanasios; Bekkema, Foppe; Tielliu, Ignace; Verhoeven, Eric L. G.

    2014-01-01

    Introduction: Juxtarenal aneurysms after previous surgical aortic reconstruction constitute a complex clinical scenario. Open redo surgery is technically demanding and usually requires suprarenal or supraceliac clamping. Standard endovascular repair is prohibited due to the lack of a proximal landin

  19. One-Stage Repair of an Interrupted Aortic Arch with an Aortopulmonary Window in a Premature Neonate.

    Science.gov (United States)

    Bobos, Dimitrios; Kanakis, Meletios A; Koulouri, Sofia; Giannopoulos, Nicholas M

    2015-12-01

    Interrupted aortic arch with an aortopulmonary window is a rare congenital entity that is associated with high morbidity and mortality, especially in premature low-birth-weight infants, and the proper timing of surgical correction remains a matter of debate. We present the case of a premature infant weighing 1.6 kg who successfully underwent one stage surgical repair to treat interrupted aortic arch with an aortopulmonary window. The therapeutic management of this patient is described below, and a review of the literature is presented.

  20. Composite valve graft combined with replacement of the ascending aorta and aortic arch in a patient with Marfan's syndrome

    Institute of Scientific and Technical Information of China (English)

    黄方炯; 叶穗辉; 陈赤红; 杨禁非; 孙东; 吴强; 于建波

    2004-01-01

    @@ Modified Bentall procedure combined with total aortic arch replacement under deep hypothermic circulatory arrest (DHCA) and retrograde cerebral perfusion (RCP)is rarely reported. We performed this operation for a patient with worsened aortic regurgitation and cardiac shock. The operation involved the button method for coronary artery reconstruction, hypothermic circulatory arrest, and retrograde cerebral protection. The supraaortic branches were anastomosed to the prosthesis as an island flap.

  1. [Hybrid operation for a posttraumatic saccular aneurysm of the aortic arch].

    Science.gov (United States)

    Ignat'ev, I M; Volodiukhin, M Iu; Zanochkin, A V; Terekhin, S V

    2013-01-01

    The article deals with a case report of successful hybrid surgical treatment of a patient presenting with a posttraumatic large false saccular aneurysm of the aortic arch with mediastinal displacement and compression of the left recurrent laryngeal nerve and trachea. The patient was subjected to a hybrid operation, i. e., bypass grafting of the brachiocephalic trunk and the left common carotid artery with a bifurcation prosthesis from the ascending aorta through sternotomy, carotid-vertebral and carotid-subclavian bypass grafting on the left in a combination with endoprosthetic repair of the aortic arch with the stent graft Valiant Thoracic 40 × 224 mm (VAMF 4040c200TE) manufactured by the Medtronic Company. The postoperative period was uneventful followed by rather rapid rehabilitation of the patient. One month after the operation, the clinical state improved considerably. His voice restored virtually completely, and breathlessness disappeared. According to the findings of MSCT angiography, the aneurysmatic cavity is thrombosed, with the stent graft showing no evidence of either dislocation or endoleak. The bifurcation bypass graft is functioning. According to the data of duplex scanning, the anastomoses established on the neck are patent. PMID:23531669

  2. Medical image of the week: atherosclerotic aneurysm of aortic arch and decsecnding thoracic aorta

    Directory of Open Access Journals (Sweden)

    Parasram M

    2016-02-01

    Full Text Available No abstract available. Article truncated after 150 words. A 94-year-old Spanish-speaking woman presented to the hospital with intermittent episodes of dyspnea and abdominal pain for one week. Her past medical history was notable for 30 pack-year smoking history and hypertension, which was reportedly controlled with medical therapy. Physical exam showed trace peripheral edema bilaterally, intact peripheral pulses, and a mild abdominal bruit. Work up at the emergency department revealed a non-ST elevation myocardial infarction with troponin T of 0.34 ng/mL but no ST-wave abnormality on electrocardiography. Chest x-ray displayed an incidental thoracic aneurysm (Figure 1. Chest computed tomography with contrast demonstrated a continuous aneurysm of the aortic arch and descending thoracic aorta with diameters measuring 6.8 cm and 6 cm, respectively (Figure 2A and 2B. Eccentric thrombi are noted in the aortic arch and the descending aorta. Interestingly, the distal descending thoracic aorta curves as it transitions to the abdominal aorta, which is evidence of a tortuous descending ...

  3. Results of surgery for aortic regurgitation due to aortic valve prolapse.

    Directory of Open Access Journals (Sweden)

    Shigenobu,Masaharu

    1988-12-01

    Full Text Available The clinical, hemodynamic and pathological findings of 13 patients with aortic regurgitation due to aortic valve prolapse caused by advanced myxomatous degeneration were evaluated. Eleven patients showed a favorable outcome with no complications resulting from surgery. One patient died from aortic dissection, and another died suddenly from an unknown cause. Five patients had mitral valve prolapse as a complication. Ten patients (77% had a long-standing history of hypertension. Twelve patients (92% were male. None of the patients had the stigmata of Marfan's syndrome. All patients had marked myxomatous degeneration of the aortic valves without any inflammatory changes. Two patients showed microcalcification; 7 demonstrated moderate fibrosis. Five patients showed severe fragility of the cusps which appeared redundant, gelatinous and softened by degenerative changes. Myxomatous degeneration of the aortic valve is not rare, and, in fact, it may be one of the most common pathologic and clinical entities associated with pure aortic insufficiency.

  4. Open aortic surgery after thoracic endovascular aortic repair.

    Science.gov (United States)

    Coselli, Joseph S; Spiliotopoulos, Konstantinos; Preventza, Ourania; de la Cruz, Kim I; Amarasekara, Hiruni; Green, Susan Y

    2016-08-01

    In the last decade, thoracic endovascular aortic aneurysm repair (TEVAR) has emerged as an appealing alternative to the traditional open aortic aneurysm repair. This is largely due to generally improved early outcomes associated with TEVAR, including lower perioperative mortality and morbidity. However, it is relatively common for patients who undergo TEVAR to need a secondary intervention. In select circumstances, these secondary interventions are performed as an open procedure. Although it is difficult to assess the rate of open repairs after TEVAR, the rates in large series of TEVAR cases (>300) have ranged from 0.4 to 7.9 %. Major complications of TEVAR that typically necessitates open distal aortic repair (i.e., repair of the descending thoracic or thoracoabdominal aorta) include endoleak (especially type I), aortic fistula, endograft infection, device collapse or migration, and continued expansion of the aneurysm sac. Conversion to open repair of the distal aorta may be either elective (as for many endoleaks) or emergent (as for rupture, retrograde complicated dissection, malperfusion, and endograft infection). In addition, in select patients (e.g., those with a chronic aortic dissection), unrepaired sections of the aorta may progressively dilate, resulting in the need for multiple distal aortic repairs. Open repairs after TEVAR can be broadly classified as full extraction, partial extraction, or full salvage of the stent-graft. Although full and partial stent-graft extraction imply failure of TEVAR, such failure is generally absent in cases where the stent-graft can be fully salvaged. We review the literature regarding open repair after TEVAR and highlight operative strategies.

  5. Magnetic resonance angiography of the aortic arch and its main arteries directed to the brain with use of head neck coil. With special reference to relation between high position of the aortic arch and kinked vertebral and carotid arteries

    Energy Technology Data Exchange (ETDEWEB)

    Morita, Hitoshi [Saitama Medical School, Moroyama (Japan)

    1996-12-01

    We studied 316 individuals who requested general health examinations (March 1993 to February 1995), and who underwent blood tests, urinalysis and MRA with a head neck coil, and 25 volunteers underwent the same examinations. The head neck coil used covered the head, neck and upper thorax, and each individual coil could transmit and receive signals. Three-dimensional time of flight MRA was employed in the investigation. The saturation pulse was placed in a coronal direction behind the slab to suppress the venous inflow signals. Our results indicate that in all individuals, MRA clearly demonstrated the aorta and its main branches extending up to the circle of Willis. It was possible to rotate the reconstructed 3-D image around the body axis permitting the visualization of secondary or more peripheral branches, depending on their size and direction. The severity of V1 kinking, classified by using the modified Mets criteria, correlated well with advancing age. V1 kinking was first evident in the third decade of life, while kinking of the internal carotid artery appeared in the fourth decade. The highest level of the aortic arch was evaluated in terms of the aorto-C2 (A-C2) distance, i.e., the distance measured from the C2 level, where the vertebral artery curved laterally in the transverse foramen of C2, and the A level, where the upper margin of the aortic arch was highest. Shortening of the A-C2 distance was noted with aging, and a good correlation between increased height of the aortic arch and aging was seen. As compared to conventional contrast arteriography, MRA of the aortic arch and its branch arteries extending into the cranium does provide accurate data. A high position of the aortic arch, buckling of the great vessels, and tortuosity, kinking and coiling of the vertebral and carotid arteries are clearly shown. (K.H.)

  6. Optimising stroke volume and oxygen delivery in abdominal aortic surgery

    DEFF Research Database (Denmark)

    Bisgaard, J; Gilsaa, T; Rønholm, E;

    2012-01-01

    BACKGROUND: Post-operative complications after open elective abdominal aortic surgery are common, and individualised goal-directed therapy may improve outcome in high-risk surgery. We hypothesised that individualised goal-directed therapy, targeting stroke volume and oxygen delivery, can reduce...... group (P = 0.01). However, the number of complications per patient or length of stay in the intensive care unit or hospital did not differ between the groups. CONCLUSION: Perioperative individualised goal-directed therapy targeting stroke volume and oxygen delivery did not affect post...... complications and minimise length of stay in intensive care unit and hospital following open elective abdominal aortic surgery. METHODS: Seventy patients scheduled for open elective abdominal aortic surgery were randomised to individualised goal-directed therapy or conventional therapy. In the intervention...

  7. Autologous adventitial overlay method reinforces anastomoses in aortic surgery.

    Science.gov (United States)

    Minato, Naoki; Okada, Takayuki; Sumida, Tomohiko; Watanabe, Kenichi; Maruyama, Takahiro; Kusunose, Takashi

    2014-05-01

    In this study, we present an inexpensive and effective method for providing a secure and hemostatic anastomosis using autologous adventitia obtained from a dissected or aneurysmal wall. The resected aortic wall is separated between the adventitia and media, and a soft, 2 × 10-cm adventitial strip is overlaid to cover the anastomotic margin. A graft is sutured to the aortic stump. This autologous adventitial overlay method can inexpensively and strongly reinforce the anastomosis during aortic surgery for dissection or aneurysm and will contribute to anastomotic hemostasis and long-term stability.

  8. Duplo arco aórtico: a quebra do silêncio Double aortic arch: the break of silence

    Directory of Open Access Journals (Sweden)

    Ana Rita Abrão

    2011-03-01

    Full Text Available Anéis vasculares representam 1-2% dos casos das cardiopatias congênitas. Relatamos um caso raro de duplo arco aórtico. Mulher, 60 anos, procurou atendimento na clínica médica apresentando 1 ano de história de disfagia, 6 meses de dispneia e 2 meses de dor torácica esporádica. Raio X de tórax revelou: hiperinsuflação pulmonar difusa, alargamento mediastinal, coração com volume e configurações normais, arco aórtico à direita e alterações degenerativas vertebrais. Tomografia computadorizada do tórax: arco aórtico duplo circundando e comprimindo a traqueia e o esôfago. Arco direito mais calibroso, emergindo dele o tronco braquiocefálico. Do arco esquerdo emergem a artéria carótida comum e a subclávia esquerda. Diagnóstico: anel vascular traqueoesofagiano decorrente do duplo arco aórtico, sendo o arco direito dominante. No presente caso, optou-se por seguimento clínico da paciente, levando-se em conta a intensidade dos sintomas apresentados.Vascular rings represent 1 to 2% of cases of congenital heart disease. We report a rare case of double aortic arch. A 60-year-old woman was admitted to the hospital presenting a one-year history of dysphagia, six months of dyspnea and two months of sporadic chest pain. Radiograph of the chest revealed diffuse pulmonary hyper inflation, widening of the mediastinum, heart of normal size and shape, a right-sized aortic arch, and degenerative changes of the thoracic spine. Computed tomography of the chest showed a double aortic arch encircling and compressing the trachea and the esophagus. The right aortic arch had a larger caliber, with brachiocephalic trunk arising from it. The left common carotid artery and the left subclavian artery arose from the left aortic arch. Diagnosis: tracheoesophageal vascular ring due to double aortic arch, with dominant right arch. In this case, we chose to follow the patient medically, taking into consideration the mildness of the symptoms.

  9. SERUM MAGNESIUM LEVELS IN AORTIC AND MITRAL VALVE REPLACEMENT SURGERIES

    Directory of Open Access Journals (Sweden)

    Srinivasa Rao

    2015-08-01

    Full Text Available BACKGROUND : The purpose of the study was to analyze serum magnesium concentration in patients undergoing Aortic and Mitral Valve replacement surgeries. METHODS: This prospective study was conducted in 60 patients who underwent elective Aortic and Mitral va lve replacement surgeries. Blood samples from radial artery were collected just before induction of anesthesia and three days post - operatively for estimation of serum magnesium. RESULTS: Magnesium level was 2.02mg/dl at baseline, 2.28mg/dl, 2.08mg/dl and 1 .90mg/dl respectively on three consecutive days post - operatively. CONCLUSION: The lowering of serum magnesium in Aortic and Mitral valve replacement surgeries postoperatively recommends the use of routine serum magnesium determination and administration to prevent post - operative arrhythmias.

  10. Minimally Invasive Cardiac Surgery: Transapical Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Ming Li

    2012-01-01

    Full Text Available Minimally invasive cardiac surgery is less traumatic and therefore leads to quicker recovery. With the assistance of engineering technologies on devices, imaging, and robotics, in conjunction with surgical technique, minimally invasive cardiac surgery will improve clinical outcomes and expand the cohort of patients that can be treated. We used transapical aortic valve implantation as an example to demonstrate that minimally invasive cardiac surgery can be implemented with the integration of surgical techniques and engineering technologies. Feasibility studies and long-term evaluation results prove that transapical aortic valve implantation under MRI guidance is feasible and practical. We are investigating an MRI compatible robotic surgical system to further assist the surgeon to precisely deliver aortic valve prostheses via a transapical approach. Ex vivo experimentation results indicate that a robotic system can also be employed in in vivo models.

  11. Thoracic type Ia endoleak: direct percutaneous coil embolization of the aortic arch at the blood entry site after TEVAR and double-chimney stent-grafts

    International Nuclear Information System (INIS)

    To introduce a novel percutaneous technique to stop blood entry at the lesser aortic arch curvature by coil embolisation in type Ia endoleak after TEVAR. A 61-year-old Marfan patient presented with type Ia endoleak of the aortic arch and a growing aortic arch pseudoaneurysm after TEVAR. Multiple preceding operations and interventions made an endovascular approach unsuccessful. Direct percutaneous puncture of the aneurysmal sac would have cured the sign, but not the cause of blood entry at the lesser curvature of the aortic arch. Direct CT-guided percutaneous puncture of the blood entry site in the aortic arch with fluoroscopically guided coil embolisation using detachable extra-long coils was successfully performed. Three weeks after the intervention, the patient developed fever because of superinfection of the pseudoaneurysm. The blood cultures and CT-guided mediastinal aspirate were sterile. After intravenous administration of antibiotics, the fever disappeared and the patient recovered. Six-month follow-up showed permanent closure of the endoleak and a shrinking aneurysmal sac. Direct percutaneous puncture of the aortic arch at the blood entry site of a thoracic type Ia endoleak after TEVAR and double-chimney stent-grafts with coil embolisation of the wedge-shaped space between the lesser aortic curvature and the stent-graft is possible. (orig.)

  12. Thoracic type Ia endoleak: direct percutaneous coil embolization of the aortic arch at the blood entry site after TEVAR and double-chimney stent-grafts

    Energy Technology Data Exchange (ETDEWEB)

    Bangard, Christopher; Franke, Mareike; Maintz, David; Chang, De-Hua [University Hospital, University of Cologne, Department of Radiology, Cologne (Germany); Pfister, Roman [University Hospital, University of Cologne, Department of Internal Medicine III, Cologne (Germany); Deppe, Antje-Christin [University Hospital, University of Cologne, Department of Cardiothoracic Surgery, Cologne (Germany); Matoussevitch, Vladimir [University Hospital, University of Cologne, Department of Vascular Surgery, Cologne (Germany)

    2014-06-15

    To introduce a novel percutaneous technique to stop blood entry at the lesser aortic arch curvature by coil embolisation in type Ia endoleak after TEVAR. A 61-year-old Marfan patient presented with type Ia endoleak of the aortic arch and a growing aortic arch pseudoaneurysm after TEVAR. Multiple preceding operations and interventions made an endovascular approach unsuccessful. Direct percutaneous puncture of the aneurysmal sac would have cured the sign, but not the cause of blood entry at the lesser curvature of the aortic arch. Direct CT-guided percutaneous puncture of the blood entry site in the aortic arch with fluoroscopically guided coil embolisation using detachable extra-long coils was successfully performed. Three weeks after the intervention, the patient developed fever because of superinfection of the pseudoaneurysm. The blood cultures and CT-guided mediastinal aspirate were sterile. After intravenous administration of antibiotics, the fever disappeared and the patient recovered. Six-month follow-up showed permanent closure of the endoleak and a shrinking aneurysmal sac. Direct percutaneous puncture of the aortic arch at the blood entry site of a thoracic type Ia endoleak after TEVAR and double-chimney stent-grafts with coil embolisation of the wedge-shaped space between the lesser aortic curvature and the stent-graft is possible. (orig.)

  13. Impact of smoking on endovascular abdominal aortic aneurysm surgery outcome.

    NARCIS (Netherlands)

    Lottman, P.E.M.; Marrewijk, C.J. van; Fransen, G.A.J.; Laheij, R.J.F.; Buth, J.

    2004-01-01

    OBJECTIVE: Smoking plays a major role in deficiencies of the vascular system, and seems to have consequences for the treatment of cardiovascular diseases. We hypothesized that smokers have a higher mortality and more complications after endovascular abdominal aortic aneurysm surgery than non-smokers

  14. Novel endovascular procedures and new developments in aortic surgery.

    Science.gov (United States)

    Cheng, S W K

    2016-09-01

    Endovascular repair has evolved to become a viable mainstream treatment for aortic pathology in both acute and elective settings. As technology advanced, traditional anatomical barriers were progressively tackled using new devices and novel procedures, and there are now multiple options available to the vascular surgeon. In the abdominal aorta, advances in endovascular aneurysm repair have been in the treatment of hostile aortic necks using new sealing concepts and ancillary procedures, and in branch preservation using fenestrations and snorkels. Access challenges have been met with a percutaneous approach and low-profile devices, and standard protocols have improved mortality for ruptured aneurysms. In the thoracic aorta, more invasive hybrid procedures have given way gradually to branched endografts. Particular challenges to the anaesthetist include blood pressure control and the prevention of stroke and paraplegia. Current focus in the thoracic aorta is in treating aortic arch pathology and in optimal management of acute and chronic dissections. This review describes the latest trends in the endovascular treatment of aortic diseases and examines the current evidence for different modalities of management. PMID:27566806

  15. CT Virtual angioscopy of aortic arch%CT仿真血管内镜观察主动脉弓

    Institute of Scientific and Technical Information of China (English)

    李新平; 陈伟; 朱智明

    2011-01-01

    [ Objective ] To explore the clinical value of CT virtual angioscopy (CTVA) in the pre- and postpro-cedure evaluation of aortic arch related diseases. [Methods] 37 cases with thoracic disease underwent aortic CT angiography on a dual-source CT scanner. CTVA of aortic arch were performed with Fly-through software in all cas-? Es by using aortic CT angiographic source image data. [Results] 34 of 37 (92%) cases showed successful CTVA images, including aortic dissection (n =12), aneurysm (n =4), pseudoaneurysm (n =3), Takayasu arteritis (n =2),aortic coarctation (n =1), aneurysm combined with aortic dissection (n =1) and 11 patients following surgical or endovascu-lar procedures. CTVA of aortic arch could identify the ostia and its variations of supra-aortic vessels, estimate the localization of abnormalities with respect to supra-aortic vessels and display the stent grafts. [ Conclusions ] CTVA of aortic arch enables non-invasive visualization of the inner contours of the vasculature, and has certain instructive significance in the diagnostic classification, preprocedure planning and postprocedure evaluation for aortic arch related diseases.%目的 探讨CT仿真血管内镜(CTVA)在主动脉弓相关疾病术前和术后评价中的价值.方法 采用双源CT对37例胸主动脉疾病患者行主动脉CT成像检查,并将主动脉CT成像的源图像调至Fly-through软件中,对所有病例行主动脉弓CTVA观察.结果 92%(34/37)的病例获得了满意的CTVA图像,包括主动脉夹层12例、真性动脉瘤4例、假性动脉瘤3例、多发性大动脉炎2例、主动脉缩窄1例、真性动脉瘤合并夹层1例及11例术后随访病例.主动脉弓CTVA能明确弓上分支血管开口位置与变异、判断病变与弓上分支开口的空间关系以及显示支架型血管.结论 主动脉弓CTVA能无创观察血管腔内情况,对主动脉弓相关疾病的诊断分型、术前计划和术后评价具有一定的指导意义.

  16. Aberrant right vertebral artery originating from the aortic arch distal to the left subclavian artery: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Soo Heui; Baek, Hye Jin [Dept. of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)

    2014-03-15

    We present a rare case of an aberrant right vertebral artery originated from the distal aortic arch. This issue has been incidentally detected on a preoperative CT angiography after a stabbing injury of the cervical spinal cord. Normally, the right vertebral artery originates from the right subclavian artery. Therefore, in this case report we will review the incidence and the embryological mechanism of this aberrant course of the right vertebral artery and we will discuss as well the clinical importance of this variation.

  17. Correlation of atherosclerotic changes in peripheral arteries with pathological involvement of aortic arch in coronary bypass patients

    Directory of Open Access Journals (Sweden)

    Eshraghi N

    2010-10-01

    Full Text Available "nBackground: A correlation between coronary artery disease (CAD and atherosclerosis of peripheral arteries and the determination of noninvasive indexes for its existence and extent have been sought by many researchers. Some studies report that the intima-media thickness (IMT of peripheral arteries could play this role. This study evaluated the correlation between the IMTs of common carotid and common femoral arteries and the degree of atherosclerosis in aortic arch and to evaluate the severity of CAD in candidates of coronary artery bypass grafting (CABG."n "nMethods: In a cross-sectional analytic-descriptive study, The severity of CAD, the grade of atherosclerosis of the aortic arch, and the IMTs of the common carotid and common femoral arteries were determined."n "nResults: There was a significant weak positive correlation between the IMT of common carotid artery (ρ = 0.193, p = 0.039 and common femoral artery (ρ = 0.206, p = 0.028 with the number of involved carotid vessels; the mean of these two parameters was not significantly different between the three CAD groups. There was not any significant relation between the IMTs of common carotid and common femoral arteries with the severity of atherosclerosis in the aortic arch too. There was not any significant relation between the presences of atherosclerotic plaque in the common carotid or the common femoral arteries with the severity of CAD. The severe atherosclerosis of the aortic arch was significantly higher in patients with three vessel disease."n "nConclusion: According to our results, the IMTs of common carotid and/or common femoral arteries may increase with the severity of CAD; however, these parameters are not a surrogate for predicting the CAD severity.

  18. Noncardiac Surgery in Patients With Aortic Stenosis

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Jørgensen, Mads Emil; Martinsson, Andreas;

    2014-01-01

    nationwide administrative registers. AS patients (n = 2823; mean age, 75.5 years, 53% female) were matched with patients without AS (n = 2823) on propensity score for AS and surgery type. RESULTS: In elective surgery, MACE (ie, nonfatal myocardial infarction, ischemic stroke, or cardiovascular death...

  19. Clinical, radiological and functional follow-up after surgical decompression of double aortic arch

    Energy Technology Data Exchange (ETDEWEB)

    Berge, Maartje ten; Laag, Johan van der; Ent, Cornelis K. van der [Department of Respiratory Diseases, Wilhelmina Children' s Hospital, Utrecht (Netherlands); Beek, Frederik J.A. [Department of Radiology, Wilhelmina Children' s Hospital, Lundlaan 6, 3584 EA Utrecht (Netherlands)

    2002-08-01

    Heading AbstractBackground. Double aortic arch (DAA) is a congenital vascular anomaly that causes tracheal and oesophageal compression. It requires surgical intervention in patients with severe symptoms.Objective. To evaluate the clinical, radiological and functional follow-up after surgical relief of the compression.Materials and methods. Ten children (seven boys) with DAA were operated on at a mean age of 1.3 years (range 0.2-7.5). At a mean age of 10.1 years (range 5-18 years), a follow-up study was performed that included clinical, radiological and functional parameters.Results. Seven children reported only mild respiratory symptoms and some trouble with swallowing. Preoperative fluoroscopy with spot images showed the mean tracheal diameter at the level of stenosis to be 37{+-}23% of the maximal diameter. At the time of follow-up, this was 70{+-}13%. The mean of the oesophageal diameter was 39{+-}20% preoperatively and 47{+-}16% postoperatively. Maximal expiratory flow volume (MEFV) curves of seven children showed typical characteristics of intrathoracic upper airway obstruction. Mean peak expiratory flow was significantly reduced (77{+-}10% of predicted, P<0.0001). Bronchial hyper-reactivity, tested by methacholine challenge, was found in two patients.Conclusions. There was marked relief of clinical symptoms after surgical decompression of DAA in all patients. In spite of this, radiological narrowing of trachea and oesophagus persisted and lung function results were abnormal at long-term follow-up. (orig.)

  20. Aortic rupture during reoperative bariatric surgery

    Directory of Open Access Journals (Sweden)

    Sorin Hostiuc

    2015-08-01

    Full Text Available Abstract Morbid obesity has become a very common problem worldwide, causing severe health-related consequences including cardiovascular or metabolic diseases, arthritis, sleep apnea, or an increased risk of cancer. Bariatric surgery was shown to be the only way to achieve sustainable weight loss and to decrease the frequency and severity of metabolic and cardiovascular comorbidities. The purpose of this article is to present a case of bariatric surgery complicated with lesion of the aorta with a lethal outcome.

  1. Senile Calcification of the Trachea, Aortic Arch, and Mitral Annulus: An Incidental Finding on Chest X-Ray.

    Science.gov (United States)

    Hosseinzadeh Maleki, Mahmood; Kazemi, Toba; Davoody, Navid

    2015-10-27

    A 94-year-old woman presented with dizziness and hypotension of 2 days' duration. She denied any syncope, presyncope, or angina. She had received a permanent pacemaker 12 years previously for the management of complete heart block (CHB), but she failed to program it. Twelve-lead electrocardiography revealed CHB with ventricular escape rhythm (40/min), so we inserted a temporary pacemaker. Anteroposterior chest X-ray showed trachea, aortic arch, and severe mitral valve calcification. Tracheal calcification is usually seen after 40 years old without clinical importance. However, it is seen in patients with renal failure, metastases, and prolonged use of warfarin as well as in pregnancy.(1) (-) (3).

  2. Single-Stage Repair of an Unusual Association: Congenital Gerbode Defect, Hypoplastic Aortic Arch, and Partially Anomalous Pulmonary Venous Return in an Infant.

    Science.gov (United States)

    Flores, Saul; Kimball, Thomas R; Nelson, David P; Morales, David L S

    2016-07-01

    We present the case of a two-month-old male with congenital Gerbode defect, hypoplastic aortic arch, and left-sided partially anomalous pulmonary venous return. The patient underwent single-stage surgical repair, which consisted of aortic arch advancement with resection of the coarctation segment, pulmonary vein repair, and primary closure of the Gerbode defect. The anomalous pulmonary vein posed a particular challenge due to its size and distance from the left atrium, which we approached with a posterior atrial wall trapdoor baffle technique, without mobilizing the affected vein. Postoperatively and at one year follow-up, there was no evidence of residual lesions and there was unobstructed flow pattern across the aortic arch and the affected pulmonary vein.

  3. Value of MRI in the diagnosis of fetal aortic arch anomalies%MRI在诊断胎儿主动脉弓畸形中的价值

    Institute of Scientific and Technical Information of China (English)

    李旭; 胡克非; 尹传高; 李庚武; 穆仲平; 李雪蕾; 胡俊; 汪晓波; 陆忠斌

    2015-01-01

    Objective To explore the value of MRI in the diagnosis of fetal aortic arch anomalies. Methods We retrospectively collected 10 fetuses with aortic arch anomalies indicated by prenatal ultrasound and underwent MR examination and were subsequently proven by autopsy or post-birth follow-up from 320 pregnant women. We focused on the observations of the location of the aortic arch and brachiocephalic artery anomalies, the locations of the liver and stomach in the abdominal cavity, and the large vessels in abdomen. The above-mentioned finding were compared with prenatal ultrasound and follow-up findings. Results Of 10 cases, right aortic arch with aberrant left subclavian artery was seen in 7 cases, right aortic arch with the mirror branch, left aortic arch with aberrant right subclavian artery, right aortic arch with aberrant left subclavian artery combined with cervical aortic arch and double aortic arch was seen in 1 case, respectively. All aortic arch anomalies detected by MRI were consistent with post-birth or autopsy findings. Ultrasound misdiagnosed aortic branch malformation in 5 places, which included right aortic arch but misdiagnosed aberrant left subclavian artery in 2 cases, right aortic arch never diagnosed mirror branch anomaly in 1 case, right aortic arch with left subclavian artery misdiagnosed cervical aortic arch in 1 case, left atrial isomerism but misdiagnosed left aortic arch with aberrant right subclavian artery in 1 case;One double aortic arch was misdiagnosed as right aortic arch with aberrant left subclavian artery in ultrasound. Conclusion Fetal cardiovascular MRI is an effective and supplementary examination to complement ultrasound in diagnosis of fetal aortic arch anomalies.%目的:探讨MRI在诊断胎儿主动脉弓畸形中的价值。方法回顾性分析2013年3月至2014年10月产前超声检查提示有发育异常,然后行MRI检查,并经引产尸检和生后随访证实为主动脉弓畸形胎儿10例。重点观察MRI图

  4. Identification of aortic arch-specific quantitative trait loci for atherosclerosis by an intercross of DBA/2J and 129S6 apolipoprotein E-deficient mice.

    Directory of Open Access Journals (Sweden)

    Yukako Kayashima

    Full Text Available The genetic background of apolipoprotein E (apoE deficient mice influences atherosclerotic plaque development. We previously reported three quantitative trait loci (QTL, Aath1-Aath3, that affect aortic arch atherosclerosis independently of those in the aortic root in a cross between C57BL6 apoEKO mice (B6-apoE and 129S6 apoEKO mice (129-apoE. To gain further insight into genetic factors that influence atherosclerosis at different vascular locations, we analyzed 335 F2 mice from an intercross between 129-apoE and apoEKO mice on a DBA/2J genetic background (DBA-apoE. The extent of atherosclerosis in the aortic arch was very similar in the two parental strains. Nevertheless, a genome-wide scan identified two significant QTL for plaque size in the aortic arch: Aath4 on Chromosome (Chr 2 at 137 Mb and Aath5 on Chr 10 at 51 Mb. The DBA alleles of Aath4 and Aath5 respectively confer susceptibility and resistance to aortic arch atherosclerosis over 129 alleles. Both QTL are also independent of those affecting plaque size at the aortic root. Genome analysis suggests that athero-susceptibility of Aath4 in DBA may be contributed by multiple genes, including Mertk and Cd93, that play roles in phagocytosis of apoptotic cells and modulate inflammation. A candidate gene for Aath5 is Stab2, the DBA allele of which is associated with 10 times higher plasma hyaluronan than the 129 allele. Overall, our identification of two new QTL that affect atherosclerosis in an aortic arch-specific manner further supports the involvement of distinct pathological processes at different vascular locations.

  5. 4-D MRI flow analysis in the course of interrupted aortic arch reveals complex morphology and quantifies amount of collateral blood flow

    Energy Technology Data Exchange (ETDEWEB)

    Hirtler, Daniel [University Hospital Freiburg, Department of Pediatric Cardiology and Congenital Heart Disease, Freiburg (Germany); Geiger, Julia; Jung, Bernd [University Hospital Freiburg, Department of Radiology, Medical Physics, Freiburg (Germany); Markl, Michael [Northwestern University, Departments of Radiology and Biomedical Engineering, Chicago, IL (United States); Arnold, Raoul [University Hospital Heidelberg, Department of Pediatric Cardiology and Congenital Heart Disease, Heidelberg (Germany)

    2013-08-15

    We present findings in a 17-year-old with interrupted aortic arch, in whom standard imaging techniques missed functional and morphological problems. Flow-sensitive four-dimensional magnetic resonance (4-D MR) enabled assessment of the complex anatomy and blood-flow characteristics in the entire aorta and direct quantification of blood flow in collateral vessels. Our findings highlight the entire morphological and functional problem of interrupted aortic arch and illustrate the potential of flow-sensitive 4-D MR for surgical planning in congenital heart disease. (orig.)

  6. Aortic aneurysm disease vs. aortic occlusive disease - differences in outcome and intensive care resource utilisation after elective surgery

    DEFF Research Database (Denmark)

    Bisgaard, Jannie; Gilsaa, Torben; Rønholm, Ebbe;

    2013-01-01

    clamping is more pronounced in patients with aortic aneurysm disease, which may affect outcome. OBJECTIVES: The aim of this observational cohort study was to evaluate outcome after open elective abdominal aortic surgery, hypothesising a higher 30-day mortality, a higher incidence of postoperative organ...... dysfunction and a longer length of stay in patients with aortic aneurysm compared with aortic occlusive disease. DESIGN: Cohort observational study based on prospective registrations from national databases. SETTING: Eight Danish hospitals, including four university and four non-university centres, from 1...... or inotropes, ICU stay more than 24 h, hospital length of stay and mortality. RESULTS: Compared with aortic occlusive disease, more patients with aortic aneurysm disease had ICU stays more than 24 h (62 vs. 45%, P ...

  7. Association of Ankle-Brachial Index and Aortic Arch Calcification with Overall and Cardiovascular Mortality in Hemodialysis

    Science.gov (United States)

    Chen, Szu-Chia; Lee, Mei-Yueh; Huang, Jiun-Chi; Shih, Ming-Chen Paul; Chang, Jer-Ming; Chen, Hung-Chun

    2016-01-01

    Peripheral artery occlusive disease and vascular calcification are highly prevalent in hemodialysis (HD) patients, however the association of the combination of ankle-brachial index (ABI) and aortic arch calcification (AoAC) with clinical outcomes in patients undergoing HD is unknown. In this study, we investigated whether the combination of ABI and AoAC is independently associated with overall and cardiovascular mortality in HD patients. The median follow-up period was 5.7 years. Calcification of the aortic arch was assessed by chest X-ray. Forty-seven patients died including 24 due to cardiovascular causes during the follow-up period. The study patients were stratified into four groups according to an ABI 4 or ≤4 according to receiver operating characteristic curve. Those with an ABI  4 (vs. ABI ≥ 0.95 and AoAC score ≤ 4) were associated with overall (hazard ratio [HR], 4.913; 95% confidence interval [CI], 1.932 to 12.497; p = 0.001) and cardiovascular (HR, 3.531; 95% CI, 1.070 to 11.652; p = 0.038) mortality in multivariable analysis. The combination of a low ABI and increased AoAC was associated with increased overall and cardiovascular mortality in patients undergoing HD. PMID:27608939

  8. Left ventricular outflow tract pseudoaneurysm formation following three aortic valve replacement surgeries

    Directory of Open Access Journals (Sweden)

    Nasrien E Ibrahim

    2015-01-01

    Full Text Available We present a case of a pseudoaneurysm arising from the left ventricular outflow tract/aortic root as a complication of aortic valve surgery. A 45-year-old Nigerian female presented to our institution′s emergency department with chest discomfort. She had three bioprosthetic aortic valve replacements in the preceding year at an outside institution for aortic regurgitation and wanted a second opinion on remaining surgical options. The learning points relevant to this case are as follows: (1 Recognizing potential complications postmultiple valve surgeries, (2 screening patients for chronic infections and rheumatologic conditions that can contribute to failed valve surgeries.

  9. Can colonoscopy diagnose transmural ischaemic colitis after abdominal aortic surgery? An evidence-based approach

    DEFF Research Database (Denmark)

    Houe, T; Thorböll, J E; Sigild, U;

    2000-01-01

    to assess the diagnostic value of colonoscopy in ischaemic colitis following abdominal aortic surgery, based on a literature review, and to introduce the concept of evidence-based medicine.......to assess the diagnostic value of colonoscopy in ischaemic colitis following abdominal aortic surgery, based on a literature review, and to introduce the concept of evidence-based medicine....

  10. Perioperative management of Debakey Ⅰ aortic dissection by new type of three branches aortic arch covered stent graft implantation%DeBakey Ⅰ型主动脉夹层的围术期处理

    Institute of Scientific and Technical Information of China (English)

    宋先荣; 孟丽; 李园园

    2011-01-01

    patient died of multi-organ failure postoperatively and another died of large area of acute myocardial infarction. After the operation, six cases had acute renal failure, five cases had tracheotomy, three cases had reoperation for hemorrhage,one case had retardant pericardial tamponade, one case suffered from spinal cord injury, one had cerebral hemorrhage, and five cases had refractory arrhythmias. Conclusion The new type of three branches aortic arch covered stent graft simplified the procedures of aortic arch operation and lowered the operative risk in treatment of Debakey Ⅰ aortic dissection. Properly control of blood pressure and pain before surgery, shorten circulatory arrest time, maintain good organ perfusion seem to be the key points to improve the prognosis in patients with aortic dissection.

  11. Aortic arch replacement with a beating heart: a simple method using continuous 3-way perfusion.

    Science.gov (United States)

    Abu-Omar, Y; Ali, J M; Colah, S; Dunning, J J

    2014-01-01

    We describe a simplified 3-way perfusion strategy that could be used in complex aortic procedures, which ensures continuous end-organ perfusion and minimizes the potential risks of cardiac, cerebral and peripheral ischaemic complications.

  12. Advances of surgical and perfusion techniques for aortic arch hypoplasia%小儿主动脉弓发育不良的手术及灌注技术进展

    Institute of Scientific and Technical Information of China (English)

    毛乐; 祝忠群

    2016-01-01

    Currently the anatomic criteria for defining aortic arch hypoplasia have remained controversial.The major circumstances are proximal transverse aortic arch of <60% of ascending aortic diameter,a distal transverse aortic arch of <50% of ascending aortic diameter,an isthmus < 40%,a diameter of transverse arch < 50% of distal ascending aortic diameter or a diameter of transverse arch <50% of distal descending aortic diameter.One common rule-of-thumb is a diameter of transverse arch <0.1 mm for each 1 kg body weight,z-score:the diameter of each segment < two standard deviations below average,z-score <2.0.There is a wide spectrum of aortic arch hypoplasia.And each patient has different anatomic and physiological characteristics.Aortic arch hypoplasia usually occurs in association with intra-cardiac anomalies.And its rates of complication,reintervention and mortality are unsatisfactory.The major surgical techniques are extended end-to-end anastomosis,subclavian flap approach,end-to-side anastomosis and patch aortoplasty.And the major perfusion techniques include deep hypothermic circuitry arrest and selective cerebral perfusion.A proper selection of surgical approaches and perfusion techniques may improve the outcomes.According to the specific status of aortic arch hypoplasia patient,individualized treatment is needed.Here we make a review of progress of surgery and perfusion technique in aortic arch hypoplasia.%目前,小儿主动脉弓发育不良的定义存在争议,主要的评价方法有:①近弓、远弓和峡部分别<升主动脉的60%、50%和40%、或者横弓直径<升主动脉远端的50%、或者横弓直径<降主动脉直径的50%;②经验法则:横弓直径(mm)<体重(kg)+1;③Z值:不同节段的大小低于正常平均值的两个标准差以下,即Z值<-2.小儿主动脉弓发育不良病变谱广,不同患儿解剖和生理特点差异大,且常合并各类心内畸形,小儿主动脉弓发育不良

  13. Late aortic lymphocele and residual ovary syndrome after gynecological surgery

    Directory of Open Access Journals (Sweden)

    Iuliano Marialetizia

    2007-12-01

    Full Text Available Abstract Background Gynecological surgery, as radical hysterectomy or pelvic and aortic lymphadenectomy, accounts for more than 50% of iatrogenic injuries. In premenopausal women, an hysterectomy with ovarian sparing and concomitant lateral ovarian transposition is frequently performed. However, the fate of the retained ovary is complicated by the residual ovarian syndrome (ROS and one of the most common postoperative complications of the lymphadenectomy procedure is the lymphocele, with an average incidence of 22–48.5%. The differential diagnosis of a postoperative fluid collection includes, in addition to a lymphocele, urinoma, hematoma, seroma or abscess and the computed tomography (CT findings alone is not enough. Case presentation We describe a patient, affected by ROS concomitant with a asymptomatic lymphocele, initially confused with an aortic lymph nodes relapse, after abdominal radical hysterectomy. The patient was subjected to a surgical approach, included a diagnostic open laparoscopy and laparotomy with sovraombelico-pubic incision, wide opening of the pelvic peritoneum and retroperitoneum. Examination of the mass revealed, macroscopically, a ovary with multiloculated cystic masses filled with clear or yellow serous fluid and the layers were composed by flat or cuboidal mesothelial cells. Conclusion The tribute of this case illustrates the atypical appearance with uncertain aetiology after complex imaging. Gynecologist and radiologist should acquaint with the appearance of fluid collection (urinoma, lymphocele, seroma, hematoma, abscess in gynecologic oncology follow-up to properly differentiated from tumor recurrence.

  14. Current role of endovascular therapy in Marfan patients with previous aortic surgery

    Directory of Open Access Journals (Sweden)

    Ibrahim Akin

    2008-03-01

    Full Text Available Ibrahim Akin, Stephan Kische, Tim C Rehders, Tushar Chatterjee, Henrik Schneider, Thomas Körber, Christoph A Nienaber, Hüseyin InceDepartment of Medicine, Division of Cardiology at the University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str. 6, 18057 Rostock, GermanyAbstract: The Marfan syndrome is a heritable disorder of the connective tissue which affects the cardiovascular, ocular, and skeletal system. The cardiovascular manifestation with aortic root dilatation, aortic valve regurgitation, and aortic dissection has a prevalence of 60% to 90% and determines the premature death of these patients. Thirty-four percent of the patients with Marfan syndrome will have serious cardiovascular complications requiring surgery in the first 10 years after diagnosis. Before aortic surgery became available, the majority of the patients died by the age of 32 years. Introduction in the aortic surgery techniques caused an increase of the 10 year survival rate up to 97%. The purpose of this article is to give an overview about the feasibility and outcome of stent-graft placement in the descending thoracic aorta in Marfan patients with previous aortic surgery.Keywords: Marfan syndrome, aortic dissection, root replacement, stent-graft, previous aortic surgery

  15. [Mortality and morbidity in surgery for abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Banke, A.B.; Andersen, Jakob Steen; Heslet, L.;

    2008-01-01

    INTRODUCTION: Patients undergoing surgery for ruptured abdominal aortic aneurysm (rAAA) have a mortality of 40-50%. The purpose of the present investigation is to document the mortality and morbidity of such patients at Rigshospitalet (RH) in 2005. The results are compared with the best results...... published internationally (benchmark) and with predicted mortality. Factors in postoperative intensive therapy that can improve morbidity and mortality are identified. MATERIAL AND METHODS: This is a retrospective calculation and analysis of mortality and morbidity. Data were collected from an Intensive...... was significantly higher than the overall ICU mortality. The ICU mortality and morbidity increased with the amount of postoperative blood loss. Patients with an initial serum creatinine concentration of mortality that was lower than that of patients with a higher initial serum creatinine...

  16. 主动脉弓手术后并发谵妄的临床分析%Clinical analysis of postoperative delirium following aortic arch operation

    Institute of Scientific and Technical Information of China (English)

    袁辉; 祁明; 黄维勤

    2013-01-01

    目的:分析主动脉弓手术后谵妄的发生率和危险因素.方法:回顾分析143例主动脉弓手术后谵妄发生率,按有无谵妄症状分成2组,对其谵妄的可能危险因素做统计学分析.结果:3例患者术后早期因心肺功能衰竭死亡外,谵妄的发生率为29.3%(41/140例).术后谵妄的危险因素包括:术前高血压病、脑血管疾病、糖尿病、术中低脑氧饱和度、体外循环(CPB)> 200 min、术中最低收缩压、最低血压持续时间、术后发热、输血量>3 000 ml.结论:主动脉弓术后谵妄发生率为29.3%,术中最低收缩压、最低血压持续时间及CPB> 200 min、术中脑氧饱和度<40%是谵妄发生的独立危险因素.%AIM:To observe the incidence,risk factors and prevention methods of delirium after aortic arch operation.METHODS:The incidence of delirium in 143 patients who received aortic arch surgery was retrospectively analyzed.Patients were divided into two groups according to occurrence or no occurrence of postoperative delirium.Possible delirium-causing risk factors were analyzed.RESULTS:Except for early postoperative death due to cardiac and pulmonary failure in three patients,the incidence of delirium was 29.3% (4i/140).Risk factors for postoperative delirium included 1) preoperative diseases such as hypertension,cerebrovascular diseases and diabetes mellitus; 2) lower cerebral oxygen saturation,cardiopulmonary bypass (CPB) > 200 min,minimum systolic blood pressure and duration of minimum blood pressure during operation,and 3) postoperative fever and blood transfusion volume > 3 000 ml.CONCLUSION:Minimum systolic blood pressure and duration of minimum blood pressure,CPB > 200min and cerebral oxygen saturation < 40% during operation are independent risk factors for the occurence of delirium.

  17. Interdependencies of aortic arch secondary flow patterns, geometry, and age analysed by 4-dimensional phase contrast magnetic resonance imaging at 3 Tesla

    International Nuclear Information System (INIS)

    It was the aim to analyse the impact of age, aortic arch geometry, and size on secondary flow patterns such as helix and vortex flow derived from flow-sensitive magnetic resonance imaging (4D PC-MRI). 62 subjects (age range = 20-80 years) without circumscribed pathologies of the thoracic aorta (ascending aortic (AAo) diameter: 3.2 ± 0.6 cm [range 2.2-5.1]) were examined by 4D PC-MRI after IRB-approval and written informed consent. Blood flow visualisation based on streamlines and time-resolved 3D particle traces was performed. Aortic diameter, shape (gothic, crook-shaped, cubic), angle, and age were correlated with existence and extent of secondary flow patterns (helicity, vortices); statistical modelling was performed. Helical flow was the typical pattern in standard crook-shaped aortic arches. With altered shapes and increasing age, helicity was less common. AAo diameter and age had the highest correlation (r = 0.69 and 0.68, respectively) with number of detected vortices. None of the other arch geometric or demographic variables (for all, P ≥ 0.177) improved statistical modelling. Substantially different secondary flow patterns can be observed in the normal thoracic aorta. Age and the AAo diameter were the parameters correlating best with presence and amount of vortices. Findings underline the importance of age- and geometry-matched control groups for haemodynamic studies. (orig.)

  18. Rescue Surgery 19 Years after Composite Root and Hemiarch Replacement

    Directory of Open Access Journals (Sweden)

    Konstantin von Aspern

    2013-01-01

    Full Text Available A 59-year-old male patient with Marfan's syndrome was referred to our clinic due to acute chest pain. His medical history contains complex surgery for type A aortic dissection 19 years ago including composite root replacement using a mechanical aortic valve. Immediate computed tomography indicated perforation at the distal ascending aortic anastomosis plus complete avulsion of both coronary ostia. The patient underwent successful rescue surgery with ascending aortic and arch replacement using a modified Cabrol technique.

  19. Giant aortic arch aneurysm complicating Kawasaki disease: an original case report

    OpenAIRE

    Kaouthar, Hakim; Rafik, Boussaada; Jihen, Ayari; Imen, Hamdi; Lilia, Chaker; Fatma, Ouarda; Hela, Msaad

    2013-01-01

    Kawasaki disease (KD) is a common acute vasculitis in pediatric population that usually involves small and middle-sized arteries, commonly coronary arteries. Although the incidence and natural course of coronary aneurysms after KD are well documented, related reports on peripheral arterial and aortic aneurysms are scarce.

  20. [Risk stratification in selective surgery of abdominal aortic aneurysm].

    Science.gov (United States)

    Iaitskiĭ, N A; Bedrov, A Ia; Moiseev, A A; Nesterova, I V

    2014-01-01

    A retrospective analysis of data of 188 patients, who underwent a selective surgery for abdominal aortic aneurism showed, that all the patients had a cardiac pathology. Ischemic heart disease and arterial hypertension had 175 (93.0%) and 177 (94.1%) of patients, respectively. Chronic nonspecific lung disease was noted in 65.4% patients and kidney disease--in 48.9%. Different complications developed in early postoperative period in 47 (25%) patients, that resulted in fatal outcome in 20(10,6%). The most frequent complication was an acute renal insufficiency, which led to fatal outcome in 40% patients. Myocardial infarction and pneumonia took the second place in the structure of postoperative complications, one half of the fatal cases was due to these. Retrospective risk stratification assessment of the development of early postoperative complications and lethality was made by Glasgow Aneurysm Score (GAS) and angiosurgical model scale V-POSSUM. It was stated, that score was up to 84 according to GAS scale and up to 28 (V-POSSUM). That fact is the evidence of high risk of the operation. On the basis of ROC curves building, the conclusion was made about greater predictive ability of V-POSSUM scoring system. PMID:25055502

  1. [Use of sutureless prosthetic aortic valves in cardiac surgery].

    Science.gov (United States)

    Santarpino, Giuseppe; Fischlein, Theodor

    2014-03-01

    In the last years, an increasing proportion of high-risk patients undergo surgical aortic valve replacement. In order to reduce the risk associated with cross-clamp time or cardioplegic ischemic time, sutureless aortic prostheses have been developed. These bioprosthetic valves are not hand sewn, and this technological advance translates into reduced implantation times, thus improving outcome of patients referred for aortic valve replacement. At present, three sutureless bioprostheses are available on the market: 3f Enable (Medtronic Inc., Minneapolis, Minnesota, USA), Perceval (Sorin Group, Saluggia, Italy) and Intuity (Edwards Lifesciences, Irvine, California, USA). This article provides an overview of the available literature on sutureless aortic valves with the aim to better define current role and future perspectives of sutureless aortic bioprostheses for the treatment of aortic valve stenosis. PMID:24770430

  2. Aorta-pulmonary septal defect and aortic origin of the right pulmonary artery with interruption of the aortic arch: a clinical analysis of 5 cases%主-肺动脉间隔缺损及右肺动脉起源于升主动脉合并主动脉弓离断(附5例报告)

    Institute of Scientific and Technical Information of China (English)

    张刚成; 韩霞; 李艳萍; 陶凉

    2011-01-01

    Objective Reviewing the experience in the diagnosis and treatment of cases with aorta-pulmonary septal defect and aortic origin of right pulmonary artery complicated with interruption of the aortic arch. Methods Reviewed clinical data from medical records for5 patients (4 boys and 1 girl, age from 1 to 18 years on admission) who had been treated in Wuhan Asia Heart Hospital between 2005 and 2009. Results All cases had type A interruption of the aortic arch ( according to Celoria and Patron's Classification) , type Ⅱ aorta-pulmonary septal defect( according to Mori Classification) and aortic origin of right pulmonary artery complicated with interruption of the aortic arch. Large patent ductus arteries were observed in all cases,and no cardiac abnormality such as ventricular septal defect was found. All patients received echocardiography and spiral CT examination, and 3 of them over 10 years of age received cardiac catheterization and angiography for the evaluation of the pulmonary artery pressure. Two patients, at the age of 14 and 18 years, had severe pulmonary hypertension and declined to receive the operation. One of the 2 cases had hemoptysis and was given prostacyclin ( Iloprost solution for inhalation, a drug for pulmonary artery hypertention ) for reducing the pulmonary pressure. The patient now has an improved cardiac fu0ction without recurrent hemoptysis. One 14-year-old case gave up the operation because of the financial problem and failed to communicate with us after discharge. Radical surgery was performed in the remaining three cases, one had serious infection in the lung and died 11 days after the operation, in one case ( 2 years old) pulmonary artery hypertension has been persisted even though drug therapy was given for a long time and was found at a poor cardiac function 18 months after the operation. One patient recovered well under routine drug therapy and has been followed-up. Conclusion Aorta-pulmonary septal defect and aortic origin of right

  3. Aortic Arch Calcification Predicts the Renal Function Progression in Patients with Stage 3 to 5 Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Lung-Chih Li

    2015-01-01

    Full Text Available Introduction. The presence of aortic arch calcification (AoAC and cardiomegaly on chest radiography has been demonstrated as important risk factors for cardiovascular mortality in patients with chronic kidney disease (CKD. However, the interrelationship among AoAC, cardiomegaly, and renal function progression remains unclear. The aim of this study is to assess whether AoAC and cardiomegaly are independently associated with the renal function progression in patients with stages 3–5 CKD. Methods. We retrospectively determined AoAC and cardiomegaly by chest X-ray in 237 patients, followed up for at least three years without entering dialysis and classified into 4 groups according to the presence or absence of AoAC and cardiomegaly. The change in renal function was measured by the slope of estimated glomerular filtration rate (eGFR. Results. Of the 237 patients, the rate of eGFR decline was significantly higher in the group with coexistence of AoAC and cardiomegaly than any other groups. Baseline AoAC and proteinuria were independently associated with eGFR decline. AoAC were independently determined by age, eGFR slope, and cardiomegaly. Conclusions. The coexistence of AoAC and cardiomegaly is associated with faster eGFR decline. AoAC is an independent determinant of renal outcomes in patients with CKD stages 3–5.

  4. Diagnostic Value of Prospective Electrocardiogram-triggered Dual-source Computed Tomography Angiography for Infants and Children with Interrupted Aortic Arch

    Institute of Scientific and Technical Information of China (English)

    Hai-Ou Li; Xi-Ming Wang; Pei Nie; Xiao-Peng Ji; Zhao-Ping Cheng; Jiu-Hong Chen; Zhuo-Dong Xu

    2015-01-01

    Background:Accurate assessment of intra-as well as extra-cardiac malformations and radiation dosage concerns are especially crucial to infants and children with interrupted aortic arch (IAA).The purpose of this study is to investigate the value of prospective electrocardiogram (ECG)-triggered dual-source computed tomography (DSCT) angiography with low-dosage techniques in the diagnosis of IAA.Methods:Thirteen patients with suspected IAA underwent prospective ECG-triggered DSCT scan and transthoracic echocardiography (TTE).Surgery was performed on all the patients.A five-point scale was used to assess image quality.The diagnostic accuracy ofDSCT angiography and TTE was compared with the surgical findings as the reference standard.A nonparametric Chi-square test was used for comparative analysis.P<0.05 was considered as a significant difference.The mean effective radiation dose (ED) was calculated.Results:Diagnostic DSCT images were obtained for all the patients.Thirteen IAA cases with 60 separate cardiovascular anomalies were confirmed by surgical findings.The diagnostic accuracy of TTE and DSCT for total cardiovascular malformations was 93.7% and 97.9% (P>0.05),and that for extra-cardiac vascular malformations was 92.3% and 99.0% (P < 0.05),respectively.The mean score of image quality was 3.77 ± 0.83.The mean ED was 0.30 ± 0.04 mSv (range from 0.23 mSv to 0.39 mSv).Conclusions:In infants and children with IAA,prospective ECG-triggered DSCT with low radiation exposure and high diagnostic efficiency has higher accuracy compared to TTE in detection of extra-cardiac vascular anomalies.

  5. Analysis on the ultrasonic diagnosis and pathognomonic features of fetal aortic arch anomaly%胎儿主动脉弓异常的超声诊断和畸形特征分析

    Institute of Scientific and Technical Information of China (English)

    陈琮瑛; 李胜利; 文华轩; 毕静茹; 官勇; 陈秀兰; 廖玉媚

    2011-01-01

    Objective: To analyze the ultrasonic features and outcomes of fetal aortic arch anomaly diagnosed by prenatal ultrasonography, understand the pathognomonic features of fetal aortic arch anomaly, improve the diagnosis rate of prenatal ultrasonography for fetal aortic arch anomaly. Methods: 91 fetuses with aortic arch anomaly who received prenatal systematical ultrasonography and were diagnosed definitely in the hospital from 2006 to 2009 were selected as study objects. The prenatal ultrasonic diagnosis, pathognomonic features and outcomes were analyzed. Results: 148 fetuses with aortic arch anomaly were diagnosed by prenatal ultrasonography through conventional heart screening views and special views of aortic arch, one fetus with coarctation of aortic arch was missed diagnosed, 91 fetuses were diagnosed definitely, including 30 fetuses with coarctation of aortic arch, 7 fetuses with interrupted aortic arch (IAA), coarctation of aortic arch and interrupted aortic arch showed small aortic diameter and unbalance of aortic diameter/pulmonary artery diameter ratio in three vessel trachea view (3VTV); 52 fetuses with right -side aortic arch and abnormal aortic branch, 2 fetuses with double aortic arch were also included,the increased distance between aortic arch and arterial duct was showed in 3VTV. 24 fetuses were combined with other severe cardiac anomalies, 7 fetuses were combined with chromosomal abnormalities and 28 fetuses were combined with extracardial anomalies. The diagnosis rate of prenatal ultrasonography of aortic arch anomaly was 92.5% (86/93) . Among 68 fetuses without other severe cardiac anomalies, 42 neonates (61.8%) had good outcomes. Conclusion: Ultrasonography is a main method to diagnose various fetal aortic arch anomalies; small aortic diameter, unbalance of aortic diameter/pulmonary artery diameter ratio and the increased distance between aortic arch and arterial duct in 3VTV are clues for diagnosis of aortic arch anomaly, aortic arch anomaly

  6. Debranching Solutions in Endografting for Complex Thoracic Aortic Dissections

    Energy Technology Data Exchange (ETDEWEB)

    Goksel, Onur Selcuk, E-mail: onurgokseljet@gmail.com [Istanbul University, Istanbul Medical Faculty, Cardiovascular Surgery, Istanbul (Turkey); Guven, Koray [Istanbul University, Istanbul Medical Faculty, Radiology, Istanbul (Turkey); Karatepe, Celalettin [Mustafa Kemal Medical Faculty, Cardiovascular Surgery, Istanbul (Turkey); Gok, Emre [Istanbul University, Istanbul Medical Faculty, Cardiovascular Surgery, Istanbul (Turkey); Acunas, Bulent [Istanbul University, Istanbul Medical Faculty, Radiology, Istanbul (Turkey); Cinar, Bayer [Medical Park Hospital, Istanbul (Turkey); Alpagut, Ufuk [Istanbul University, Istanbul Medical Faculty, Cardiovascular Surgery, Istanbul (Turkey)

    2014-08-15

    Conventional surgical repair of thoracic aortic dissections is a challenge due to mortality and morbidity risks. We analyzed our experience in hybrid aortic arch repair for complex dissections of the aortic arch. Between 2009 and 2013, 18 patients (the mean age of 67 ± 8 years-old) underwent hybrid aortic arch repair. The procedural strategy was determined on the individual patient. Thirteen patients had type I repair using trifurcation and another patient with bifurcation graft. Two patients had type II repair with replacement of the ascending aorta. Two patients received extra-anatomic bypass grafting to left carotid artery allowing covering of zone 1. Stent graft deployment rate was 100%. No patients experienced stroke. One patient with total debranching of the aortic arch following an acute dissection of the proximal arch expired 3 months after TEVAR due to heart failure. There were no early to midterm endoleaks. The median follow-up was 20 ± 8 months with patency rate of 100%. Various debranching solutions for different complex scenarios of the aortic arch serve as less invasive procedures than conventional open surgery enabling safe and effective treatment of this highly selected subgroup of patients with complex aortic pathologies.

  7. [Anesthesia and recovery of infrarenal abdominal aortic aneurysm surgery].

    Science.gov (United States)

    Beye, S A; Kane, O; Tchikangoua, T N; Ndiaye, A; Dieng, P A; Ciss, G; Ba, P S; Ndiaye, M

    2009-01-01

    The aim of this study was to evaluate the anaesthetic assumption of responsibility of the surgery of the aneurism of under renal abdominal aorta. It was a retrospective study over two years (April 2005 - April 2007). Seven patients were operated, the mean age was 69,4 years. An operational pre evaluation was carried out among all patients including/understanding an interrogation, a clinical examination and a clinical assessment. All the patients profited from a general anaesthesia with controlled ventilation. Arterial hypertension (5 cases) was the independent factor of risk followed by the nicotinism (2 cases) with a patient at the stage of obstructive chronic broncho-pneumonopathy (BPCO). A patient was allowed in a table of rupture with acute abdominal pain and a cardiovascular collapse. Electrocardioscopic anomalies were noted among three patients with type of: HVD+ HBAG; HVG; HAG. A patient presented a hypertrophy cardiopathy with deterioration of the function of the VG and an important pulmonary arterial hypertension. A tensionnelle fall was found among three patients after induction with the midazolam. The aortic time of clampage varied between 20 and 120 mn with an average of 57, 6 mn. The incidents at the time of the clampage were: a bradycardia, a hypertensive push and a hypotension. No incident was observed at the time of the declampage. The blood losses per operational were estimated on average at 1000 ml and the numbers of transfusion by patient was on average of 4 pockets. The post operative issue was simple among 5 patients. A surgical recovery was necessary in front of a case of thrombosis of prosthesis. An oligoanurie, an acute respiratory insufficiency was found at the patient admitted in a table of rupture. The intermediate duration of stay threw 11 days. The maintenance of a homodynamic stability per and post operational remainder a good strategy to prevent the operational complications post. PMID:19666389

  8. Adding an endovascular aortic surgery program to a rural regional medical centre

    Science.gov (United States)

    Marelli, Daniel; Woo, Edward; Watson, Michael; Fedalen, Paul; Wang, Grace; Stallings, Megan; Fairman, Ronald; Mannion, John

    2013-01-01

    Background Abdominal aortic aneurysms requiring surgical intervention are generally treated by endovascular means. Such procedures are not always offered in rural hospitals, possibly leaving patients underserved. We reviewed our experience initiating an endoaortic surgery program. Methods A surgeon in a rural centre was credentialed to perform endovascular aortic aneurysm repair through collaboration with a university centre and was proctored locally for the first 5 abdominal aneurysm repairs. Web-based image storage was used to review complex cases as part of an ongoing partnership. Referred patients were screened for multiple aneurysms and underwent long-term monitoring. Results In all, 160 patients were evaluated for 176 aortic pathologies. Twenty-five patients (17 men) aged 55–89 years underwent 26 endovascular abdominal (n = 23) or thoracic (n = 3) aortic procedures. Emergent endovascular procedures were not performed. There were no operative deaths, requirements for dialysis or conversions to open repair. Two endoleaks required early reintervention. The median length of stay in hospital for endovascular procedures was 2.5 days. Chronic endoleaks were observed in 7 patients. An additional 8 patients underwent open abdominal aneurysm repair locally and 15 patients were referred to the university program. Conclusion Creation of an endovascular aortic surgery program in a rural hospital is feasible through collaboration with a high-volume centre. Patient safety is enhanced by obtaining second opinions using web-based image review. Most interventions are for abdominal aortic aneurysms, but planning for a comprehensive aortic clinic is preferable. PMID:24067525

  9. Association of Brachial-Ankle Pulse Wave Velocity and Cardiomegaly With Aortic Arch Calcification in Patients on Hemodialysis.

    Science.gov (United States)

    Shin, Ming-Chen Paul; Lee, Mei-Yueh; Huang, Jiun-Chi; Tsai, Yi-Chun; Chen, Jui-Hsin; Chen, Szu-Chia; Chang, Jer-Ming; Chen, Hung-Chun

    2016-05-01

    Aortic arch calcification (AoAC) is associated with cardiovascular and all-cause mortality in end-stage renal disease population. AoAC can be simply estimated with an AoAC score using plain chest radiography. The objective of this study is to evaluate the association of AoAC with brachial-ankle pulse wave velocity (baPWV) and cardiomegaly in patients who have undergoing hemodialysis (HD).We retrospectively determined AoAC and cardiothoracic ratio (CTR) by chest x-ray in 220 HD patients who underwent the measurement of baPWV. The values of baPWV were measured by an ankle-brachial index-form device. Multiple stepwise logistic regression analysis was used to identify the factors associated with AoAC score >4.Compared patients with AoAC score ≦4, patients with AoAC score >4 had older age, higher prevalence of diabetes and cerebrovascular disease, lower diastolic blood pressure, higher baPWV, higher CTR, higher prevalence of CTR ≧50%, lower total cholesterol, and lower creatinine level. After the multivariate stepwise logistic analysis, old age, cerebrovascular disease, high baPWV (per 100 cm/s, odds ratio [OR] 1.065, 95% confidence interval [CI] 1.003-1.129, P = 0.038), CTR (per 1%, OR 1.116, 95% CI 1.046-1.191, P = 0.001), and low total cholesterol level were independently associated with AoAC score >4.Our study demonstrated AoAC severity was associated with high baPWV and high CTR in patients with HD. Therefore, we suggest that evaluating AoAC on plain chest radiography may be a simple and inexpensive method for detecting arterial stiffness in HD patients. PMID:27175684

  10. Prenatal ultrasonic diagnosis of fetal interrupted aortic arch%胎儿主动脉弓离断产前超声诊断分析

    Institute of Scientific and Technical Information of China (English)

    董莹; 王玲; 赵晟; 郭宁; 肖蕾

    2014-01-01

    目的:探讨产前超声对胎儿主动脉弓离断(IAA)的诊断价值,分析漏、误诊原因,提高产前诊断率。方法回顾性分析16例胎儿主动脉弓异常超声图像特征,与正常胎儿超声图像、解剖结果进行对比研究,并分析胎儿IAA与染色体异常的相关性。结果16例产前诊断IAA病例,经解剖确诊15例,超声诊断正确率为94%(15/16),1例为主动脉弓严重缩窄(CoA),1例分型错误,3例产前超声不能分型病例获得明确分型,超声分型符合率为73%(11/15)。确诊的15例全部合并室间隔缺损,其中5例合并完全性心内膜垫缺损,合并心脏外畸形者9例。7例进行了染色体核型检查,3例18‐三体,1例13‐三体,3例正常,18‐三体发生率为43%(3/7)。结论产前超声对胎儿IAA的诊断准确率高,但在明确分型方面有待提高。胎儿IAA与严重CoA的鉴别存在困难。18‐三体在IAA胎儿染色体异常中发生率较高。%Objective To evaluate the value of prenatal ultrasound in the interrupted aortic arch (IAA), and analyze the reasons of misdiagnosis and improve diagnostic ratio of this kind of defects. Methods Ultrasonic characteristics were analyzed in 16 fetuses with aortic arch anomalies, which were compared with ultrasound image and autopsy results of the normal fetus. The relativity of fetal IAA and abnormal chromosome was also analyzed. Results Among the 16 cases, 15 cases were confirmed by anatomy and the accuracy of ultrasound diagnosis was 94% (15/16), of which one case was serious constriction of aortic arch, one case was error type, three cases were obtained explicit type due to unsatisfactory results of prenatal ultrasound. The coincidence rate of ultrasonic type was 73% (11/15). All of the corrected diagnosed cases were detected with ventricular septal, of which 5 cases were detected with complete endocardial cushion defect, 9 cases were found extra cardiac

  11. Combined surgical and catheter-based treatment of extensive thoracic aortic aneurysm and aortic valve stenosis

    DEFF Research Database (Denmark)

    De Backer, Ole; Lönn, Lars; Søndergaard, Lars

    2015-01-01

    endovascular aneurysm repair (TEVAR) has changed and extended management options in thoracic aorta disease, including in those patients deemed unfit or unsuitable for open surgery. Accordingly, transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with symptomatic severe aortic......An extensive thoracic aortic aneurysm (TAA) is a potentially life-threatening condition and remains a technical challenge to surgeons. Over the past decade, repair of aortic arch aneurysms has been accomplished using both hybrid (open and endovascular) and totally endovascular techniques. Thoracic...

  12. Results of Castro Bernardes intraluminal ring in surgery for ascending aortic aneurysms and dissections

    Directory of Open Access Journals (Sweden)

    Fernando Rotatori Novaes

    2013-06-01

    Full Text Available OBJECTIVE: To demonstrate surgical results using Castro Bernardes intraluminal ring in ascending aorta surgery, instead of conventional suture. METHODS: 95 patients underwent ascending aorta surgery from December 2008 to April 2011 at Madre Tereza Hospital (Belo Horizonte, MG, Brazil, using Castro Bernardes intraluminal ring instead of conventional suture of the aorta. RESULTS: Ninety five patients underwent ascending aorta surgery with Castro-Bernardes intraluminal ring. Thirty patients presented acute dissection and 65 aneurism. Overall postoperative mortality was 15.78% (15/95. Nine patients in 15 (60% died due to acute type A dissection. For acute type A dissection, mortality was 30% and for aneurism mortality was 9.23%. The intraluminal ring was inserted in distal position in 89 patients and in proximal and distal position in 6 patients. Mortality was related to Bentall & De Bono or Cabrol associated techniques. Average extracorporeal circulation time was 57.4 minutes and average aortic cross-clamping time was 37 minutes. CONCLUSION: The use of Castro Bernardes intraluminal ring in ascending aortic surgery avoiding conventional suture reduces extracorporeal circulation time and aortic cross-clamping time, improving surgical results. This approach simplifies ascending aortic surgery whether the disease is type A dissection or aneurysm, and may be considered a good alternative technique.

  13. Analysis of the morphology of aortic arch in the cerebral angiography%全脑血管造影术中主动脉弓形态学的分析

    Institute of Scientific and Technical Information of China (English)

    张永力; 刘方军

    2011-01-01

    Objective To analyze the variations and malformations of the aortic arch branches in the cerebral angiography and the changes of aortic arch in patients with different ages. Methods The cere- brai angiography of 774 consecutive patients were included in the study. Angiography of aortic arch and the superselective angiography of its branch arteries were pedormed via femoral artery catheterization. The vari-ations and malformations of aortic arch branches were analyzed. The effects of age on the Myla type, the sharp angles of each aortic arch branches, the brachiocephalic trunk arising from the ascending segment of aortic arch, as well as the vascular tortuos conditions of the aortic arch branches were analyzed. Results ①Aortic arch anomalies were found in 78 cases ( 10.08% ). Of which 68 cases (8.79%) had aortic arch variations;10 cases( 1.29% ) had aortic arch. ②With the increase of age, the proportion of Myla type I aortic arch decreased; the proportions of Myla type II and III aortic arch increased. ③With the increase of age, the inci-dences of the sharp angles of brachiocephalic trunk, left common carotid artery and left subclavian artery increased gradually, and the proportion of brachiocephalic trunk arising from the ascending segment of aortic arch increased. ④With the increase of age, the incidence of non-tortuosity in aortic arch branches decreased gradually, and the incidences of mild, moderate and severe tortuosities increased gradually. ⑤Angiography on each aortic arch branch of 75l cases in this group was successful, and 23 cases failed, in which 5 because of variations of aortic arch, I because of aortic arch malformation, and 17 because of advanced age, sharp singles on aortic arch branches, and severe vascular tortuosity. Conclusion We should fully master the ex-ceptionally complex anatomy and imaging findings of aortic arch and make the cerebral angiography and inter-ventional treatment to be more safe and effective in combination

  14. [A hybrid approach to surgery for thoracic aortic aneurysm

    DEFF Research Database (Denmark)

    L., de la Motte; Baekgaard, N.; Jensen, L.P.;

    2009-01-01

    A 57-year-old male, previously treated surgically with insertion of grafts for type A and B aortic dissection, presented with a pulsatile mass in the jugular fossa. Further examination verified a pseudoaneurysm the inlet of which was located at the proximal anastomotic site of the descending aort...

  15. Does epidural sufentanil provide effective analgesia per- and postoperatively for abdominal aortic surgery?

    NARCIS (Netherlands)

    Broekema, AA; Kuizenga, K; Hennis, PJ

    1996-01-01

    assess the efficacy of epidural sufentanil in providing per- and postoperative analgesia, 40 patients undergoing elective abdominal aortic surgery received either 50 mu g sufentanil in 10 ml normal saline solution (n=20, ES group) or 10 mi normal saline (n=20, control group) via a thoracic epidural

  16. Similar cerebral protective effectiveness of antegrade and retrograde cerebral perfusion during deep hypothermic circulatory arrest in aortic surgery: a meta-analysis of 7023 patients.

    Science.gov (United States)

    Guo, Shasha; Sun, Yanhua; Ji, Bingyang; Liu, Jinping; Wang, Guyan; Zheng, Zhe

    2015-04-01

    In aortic arch surgery, deep hypothermic circulatory arrest (DHCA) combined with cerebral perfusion is employed worldwide as a routine practice. Even though antegrade cerebral perfusion (ACP) is more widely used than retrograde cerebral perfusion (RCP), the difference in benefit and risk between ACP and RCP during DHCA is uncertain. The purpose of this meta-analysis is to compare neurologic outcomes and early mortality between ACP and RCP in patients who underwent aortic surgery during DHCA. PubMed, EMBASE, and the Cochrane Library were searched using the key words "antegrade," "retrograde," "cerebral perfusion," "cardiopulmonary bypass," "extracorporeal circulation," and "cardiac surgery" for studies reporting on clinical endpoints including early mortality, stroke, temporary neurologic dysfunction (TND), and permanent neurologic dysfunction (PND) in aortic surgery requiring DHCA with ACP or RCP. Heterogeneity was analyzed with the Cochrane Q statistic and I(2) statistic. Publication bias was tested with Begg's funnel plot and Egger's test. Thirty-four studies were included in this meta-analysis, with 4262 patients undergoing DHCA + ACP and 2761 undergoing DHCA + RCP. The overall pooled relative risk for TND was 0.722 (95% CI = [0.579, 0.900]), and the z-score for overall effect was 2.9 (P = 0.004). There was low heterogeneity (I(2) = 18.7%). The analysis showed that patients undergoing DHCA + ACP had better outcomes than those undergoing DHCA + RCP in terms of TND, while there were no significant differences between groups in terms of PND, stroke, and early mortality. This meta-analysis indicates that DHCA + ACP has an advantage over DHCA + RCP in terms of TND, while the two methods show similar results in terms of PND, early mortality, and stroke.

  17. Anatomical study of aortic arch branches' variations with MRA and its significance%主动脉弓分支变异的MRA解剖学分析及其临床意义

    Institute of Scientific and Technical Information of China (English)

    李淑华; 狄玉进; 徐金法; 白敏; 陈军; 布春青

    2011-01-01

    目的:应用磁共振血管成像(MRA)分析主动脉弓分支变异的解剖学特征,探讨MRA评价主动脉弓分支变异的临床意义.方法:对1300例在我院磁共振室接受主动脉弓及其以上MRA检查的患者进行回顾性分析,分析不同类型主动脉弓分支变异的发生情况,并讨论主动脉弓分支变异的临床意义.结果:1300例患者中,形态正常者1207例(92.85%).即头臂干(BT)、左颈总动脉(LCCA)、左锁骨下动脉(LSA)从右向左分别发自主动脉弓,存在变异者93例(7.15%).共发现9种不同类型的变异.包括LCCA与BT共干发自主动脉弓43例(3.31%)·左椎动脉(LVA)于LCCA和LSA之间直接发自主动脉弓28例(2.15%).右颈总动脉(RCCA)直接发自主动脉弓伴迷走右锁骨下动脉(RSA)7例(0.54%).LCCA与RCCA共干发自主动脉弓伴迷走RSA 3例(0.23%).LCCA与BT共干,伴LVA直接发自主动脉弓5例(0.38%).LVA与LSA共干发自主动脉弓3例(0.23%).RCCA发自主动脉弓,右椎动脉(RVA)发自RCCA伴迷走RSA 2例(0.15%),LCCA,RCCA,LVA,RSA均发自主动脉弓1例(0.08%).LCCA与BT共干发自主动脉弓,LVA缺如,伴原始三叉动脉1例(0.08%).结论:主动脉弓分支变异种类繁多,MRA能很好的评价主动脉弓分支数量及其形态与开口位置,对临床有重要意义.%Objective : To evaluate the anatomical features of human aortic arch branch variations using magnetic resonance angiography (MRA) and its clinical significance, Methods;1300 patients who received aortic arch MRA were analyzed retrospectively. The aortic arch branch variations were summarized and the clinical significance was researched. Results : In 1300 cases.1207 of them ( 92. 85%) , which was a normal form, the brachiacephalic trunk ( BT) , left common carotid artery (LCCA) and left subclavian artery (LSA) originated separately from the aortic arch and 93 of them (7. 15%) were a variation form. Nine different types were found In 43 cases (3. 31%), BT and LCCA had a common trunk

  18. 停循环和局部脑灌在主动脉弓中断手术中的应用%The usefulness of deep hypothermic circulatory arrest and regional cerebral perfusion in interrupted aortic arch

    Institute of Scientific and Technical Information of China (English)

    郭铮; 王伟; 张蔚; 沈佳; 唐嘉忠; 朱德明

    2013-01-01

    Objective To evaluate the effects of deep hypothermic circulatory arrest (DHCA) and regional cerebral perfusion (RCP) in interrupted aortic arch (IAA) corrective surgery.Methods Thirty-one infants younger than 3-month-old with IAA were undergone corrective surgery with DHCA or RCP.The bypass time,aortic clamp time,DHCA or RCP time,hematocrit,ventilation time,ICU stay time and post-operative complications were recorded and compared between two groups.Results The bypass time,aortic clamp time were longer in RCP group,and the RCP time was longer than DHCA time.One postoperative death and two neurological complications took place in DHCA group,while no mortality and neurological complications in RCP group.There were no significant differences in mortality and morbidity between two groups.Conclusion Because complicated surgery is undergone in IAA corrective procedure,RCP technique is safer to protect the brain function.%目的 比较深低温停循环(DHCA)与局部低流量脑灌(RCP)在小儿主动脉弓中断(IAA)纠治手术中的应用效果.方法 总结31例3个月以下的IAA合并室间隔缺损、房间隔缺损的婴儿手术病例,分为DHCA和RCP两组不同的体外循环方式,对术中转流时间,阻断时间,红细胞比容,停循环或脑灌时间,呼吸机插管时间,ICU滞留时间,术后低心排出量,肾功能衰竭,肺部炎症,出凝血障碍,多器官功能障碍,神经系统并发症,院内死亡率等情况进行分析.结果 RCP组手术的体外循环时间,阻断时间及脑灌时间显著长于DHCA组.DHCA组患儿死亡1例,神经系统并发症2例,RCP组无死亡和神经系统并发症,但两组无统计学差异.结论 IAA手术需要较长时间在主动脉上进行操作,采用RCP技术可以更好的保护神经系统功能,减少并发症.

  19. Unreliability of aortic size index to predict risk of aortic dissection in a patient with Turner syndrome

    Science.gov (United States)

    Nijs, Jan; Gelsomino, Sandro; Lucà, Fabiana; Parise, Orlando; Maessen, Jos G; Meir, Mark La

    2014-01-01

    Aortic size index (ASI) has been proposed as a reliable criterion to predict risk for aortic dissection in Turner syndrome with significant thresholds of 20-25 mm/m2. We report a case of aortic arch dissection in a patient with Turner syndrome who, from the ASI thresholds proposed, was deemed to be at low risk of aortic dissection or rupture and was not eligible for prophylactic surgery. This case report strongly supports careful monitoring and surgical evaluation even when the ASI is < 20 mm/m2 if other significant risk factors are present. PMID:24944765

  20. Surgery for abdominal aortic aneurysms. A survey of 656 patients

    DEFF Research Database (Denmark)

    Olsen, P S; Schroeder, T; Agerskov, Kim;

    1991-01-01

    Between 1979 and 1988, 656 patients were operated upon for abdominal aortic aneurysm. Elective operation was performed in 287 patients (44%) and acute operation in 369 patients. A ruptured aneurysm was found in 218 patients (33%). Patients with arteriosclerotic heart disease, hypertension, impaired...... renal function or chronic pulmonary disease showed an increased perioperative mortality. Development of postoperative cardiac and renal complications could not be related to previous cardiac or renal diseases. The major postoperative complications were renal failure in 81 patients (12%), pulmonary...... insufficiency in 77 patients (11%) and cardiac complications in 96 patients (13%). Failure of one or more organs occurred in 153 patients (23%) and the mortality rate for patients with multiorgan failure was 68%. Complications leading to reoperation occurred in 93 patients (14%). The perioperative mortality...

  1. Aneurysms: thoracic aortic aneurysms.

    Science.gov (United States)

    Chun, Kevin C; Lee, Eugene S

    2015-04-01

    Thoracic aortic aneurysms (TAAs) have many possible etiologies, including congenital heart defects (eg, bicuspid aortic valves, coarctation of the aorta), inherited connective tissue disorders (eg, Marfan, Ehlers-Danlos, Loeys-Dietz syndromes), and degenerative conditions (eg, medial necrosis, atherosclerosis of the aortic wall). Symptoms of rupture include a severe tearing pain in the chest, back, or neck, sometimes associated with cardiovascular collapse. Before rupture, TAAs may exert pressure on other thoracic structures, leading to a variety of symptoms. However, most TAAs are asymptomatic and are found incidentally during imaging for other conditions. Diagnosis is confirmed with computed tomography scan or echocardiography. Asymptomatic TAAs should be monitored with imaging at specified intervals and patients referred for repair if the TAAs are enlarging rapidly (greater than 0.5 cm in diameter over 6 months for heritable etiologies; greater than 0.5 cm over 1 year for degenerative etiologies) or reach a critical aortic diameter threshold for elective surgery (5.5 cm for TAAs due to degenerative etiologies, 5.0 cm when associated with inherited syndromes). Open surgery is used most often to treat asymptomatic TAAs in the ascending aorta and aortic arch. Asymptomatic TAAs in the descending aorta often are treated medically with aggressive blood pressure control, though recent data suggest that endovascular procedures may result in better long-term survival rates. PMID:25860136

  2. Arco aórtico derecho, divertículo de Kommerell y arteria subclavia izquierda aberrante Right aortic arch, Kommerell's diverticulum and aberrant left subclavian artery

    Directory of Open Access Journals (Sweden)

    I. Simón-Yarza

    2011-08-01

    Full Text Available La arteria subclavia derecha aberrante o «arteria lusoria» es la variante anatómica más común del desarrollo embrionario de la aorta y sus ramas, llegando a estar presente en un 0,5-2% de la población; con menos frecuencia se puede encontrar una arteria subclavia izquierda aberrante asociada al arco aórtico derecho. Estas variantes anatómicas deben incluirse en el diagnóstico diferencial del ensanchamiento mediastínico superior visible en la radiografía de tórax. Se presenta el caso clínico de un paciente que presentaba arco aórtico derecho y arteria subclavia izquierda aberrante con dilatación en su origen (divertículo de Kommerell como causa de ensanchamiento mediastínico superior de etiología incierta detectado de manera incidental en una radiografía de tórax realizada en un paciente con sintomatología respiratoria.The right aberrant subclavian artery or «arteria lusoria» is the most common anatomical variant of the embryonic development of the aorta and its branches, with a presence in 0.5-2% of the population. Less frequently, a right aortic arch with aberrant left subclavian artery may be present. These anatomical variations should be included in the differential diagnosis of superior mediastinal widening seen on chest radiographs. In this report, we present a right aortic arch with left aberrant subclavian artery dilated at its origin (Kommerell's diverticulum as a cause of superior mediastinal widening detected incidentally on a chest radiograph.

  3. Endovascular Treatment for Proximal Anastomotic Pseudoaneurysm after Total Arch Replacement in Behcet's Disease.

    Science.gov (United States)

    Sakata, Tomoki; Ueda, Hideki; Watanabe, Michiko; Kohno, Hiroki; Tamura, Yusaku; Abe, Shinichiro; Inage, Yuichi; Ikeuchi, Hiroki; Kanda, Tomoyoshi; Fujii, Masahiko; Matsumiya, Goro

    2016-07-01

    A 17-year-old patient underwent total arch replacement for aortic arch aneurysm due to vascular Behcet's disease (BD). Follow-up computed tomography, performed 6 months after the operation, demonstrated pseudoaneurysm formation at the proximal anastomotic site. We performed endovascular treatment and used a short stent graft that was originally designed for abdominal aortic aneurysm. To avoid the occlusion of the coronary or brachiocephalic artery (BCA) due to stent graft migration, we used right ventricular rapid pacing and BCA ballooning. Thus, we believe that endovascular treatment can be used for anastomotic complications in the ascending aorta after open surgery for connective tissue disorders including BD. PMID:27174345

  4. Short report Neutrophil gelatinase-associated lipocalcin (NGAL) as a biomarker of dialysis-dependent acute kidney injury following infrarenal aortic surgery

    DEFF Research Database (Denmark)

    Jørgensen, Helene Korvenius; Stæhr, Jannie Bisgaard; Gilsaa, Torben

    2013-01-01

    Background: Acute kidney injury (AKI) is common following abdominal aortic surgery. NGAL might be useful in the early diagnosis of AKI since it responds rapidly to ischaemic damage. Methods: Twenty patients undergoing elective infrarenal aortic surgery. U-NGAL was measured before surgery and 24, 48...

  5. MULTIPLE SURGICAL TREATMENT OF COMPLEX AORTIC ARCH AND DESCENDING AORTA DISEASE%主动脉弓降部病变的外科综合治疗

    Institute of Scientific and Technical Information of China (English)

    邱罕凡; 陈道中; 陈良万; 林峰; 曹华

    2012-01-01

    Objective To investigate the methods and effectiveness of multipie surgical treatment for complex aortic arch and descending aorta disease, including cardiopulmonary bypass operation, hybrid operation, and total endovascular aneurysm repair (EVAR). Methods Between October 2006 and September 2011, 48 patients with complex aortic arch and descending aorta disease were treated. There were 31 males and 17 females, aged from 28 to 81 years (mean, 52.4 years). The disease duration ranged from 1 to 90 days (mean, 10.2 days). There were 30 cases of type B aortic dissection involving the aortic arch, 11 cases of thoracic aortic aneurysm, 3 cases of thoracic pseudoaneurysme, 3 cases of penetrating aortic ulcer, and 1 case of aortoesophageal fistula. Cardiopulmonary bypass operation, hybrid operation, and total EVAR were performed in 15, 12, and 21 cases, respectively. Results In the patients undergoing cardiopulmonary bypass operation, the following complications occurred: 1 case of bleeding, 1 case of coma, 3 cases of psychiatric disorders, 4 cases of pneumonia, 2 cases of acute renal insufficiency, and 2 cases of multi-organ dysfunction; finally 3 patients died. In the patients undergoing hybrid operation, cerebral infarction and renal function failure occurred in 1 case. In the patients undergoing total EVAR, no complication occurred. A total of 41 patients were followed up 2 to 60 months (mean, 28.6 months). Slight left subclavian steal syndrome occurred in 3 cases, but self relieved. Other patients recovered to normal life. Conclusion In the surgical treatments of complex aortic arch and descending aorta disease, cardiopulmonary bypass operation will be gradually replaced by EVAR because of the surgical trauma and risk, hybrid operation is an important technique, and total EVAR will be the future progress.%目的 探讨开胸体外循环直视手术、解剖外旁路联合动脉腔内修复(endovascular aneurysm repair,EVAR)杂交手术以及完全EVAR手术治疗主

  6. How to Perfuse: Concepts of Cerebral Protection during Arch Replacement

    Directory of Open Access Journals (Sweden)

    Andreas Habertheuer

    2015-01-01

    Full Text Available Arch surgery remains undoubtedly among the most technically and strategically challenging endeavors in cardiovascular surgery. Surgical interventions of thoracic aneurysms involving the aortic arch require complete circulatory arrest in deep hypothermia (DHCA or elaborate cerebral perfusion strategies with varying degrees of hypothermia to achieve satisfactory protection of the brain from ischemic insults, that is, unilateral/bilateral antegrade cerebral perfusion (ACP and retrograde cerebral perfusion (RCP. Despite sophisticated and increasingly individualized surgical approaches for complex aortic pathologies, there remains a lack of consensus regarding the optimal method of cerebral protection and circulatory management during the time of arch exclusion. Many recent studies argue in favor of ACP with various degrees of hypothermic arrest during arch reconstruction and its advantages have been widely demonstrated. In fact ACP with more moderate degrees of hypothermia represents a paradigm shift in the cardiac surgery community and is widely adopted as an emergent strategy; however, many centers continue to report good results using other perfusion strategies. Amidst this important discussion we review currently available surgical strategies of cerebral protection management and compare the results of recent European multicenter and single-center data.

  7. The myocardial protective effect of dexmedetomidine in high-risk patients undergoing aortic vascular surgery

    Science.gov (United States)

    Soliman, Rabie; Zohry, Gomaa

    2016-01-01

    Objective: The aim of the study was to assess the effect of dexmedetomidine in high-risk patients undergoing aortic vascular surgery. Design: A randomized prospective study. Setting: Cairo University, Egypt. Materials and Methods: The study included 150 patients undergoing aortic vascular surgery. Intervention: The patients were classified into two groups (n = 75). Group D: The patients received a loading dose of 1 μg/kg dexmedetomidine over 15 min before induction and maintained as an infusion of 0.3 μg/kg/h to the end of the procedure. Group C: The patients received an equal volume of normal saline. The medication was prepared by the nursing staff and given to anesthetist blindly. Measurements: The monitors included the heart rate, mean arterial blood pressure, central venous pressure, electrocardiogram (ECG), serum troponin I level, end-tidal sevoflurane, and total dose of morphine in addition transthoracic echocardiography to the postoperative in cases with elevated serum troponin I level. Main Results: The dexmedetomidine decreased heart rate and minimized the changes in blood pressure compared to control group (P vascular surgery. It decreases the changes in heart rate and blood pressure during the procedures. It provides cardiac protection in high-risk patients reflected by decreasing the incidence of myocardial ischemia and serum level of troponin. The main side effects of dexmedetomidine were hypotension and bradycardia. PMID:27716690

  8. Computer Simulations of Pulsatile Human Blood Flow Through 3D-Models of the Human Aortic Arch, Vessels of Simple Geometry and a Bifurcated Artery: Investigation of Blood Viscosity and Turbulent Effects

    CERN Document Server

    Sultanov, Renat A

    2008-01-01

    We report computational results of blood flow through a model of the human aortic arch and a vessel of actual diameter and length. On the top of the aortic arch the branching of the %%three arteries are included: the subclavian and jugular. A realistic pulsatile flow is used in all simulations. Calculations for bifurcation type vessels are also carried out and presented. Different mathematical methods for numerical solution of the fluid dynamics equations have been considered. The non-Newtonian behaviour of the human blood is investigated together with turbulence effects. A detailed time-dependent mathematical convergence test has been carried out. The results of computer simulations of the blood flow in vessels of three different geometries are presented: for pressure, strain rate and velocity component distributions we found significant disagreements between our results obtained with realistic non-Newtonian treatment of human blood and the widely used method in the literature: a simple Newtonian approximati...

  9. Endovascular Repair of a Ruptured Aortic Extra-anatomic Bypass Pseudoaneurysm After Previous Coarctation Surgery.

    Science.gov (United States)

    Hörer, Tal; Toivola, Asko

    2015-01-01

    We present a short case of a total endovascular repair of a ruptured thoracic pseudoaneurysm after previous coarctation aortic conduit bypass surgery. A 67-year-old man with two previous coarctation repairs many years ago was admitted with chest pain, dyspnea, and hemoptysis. Computed tomography showed a rupture in the distal anastomosis of the thoracic extra-anatomic graft. Successful treatment was achieved by placement of an endovascular stent graft between the old graft and the native aorta and with a vascular plug occlusion of the native aorta.

  10. Impact of methodology and the use of allometric scaling on the echocardiographic assessment of the aortic root and arch: a study by the Research and Audit Sub-Committee of the British Society of Echocardiography.

    Science.gov (United States)

    Oxborough, David; Ghani, Saqib; Harkness, Allan; Lloyd, Guy; Moody, William; Ring, Liam; Sandoval, Julie; Senior, Roxy; Sheikh, Nabeel; Stout, Martin; Utomi, Victor; Willis, James; Zaidi, Abbas; Steeds, Richard

    2014-09-01

    The aim of the study is to establish the impact of 2D echocardiographic methods on absolute values for aortic root dimensions and to describe any allometric relationship to body size. We adopted a nationwide cross-sectional prospective multicentre design using images obtained from studies utilising control groups or where specific normality was being assessed. A total of 248 participants were enrolled with no history of cardiovascular disease, diabetes, hypertension or abnormal findings on echocardiography. Aortic root dimensions were measured at the annulus, the sinus of Valsalva, the sinotubular junction, the proximal ascending aorta and the aortic arch using the inner edge and leading edge methods in both diastole and systole by 2D echocardiography. All dimensions were scaled allometrically to body surface area (BSA), height and pulmonary artery diameter. For all parameters with the exception of the aortic annulus, dimensions were significantly larger in systole (P<0.05). All aortic root and arch measurements were significantly larger when measured using the leading edge method compared with the inner edge method (P<0.05). Allometric scaling provided a b exponent of BSA(0.6) in order to achieve size independence. Similarly, ratio scaling to height in subjects under the age of 40 years also produced size independence. In conclusion, the largest aortic dimensions occur in systole while using the leading edge method. Reproducibility of measurement, however, is better when assessing aortic dimensions in diastole. There is an allometric relationship to BSA and, therefore, allometric scaling in the order of BSA(0.6) provides a size-independent index that is not influenced by the age or gender. PMID:26693286

  11. 国人升主动脉及主动脉弓的CT解剖研究%CT topography of asending aorta and aortic arch in adult Chinese

    Institute of Scientific and Technical Information of China (English)

    张敏宏; 郭伟; 刘小平; 尹太; 贾鑫; 杜昕

    2009-01-01

    Objective To study the anatomical characteristics of ascending aortic and aortic arch in adult Chinese. Methods From Sep 2006 to Sep 2007, we retrospectivly reviewed 388 volunteers undergoing thoracic aorta CTA in our institution. We measured the diameter of ascending aorta, aortic arch, and branch vessels of aortic arch respectively in AW4.2 work station. CHESS statistical software was used to analyze data. Results The aortic diameter above coronary artery (CA) (D1), the level at origin of brachiocephalie trunk (BCT) ( D3 ), the halfway of the AA( D2 ), the level at origin of LCCA( D4 ) , the level at origin of LSA ( D5 ) and the level at distal origin of LSA ( D6 ) respectively are: ( 34 ± 5 ) mm; ( 33 ± 4) mm; ( 34 ± 5 ) mm; ( 30 ± 4) mm; ( 28 ± 3 ) mm; ( 26 ± 3 ) mm. The diameters of two level between the origin of BCT and RSA are ( 13. 1 ± 1.9) mm, ( 12. 8±2. 3) mm, respectively. The diameter of two level at LCCA is ( 8. 7 ± 1.5 )mm and ( 7. 9 ± 1. 0) mm respectively. The diameter of two level between the origin of LSA and L-vertebral arteryis (10.7±1.7) mm,(9.3±1.3) mm, respectively. Conclusion The data of the diameter and length of ascending aort and vasculature arising from the arch abtained by CT topography in Chinese volunteers are very useful for clinical practice.%目的 通过CT血管造影(computed tomographic arteriography,CTA)方式回顾性研究中国人群升主及弓部血管的直径、长度特点;方法选择2006年9月至2007年9月接受胸主动脉CT血管造影的患者388例,使用GE公司AW4.2工作站测量升主、弓部、弓上分支的直径及长度数据,运用统计学软件进行分析.结果 冠脉开口以上至左锁骨下动脉以远的主动脉直径D1-D6分别为(34±5)mm;(34±5)mm;(33±4)mm;(30±4)mm;(28±3)mm;(26±3)mm.头臂干两处直径d1,d2分别为(13±2)mm;(13±2)mm.左颈总动脉两处直径d3,d4分别为(8.7±1.5)mm;(7.9±1.0)mm.左锁骨下动脉两处直径d5,d6分别为(10.7±1.7)mm;(9.3±1.3)mm

  12. 主动脉夹层动脉瘤的杂交外科治疗%Hybrid treatment of aortic dissecting aneurysm with entrance in aortic arch

    Institute of Scientific and Technical Information of China (English)

    邬晓臣; 张近宝; 欧阳辉; 丁盛; 岳琴; 周凯; 辛梅; 张宇兵

    2011-01-01

    Objective To observe hybrid surgical techniques and therapeutic effects of vascular prosthesis bridging and endovascular stent graft exclusion in aortic dissecting aneurysm. Methods Thirty-eight patients with aortic dissection (AD) were treated by hybrid surgical treatment, including 19 cases of left-right common carotid arteries bypass graft, 12 cases of common carotid artery-ascending aorta bypass graft, 4 cases of common carotid artery-subclavian artery bypass graft and 3 cases of abdominal aorta-bilateral renal artery bypass graft. Clinical and computed tomography outcome were analyzed during follow-up. Results Successful operation was performed in all cases, with tiny incision and complete disappearance of the false lumen or remarkable decrease of the endoleak on the angiograms. No case of stent migration, 1 case of internal hemorrhage due to trauma, 3 cases of new breaks were observed and cured by endovascular graft exclusion. There were 2 cases of death. Conclusion Hybrid surgical procedure, with fewer complications and quicker recovery, has great therapeutic effect in treatment of aortic dissection.%目的 探讨主动脉弓部破口的主动脉夹层动脉瘤的杂交外科治疗经验.方法 分析应用杂交外科手术治疗38例主动脉夹层患者,按照架桥方法及术式分为:颈总动脉间架桥加腔内隔绝术19例,颈总动脉-升主动脉架桥加腔内隔绝术12例,颈总动脉-锁骨下动脉架桥加腔内隔绝术4例,腹主动脉-双侧肾动脉架桥加腔内隔绝术3例.结果 所有患者夹层破口均被闭合,恢复真腔血流,住院死亡2例(成功率5.2%),术后复查均未发生支架移位,1例原夹层破口处出现内漏,3例出现新破口,再次分别行腔内支架隔绝治愈.结论 主动脉夹层动脉瘤可通过外科手术结合腔内隔绝介入的综合外科治疗方案可以取得良好的效果,降低手术风险,提高手术治愈率.

  13. Associated bare stenting of distal aorta with a Djumbodis® system versus conventional surgery in type A aortic dissection

    Science.gov (United States)

    Sirota, Dmitry; Nader, Joseph; Lyashenko, Maxim; Chernyavsky, Alexander

    2016-01-01

    Background The effectiveness of additional stenting of the distal aorta as compared to conventional surgery alone in type A aortic dissection (TAD) has yet to be proven. Methods We conducted this multicenter comparative study to evaluate the effects of antegrade bare stenting of the dissected aorta beyond the distal anastomosis with a Djumbodis® device system (DDS). Outcomes that were measured included early outcomes, overall mortality from aortic cause and late aortic events including re-interventions. A consecutive series of 134 patients operated on in two participating centers were distributed into study and control groups according to the treatment received: conventional surgery with DDS (DJ group, n=42) or without (control group, n=92). Results Operative mortality was 21.4% and 17.6% in the DJ and control groups, respectively (P=0.9), and was within pre-specified alarm lines for both groups. In multivariate analysis, the only independent predictor of operative mortality was the presence of any complication (cardiac tamponade or malperfusion, P=0.05), which occurred more in the DJ group (OR =1.3; non-significant). Sixty patients were included into the matched survivors cohorts study (propensity scoring). The aortic event-free survival at 7 years for early survivors was 77%±10% and 48%±11% in the matched DJ group and control group, respectively (HR =0.66). Late mortality from an aortic cause was 10% and 20% in the matched DJ group and control group, respectively (RR =0.5). Actuarial freedom from aortic or vascular interventions was 71%±10% and 67%±9% in the matched DJ and control group, respectively. Operative mortality was not influenced by the use of DDS as compared to conventional surgery alone for TAD. Conclusions We observed a trend towards better organ perfusion in the DJ group postoperatively, and more aortic events and deaths of aortic cause in the control group during follow-up. PMID:27563546

  14. Pericarditis as initial manifestation of proximal aortic dissection in young patients.

    Science.gov (United States)

    Bains, Suchdeep Raj; Kedia, Anita; Roldan, Carlos A

    2008-03-01

    Pericarditis was the primary manifestation of aortic dissection in these 2 young men. Both patients had no phenotypic characteristics of Marfan or Ehlers-Danlos syndrome. These patients had pleuritic chest pain and characteristic electrocardiographic changes consistent with pericarditis. However, timely performed transthoracic echocardiograms revealed proximal aortic dissection with hemopericardium noted at surgery in both cases. Although the sensitivity of transthoracic echocardiogram for proximal aortic dissection is approximately 60%, certain findings can alert the physician to the possibility of aortic dissection. Therefore, in young patients with suspected pericarditis, a timely performed transthoracic echocardiogram should include a careful evaluation of the ascending aorta and arch to rule out this lethal diagnosis. PMID:18358965

  15. Surgical Treatment of Aortic Aneurysm and Aortic Dissection:A Retrospective Analysis of 122 Cases

    Institute of Scientific and Technical Information of China (English)

    Tucheng SUN; Xionggang JIANG; Kailun ZHANG; Jie CAI; Shu CHEN; NYANGASSA B J; Zongquan SUN

    2009-01-01

    The study summarizes the clinical experience of surgical treatments of various types of thoracic aneurysm and aortic dissection.Clinical data of 122 patients with thoracic aneurysm and aortic dissection during July 2005 to July 2008 were retrospectively analyzed.The elective operations were performed in 107 patients while emergency surgery was done in 15 cases.Different surgical strategies were employed on the basis of diseased region,including simple ascending aortic replacement (n=3),aortic root replacement (n=43),hemi-arch replacement/total arch replacement + elephant trunk technique (n=32),thoracic/thoracoabdominal aortic replacement (n=8) and endovascular repair (n=36).In this series,there is 4 cases of perioperative death due to massive cerebral hemorrhage (n=1),respiratory failure (n=1) and multiple organ dysfunction syndrome (MODS) (n=2).Three cases developed post-operative massive cerebral infarction and the relatives of the patients abandoned treatment.Instant success rate of endovascular repair was 100%.The intimal rupture was sealed.Blood flow was unobstructed in true lumen and no false lumen was visualized.It was concluded that aggressive surgery should be considered in the patients with thoracic aneurysm and aortic dissection.Surgical procedures should vary with the location and the nature of the lesions.

  16. Health-related quality-of-life in patients after elective surgery for abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Ehlers, Lars Holger; Laursen, Kathrine Bang; Berg Jensen, Morten

    2011-01-01

    Purpose: The purpose of this study was to describe the health-related quality-of-life (QoL) in patients after elective surgery for abdominal aortic aneurysm (AAA) compared to a normal population and to study the association between QoL and number of years since surgery. Methods: All Danish men who...... underwent elective surgery for AAA at the age of 65 or more in the period from 1989–2007 in Denmark were invited to participate in the survey. Of 722 patients, 375 were alive and 328 (87%) responded. The nstruments EQ-5D (European Quality of life), EQ-VAS and SF-12 (Short Form Health Survey) were applied...... for measuring health-related QoL. Multiple regression analysis was used to study the association between QoL and number of years since AAA surgery. Results: A significantly poorer QoL was found in patients having had AAA surgery compared to the normal population as measured with the SF-12 and the EQ...

  17. Duration of deep hypothermia during aortic surgery and the risk of perioperative blood transfusion

    Directory of Open Access Journals (Sweden)

    Michael Mazzeffi

    2012-01-01

    Full Text Available Deep hypothermia, which is used during thoracic aortic surgery for neuroprotection, is associated with coagulation abnormalities in animal and in vitro models. However, there is a paucity of data regarding the impact of deep hypothermia duration on perioperative bleeding. The objective of the current study was to examine the relationship between the duration of deep hypothermia and perioperative bleeding. A retrospective review of 507 consecutive thoracic aortic surgery patients who had surgery with deep hypothermic circulatory arrest was performed. The degree of bleeding and coagulopathy was estimated using perioperative transfusion. Log linear modeling with Poisson regression was used to analyze the relationship between deep hypothermia duration and perioperative bleeding, while controlling for other preselected variables. There was a significant association between deep hypothermia duration and RBC transfusion (P = 0.001. There was no significant association between deep hypothermia duration and FFP and platelet transfusion (P = 0.18 and P = 0.06. The association between deep hypothermia duration and the amount of bleeding (RBC transfusion was dependent on total CPB time. In general, for shorter CPB times (approximately 120 to 180 minutes there was an upward sloping line or positive relationship between deep hypothermia duration and bleeding. However, for cases with longer CPB times (300 to 360 minutes, there was no such relationship. The relationship between deep hypothermia duration and perioperative bleeding is dependent on CPB time. For surgeries with short CPB times (120 to 180 minutes, prolonged deep hypothermia is associated with increased post-operative bleeding, as estimated by RBC transfusion. For cases with longer CPB times (300 to 360 minutes, there appears to be no relationship.

  18. A Fatal Aortoesophageal Fistula Caused by Critical Combination of Double Aortic Arch and Nasogastric Tube Insertion for Superior Mesenteric Artery Syndrome

    Directory of Open Access Journals (Sweden)

    Tomofumi Miura

    2010-06-01

    Full Text Available Double aortic arch (DAA is a rare vascular congenital abnormality. Since a vascular ring surrounds bronchus and esophagus, any oral or nasal intubation can physically cause fatal aortoesophageal fistula (AEF. We report herein the first case of association of DAA and superior mesenteric artery (SMA syndrome and the second case of AEF caused by nasogastric intubation in an adult with DAA. A 19-year-old woman visited our hospital for nausea and vomiting. She was diagnosed with SMA syndrome by computed tomography (CT. Nasogastric intubation relieved her symptoms in 4 days. Extramural compression with top ulceration was found in esophagogastroduodenoscopy on the 5th hospital day. She suddenly showed massive hematemesis on the 12th hospital day. AEF was found by CT. Soon, she died despite of intensive care. Retrospective interview disclosed the fact that DAA was pointed out in her childhood. We conclude that intubation must be avoided in DAA and a detailed clinical interview about DAA is mandatory to avoid AEF.

  19. “烟囱”技术在治疗累及主动脉弓分支动脉的Stanford B型主动脉夹层中的应用%Endovascular aortic repair plus chimney technique in the treatment of Stanford type B aortic dissection involving aortic arch

    Institute of Scientific and Technical Information of China (English)

    舒畅; 王暾; 黎明; 李鑫; 李全明; 方坤

    2012-01-01

    Objective To evaluate the efficacy of endovascular aortic repair plus chimney technique in the treatment of Stanford type B aortic dissection involving aortic arch.Methods From June 2009 to March 2012,32 patients of aortic arch dissection with primary entry tear next to the orifices of supra-aortic arteries were treated with chimney technique.Chimney technique was used to reconstruct left subclavian artery (n =2) and left common carotid artery (n =28).Double chimney technique was use to reconstruct innominate artery and left common carotid artery simultaneously in 2 patients.Results Four patients received emergency operation.All patients survived and were followed up for 14.3 ± 7.4 months.No type Ⅰ endoleak occurred.Among 4 patients with Type Ⅱ endoleak,3 received PDA occluding implantation in left subclavian artery and 1 patient in puerperium with Marian syndrome and pregnancy-induced hypertension syndrome recovered by conservative treatment.No severe neurological complications and left subclavian artery ischemia occurred.The locations of aortic and chimney stent-grafts were stable without any migration.All stent-grafts remained patent.Conclusion Endovascular aortic repair plus chimney technique is a safe and effective treatment for Stanford type B aortic dissection involving aortic arch.%目的 探讨“烟囱”技术在累及主动脉弓部分支动脉的Stanford B型夹层的治疗作用.方法 对2009年6月至2012年3月中南大学湘雅二医院血管外科采用“烟囱”技术治疗的第一破口邻近主动脉弓部分支动脉起始端的32例Stanford B型主动脉夹层患者进行回顾性研究.“烟囱”技术重建左锁骨下动脉2例,重建左颈总动脉28例,采用“双烟囱”技术同时重建无名动脉和左颈总动脉2例.结果 急诊手术4例.手术成功率100%,无Ⅰ型内漏发生.4例发生左锁骨下动脉Ⅱ型内漏,3例采用PDA封堵器封堵内漏,1例合并Marfan综合征和妊高症,予以保守治疗,11

  20. Outcomes of single-stage total arch replacement via clamshell incision

    Directory of Open Access Journals (Sweden)

    Ishizaka Toru

    2011-09-01

    Full Text Available Abstract Background Treatment of complex aortic pathologies involving the transverse arch with extensive involvement of the descending aorta remains a surgical challenge. Since clamshell incision provides superior exposure of the entire thoracic aorta, we evaluated the use of this technique for single-stage total arch replacement by arch vessel reconstruction. Methods The arch-first technique combined with clamshell incision was used in 38 cases of aneurysm and aortic disease in 2008 and 2009. Extensive total arch replacement was used with clamshell incision for reconstruction of arch vessels under deep hypothermic circulatory arrest. Results Overall 30-day mortality was 13%. The mean operating time was approximately 8 hours. Deep hypothermia resulted in mean CPB time exceeding 4.5 hours and mean duration of circulatory arrest was 25 minutes. The overall postoperative temporary and permanent neurologic dysfunction rates were 3% and 3% for elective and 3% and 0% for emergency surgery, respectively. All patients except the five who died in hospital were discharged without nursing care after an average post-operative hospital stay of 35 days. Conclusions The arch-first technique, combined with clamshell incision, provides expeditious replacement of the thoracic aorta with an acceptable duration of hypothermic circulatory arrest and minimizes the risk of retrograde atheroembolism by using antegrade perfusion.

  1. Brachiocephalic Artery Cannulation in Proximal Aortic Surgery that Requires Circulatory Arrest

    Science.gov (United States)

    Unal, Mehmet; Akar, Ilker; Ince, Ilker; Aslan, Cemal; Koc, Fatih; Kafali, Haluk

    2014-01-01

    The brachiocephalic artery is an alternative cannulation site in the repair of ascending aortic lesions that require circulatory arrest. We evaluate the effectiveness and safety of this technique. Proximal aortic surgery was performed in 32 patients from 2006 through 2012 via brachiocephalic artery cannulation and circulatory arrest. Twenty-four (75%) of the patients were men. The mean age was 48.69 ± 9.43 years (range, 30–68 yr). Twelve had type I dissection, 2 had type II dissection, and 18 had true aneurysms of the ascending aorta. All operations were performed through a median sternotomy. The arterial cannula was inserted through an 8-mm vascular graft anastomosed to the brachiocephalic artery in an end-to-side fashion. In dissections, the distal anastomosis was performed without clamping the aorta. The patients were cooled to 24 °C, and circulatory arrest was established. The brachiocephalic and left carotid arteries were clamped, and antegrade cerebral perfusion was started at a rate of 10 mL/kg/min. Cardiopulmonary bypass was resumed after completion of the distal anastomosis and the initiation of rewarming. The proximal anastomosis was then performed. None of the patients sustained a major neurologic deficit, but 5 patients experienced transient postoperative agitation (<24 hr). There were 2 early deaths (6.25%), on the 3rd and the 11th postoperative days, both unrelated to the cannulation technique. Brachiocephalic artery cannulation through a graft can be a safe and effective technique in proximal aortic surgical procedures that require circulatory arrest. PMID:25593522

  2. Inflammatory aortic arch syndrome: contrast-enhanced, three-dimensional MR - angiography in stenotic lesions; Entzuendliches Aortenbogensyndrom: Stenosediagnostik mittels kontrastmittelverstaerkter 3D-MR-Angiographie im Vergleich mit der DSA

    Energy Technology Data Exchange (ETDEWEB)

    Both, M.; Mueller-Huelsbeck, S.; Biederer, J.; Heller, M.; Reuter, M. [Universitaetsklinikum Schleswig-Holstein, Kiel (Germany). Klinik fuer Diagnostische Radiologie; Reinhold-Keller, E.; Gross, W.L. [Rheumaklinik Bad Bramstedt GmbH (Germany)

    2004-01-01

    Purpose: To determine the value of contrast-enhanced, three-dimensional MR angiography for the evaluation of stenotic and occlusive vascular lesions in inflammatory aortic arch syndrome. Materials and Methods: 14 patients with inflammatory aortic arch syndrome (giant cell arteritis: n = 8, Takayasu arteritis: n = 4, ankylosing spondylitis: n = 1 sarcoidosis: n = 1) underwent MR angiography of the aortic arch and the supra-aortic vessels (n = 15,2 patients were examined twice) and of the abdominal aorta (n = 2). MRA was performed using a 3D-FLASH sequence (TR/TE 4.6/1.8 ms, flip angle 30 ) on a 1.5T system. MRA imaging was compared with the findings of DSA, which served as gold standard. Results: In a total of 467 examined vascular territories, DSA revealed 50 stenoses and 35 occlusions. All lesions were detected by MRA. In 23 segments, the degree of stenosis was overestimated by MRA. Sensitivity and specificity of MRA were 100% and 94,3%, positive and negative predictive values were 73.6 and 100%, and the accuracy was 95,1%. Conclusions: Despite a tendency to overestimate stenoses, contrast-enhanced three-dimensional MR angiography is a valid, non-invasive technique in the assessment of inflammatory aortic arch syndrome. (orig.) [German] Ziel: Bestimmung der Aussagekraft der kontrastmittelverstaerkten 3D-Magnetresonanzangiographie bei der Bewertung stenosierender und okkludierender Gefaessveraenderungen im Rahmen des entzuendlichen Aortenbogensyndroms. Material und Methoden: Bei 14 Patienten mit entzuendlichem Aortenbogensyndrom (Arteriitis temporalis: n = 8, Takayasu-Arteriitis: n = 4, Morbus Bechterew: n = 1, Sarkoidose: n = 1) erfolgte eine MRA des Aortenbogens und der supraaortalen Aeste (n = 15, darunter zwei Doppeluntersuchungen) sowie der Aorta abdominalis (n = 2). Zur Anwendung kam eine kontrastmittelverstaerkte 3D-FLASH-Sequenz (TR/TE 0,4/1,8 ms, Flipwinkel 30 ) an einem 1,5 Tesla-System. Die Befunde der MRA wurden mit der DSA als Referenzmethode

  3. The use of methylene blue in abdominal aortic surgery: a case report.

    Science.gov (United States)

    Piraccini, E; Agnoletti, V; Corso, R; Maitan, S; Gambale, G

    2010-01-01

    The open abdominal aortic surgery includes a well-known phase in which arterial blood flow is stopped by occluding clamps, resulting in peculiar physiologic changes usually superimposed on advanced pathologic conditions. An anesthetic plan should aim at providing hemodynamic stability and preserving organ function. Clamp removal leads to an acute fall in blood pressure following a decrease in systemic vascular resistance, caused by reactive hyperemia due to opening of the previously minimally perfused vascular beds. Several different mediators, including the nitrous oxide (NO) pathway, have been thought to be responsible for this hemodynamic effect. The massive production of NO by the inducible isoform of NO synthase could be partially responsible for the profound vasodilatation and myocardial dysfunction. The dye methylene blue (MB) has been used as to prevent vasodilatation in other clinical situations like sepsis, cardiopulmonary bypass and liver transplantation. We describe its use in a patient with poor hemodynamic status, who was submitted to aortic aneurism repair with infrarenal cross clamp. The intervention was also associated with a severe bleeding. In this case MB allowed us to control hypotension with relatively low doses of vasopressors. PMID:23440623

  4. Surgical treatment of interrupted aortic arch associated with ventricular septal defect and patent ductus arteriosus in patients over one year of age

    Institute of Scientific and Technical Information of China (English)

    Li Zhiqiang; Li Bin; Fan Xiangming; Su Junwu; Zhang Jing; He Yan; Liu Yinglong

    2014-01-01

    Background Interrupted aortic arch (IAA) is a rare congenital anomaly affecting 1.5% of infants with congenital heart disease.Neonatal repair of IAA is required to avoid irreversible pulmonary vascular lesion.However,in China,patients with IAA associated with ventricular septal defect (VSD) and patent ductus arteriosus (PDA) over one year of age are common.So we investigated the outcome of surgical treatment of IAA with VSD and PDA in patients over one year of age.Methods From January 2009 to December 2012,19 patients with IAA have undergone complete single-stage repair.The patients' mean age was 4.4 years,ranging 1 to 15 years; and their mean weight was 12.8 kg,ranging 4.2 to 36.0 kg.Fifteen IAA were type A,four were type B.Preoperative cardiac catheterization data were available from all patients.Mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) were measured.The measurements of postoperative pulmonary artery pressure were taken in the operating room at the end of the case.All patients underwent echocardiographic examinations before discharged from the hospital.In addition,cardiac catheterization and echocardiographic examinations were performed during follow-up.Selective brain perfusion through the innominate artery during aortic arch reconstruction was used in all patients.Mean follow-up was (1.6±0.8) years.Results There were two hospital deaths (2/19,11%).One patient died of pulmonary hypertension crisis,and another died of postoperative low cardiac output.Five cases had other main postoperative complications but no postoperative neurologic complications.Seventeen survivors were followed up,and there were no late deaths or reoperation.Mean cross-clamp duration was (85±22) minutes and selective brain perfusion duration was (34±11) minutes.Two patients required delayed sternal closure at two days postoperatively.Intensive care unit and hospital stays were (9±8) days and (47±24) days,respectively.Pressure gradients across

  5. [Peritoneal dialysis in a patient with right hemiparesis, lupus nephritis, significant insufficiency of arteries of aortic arch and celiac disease: case report].

    Science.gov (United States)

    Altabas, Karmela; Crne, Natasa; Franjić, Björn Dario; Pavlović, Drasko; Josipović, Josipa

    2012-10-01

    Peritoneal dialysis (PD) is a method of choice in patients in whom there are difficulties concerning creation of AV fistula. A 38-year old female patient came to our hospital because of a need of making an AV fistula. She had end-stage renal insufficiency of unknown origin. She had a right hemiparesis with a contracture of the right fist and epilepsy because of the stroke she suffered in 1993. After doing the diagnostics, we have found that patient had lupus nephritis, occlusion of brachiocephalic trunk, right and left common carotid artery and left subclavian artery. We also diagnosed celiac disease and a significant anemia. It was not possible to form an AV fistula, as it was not possible to do an assisted PD. Because of the right hemiparesis and contracture of the right fist, the possibility of performing PD independently was questionable. Despite the handicap, the patient had strong motivation and she managed to master the technique of PD independently. Even though it was estimated that she had a high risk score for applying anesthesia (ASA IV), the insertion of the peritoneal catheter went without complications. Because of the comorbidity, especially because of the significant stenosis and occlusions of the arteries of aortic arch, the kidney transplantation will not be performed. In the last fifteen months, the patient is performing PD independently, without any infectious complications, she is feeling well and is satisfied with the quality of her life. The consequences of the renal insufficiency are under control, systemic lupus erythematosus is, with a low dose of corticosteroids, in a steady state, malnutrition is corrected, but there is still hypoalbuminemia noted.

  6. Distal small bowel motility and lipid absorption in patients following abdominal aortic aneurysm repair surgery

    Institute of Scientific and Technical Information of China (English)

    Robert J Fraser; Paul Jury; John Dent; Marc Ritz; Addolorata C Di Matteo; Rosalie Vozzo; Monika Kwiatek; Robert Foreman; Brendan Stanley; Jack Walsh; Jim Burnett

    2006-01-01

    AIM: To investigate distal small bowel motility and lipid absorption in patients following elective abdominal aortic aneurysm (AAA) repair surgery.METHODS: Nine patients (aged 35-78 years; body mass index (BMI) range: 23-36 kg/m2) post-surgery for AAA repair, and seven healthy control subjects (20-50 years;BMI range: 21-29 kg/m2) were studied. Continuous distal small bowel manometry was performed for up to 72 h, during periods of fasting and enteral feeding (Nutrison(R)). Recordings were analyzed for the frequency,origin, length of migration, and direction of small intestinal burst activity. Lipid absorption was assessed on the first day and the third day post surgery in a subset of patients using the 13C-triolein-breath test, and compared with healthy controls. Subjects received a 20-min intraduodenal infusion of 50 mL liquid feed mixed with 200 μL 13C-triolein. End-expiratory breath samples were collected for 6 h and analyzed for 13CO2 concentration.RESULTS: The frequency of burst activity in the proximal and distal small intestine was higher in patients than in healthy subjects, under both fasting and fed conditions (P<0.005). In patients there was a higher proportion of abnormally propagated bursts (71% abnormal), which began to normalize by d 3 (25% abnormal) post-surgery.Lipid absorption data was available for seven patients on d 1 and four patients on d 3 post surgery. In patients,absorption on d 1 post-surgery was half that of healthy control subjects (AUC 13CO2 1323 ± 244 vs 2 646 ±365;P< 0.05, respectively), and was reduced to the one-fifth that of healthy controls by d 3 (AUC 13CO2 470 ± 832 vs 2646 ± 365; P< 0.05, respectively).CONCLUSION: Both proximal and distal small intestinal motor activity are transiently disrupted in critically ill patients immediately after major surgery,with abnormal motility patterns extending as far as the ileum. These motor disturbances may contribute to impaired absorption of enteral nutrition, especially when

  7. Implant restoration of edentulous jaws with 3D software planning, guided surgery, immediate loading, and CAD-CAM full arch frameworks

    OpenAIRE

    Silvio Mario Meloni; Giacomo De Riu; Milena Pisano; Francesco Maria Lolli; Alessandro Deledda; Guglielmo Campus; Antonio Tullio

    2013-01-01

    Purpose. The aim of this study was to analyze the clinical and radiographic outcomes of 23 edentulous jaws treated with 3D software planning, guided surgery, and immediate loading and restored with CAD-CAM full arch frameworks. Materials and Methods. This work was designed as a prospective case series clinical study. Twenty patients have been consecutively rehabilitated with an immediately loaded implant supported fixed full prosthesis. A total of 120 fixtures supporting 23 bridges were place...

  8. Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection

    DEFF Research Database (Denmark)

    Bonser, Robert S; Ranasinghe, Aaron M; Loubani, Mahmoud;

    2011-01-01

    malperfusion complications are necessary. The goals of surgery are to save life by prevention of pericardial tamponade or intra-pericardial aortic rupture, to resect the primary entry tear, to correct or prevent any malperfusion and aortic valve regurgitation, and if possible to prevent late dissection...

  9. Long-term implications of emergency versus elective proximal aortic surgery in Marfan syndrome patients in the GenTAC Registry

    Science.gov (United States)

    Song, Howard K.; Kindem, Mark; Bavaria, Joseph E.; Dietz, Harry C.; Milewicz, Dianna M.; Devereux, Richard B.; Eagle, Kim A.; Maslen, Cheryl L.; Kroner, Barbara L.; Pyeritz, Reed E.; Holmes, Kathryn W.; Weinsaft, Jonathan W.; Menashe, Victor; Ravekes, William; LeMaire, Scott A.

    2011-01-01

    Objective Marfan syndrome patients with aortic root aneurysms undergo elective aortic root replacement to avoid the life-threatening outcomes of aortic dissection and emergency repair. The long-term implications of failed aortic surveillance leading to acute dissection and emergency repair are poorly defined. We compared the long-term clinical courses of Marfan syndrome patients who survive emergency versus elective proximal aortic surgery. Methods The GenTAC Registry is an NIH-funded, multicenter database and biorepository that enrolls patients with genetically triggered thoracic aortic aneurysms. Of the 635 patients with Marfan syndrome enrolled as of March 2011, 194 had undergone proximal aortic replacement. Patients were grouped according to emergent (n=47) or elective (n=147) status at the time of surgery. Results Patients in the emergent group were more likely to have incomplete proximal aortic resection; 83% of emergency procedures included aortic root replacement, compared with 95% of elective procedures. At long-term follow-up (mean, >6 years), emergent patients had a higher incidence of chronic dissection of the distal aorta and had significantly larger diameters in distal aortic segments than elective patients. Additionally, emergent patients had undergone more operations (1.31 vs 1.11 procedures/patient; P=0.01) and had lower activity scores on a health-related quality-of-life survey. Conclusions For Marfan syndrome patients, failed aortic surveillance and consequent emergency dissection repair have important long-term implications with regard to status of the distal aorta, the need for multiple procedures, and quality of life. These findings emphasize the importance of aortic surveillance and timely elective aortic root aneurysm repair for Marfan syndrome patients. PMID:22104675

  10. Incidence of coronary artery disease before valvular surgery in isolated severe aortic stenosis

    Institute of Scientific and Technical Information of China (English)

    Eun Jeong Cho; Sung-Ji Park; Sung-A Chang; Dong Seop Jeong; Sang-Chol Lee; Seung Woo Park; Pyo Won Park

    2014-01-01

    Background Angina pectoris has been recognized as one of the principal symptoms of aortic valve stenosis (AS),even in patients without significant coronary artery disease (CAD).However,the incidence of angina pectoris and related CAD in such patients is controversial.There is continuing debate as to whether coronary angiography is necessary before aortic valve replacement (AVR) in patients with severe AS.The purpose of this study was to evaluate the incidence and predictors of CAD in patients with severe AS in a Korean population.Methods Data from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Korea were entered in a prospective registry beginning in 1995.Clinical and echocardiographic follow-up data were recorded into the database annually.Significant CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70% and left main coronary arteries having an estimated narrowing of ≥50% on coronary angiography.We excluded patients with multiple valve disease,significant aortic regurgitation,or prior CAD or valve surgery.Results Totally 574 patients with severe AS (mean age,(65.9±9.6) years) were enrolled in this study.Significant CAD was found in 61 patients (10.6%).Factors associated with increased likelihood of CAD were age,hypertension,diabetes mellitus,chronic renal failure,carotid disease,and aorta calcification.In Logistic regression analysis,the independent predictor of the presence of CAD was age (P=0.011).The incidence of CAD increased significantly at 69.2 years of age.Having two risk factors for cardiovascular disease was the most useful cutoff to predict whether a patient was going to have significant CAD.Conclusions There was a low incidence of significant CAD in a population of Korean patients with severe AS.Therefore,coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients more than

  11. 胎儿右位主动脉弓与染色体异常的相关性分析%Correlation between fetal right aortic arch and chromosome abnormality

    Institute of Scientific and Technical Information of China (English)

    刘锦平; 李亮; 王静

    2016-01-01

    目的:对系统超声检出胎儿右位主动脉弓与染色体异常的相关性进行分析。方法采集2009年1月至2014年12月在我院进行系统超声产前筛查19例右位主动脉弓胎儿,所有入选右位主动脉弓胎儿均进行羊水穿刺进行染色体核型分析,评价系统超声检测出的胎儿右位主动脉弓与染色体异常之间的相关性。结果15例右位主动脉弓超声像图表现气管和食管被气管左侧的动脉导管和气管后方的迷走左锁骨下动脉围成一“U”字形血管结构;1例胎儿有双主动脉弓超声主要表现为气管和食管被左右两侧的主动脉弓环绕成一个“O”字形包绕;3例右位主动脉弓胎儿另有左位动脉导管及头臂动脉影像分支,超声图主要表现为动脉导管在三血管-气管切面上并未有显示出来,气管的前方是动脉导管,未形成血管环;19例右位主动脉弓胎儿均进行染色体核型分析,3例伴室间隔缺损、单心房、三尖瓣闭锁、肺动脉狭窄,核型为18-三体;4例伴室间隔缺损、完全性房室通道、单心房、右室双出口、肺动脉狭窄近闭锁,核型为18-三体;3例伴单心室、单心房,核型为21-三体;1例法洛四联症和1例右位心、主动脉狭窄,伴有22q11.2。结论在产前胎儿超声筛查中要重视三血管-气管切面上的超声图像,有助于提高右位主动脉弓的检出率,胎儿右位主动脉弓与18-三体、21-三体等染色体病有明显相关性,若发现胎儿右位主动脉弓,应进行染色体核型进一步分析,排除染色体病变,从而达到优生优育的目的。%Objective To analyze the correlation between fetal right aortic arch and chromosome ab-normality by ultrasound.Methods From January Jan 2009 to Dec 2014,nineteen cases with fetal right aortic arch were enrolled.They were all determined by chromosome karyotype analysis.The correlation of fetal right aortic arch and chromosome abnormalities detected

  12. Speckle-tracking echocardiography for predicting outcome in chronic aortic regurgitation during conservative management and after surgery

    DEFF Research Database (Denmark)

    Olsen, Niels Thue; Søgaard, Peter; Larsson, Henrik B W;

    2011-01-01

    >15%, or decrease in LV ejection fraction >10%). Results Reduced myocardial systolic strain, systolic strain rate, and early diastolic strain rate by speckle-tracking echocardiography was associated with disease progression during conservative management (-16.3% vs. -19.0%, p = 0.02; -1.04 vs. -1.19 s......Objectives The aim of this study was to test myocardial deformation imaging using speckle-tracking echocardiography for predicting outcomes in chronic aortic regurgitation. Background In chronic aortic regurgitation, left ventricular (LV) dysfunction must be detected early to allow timely surgery...... conservatively with frequent clinical visits and sequential echocardiography and followed for an average of 19 ± 8 months, while 29 patients underwent surgery for the valve lesion and were followed for 6 months post-operatively. Baseline LV function by speckle-tracking and conventional echocardiography...

  13. Hybrid procedure for a descending thoracic and subclavian artery aneurysm in a patient with previous abdominal aortic surgery: Case report

    OpenAIRE

    Radak Đorđe; Tanasković Slobodan; Unić-Stojanović Dragana; Jović Miomir; Babić Srđan; Sagić Dragan

    2015-01-01

    Introduction. Hybrid procedures represent staged or simultaneous endovascular and open surgical techniques in the treatment of complex pathologies of the thoracic and abdominal aorta. We are presenting a patient with previous abdominal aortic surgery in whom hybrid vascular procedure for descending aorta and left subclavian artery aneurysm was performed. Case Outline. A 63-year-old female patient was admitted for computed tomography angiography. Descending ...

  14. The effects of aprotinin on blood product transfusion associated with thoracic aortic surgery requiring deep hypothermic circulatory arrest.

    LENUS (Irish Health Repository)

    Seigne, P W

    2012-02-03

    OBJECTIVE: To compare the effects of aprotinin on blood product use and postoperative complications in patients undergoing thoracic aortic surgery requiring deep hypothermic circulatory arrest. DESIGN: A retrospective study. SETTING: A university hospital. PARTICIPANTS: Nineteen patients who underwent elective or urgent thoracic aortic surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The total number of units of packed red blood cells, fresh frozen plasma, and platelets was significantly less in the group that received aprotinin (p = 0.01, 0.04, and 0.01). The intraoperative transfusion of packed red blood cells and platelets, collection and retransfusion of cell saver, and postoperative transfusion of fresh frozen plasma were also significantly less in the aprotinin group (p = 0.01, 0.02, 0.01, and 0.05). No patient in either group sustained renal dysfunction or a myocardial infarction. Two patients who had not received aprotinin suffered from chronic postoperative seizures, and one patient who had received aprotinin sustained a perioperative stroke. CONCLUSIONS: Low-dose aprotinin administration significantly decreases blood product transfusion requirements in the setting of thoracic aortic surgery requiring deep hypothermic circulatory arrest, and it does not appear to be associated with renal or myocardial dysfunction.

  15. Perioperative intra-aortic balloon counterpulsation in a patient with myocardium at risk undergoing urgent noncardiac surgery

    Directory of Open Access Journals (Sweden)

    Tim Nebelsiek

    2015-01-01

    Full Text Available We are presenting the case of a 76-year-old female scheduled for major abdominal surgery. Her past medical history was remarkable for a three-vessel coronary artery disease, with a severely impaired left ventricular function. She had already undergone complex coronary artery bypass surgery. Currently, she presented with the rare constellation of a hemodynamic relevant and interventionally intractable stenosis of the left subclavian artery proximal to a crucial coronary bypass from left internal mammary artery to the left anterior descending. To protect this patient from perioperative myocardial infarction, an intra-aortic balloon pump was successfully used.

  16. Pharmacokinetics and pharmacodynamics of propofol in patients undergoing abdominal aortic surgery.

    Science.gov (United States)

    Wiczling, Paweł; Bienert, Agnieszka; Sobczyński, Paweł; Hartmann-Sobczyńska, Roma; Bieda, Krzysztof; Marcinkowska, Aleksandra; Malatyńska, Maria; Kaliszan, Roman; Grześkowiak, Edmund

    2012-01-01

    Available propofol pharmacokinetic protocols for target-controlled infusion (TCI) were obtained from healthy individuals. However, the disposition as well as the response to a given drug may be altered in clinical conditions. The aim of the study was to examine population pharmacokinetics (PK) and pharmacodynamics (PD) of propofol during total intravenous anesthesia (propofol/fentanyl) monitored by bispectral index (BIS) in patients scheduled for abdominal aortic surgery. Population nonlinear mixed-effect modeling was done with Nonmem. Data were obtained from ten male patients. The TCI system (Diprifusor) was used to administer propofol. The BIS index served to monitor the depth of anesthesia. The propofol dosing was adjusted to keep BIS level between 40 and 60. A two-compartment model was used to describe propofol PK. The typical values of the central and peripheral volume of distribution, and the metabolic and inter-compartmental clearance were V(C) = 24.7 l, V(T) = 112 l, Cl = 2.64 l/min and Q = 0.989 l/min. Delay of the anesthetic effect, with respect to plasma concentrations, was described by the effect compartment with the rate constant for the distribution to the effector compartment equal to 0.240 min(-1). The BIS index was linked to the effect site concentrations through a sigmoidal E(max) model with EC(50) = 2.19 mg/l. The body weight, age, blood pressure and gender were not identified as statistically significant covariates for all PK/PD parameters. The population PK/PD model was successfully developed to describe the time course and variability of propofol concentration and BIS index in patients undergoing surgery.

  17. Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection

    DEFF Research Database (Denmark)

    Bonser, Robert S; Ranasinghe, Aaron M; Loubani, Mahmoud;

    2011-01-01

    Acute type A aortic dissection is a lethal condition requiring emergency surgery. It has diverse presentations, and the diagnosis can be missed or delayed. Once diagnosed, decisions with regard to initial management, transfer, appropriateness of surgery, timing of operation, and intervention for...... malperfusion complications are necessary. The goals of surgery are to save life by prevention of pericardial tamponade or intra-pericardial aortic rupture, to resect the primary entry tear, to correct or prevent any malperfusion and aortic valve regurgitation, and if possible to prevent late dissection......-related complications in the proximal and downstream aorta. No randomized trials of treatment or techniques have ever been performed, and novel therapies-particularly with regard to extent of surgery-are being devised and implemented, but their role needs to be defined. Overall, except in highly specialized centers...

  18. Reoperation on aortic disease in patients with previous aortic valve surgery%主动脉瓣置换术后患者再次主动脉外科干预47例

    Institute of Scientific and Technical Information of China (English)

    张良; 常谦; 孙晓刚; 于存涛; 钱向阳

    2013-01-01

    Objective Retrospectively analyze 47 cases received reoperation with aortic disease after aortic valve replacement to deepen the understanding of aortic valve disease.Methods From January 2003 to June 2012,47 patients with previous aortic valve replacement received aortic root or other aortic operation because of new aortic disease.38 male and 9 female,the interval (6.0 ± 3.8) years. All cases with new aortic disease were diagnosed by cardiac ultrasound and aortic computed tomography.Bentall's procedure were operated on 14 patients,total aortic arch replacement with elephant trunk procedure on 14 patients,aortic root and aortic arch with elephant trunk procedure on 7 patients,ascending aortic replacement on 10patients,total thoracic and abdominal aorta replacement on 2 cases.All patients were followed by clinic interview or telephone.Results Aortic dissection and aneurysmal dilatation were occurred on ascending aorta,each account for 50%,in patients with previous aortic valve replacement because of rheumatic valve disease and bicuspid aortic valve; 3 cases with Marfan syndrome occurred ascending aortic dilatation and 4 cases occurred aortic dissection.Diameter in ascending aorta increased (5.2 + 7.1)mm per year and aortic sinus (3.3 ± 3.1)mm per year.The value of ascending aortic dilatation per year in patients with rheumatic disease was higher than patients with Marfan syndrome(P < 0.05).47 patients were re-operated in fuwai hospital,1 patients died in operating room because aortic dissection seriously involved right coronary artery.7 patients have renal insufficiency after operation and all were cured by hemofiltration; neurological complication occurred in 14 patients including that 7 patients stroked and 7 patients had transient brain dysfunciotn.There were no postoperative spinal cord deficits occurred.All patients were followed up,the mean follow up time were(53.49 +33.79) months.8 cases were died during follow-up and threeyear survival rate was 83

  19. Aortic aneurysm surgery: problems and innovations Cirurgia do aneurisma aórtico: problemas e inovações

    Directory of Open Access Journals (Sweden)

    Ralf Kolvenbach

    2009-12-01

    Full Text Available A long way was traveled since the first surgery was performed for the treatment of abdominal aortic aneurysm. Throughout this time, several innovations have been created in order to reduce the invasiveness of the surgical procedures and to improve their safety and durability. This review discusses the major and recent advances on aortic aneurysm interventions, including, the endovascular aortic repair, the laparoscopic aortic surgery, the conventional hybrid and endovascular techniques, combined laparoscopic and endovascular techniques, as well as future prospects for both thoracic and abdominal aorta. Faced with so many changes and developments, modern vascular surgeons must keep their minds open to innovations and should develop comprehensive training with different techniques, to provide the best therapeutic option for their patients.Um longo caminho foi percorrido desde as primeiras intervenções cirúrgicas feitas para o tratamento do aneurisma de aorta abdominal. Ao longo deste tempo, várias inovações foram criadas, no sentido de reduzir a invasividade dos procedimentos e melhorar sua segurança e durabilidade. Nesta revisão, são discutidos os principais e recentes avanços em intervenções sobre aneurismas aórticos, incluindo a restauração aórtica endovascular, a cirurgia aórtica videolaparoscópica, as técnicas híbridas convencionais e endovasculares, as técnicas combinadas videolaparoscópicas e endovasculares, bem como as perspectivas futuras, tanto para aorta torácica como abdominal. Diante de tantas transformações e evolução, o cirurgião vascular moderno terá que ter sua mente aberta para as novidades e desenvolver capacitação ampla com diferentes técnicas para proporcionar a melhor opção terapêutica para seus pacientes.

  20. Perioperative glutamine supplementation restores disturbed renal arginine synthesis after open aortic surgery: a randomized controlled clinical trial.

    Science.gov (United States)

    Brinkmann, Saskia J H; Buijs, Nikki; Vermeulen, Mechteld A R; Oosterink, Efraim; Schierbeek, Henk; Beishuizen, Albertus; de Vries, Jean-Paul P M; Wisselink, Willem; van Leeuwen, Paul A M

    2016-09-01

    Postoperative renal failure is a common complication after open repair of an abdominal aortic aneurysm. The amino acid arginine is formed in the kidneys from its precursor citrulline, and citrulline is formed from glutamine in the intestines. Arginine enhances the function of the immune and cardiovascular systems, which is important for recovery after surgery. We hypothesized that renal arginine production is diminished after ischemia-reperfusion injury caused by clamping of the aorta during open abdominal aortic surgery and that parenteral glutamine supplementation might compensate for this impaired arginine synthesis. This open-label clinical trial randomized patients who underwent clamping of the aorta during open abdominal aortic surgery to receive a perioperative supplement of intravenous alanyl-glutamine (0.5 g·kg(-1)·day(-1); group A, n = 5) or no supplement (group B, n = 5). One day after surgery, stable isotopes and tracer methods were used to analyze the metabolism and conversion of glutamine, citrulline, and arginine. Whole body plasma flux of glutamine, citrulline, and arginine was significantly higher in group A than in group B (glutamine: 391 ± 34 vs. 258 ± 19 μmol·kg(-1)·h(-1), citrulline: 5.7 ± 0.4 vs. 2.8 ± 0.4 μmol·kg(-1)·h(-1), and arginine: 50 ± 4 vs. 26 ± 2 μmol·kg(-1)·h(-1), P glutamine (4.8 ± 0.7 vs. 1.6 ± 0.3 μmol·kg(-1)·h(-1)), citrulline from arginine (2.3 ± 0.3 vs. 0.96 ± 0.1 μmol·kg(-1)·h(-1)), and arginine from glutamine (7.7 ± 0.4 vs. 2.8 ± 0.2 μmol·kg(-1)·h(-1)), respectively (P arginine is severely reduced after clamping during aortic surgery. This study shows that an intravenous supplement of glutamine increases the production of citrulline and arginine and compensates for the inhibitory effect of ischemia-reperfusion injury.

  1. Bio-Bentall procedure in surgery for complex aortic valve-ascending aortic disease%Bio-Bentall手术治疗复杂主动脉瓣-升主动脉疾病

    Institute of Scientific and Technical Information of China (English)

    杨岷; 束余声; 石维平; 樊纪丹; 尤庆生; Otto E.Dapunt

    2012-01-01

    目的 报道应用无支架全主动脉根部生物瓣膜进行全主动脉根部置换术(Bio-Bentall手术)的早、中期临床效果.方法 回顾2001年11月到2009年3月病例,317例接受Bio-Bentall手术,男196例,女121例;年龄17 ~ 94岁,平均(70.3±10.2)岁,大于75岁的患者97例.均应用MedtronicFreestyle无支架全主动脉根部生物瓣膜进行全主动脉根部置换.203例患者仅行全主动脉根部置换或者主动脉根部置换加升主动脉置换(ARR),114例同期行其他手术(ARR+),其中冠状动脉旁路移植术82例,主动脉弓置换术36例,二尖瓣成形术11例.结果 ARR手术(190±57) min,主动脉阻断( 88±27) min.ARR+手术(282±93) min,主动脉阻断(110 -32) min.手术死亡25例,占7.9%.ARR者死亡11例,占5.4%;住ICU(4.9 ±8.1)天,住院(9.8±8.1)天.ARR组3例紧急行冠状动脉旁路移植手术.术后超声心动图显示跨瓣膜压力阶差低,尤其行间断单纯缝合(非褥式缝合)者压差更小.结论 Bio-Bentall手术保留了猪主动脉根部的完整性,不增加围术期和远期病死率,尤其适合小主动脉根部的老年主动脉瓣膜患者.%Objective The stentless full root aortic bioprosthesis has superior hemodynamics.Clinical data of Bio-Bentall procedure using stentless full root bioprosthesis of our center was retrospectively analyzed in this perspective for validation.Methods From November 2001 to March 2009,317 adult patients ( 196 male and 121 female) underwent modified Bio-Bentall procedure using the Medtronic Freestyle xenograft as a full root replacement.Two hundred and three patients received an isolated root replacement or a root and ascending aortic replacement (ARR).In 114 patients a variety of concomitant procedures including coronary artery bypass grafting ( n =32 ),mitral valve repair ( n =11 ) and aortic arch replacement ( n =36 ) were performed.(ARR + ).Results Mean patient age was (70.3 ± 10.2) years (range 17 -94 years),97 patients were 75 and

  2. Endovascular procedures, carotid endarterectomies, and aortic surgery should preferentially be done by a vascular trainee rather than a general surgery resident.

    Science.gov (United States)

    Seabrook, Gary R; Sharp, John

    2005-03-01

    This article is the result of a debate. The motion proposed was that "endovascular procedures, carotid endarterectomies, and aortic surgery should be done preferentially by a vascular trainee rather than a general surgery resident.'' Arguments in favor of the motion were that with the development of endovascular surgery, there are now less open vascular procedures to perform and hence, vascular trainees needed to hone their skills on these limited cases rather than waste that experience on a general surgery resident. This focused training experience would allow vascular fellows to be become more highly skilled vascular surgeons. Additionally, endovascular procedures are an important component of modern vascular surgery, and it is important for the vascular fellow to develop significant experience with and acquire the appropriate numbers of endovascular cases to get the necessary credentials when going into a vascular practice. Arguments against the motion were that exposure to vascular cases will make a better general surgeon, one who will also be well equipped to deal with trauma cases and situations where the control of bleeding might be life saving. Additionally, the issue of exposure of general surgery residents to vascular cases might be a positive recruitment strategy for future vascular fellows. The motion was carried by a small majority vote.

  3. Aortic stenting.

    Science.gov (United States)

    Droc, Ionel; Calinescu, Francisca Blanca; Droc, Gabriela; Blaj, Catalin; Dammrau, Rolf

    2015-01-01

    The approach to aortic pathology is nowadays more and more endovascular at both thoracic and abdominal levels. Thoracic stenting has gained worldwide acceptance as first intention to treat pathologies of the descending thoracic aorta. Indications have been extended to aortic arch aneurysms and also to diseases of the ascending aorta. The current devices in use for thoracic endovascular repair (TEVAR) are Medtronic Valiant, Gore TAG, Cook Tx2 and Jotec. The choice of the endograft depends on the thoracic aortic pathology and the anatomical suitability. The technological evolution of the abdominal aortic endografts was very rapid, arriving now at the fourth generation. We report the results of 55 elective cases of endovascular abdominal aortic repair (EVAR) performed in two vascular surgical centers in Romania and Germany. The prostheses used were 16 E-vita Abdominal XT, 12 Excluder, eight Talent, seven PowerLink, three Endurant and nine custom-made, fenestrated or branched from Jotec. The mean follow-up was 18 months with CT-scan, duplex ultrasound and contrast-enhanced ultrasound. The mortality was 2%. EVAR tends to become the gold standard for abdominal aortic aneurysm repair. Technological development of the devices with lowest profile introduction systems will permit to extend the anatomical indications to new frontiers. PMID:26200430

  4. Aortic Annular Enlargement during Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Selman Dumani

    2016-09-01

    Full Text Available In the surgery of aortic valve replacement is always attempted, as much as possible, to implant the larger prosthesis with the mains goals to enhance the potential benefits, to minimise transvalvular gradient, decrease left ventricular size and avoid the phenomenon of patient-prosthesis mismatch. Implantation of an ideal prosthesis often it is not possible, due to a small aortic annulus. A variety of aortic annulus enlargement techniques is reported to avoid patient-prosthesis mismatch. We present the case that has submitted four three times open heart surgery. We used Manouguian technique to enlarge aortic anulus with excellent results during the fourth time of surgery.

  5. Beating Heart Mitral Valve Replacement Surgery without Aortic Cross-Clamping via Right Thoracotomy in a Patient with Compromised Left Ventricular Functions

    Directory of Open Access Journals (Sweden)

    Ahmet Baris-Durukan

    2015-10-01

    Full Text Available Global myocardial ischemia and ischemia-reperfusion injury are potential adverse events related with cardioplegic arrest. Beating heart surgery has avoided such complications and adapted to valve surgery following successful results published on myocardial revascularization. Difficulty in weaning from cardiopulmonary bypass may be lessened by using on-pump beating heart surgery for mitral valve interventions. Here we describe a 64-year-old male patient with severe mitral regurgitation and dilated cardiomyopathy. Beating heart mitral valve replacement surgery was performed without aortic cross-clamping through a right thoracotomy approach. We believe that, particularly in patients with poor left ventricular functions, beating heart mitral valve surgery may be advantageous

  6. Hybrid procedure for a descending thoracic and subclavian artery aneurysm in a patient with previous abdominal aortic surgery: Case report

    Directory of Open Access Journals (Sweden)

    Radak Đorđe

    2015-01-01

    Full Text Available Introduction. Hybrid procedures represent staged or simultaneous endovascular and open surgical techniques in the treatment of complex pathologies of the thoracic and abdominal aorta. We are presenting a patient with previous abdominal aortic surgery in whom hybrid vascular procedure for descending aorta and left subclavian artery aneurysm was performed. Case Outline. A 63-year-old female patient was admitted for computed tomography angiography. Descending aorta aneurysm (7.6 cm as well as aneurysm of the left subclavian artery (LSA was noted. Eight years ago she underwent abdominal aortic aneurysm resection and aortoiliac bypass. Standard TEVAR (thoracic endovascular aortic repair procedure couldn’t be done due to small dimensions of previous “Y” graft (12.6 mm, so first we did LSA transposition and after three days hybrid procedure. After “Y” graft exposure, anastomosis between the corps of “Y” graft and tubular graft 10 mm was created and through this conduit thoracic stent-graft was placed followed by complete “Y” graft replacement. After 6 months angiography showed regular postoperative findings. Conclusion. Combined surgical and endovascular procedures in thoracic aorta pathology treatment could be useful solutions with favorable outcome. [Projekat Ministarstva nauke Republike Srbije, br. 41002

  7. Deployment Accuracy of the Conformable GORE® TAG® Thoracic Endoprosthesis in the Treatment of Zones 2 and 3 Aortic Arch Aneurysms Compared with the Previous TAG®

    OpenAIRE

    Ito, Eisaku; Kanaoka, Yuji; Maeda, Koji; Ohta, Hiroki; ISHIDA, ATSUSHI; Ohki, Takao

    2015-01-01

    Purposes: When placing stent grafts, deployment accuracy and birdbeaking due to inadequate conformability and device apposition along the inner curvature of the arch have been encountered. The new Conformable GORE® TAG® Thoracic Endoprosthesis (CTAG) is designed to have enhanced compression resistance and improved conformability in difficult anatomy. The present study compared the deployment accuracy and conformability of the CTAG Device with TAG Device.

  8. Surgical Management of Ascending Aortic Aneurysm and Its Complications

    Directory of Open Access Journals (Sweden)

    Sisira Sran

    2014-01-01

    Full Text Available Ascending aortic aneurysms involving the proximal aortic arch, arising anywhere from the aortic valve to the innominate artery, represent various problems in which open surgery is generally required. Surgical options include excision of the aortic pathology or wrapping the aneurysm shell with an aortic Dacron graft. Intervention using the latter method can lead to extravasation of blood along the suture lines resulting in continuous bleeding within the periprosthetic space. The Cabrol technique was developed as a method for decompression of postoperative leaks by the formation of a conduit system from the periprosthetic space to the right atrium. The coronary ostia are anastomosed to a second graft in an end-to-end fashion, which is then anastomosed to the ascending aortic conduit side to side. The native aorta is then sewn around the prosthesis, hereby creating a shunt to drain anastomotic leakage. This shunt reduces postsurgical risk of pseudoaneurysm formation and normally closes a few days following surgery. We discuss the case of a patient who underwent Cabrol’s variation and six months later was demonstrated to have a patent shunt.

  9. Medical image of the week: aortic ring

    Directory of Open Access Journals (Sweden)

    Wong C

    2014-10-01

    Full Text Available No abstract available. Article truncated after 150 words. A 78 year old man presented with altered mental status and was found to have an intraventricular hemorrhage. He was intubated for airway protection. On the post-intubation chest radiograph (Figure 1, the patient was noted to have a widening of the right paratracheal stripe. A CT chest (Figure 2 was obtained to characterize this finding and revealed an aortic ring which encircles the trachea and esophagus. Vascular rings are uncommon congenital abnormalities, accounting for approximately 1% of congenital heart disease. Complete vascular rings can occur with a right aortic arch with a ligamentum arteriosum or with a double aortic arch, such as with our patient (1. This ring can cause airway compression, stridor, esophageal compression, or no symptoms at all. As the embryo develops, the left fourth pharyngeal arch normally persists to become the aortic arch while the right fourth pharyngeal arch regresses. If both fourth pharyngeal arches persist, a ...

  10. Analysis of Perioperative Factors for Neurological Dysfunction in Patients with Thoracic Aortic Surgery

    Directory of Open Access Journals (Sweden)

    Manabu Shiraishi

    2013-06-01

    Conclusions: Prolonged duration of deep hypothermic circulatory arrest plus retrograde cerebral perfusion and pre-operative neurological dysfunctions were risk factors for permanent neurological dysfunction. The moderate hypothermic circulatory arrest plus an antegrade cerebral perfusion method used at our institution can reduce the incidence of postoperative neurological dysfunction. [Arch Clin Exp Surg 2013; 2(3.000: 141-148

  11. Delayed Surgery for Aortic Dissection after Intravenous Thrombolysis in Acute Ischemic Stroke

    Science.gov (United States)

    Choi, Nari; Yoon, Jee-Eun; Park, Byoung-Won; Chang, Won-Ho; Kim, Hyun-Jo; Lee, Kyung Bok

    2016-01-01

    We report a case of aortic dissection masquerading as acute ischemic stroke followed by intravenous thrombolysis. A 59-year-old man presented with dizziness. After examination, the patient had a seizure with bilateral Babinski signs. Soon after identifying multiple acute infarctions in both hemispheres on diffusion-weighted brain magnetic resonance (MR) imaging, tissue plasminogen activator (t-PA) was administered. Both common carotid arteries were invisible on MR angiography, and subsequent chest computed tomography revealed an aortic dissection. The emergency operation was delayed for 13 hours due to t-PA administration. The patient died of massive bleeding. PMID:27734002

  12. Prophylactic aortic root surgery in patients with Marfan syndrome : 10 years' experience with a protocol based on body surface area

    NARCIS (Netherlands)

    Aalberts, Jan J. J.; van Tintelen, J. Peter; Hillege, Hans L.; Boonstra, Piet W.; van den Berg, Maarten P.; Waterbolk, T

    2008-01-01

    Background: Current guidelines recommending prophylactic aortic root replacement in Marfan syndrome are based on absolute diameters of the aortic root. However, aortic root diameter is a function of body surface area (BSA). Here, we report our experience with a protocol for prophylactic aortic root

  13. Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection.

    Science.gov (United States)

    Lee, Jae-Hong; Na, Bubse; Hwang, Yoohwa; Kim, Yong Han; Park, In Kyu; Kim, Kyung-Hwan

    2016-02-01

    A 49-year-old male presented with chills and a fever. Five years previously, he underwent ascending aorta and aortic arch replacement using the elephant trunk technique for DeBakey type 1 aortic dissection. The preoperative evaluation found an esophago-paraprosthetic fistula between the prosthetic graft and the esophagus. Multiple-stage surgery was performed with appropriate antibiotic and antifungal management. First, we performed esophageal exclusion and drainage of the perigraft abscess. Second, we removed the previous graft, debrided the abscess, and performed an in situ re-replacement of the ascending aorta, aortic arch, and proximal descending thoracic aorta, with separate replacement of the innominate artery, left common carotid artery, and extra-anatomical bypass of the left subclavian artery. Finally, staged esophageal reconstruction was performed via transthoracic anastomosis. The patient's postoperative course was unremarkable and the patient has done well without dietary problems or recurrent infections over one and a half years of follow-up. PMID:26889449

  14. Endovascular treatment of thoracic aortic diseases

    Directory of Open Access Journals (Sweden)

    Davidović Lazar

    2013-01-01

    Full Text Available Bacground/Aim. Endovascular treatment of thoracic aortic diseases is an adequate alternative to open surgery. This method was firstly performed in Serbia in 2004, while routine usage started in 2007. Aim of this study was to analyse initial experience in endovacular treatment of thoracic aortic diseses of three main vascular hospitals in Belgrade - Clinic for Vascular and Endovascular Surgery of the Clinical Center of Serbia, Clinic for Vascular Surgery of the Military Medical Academy, and Clinic for Vascular Surgery of the Institute for Cardiovascular Diseases “Dedinje”. Methods. Between March 2004. and November 2010. 41 patients were treated in these three hospitals due to different diseases of the thoracic aorta. A total of 21 patients had degenerative atherosclerotic aneurysm, 6 patients had penetrating aortic ulcer, 6 had posttraumatic aneurysm, 4 patients had ruptured thoracic aortic aneurysm, 1 had false anastomotic aneurysm after open repair, and 3 patients had dissected thoracic aneurysm of the thoracoabdominal aorta. In 15 cases the endovascular procedure was performed as a part of the hybrid procedure, after carotidsubclavian bypass in 4 patients and subclavian artery transposition in 1 patient due to the short aneurysmatic neck; in 2 patients iliac conduit was used due to hypoplastic or stenotic iliac artery; in 5 patients previous reconstruction of abdominal aorta was performed; in 1 patient complete debranching of the aortic arch, and in 2 patients visceral abdominal debranching were performed. Results. The intrahospital mortality rate (30 days was 7.26% (3 patients with ruptured thoracic aneurysms died. Endoleak type II in the first control exam was revealed in 3 patients (7. 26%. The patients were followed up in a period of 1-72 months, on average 29 months. The most devastating complication during a followup period was aortoesofageal fistula in 1 patient a year after the treatment of posttraumatic aneurysm. Conversion was

  15. Implant Restoration of Edentulous Jaws with 3D Software Planning, Guided Surgery, Immediate Loading, and CAD-CAM Full Arch Frameworks

    Science.gov (United States)

    De Riu, Giacomo; Pisano, Milena; Campus, Guglielmo; Tullio, Antonio

    2013-01-01

    Purpose. The aim of this study was to analyze the clinical and radiographic outcomes of 23 edentulous jaws treated with 3D software planning, guided surgery, and immediate loading and restored with CAD-CAM full arch frameworks. Materials and Methods. This work was designed as a prospective case series clinical study. Twenty patients have been consecutively rehabilitated with an immediately loaded implant supported fixed full prosthesis. A total of 120 fixtures supporting 23 bridges were placed. 117 out of 120 implants were immediately loaded. Outcome measures were implants survival, radiographic marginal bone levels and remodeling, soft tissue parameters, and complications. Results. 114 of 117 implants reached a 30 months follow-up, and no patients dropped out from the study. The cumulative survival rate was 97.7%; after 30 months, mean marginal bone level was 1.25 ± 0.31 mm, mean marginal bone remodeling value was 1.08 ± 0.34, mean PPD value was 2.84 ± 0.55 mm, and mean BOP value was 4% ± 2.8%. Only minor prosthetic complications were recorded. Conclusion. Within the limitations of this study, it can be concluded that computer-guided surgery and immediate loading seem to represent a viable option for the immediate rehabilitations of completely edentulous jaws with fixed implant supported restorations. This trial is registered with Clinicaltrials.gov NCT01866696. PMID:23983690

  16. Implant Restoration of Edentulous Jaws with 3D Software Planning, Guided Surgery, Immediate Loading, and CAD-CAM Full Arch Frameworks

    Directory of Open Access Journals (Sweden)

    Silvio Mario Meloni

    2013-01-01

    Full Text Available Purpose. The aim of this study was to analyze the clinical and radiographic outcomes of 23 edentulous jaws treated with 3D software planning, guided surgery, and immediate loading and restored with CAD-CAM full arch frameworks. Materials and Methods. This work was designed as a prospective case series clinical study. Twenty patients have been consecutively rehabilitated with an immediately loaded implant supported fixed full prosthesis. A total of 120 fixtures supporting 23 bridges were placed. 117 out of 120 implants were immediately loaded. Outcome measures were implants survival, radiographic marginal bone levels and remodeling, soft tissue parameters, and complications. Results. 114 of 117 implants reached a 30 months follow-up, and no patients dropped out from the study. The cumulative survival rate was 97.7%; after 30 months, mean marginal bone level was  mm, mean marginal bone remodeling value was , mean PPD value was  mm, and mean BOP value was 4% ± 2.8%. Only minor prosthetic complications were recorded. Conclusion. Within the limitations of this study, it can be concluded that computer-guided surgery and immediate loading seem to represent a viable option for the immediate rehabilitations of completely edentulous jaws with fixed implant supported restorations. This trial is registered with Clinicaltrials.gov NCT01866696.

  17. 自体肺动脉组织一期矫治主动脉弓病变合并心内畸形%One-stage repair of congenital aortic arch disease with other cardiac defects by using autologous pulmonary artery tissue

    Institute of Scientific and Technical Information of China (English)

    薛辉; 吴清玉; 李洪银; 张明奎; 奚吉成; 潘广玉; 徐忠华

    2010-01-01

    Objective To analyze the surgical strategy and result of one-stage repair for congenital aortic arch disease associated with other cardiac anomalies. Methods Between April 1993 and November 2009, 25 consecutive patients aged 26 d to 6. 5 years underwent one-stage repair for congenital aortic arch disease with other cardiac anomalies. Among them, 6 patients had coarctation of aorta, 6 patients had interrupted aortic arch, and 13 cases had hypoplasia of aortic arch. The surgical techniques include excision of the anterior wall of pulmonary artery, resection of patent ductus arteriosus tissue, aortic arch reconstruction with autologous pulmonary artery wall, reconstruction of the pulmonary artery and repair of the associated defects. Results Twenty-four patients survived and recovered uneventfully. One patient died of pulmonary hypertention crisis in hospital. The reconstruction of the aorta and the correction of the intracardiac anomalies were proved by postoperative echocardiography and CT scan. There were no neurological or other complications. The follow-up showed that all patients developed normally and there were no restenosis of the aorta arch. Conclusions With the benefits of growth potential and less tension, autologous pulmonary artery tissue is an optimal choice in aortic arch reconstruction. One-stage repair of congenital aortic arch disease associated with other cardiac anomalies can achieve good results.%目的 探讨自体肺动脉组织一期矫治主动脉弓病变合并心内畸形的手术方法和治疗效果.方法 1993年4月至2009年11月,共25例主动脉弓病变合并心内畸形的患儿接受了一期矫治手术.男性17例,女性8例;年龄26 d~6.5岁,平均11个月;体质量3.0~14.5 kg,平均12.4 kg.其中6例患儿为主动脉弓缩窄,6例为主动脉弓中断,13例为主动脉弓发育不良.手术技术包括切开肺动脉前壁,切除动脉导管,应用部分自体肺动脉壁重建主动脉弓,重建肺动脉,并

  18. Medical image of the week: acute aortic dissection

    Directory of Open Access Journals (Sweden)

    Desai H

    2015-06-01

    Full Text Available No abstract available. Article truncated after 150 words. An 85-year-old gentleman with the past medical history significant for hypertension, smoking, and coronary artery disease presented to the emergency department (ED with complains of sudden onset of chest pain. His pain was described as squeezing and radiating to the back, associated with nausea and vomiting. His chest pain improved with nitroglycerin in ED. Chest x-ray showed a tortuous aortic knob and widened mediastinum. He underwent a CT angiogram, which showed, Stanford Type B aortic dissection, from distal aortic arch to renal arteries (Figure 1. He was managed in the hospital conservatively with tight blood pressure control given the type of dissection and no surgical intervention was done. He was uneventfully discharged with follow up arranged with vascular surgery. Aortic dissection is classified by Stanford Criteria as Type A which involves the ascending aorta and arch and Type B when it involves the descending aorta. Type A dissection is a ...

  19. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... North Carolina. My name is John Streitman and I'm a cardiothoracic surgeon here at the Heart ... the corrective surgery of aortic valve replacement. If I have aortic stenosis, are there any activities that ...

  20. Estratégia cirúrgica na transposição das grandes artérias associada à obstrução do arco aórtico Surgical strategy in transposition of the great arteries with aortic arch obstruction

    Directory of Open Access Journals (Sweden)

    Bayard Gontijo Filho

    2007-06-01

    Full Text Available OBJETIVO: Analisar nossa experiência no tratamento cirúrgico da transposição das grandes artérias (TGA associada à obstrução do arco aórtico. MÉTODO: Entre janeiro de 1998 e dezembro de 2005, realizamos 223 operações de Jatene para correção de TGA: 21 (9,4% pacientes apresentavam obstruções do arco aórtico. A anatomia do arco aórtico evidenciou: coarctação da aorta localizada (n=10; coarctação com hipoplasia tubular do arco aórtico (n=6; interrupção do arco aórtico (n=5. Comunicação interventricular (CIV: 19 pacientes (90,5%, sendo 11 do tipo Taussig-Bing. Desproporção importante entre aorta e artéria pulmonar e anomalias coronárias foram achados freqüentes. Houve 7 correções em dois estágios e 14 correções em um único estágio. A reconstrução do arco foi realizada por ressecção e anastomose término-terminal ampliada (13 ou por translocação da aorta ascendente (8. RESULTADO: Houve cinco (23,8% óbitos hospitalares; apenas um (11,1% nos últimos nove casos consecutivos. Reoperações no período hospitalar: revisão de hemostasia (5, CIV residual + coarctação não identificada (1, estenose residual de arco aórtico (1. Após a alta, houve dois óbitos e três pacientes foram submetidos a reintervenções para estenose da via de saída do ventrículo direito. CONCLUSÃO: O tratamento da transposição das grandes artérias associada à obstrução do arco aórtico apresenta alta complexidade e morbi-mortalidade. Empregamos as correções em um e em dois estágios, obtendo resultados comparáveis. Nossa preferência atual é pela correção precoce em um único estágio para todos os pacientes, independente de sua configuração anatômica.OBJECTIVE:To analyze our experience in the surgical correction of transposition of the great arteries associated with aortic arch obstruction. METHOD: From January 1998 to December 2005 we performed 223 arterial switch operations for transposition of the great

  1. Hybrid repair of a very late, post-aortic coarctation surgery thoracic aneurysm: a case report

    Directory of Open Access Journals (Sweden)

    Tilea Ioan

    2012-08-01

    Full Text Available Abstract Introduction Local aneurysms after surgical repair of coarctation of the aorta occur mainly in patients surgically treated by Dacron patch plasty during adulthood. The management of these patients is always problematic, with frequent complications and increased mortality rates. Percutaneous stent-graft implantation avoids the need for surgical reintervention. Case presentation We report a case involving the hybrid treatment by stent-graft implantation and transposition of the left subclavian artery to the left common carotid artery of an aneurysmal dilatation of the thoracic aorta that occurred in a 64-year-old Caucasian man, operated on almost 40 years earlier with a Dacron patch plasty for aortic coarctation. Our patient presented to our facility for evaluation with back pain and shortness of breath after minimal physical effort. A physical examination revealed stony dullness to percussion of the left posterior thorax, with no other abnormalities. The results of chest radiography, followed by contrast-enhanced computed tomography and aortography, led to a diagnosis of giant aortic thoracic aneurysm. Successful treatment of the aneurysm was achieved by percutaneous stent-graft implantation combined with transposition of the left subclavian artery to the left common carotid artery. His post-procedural recovery was uneventful. Three months after the procedure, computed tomography showed complete thrombosis of the excluded aneurysm, without any clinical signs of left lower limb ischemia or new onset neurological abnormalities. Conclusions Our patient’s case illustrates the clinical outcomes of surgical interventions for aortic coarctation. However, the very late appearance of a local aneurysm is rather unusual. Management of such cases is always difficult. The decision-making should be multidisciplinary. A hybrid approach was considered the best solution for our patient.

  2. Effects of aortic root motion on wall stress in the Marfan aorta before and after personalised aortic root support (PEARS) surgery.

    Science.gov (United States)

    Singh, S D; Xu, X Y; Pepper, J R; Izgi, C; Treasure, T; Mohiaddin, R H

    2016-07-01

    Aortic root motion was previously identified as a risk factor for aortic dissection due to increased longitudinal stresses in the ascending aorta. The aim of this study was to investigate the effects of aortic root motion on wall stress and strain in the ascending aorta and evaluate changes before and after implantation of personalised external aortic root support (PEARS). Finite element (FE) models of the aortic root and thoracic aorta were developed using patient-specific geometries reconstructed from pre- and post-PEARS cardiovascular magnetic resonance (CMR) images in three Marfan patients. The wall and PEARS materials were assumed to be isotropic, incompressible and linearly elastic. A static load on the inner wall corresponding to the patients' pulse pressure was applied. Cardiovascular MR cine images were used to quantify aortic root motion, which was imposed at the aortic root boundary of the FE model, with zero-displacement constraints at the distal ends of the aortic branches and descending aorta. Measurements of the systolic downward motion of the aortic root revealed a significant reduction in the axial displacement in all three patients post-PEARS compared with its pre-PEARS counterparts. Higher longitudinal stresses were observed in the ascending aorta when compared with models without the root motion. Implantation of PEARS reduced the longitudinal stresses in the ascending aorta by up to 52%. In contrast, the circumferential stresses at the interface between the supported and unsupported aorta were increase by up to 82%. However, all peak stresses were less than half the known yield stress for the dilated thoracic aorta. PMID:27255604

  3. Staged ridge-split evaluated using cone beam computed tomography and peri-implant plastic surgery in the mandibular arch

    Directory of Open Access Journals (Sweden)

    Nikhil Vasant Jain

    2015-01-01

    Full Text Available Lack of sufficient bone to place an implant at a functionally and an esthetically appropriate position is a common problem, especially in the mandibular posterior region. Narrow edentulous alveolar ridges <5 mm wide require bone augmentation before implant placement to establish a bony wall of at least 1 mm around the endosseous implant. Various surgical widening techniques are available, including lateral augmentation with or without guided bone regeneration, ridge-split technique and horizontal distraction osteogenesis. The ridge-split technique aims at creating a new implant bed by longitudinal osteotomy of the alveolar bone. The buccal cortex is repositioned laterally by greenstick fracture, and the space between the buccal and lingual cortices is filled with a graft material. Peri-implant plastic surgery focuses on harmonizing peri-implant structures by means of hard- and soft-tissue engineering and includes bone structure enhancement, soft-tissue enhancement, precision in implant placement and improves quality of the prosthetic restoration. The rationale for the peri-implant plastic surgery approach goes well beyond pure esthetics as it creates peri-implant keratinized mucosa and interimplant soft-tissue height in order to avoid food impaction, interimplant airflow, and speech problems. This case report demonstrates a staged ridge-split technique evaluated with cone beam computed tomography using a piezosurgical unit and a surgical technique to restore a papilla-like tissue at the time of the second-stage implant surgery.

  4. Emergent endovascular vs. open surgery repair for ruptured abdominal aortic aneurysms: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Chuan Qin

    Full Text Available OBJECTIVES: To systematically review studies comparing peri-operative mortality and length of hospital stay in patients with ruptured abdominal aortic aneurysms (rAAAs who underwent endovascular aneurysm repair (EVAR to patients who underwent open surgical repair (OSR. METHODS: The Medline, Cochrane, EMBASE, and Google Scholar databases were searched until Apr 30, 2013 using keywords such as abdominal aortic aneurysm, emergent, emergency, rupture, leaking, acute, endovascular, stent, graft, and endoscopic. The primary outcome was peri-operative mortality and the secondary outcome was length of hospital stay. RESULTS: A total of 18 studies (2 randomized controlled trials, 5 prospective studies, and 11 retrospective studies with a total of 135,734 rAAA patients were included. rAAA patients who underwent EVAR had significantly lower peri-operative mortality compared to those who underwent OSR (overall OR = 0.62, 95% CI = 0.58 to 0.67, P<0.001. rAAA patients with EVAR also had a significantly shorter mean length of hospital stay compared to those with OSR (difference in mean length of stay ranged from -2.00 to -19.10 days, with the overall estimate being -5.25 days (95% CI = -9.23 to -1.26, P = 0.010. There was no publication bias and sensitivity analysis showed good reliability. CONCLUSIONS: EVAR confers significant benefits in terms of peri-operative mortality and length of hospital stay. There is a need for more randomized controlled trials to compare outcomes of EVAR and OSR for rAAA.

  5. Occlusive ascending aorta and arch atheroma treated with deep hypothermic circulatory arrest and thromboendarterectomy.

    LENUS (Irish Health Repository)

    O' Sullivan, Katie E

    2013-12-01

    We describe an uncommon presentation of severely advanced aortic atherosclerosis in a 48-year old man with a history of hypertension and heavy smoking. Initial presentation with upper limb ischaemia led to the diagnosis of an aortic arch atheroma occluding 90% of the aortic lumen, managed with deep hypothermic circulatory arrest and aortic thromboendarterectomy. To our knowledge, this is the first reported case of atherosclerotic plaque resulting in aortic occlusion and requiring emergent operative intervention.

  6. From the ground up: building a minimally invasive aortic valve surgery program.

    Science.gov (United States)

    Nguyen, Tom C; Lamelas, Joseph

    2015-03-01

    Minimally invasive aortic valve replacement (MIAVR) is associated with numerous advantages including improved patient satisfaction, cosmesis, decreased transfusion requirements, and cost-effectiveness. Despite these advantages, little information exists on how to build a MIAVR program from the ground up. The steps to build a MIAVR program include compiling a multi-disciplinary team composed of surgeons, cardiologists, anesthesiologists, perfusionists, operating room (OR) technicians, and nurses. Once assembled, this team can then approach hospital administrators to present a cost-benefit analysis of MIAVR, emphasizing the importance of reduced resource utilization in the long-term to offset the initial financial investment that will be required. With hospital approval, training can commence to provide surgeons and other staff with the necessary knowledge and skills in MIAVR procedures and outcomes. Marketing and advertising of the program through the use of social media, educational conferences, grand rounds, and printed media will attract the initial patients. A dedicated website for the program can function as a "virtual lobby" for patients wanting to learn more. Initially, conservative selection criteria of cases that qualify for MIAVR will set the program up for success by avoiding complex co-morbidities and surgical techniques. During the learning curve phase of the program, patient safety should be a priority. PMID:25870815

  7. From the ground up: building a minimally invasive aortic valve surgery program.

    Science.gov (United States)

    Nguyen, Tom C; Lamelas, Joseph

    2015-03-01

    Minimally invasive aortic valve replacement (MIAVR) is associated with numerous advantages including improved patient satisfaction, cosmesis, decreased transfusion requirements, and cost-effectiveness. Despite these advantages, little information exists on how to build a MIAVR program from the ground up. The steps to build a MIAVR program include compiling a multi-disciplinary team composed of surgeons, cardiologists, anesthesiologists, perfusionists, operating room (OR) technicians, and nurses. Once assembled, this team can then approach hospital administrators to present a cost-benefit analysis of MIAVR, emphasizing the importance of reduced resource utilization in the long-term to offset the initial financial investment that will be required. With hospital approval, training can commence to provide surgeons and other staff with the necessary knowledge and skills in MIAVR procedures and outcomes. Marketing and advertising of the program through the use of social media, educational conferences, grand rounds, and printed media will attract the initial patients. A dedicated website for the program can function as a "virtual lobby" for patients wanting to learn more. Initially, conservative selection criteria of cases that qualify for MIAVR will set the program up for success by avoiding complex co-morbidities and surgical techniques. During the learning curve phase of the program, patient safety should be a priority.

  8. Computer-Guided Implant Surgery in Fresh Extraction Sockets and Immediate Loading of a Full Arch Restoration: A 2-Year Follow-Up Study of 14 Consecutively Treated Patients

    Directory of Open Access Journals (Sweden)

    M. Daas

    2015-01-01

    Full Text Available Statement of Problem. Low scientific evidence is identified in the literature for combining implant placement in fresh extraction sockets with immediate function. Moreover, the few studies available on immediate implants in postextraction sites supporting immediate full-arch rehabilitation clearly lack comprehensive protocols. Purpose. The purpose of this study is to report outcomes of a comprehensive protocol using CAD-CAM technology for surgical planning and fabrication of a surgical template and to demonstrate that immediate function can be easily performed with immediate implants in postextraction sites supporting full-arch rehabilitation. Material and Methods. 14 subjects were consecutively rehabilitated (13 maxillae and 1 mandible with 99 implants supporting full-arch fixed prostheses followed between 6 and 24 months (mean of 16 months. Outcome measures were prosthesis and implant success, biologic and prosthetic complications, pain, oedema evaluation, and radiographic marginal bone levels at surgery and then at 6, 12, 18, and 24 months. Data were analyzed with descriptive statistics. Results. The overall cumulative implant survival rate at mean follow-up time of 16 months was 97.97%. The average marginal bone loss was 0,9 mm. Conclusions. Within the limitations of this study, the results validate this treatment modality for full-arch rehabilitations with predictable outcomes and high survival rate after 2 years.

  9. Computer-Guided Implant Surgery in Fresh Extraction Sockets and Immediate Loading of a Full Arch Restoration: A 2-Year Follow-Up Study of 14 Consecutively Treated Patients.

    Science.gov (United States)

    Daas, M; Assaf, A; Dada, K; Makzoumé, J

    2015-01-01

    Statement of Problem. Low scientific evidence is identified in the literature for combining implant placement in fresh extraction sockets with immediate function. Moreover, the few studies available on immediate implants in postextraction sites supporting immediate full-arch rehabilitation clearly lack comprehensive protocols. Purpose. The purpose of this study is to report outcomes of a comprehensive protocol using CAD-CAM technology for surgical planning and fabrication of a surgical template and to demonstrate that immediate function can be easily performed with immediate implants in postextraction sites supporting full-arch rehabilitation. Material and Methods. 14 subjects were consecutively rehabilitated (13 maxillae and 1 mandible) with 99 implants supporting full-arch fixed prostheses followed between 6 and 24 months (mean of 16 months). Outcome measures were prosthesis and implant success, biologic and prosthetic complications, pain, oedema evaluation, and radiographic marginal bone levels at surgery and then at 6, 12, 18, and 24 months. Data were analyzed with descriptive statistics. Results. The overall cumulative implant survival rate at mean follow-up time of 16 months was 97.97%. The average marginal bone loss was 0,9 mm. Conclusions. Within the limitations of this study, the results validate this treatment modality for full-arch rehabilitations with predictable outcomes and high survival rate after 2 years. PMID:26064119

  10. High Spinal Anesthesia Enhances Anti-Inflammatory Responses in Patients Undergoing Coronary Artery Bypass Graft Surgery and Aortic Valve Replacement: Randomized Pilot Study.

    Directory of Open Access Journals (Sweden)

    Trevor W R Lee

    Full Text Available Cardiac surgery induces many physiologic changes including major inflammatory and sympathetic nervous system responses. Here, we conducted a single-centre pilot study to generate hypotheses on the potential immune impact of adding high spinal anaesthesia to general anaesthesia during cardiac surgery in adults. We hypothesized that this strategy, previously shown to blunt the sympathetic response and improve pain management, could reduce the undesirable systemic inflammatory responses caused by cardiac surgery.This prospective randomized unblinded pilot study was conducted on 14 patients undergoing cardiac surgery for coronary artery bypass grafting and/or aortic valve replacement secondary to severe aortic stenosis. The primary outcome measures examined longitudinally were serum pro-inflammatory (IL-6, IL-1b, CCL2, anti-inflammatory (IL-10, TNF-RII, IL-1Ra, acute phase protein (CRP, PTX3 and cardiovascular risk (sST2 biomarkers.The kinetics of pro- and anti-inflammatory biomarker was determined following surgery. All pro-inflammatory and acute phase reactant biomarker responses induced by surgical stress were indistinguishable in intensity and duration between control groups and those who also received high spinal anaesthesia. Conversely, IL-10 levels were markedly elevated in both intensity and duration in the group receiving high spinal anesthesia (p = 0.005.This hypothesis generating pilot study suggests that high spinal anesthesia can alter the net inflammatory response that results from cardiac surgery. In appropriately selected populations, this may add incremental benefit by dampening the net systemic inflammatory response during the week following surgery. Larger population studies, powered to assess immune, physiologic and clinical outcomes in both acute and longer term settings, will be required to better assess potential benefits of incorporating high spinal anesthesia.ClinicalTrials.gov NCT00348920.

  11. Valve-in-Valve Replacement Using a Sutureless Aortic Valve

    Science.gov (United States)

    Dohmen, Pascal M.; Lehmkuhl, Lukas; Borger, Michael A.; Misfeld, Martin; Mohr, Friedrich W.

    2016-01-01

    Patient: Female, 61 Final Diagnosis: Tissue degeneration Symptoms: Dyspnea Medication: — Clinical Procedure: Redo valve replacement Specialty: Surgery Objective: Rare disease Background: We present a unique case of a 61-year-old female patient with homograft deterioration after redo surgery for prosthetic valve endocarditis with root abscess. Case Report: The first operation was performed for type A dissection with root, arch, and elephant trunk replacement of the thoracic aorta. The present re-redo surgery was performed as valve-in-valve with a sutureless aortic biopros-thesis. The postoperative course was uneventful and the patient was discharged on day 6. Conclusions: The current case report demonstrates that sutureless bioprostheses are an attractive option for surgical valve-in-valve procedures, which can reduce morbidity and mortality. PMID:27694795

  12. Aneurisma do ducto arterioso associado a interrupção do arco aórtico Aneurysm of the arterial duct associated to aortic arch interruption

    Directory of Open Access Journals (Sweden)

    Paulo Zielinsky

    1998-07-01

    Full Text Available É relatado um caso de aneurisma de ducto arterioso, com diagnóstico pré-natal, o que é muito raro, numa gestante com 33 semanas, onde o feto apresentou uma dilatação aneurismática do canal arterial, com calibre uniformemente aumentado, inserindo-se na aorta descendente, associado à interrupção do arco aórtico. A criança nasceu de parto cesáreo e manteve-se estável com o uso de prostaglandina até o 9º dia de vida, quando foi levada à cirurgia, tendo falecido durante o procedimento por falência biventricular. Este é o primeiro relato da associação desta anomalia com outra malformação cardiovascular intra-uterina, mostrando que este achado nem sempre é associado a uma evolução benigna.Aneurysm of the arterial duct is an infrequent finding, which is very rarely detected prenatally. A case of antenatal diagnosis in a pregnant patient (33 weeks is reported. The fetus presented an aneurysmatic dilation of the arterial duct with uniformly enlarged diameter, inserting into the descending aorta, which was interrupted. The neonate was born by cesarean section and was kept on postaglandins till the 9th day of life, when he was sent to surgery. During the surgical procedure, the baby died as a result of biventricular failure. This is the first report of prenatal association of aneurysm of the ducts anteriosus with other cardiovascular malformations and emphasizes that this finding does not always have a benign course.

  13. Comparison of clinical curative effect between open surgery and endovascular repair of abdominal aortic aneurysm in China

    Institute of Scientific and Technical Information of China (English)

    WANG Si-wen; LIN Ying; YAO Chen; LIN Pei-liang; WANG Shen-ming

    2012-01-01

    Objective To compare clinical curative effects of open surgery (OS) or endovascular repair (EVAR) for patients with abdominal aortic aneurysm (AAA) in China.Data sources We performed a comprehensive search of both English and Chinese literatures involving case studies on retrograde OS or EVAR of AAA in China from January 1976 to December 2010.Study selection According to the inclusion criteria,76 articles were finally analyzed to compare patient characteristics,clinical success,complications,and prognosis.Results We analyzed a total of 2862 patients with 1757 undergoing OS (OS group) and 1105 undergoing EVAR (EVAR group).There was no significant difference in the success rate of the procedures.Operative time,length of ICU stay,fasting time,duration of total postoperative stay,blood loss,and blood transfusion requirements during the procedure were significantly lower in the EVAR group.A 30-day follow up revealed more cardiac,renal,pulmonary,and visceral complications in the OS group (P<0.01).Low-limb ischemia,however,was more common in the EVAR group (P<0.05).The 30-day mortality rate,including aorta-related and non-aorta related mortality,was significantly lower in the EVAR group (P<0.01).In the follow-up period,there were more patients with occlusions of artificial vessel and late endoleak in the EVAR group (P<0.01).The overall late mortality rate was higher in the OS group (P <0.01),especially non-aorta-related late mortality and mortality during the fourth to the sixth year (P<0.01).Conclusions EVAR was safer and less invasive for AAA patients.Patients suffered fewer complications and recovered sooner.However,complications such as artificial vessel occlusion,low-limb ischemia,and endoleak were common in EVAR.Clinicians should carry out further research to solve these complications and improve the efficacy of EVAR.

  14. Fatores de risco na cirurgia das dissecções da aorta ascendente e arco aórtico Risk factors in surgery for thoracic aortic dissection

    Directory of Open Access Journals (Sweden)

    Luiz Felipe P Moreira

    1987-08-01

    restrict to ascending aorta in 9. The most common surgical procedure was the interposition of Dacron graft in the ascending aorta associated to obliteration of false lumen. The aortic arch was approached only in 5 patients. The overall operative mortality was 27.7% and patients with acute dissections had mortality rate of 43.5%. There was a direct relationship between the causes of death and preoperative complications in 45% of these cases. The following factors were considered predictors of high operative risk: previous neurologic compromise, cardiac tamponade, persistent shock, acute myocardial ischemia and renal dysfunction. Involvement of innominate or carotid arteries by dissection, presence of intimal tear in aortic arch, mesenteric ischemia and only in the acute cases, moderate or severe aortic valve incompetence were also correlated with a higher operative mortality. In conclusion, the operative risk of the treatment of proximal aortic dissection has a relationship with preoperative clinical condition. Better results in the acute stage could be improved by early diagnosis and adequate medical therapy during investigation period.

  15. Aortic growth rates in chronic aortic dissection

    Energy Technology Data Exchange (ETDEWEB)

    Kelly, A.M. [Department of Radiology, Division of Thoracic Radiology, University of Michigan Medical Center (United States)]. E-mail: ainekell@med.umich.edu; Quint, L.E. [Department of Radiology, Division of Thoracic Radiology, University of Michigan Medical Center (United States); Nan, B. [School of Public Health, University of Michigan, Ann Arbor, Michigan (United States); Zheng, J. [School of Public Health, University of Michigan, Ann Arbor, Michigan (United States); Cronin, P. [Department of Radiology, Division of Thoracic Radiology, University of Michigan Medical Center (United States); Deeb, G.M. [Division of Cardiac Surgery, University of Michigan Medical Center (United States); Williams, D.M. [Division of Vascular Interventional Imaging, University of Michigan Medical Center (United States)

    2007-09-15

    Aim: To determine and compare rates of descending aortic enlargement and complications in chronic aortic dissection with and without a proximal aortic graft. Methods and materials: Fifty-two patients with dissection involving the descending aorta and who had undergone at least two computed tomography (CT) examinations at our institution between November, 1993 and February, 2004 were identified, including 24 non-operated patients (four type A, 20 type B) and 28 operated patients (type A). CT examinations per patient ranged from two to 10, and follow-up ranged from 1-123 months (mean 49 months, median 38.5 months). On each CT image, the aortic short axis (SA), false lumen (FL), and true lumen (TL) diameters were measured at the longitudinal midpoint of the dissection and at the point of maximum aortic diameter. Complications were tabulated, including aortic rupture and aortic enlargement requiring surgery. Results: For non-operated patients, the midpoint and maximum point SA, TL, and FL diameters increased significantly over time. For operated patients, the midpoint and maximum point SA and FL diameters increased significantly over time. In both groups, aortic enlargement was predominantly due to FL expansion. Diameter increases in non-operated patients were significantly larger than those in operated patients. The rate of change in aortic diameter was constant, regardless of aortic size. Four non-operated and six operated patients developed aortic complications. Conclusions: In patients with a dissection involving the descending thoracic aorta, the FL increased in diameter over time, at a constant rate, and to a greater degree in non-operated patients (mostly type B) compared with operated patients (all type A)

  16. Valve-sparing aortic root replacement and aortic valve repair in a patient with acromegaly and aortic root dilatation

    Directory of Open Access Journals (Sweden)

    Karel Van Praet

    2015-07-01

    Full Text Available Aortic regurgitation and dilatation of the aortic root and ascending aorta are severe complications of acromegaly. The current trend for management of an aortic root aneurysm is valve-sparing root replacement as well as restoring the diameter of the aortic sinotubular junction (STJ and annulus. Our case report supports the recommendation that in patients with acromegaly, severe aortic root involvement may indicate the need for surgery.

  17. Overview of current surgical strategies for aortic disease in patients with Marfan syndrome.

    Science.gov (United States)

    Miyahara, Shunsuke; Okita, Yutaka

    2016-09-01

    Marfan syndrome is a heritable, systemic disorder of the connective tissue with a high penetrance, named after Dr. Antoine Marfan. The most clinically important manifestations of this syndrome are cardiovascular pathologies which cause life-threatening events, such as acute aortic dissections, aortic rupture and regurgitation of the aortic valve or other artrioventricular valves leading to heart failure. These events play important roles in the life expectancy of patients with this disorder, especially prior to the development of effective surgical approaches for proximal ascending aortic disease. To prevent such catastrophic aortic events, a lower threshold has been recommended for prophylactic interventions on the aortic root. After prophylactic root replacement, disease in the aorta beyond the root and distal to the arch remains a cause for concern. Multiple surgeries are required throughout a patient's lifetime that can be problematic due to distal lesions complicated by dissection. Many controversies in surgical strategies remain, such as endovascular repair, to manage such complex cases. This review examines the trends in surgical strategies for the treatment of cardiovascular disease in patients with Marfan syndrome, and current perspectives in this field. PMID:26586198

  18. 合并有主动脉弓及升主动脉倒撕裂的DeBakeyⅢ型主动脉夹层腔内介入治疗的时机和效果%Timing of TEVAR treatment in DeBakeyⅢtype aortic dissection associated with arch and ascending aorta anti-tearing

    Institute of Scientific and Technical Information of China (English)

    王志伟; 管生; 王稼祥; 李震

    2013-01-01

    Objective To explore the timing and the efficacy of TEVAR treatment in DeBakeyⅢtype aortic dissection associated with arch and ascending aorta anti-tearing. Methods Clinical data of 10 patients with DeBakeyⅢaortic dissection associated with arch and ascending aorta anti-tearing from January 2010 to January 2013 were retrospectively analyzed. All the patients had ifnally stepped stent therapy on the basis of conservative treatment, were erplored according to the follow up results. Results One case conducted TEVAR treatment three days after admission because of poor blood pressure control, but died of sudden pericardial tamponade postoperative two days. After 4 weeks’ conservative treatment all of 9 patients were performed TEVAR, the postoperative patients recovered well and were followed up for 6 to 30 months without adverse events. Conclusions False lumen thrombosis in ascending aorta and aortic arch are stable and partially absorbed after four weeks with conservative management in the patients who have DeBakeyⅢaortic dissection with arch and ascending aorta anti-tearing, and then the aortic arch can provide a relatively stable anchoring zone in the proximal end for TEVAR.%目的:探讨主动脉腔内修复术(TEVAR)治疗合并有主动脉弓和(或)升主动脉倒撕裂的DeBakeyⅢ型主动脉夹层的手术时机及疗效。方法对2010年1月至2013年1月郑州大学第一附属医院介入科收治的10例DeBakeyⅢ型主动脉夹层、同时合并有主动脉弓和(或)升主动脉逆向撕裂患者,在保守治疗的基础上行介入覆膜支架治疗,结合随访情况,探讨对该类患者行主动脉腔内修复术(TEVAR)的可行性、治疗时机及效果。结果1例患者血压控制差,入院后第3天行TEVAR治疗,术后第2天突发心包填塞而死亡;余9例患者在保守治疗4周,CT血管造影(CTA)显示逆向撕裂假腔内血栓稳定并部分吸收后,均安全实施了常规TEVAR,术

  19. The surgical importance of an axillary arch in sentinel node biopsy.

    LENUS (Irish Health Repository)

    Ridgway, P F

    2011-03-01

    When Carl Langer described the aberrant axillary arch in 1846 its relevance in sentinel node biopsy (SNB) surgery could not have been contemplated. The authors define an incidence and elucidate relevance of the arch in SNB of the axilla.

  20. 选择性肋间动脉灌注在降主动脉手术中的应用%Selective intercostal arterial perfusion during descending aortic surgery

    Institute of Scientific and Technical Information of China (English)

    王东进; 周庆; 李庆国; 武忠

    2009-01-01

    目的 探讨选择性肋间动脉灌注在降主动脉手术中对脊髓的保护作用.方法 2007年8月至2009年3月,5例降主动脉夹层和2例降主动脉瘤病人行降主动脉置换术.术中保留置换降主动脉上所有肋间动脉,进行选择性肋间动脉灌注,以减少脊髓缺血时间及程度以达到脊髓保护的目的 .术后早期观察和中期随访是否有截瘫发生.结果 术中脊髓缺血23~27 min,平均(24.8±1.6) min.7例术后均未发生截瘫,治愈出院.随访1~19个月,全组无截瘫,生活质量良好.结论 选择性肋间动脉灌注可缩短脊髓缺血时间和程度,脊髓保护效果良好,并可大大降低手术操作难度.%Objective This clinical study evaluated the efficacy of selective intercostal arterial perfusion for protection of spinal cord during descending aortic surgery.Methods From August 2007 to March 2009,7 patients received descending aorta replacement for type B dissection (5 patients) or thoracic aortic aneurysm (2 patients).Descending aorta replacement was performed through a posterolateral incision and left femoral vein-artery bypass in 1 case and left atrial-left femoral artery (LA-FA) bypass in 6.The grafts extended from the distal arch at the root of subclavian artery to the descending aorta at the T10-11 vertebra.The posterior wall of the descending aorta with intercostal arteries was sutured to form an 15 mm tube in diameter and an end-to-side anastomosis was made to an 8 mm graft branch.Selective intercostal arterial perfusion was performed from the T1 intercostal artery to the T10-11 intercostal artery through the 8 mm graft branch to protect spinal cord from ischemia.Cerebrospinal fluid pressure was monitored and cerebrospinal fluid drainage was performed necessarily.Results The replaced grafts measured from 19 to 23 cm [mean (20.2±1.4) cm].The CPB duration ranged from73-84 min [mean (24.8 ± 1.6) min].The mean ischemic duration was 23 to 27min [mean(24.8 ± 1.6) min

  1. [Heart and vascular surgery interventions with hypothermic circulatory arrest in adults].

    Science.gov (United States)

    Kipfer, B; Leupi, F; Althaus, U

    1990-10-01

    In the period between 1981 and 1988, 51 patients were operated on the thoracic aorta using the hypothermic circulatory arrest technique. 31 patients had a dissection of the thoracic aorta, in 16 cases, an aneurysm was the reason for the intervention. In addition, we used the hypothermic circulatory arrest for a thrombectomy in the aortic arch and two mitral-valve replacements. The following operations were performed: 14 x composite graft, 19 x supracoronar prosthesis (6 x with aortic valve replacement, 3 x with partial replacement of aortic arch), 17 operations were performed either for aortic arch or aorta descendens replacement. In our retrospective study, 7 courses were fata (14%), 3 patients had complications with residuals. Compared with a group of 105 patients operated on the thoracic aorta in the same period without circulatory arrest, we found no difference with regard to the lethality and morbidity. We conclude that the hypothermic circulatory arrest is a safe technique for selected problems in cardiovascular surgery in adults. PMID:2074178

  2. [Thoracic Endovascular Aortic Repair Following Axillo-femoral Bypass in a Patient with Stanford B Acute Aortic Dissection Accompanied by Abdominal Visceral Ischemia;Report of a Case].

    Science.gov (United States)

    Nishimoto, Takayuki; Bonkohara, Yukihiro; Azuma, Takashi; Iijima, Masaki; Higashidate, Masafumi

    2016-09-01

    A 60-year-old woman was transfer-red to the emergency department of our medical center with worsening chest and back pain. Computed tomography revealed Stanford type B aortic dissection. There was a false lumen from the distal arch to the abdominal aorta just above the celiac artery. Although she was at 1st treated conservatively, she abruptly developed acute renal failure and lower limb ischemia because of an enlarged false lumen, and emergency axillo-femoral bypass surgery was performed with an 8 mm tube graft. However, renal failure gradually worsened, which necessitated continuous hemodiafiltration was performed. Thoracic endovascular aortic repair was then performed, and her renal function recovered. PMID:27586321

  3. Aortic insufficiency

    Science.gov (United States)

    ... Heart valve - aortic regurgitation; Valvular disease - aortic regurgitation; AI - aortic insufficiency ... BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: ...

  4. Hybrid treatment of penetrating aortic ulcer

    Energy Technology Data Exchange (ETDEWEB)

    Lara, Juan Antonio Herrero; Martins-Romeo, Daniela de Araujo; Escudero, Carlos Caparros; Falcon, Maria del Carmen Prieto; Batista, Vinicius Bianchi, E-mail: jaherrero5@hotmail.com [Unidade de Gestao Clinica (UGC) de Diagnostico por Imagem - Hosppital Universitario Virgen Macarena, Sevilha (Spain); Vazquez, Rosa Maria Lepe [Unit of Radiodiagnosis - Hospital Nuestra Senora de la Merced, Osuna, Sevilha (Spain)

    2015-05-15

    Penetrating atherosclerotic aortic ulcer is a rare entity with poor prognosis in the setting of acute aortic syndrome. In the literature, cases like the present one, located in the aortic arch, starting with chest pain and evolving with dysphonia, are even rarer. The present report emphasizes the role played by computed tomography in the diagnosis of penetrating atherosclerotic ulcer as well as in the differentiation of this condition from other acute aortic syndromes. Additionally, the authors describe a new therapeutic approach represented by a hybrid endovascular surgical procedure for treatment of the disease. (author)

  5. Surgical Treatment of Patients Enrolled in the National Registry of Genetically Triggered Thoracic Aortic Conditions (GenTAC)

    Science.gov (United States)

    Song, Howard K.; Bavaria, Joseph E.; Kindem, Mark W.; Holmes, Kathryn W.; Milewicz, Dianna M.; Maslen, Cheryl L.; Pyeritz, Reed E.; Basson, Craig T.; Eagle, Kim; Tolunay, H. Eser; Kroner, Barbara L.; Dietz, Hal; Menashe, Victor; Devereux, Richard B.; Desvigne-Nickens, Patrice; Ravekes, William; Weinsaft, Jonathan W.; Brambilla, Donald; Stylianou, Mario P.; Hendershot, Tabitha; Mitchell, Megan S.; LeMaire, Scott A.

    2011-01-01

    Background Genetic disorders are an important cause of thoracic aortic aneurysms (TAAs) in young patients. Despite advances in the treatment of genetically triggered TAAs, the optimal syndrome-specific treatment approach remains undefined. We used data from the NIH-funded, multicenter National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC) to characterize the contemporary surgical treatment of patients with genetically triggered TAAs. Methods GenTAC’s aim is to collect longitudinal clinical data and banked biospecimens from 2800 patients with genetically triggered TAAs. We analyzed data from all patients enrolled in GenTAC to date whose clinical data were available (n=606; mean age, 37.5 years). Results The patients’ primary diagnoses included Marfan syndrome (35.8%), bicuspid aortic valve with aneurysm (29.2%), and familial TAAs and dissections (10.7%). More than half of patients (56.4%) had undergone at least 1 operation; the most common indications were aneurysm (85.7%), valve dysfunction (65.8%), and dissection (25.4%). Surgical procedures included replacement of the aortic root (50.6%), ascending aorta (64.8%), aortic arch (27.9%), and descending or thoracoabdominal aorta (12.4%). Syndrome-specific differences in age, indications for surgery, and procedure type were identified. Conclusions Patients with genetically transmitted TAAs evaluated in tertiary care centers frequently undergo surgery. Aneurysm repairs most commonly involve the aortic root and ascending aorta; distal repairs are less common. Like TAAs themselves, complications of TAAs, including dissection and aortic valve dysfunction, are important indications for surgery. Future studies will focus on syndrome- and gene-specific phenotypes, biomarkers, treatments, and outcomes to improve the treatment of patients with TAAs. PMID:19699898

  6. The use of computer-guided flapless dental implant surgery (NobelGuide) and immediate function to support a fixed full-arch prosthesis in fresh-frozen homologous patients with bone grafts.

    Science.gov (United States)

    Nocini, Pier Francesco; Castellani, Roberto; Zanotti, Guglielmo; Bertossi, Dario; Luciano, Umberto; De Santis, Daniele

    2013-11-01

    The behavior of fresh-frozen homologous bone (FFB) when used in combination with computer-guided implant surgery has not been investigated yet, and there is a lack of clinical evidence in the literature. The purpose of this retrospective study is to evaluate the implant survival and related fixed full-arch prostheses at the 1- to 5-year follow-up when performed with immediate function using a flapless surgical procedure and computer-aided technology (NobelGuide; Nobel Biocare AB, Goteborg, Sweden) in patients previously treated with FFB grafts. Furthermore, the related values of torque and complications observed were analyzed and discussed. Clinical charts of patients with edentulous arches treated with FFB grafts and NobelGuide system with at least 1 year follow-up were reviewed retrospectively.A total of 65 patients met the criteria of inclusion, receiving a total of 342 implants and 77 full-arch prostheses, with a mean follow-up of 32.87 months (range, 1-5 years). Survival of implants and prostheses was high, reaching 96.5% and 95%, respectively. Factors significantly related to failure of the implants were smoking, position of the implant as last distal abutment, and fracture of basal maxillary bone. Prostheses survival was influenced by bruxism, failure of multiple implants, and torque level of implant equal to 0 at implant insertion. All implants and prostheses failures occurred in the first year. A higher torque level at implant insertion did not correspond to a lower risk of implant failure.Within the limitations of our retrospective study, this treatment modality was predictable with high survival rates and high insertion torque. However, a few implant and prosthetic failures were found, together with several complications. PMID:24220464

  7. Acute aortic dissection in a young healthy athlete with androgenic anabolic steroid use: A case report

    Directory of Open Access Journals (Sweden)

    Barman M, Djamel B, Mathews J

    2014-07-01

    Full Text Available Background: Acute aortic dissection can occur at the time of intense physical exertion in strength-trained athletes like weight lifters, bodybuilders, throwers, and wrestlers. Rapid rise in blood pressure and history of hypertension are the most common causes of aortic dissection in athletes. It is a very tragic event because of its high mortality rate of about 32% in young patients. We report a case of aortic dissection in a young weightlifter with a history of anabolic steroid usage with an extensive intimal tear of the aorta at Sino tubular junction and arch. All athletes must be assessed for predisposing factors for aortic dissection, and all patients should be encouraged to undergo appropriate diagnostic studies, like echocardiography and blood pressure monitoring while weightlifting to recognize possible predisposing factors for aortic dissection. Athletes who do have a problem should be encouraged to avoid or limit their exercise or activity by their cardiologist. It is vital that this disastrous event be prevented in young people. In conclusion, although a rare occurrence, AD should be considered in symptomatic patients with any family history of early cardiac deaths, a history suggestive of a connective tissue disorder (that is, multiple joint surgeries or who practice weightlifting.

  8. Cirurgia conservadora de próteses aórtica e mitral na endocardite infecciosa Conservative surgery for aortic and mitral prosthesis in infective endocarditis

    Directory of Open Access Journals (Sweden)

    Kanim Kalil KASSAB

    2001-03-01

    Full Text Available A endocardite infecciosa (EI acometendo próteses valvares é uma complicação freqüente, sendo tratada geralmente com cirurgia, devido ao seu difícil controle clínico e má resposta à antibioticoterapia. Este relato descreve o caso de uma paciente com EI, acometendo simultaneamente as biopróteses aórtica (Ao e mitral (Mi após vinte e quatro meses de cirurgia de implantes valvares, submetida a tratamento cirúrgico conservador, e com resultado favorável. Discutem-se as vantagens deste procedimento em situações específicas.Infective endocarditis is a frequent complication for valvar prosthesis currently treated with surgery, orving to its difficult control and poor response to therapy with antibiotics. Although conservative surgery for infective endocarditis of prosthesis is not a procedure of choice, this report shows a case of infective endocarditis of aortic and mitral prosthesis, after 24 months of implantation, treated by conservative surgery with favorable outcome.

  9. Testing the generalizability of national reimbursement rates with respect to local setting: the costs of abdominal aortic aneurysm surgery in Denmark

    Directory of Open Access Journals (Sweden)

    Søren Løvstad Christensen

    2010-09-01

    Full Text Available Søren Løvstad Christensen1, Mette Kjoelby1,2, Lars Ehlers31Health Technology Assessment and Health Services Research, Centre for Public Health, Central Denmark Region, Denmark; 2School of Public Health, Aarhus University, Denmark; 3Health Economics and Management, Aalborg University, DenmarkObjective: The purpose of this study is to investigate if the Danish national diagnosis-related group (DRG tariffs for surgery for abdominal aortic aneurysm (AAA were good estimates of the actual costs in two local hospitals in the Central Region of Denmark.Methods: We collected clinical data for 178 AAA patients operated at Skejby Hospital and Viborg Hospital in the period 2005–2006 from the Danish National Vascular Registry and economic data from the administrative systems in the hospitals. We used bootstrap methods to calculate 95% confidence intervals (CIs for the mean costs of surgery for ruptured AAA, nonruptured AAA and AAA where the patient died within 30 days by applying a cost-trimming rule that the Danish National Board of Health uses in calculating national DRG tariffs.Results: The national DRG tariff lies within the calculated Danish Krone (DKK CIs (CI ruptured AAA, 98,178–195,327 [€13,196–€26,254]; CI nonruptured AAA, 79,039–98,178 [€10,624–€13,196]; CI dead, 42,023–111,685 [€5,648–€15,011], and thus national DRG tariffs could be a good estimate for the actual costs in the local hospitals.Conclusion: The bootstrap method is useful for testing the generalizability of national DRG tariffs as estimates of local surgical costs.Keywords: bootstrap method, costs, DRG, abdominal aortic aneurysm

  10. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... for patients who would not tolerate well a traditional open operation or a less invasive operation, as ... physical reserve. So Barbara Bush recently had a traditional aortic valve replacement surgery. What makes a patient ...

  11. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... symptoms and ultimately surgery may be in the future. The symptoms seen primarily with aortic stenosis at ... echocardiography is? Echocardiography is the use of ultrasound technology. Ultrasound technology is a form of the same ...

  12. Association of Aortic Calcification on Plain Chest Radiography with Obstructive Coronary Artery Disease

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Yeong Han; Chang, Jeong Ho [Dept. of Diagnostic Radiology, Daegu Catholic University Hospital, Daegu (Korea, Republic of); Park, Jong Sam [Dept. of Radiologic Tecnology, Daegu Health College, Daegu (Korea, Republic of)

    2009-03-15

    This study was conducted to determine an association between aortic calcification viewed on plain chest radiography and obstructive coronary artery disease. Retrospective review of all chest radiography obtained from consecutive patients undergoing coronary angiography. Chest PA images were reviewed by technical radiologist and radiologist. Considering the presence of aortic arch calcification, images were compared with the results of coronary angiography. In addition, the size of aortic arch calcification were divided into two groups - the smaller and the larger than 10 mm. Among the total 846 patients, the number of the patients with obstructive coronary artery disease is total 417 (88.3%) in males and 312 (83.4%) in females. Considering the presence of aortic arch calcification, the positive predictive value of relation between aortic arch calcification and obstructive coronary artery disease was 91.4% and the relative risk of the group with aortic arch calcification to the opposite group was 1.10. According to the size of aortic arch calcification and obstructive coronary artery disease, the positive predictive value was 91.9% and the relative risk between two groups was 1.04. This study shows that aortic calcification was closely associated with obstructive coronary artery disease. If the aortic calcification is notified on plain chest radiography, we strongly recommend to consult with doctor.

  13. Association of Aortic Calcification on Plain Chest Radiography with Obstructive Coronary Artery Disease

    International Nuclear Information System (INIS)

    This study was conducted to determine an association between aortic calcification viewed on plain chest radiography and obstructive coronary artery disease. Retrospective review of all chest radiography obtained from consecutive patients undergoing coronary angiography. Chest PA images were reviewed by technical radiologist and radiologist. Considering the presence of aortic arch calcification, images were compared with the results of coronary angiography. In addition, the size of aortic arch calcification were divided into two groups - the smaller and the larger than 10 mm. Among the total 846 patients, the number of the patients with obstructive coronary artery disease is total 417 (88.3%) in males and 312 (83.4%) in females. Considering the presence of aortic arch calcification, the positive predictive value of relation between aortic arch calcification and obstructive coronary artery disease was 91.4% and the relative risk of the group with aortic arch calcification to the opposite group was 1.10. According to the size of aortic arch calcification and obstructive coronary artery disease, the positive predictive value was 91.9% and the relative risk between two groups was 1.04. This study shows that aortic calcification was closely associated with obstructive coronary artery disease. If the aortic calcification is notified on plain chest radiography, we strongly recommend to consult with doctor.

  14. Impact on calcification of aortic arch by lifestyle-related,physiologic and biochemical factors%主动脉弓钙化影响因素的调查与分析

    Institute of Scientific and Technical Information of China (English)

    周海林; Thomas GN; 江朝强; 林大庆; 郑家强; 刘斌; 张维森; 徐琳; 靳雅丽; 朱彤

    2009-01-01

    Objective To explore the impact of lifestyle-related,physiological and biochemical factors on aortic arch calcification(AAC).Methods 20 430 subjects aged 50 to 85 years were included in this study from the first and second recruitment phase of the Guangzhou Biobank Cohort Study.All the subjects received face-to-face interviews to collect detailed information on their socio-demographic background,occupational exposures,living environment,lifestyle,family and personal disease histories,and received a physical examination and tests including 12-lead ECG,chest radiograph,and pulmonary function testing.Each subject was screened for a range of fasting biochemical parameters.Radiographs were reviewed by two senior radiologists.300 radiographs were independently read by the two radiologists to assess agreement using Kappa coefficient.Logistic regression was used to assess the association between life style,physiological and biocheroical factors and AAC.Resuits (1)The rate of agreement on diagnosis for the two radiologists was 85% and Kappa coefficient was 0.68(P<0.01) which showed a moderate agreementbetween the two radiologists.(2) Except hypertension,the subjects were significantly difierent on their lifestyle,physiological and biochemical factors in both men and women(P<0.05).(3)AAC was significantly associated with older age,smoking status,LDL-C,and hypertension(P<0.01)in both genders.Ors(95%CI)indicated the following results:age was 1.11(1.10-1.12) in men and 1.12 (1.12-1.13)in women;smoking as 1.31(1.17-1.47)in men and 1.31(1.09-1.57)in women;LDL-Cas 1.16(1.06-1.27) in men and 1.38(1.22-1.56) in women,hypertension as 1.33(1.18-1.50) in men and 1.27(1.18-1.38) in women.However,diabetes was found to be associated with an increased risk of AAC in women[OR(95%CI)]1.38(1.22-1.56).Conclusion Age,smoking,hypertension and Low-density lipoprotcin level were risk factors to beth genders,on AAC,while diabetes increased the risk of AAC,in women.%目的 探讨生活习惯及生

  15. Modificação técnica para correção de coarctação aórtica com hipoplasia do arco aórtico Technical modification for correction of aortic coarctation using hypoplastic arch

    Directory of Open Access Journals (Sweden)

    José Alberto Caliani

    2008-09-01

    2005 and July 2006, nine newborn patients with aortic coarctation and significant aortic hypoplasia were selected, and underwent a new surgical approach in order to correct this aortic defect. The definition of aortic arch hypoplasia according to Moulaert's criteria is an aortic arch with a diameter that is less than 50% of the diameter of the ascending aorta. In this study, only patients with proximal and distal aortic hypoplasia were selected. Many techniques were previously used, but significant residual gradients were observed, as well as the incovenience of definitive occlusion of the left subclavian artery. The aim of this study is to describe a new surgical technique that includes left posterolateral thoracotomy, wide mobilization of descending aorta with occlusion of the first two intercostal branches, transection of the left subclavian artery at its base, wide resection of the hypoplastic area and the surronding regions of the ductus arteriosus; end-to-end anastomosis between the aortic arch and descending aorta, with 7-0 PDS thread and reimplantation of the subclavian artery into the left carotid artery with side-to-end anastomosis. RESULTS: There were no perioperative or late deaths. The mean residual gradient was 5 mmHg. Up to now, there were no cases of recoarctation or medullary neurological lesions. CONCLUSION: Despite the small number of cases and the short follow-up, this technique modification may be an excellent option for the treatment of this complex situation.

  16. Treatment of infrarenal abdominal aortic dissection concomitant with an aneurysm

    Institute of Scientific and Technical Information of China (English)

    WANG Li-xin; ZHU Ting; FU Wei-guo; WANG Yu-qi; XI Xun; GUO Da-qiao; CHEN Bin; JIANG Jun-hao; YANG Ju; SHI Zhen-yu

    2007-01-01

    @@ Aortic dissection occurs when layers of the aortic walls are separated by the blood flow through an intimal tear. Dissection of the aorta most frequently originates in the ascending aorta (70%), followed by the descending aorta (22%), the aortic arch (7%) and the abdominal aorta (1/%).1 The dissection limited to the abdominal aorta is rare.2 An isolated abdominal aortic dissection (IAAD) concomitant with an abdominal aortic aneurysm (AAA) is uncommon. We present here one patient with IAAD and AAA treated by endovascular therapy.

  17. Influence of preoperative coronary collateral circulation on in-hospital mortality in patients undergoing coronary artery bypass graft surgery with intra-aortic balloon pump support

    Institute of Scientific and Technical Information of China (English)

    Hasan Gungor; Cemil Zencir; Abraham Samuel Babu; Cagdas Akgullu; Ufuk Eryilmaz; Ali Zorlu; Mithat Selvi

    2014-01-01

    Background Outcomes in patients requiring coronary artery bypass graft (CABG) surgery have been improved with devices such as the intra-aortic balloon pump (IABP).Good coronary collateral circulation (CCC) has been shown to reduce mortality in patients with coronary artery disease (CAD).We aimed to investigate whether poor preoperative CCC grade is a predictor of in-hospital mortality in CABG surgery requiring IABP support.Methods Fifty-five consecutive patients who were undergoing isolated first time on-pump CABG surgery with IABP support were enrolled into this study and CCC of those patients was evaluated.Results Twenty-seven patients had poor CCC and 28 patients had good CCC.In-hospital mortality rate in poor CCC group was significantly higher than good CCC group (14 (50%) vs.4 (13%),P=0.013).Preoperative hemoglobin level (OR:0.752; 95% CI,0.571-0.991,P=0.043),chronic obstructive pulmonary disease (OR:6.731; 95% CI,1.159-39.085,P=0.034) and poor CCC grade (OR:5.750; 95% CI,1.575-20.986,P=0.008) were associated with post-CABG in-hospital mortality.Poor CCC grade (OR:4.853; 95% CI,1.124-20.952,P=0.034) and preoperative hemoglobin level (OR:0.624; 95% CI,0.476-0.954,P=0.026) were independent predictors of in-hospital mortality after CABG.Conclusion Preoperative poor CCC and hemoglobin are predictors of in-hospital mortality after CABG with IABP support.

  18. [Innovation in Surgery for Advanced Lung Cancer].

    Science.gov (United States)

    Nakano, Tomoyuki; Yasunori, Sohara; Endo, Shunsuke

    2016-07-01

    Thoracoscopic surgery can be one of less invasive surgical interventions for early stage lung cancer. Locally advanced lung cancer, however, cannot avoid aggressive procedures including pneumonectomy and/or extended combined resection of chest wall, aorta, esophagus, etc. for complete resection. Surgical approach even for advanced lung cancer can be less invasive by benefit from new anti-cancer treatment, innovated manipulations of bronchoplasty and angioplasty, and bench surgery( lung autotransplantation technique). We herein reviewed the strategy to minimize invasive interventions for locally advanced lung cancer, introducing 2 successful cases with advanced lung cancer. The 1st patient is a 62-year old man with centrally advanced lung cancer invading to mediastinum. Right upper sleeve lobectomy with one-stoma carinoplasty following induction chemoradiation therapy was successful. The operation time was 241 minutes. The performance status is good with no recurrence for 60 months after surgery. The 2nd is a 79-year old man with advanced lung cancer invading to the distal aortic arch. Left upper segmentectomy following thoracic endovascular aortic repair with stentgraft was successful with no extracorporeal circulation. The operation time was 170 minutes. The performance status is good with no recurrence for 30 months after surgery. The invasiveness of surgical interventions for local advanced lung cancer can be minimized by innovated device and new anti-cancer drugs. PMID:27440037

  19. [Efficacy of UFT in the treatment of para-aortic lymph node metastasis following gastric cancer surgery: case report].

    Science.gov (United States)

    Ishikawa, T; Matsusaka, T; Wakasugi, K; Tashiro, H; Yanaga, K; Yamamura, S; Sonoda, K; Kume, K

    2000-05-01

    The patient was a 68-year-old man who underwent pyloric gastrectomy for advanced stomach cancer on December 6, 1996. The histopathological diagnosis was poorly differentiated adenocarcinoma, ss, ly3, v1, n2 (+), and stage IIIa. Postoperative adjuvant chemotherapy consisted of short-term intravenous infusion of 5-FU, 320 mg/m2/day (= 480 mg/body) for 5 days beginning on postoperative day (POD) 1, and oral 5-FU, 200 mg/day, for 1 year beginning on POD 14. The preoperative CEA value was 316.2 ng, but it fluctuated below 10 ng postoperatively. About one year after the operation, the patient began to complain of epigastric pain, loss of appetite, and general malaise. CT of the upper abdomen revealed a 1.5-cm para-aortic lymph node, and the CEA value of 319.0 ng was abnormally high. 5-FU was stopped, oral UFT at 300 mg/day was started, and the patient's course was followed. Three months after the start of UFT, the lymph node had shrunk on CT (shrinkage rate: 66.7%), and the CEA value had decreased to 14.3 ng. As though corresponding to these changes there was a gradual decrease in the epigastric pain, general malaise, etc., and the patient's appetite also returned. There were no subsequent elevations in the CEA values or increases in the size of the para-aortic lymph nodes, and the patient's general condition was favorably maintained. UFT appeared to be effective against the lymph node metastasis around the aorta in this case. PMID:10832445

  20. [Inflammatory abdominal aortic aneurysm].

    Science.gov (United States)

    Ziaja, K; Sedlak, L; Urbanek, T; Kostyra, J; Ludyga, T

    2000-01-01

    The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

  1. Cirurgia da endocardite em valva aórtica: opção para tratamento de abscesso aórtico Surgery for Aortic Valve endocarditis: treatment options for aortic abscess

    Directory of Open Access Journals (Sweden)

    Antoninho Sanfins Arnoni

    2008-08-01

    fistulae. For this reason, surgeons have been developing tactical options to repair it. There is consensus around the fact that the removal of infected tissue promotes radical cleaning, and that the outcome of the treatment has been improved by the manufacture of biological glues which facilitate the closure of abscesses and by the creation of new valve replacements. OBJECTIVE:To demonstrate yet one more treatment option for aortic abscess for selected cases: a valved conduit placed in infra-coronary position. METHODS: We employed the technique in three patients: in two of them we employed a valved conduit with a mechanical prosthesis and in one of them a valved conduit with a biological prosthesis. Two patients needed associated procedures such as replacement of mitral valve in one of them and tricuspid valvoplasty in the other. All cases involved reoperation of prostheses in aortic position. RESULTS: The progression during surgery and in the early postoperative period was satisfactory and the three patients were discharged from the Intensive Care Unit and were sent to hospital rooms. One of the patients progressed to death during hospital stay due to severe comorbidities which were present in the preoperative period, and which related to esophageal varices and hepatic involvement. The other two progressed well in the late postoperative period. CONCLUSION: We believe that this option is yet one more alternative for the treatment of abscesses with great involvement of aortic ring structures and mitro-aortic continuity.

  2. Aortic Aneurysm

    Science.gov (United States)

    ... Most aneurysms are in the aorta, the main artery that runs from the heart through the chest and abdomen. There are two types of aortic aneurysm: Thoracic aortic aneurysms (TAA) - these occur in the part of the aorta running through the chest Abdominal aortic aneurysms (AAA) - these occur in the part ...

  3. Guilt by association: a paradigm for detection of silent aortic disease

    OpenAIRE

    Ziganshin, Bulat A.; Elefteriades, John A.

    2016-01-01

    Detection of clinically silent thoracic aortic aneurysm (TAA) is challenging due to the lack of symptoms (until aortic rupture or dissection occurs). A large proportion of TAA are identified incidentally while imaging a patient for other reasons. However, recently several clinical “associates” of TAA have been described that can aid in identification of silent TAA. These “associates” include intracranial aneurysm, aortic arch anomalies, abdominal aortic aneurysm (AAA), simple renal cysts (SRC...

  4. Pharmacokinetics and pharmacodynamics of propofol and fentanyl in patients undergoing abdominal aortic surgery - a study of pharmacodynamic drug-drug interactions.

    Science.gov (United States)

    Wiczling, Paweł; Bieda, Krzysztof; Przybyłowski, Krzysztof; Hartmann-Sobczyńska, Roma; Borsuk, Agnieszka; Matysiak, Jan; Kokot, Zenon J; Sobczyński, Paweł; Grześkowiak, Edmund; Bienert, Agnieszka

    2016-07-01

    Propofol is routinely combined with opioid analgesics to ensure adequate anesthesia during surgery. The aim of the study was to assess the effect of fentanyl on the hypnotic effect of propofol and the possible clinical implications of this interaction. The pharmacokinetic/pharmacodynamic (PK/PD) data were obtained from 11 patients undergoing abdominal aortic surgery, classified as ASA III. Propofol was administered by a target-controlled infusion system. Fentanyl 2-3 µg/kg was given whenever insufficient analgesia occurred. The bispectral index (BIS) was used to monitor the depth of anesthesia. A population PK/PD analysis with a non-linear mixed-effect model (NONMEM 7.2 software) was conducted. Two-compartment models satisfactorily described the PK of propofol and fentanyl. The delay of the anesthetic effect in relation to PK was described by the effect compartment. The BIS was linked to propofol and fentanyl effect-site concentrations through an additive Emax model. Context-sensitive decrement times (CSDT) determined from the final model were used to assess the influence of fentanyl on the recovery after anesthesia. The population PK/PD model was successfully developed to describe simultaneously the time course and variability of propofol and fentanyl concentrations and BIS. Additive propofol-fentanyl interactions were observed and quantitated. The duration of the fentanyl infusion had minimal effect on CSDT when it was shorter than the duration of the propofol infusion. If the fentanyl infusion was longer than the propofol infusion, an almost two-fold increase in CSDT occurred. Additional doses of fentanyl administered after the cessation of the propofol infusion result in lower BIS values, and can prolong the time of recovery from anesthesia. Copyright © 2016 John Wiley & Sons, Ltd.

  5. Intra-aortic balloon pump use does not affect the renal function in patients undergoing off pump coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Muniraju Geetha

    2011-01-01

    Full Text Available Renal dysfunction is known to occur during cardiac surgery. A few factors such as perioperative hypotension, use of potential nephrotoxic therapeutic agents, radio opaque contrast media in the recent past, intra-aortic balloon pump (IABP and cardiopulmonary bypass have been blamed as the contributing factors to the causation of postoperative renal dysfunction in cardiac surgical patients. At times, in patients with renal failure and low cardiac output status, one may face the dilemma if the use of IABP is safe. We undertook this prospective observational study to determine the degree of possible renal injury when IABP is used by measuring serial values of serum creatinine and Cystatin C. Elective patients scheduled for off-pump coronary artery bypass surgery requiring preoperative use of IABP were included in this study. Cystatin C and serum creatinine levels were checked at fixed intervals after institution of IABP. Twenty-two patients were eligible for enrolment to the study. There was no significant change in the values of serum creatinine; from the basal value of 1.10 ± 0.233 to 0.98 ± 0.363 mg /dL (P value >0.05. Cystatin C levels significantly decreased from the basal level of 0.98 ± 0.29 to 0.89 ± 0.23 (P value <0.05. Contrary to the belief, Cystatin C, the early indicator of renal dysfunction decreases suggesting absence of renal injury after the use of IABP. Absence of elevation of cystatin C levels in our study suggests the lack of potential of the IABP to cause renal dysfunction in patients who received elective IABP therapy preoperatively.

  6. A Case of Gastric Cancer with Residual Tumor Only in the Para-Aortic Lymph Nodes after Systemic Chemotherapy followed by Conversion Surgery

    Directory of Open Access Journals (Sweden)

    Masayuki Tsutsuyama

    2015-07-01

    Full Text Available We report the case of a 60-year-old male who was diagnosed with gastric cancer. Upper gastrointestinal endoscopy indicated advanced cancer in the posterior wall of the gastric body. Biopsy revealed poorly differentiated adenocarcinoma. Abdominal computed tomography demonstrated thickening of the gastric wall and enlargement of the regional lymph nodes and of the para-aortic lymph nodes (PAN. The involvement of the PAN extended from the celiac axis to the caudal area of the inferior mesenteric artery [cT3N3aH0P0M1(LYM, stage IV]. Systemic chemotherapy was initiated. After 3 courses of S-1 plus cisplatin combination chemotherapy, the primary lesion and the enlarged lymph nodes revealed marked regression except for a minute residual lesion in the lymph nodes. Upon obtaining informed consent, open distal gastrectomy, D2 lymphadenectomy with PAN dissection, and Roux-en-Y reconstruction were performed. The patient was discharged from the hospital 35 days after the operation. Histopathological examination of the resected samples revealed malignant cells only in the PAN, not in the stomach or in the regional lymph nodes [ypT0N0M1(LYM, stage IV]. Currently, the patient is undergoing postoperative adjuvant chemotherapy with S-1 and has remained well without any recurrence after 6 months following surgery.

  7. A Case of Gastric Cancer with Residual Tumor Only in the Para-Aortic Lymph Nodes after Systemic Chemotherapy followed by Conversion Surgery

    Science.gov (United States)

    Tsutsuyama, Masayuki; Ito, Seiji; Ito, Yuichi; Misawa, Kazunari; Kawakami, Jiro; Natsume, Seiji; Uemura, Norihisa; Kinoshita, Takashi; Kimura, Kenya; Senda, Yoshiki; Abe, Tetsuya; Komori, Koji; Yatabe, Yasushi; Niwa, Yasumasa; Shimizu, Yasuhiro; Kinoshita, Taira

    2015-01-01

    We report the case of a 60-year-old male who was diagnosed with gastric cancer. Upper gastrointestinal endoscopy indicated advanced cancer in the posterior wall of the gastric body. Biopsy revealed poorly differentiated adenocarcinoma. Abdominal computed tomography demonstrated thickening of the gastric wall and enlargement of the regional lymph nodes and of the para-aortic lymph nodes (PAN). The involvement of the PAN extended from the celiac axis to the caudal area of the inferior mesenteric artery [cT3N3aH0P0M1(LYM), stage IV]. Systemic chemotherapy was initiated. After 3 courses of S-1 plus cisplatin combination chemotherapy, the primary lesion and the enlarged lymph nodes revealed marked regression except for a minute residual lesion in the lymph nodes. Upon obtaining informed consent, open distal gastrectomy, D2 lymphadenectomy with PAN dissection, and Roux-en-Y reconstruction were performed. The patient was discharged from the hospital 35 days after the operation. Histopathological examination of the resected samples revealed malignant cells only in the PAN, not in the stomach or in the regional lymph nodes [ypT0N0M1(LYM), stage IV]. Currently, the patient is undergoing postoperative adjuvant chemotherapy with S-1 and has remained well without any recurrence after 6 months following surgery. PMID:26351440

  8. Review of reported causes of device embolization following trans-catheter aortic valve implantation.

    Science.gov (United States)

    Ibebuogu, Uzoma N; Giri, Smith; Bolorunduro, Oluwaseyi; Tartara, Paolo; Kar, Saibal; Holmes, David; Alli, Oluseun

    2015-06-15

    Transcatheter heart valve (THV) embolization is a rare but serious complication of transcatheter aortic valve implantation. Studies, including case reports, case series, and original reports published between 2002 and 2013, with regard to THV embolization were identified with a systemic electronic search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A total of 19 publications describing 71 patients were identified. Most patients (64%) were men, with a mean age of 80 ± 6 years and a mean logistic European System for Cardiac Operative Risk Evaluation score of 22.4 ± 9.3%. Balloon-expandable valves were used in 72% of the patients. The reported transcatheter aortic valve replacement access site was transfemoral in 80% of patients. Most cases (90%) occurred <1 hour after implantation, whereas 10% had late embolization (range 4 hours to 43 days). The most common site of embolization was the ascending aorta (38%), followed by the left ventricle (31%), descending aorta (23%), and aortic arch (8%). Open-heart surgery was required in 28% for valve retrieval and replacement. The 30-day stroke and mortality rates were 11% and 17%, respectively. Ventricular embolization and urgent conversion to open-heart surgery were significantly associated with death during hospitalization (p = 0.017 and p = 0.029, respectively). Likely causes of embolization were identified in 59 patients, with positioning error as the most commonly reported (47%), followed by pacing error (13%). In conclusion, THV embolization occurred early after transcatheter aortic valve implantation. The ascending aorta was the most common site of embolization. Higher 30-day stroke and mortality rates were associated with THV embolization compared with most published series of transcatheter aortic valve implantation outcomes. PMID:25882773

  9. Modificação técnica na cirurgia da estenose aórtica supravalvar Technical modifications in the surgery of supravalvar aortic stenosis

    Directory of Open Access Journals (Sweden)

    Magaly Arrais dos Santos

    1996-12-01

    íodo pós-operatório de 3 meses a 4 anos e 5 meses, não houve óbito; todos os pacientes estão assintomáticos, evoluindo satisfatoriamente, sem gradiente entre a cavidade livre do ventrículo esquerdo e aorta ascendente, conforme ecocardiograma, Doppler, ressonância nuclear magnética e estudo hemodinâmico. Estes resultados nos permitem concluir ser esta técnica adequada para a correção cirúrgica da estenose supravalvar aórtica localizada, por não utilizar enxertos artificiais e realizar a sutura da aorta em uma linha sinusoidal, evitando, assim, reestenose.A technical modification in the surgery of supravalvar aortic stenosis has been developed since October 1991 to December 1995, without using artificial grafts, but only healthy tissue of the ascending aorta thus permitting a suitable enlargement of the aortic root. The aim of this technique is to avoid complications of re-estenosis of aortic root in the late evolution of patientes submitted to surgical treatment of localized supravalvar aortic stenosis which was provoked by calcification and hardening of prosthetic material used for the enlargement of one or more Valsalva sinuses, with or whitout transversal section of the aorta. Ten patients underwent a surgery in this meantime, with clinical and hemodynamic diagnosis of localized supravalvar aortic stenosis. Their ages varied from 11 months to 38 years (mean = 13.2 years, the weight varied from 7.500 kg to 56 kg (mean = 29.1 kg, and the height varied from 72 cm to 1.68 m (mean = 1.5 m. Six of these patients were male. Three of them were asymptomatic; 4 had dyspnea, 2 were tired at efforts, 2 had palpitations, 1 had paresthesia in the lower limbs, and 1 cyanosis at crying; 6 of them bore Williams syndrome. The systolic gradient between free cavity of left ventricle and aorta varied from 50 to 100 mmHg (mean = 73.5.The patients were operated on with extracorporeal circulation, moderate hypothermia, crystalloid cardioplegia in the 7 first cases and bloody

  10. Minimally invasive aortic valve replacement

    DEFF Research Database (Denmark)

    Foghsgaard, Signe; Schmidt, Thomas Andersen; Kjaergard, Henrik K

    2009-01-01

    In this descriptive prospective study, we evaluate the outcomes of surgery in 98 patients who were scheduled to undergo minimally invasive aortic valve replacement. These patients were compared with a group of 50 patients who underwent scheduled aortic valve replacement through a full sternotomy...... operations were completed as mini-sternotomies, 4 died later of noncardiac causes. The aortic cross-clamp and perfusion times were significantly different across all groups (P valve replacement...... is an excellent operation in selected patients, but its true advantages over conventional aortic valve replacement (other than a smaller scar) await evaluation by means of randomized clinical trial. The "extended mini-aortic valve replacement" operation, on the other hand, is a risky procedure that should...

  11. [ENDOVASCULAR ABDOMINAL AORTIC ANEURISM REPAIR].

    Science.gov (United States)

    Maĭstrenko, D N; Generalov, M I; Tarazov, P G; Zherebtsov, F K; Osovskikh, V V; Ivanov, A S; Oleshchuk, A N; Granov, D A

    2015-01-01

    The authors analyzed the single-center experience of treatment of 72 patients with abdominal aortic aneurisms and severe accompanied pathology. The aneurisms were repaired by stent-grafts. All the patients had abdominal aortic aneurisms with the diameters from 41 to 84 mm against the background of severe somatic pathology. It was a contraindication to planned open surgery. An installation of stent-graft was successful in all 72 follow-ups. It wasn't necessary to use a conversion to open surgery. The follow-up period consisted of 44,6?2,1 months. Control ultrasound and computer tomography studies hadn't revealed an increase of aneurism sack sizes or "eakages". A reduction of abdominal aortic aneurism sizes was noted in 37 patients on 4-5% during first year after operation. The stent-graft implantation extends the possibilities of abdominal aortic aneurism treatment for patients from a high surgical risk group. PMID:26234059

  12. [Anomalies of the subrenal inferior vena cava in the surgery of non-specific and inflammatory abdominal aortic aneurysms].

    Science.gov (United States)

    Gargiulo, M; Stella, A; Caputo, M; Brusori, S; Pedrini, L; Tarantini, S; Curti, T

    1993-01-01

    The sub-renal abnormalities of the lower vena cava (LVC) (left LVC, double LVC) are determined by a deterioration of the alteration process of supra-cardinal veins. Though they are rare, it is necessary to look for them during surgery of abdominal aorta in order to lower the risk of iatrogenic venous injuries. You will find below the description of six cases of sub-renal lower vena cava abnormality (3 double LVC, 3 left LVC) associated with an abdominal aorta aneurism (4 non specific aneurisms, 2 inflammations ones) as well as the diagnostic aspects and the technical issues they cause during the reconstruction of a non specific and inflammation aneurism of the abdominal aorta. PMID:8248315

  13. Transcatheter Aortic Valve Replacement in a Nonagenarian

    OpenAIRE

    Kneitz, Abby; Clifton, William; Kar, Biswajit; Delgado, Reynolds M.

    2013-01-01

    Approximately 30% to 40% of elderly patients with severe, symptomatic aortic valve stenosis are deemed ineligible for surgery because of high perioperative risk. We describe the use of an alternative transfemoral approach known as transcatheter aortic valve implantation in a nonagenarian patient with severe aortic stenosis. Our patient recovered successfully, and by the time of her most recent follow-up visit, 7 months after the procedure, she had regained a substantial degree of function. Th...

  14. Transcatheter aortic valve replacement in elderly patients

    Institute of Scientific and Technical Information of China (English)

    Dimytri Siqueira; Alexandre Abizaid; Magaly Arrais J.; Eduardo Sousa

    2012-01-01

    Aortic stenosis is the most common native valve disease, affecting up to 5% of the elderly population. Surgical aortic valve replacement reduces symptoms and improves survival, and is the definitive therapy in patients with symptomatic severe aortic stenosis. However, despite the good results of classic surgery, risk is markedly increased in elderly patients with co-morbidities. Transcatheter aortic valve replacement (TAVR) allows implantation of a prosthetic heart valve within the diseased native aortic valve without the need for open heart surgery and cardiopulmonary bypass, offering a new therapeutic option to elderly patients considered at high surgical risk or with contraindications to surgery. To date, several multicenter registries and a randomized trial have confirmed the safety and efficacy of TAVR in those patients. In this chapter, we review the background and clinical applications of TAVR in elderly patients.

  15. Aortic valve replacement

    DEFF Research Database (Denmark)

    Kapetanakis, Emmanouil I; Athanasiou, Thanos; Mestres, Carlos A;

    2008-01-01

    BACKGROUND AND AIMS OF THE STUDY: Prompted by anecdotal evidence and observations by surgeons, an investigation was undertaken into the potential differences in implanted aortic valve prosthesis sizes, during aortic valve replacement (AVR) procedures, between northern and southern European...... countries. METHODS: A multi-institutional, non-randomized, retrospective analysis was conducted among 2,932 patients who underwent AVR surgery at seven tertiary cardiac surgery centers throughout Europe. Demographic and perioperative variables including valve size and type, body surface area (BSA) and early......: Prostheses with diameter valve size was also smaller in southern compared to northern European patients (21.6 +/- 2.1 mm versus 23.4 +/- 2.2 mm, p

  16. Substituição do arco aórtico sem parada circulatória total: técnicas, táticas e resultados Substitution of the aortic arch without total circulatory arrest: techniques, tactics and results

    Directory of Open Access Journals (Sweden)

    Fernando Antônio Roquette REIS FILHO

    2001-09-01

    Full Text Available INTRODUÇÃO: A despeito dos avanços da cirurgia cardiovascular, das técnicas de circulação extracorpórea e dos métodos de proteção cerebral, a mortalidade nas operações de substituição ou reparo do arco aórtico permanece elevada. As alterações decorrentes da hipotermia profunda e as lesões neurológicas ainda são a maior causa de morbi-mortalidade. OBJETIVO: Demonstrar um conjunto de técnicas e táticas cirúrgicas que permite realizar a substituição do arco aórtico sem a necessidade de hipotermia e parada circulatória total e apresentar os resultados alcançados em um grupo de 10 pacientes. CASUÍSTICA E MÉTODOS: Dez pacientes do sexo masculino, com idade média de 48,7 anos, foram submetidos a substituição do arco aórtico, utilizando-se hipotermia moderada, canulação arterial em artéria subclávia direita e femoral esquerda, perfusão cerebral seletiva pela artéria subclávia e confecção da anastomose dos vasos arco no primeiro tempo. RESULTADOS: O tempo médio de perfusão cerebral seletiva foi de 14,1 minutos, de isquemia miocárdica 39,6 minutos e de circulação extracorpórea 98,9 minutos. A temperatura esofágica média foi de 26,6º C (24º C a 30º C. O tempo médio de internação foi de 18,4 dias (8 a 40. Não ocorreram óbitos imediatos ou tardios. Dois pacientes apresentaram confusão mental temporária e um apresentou hemiparesia que foi revertida. CONCLUSÕES: A combinação de técnicas e táticas empregadas permitiu uma efetiva correção das lesões em um campo cirúrgico amplo e seco. Ofereceu uma excelente proteção cerebral sem a necessidade de hipotermia profunda o que diminuiu substancialmente as complicações pós-operatórias.INTRODUCTION: Despite the development in cardiovascular techniques such as in cardiopulmonary bypass and cerebral protection the mortality in the correlations of the diseases of the aortic arch remains high. Deep hypothermic circulatory arrest and cardiopulmonary

  17. Carotid artery inflow in operations to correct aortic diseases (ascending, arch and descending Circulação extracorpórea pela artéria carótida comum direita na correção de doenças da aorta ascendente, arco aórtico e aorta descendente

    Directory of Open Access Journals (Sweden)

    Januário M. Souza

    2003-06-01

    Full Text Available OBJECTIVE: Femoral artery cannulation has been used as the preferred option in operations to correct ascending aorta and aortic arch aneurysms and dissections. The axillary artery is an alternative site for cannulation. We have used arterial inflow via the common carotid artery in nine patients. METHOD: Nine patients were operated on with ages ranging from 46 to 80 years (mean 62.1 ± 12.54, six were male. Four patients had true aneurysms, three had aortic dissections and two a combination of dissections and true aneurysms. Five patients had undergone previous cardiovascular operations. Deep hypothermia with circulation arrest was used in two patients and in seven, antegrade cerebral perfusion was used. RESULTS: All nine patients awoke from the operation without cerebral damage. Two patients died, one on the 7th postoperative day due to respiratory failure and the other one on the third postoperative day due to a rupture of a thoracoabdominal aortic aneurysm. CONCLUSION: The carotid artery can be a safe alternative of arterial inflow in operations to correct ascending aorta and aortic arch diseases. This strategy allows antegrade cerebral perfusion during the operation even during arch resection and reconstruction.OBJETIVO: A canulação da artéria femoral tem sido a via mais comum para o retorno arterial, nas operações para correção de aneurismas ou dissecções da aorta ascendente e ou arco aórtico. Mais recentemente, a artéria subclávia também tem sido usada. O objetivo deste trabalho é apresentar uma experiência inicial, com nove pacientes, em que se utilizou a artéria carótida comum direita para este retorno. MÉTODO: Operaram-se nove pacientes com idade de 46 - 80 anos (62,1± 12,54, seis eram do sexo masculino, quatro tinham aneurismas verdadeiros, três apresentavam dissecções e, em dois, havia combinação de dissecção com aneurisma verdadeiro. Eram cinco reoperações. Em quatro pacientes (reoperações a circula

  18. A rare cause of recurrent aortic dissection.

    Science.gov (United States)

    Agrawal, Yashwant; Gupta, Vishal

    2016-07-01

    We report the case of a 19-year-old man with a history of Loeys-Dietz syndrome (LDS), which was diagnosed when he had a Stanford type A aortic dissection. He also had multiple aneurysms including ones in the innominate, right common carotid, and right internal mammary arteries. He had had multiple procedures including Bentall's procedure, repeat sternotomy with complete arch and valve replacement, and coil embolization of internal mammary artery aneurysm in the past. His LDS was characterized by gene mutation for transforming growth factor-β receptor 1. He presented to our facility with sudden onset of back pain, radiating to the right shoulder and chest. He was diagnosed with Stanford type B aortic dissection and underwent thoracic aorta endovascular repair for his aortic dissection. This case represents the broad spectrum of pathology associated with LDS where even with regular surveillance and aggressive medical management the patient developed Stanford B aortic dissection. PMID:27358537

  19. A modified total arch replacement combined with a stented elephant trunk implantation for acute type A dissection under deep hypothermic circulatory arrest and selective antegrade cerebral perfusion

    OpenAIRE

    Yang, Su-Min; Xu, Ping; Cheng-xiang LI; Huang, Qiang; Gao, Hong-Bo; Li, Zhen-Fu; Chang, Qing

    2014-01-01

    Objectives Since the optimal management of patients with acute aortic dissection is unclear, this study analyzed total arch replacement combined with stented elephant trunk implantation in the treatment of acute type A aortic dissection. Methods Between February 2008 and February 2013, 86 consecutive patients admitted to our hospital for acute type A dissection underwent total arch replacement combined with stented elephant trunk implantation under deep hypothermic circulatory arrest. The Ben...

  20. Clarifying the anatomy of the fifth arch artery

    Directory of Open Access Journals (Sweden)

    Saurabh Kumar Gupta

    2016-01-01

    Full Text Available The artery allegedly forming in the fifth pharyngeal arch has increasingly been implicated as responsible for various vascular malformations in patients with congenitally malformed hearts. Observations from studies on developing embryos, however, have failed to provide support to substantiate several of these inferences such that the very existence of the fifth arch artery remains debatable. To the best of our knowledge, in only a solitary human embryo has a vascular channel been found that truly resembled the artery of the fifth arch. Despite the meager evidence to support its existence, the fifth arch artery has been invoked to explain the morphogenesis of double-barreled aorta, some unusual forms of aortopulmonary communications, and abnormalities of the brachiocephalic arteries. In most of these instances, the interpretations have proved fallible when examined in the light of existing knowledge of cardiac development. In our opinion, there are more plausible alternative explanations for the majority of these descriptions. Double-barreled aorta is more likely to result from retention of the recently identified dorsal collateral channels while abnormalities of brachiocephalic arteries are better explained on the basis of extensive remodeling of aortic arches during fetal development. Some examples of aortopulmonary communications, nonetheless, may well represent persistence of the developing artery of the fifth pharyngeal arch. We here present one such case - a patient with tetralogy of Fallot and pulmonary atresia, in whom the fifth arch artery provided a necessary communication between the ascending aorta and the pulmonary arteries. In this light, we discuss the features we consider to be essential before attaching the tag of "fifth arch artery" to a candidate vascular channel.

  1. The German Aortic Valve Registry (GARY): in-hospital outcome

    OpenAIRE

    Hamm, Christian W.; Möllmann, Helge; Holzhey, David; Beckmann, Andreas; Veit, Christof; Figulla, Hans-Reiner; Cremer, J; Kuck, Karl-Heinz; Lange, Rüdiger; Zahn, Ralf; Sack, Stefan; Schuler, Gerhard; Walther, Thomas; Beyersdorf, Friedhelm; Böhm, Michael

    2013-01-01

    Background Aortic stenosis is a frequent valvular disease especially in elderly patients. Catheter-based valve implantation has emerged as a valuable treatment approach for these patients being either at very high risk for conventional surgery or even deemed inoperable. The German Aortic Valve Registry (GARY) provides data on conventional and catheter-based aortic procedures on an all-comers basis. Methods and results A total of 13 860 consecutive patients undergoing repair for aortic valve d...

  2. Early inflammatory response following elective abdominal aortic aneurysm repair: A comparison between endovascular procedure and conventional, open surgery

    Directory of Open Access Journals (Sweden)

    Marjanović Ivan

    2011-01-01

    . The study showed a statistically significantly shorter time of treatment in the EVAR group (average 90 min compared to the OR group (average 136 min. Also, there was a statistically significantly less blood loss in the patients operated on by the use of EVAR surgery (average 60 mL as compared to the patients treated with OR techinique (average 495 mL, as well as a shorter postoperative hospitalization of patients in the EVAR group (average 4 days compared to the OR group (average 8 days. The OR group was detected with a statistically significant increase of leucocytes and statistically significant fall of the number of thrombocytes in comparison with the EVAR group in all the investigated terms. A significant concentration rise of IL-2 in the OR group and concentration rise of IL-6 in the EVAR group was shown 24 hours after the procedure, whereas on the second postoperative day there was detected a significant fall of IL-6 in the EVAR group. IL-4 concentration in the OR group was significantly higher as of the third postoperative day in comparison to the EVAR group. There was no significant difference in IL-10 concentration between the groups. Conclusion. The EVAR techinique is a safer and less invasive and less traumatic procedure for patients than the OR of AAA. Following the EVAR, there are less inflammatory reactions in the early postoperative periodas compared to the OR and therefore less possibility of the development of systemic inflammatory respons syndrome in patients treated.

  3. Glossary to ARCH (GARCH)

    DEFF Research Database (Denmark)

    Bollerslev, Tim

    The literature on modeling and forecasting time-varying volatility is ripe with acronyms and abbreviations used to describe the many different parametric models that have been put forth since the original linear ARCH model introduced in the seminal Nobel Prize winning paper by Engle (1982......).  The present paper provides an easy-to-use encyclopedic reference guide to this long list of ARCH acronyms.  In addition to the acronyms associated with specific parametric models, I have also included descriptions of various abbreviations associated with more general statistical procedures and ideas...

  4. Reinforced aortic root reconstruction for acute type A aortic dissection involving the aortic root

    Directory of Open Access Journals (Sweden)

    Han Qing-qi

    2013-06-01

    Full Text Available OBJECTIVE: There are debates regarding the optimal approach for AAAD involving the aortic root. We described a modified reinforced aortic root reconstruction approach for treating AAAD involving the aortic root. METHODS: A total of 161 patients with AAAD involving the aortic root were treated by our modified reinforced aortic root reconstruction approach from January 1998 to December 2008. Key features of our modified approach were placement of an autologous pericardial patch in the false lumen, lining of the sinotubular junction lumen with a polyester vascular ring, and wrapping of the vessel with Teflon strips. Outcome measures included post-operative mortality, survival, complications, and level of aortic regurgitation. RESULTS: A total of 161 patients were included in the study (mean age: 43.3 1 15.5 years. The mean duration of follow-up was 5.1 1 2.96 years (2-12 years. A total of 10 (6.2% and 11 (6.8% patients died during hospitalization and during follow-up, respectively. Thirty-one (19.3% patients experienced postoperative complications. The 1-, 3-, 5-, and 10-year survival rates were 99.3%, 98%, 93.8%, and 75.5%, respectively. There were no instances of recurrent aortic dissection, aortic aneurysm, or pseudoaneurysm during the entire study period. The severity of aortic regurgitation dramatically decreased immediately after surgery (from 28.6% to 0% grade 3-4 and thereafter slightly increased (from 0% to 7.2% at 5 years and 9.1% at 10 years. CONCLUSION: This modified reinforced aortic root reconstruction was feasible, safe and durable/effective, as indicated by its low mortality, low postoperative complications and high survival rate.

  5. Hybrid treatment of recurring thoracoabdominal aortic aneurysm concomitant with retrograde type A aortic dissection

    Institute of Scientific and Technical Information of China (English)

    ZHANG Min-hong; GUO Wei; DU Xin; XIONG Jiang

    2010-01-01

    So far, standard therapy of complex thoracoabdominal aortic disease is open surgical repair requiring aortic clamping and replacement of the involved segment.Despite significant improvements, morbidity and mortality of open surgery remain high.I As a result, open surgery is often withheld owing to severe comorbidities of the patients. Endovascular technique has emerged as an alternative for treatment of these diseases in high risk patients,2 and has enlarged the options of treatment of complex aortic diseases. However, an endovascular approach alone is often deemed unsuitable for some complex aortic disorders because of the close proximity of the supraaortic or visceral branches. A hybrid open-endovascular approach has therefore been proposed as a viable alternative. We present here a unique patient with recurring thoracoabdominal aortic aneurysm (TAAA) concomitant with an aortic dissection (AD) treated by a hybrid open-endovascular approach.

  6. 食管癌切除行弓上食管胃机械吻合术150例%Use of disposable pipe type stapling aortic arch anastomosis of esophagusand stomach on 150 cases of middle and lower esophageal cancer

    Institute of Scientific and Technical Information of China (English)

    贾伟; 于文江; 岳志; 常王玉

    2012-01-01

    Objective To summarize the clinical experience of using of disposable pipe type stapling aortic arch anastomosis of esophagus and stomach. Methods Retrospective analysis was made of 150 cases of middle and lower esophageal cancer resection, with disposable pipe type of stapling bow mechanical esophagogastric anastomosis. Results A hundred and forty-nine cases achieved successful, however,1 patient failed. There was one case of anastomotic bleeding. Postoperative follow-up was performed on 144 cases,3 deaths,the causes of which were anastomotic fistula,a serious infection in 1 ,and aortic esophageal fistula in 2 cases. There was chylothorax in 1 case,cured by symptomatic treatment. The other patients recovered well. Long-term anastomotic stricture appeared in 5 cases, all expanded by balloon dilator to ease or cure after 7 times. 6 cases lost. Conclusion The use of lower esophageal intercostal posterolateral left chest incision and pipe-type esophagus and stomach stapling arch anastomosis performs with surgical difficulty, but there are fewer complications and improved quality of life of patients after the stomach intestine reconstruction.%目的 探讨一次性弯管型吻合器行主动脉弓上食管胃吻合术的临床经验.方法 回顾性分析150例采用一次性弯管型吻合器行弓上食管胃机械吻合根治性切除术中、下段食管癌.结果 一次吻合成功149例,1例失败改为弓旁手工吻合.全组患者1例吻合口出血.术后随访144例,死亡3例,死亡原因:吻合口瘘、严重感染1例,食管主动脉瘘2例.,乳糜胸1例,经对症处理治愈;其余患者术后恢复良好.远期出现吻合口狭窄5例,均经球囊扩张器扩张7次后缓解或治愈.6例失访.结论 中、下段食管癌采用左胸后外侧肋间切口,使用弯管型吻合器行食管胃弓上吻合,手术难度虽较大,但术后胃肠道重建并发症较少,患者的生活质量得到提高.

  7. Interrupção do arco aórtico tipo B em uma paciente com síndrome de olho de gato Interrupción del arco aórtico tipo B en una paciente con síndrome del ojo de gato Interrupted aortic arch type B in A patient with cat eye syndrome

    Directory of Open Access Journals (Sweden)

    Sintia Iole Nogueira Belangero

    2009-05-01

    Full Text Available Relatamos um caso de paciente com Síndrome do Olho de Gato (Cat Eye Syndrome-CES e interrupção do arco aórtico tipo B, um achado típico na síndrome da deleção 22q11.2. A análise cromossômica e a técnica de hibridização fluorescente in situ (FISH mostraram um cromossomo marcador isodicêntrico supranumerário com bi-satélite derivado do cromossomo 22. O segmento de 22pter a 22q11.2 no cromossomo supranumerário encontrado em nosso paciente não estava em sobreposição com a região deletada em pacientes com a síndrome da deleção 22q11.2. Entretanto, o achado de interrupção do arco aórtico tipo B não é usual na CES, mas é um defeito cardíaco freqüente na síndrome da deleção 22q11.Informamos un caso de paciente con Síndrome de Ojo de Gato (Cat Eye Syndrome-CES e Interrupción del Arco Aórtico tipo B, un hallazgo típico en el síndrome de la deleción 22q11.2. El análisis cromosómico y la técnica de hibridación in situ fluorescente (FISH mostraron un cromosoma marcador isodicéntrico supernumerario bisatelitado derivado del cromosoma 22. El segmento de 22pter a 22q11.2 en el cromosoma supernumerario encontrado en nuestro paciente no estaba en sobreposición con la región deletada en pacientes con el síndrome de la deleción 22q11.2. Con todo, el hallazgo de interrupción del arco aórtico tipo B no es usual en el CES, sino que es un defecto cardíaco frecuente en el síndrome de deleción 22q11.We report a patient with cat eye syndrome and interrupted aortic arch type B, a typical finding in the 22q11.2 deletion syndrome. Chromosomal analysis and fluorescent in situ hybridization (FISH showed a supernumerary bisatellited isodicentric marker chromosome derived from chromosome 22. The segment from 22pter to 22q11.2 in the supernumerary chromosome found in our patient does not overlap with the region deleted in patients with the 22q11.2 deletion syndrome. However, the finding of an interrupted aortic arch type B is

  8. Open surgical repair of abdominal aortic aneurysm: Proximal aortic control by endoaortic balloon - A novel approach

    OpenAIRE

    Balakrishnan Soundaravalli; Palaniappan, M.; Rajani Sundar; Chandrasekar, P.

    2012-01-01

    Patients with infrarenal abdominal aortic aneurysm with unfavorable anatomy for endovascular aneurysm repair have to undergo open surgical repair. Open surgery has its own morbidity in terms of proximal clamping and declamping, bleeding and prolonged hospital stay and mortality. We present two such patients with juxtarenal abdominal aortic aneurysm who underwent open surgical repair. The proximal aortic control during open surgical repair of the aneurysm was achieved by endoaortic balloon occ...

  9. Open surgical repair of abdominal aortic aneurysm: Proximal aortic control by endoaortic balloon - A novel approach

    Directory of Open Access Journals (Sweden)

    Balakrishnan Soundaravalli

    2012-01-01

    Full Text Available Patients with infrarenal abdominal aortic aneurysm with unfavorable anatomy for endovascular aneurysm repair have to undergo open surgical repair. Open surgery has its own morbidity in terms of proximal clamping and declamping, bleeding and prolonged hospital stay and mortality. We present two such patients with juxtarenal abdominal aortic aneurysm who underwent open surgical repair. The proximal aortic control during open surgical repair of the aneurysm was achieved by endoaortic balloon occlusion technique.

  10. Evolution of Endovascular Treatment for Complex Thoracic Aortic Disease

    OpenAIRE

    Roselli, Eric E.

    2008-01-01

    In a relatively short period of time, transcatheter and endovascular approaches to treat thoracic aortic and structural heart disease have exploded onto the scene. New device frontiers already being forged in the experimental stages include expanded indications and variations of fenestrated and branch stentgrafting to treat thoracoabdominal and arch disease, endovascular ascending and aortic root repair, and all of the cardiac valves. A fundamental concept to optimize durability of endovascul...

  11. Guilt by association: a paradigm for detection of silent aortic disease.

    Science.gov (United States)

    Ziganshin, Bulat A; Elefteriades, John A

    2016-05-01

    Detection of clinically silent thoracic aortic aneurysm (TAA) is challenging due to the lack of symptoms (until aortic rupture or dissection occurs). A large proportion of TAA are identified incidentally while imaging a patient for other reasons. However, recently several clinical "associates" of TAA have been described that can aid in identification of silent TAA. These "associates" include intracranial aneurysm, aortic arch anomalies, abdominal aortic aneurysm (AAA), simple renal cysts (SRC), bicuspid aortic valve, temporal arteritis, a positive family history of aneurysm disease, and a positive thumb-palm sign. In this article we examine these associates of TAA and the data supporting their involvement with asymptomatic TAA. PMID:27386404

  12. Unexpected death caused by rupture of a dilated aorta in an adult male with aortic coarctation

    DEFF Research Database (Denmark)

    Leth, Peter Mygind; Knudsen, Peter Juel Thiis

    2015-01-01

    Aortic coarctation (AC) is a congenital aortic narrowing. We describe for the first time the findings obtained by unenhanced post mortem computed tomography (PMCT) in a case where the death was caused by cardiac tamponade from a ruptured aneurysmal dilatation of the ascending aorta and the aortic...... and the aortic arch without aortic dissection associated with AC is an uncommon cause of haemopericardium that has only been described a few times before. The case is discussed in relation to other reported cases and in the context of the present understanding of this condition....

  13. Surgery for severe aortic stenosis with low transvalvular gradient and poor left ventricular function – a single centre experience and review of the literature

    Directory of Open Access Journals (Sweden)

    Vchivkov Ilja

    2007-01-01

    Full Text Available Abstract Background A retrospective comparative study was designed to determine whether the transvalvular gradient has a predictive value in the assessment of operative outcome in patients with severe aortic stenosis and poor left ventricular function. Methods From a surgical database, a series of 30 consecutive patients, who underwent isolated aortic valve replacement for severe aortic stenosis with depressed left ventricular (LV function (EF 40 mmHg (n = 17. Both groups were then comparatively assessed with respect to perioperative organ functions and mortality. Results Both groups were well matched with respect to the preoperative clinical status. LG-Group had a larger aortic valve area, higher LVEDP, larger LVESD and LVEDD, and higher mean pulmonary pressures. The immediate postoperative outcome, hospital morbidity and mortality did not differ significantly among the groups. Conclusion In patients with severe aortic stenosis and poor LV function, the mean transvalvular gradient, although corresponds to reduced LV performance, has a limited prognostic value in the assessment of surgical outcome. Generally, operating on this select group of patients is safe.

  14. The use of selective cerebral perfusion through right axillary artery cannulation in aortic aneurysm surgery%经右侧腋动脉插管选择性单侧脑灌注在主动脉瘤手术中的应用

    Institute of Scientific and Technical Information of China (English)

    姚昊; 王强; 骆璇; 王喆妍; 陈杨

    2011-01-01

    Objective To summarize the experiences of selective cerebral perfusion through right axillary artery cannulation in aortic aneurysm surgery. Methods Methods Retrospectively analyzed 105 cases ( from May 2009 to May 2011 ) of aortic aneurysm surgery with deep hypothermic circulatory arrest ( DHCA ). 78 cases were male and 27 cases were female. The operation procedure included Bentall procedure and semi arch replacement in 6 cases, ascending aorta replacement and semi arch replacement in 5 cases, Bentall procedure and elephant trunk technique in 61 cases, ascending aorta replacement and elephant trunk technique in 33 cases. Combined operations included coronery artery bypass grafting ( 10 cases ), mitral valve replacement or mitral valve repair ( 24 cases ) and tricuspid valve repair ( 11 cases ). Results Average cardiopulmonary bypass time was 81 -374 ( 178. 6 ±41. 5 ) min, average DHCA time was 8 - 36 ( 23.2 ± 10. 1 ) min, average selective cerebral perfusion time was 8 - 46 ( 30. 4 ± 12. 4 ) min, nasopharynx temperature during DHCA was 15. 5 -23. 5 ( 19. 5 ± 1. 7 )℃ , rectal temperature during DHCA was 18.0-25.6 ( 20.6 ± 1. 6 )℃. 89 patients'hearts automaticly reheated and 16 reheated after defibrillation. 5 cases died postoperatively. The complications included mul-tiorgan failure for 3 cases, malignant arrhythmia for 1 case and sudden bleeding for 1 case. Conclusion The use of selective cerebral perfusion through right axillary artery cannulation in aortic aneurysm surgery can get effective brain protection and reduce the postoperative nervous system complications with acceptable results.%目的 总结经右侧腋动脉插管选择性脑灌注(SCP)在主动脉瘤手术中应用的经验.方法 回顾性分析我院2009年5月至2011年5月期间采用深低温停循环(DHCA)SCP的手术方式治疗的105例主动脉瘤患者.男78例,女27例.行Bentall+次全弓置换6例,行升主动脉置换+次全弓置换5例,行Bentall+全弓置换+降主

  15. Retalho de pericárdio pediculado vascularizado autógeno para aortoplastia e correção da coarctação simples de aorta torácica, ou associada à hipoplasia, atresia ou interrupção do arco aórtico Pediculated autologous vascularized pericardial flap aortoplasty for correction of simple aortic coarctation or associated with hypoplasia, atresia or interruption of aortic arch

    Directory of Open Access Journals (Sweden)

    Paulo Rodrigues da Silva

    2006-12-01

    . CONCLUSÃO: A técnica do emprego do retalho pericárdico pediculado, vascularizado e autógeno é a mais adequada e a mais completa em comparação com todas as outras técnicas cirúrgicas existentes para correção dos diferentes tipos de coarctação da aorta torácica, nas suas formas simples ou associadas a outras lesões aórticas. É indicada em todas as faixas etárias, inclusive em recém-natos.OBJECTIVE: Eighteen years ago, two young male patients of 8 months and 13 years with aortic coarctation associated to aortic hypoplasia between the left subclavian artery and the coarctated area, were submitted to surgical correction using a new world-pioneering surgical technique developed in our service. METHOD: This technique consists of sectioning the patent ductus arteriosus, followed by resection of all the coarctated tissue in the aortic wall and aortoplasty correction by means of the lengthwise implantation of a pediculated autogenous pericardial flap. This flap is inserted into the thoracic aorta, from the root of the left subclavian artery to 2.0 cm below the coarctated area. RESULTS: For both patients, the blood pressure and arterial pulses of both arms and legs have been normal since the surgery until the present moment. Clinical examination and Doppler evaluation evidenced no pressure gradient between arms and legs, normal blood flow and no pressure gradient through the coarctated area. Both patients were submitted to other evaluations 18 years after surgery, including cardiac and thoracic aortic catheterization followed by aortography. These evaluations demonstrated normal aortic configuration, with normal diameter, including the areas above and below the coarctated site. There was no evidence of any kind of degenerative lesions of the vascularized pericardial flap or re-coarctation of the lesion and no signs of aneurysms forming or the presence of atherosclerosis of the flap. Moreover, and very importantly, it was evident that the pediculated completely

  16. Combined surgical and endovascular approach to treat a complex aortic coarctation without extracorporeal circulation.

    Science.gov (United States)

    Carrel, Thierry P; Berdat, Pascal A; Baumgartner, Iris; Dinkel, Hans-Peter; Schmidli, Jürg

    2004-10-01

    Various therapeutic approaches have been proposed to treat complex coarctation of the aorta (eg, recoarctation, which requires repetitive interventions, or coarctation with a hypoplastic aortic arch). Resection followed by end-to-end anastomosis or by graft interposition is technically demanding and exposes the patient to considerable perioperative risks. Cardiopulmonary bypass and deep hypothermic circulatory arrest may be necessary to control the distal aortic arch. The role of stent technology in treating this type of lesion has not yet been defined. We present a 21-year-old woman with a recurrent coarctation of the aorta associated with a hypoplastic aortic arch and a pseudoaneurysm of the proximal descending aorta. She had undergone 4 previous interventions. Treatment consisted of a combined surgical and endovascular approach without cardiopulmonary bypass and included extraanatomic aortic bypass, partial debranching of the supraaortic vessels, and stent-graft insertion to exclude the aneurysm.

  17. Diagnosis of aortic aneurysms by scintigraphy and ultrasonography

    Energy Technology Data Exchange (ETDEWEB)

    Caille, G. (Centre Hospitalier, Saint-Nazaire (France)); Chatal, J.F.; Tellier, J.L.; Talmant, C.; Guihard, R. (Centre Rene-Gauducheau, 44 - Nantes (France))

    1981-10-01

    Angioscintigraphy, performed on 50 patients suspected of aortic aneurysm and complemented by abdominal ultrasonography in 31 cases, disclosed: - Three cases of thoracic aortic aneurysm, 2 of which were confirmed by arteriography and surgery. It was impossible to perform surgery in the third case, no arteriography was done. Strict agreement with standard thoracic images had made the angioscintigraphic diagnosis seem correct. Twenty-seven cases of abdominal aortic aneurysms were confirmed by arteriography or surgery. Ultrasonography disclosed an abdominal aortic aneurysm in 26 cases, 20 of which were confirmed. The agreement of the two procedures in 10 unconfirmed cases led us to consider the diagnosis as correct. Angioscintigraphy appears to be a reliable procedure for detecting thoracic and abdominal aortic aneurysms. Ultrasonography is the simplest and least costly procedure for study of abdominal aortic aneurysms.

  18. Diagnosis of aortic aneurysms by scintigraphy and ultrasonography

    International Nuclear Information System (INIS)

    Angioscintigraphy, performed on 50 patients suspected of aortic aneurysm and complemented by abdominal ultrasonography in 31 cases, disclosed: - Three cases of thoracic aortic aneurysm, 2 of which were confirmed by arteriography and surgery. It was impossible to perform surgery in the third case, no arteriography was done. Strict agreement with standard thoracic images had made the angioscintigraphic diagnosis seems correct. - Twenty-seven cases of abdominal aortic aneurysms confirmed by arteriography or surgery. Ultrasonography disclosed an abdominal aortic aneurysm in 26 cases, 20 of which were confirmed. The agreement of the two procedures in 10 unconfirmed cases led us to consider the diagnosis as correct. Angioscintigraphy appears to be a reliable procedure for detecting thoracic and abdominal aortic aneurysms. Ultrasonography is the simplest and least costly procedure for study of abdominal aortic aneurysms

  19. Burmese Arched Harp

    Science.gov (United States)

    Williamson, Robert M.

    Our knowledge of the history, construction, and tunings of the Burmese arched harp (saùng gauk) comes from a variety of sources. Conversations with master harpists, together with recordings made of their performances between 1960 and 1980, provide richly detailed examples of the effect of Western music on a non-Western musical tradition. Scholars' essays and conference proceedings complement these first-hand accounts, expanding our understanding of Burmese music and musical instruments.

  20. The ARCHES Project

    Science.gov (United States)

    Motch, C.; Arches Consortium

    2015-09-01

    The Astronomical Resource Cross-matching for High Energy Studies (ARCHES) project is a FP7-Space funded programme started in 2013 and involving the Observatoire Astronomique de Strasbourg including the CDS (France), the Leibniz- Institut für Astrophysik Potsdam (Germany), the University of Leicester (UK), the Universidad de Cantabria (IFCA, Spain) and the Instituto Nacional de Tecnica Aeroespacial (Spain). ARCHES will provide the international astronomical community with well-characterised multi-wavelength data in the form of spectral energy distributions (SEDs) for large samples of objects extracted from the 3XMM X-ray catalogue of serendipitous sources. The project develops new tools implementing fully probabilistic simultaneous cross-correlation of several catalogues and a multi-wavelength finder for clusters of galaxies. SEDs are based on an enhanced version of the 3XMM catalogue and on a careful selection of the most relevant multi-wavelength archival catalogues. In order to ensure the largest audience, SEDs will be distributed to the international community through CDS services and through the Virtual Observatory. These enhanced resources are tested in the framework of several science cases. More information may be found at http://www.arches-fp7.eu/

  1. De Bakey Ⅰ型主动脉夹层的外科治疗%Surgical Treatment of De Bakey Ⅰ Aortic Dissection

    Institute of Scientific and Technical Information of China (English)

    陶登顺; 王辉山; 姜辉; 张南滨; 宋恒昌; 葛玉光; 杨忠路

    2011-01-01

    Objective To explore the surgical procedures and cerebral protection and improve surgical results by summarizing the experiences of surgical treatment of 68 patients of De Bakey Ⅰ aortic dissection. Methods We retrospectively analyzed the clinical data of 68 patients (including 45 males and 23 females aged 29 to 72 years with an age of 44.5±17.2 years) with De Bakey Ⅰ aortic dissection who were treated in the General Hospital of Shenyang Command between May 2004 and April 2010. Acute aortic dissection (occurring within 2 weeks) was present in 57 patients and chronic aortic dissection in 11. The intimal tear was located in the ascending aorta in 45 patients, in the aortic arch in 12 and in the descending part of the aortic arch in 11. Thirty-five patients underwent emergency operation and 33 underwent selected or limited operation. The operations were performed under hypothermic circulation arrest plus selective antegrade cerebral perfusion or right vena cave retrograde cerebral perfusion to protect the brain. Total arch replacement and stented elephant trunk were performed in 25 patients, Bentall operation with concomitant total arch replacement and stented elephant trunk in 16 patients, pure right semi aortic arch replacement and stented elephant trunk in 15 patients, total aortic arch replacement in 7 patients, right semi aortic arch replacement and stented elephant trunk in 3 patients, and Cabrol operation with concomitant aortic conduit with valve and total arch replacement and stented elephant trunk in 2 patients. Results Five patients (4 with acute aortic dissection and 1 with chronic aortic dissection) died with an operative mortality of 7.4% (5/68). The causes of death were anastomotic bleeding during surgery in 1 patient, postoperative low cardiac output syndrome and malignant arrhythmia in 2, acute renal failure in 1 and cerebral complications in 1. During peri-operative period, psychotic symptoms occurred in 5 patients,pericardial effusion in 2

  2. Cardiac surgery of premature and low birthweight newborns: is a change of fate possible?

    Science.gov (United States)

    Alkan-Bozkaya, Tijen; Türkoğlu, Halil; Akçevin, Atif; Paker, Tufan; Ozkan-Çerçi, Hilda; Dindar, Aygün; Ersoy, Cihangir; Bayer, Vedat; Aşkin, Demet; Undar, Akif

    2010-11-01

    Low birthweight (LBW) continues to be a high-risk factor in surgery for congenital heart disease. This risk is particularly very high in very low birthweight infants under 1500g and extremely LBW infants under 1000g. From January 2005 to December 2008, 33 consecutive LBW neonates underwent cardiac surgery in our clinic in keeping with the criteria for choice of surgery. Their weight range was between 800 and 1900g. Nine of them were under 1000g. Cardiopulmonary bypass (CPB) was used in 17 patients (39.5%) and pulsatile perfusion mode was applied to patients in the CPB group. The same surgical team operated to achieve palliation (8 patients, 24.2%) or full repair (25 patients, 75.8%). Median gestational age was 36 weeks with 12 (36.4%) premature babies (≤37 weeks). Median age at operation was 5 days. Pathologies were single ventricle (n=3), pulmonary atresia-ventricular septal defect (n=3), aortic coarctation (n=10), aorticopulmonary window and interrupted aortic arch combination (n=6), patent arterial duct (n=11), critical aortic stenosis (n=8), and tetralogy of Fallot with pulmonary atresia (n=2). One infant had VATER syndrome. Selective cerebral perfusion technique was used in complex arch pathologies for cerebral protection. Median follow-up was 14 months. There were four early postoperative deaths. None of the cases showed a need for early reoperation. The acceptable early- and midterm mortality rates in this group suggest that these operations can be successfully performed. There is a need for further multicenter studies to evaluate these high-risk groups.

  3. Effects of Adjustable Spine Arched Support and Herbs on the Amount of Bleeding in the Patients with Lumbar Surgery during Perioperative Period%可调式脊柱弓形架联合中药对腰椎围手术期出血量的影响

    Institute of Scientific and Technical Information of China (English)

    吴锦秋; 赵军; 邓强; 裴生太; 谢兴文; 杨波

    2014-01-01

    Objective:To analyze the effects of adjustable spine arched support and the drugs of stagnation-e-liminating to stop bleeding on reducing blood loss and postoperative drainage in posterior lumbar surgery. Methods:Altogether 67 patients with posterior lumbar surgery were randomly divided into two groups, the treatment group re-ceived adjustable spine arched support and the drugs of stagnation-eliminating to stop bleeding, the control group traditional prone mat and the water with brown sugar, Both groups were compared in the aspects of shortening surgi-cal time, reducing blood loss in the surgery and postoperative drainage. Results:Compared with the control group, the treatment group shows obvious advantages in the evaluation of associated indexes. Conclusion:Adjustable spine arched support and the drugs of stagnation-eliminating to stop bleeding could effectively reduce blood loss and post-operative drainage in posterior lumbar surgery, providing an effective intervention for solving the problems of the bleeding in perioperative period after posterior lumbar surgery.%目的:分析可调式脊柱弓形架联合化瘀止血药对减少腰椎后路术中出血量及术后引流量的影响。方法:随机选取67例腰椎后路手术患者,分成2组,治疗组使用可调式脊柱弓形架和化瘀止血药,对照组使用传统俯卧垫并服用红糖水,从缩短手术时间、减少术中出血量及术后引流量方面进行对比研究。结果:较之于对照组,治疗组在相关指标评价中优势明显。结论:可调式脊柱弓形架联合化瘀止血药,能有效减少术中出血量及术后引流量,为解决腰椎后路围手术期出血问题提供了一种有效的干预方法。

  4. [Aortic aneurysm].

    Science.gov (United States)

    Villar, Fernando; Pedro-Botet, Juan; Vila, Ramón; Lahoz, Carlos

    2013-01-01

    Aortic aneurysm is one important cause of death in our country. The prevalence of abdominal aortic aneurism (AAA) is around 5% for men older than 50 years of age. Some factors are associated with increased risk for AAA: age, hypertension, hypercholesterolemia, cardiovascular disease and, in particular, smoking. The medical management of patients with an AAA includes cardiovascular risk treatment, particularly smoking cessation. Most of major societies guidelines recommend ultrasonography screening for AAA in men aged 65 to 75 years who have ever smoked because it leads to decreased AAA-specific mortality. PMID:24238836

  5. New temporary internal introducer shunt for brain perfusion during total endovascular arch replacement with in situ fenestration technique.

    Science.gov (United States)

    Sonesson, Björn; Resch, Tim; Dias, Nuno; Malina, Martin

    2012-10-01

    Complete endovascular arch replacement by in situ fenestration technique requires maintenance of cerebral perfusion during the fenestration procedure by an extracorporeal femoral-carotid bypass. The bypass has the disadvantages of being invasive, requiring a pump, and shunting blood extracorporeally. This report describes bench testing and an in vivo experimental animal setup with an endovascular, temporary introducer shunt. This technique represents an adjunctive step toward a complete endovascular repair for the aortic arch. PMID:22857810

  6. A longitudinal analysis of the relationship between in-hospital mortality in New York State and the volume of abdominal aortic aneurysm surgeries performed.

    OpenAIRE

    Hannan, E L; Kilburn, H; O'Donnell, J. F.; Bernard, H R; Shields, E P; Lindsey, M L; Yazici, A.

    1992-01-01

    This study uses New York State hospital discharge data to examine the relationship between in-hospital mortality for a patient receiving an abdominal aortic aneurysm resection and the volume of aneurysm operations performed in the previous year at the hospital where the operation took place and by the surgeon performing the operation. Previous research on this topic is extended in several respects: (1) A three-year data base is used to examine the manner in which hospital and surgeon volume j...

  7. A phase II trial of Xeloda and oxaliplatin (XELOX) neo-adjuvant chemotherapy followed by surgery for advanced gastric cancer patients with para-aortic lymph node metastasis

    OpenAIRE

    Wang, Yan; Yu, Yi-yi; Li, Wei; Feng, Yi; Hou, Jun; Ji, Yuan; Sun, Yi-Hong; Shen, Kun-Tang; Shen, Zhen-Bin; Qin, Xin-Yu; Liu, Tian-shu

    2014-01-01

    Purpose Gastric cancer with para-aortic lymph node (PAN) involvement is regarded as advanced disease, and only chemotherapy is recommended from the guidelines. In unresectable cases, neoadjuvant chemotherapy could prolong survival if conversion to resectability could be achieved. Methods The study was a single-arm phase II trial. Patients who were diagnosed with gastric cancer and PAN involvement (Stations No. 16a2/16b1) were treated with capecitabine and oxaliplatin combination chemotherapy ...

  8. The ARCHES project

    CERN Document Server

    Motch, C; Genova, F; Esteban, F Jiménez-; López, M; Michel, L; Mingo, B; Mints, A; Gómez-Morán, A Nebot; Pineau, F -X; Rosen, S; Sanchez, E; Schwope, A; Solano, E; Watson, M

    2016-01-01

    ARCHES (Astronomical Resource Cross-matching for High Energy Studies) is a FP7-Space funded project whose aim is to provide the international astronomical community with well-characterised multi-wavelength data in the form of spectral energy distributions (SEDs) for large samples of objects extracted from the 3XMM DR5 X-ray catalogue of serendipitous sources. The project has developed new tools implementing fully probabilistic simultaneous cross-correlation of several catalogues for unresolved sources and a multi-wavelength finder for clusters of galaxies for extended sources. These enhanced resources have been tested in the framework of several science cases.

  9. Acute aortic dissection in pregnant women.

    Science.gov (United States)

    Yang, Zhaohua; Yang, Shouguo; Wang, Fangshun; Wang, Chunsheng

    2016-05-01

    Acute aortic dissection occurring during pregnancy represents a lethal risk to both the mother and fetus. Management of parturient with acute aortic dissection is complex. We report our experience of two pregnancies with type A acute aortic dissection. One patient is a 31-year-old pregnant woman (33rd gestational week) with a bicuspid aortic valve and the other is a 32-year-old pregnant woman (30th gestational week) with the Marfan syndrome. In both cases, a combined emergency operation consisting of Cesarean section, total hysterectomy prior to corrective surgery for aortic dissection was successfully performed within a relatively short period of time after the onset. Both patients' postoperative recovery was uneventful, and we achieved a favorable maternal and fetal outcome. PMID:25085319

  10. Aortic Blood Flow Reversal Determines Renal Function: Potential Explanation for Renal Dysfunction Caused by Aortic Stiffening in Hypertension.

    Science.gov (United States)

    Hashimoto, Junichiro; Ito, Sadayoshi

    2015-07-01

    Aortic stiffness determines the glomerular filtration rate (GFR) and predicts the progressive decline of the GFR. However, the underlying pathophysiological mechanism remains obscure. Recent evidence has shown a close link between aortic stiffness and the bidirectional (systolic forward and early diastolic reverse) flow characteristics. We hypothesized that the aortic stiffening-induced renal dysfunction is attributable to altered central flow dynamics. In 222 patients with hypertension, Doppler velocity waveforms were recorded at the proximal descending aorta to calculate the reverse/forward flow ratio. Tonometric waveforms were recorded to measure the carotid-femoral (aortic) and carotid-radial (peripheral) pulse wave velocities, to estimate the aortic pressure from the radial waveforms, and to compute the aortic characteristic impedance. In addition, renal hemodynamics was evaluated by duplex ultrasound. The estimated GFR was inversely correlated with the aortic pulse wave velocity, reverse/forward flow ratio, pulse pressure, and characteristic impedance, whereas it was not correlated with the peripheral pulse wave velocity or mean arterial pressure. The association between aortic pulse wave velocity and estimated GFR was independent of age, diabetes mellitus, hypercholesterolemia, and antihypertensive medication. However, further adjustment for the aortic reverse/forward flow ratio and pulse pressure substantially weakened this association, and instead, the reverse/forward flow ratio emerged as the strongest determinant of estimated GFR (P=0.001). A higher aortic reverse/forward flow ratio was also associated with lower intrarenal forward flow velocities. These results suggest that an increase in aortic flow reversal (ie, retrograde flow from the descending thoracic aorta toward the aortic arch), caused by aortic stiffening and impedance mismatch, reduces antegrade flow into the kidney and thereby deteriorates renal function.

  11. Endovascular Aortic Aneurysm Repair with Chimney and Snorkel Grafts: Indications, Techniques and Results

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Rakesh P., E-mail: rpatel9@nhs.net [Northwick Park Hospital, Department of Vascular Radiology (United Kingdom); Katsargyris, Athanasios, E-mail: kthanassos@yahoo.com; Verhoeven, Eric L. G., E-mail: Eric.Verhoeven@klinikum-nuernberg.de [Klinikum Nuernberg, Department of Vascular and Endovascular Surgery (Germany); Adam, Donald J., E-mail: donald.adam@tiscali.co.uk [Heartlands Hospital, Department of Vascular Surgery (United Kingdom); Hardman, John A., E-mail: johnhardman@doctors.org.uk [Royal United Hospital Bath, Department of Vascular Radiology (United Kingdom)

    2013-12-15

    The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR.

  12. Computer-Guided Implant Surgery in Fresh Extraction Sockets and Immediate Loading of a Full Arch Restoration: A 2-Year Follow-Up Study of 14 Consecutively Treated Patients

    OpenAIRE

    2015-01-01

    Statement of Problem. Low scientific evidence is identified in the literature for combining implant placement in fresh extraction sockets with immediate function. Moreover, the few studies available on immediate implants in postextraction sites supporting immediate full-arch rehabilitation clearly lack comprehensive protocols. Purpose. The purpose of this study is to report outcomes of a comprehensive protocol using CAD-CAM technology for surgical planning and fabrication of a surgical templa...

  13. Study of Coronary Artery Disease in Single Aortic Valvular Disease

    Institute of Scientific and Technical Information of China (English)

    张斌; 杨伟民; 占亚平

    2003-01-01

    Objectives To analyze the results of coronary angiographies (GAG) in patients with single aortic valvular heart disease; To study the relationship between aortic valve diseases and coronary artery disease (CAD). Methods 105 patients with single aortic valvular heart disease before surgery underwent angiography. The data of clinical characteristics and angiographies were analyzed. Results 51 patients had symptoms of angina pectoris among 105 patients with single aortic valvular heart disease. Seven of them were confirmed coronary artery disease by angiographies. Although the incidence of angina in aortic valve stenosis group was significantly higher than that in aortic valve regurgitation, the probability of combination of CAD in aortic valve stenosis group was similar to the later. However, the probability of combination of CAD in degenerative aortic valve group was significantly higher than the groups of rheumatic, congenitally bicuspid aortic valves, and other causes (p <0.01).Conclusions Angina pectoris is not sensitive for diagnosis of CAD in single aortic valve heart disease.The probability of combination of CAD in degenerative aortic valve disease is higher than that in aortic valve disease with other causes. Coronary angiography is strongly suggested for these patients.

  14. LANGER’S AXILLARY ARCH AND ITS CLINICAL IMPLICATIONS

    Directory of Open Access Journals (Sweden)

    Jyothi K C

    2014-09-01

    Full Text Available Introduction: The axillary arch muscle of Langer is the most common anatomical variant of axillary musculature which is of clinical and surgical importance. It may lead to neurovascular compression syndrome in the cervicoaxillary region and can be misinterpreted while examining axilla and also impairs movements of shoulder joint. Observation: During routine dissection of axilla for undergraduate teaching, an unusual muscular slip in the left axilla was observed .The muscular slip was extending from lattisimus dorsi muscle to undersurface of pectoralis major muscle, arching over axillary vessels and cords of brachial plexus. Conclusion: The axillary arch may cause obstruction to axillary vessels and nerves and may be involved in thoracic outlet syndrome and shoulder instability. The knowledge of this muscular variant could help to minimize intraoperative complications related to surgeries in or nearby axilla such as mastectomy, breast reconstruction and axillary lymphadenectomy or lymph node biopsy.

  15. 氨甲环酸对Stanford A型主动脉夹层术患者的血液保护作用%Blood-saving effect of tranexamic acid in patients undergoing Stanford type A aortic dissection surgery

    Institute of Scientific and Technical Information of China (English)

    徐红党; 周俊辉; 韩宇; 刘旭平; 王平凡; 高传玉

    2015-01-01

    Objective To investigate the blood-saving effect of tranexamic acid in patients undergoing Stanford type A aortic dissection surgery.Methods Fifty-six patients of both sexes with acute Stanford type A aortic dissection, aged 34-58 yr, weighing 62-84 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ , with their left ventricular ejection fraction > 40%, undergoing emergency surgery, were randomly divided into 2 groups: control group (group C, n=26) and tranexamic acid group (group TA, n=30).Tranexamic acid was infused as a bolus of 10 mg/kg over 30 min before skin incision followed by an infusion of 10 mg · kg-1 · h-1 throughout the surgery in group TA.The equal volume of normal saline was given instead in group C.The total volume of drainage at 24 h after operation, the postoperative requirement of allogeneic red blood cells, fresh frozen plasma and platelets, and re-thoracotomy for bleeding were recorded.The postoperative mechanical ventilation time, duration of intensive care unit stay, and complications after operation were also recorded.Results Compared with group C, the total volume of drainage at 24 h after operation, and the requirement of allogeneic red blood cells, fresh frozen plasma and platelets were significantly reduced, the incidence of rethoracotomy for bleeding was decreased, the postoperative mechanical ventilation time, and duration of intensive care unit stay were shortened, and the incidence of postoperative acute lung injury and transient neurological dysfunction were decreased in group TA.Conclusion Tranexamic acid has blood-saving effect and can reduce postoperative bleeding and allogeneic blood transfusion in patients undergoing Stanford type A aortic dissection surgery.%目的 探讨氨甲环酸对Stanford A型主动脉夹层术患者的血液保护作用.方法 急诊行Stanford A型主动脉夹层术患者56例,性别不限,年龄34~58岁,体重62~84 kg,ASA分级Ⅱ或Ⅲ级,左室射血分数>40%.采

  16. Treatment of aortic stenosis with a self-expanding transcatheter valve

    DEFF Research Database (Denmark)

    Linke, Axel; Wenaweser, Peter; Gerckens, Ulrich;

    2014-01-01

    AIM: Transcatheter aortic valve implantation has become an alternative to surgery in higher risk patients with symptomatic aortic stenosis. The aim of the ADVANCE study was to evaluate outcomes following implantation of a self-expanding transcatheter aortic valve system in a fully monitored, mult...

  17. Semi- and Nonparametric ARCH Processes

    Directory of Open Access Journals (Sweden)

    Oliver B. Linton

    2011-01-01

    Full Text Available ARCH/GARCH modelling has been successfully applied in empirical finance for many years. This paper surveys the semiparametric and nonparametric methods in univariate and multivariate ARCH/GARCH models. First, we introduce some specific semiparametric models and investigate the semiparametric and nonparametrics estimation techniques applied to: the error density, the functional form of the volatility function, the relationship between mean and variance, long memory processes, locally stationary processes, continuous time processes and multivariate models. The second part of the paper is about the general properties of such processes, including stationary conditions, ergodic conditions and mixing conditions. The last part is on the estimation methods in ARCH/GARCH processes.

  18. ALTERNATIVE METHOD OF SURGICAL CORRECTION OF DISSECTING AORTIC ANEURYSMS WITH AORTIC INSUFFIECIENCY

    Directory of Open Access Journals (Sweden)

    M. L. Semenovsky

    2009-01-01

    Full Text Available Patients with dissecting aortic aneurysm and associated acute aortic insufficiency form a group of seriously ill patients with significant cardiac failure, generally involving other organs and systems. It justifies an attempt to reduce a surgical risk, by using more sparing procedures, including supracoronary replacement of the ascending aorta with its root reconstruction. The latter has been performed in 27 patients (mean 54,5 ± 2,1 years with dissecting aortic aneurysm and aortic valvular insufficiency in 1996 to 2009. The major etiological factor was atherosclerosis (88%/ Seventeen (63%, 6 (22,2% and 4 (16% had types I, IIA and II dissection, respectively. Overall hospital mortality was 11%. In late period, progressive aneurysm dissection needed reinterventions in 2 cases. The competence of the reconstructed aortic valve was satisfactory both just after surgery and throughout the follow-up. Indications for this option of chronic correction, surgical techniques, and immediate and long-term results are outlined. 

  19. Simple Way of Recording Dental Arch Forms

    OpenAIRE

    Gupta, Shreya; Ratre, Ram Kishore; Jain, Sandhya; Chandki, Rita

    2015-01-01

    Like finger prints each individual has a unique dental arch form design. Recording patient’s dental arch form may be required in various fields in dentistry be it longitudinal studies for evaluating growth, forensic dentistry and most importantly in orthodontic practice for fabricating arch wires for individual patients. An easy and practical method to obtain individual arch form for each patient is explained.

  20. Haemostasis monitoring during sequential aortic valve replacement and liver transplantation

    NARCIS (Netherlands)

    Sieders, E.; De Somer, F.; Bouchez, S.; Szegedi, L.; Van Belleghem, Y.; Colle, I.; Troisi, R.

    2010-01-01

    Despite advances in anaesthesiological and surgical techniques, cardiac surgery in cirrhotic patients remains hazardous. This report outlines our experience with haemostasis monitoring in two consecutive cases of sequential aortic valve replacement and liver transplantation. Clotting disturbances pr

  1. Aortic valve bypass

    DEFF Research Database (Denmark)

    Lund, Jens T; Jensen, Maiken Brit; Arendrup, Henrik;

    2013-01-01

    In aortic valve bypass (AVB) a valve-containing conduit is connecting the apex of the left ventricle to the descending aorta. Candidates are patients with symptomatic aortic valve stenosis rejected for conventional aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI...

  2. Repair of recurrent pseudoaneurysm of the mitral-aortic intervalvular fibrosa: Role of transesophageal echocardiography

    OpenAIRE

    Shreedhar S Joshi; Ashwini Thimmarayappa; P S Nagaraja; Jagadeesh, A. M.; Arul Furtado; Seetharam Bhat

    2014-01-01

    Pseudoaneurysm of mitral-aortic intervalvular fibrosa (P-MAIVF) is a rare cardiac surgical condition. P-MAIVF commonly occurs as a complication of aortic and mitral valve replacement surgeries. The surgical trauma during replacement of the valves weakens the avascular mitral and aortic intervalvular area. We present a case of P-MAIVF recurrence 5 years after a primary repair. Congestive cardiac failure was the presenting feature with mitral and aortic regurgitation. In view of the recurrence,...

  3. Surgery cooperation and nursing of cervical posterior single door verte-bral canal expanded forming with ARCH plate fixation surgery%颈后路单开门椎管扩大成形ARCH板内固定术的手术配合及护理

    Institute of Scientific and Technical Information of China (English)

    赵雪枝; 黄长智; 陈小雁

    2015-01-01

    目的:探讨颈后路单开门椎管扩大成形ARCH钛板内固定术的护理配合。方法选取本院2010年11月~2013年11月的20例颈椎管狭窄症患者作为研究对象,对术前动力系统、手术体位、Mayfield头架的摆放及术中涉及的器械、动力系统的使用及围手术期护理等问题进行总结。结果20例患者手术顺利,无一例因手术体位和动力系统原因影响手术进程。术后均未出现脊髓损伤、血肿等并发症。术后6~12个月随访,未发现内固定物松动、移位、断裂等现象,患者神经功能恢复良好。结论颈后路单开门椎管扩大成形术是目前治疗颈椎管狭窄症较好的一种手术方式。掌握Mayfield头架的使用、手术体位的摆放,熟悉手术步骤、动力系统准备和使用及做好围术期护理有助于手术的顺利完成和患者的早期康复。%Objective To explore the cooperation and nursing of the cervical posterior single door vertebral canal ex-panded forming with ARCH plate fixation surgery. Methods 20 cases with cervical stenosis from November 2010 to November 2013 in our hospital were selected as the research object,preoperative dynamic system,surgical position,the placement of Mayfield skull traction frame and involved in the surgery of equipment,the use of the dynamic system and perioperative nursing were summarized. Results 20 cases were operated successfully,and there was no case affected the surgical process due to surgical position and dynamic system.There was no complication such as spinal cord injury or hematoma.All patients received follow-up for 6~12 months,without the phenomenons such as internal fixation loosening or displacement or fractures.All patients nervous function recovered well. Conclusion Cervical posterior single door vertebral canal expanded forming is an effective treatment in the case of cervical spinal stenosis disease.To master the use of Mayfield skull traction frame,the placement of

  4. Presentation of an uncommon form of aortic dissection and rupture in Marifoan syndrome

    International Nuclear Information System (INIS)

    In Marfan syndrome, aneurysmatic enlargement of ascending aorta and dissection starting at the root are the most common cardiovascular complications. We present an infrequent case of a 15-year-old patient with a typical case of Marfan syndrome. CT disclosed an aorta and aortic arch of normal size with dissection originating distally with respect to the point where left subclavian artery arises. The disecction extended to descending aorta and to iliac and femoral arteries. Aortic rupture occurred in the arch, with massive hemothorax. The CT findings were confirmed at necropsy. 9 refs

  5. Type B Aortic Dissection: Management Updates

    Directory of Open Access Journals (Sweden)

    Naghmeh Moshtaghi

    2009-12-01

    Full Text Available Acute aortic dissection (AAD is the most frequent catastrophic event of the aorta; it occurs nearly three times as frequently as the rupture of abdominal aortic aneurysm. Sixty percent of dissection cases are classified as proximal or type A and 40% as distal or type B, according to the Stanford Classification. The most frequent causes of death in acute type B dissection are aortic rupture and malperfusion syndrome.We herein review recent data suggesting different management modalities of type B aortic dissection, including medical, surgical, and endovascular treatments. Although medical therapy is still the standard approach in uncomplicated cases, there are subgroups of patients who may benefit from endovascular management. Endovascular techniques or surgery are valuable options for complicated cases. Hybrid suites, multidisciplinary approaches, and good imaging techniques can be considered as the key to success in this regard.

  6. Valve selection in aortic valve endocarditis

    Science.gov (United States)

    Zubrytska, Yana

    2016-01-01

    Aortic prosthetic valve endocarditis (PVE) is a potentially life-threatening disease. Mortality and incidence of infective endocarditis have been reduced in the past 30 years. Medical treatment of aortic PVE may be successful in patients who have a prompt response after antibiotic treatment and who do not have prosthetic dysfunction. In advanced stages, antibiotic therapy alone is insufficient to control the disease, and surgical intervention is necessary. Surgical treatment may be lifesaving, but it is still associated with considerable morbidity and mortality. The aim of surgery is to perform a radical excision of all infected and necrotic tissue, reconstruction of the left ventricle outflow tract, and replacement of the aortic valve. There is no unanimous consensus on which is the optimal prosthesis to implant in this context, and several surgical techniques have been suggested. We aim to analyze the efficacy of the surgical treatment and discuss the issue of valve selection in patients with aortic valve endocarditis.

  7. Screening for aortic aneurysm after treatment of coarctation.

    Science.gov (United States)

    Hoffman, James L; Gray, Robert G; LuAnn Minich, L; Wilkinson, Stephen E; Heywood, Mason; Edwards, Reggie; Weng, Hsin Ti; Su, Jason T

    2014-01-01

    Isolated coarctation of the aorta (CoA) occurs in 6-8 % of patients with congenital heart disease. After successful relief of obstruction, patients remain at risk for aortic aneurysm formation at the site of the repair. We sought to determine the diagnostic utility of echocardiography compared with advanced arch imaging (AAI) in diagnosing aortic aneurysms in pediatric patients after CoA repair. The Congenital Heart Databases from 1996 and 2009 were reviewed. All patients treated for CoA who had AAI defined by cardiac magnetic resonance imaging (MRI), computed tomography (CT), or catheterization were identified. Data collected included the following: type, timing, and number of interventions, presence and time to aneurysm diagnosis, and mortality. Patients were subdivided into surgical and catheterization groups for analysis. Seven hundred and fifty-nine patients underwent treatment for CoA during the study period. Three hundred and ninety-nine patients had at least one AAI. Aneurysms were diagnosed by AAI in 28 of 399 patients at a mean of 10 ± 8.4 years after treatment. Echocardiography reports were available for 380 of 399 patients with AAI. The sensitivity of echocardiography for detecting aneurysms was 24 %. The prevalence of aneurysms was significantly greater in the catheterization group (p Aneurysm was also diagnosed earlier in the catheterization group compared with the surgery group (p = 0.02). Multivariate analysis showed a significantly increased risk of aneurysm diagnosis in patients in the catheterization subgroup and in patients requiring more than three procedures. Aortic aneurysms continue to be an important complication after CoA repair. Although serial echocardiograms are the test of choice for following-up most congenital cardiac lesions in pediatrics, our data show that echocardiography is inadequate for the detection of aneurysms after CoA repair. Because the time to aneurysm diagnosis was shorter and the risk greater in the

  8. Endovascular treatment of aortic pathologies - State of the art. Part 1 - Aneurysms of abdominal aorta

    International Nuclear Information System (INIS)

    Endovascular treatment of aortic pathologies is actually an alternative to open surgery. It has proven to be safe, showing similar or better results to those achieved by surgery. In this article, treatment of aortic pathologies by means of endoprosthesis is presented, as well as its indications, contraindications and future treatment with this kind of devices

  9. Fatores de morbimortalidade na cirurgia eletiva do aneurisma da aorta abdominal infra-renal: experiência de 134 casos Morbidity and mortality factors in the elective surgery of infrarenal abdominal aortic aneurysm: a case study with 134 patients

    Directory of Open Access Journals (Sweden)

    Aquiles Tadashi Ywata de Carvalho

    2008-09-01

    aortic aneurysm (AAA can result in serious complications. To optimize treatment outcome it is important to identify patients at risk of having complications and implement prophylaxis. OBJECTIVES: To analyze early surgical mortality rate and postsurgical complications, and to identify risk factors related to morbidity and mortality. METHOD: A total of 134 patients with infrarenal AAA submitted to elective surgical correction from February 2001 to December 2005 were analyzed. RESULTS: The mortality rate (5.2% was secondary mainly to acute myocardial infarction and intestinal ischemia. Heart-related complications were the most frequent, followed by lung and kidney complications. Presence of diabetes mellitus, congestive heart failure, coronary artery disease, and scintigraphy suggestive of ischemia were related to cardiac complications. Advanced age, chronic obstructive lung disease and reduced forced vital capacity were related to higher risks of atelectasis and pulmonary infection. Presence of renal failure, prolonged aortic clamping and high urea rates were related to acute renal failure. Smoking and advanced age were associated with lower limb ischemia. Presence of obstructive coronary insufficiency and prolonged aortic clamping and surgery time were associated with higher mortality rate. CONCLUSION: The morbidity and mortality rate was compatible with data found in the national and international literature, secondary to cardiac, pulmonary and kidney complications. Identified risk factors before and during the surgery were related to these complications.

  10. Renal embolism as a primary manifestation of Streptococcus dysgalactiae subspecies equisimilis endocarditis in a patient with chronic aortic dissection.

    Science.gov (United States)

    Ishimaru, Naoto; Kinami, Saori; Ohnishi, Hisashi; Takagi, Asuka; Kawamoto, Megumi; Doukuni, Ryota; Umezawa, Kanoko; Oozone, Sachiko; Yoshimura, Sho; Sakamoto, Susumu

    2015-06-01

    We report a case of renal embolism as an initial manifestation of Streptococcus dysgalactiae subspecies equisimilis (SDSE) endocarditis in a patient with chronic aortic dissection. A 37-year-old man who underwent total aortic arch replacement owing to aortic dissection, presented with a 3-h history of fever, chills, and acute right-sided flank pain. The endocarditis affected the native aortic valve and was complicated by a renal embolism. Blood culture results were positive for SDSE. Intravenous penicillin resulted in satisfactory clinical and echocardiographic recovery. PMID:26110298

  11. Mechanism of aortic root dilation and cardiovascular function in tetralogy of Fallot.

    Science.gov (United States)

    Seki, Mitsuru; Kuwata, Seiko; Kurishima, Clara; Nakagawa, Ryo; Inuzuka, Ryo; Sugimoto, Masaya; Saiki, Hirofumi; Iwamoto, Yoichi; Ishido, Hirotaka; Masutani, Satoshi; Senzaki, Hideaki

    2016-05-01

    The aortic root dilation in tetralogy of Fallot (TOF) is a long-term clinical problem, because a severely dilated aorta can lead to aortic regurgitation, dissection, or rupture, which can be fatal, necessitating surgical intervention. The details of the mechanism of aortic root dilation, however, are unclear. We have shown that aortic stiffness is increased in patients with repaired TOF, and may mirror the histological abnormality of elastic fiber disruption and matrix expansion. This aortic stiffness is related closely to the aortic dilation, indicating that aortic stiffness may be a predictor of outcome of aortic dilation. Furthermore, the aortic volume overload is a very important determinant of aortic diameter in TOF patients before corrective surgery. In addition, a chromosomal abnormality and the transforming growth factor-β signaling pathway, a major contributor to aortic dilation in Marfan syndrome, also affect this mechanism. In this way, aortic dilation in TOF patients is suggested to be a multifactorial disorder. The aim of this review was therefore to clarify the mechanism of aortic dilation in TOF, focusing on recent research findings. Studies linking histopathology, mechanical properties, molecular/cellular physiology, and clinical manifestations of aortic dilation facilitate appropriate treatment intervention and improvement of long-term prognosis of TOF. PMID:26809655

  12. Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis: a meta analysis

    Institute of Scientific and Technical Information of China (English)

    WU Yi-cheng; ZHANG Jian-feng; SHEN Wei-feng; ZHAO Qiang

    2013-01-01

    Background Transcatheter aortic valve implantation (TAVI) has emerged as the treatment choice for non-operable patients with severe symptomatic aortic stenosis (AS) and may be a good alternative to surgery for those at very high or prohibitive surgical risk.We performed a meta-analysis to evaluate the comparative benefits of TAVI versus surgical aortic valve replacement (SAVR) in patients with severe AS.Methods A comprehensive literature search of PubMed,Embase,ScienceDirect and Cochrane Central Register of Controlled trials was performed,and randomized trials as well as cohort studies with propensity score analysis were included.Results One randomized trial (n=699) and six retrospective cohort studies (n=781) were selected for meta-analysis.Mortality at 30-day and 1-year follow-up was comparable between TAVI and SAVR.Despite similar incidences of stroke,myocardial infarction,re-operation for bleeding,and renal failure requiring dialysis,TAVI was associated with a lower occurrence rate of new-onset atrial fibrillation (OR 0.51,95% CI 0.33-0.78) and shorter procedural time (mean difference -67.50 minutes,95% CI-87.20 to-47.81 minutes).Post-operative aortic regurgitation and permanent pacemaker implantation were more common in patients after TAVI than in those with SAVR (OR 5.53,95% CI 3.41-8.97; OR 1.71,95% Cl 1.02-2.84,respectively).Conclusion In patients with severe symptomatic AS,TAVI and SAVR did not differ with respect to short-and mid-term survival,but the incidence of permanent pacemaker implantation and post-procedural aortic regurgitation remain relatively high after TAVI.

  13. Aortic Aneurysm Statistics

    Science.gov (United States)

    ... connective tissue disorders, such as Marfan syndrome and Ehlers-Danlos syndrome, get thoracic aortic aneurysms. Signs and symptoms of thoracic aortic aneurysm can include Sharp, sudden pain in the chest or upper back. Shortness of ...

  14. Aortic aneurysm repair - endovascular

    Science.gov (United States)

    EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... Endovascular aortic repair is done because your aneurysm is very large, growing quickly, or is leaking or bleeding. You may have ...

  15. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to become you to our live webcast. Today we’re going to repair an abdominal aortic aneurysm ... and together as a team of multidisciplinary physicians, we’re going to repair an abdominal aortic aneurysm ...

  16. Theory of Arched Structures Strength, Stability, Vibration

    CERN Document Server

    Karnovsky, Igor A

    2012-01-01

    Theory of Arched Structures: Strength, Stability, Vibration presents detailed procedures for analytical analysis of the strength, stability, and vibration of arched structures of different types, using exact analytical methods of classical structural analysis. The material discussed is divided into four parts. Part I covers stress and strain with a particular emphasis on analysis; Part II discusses stability and gives an in-depth analysis of elastic stability of arches and the role that matrix methods play in the stability of the arches; Part III presents a comprehensive tutorial on dynamics and free vibration of arches, and forced vibration of arches; and Part IV offers a section on special topics which contains a unique discussion of plastic analysis of arches and the optimal design of arches.

  17. Repair of Late Retrograde Type A Aortic Dissection After TEVAR: Causes and Management.

    Science.gov (United States)

    Mosquera, Victor X; Marini, Milagros; Fraga-Manteiga, Daniel; Gulias, Daniel; Cuenca, Jose J

    2016-03-01

    One of the most feared complications of thoracic endovascular aortic repair (TEVAR) and hybrid arch repair is retrograde type A aortic dissection (RTAD). More than two-thirds of RTAD occurs in the immediate postoperative period and first postoperative month. In presentations beyond that point, progression of the native aortopathy must be considered. We report a late presentation of an RTAD seven months after hybrid repair of an aortic intramural hematoma with an ulcer-like projection, and review the causes and management of this TEVAR complication.

  18. Hybrid Endovascular Aorta Repair with Simultaneous Supra-aortic Branch or Iliac Branch Revascularization

    Institute of Scientific and Technical Information of China (English)

    Yue-hong Zheng; Nim Choi; Hong-ru Deng; CU Kouk; Kun Yu; Furtado Rui

    2009-01-01

    Objective To describe a hybrid endovascular procedure for aorta repair with different kinds of bypass followed by concomitant placement of stent graft in the aorta.Methods From June 2007 to May 2008,5 consecutive patients who presented with aortic aneurysm or dissection were treated with a new hybrid aorta repair technique.Complete surgical rerouting of supra-aortic vessels was simultaneously created by endovascular repair of aortic arch aneurysm with stent graft.Hybrid left carotid-subclavian bypass with stent graft deployment covering the ostium of the left subclavian artery was performed in a Debakey type Ⅲ aortic dissection case.The supra-aortic branch was revascularized in 2 cases from ascending aorta to bilateral common carotid arteries using a 16-8 mm bifurcated graft,then total aortic arch and descending artery was occluded with stent-graft.The left carotid artery to the left subclavian artery bypass was created in 1 case,followed by stent-graft deployment.Two cases of infrarenal abdominal aortic aneurysm underwent left external iliac artery to left internal iliac artery bypass by a retroperineal route,then hybrid procedure was performed with bifurcated stent-graft.All stent grafts were deployed via a retrograde femoral artery approach in 5 patients.Results Technical success with complete aneurysmal exclusion was achieved in all patients.There was no incidence of endoleak.During a follow-up period of 2 to 10 months,documented perioperative neurologic events did not occur in all patients.One patient suffered from adult respiratory distress syndrome.After received tracheostomy,he recovered later.There was one death resulting from a postoperative myocardial infarction.Conclusion Hybrid arch repair provides an alternative therapy to patients otherwise considered prohibitively high risk for traditional open arch and thoracoabdominal aorta repair.

  19. Experimental behavior of FRP strengthened masonry arches

    OpenAIRE

    Oliveira, Daniel V.; Basílio, Ismael; Lourenço, Paulo B.

    2010-01-01

    This paper deals with the experimental behavior of solid clay brick masonry arches strengthened with glass fiber reinforced polymer composites. Twelve half-scaled segmental masonry arches subjected to a load applied at the quarter span were tested under displacement control up to failure. The arches were built using handmade low strength bricks and a commercial lime-based mortar, trying to mimic ancient structures. Besides reference unreinforced arches, five different strengthening arrangemen...

  20. Endovascular aortic repair: First twenty years

    Directory of Open Access Journals (Sweden)

    Končar Igor

    2012-01-01

    Full Text Available Endovascular aortic/aneurysm repair (EVAR was introduced into clinical practice at the beginning of the nineties. Its fast development had a great influence on clinicians, vascular surgeons and interventional radiologists, educational curriculums, patients, industry and medical insurance. The aim of this paper is to present the contribution of clinicians and industry to the development and advancement of endovascular aortic repair over the last 20 years. This review article presents the development of EVAR by focusing on the contribution of physicians, surgeons and interventional radiologists in the creation of the new field of vascular surgery termed hybrid vascular surgery, and also the contribution of technological advancement by a significant help of industrial representatives – engineers and their counselors. This article also analyzes studies conducted in order to compare the successfulness of EVAR with up-to-now applied open surgical repair of aortic aneurysms, and some treatment techniques of other aortic diseases. During the first two decades of its development the EVAR method was rapidly progressing and was adopted concurrently with the expansion of technology. Owing to large randomized studies, early and long-term results indicate specific complications of this method, thus influencing further technological improvement and defining risk patients groups in whom the use of the technique should be avoided. Good results are insured only in centers, specialized in vascular surgery, which have on their disposal adequate conditions for solving all complications associated with this method.

  1. Iatrogenic aortic root and left main dissection during non-emergency coronary surgery: a solution applicable to heavily calcified coronary arteries†.

    Science.gov (United States)

    Kieser, Teresa M; Spence, Frank P; Kowalewski, Richard

    2016-02-01

    Dissection of the left main coronary artery during coronary artery bypass graft (CABG) surgery is a rare, potentially lethal complication, usually diagnosed at post-mortem. During the cross-clamp period of a 4-vessel coronary artery bypass graft procedure in a 74-year old hypertensive woman, retrograde dissection occurred in a diffusely diseased marginal artery when perfused with cardioplegic solution at a pressure of 140-150 mmHg through a vein graft. The dissection extended back to the left main artery, included the posterior proximal ascending aorta and then down the left anterior descending artery (LAD). Transoesophageal echocardiography (TOE) confirmed the left main dissection and showed anterior-septal-lateral akinesis in a previously normally functioning left ventricle (LV). The circumferentially calcified proximal LAD was grafted with a saphenous vein by carving an oval area of calcium creating an elliptical opening in the artery wall. Normal LV function returned and, in the area of the left main dissection, there was only thickening with no colour flow. Eight months postoperatively cardiac catheterization showed normal LV function, patent vein grafts to the right coronary artery and proximal LAD, left internal mammary artery to distal LAD and an occluded sequential marginal vein graft. Twelve years postoperatively, the patient is well with Class I angina, on medication. There is no previous documentation of a diagnosed and successfully treated left main dissection during CABG surgery. Since this case using the technique of creating an oval opening in a circumferentially calcified coronary artery (with an otherwise satisfactory lumen), the author has been using this technique to bypass otherwise non-bypassable arteries; this technique may be useful to help patients with severe calcific coronary artery disease.

  2. Fatores de risco pré, intra e pós-operatórios para mortalidade hospitalar em pacientes submetidos à cirurgia de aorta Risk factors for pre, intra, and postoperative hospital mortality in patients undergoing aortic surgery

    Directory of Open Access Journals (Sweden)

    Mário Issa

    2013-03-01

    ção pulmonar, EuroScore e tempo de CEC associaram-se ao desfecho clínico composto hospitalar.OBJECTIVES: The primary objective was to identify predictors of hospital mortality in patients undergoing aortic surgery. The secondary objective was to identify factors associated with clinical outcome composed hospital (death, bleeding, neurologic complications or ventricular dysfunction. METHODS: A cross-sectional design with longitudinal component. Through chart review, 257 patients were included. Inclusion criteria were: aortic dissection Stanford type A and ascending aortic aneurysm. Exclusion criteria were acute aortic dissection, of any kind, and no aortic aneurysm involving the ascending segment. Variables assessed: demographics, preoperative factors, intraoperative and postoperative. RESULTS: Variables with increased risk of hospital mortality (OR, 95% CI, P value: black ethnicity (6.8, 1.54-30.2; 0.04, cerebrovascular disease (10.5, 1.12-98.7; 0.04, hemopericardium (35.1, 3.73-330.2; 0.002, Cabrol operation (9.9, 1.47-66.36; 0.019, CABG simultaneous (4.4; 1.31 to 15.06; 0.017, bleeding (5.72, 1.29-25.29; 0.021 and cardiopulmonary bypass (CPB time [min] (1.016; 1.0071.026; 0.001. Thoracic pain was associated with reduced risk of hospital death (0.27, 0.08-0.94, 0.04. Variables with increased risk of hospital clinical outcome compound were: use of antifibrinolytic (3.2, 1.65-6.27; 0.0006, renal complications (7.4, 1.52-36.0; 0.013, pulmonary complications (3.7, 1.58.8, 0.004, EuroScore (1.23; 1.08-1.41; 0.003 and CPB time [min] (1.01; 1.00 to 1.02; 0.027. CONCLUSION: Ethnicity black, cerebrovascular disease, hemopericardium, Cabrol operation, CABG simultaneous, hemostasis review and CPB time was associated with increased risk of hospital death. Chest pain was associated with reduced risk of hospital death. Use of antifibrinolytic, renal complications, pulmonary complications, EuroScore and CPB time were associated with clinical outcome hospital compound.

  3. Contemporary management of blunt aortic trauma.

    Science.gov (United States)

    Dubose, J J; Azizzadeh, A; Estrera, A L; Safi, H J

    2015-10-01

    Blunt thoracic aortic injury (BTAI) remains a common cause of death following blunt mechanisms of trauma. Among patients who survive to reach hospital care, significant advances in diagnosis and treatment afford previously unattainable survival. The Society for Vascular Surgery (SVS) guidelines provide current best-evidence suggestions for treatment of BTAI. However, several key areas of controversy regarding optimal BTAI care remain. These include the refinement of selection criteria, timing for treatment and the need for long-term follow-up data. In addition, the advent of the Aortic Trauma Foundation (ATF) represents an important development in collaborative research in this field. PMID:25868973

  4. Risk factors for delayed removal of tracheal intubation after surgery for Stanford A aortic dissection%Stanford A型主动脉夹层术后气管插管延迟拔除危险因素分析

    Institute of Scientific and Technical Information of China (English)

    范阜东; 周庆; 葛敏; 王东进

    2014-01-01

    目的探讨 Stanford A 型主动脉夹层术后气管插管延迟拔除的危险因素。方法回顾性分析2008年12月至2014年1月于南京大学医学院附属鼓楼医院心胸外科行手术治疗的161例 Stanford A 型主动脉夹层患者的临床资料。根据术后是否延迟拔除气管插管,将所有患者分为延迟拔管组(n =118)及非延迟拔管组(n =43),分析和比较两组患者围术期相关资料,采用多因素 Logistic 回归分析 Stanford A 型主动脉夹层术后气管插管延迟拔除的危险因素。结果Stanford A 型主动脉夹层患者术后气管插管延迟拔除发生率为73.3%(118/161),118例延迟拔管患者中2012年以前收治的有79例,占66.9%(79/118),2012年以后收治的有39例,占33.1%(39/118);患者总体住院死亡12例,病死率为7.45%(12/161),死亡原因均为出血或器官功能障碍。术后延迟拔管组患者年龄高于非延迟拔管组,阻断时间长于非延迟拔管组(P 均<0.05),延迟拔管组患者输血量较未延迟拔管组患者显著增加(P =0.00)。多因素 Logistic 回归模型分析显示:围术期输血量>3000 ml(OR =26.469,P =0.000)及年龄(OR =3.010,P =0.040)是影响术后延迟拔管的危险因素。结论对于高龄 Stanford A 型主动脉夹层患者,术后延迟拔除气管插管风险可能会增加,而尽可能地减少围术期输血量,则可能减少长期气管插管的风险。%Objective To analyze the risk factors for delayed removal of tracheal intubation after surgery for patients with Stanford A aortic dissection .Methods From December 2008 to January 2014,161 patients with Stanford A aortic dissection underwent surgery were retrospectively analyzed .Patients were divided into delayed removal of tracheal intubation group (delayed group,n =118)and non-delayed removal of tracheal intubation group (non-delayed group

  5. Comparison of Commercially Available Arch Wires with Normal Dental Arch in a Group of Iranian Population

    OpenAIRE

    Zohreh Hedayati; Farnaz Fakhri; Vahid Moshkel Gosha

    2015-01-01

    Statement of the Problem The stability of orthodontic treatment depends on preserving the patient’s pretreatment arch form and arch size during and after treatment. Purpose This investigation was aimed to study the size and shape of Iranian mandibular dental arch and evaluate the correlation of their average dental arch with commercially available preformed rectangular nickel-titanium arch wires. Materials and Method In this study, 148 subjects were selected among students of Shiraz Universit...

  6. Surgery of the aortic root: should we go for the valve-sparing root reconstruction or the composite graft-valve replacement is still the first choice of treatment for these patients?

    Directory of Open Access Journals (Sweden)

    Fernando de Azevedo Lamana

    2015-09-01

    Full Text Available AbstractObjective:To compare the results of the root reconstruction with the aortic valve-sparing operation versus composite graftvalve replacement.Methods:From January 2002 to October 2013, 324 patients underwent aortic root reconstruction. They were 263 composite graft-valve replacement and 61 aortic valve-sparing operation (43 reimplantation and 18 remodeling. Twenty-six percent of the patients were NYHA functional class III and IV; 9.6% had Marfan syndrome, and 12% had bicuspid aortic valve. There was a predominance of aneurysms over dissections (81% vs. 19%, with 7% being acute dissections. The complete follow-up of 100% of the patients was performed with median follow-up time of 902 days for patients undergoing composite graft-valve replacement and 1492 for those undergoing aortic valve-sparing operation.Results:In-hospital mortality was 6.7% and 4.9%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns. During the late follow-up period, there was 0% moderate and 15.4% severe aortic regurgitation, and NYHA functional class I and II were 89.4% and 94%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns. Root reconstruction with aortic valve-sparing operation showed lower late mortality (P=0.001 and lower bleeding complications (P=0.006. There was no difference for thromboembolism, endocarditis, and need of reoperation.Conclusion:The aortic root reconstruction with preservation of the valve should be the operation being performed for presenting lower late mortality and survival free of bleeding events.

  7. Radiotherapy-induced aortic valve disease associated with porcelain aorta

    International Nuclear Information System (INIS)

    Mediastinal irradiation has been reported to induce cardiac disease such as pericarditis, valvular dysfunction, conduction abnormalities, accelerated arteriosclerosis of the coronary arteries, and also calcifications of the ascending aorta. We herein describe a case of radiotherapy-induced porcelain aorta and aortic valve disease and their surgical treatment. The patient was diagnosed with myasthenia gravis (MG) in 1965 (Osserman's type II), and mediastinal irradiation was performed in 1970 for treatment of thymic tumor associated with MG. Thirty years after radiation therapy, complete atrioventricular block and aortic valve disease with severe calcification of the ascending aorta and aortic arch (porcelain aorta) were detected on echo cardiogram and cardiac catheterization. A permanent pacemaker was implanted via the left subclavian vein and aortic valve replacement was performed under extracorporeal circulation established by selective cerebral perfusion and balloon occlusion instead of aortic cross-clamping. As no risk factors of arteriosclerosis such as hypercholesterolemia, hyperglycemia and hypertension were apparent, we concluded that the aortic valve disease and porcelain aorta were primarily induced by radiotherapy. (author)

  8. Association between aortic valve calcification measured on non-contrast computed tomography and aortic valve stenosis in the general population

    DEFF Research Database (Denmark)

    Paulsen, Niels Herluf; Carlsen, Bjarke Bønløkke; Dahl, Jordi Sanchez;

    2016-01-01

    BACKGROUND: Aortic valve calcification (AVC) measured on non-contrast computed tomography (CT) has shown correlation to severity of aortic valve stenosis (AS) and mortality in patients with known AS. The aim of this study was to determine the association of CT verified AVC and subclinical...... group were invited for a supplementary echocardiography. AS was graded by indexed aortic valve area (AVAi) on echocardiography as moderate 0.6-0.85 cm(2)/m(2) and severe valve surgery, and artifacts from...

  9. MR findings of thoracic and abdominal aortic aneurysms: comparison with angiographic and surgical findings

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Yoong Ki; Kim, Tae Kyoung; Song, Jae Uoo; Kim, Seung Hoon; Lee, Han Kyung; Chung, Jin Wook; Park, Jae Hyung [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

    1994-11-15

    To assess the utility of spin-echo magnetic resonance(MR) imaging in the evaluation of thoracic and abdominal aortic aneurysm. The spin-echo MR images of 27 aortic aneurysms in 22 patients were analyzed and correlated with angiography and/or operative findings retrospectively. Evaluations included location, type, and maximum diameter of the aneuyusm, mural thrombus, major branch involvement, and relationship with adjacent organ. The location of aneurysms was ascending thoracic aorta in seven cases, ascending thoracic aorta and aortic arch in one, descending thoracic aorta in six, thoracoabdominal aorta in three, and abdominal aorta in eight. Nineteen were fusiform, and eight were saccular. The mean of maximum diameters of the aneurysms was 7.9cm (4-10cm) on MR and 7.3cm (3-10cm) on angiography. Mural thrombus were noted in 13 cases on MR imaging and seven cases on angiography. Angiography also underestimated the amount of mural thrombus. Eight cases involved major aortic branches. Although MR imaging and angiography were equal in the assessment of major abdominal aortic branches, MR imaging could not clearly demonstrate arch vessels, especially left subclavian artery, in aortic arch aneurysms. Among seven ascending thoracic aneurysms, six had aortic regurgitation. MR imaging showed left ventricular enlargement in all six cases. There was pericardial effusion in four cases which were noted only on MR imaging. MR imaging demonstrated hydronephrosis and renal atrophy in two cases of abdominal aortic aneurysms respectively. In the assessment of size of the aneurysm, mural thrombus, and relation with adjacent organs, MR imaging was better than angiography. MR and angiographic findings were equal in the assessment of the location and type of the aneurysm. Angiography was better than MR imaging in the assessment of major branch involvement, especially left subclavian artery.

  10. Sternal Wound Infection by Trichosporon inkin following Cardiac Surgery

    OpenAIRE

    Davies, Frances; Logan, Sarah; Johnson, Elizabeth; Klein, John L.

    2006-01-01

    Wound infection following cardiac surgery is well described but is rarely due to fungal infection. We describe a case of sternal wound infection caused by Trichosporon inkin with a fatal outcome, in an immunocompetent patient following aortic root surgery.

  11. Including aortic valve morphology in computational fluid dynamics simulations: initial findings and application to aortic coarctation.

    Science.gov (United States)

    Wendell, David C; Samyn, Margaret M; Cava, Joseph R; Ellwein, Laura M; Krolikowski, Mary M; Gandy, Kimberly L; Pelech, Andrew N; Shadden, Shawn C; LaDisa, John F

    2013-06-01

    Computational fluid dynamics (CFD) simulations quantifying thoracic aortic flow patterns have not included disturbances from the aortic valve (AoV). 80% of patients with aortic coarctation (CoA) have a bicuspid aortic valve (BAV) which may cause adverse flow patterns contributing to morbidity. Our objectives were to develop a method to account for the AoV in CFD simulations, and quantify its impact on local hemodynamics. The method developed facilitates segmentation of the AoV, spatiotemporal interpolation of segments, and anatomic positioning of segments at the CFD model inlet. The AoV was included in CFD model examples of a normal (tricuspid AoV) and a post-surgical CoA patient (BAV). Velocity, turbulent kinetic energy (TKE), time-averaged wall shear stress (TAWSS), and oscillatory shear index (OSI) results were compared to equivalent simulations using a plug inlet profile. The plug inlet greatly underestimated TKE for both examples. TAWSS differences extended throughout the thoracic aorta for the CoA BAV, but were limited to the arch for the normal example. OSI differences existed mainly in the ascending aorta for both cases. The impact of AoV can now be included with CFD simulations to identify regions of deleterious hemodynamics thereby advancing simulations of the thoracic aorta one step closer to reality. PMID:22917990

  12. Comparison of Commercially Available Arch Wires with Normal Dental Arch in a Group of Iranian Population

    Directory of Open Access Journals (Sweden)

    Zohreh Hedayati

    2015-06-01

    Full Text Available Statement of the Problem: The stability of orthodontic treatment depends on preserving the patient’s pretreatment arch form and arch size during and after treatment. Purpose: This investigation was aimed to study the size and shape of Iranian mandibular dental arch and evaluate the correlation of their average dental arch with commercially available preformed rectangular nickel-titanium arch wires. Materials and Method: In this study, 148 subjects were selected among students of Shiraz University of Medical Sciences. The inclusion criteria were having Angle class I in molar and canine relationships, and normal growth pattern. Intercanine and intermolar widths were measured after scanning their mandibular dental casts. Three main arch form templates; square, ovoid and tapered (Orthoform TM; 3M, Unitek, CA, USA and 12 commercially available preformed mandibular nickel-titanium arch wires were scanned. Intercanine and intermolar widths of arch wires were compared with dental arch widths of the study samples. Arch width, arch form and the most appropriate arch wire were determined for each cast. Student’s t-test was used to compare arch widths and arch depths of male and female sub-jects. Coefficient of variance was used to determine the variability of indices in the study samples. Results: Most preformed arch wires were wider than the average width of the nor-mal Iranian dental arch. The most frequent arch form in Iranian population was tapered. Inter molar width was the only statistically significant variable between males and females. Conclusion: Variation in available preformed arch wires does not entirely cover the range of diversity of the normal dental arch of our population. Narrow arc

  13. ED 02-1 ACUTE AORTIC SYNDROME.

    Science.gov (United States)

    Song, Jae-Kwan

    2016-09-01

    ascending or aortic arch repairs. Currently available CT or TEE cannot identify this type of localized intimal tear, with the only imaging characteristic reported to be a localized eccentric bulging or aneurysm. This feature is too subtle to diagnose accurately using conventional imaging modalities, suggesting that surgical exploration be performed in patients with aortic pain and aortic root dilatation who show unexplained aortic regurgitation or pericardial effusion. Further investigations are necessary to evaluate the clinical significance and outcomes of patients with incomplete dissection.Non-invasive imaging modalities such as CT and TEE have contributed to a better understanding of acute aortic syndrome, resulting in inclusion of IMH and atypical dissection as new disease entities. Differences in imaging findings may be due to differences in the hemodynamic status of the false lumen, resulting from the wide spectrum of intimal tears, from a localized or 'micro-intimal tear' to a large tear with flow communication resulting in a 'double channel aorta'. Further investigation is required to determine whether the application of different treatment options following risk stratification based on imaging results is rational and can improve the clinical outcomes of patients with this syndrome. PMID:27643004

  14. Aortic Valve Sparing in Different Aortic Valve and Aortic Root Conditions.

    Science.gov (United States)

    David, Tirone E

    2016-08-01

    The development of aortic valve-sparing operations (reimplantation of the aortic valve and remodeling of the aortic root) expanded the surgical armamentarium for treating patients with aortic root dilation caused by a variety of disorders. Young adults with aortic root aneurysms associated with genetic syndromes are ideal candidates for reimplantation of the aortic valve, and the long-term results have been excellent. Incompetent bicuspid aortic valves with dilated aortic annuli are also satisfactorily treated with the same type of operation. Older patients with ascending aortic aneurysm and aortic insufficiency secondary to dilated sinotubular junction and a normal aortic annulus can be treated with remodeling of the aortic root or with reimplantation of the aortic valve. The first procedure is simpler, and both procedures are likely equally effective. As with any heart valve-preserving procedure, patient selection and surgical expertise are keys to successful and durable repairs. PMID:27491910

  15. Unicuspid aortic valve disease: a magnetic resonance imaging study

    International Nuclear Information System (INIS)

    Purpose: congenitally malformed aortic valves are a common finding in adults with aortic valve disease. Most of these patients have bicuspid aortic valve disease. Unicuspid aortic valve disease (UAV) is rare. The aim of our study was to describe valve morphology and the dimensions of the proximal aorta in a cohort of 12 patients with UAV in comparison to tricuspid aortic valve disease (TAV) using magnetic resonance imaging (MRI). Materials and methods/results: MRI studies were performed on a 1.5 T scanner in a total of 288 consecutive patients with aortic valve disease. 12 aortic valves were retrospectively classified as UAV. Annulus areas and dimensions of the thoracic aorta were retrospectively compared to a cohort of 103 patients with TAV. In UAV, valve morphology was unicuspid unicommissural with a posterior commissure in all patients. Mean annulus areas and mean diameters of the ascending aorta were significantly greater in UAV compared to TAV (12.6 ± 4.7 cm2 vs. 8.7 ± 2.3 cm2, p < 0.01 and 4.6 ± 0.7 cm vs. 3.6 ± 0.5 cm, p < 0.0001, respectively), while no differences were observed in the mean diameters of the aortic arch (2.3 ± 0.6 cm vs. 2.3 ± 0.4 cm, p = 0.69). The diameters of the descending aorta were slightly smaller in UAV compared to TAV (2.2 ± 0.5 cm vs. 2.6 ± 0.3 cm, p < 0.05). (orig.)

  16. The Arches Cluster Mass Function

    CERN Document Server

    Kim, S S; Kudritzki, R P; Najarro, F; Kim, Sungsoo S.; Figer, Donald F.; Kudritzki, Rolf P.

    2006-01-01

    We have analyzed H and K_s-band images of the Arches cluster obtained using the NIRC2 instrument on Keck with the laser guide star adaptive optics (LGS AO) system. With the help of the LGS AO system, we were able to obtain the deepest ever photometry for this cluster and its neighborhood, and derive the background-subtracted present-day mass function (PDMF) down to 1.3 Msun for the 5 arcsec-9 arcsec annulus of the cluster. We find that the previously reported turnover at 6 Msun is simply due to a local bump in the mass function (MF), and that the MF continues to increase down to our 50 % completeness limit (1.3 Msun) with a power-law exponent of Gamma = -0.91 for the mass range of 1.3 < M/Msun < 50. Our numerical calculations for the evolution of the Arches cluster show that the Gamma values for our annulus increase by 0.1-0.2 during the lifetime of the cluster, and thus suggest that the Arches cluster initially had Gamma of -1.0 ~ -1.1, which is only slightly shallower than the Salpeter value.

  17. IABP在心脏瓣膜病手术治疗中的应用%Intra-aortic Balloon Pump in the Treatment of Valvular Heart Disease Following Heart Surgery.

    Institute of Scientific and Technical Information of China (English)

    任崇雷; 姜胜利; 高长青; 李伯君; 肖苍松

    2011-01-01

    pump (IABP) in the treatment of valvular heart disease following heart surgery. Methods From October 2008 to August 2010, 450 consecutive patients with valvular heart disease underwent valve replacement with extracorporeal circulation ( ECC) in Chinese PLA General Hospital. Among them, 20 patients required intra - operative or post - operative IABP support. There were 9 males and 11 females. The mean age at operation was 54. 60 ± 10. 94 years ( range from 28 to 72 years) . Their etiological diagnoses were rheumatic heart valve disease in 14 patients, valve lesion recurrence or relapse after cardiac surgery in 3 patients, infective endocarditis in 2 patients, congenital heart disease in 2 patients and degeneration valve disease in 1 patient. They included 6 patients combined with coronary heart disease by coronary arteriongra-phy, 2 patients with giant left atrium, 6 patients with small left ventricle, 5 patients with generous thrombus in left atrium, 10 patients with severe bicuspid regurgitation and pulmonary hypertension measured by echocardiography. There were 1 patient in class Ⅱ , 13 patients in class Ⅲ and 6 patients in class Ⅳ of New York Heart Association functional. Among them, 3 patients received double valve replacement, 10 patients received mitral valve replacement, 4 patients received aortic valve replacement, 3 patients received mitral vave plasty, bicuspid valve replacement and perivalvular leakage repair respectively. Four patients underwent simultaneous CABC and valve procedures, and 5 patient combined with heart embolectomy. Results The 20 patient's cardiopulmonary bypass ( CPB) time was 174.0 ± 71.5 minutes, and their clamp - cross time was 106.0 ±43. 8 minutes. Among of them, 10 patents required intra - operative IABP support for weaning from CPB or low output cardiac syndrome; the others required post - operative IABP support for low output cardiac syndrome in the intensive care unit. The IABP support time was 53.0 ± 28. 3 hours ( range

  18. Medtronic Freestyle Aortic Root Bioprosthesis Implantation for the Infective Endocarditis on Aortic Root

    Directory of Open Access Journals (Sweden)

    Zekeriya Arslan

    2013-10-01

    Full Text Available    Infective endocarditis and periannular abscess formation are serious problems in cardiac valve surgery, requiring extensive surgical debridement and reconstruction of the aortic annulus. We aimed to report two cases which were successfully treated with bioprosthetic valve implantation for infective endocarditis. Transosephageal echocardiography were performed for the diagnosis of one prosthetic and one native destructive aortic valve endocarditis in association with congestive heart failure (NYHA class-VI and abscess formation. Medtronic Freestyle stentless aortic root bioprosthesis was implanted into the left ventricular outflow tract after surgical radical aortic root debridement for each patient followed with medical treatment, which was extended to six weeks. Neither early nor late mortality was detected. One patient required prolonged ventilatory support (two days and permanent DDD-R pacing. Echocardiography showed no signs of valve dysfunction or recurrent endocarditis for both patients in 10 months follow up.Medtronic Freestyle stentless aortic root bioprosthesis may be a good alternative way of treatment to aortic valve and root endocarditis instead of homograft.

  19. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... opens freely when the heart contracts. On the right, we see a picture of the aortic valve ... the aortic valve because the probe is sitting right behind the aortic valve. Lots of patients on ...

  20. Image quality and diagnostic accuracy of unenhanced SSFP MR angiography compared with conventional contrast-enhanced MR angiography for the assessment of thoracic aortic diseases

    Energy Technology Data Exchange (ETDEWEB)

    Krishnam, Mayil S. [University of California, Cardiovascular and Thoracic Imaging, UCI Medical Center, Irvine, CA (United States); Tomasian, Anderanik; Malik, Sachin; Ruehm, Stefan G. [University of California at Los Angeles, Department of Radiological Sciences, Ronald Reagan Medical Center, Los Angeles, CA (United States); Desphande, Vibhas; Laub, Gerhard [Siemens Medical Solutions, Los Angeles, CA (United States)

    2010-06-15

    The purpose of this study was to determine the image quality and diagnostic accuracy of three-dimensional (3D) unenhanced steady state free precession (SSFP) magnetic resonance angiography (MRA) for the evaluation of thoracic aortic diseases. Fifty consecutive patients with known or suspected thoracic aortic disease underwent free-breathing ECG-gated unenhanced SSFP MRA with non-selective radiofrequency excitation and contrast-enhanced (CE) MRA of the thorax at 1.5 T. Two readers independently evaluated the two datasets for image quality in the aortic root, ascending aorta, aortic arch, descending aorta, and origins of supra-aortic arteries, and for abnormal findings. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were determined for both datasets. Sensitivity, specificity, and diagnostic accuracy of unenhanced SSFP MRA for the diagnosis of aortic abnormalities were determined. Abnormal aortic findings, including aneurysm (n = 47), coarctation (n = 14), dissection (n = 12), aortic graft (n = 6), intramural hematoma (n = 11), mural thrombus in the aortic arch (n = 1), and penetrating aortic ulcer (n = 9), were confidently detected on both datasets. Sensitivity, specificity, and diagnostic accuracy of SSFP MRA for the detection of aortic disease were 100% with CE-MRA serving as a reference standard. Image quality of the aortic root was significantly higher on SSFP MRA (P < 0.001) with no significant difference for other aortic segments (P > 0.05). SNR and CNR values were higher for all segments on SSFP MRA (P < 0.01). Our results suggest that free-breathing navigator-gated 3D SSFP MRA with non-selective radiofrequency excitation is a promising technique that provides high image quality and diagnostic accuracy for the assessment of thoracic aortic disease without the need for intravenous contrast material. (orig.)

  1. Internal mammary artery dilatation in a patient with aortic coarctation, aortic stenosis, and coronary disease. Case report

    Directory of Open Access Journals (Sweden)

    Martinez Cereijo Jose M

    2011-04-01

    Full Text Available Abstract The ideal surgical approach is unclear in adult patients with coarctation of the aorta that is associated with other cardiovascular pathologies that require intervention. Standard median sternotomy allows simultaneous, coronary revascularization surgery, valve replacement and repair of aortic coarctation. However the collateral circulation and the anatomy of the mammary arteries must be determined, to avoid possible complications. We report a case of a 69 year-old man with aortic coarctation, aortic stenosis, coronary artery disease and internal mammary artery dilatation who underwent concomitant surgical procedures through a median sternotomy.

  2. Traumatic pseudoaneurysm of the brachiocephalic artery following medianoscopy: initial endovascular repair followed by open surgery--a case report.

    Science.gov (United States)

    Biebl, Matthias; Neuhauser, B; Perkmann, R; Tauscher, T; Waldenberger, P; Fraedrich, G

    2003-06-01

    Endovascular stent graft repair of traumatic vessel injuries is gaining worldwide acceptance as a minimally invasive alternative to open surgical repair. However, effective endovascular repair fails if the aneurysm is not completely excluded. Conversion to open surgery may be unavoidable in such cases. Herein we describe the case of a 45-year-old man who was referred to our hospital with a pseudoaneurysm of the proximal brachiocephalic artery caused by biopsy during diagnostic medianoscopy. The pseudoaneurysm was primarily treated by stent-graft implantation into the proximal brachiocephalic artery. As a result of the unfavorable location of the lesion exclusion of the aneurysm failed and the initial therapy had to be extended to open reconstruction of the brachiocephalic artery. A bypass procedure from the aortic arch to the right common carotid artery was performed with reinsertion of the right subclavian artery to exclude the pseudoaneurysm.

  3. Aortic dissection with the entrance tear in transverse aorta: analysis of 12 autopsy patients.

    Science.gov (United States)

    Roberts, C S; Roberts, W C

    1990-11-01

    Clinical and autopsy findings are described in 12 patients who had fatal aortic dissection with the entrance tear in the transverse aorta. The 12 patients represent 7% of 182 autopsies of spontaneous aortic dissection studied by us. The ages of the 12 patients at death ranged from 37 to 87 years (mean, 67 years). Eight were men; 8 had a history of systemic hypertension, and 10 had hearts of increased weight. Diagnosis of aortic dissection was made during life in only 4 of the 12 patients. All 12 patients died of rupture of the false channel within 2 weeks of onset of signs or symptoms compatible with dissection. The direction of aortic dissection from the entrance tear was entirely retrograde in 4 patients, entirely anterograde in 4 patients, and in both directions in 4 patients. Hemopericardium occurred in the first group, left hemothorax in the second group, and either in the last group. Of the 8 patients in whom the ascending aorta was involved, the retrograde dissection in each extended to the aortic root, 6 had pulmonary adventitial hemorrhage, and 4 had involvement of the arch arteries by dissection. In the 4 patients with strictly anterograde dissection, none had dissection in the arch arteries. Thus, tear in the transverse aorta causes a dissection that is usually fata, that often dissects retrogradely, and that may mimic dissection from a tear in ascending aorta. Aortic dissection from a tear in transverse aorta requires early operative intervention. PMID:2241339

  4. Successful reversal of recurrent spinal cord ischemia following endovascular repair of a descending thoracic aortic aneurysm

    OpenAIRE

    Appoo, J J; Gregory, H D; Toeg, H D; Prusinkiewicz, C A; Kent, W D T; Ferland, A; Ha, D V

    2012-01-01

    Despite recent advances in technique, spinal cord ischemia remains one of the most dreaded complications of thoracic aortic surgery. Recently, it has been suggested that thoracic endovascular aortic repair may decrease the risk of paraplegia. We present a case of delayed paraplegia following thoracic endovascular aortic repair that was successfully reversed on 3 separate occasions in the same patient. This highlights the importance of vigilant clinical assessments, efficient multidisciplinary...

  5. New St. Jude Medical Portico™ transcatheter aortic valve: features and early results.

    Science.gov (United States)

    Spence, M S; Lyons, K; McVerry, F; Smith, B; Manoharan, G B; Maguire, C; Doherty, R; Anderson, L; Morton, A; Hughes, S; Hoeritzauer, I; Manoharan, G

    2013-06-01

    Patients with symptomatic aortic valve disease who are inoperable or have high surgery-related risks may be treated with transcatheter aortic valve implantation devices. With this method increasingly applied, device innovations are aimed at achieving improved procedural results and therapeutic outcome. This paper describes the innovations implemented in the St. Jude Medical Portico™ system for transcatheter aortic valve implantation, the application of this system and initial clinical experience. PMID:23681129

  6. Abdominal Aortic Aneurysms: Treatments

    Science.gov (United States)

    ... access catheters Vertebroplasty Women and vascular disease Women's health Social Media Facebook Twitter ... Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists are vascular ...

  7. Evaluation of the fit of preformed nickel titanium arch wires on normal occlusion dental arches

    Directory of Open Access Journals (Sweden)

    Rakhn G. Al-Barakati

    2016-01-01

    Conclusions: Using an archwire form with the best fit to the dental arch should produce minimal changes in the dental arch form when NiTi wires are used and require less customization when stainless-steel wires are used.

  8. Endovascular aortic injury repair after thoracic pedicle screw placement.

    Science.gov (United States)

    Pesenti, S; Bartoli, M A; Blondel, B; Peltier, E; Adetchessi, T; Fuentes, S

    2014-09-01

    Our objective was to describe the management and prevention of thoracic aortic injuries caused by a malposition of pedicle screws in corrective surgery of major spine deformities. Positioning pedicle screws in thoracic vertebras by posterior approach exposes to the risk of injury of the elements placed ahead of the thoracic spine, as the descending thoracic aorta. This complication can result in a cataclysmic bleeding, needing urgent vascular care, but it can also be totally asymptomatic, resulting in the long run in a pseudoaneurysm, justifying the systematic removal of the hardware. We report the case of a 76-year-old woman who underwent spinal correction surgery for thoraco-lumbar degenerative kypho-scoliosis. Immediately after the surgery, a thoracic aortic injury caused by the left T7 pedicle screw was diagnosed. The patient underwent a two-step surgery. The first step was realized by vascular surgeons and aimed to secure the aortic wall by short endovascular aortic grafting. During the second step, spine surgeons removed the responsible screw by posterior approach. The patient was discharged in a rehabilitation center 7 days after the second surgery. When such a complication occurs, a co-management by vascular and spine surgeons is necessary to avoid major complications. Endovascular management of this kind of vascular injuries permits to avoid an open surgery that have a great rate of morbi-mortality in frail patients. Nowadays, technologies exist to prevent this kind of event and may improve the security when positioning pedicle screws. PMID:25023930

  9. Staged and hybrid approach in the treatment of complex aortic dissection

    Institute of Scientific and Technical Information of China (English)

    WANG Li-xin; FU Wei-guo; GUO Da-qiao; CHEN Bin; JIANG Jun-hao; YANG Jue; SHI Zhen-yu; WANG Yu-qi

    2008-01-01

    @@ Multilevel aortic disease presents a formidable challenge for vascular surgeons. In the past, multilevel aortic surgery was performed simultaneously or subsequently. Single-stage intervention is thought to be associated with a high incidence of complications, and sequential repair requires several major surgical interventions.

  10. Management with the insufficient proximal landing zone for endovascular repair in aortic dissection

    Institute of Scientific and Technical Information of China (English)

    MA Hao; YANG Hong-yu; ZOU Jun-jie; ZHANG Xi-wei

    2011-01-01

    Background Sufficient length of the proximal landing zone (PLZ) is the key for a successful thoracic endovascular aortic repair (TEVAR) of an aortic lesion. The aim of this research was to investigate the safety, feasibility, efficacy, and problems of endovascular repair for aortic dissection with insufficient PLZ.Methods The clinical data between August 2005 and February 2010 from patients with insufficient PLZ for endovascular repair of aortic dissection were retrospectively reviewed. According to the classification proposed by Ishimaru, aortic zone 0 was involved in 3 cases, zone 1 in 10 cases, and zone 2 in 11 cases. A hybrid surgical procedure of supraortic debranching and revascularization, directly coverage the orifice of left subclavian artery, or a left common carotid artery chimney graft technique were performed to obtain an adequate proximal aortic landing zone.Results There was no significant difference in risk factors and diameter of the PLZ between Zone 0, Zone 1, and Zone 2. But the length of the PLZ was significantly different in the three groups (P <0.01). There was no significant difference in technical and clinical success rate between the groups.Conclusions The procedure for extending an insufficient PLZ for endovascular repair for aortic arch pathology is feasible and relatively safe. The applicability of TEVAR in such aortic disorders may be expanded.

  11. Impact of Endografting on the Thoracic Aortic Anatomy: Comparative Analysis of the Aortic Geometry before and after the Endograft Implantation

    Energy Technology Data Exchange (ETDEWEB)

    Midulla, Marco, E-mail: marco.midulla@chru-lille.fr [University Hospital of Lille, Cardiovascular and Interventional Radiology (France); Moreno, Ramiro, E-mail: ramoroa@gmail.com [Rangueil University Hospital, Department of Radiology (France); Negre-Salvayre, Anne, E-mail: anne.negre-salvayre@inserm.fr [INSERM, UMR 1048, I2MC (France); Nicoud, Franc, E-mail: franck.nicoud@univ-montp2.fr [CNRS, UMR 5149 I3M, CC 051, University Montpellier II (France); Pruvo, Jean Pierre, E-mail: jean-pierre.pruvo@chru-lille.fr [University Hospital of Lille, Cardiovascular and Interventional Radiology (France); Haulon, Stephan, E-mail: stephan.haulon@chru-lille.fr [University Hospital of Lille, Department of Vascular Surgery (France); Rousseau, Hervé, E-mail: rousseau.h@chu-toulouse.fr [Rangueil University Hospital, Department of Radiology (France)

    2013-03-13

    PurposeAlthough the widespread acceptance of thoracic endovascular aortic repair (TEVAR) as a first-line treatment option for a multitude of thoracic aortic diseases, little is known about the consequences of the device implantation on the native aortic anatomy. We propose a comparative analysis of the pre- and postoperative geometry on a clinical series of patients and discuss the potential clinical implicationsMethodsCT pre- and postoperative acquisitions of 30 consecutive patients treated by TEVAR for different pathologies (20 thoracic aortic aneurysms, 6 false aneurysms, 3 penetrating ulcers, 1 traumatic rupture) were used to model the vascular geometry. Pre- and postoperative geometries were compared for each patient by pairing and matching the 3D models. An implantation site was identified, and focal differences were detected and described.ResultsSegmentation of the data sets was successfully performed for all 30 subjects. Geometry differences between the pre- and postoperative meshes were depicted in 23 patients (76 %). Modifications at the upper implantation site were detected in 14 patients (47 %), and among them, the implantation site involved the arch (Z0–3) in 11 (78 %).ConclusionModeling the vascular geometry on the basis of imaging data offers an effective tool to perform patient-specific analysis of the vascular geometry before and after the treatment. Future studies will evaluate the consequences of these changes on the aortic function.

  12. Aneurismas da aorta Aortic aneurysms

    Directory of Open Access Journals (Sweden)

    Januário M Souza

    1992-09-01

    Full Text Available Entre janeiro de 1979 e janeiro de 1992, foram realizadas 212 operações para correção de aneurismas e de dissecções da aorta. Neste trabalho serão analisados 104 procedimentos cirúrgicos (em 97 pacientes para correção de aneurismas. A idade dos pacientes variou de 14 a 79 anos (média 59,5 anos e o sexo predominante foi o masculino, com 75 pacientes. Os aneurismas localizavam-se na aorta ascendente em 46 pacientes, na croça em 8, na aorta descendente em 8, na aorta toráco-abdominal em 8, na aorta abdominal em 21, na aorta descendente e abdominal em 2, na aorta ascendente e tóraco-abdominal em 2, na aorta ascendente e descendente em 1, na aorta ascendente, croça e descendente em 1. Doenças cardiovasculares associadas estavam presentes em 39 pacientes, sendo valvopatia aórtica em 18 (excluídos os pacientes com ectasiaânulo-aórtíca, insuficiência coronária em 17, coarctação da aorta em 2, persistência do canal arterial em 1 e valvopatia mitral e aórtica em 1. A mortalidade imediata (hospitalar e/ou 30 dias foi de 14,4%, sendo de 27,7% (5/18 para pacientes com mais de 70 anos e de 11,3% (9/79 para pacientes com idade inferior a 70 anos. Os aneurismas localizados na aorta ascendente e croça foram operados como o auxílio de circulação extracorpórea. Parada circulatória e hipotermia profunda foram utilizadas em todos os pacientes com aneurisma da croça. O estudo tomográfico e angiográfico deve ser de toda a aorta, pela possibilidade de aneurismas de localizações múltiplas.Among 212 patients undergoing operation for aortic aneurysm and aortic dissection between January 1979 and January 1992, 97 were operated on for aneurysms. The aneurysms were localized in: ascending aorta in 46 patients, transverse aortic arch in 8, descending aorta in 8, thoracoabdominal aorta in 8, abdominal (infrarenal aorta in 21, descending and abdominal aorta in 2, ascending and thoracoabdominal aorta in 2, ascending and descending in 1

  13. Monozygotic twins with Marfan's syndrome and ascending aortic aneurysm.

    Science.gov (United States)

    Redruello, Héctor Jorge; Cianciulli, Tomas Francisco; Rostello, Eduardo Fernandez; Recalde, Barbara; Lax, Jorge Alberto; Picone, Victorio Próspero; Belforte, Sandro Mario; Prezioso, Horacio Alberto

    2007-08-01

    Marfan's syndrome is a hereditary connective tissue disease, in which cardiovascular abnormalities (especially aortic root dilatation) are the most important cause of morbidity and mortality. In this report, we describe two 24-year-old twins, with a history of surgery for lens subluxation and severe cardiovascular manifestations secondary to Marfan's syndrome. One of the twins suffered a type A aortic dissection, which required replacement of the ascending aorta, and the other twin had an aneurysmal dilatation of the ascending aorta (46mm) and was prescribed medical treatment with atenolol and periodic controls to detect the presence of a critical diameter (50mm) that would indicate the need for prophylactic surgery.

  14. Aortic aneurysm and diverticulum of Kommerell: a dreadful concomitance

    Directory of Open Access Journals (Sweden)

    Fernando Peixoto Ferraz de Campos

    2012-12-01

    Full Text Available First described in 1936, the diverticulum of Kommerell (DOK is a dilatation of the proximal segment of an aberrant subclavian artery. Appearing more frequently in the left-sided aortic arch, the aberrant right subclavian artery passes behind the esophagus toward the right arm, causing symptoms in the minority of cases. Diagnosis is generally incidental with this pattern. When symptomatic, dysphagia, respiratory symptoms, hoarseness, chest pain, and upper limb ischemia are the most common complaints. Although debatable, the origin of DOK is accepted as being degenerative or congenital. The degenerative condition is normally associated with atherosclerosis and occurs more frequently after the age of 50 years with no gender predominance. Complications may be life threatening and are more commonly related to the diverticulum aneurysm or when associated with aortic diseases such as aneurysms or dissection. The authors present a case of a 67-year-old male with a history of acute chest pain, neurological disturbances, and hypertensive crisis. The diagnostic workup revealed an aortic arch aneurysm with intramural hematoma and a diverticulum aneurysm of Kommerell. Treatment was conservative at first. The patient presented a satisfactory outcome and was referred to an outpatient clinic for follow up and further therapeutic consolidation.

  15. Thoracic endovascular aortic repair for complicated chronic type B aortic dissection in a patient on hemodialysis with recurrent ischemic colitis.

    Science.gov (United States)

    Miyazaki, Yuko; Furuyama, Tadashi; Matsubara, Yutaka; Yoshiya, Keiji; Yoshiga, Ryosuke; Inoue, Kentaro; Matsuda, Daisuke; Aoyagi, Yukihiko; Kato, Masaaki; Matsumoto, Takuya; Maehara, Yoshihiko

    2016-12-01

    We present a successful case of thoracic endovascular aortic repair (TEVAR) for chronic Stanford type B aortic dissection (B-AD) with recurrent ischemic colitis. The patient was a 56-year-old woman with abdominal pain as the main complaint who had two operations previously: the total arch replacement 8 years ago and the Bentall 7 years ago for acute Stanford type A aortic dissection. Her abdominal pain worsened as her blood pressure became low during her hemodialysis treatment. An enhanced computed tomography scan was performed on the patient and showed chronic B-AD that occurred from the distal anastomotic part of the total arch graft to the bilateral common iliac arteries. The celiac artery and superior mesenteric artery (SMA) arose from the true lumen, and these were compressed by the expanded false lumen. Her complicated chronic B-AD was treated with the Zenith Dissection Endovascular System, and its procedure was performed as her proximal entry tear was covered by a proximal tapered Zenith TX2 stent graft, supplemented by a noncovered aortic stent extending across both renal arteries, the SMA, and the celiac artery. Seven days after this operation, enhanced computed tomography showed that the patient's true lumen was expanded and her blood flow to the true lumen and SMA was improved. On the other hand, her false lumen tended to be thrombosed. Consequently, she was discharged 10 days after the operation without any postoperative complications as she had no abdominal complaints even though she underwent hemodialysis three times per week after the operation. We believe that TEVAR supplemented by a noncovered aortic stent is an effective treatment, even for highly chronic B-AD in dialysis patients. PMID:27090121

  16. Imaging in aortic dissection

    International Nuclear Information System (INIS)

    Aortic dissection (AD) is a catastrophic aortic disease. Imaging techniques play an invaluable role in the diagnostic evaluation and management of patients with AD. Major signs of AD with different imaging modalities are described in this article with a pertinent discussion on guidelines for the optimized approach of imaging study (13 refs.)

  17. Thrombocytosis following splenectomy and aortic valve replacement for idiopathic thrombocytopaenic purpura with bicuspid aortic valve

    Directory of Open Access Journals (Sweden)

    Sarika Katiyar

    2015-01-01

    Full Text Available Idiopathic thrombocytopaenic purpura (ITP patients are at high risk for complications during and after cardiac surgeries involving cardiopulmonary bypass. The main clinical problem of primary ITP is an increased risk of bleeding although bleeding may not always be present. More recently, thrombosis has become appreciated as another potential complication of the procedure. We report a 22-year-old female patient with ITP with bicuspid aortic valve and splenomegaly, who underwent uncomplicated aortic valve replacement and splenectomy simultaneously. She was readmitted with chest pain due to coronary thrombosis following splenectomy which made the management difficult. We describe our experience in managing this patient who presented with thrombotic complication rather than bleeding in post-operative period and the challenges met in maintaining appropriate anticoagulation for aortic valve replacement as well as thrombosis, post-splenectomy

  18. Tympanic ossicles and pharyngeal arches.

    Science.gov (United States)

    Whyte, J; Cisneros, A; Yus, C; Fraile, J; Obón, J; Vera, A

    2009-02-01

    We have performed a study on 11 human embryos regarding the development of the tympanic ossicles and their relationship with the first pharyngeal arch. After performing measurements to date the embryos and foetuses chronologically, we performed a meticulous dissection of the temporal bones. Subsequently, they were fixed in 10% formol, decalcified with 2% nitric acid, embedded in Paraplast, sectioned in 7-mm sequences and stained with Martin's trichrome technique. In the 21- and 24-mm cranium-raquis (CR) length human embryos, we have observed the head of the malleus and the body of the incus close to Meckel's cartilage, in addition to the handle of the malleus, the long limb of the incus and the stapes. Between them there was a mesenchymal band inside the primordium of the tympanic cavity. In the 27-mm CR embryo, the various components of the malleus and incus were fusing, and in the 30-mm CR embryo the union was complete. From our observations, we can conclude that the malleus and the incus are derived from the first and second pharyngeal arches.

  19. Anesthesia Approach in Endovascular Aortic Reconstruction

    Directory of Open Access Journals (Sweden)

    Ayşin Alagöl

    2013-03-01

    Full Text Available Introduction: We have analyzed our initial results of our anesthesia techniques in our new-onset endovascular aortic reconstruction cases.Patients and Methods: The perioperative data of 15 elective and emergent endovascular aortic reconstruction cases that were operated in 2010-2011 were collected in a database. The choice of anesthesia was made by the risk factors, surgical team’s preferences, type and location of the aortic pathology and by the predicted operation duration. The data of local and general anesthesia cases were compared.Results: Thirteen (86.7% cases were male and 2 (13.3% female. Eleven patients were in ASA Class III. The demographic parameters, ASA classifications, concurrent diseases were similar in both groups. Thirteen (86.7% cases had infrarenal abdominal aortic aneurysm and 2 (13.3% had Type III aortic dissection. The diastolic arterial pressures were lower in general anesthesia group in 20th and 40th minutes’ measurements just like the mean arterial pressure measurements at the 40th, 100th minutes and during the deployment of the graft. Postoperative mortality occurred in 3 (20.0% patients and they all had general anesthesia and they were operated on emergency basis. Postoperative morbidity occurred in four patients that had general anesthesia (acute renal failure, multi-organ failure and pneumonia. The other patient had atrial fibrillation on the 1st postoperative day and was converted to sinus rhythm with amiodarone infusion.Conclusion: Edovascular aortic reconstruction procedures can safely be performed with both general and local anesthesia less invasively compared to open surgery. General anesthesia may be preferred for the better hemodynamic control.

  20. Maxillary and mandibular anterior crown width/height ratio and its relation to various arch perimeters, arch length, and arch width groups

    Science.gov (United States)

    Shahid, Fazal; Alam, Mohammad Khursheed; Khamis, Mohd Fadhli

    2015-01-01

    Objective: To investigate the maxillary and mandibular anterior crown width/height ratio and its relation to various arch perimeters, arch length, and arch width (intercanine, interpremolar, and intermolar) groups. Materials and Methods: The calculated sample size was 128 subjects. The crown width/height, arch length, arch perimeter, and arch width of the maxilla and mandible were obtained via digital calliper (Mitutoyo, Japan). A total of 4325 variables were measured. The sex differences in the crown width and height were evaluated. Analysis of variance was applied to evaluate the differences between arch length, arch perimeter, and arch width groups. Results: Males had significantly larger mean values for crown width and height than females (P ≤ 0.05) for maxillary and mandibular arches, both. There were no significant differences observed for the crown width/height ratio in various arch length, arch perimeter, and arch width (intercanine, interpremolar, and intermolar) groups (P ≤ 0.05) in maxilla and mandible, both. Conclusions: Our results indicate sexual disparities in the crown width and height. Crown width and height has no significant relation to various arch length, arch perimeter, and arch width groups of maxilla and mandible. Thus, it may be helpful for orthodontic and prosthodontic case investigations and comprehensive management. PMID:26929686

  1. Low‐gradient aortic valve stenosis: value and limitations of dobutamine stress testing

    OpenAIRE

    J. Bermejo; Yotti, R.

    2006-01-01

    Aortic valve stenosis has already reached endemic proportions in Western countries. As the prognosis of low‐flow aortic valve stenosis under medical treatment is dismal, surgery is recommended in most patients. Preoperative dobutamine stress testing may help to assess surgical risk, but there is no strong scientific evidence to deny surgery based exclusively on the results of this test. The problems associated with clinical decision making in this condition are reviewed.

  2. 主动脉夹层术后谵妄的临床特点和相关危险因素研究%Study on morbidity and related risk factors of postoperative delirium after aortic dissection surgery

    Institute of Scientific and Technical Information of China (English)

    李晓晴; 马闻建; 姜霁纹; 王超; 王力; 毕齐

    2014-01-01

    Objective To study the morbidity,clinical presentation and risk factors of postoperative delirium after aortic dissection surgery.Methods All 84 patients after aortic dissection surgery were evaluated with Confusion Assessment Method (CAM).Results Delirium occurred in 28 patients and morbidity of postoperative delirium was 33.3%.Twenty-one patients (75.0%) suffered from transient delirium (< 24 h).Seven patients (25.0%) suffered from continuous delirium.The common clinical symptoms of delirium included increasing psychomotor activity (82.1%),a disordered sleep-wake cycle (75.0%),a reduced level of consciousness,attention abnormalities and cognitive impairments.Variables were analyzed by uni-/multivariable logistic regression,including preoperative variables,intraoperative variables and postoperative variables.Univariate logistic regression analysis results showed that delirium was associated with left ventricular ejection fraction (≤30%) [P =0.023,odds ratio (OR) =1.99,95 % confidence interval (CI):1.29-3.31],previous cerebral infarction (P =0.002,OR =2.86,95 % CI:1.43-5.72),surgery time (P =0.023,OR =0.90,95 % CI:0.49-1.67),deep hypothermic circulatory arrest (DHCA) time (P =0.019,OR =1.18,95 % CI:1.06-2.97),mechanical ventilation time (P =0.043,OR =1.17,95% CI:1.00-1.37),arterial oxygen saturation(P =0.001,OR =2.77,95% CI:1.51-5.11),intensive care unit (ICU) time (P =0.036,OR 1.10,95 % CI:1.10-1.21).The logistic stepwise regression analysis indicated that the independent perioperative risk factors of delirium included cerebrovascular accident history (P =0.017,OR =1.48,95 % CI:1.07-2.04),DHCA time (P =0.002,OR =2.86,95 % CI:1.43-5.72) and ICU duration time(P=0.030,OR =2.18,95%CI:1.07-4.44).Conclusion The independent risk factors of postoperative delirium include previous cerebral infarction,DHCA-time and ICU duration time.%目的 研究主动脉夹层术后谵妄的发生率、临床特点以及相关危险因素.方法 以2013

  3. Effects of psychiatric disorders on Type A acute aortic dissection pathogenesis and analysis of follow-up results

    Directory of Open Access Journals (Sweden)

    Paolo Nardi

    2015-12-01

    Full Text Available Aims: A connection between psychiatric disorders (PDs and Type A acute aortic dissection (AAD has not been shown. The aim of this study was to define the psychological profile of patients treated for AAD, and to analyze the prevalence of PDs in their medical histories, in the immediate postoperative period, and at a mid-term follow-up. Patients and Methods: From March 2005 to October 2014, 240 consecutive patients underwent surgery for AAD. 60 patients (mean age 60+/-13 years; 43 males underwent psychiatric consultation postoperatively, and they represent the subjects of our retrospective study. Ascending aorta +/- arch replacement was performed in 43 patients, whereas the Bentall procedure +/- arch replacement was performed in 17. Data were retrospectively analyzed. Follow-ups were completed in 59 patients (mean duration 35+/-23 months. Results: PDs were present in the medical histories of 34 patients. Postoperatively, in 28 cases, a definitive diagnosis of PD (group PD was made in agreement with the diagnostic and statistical manual of mental disorders-IV criteria, including: Major depression (n=13, anxious-depressive syndrome (n=6, bipolar disorder Type 2 (n=4, panic attacks (n=2, paranoid schizophrenia (n=1, and anxiety (n=2. 32 patients without a definitive psychiatric diagnosis were classified as Group non-PD. In the postoperative period, clinical manifestations of PDs, including delirium, persistent spatio-temporal disorientation, and psychomotor agitation were evident in 22 patients (78% in group PD versus 8 patients (25% in group non-PD (P<0.0001. During follow-up, only one death for non-cardiac reasons occurred in group PD. There were no suicides; only 10 patients of group PD required PD treatment (P<0.0001 vs. early postoperative findings; 4 patients in group non-PD required PD treatment. Conclusion: Our findings suggest a strong relationship between PD and AAD. Because the psychiatric conditions appeared to be largely stable after

  4. Management of severe asymmetric pectus excavatum complicating aortic repair in a patient with Marfan's syndrome.

    Science.gov (United States)

    Yeung, Jonathan C; Marcuzzi, Danny; Peterson, Mark D; Ko, Michael A

    2016-05-01

    We describe the case of a 28-year old man with Marfan's syndrome and severe pectus excavatum who required an aortic root replacement for an ascending aortic aneurysm. There was a near-vertical angulation of the sternum that presented challenges with opening and exposure of the heart during aortic surgery. Furthermore, removal of the sternal retractor after aortic repair resulted in sudden loss of cardiac output. A Ravitch procedure was then performed to successfully close the chest without further cardiovascular compromise. We propose that patients with a severe pectus excavatum and mediastinal displacement seen on preoperative CT scanning should be considered for simultaneous, elective repair. PMID:26874148

  5. Management of severe asymmetric pectus excavatum complicating aortic repair in a patient with Marfan's syndrome.

    Science.gov (United States)

    Yeung, Jonathan C; Marcuzzi, Danny; Peterson, Mark D; Ko, Michael A

    2016-05-01

    We describe the case of a 28-year old man with Marfan's syndrome and severe pectus excavatum who required an aortic root replacement for an ascending aortic aneurysm. There was a near-vertical angulation of the sternum that presented challenges with opening and exposure of the heart during aortic surgery. Furthermore, removal of the sternal retractor after aortic repair resulted in sudden loss of cardiac output. A Ravitch procedure was then performed to successfully close the chest without further cardiovascular compromise. We propose that patients with a severe pectus excavatum and mediastinal displacement seen on preoperative CT scanning should be considered for simultaneous, elective repair.

  6. Effect of abdominal aortic grafts on aortic stiffness and central hemodynamics.

    Science.gov (United States)

    Lantelme, Pierre; Dzudie, Anastase; Milon, Hugues; Bricca, Giampiero; Legedz, Liliana; Chevalier, Jean-Michel; Feugier, Patrick

    2009-06-01

    Graft-prosthesis and stentgraft placements are effective modalities for treating abdominal aortic aneurysm, but related changes in arterial stiffness are not well established. The present study sought to assess aortic stiffness after aneurism repair by measuring pulse wave velocity (PWV). The graft-related variation of carotid-femoral PWV was compared with that of carotid-radial PWV, the latter being unaffected by vascular treatment. The secondary objective was to evaluate potential differences between graft-prosthesis and stentgraft in terms of aortic stiffness and augmentation index, a composite indicator integrating wave reflexion. Fifty patients were included (39 had a graft-prosthesis and 11 had a stentgraft). In the whole group and after a median postoperative follow-up of 47 days, carotid-femoral PWV increased by +1.0 m/s [-12.3, +10.3], while carotid-radial PWV slightly decreased by -0.3 m/s [-4.4; +3.5] (P = 0.001). The effect of the type of prosthesis on the PWV was not significant. Nevertheless, the augmentation index increased after stentgraft implantation (+4% [-10; +17]) and decreased after graft-prosthesis placement (-8.5% [-47; +17]) (P aortic grafts on aortic stiffness. Besides, it suggests that stentgraft increases reflected waves more than graft-prostheses. These changes of vascular properties may influence the outcomes after surgery. PMID:19342960

  7. Has percutaneous aortic valve replacement taken center stage in the treatment of aortic valve disease?

    Science.gov (United States)

    Kumar, Gideon Praveen; Cui, Fangsen; Mathew, Lazar; Leo, Hwa Liang

    2013-01-01

    Modern biomedical advances have propelled percutaneous valve replacement into an effective and powerful therapy for many heart valve diseases, especially aortic valve stenosis. Experiences so far suggest that outcomes for new percutaneous valve replacement surgery compare favorably with that of traditional valve surgery in selected patients with severe symptomatic aortic stenosis. The inception of percutaneous aortic valve replacement (PAVR) began in 1992 when the potential for treating valve diseases was demonstrated through a modern technique of endoluminal deployment of a catheter-mounted crimped stented heart valve in an animal model. The first successful demonstration of such novel technique of surgical replacement of a heart valve was performed in 2002, when valve implantation in a patient with aortic stenosis was reported. Despite initial stumbles and a perception of being an uphill task, PAVR has emerged as one of the breakthroughs in surgical procedures. More than 1500 citations were found in PubMed, half of which were available after 2011. This is primarily because more than 50,000 procedures are being performed in more than 40 countries worldwide, with encouraging outcomes, and several stented valves have been launched in the market. This review provides a detailed analysis of the current state of the art of PAVR. Moreover, a competitive landscape of various devices available in the market and their design considerations, biomaterial selections, and overall hemodynamic performance are presented. PMID:24941416

  8. Medical treatments in aortic stenosis: Role of statins and angiotensin-converting enzyme inhibitors

    Directory of Open Access Journals (Sweden)

    Davičević Žaklina

    2010-01-01

    Full Text Available Calcific arotic stenosis and atherosclerosis. Aortic stenosis is the most frequent valvular heart disease in-western world and its incidence continues to rise. Aortic sclerosis is the first characteristic lesion of the cusps, which is today considered a process similar to atherosclerosis. The progression of the disease is an active process leading to forming of bone matrix and heavily calcified stiff cusps by inflammatory cells and osteopontin. Aortic stenosis is a chronic, progressive disease which can remain asymptomatic for a long time even in the presence of severe aortic stenosis. Medical treatment for aortic stenosis. The need for alternative to aortic valve surgery is highlighted by increasing longevity of the population and new therapeutic strategies to limit disease progression are needed to delay or potentially avoid, the need for valve surgery. Currently, there are no established disease modifying treatments in regard to the progression of aortic stenosis. The first results about influence of angiotenzin-converting enzyme inhibitors and statins on aortic sclerosis and stenosis progression are promising. Statins are likely to reduce cardiovascular events rather than disease progression, but may be potentially a valuable preventive treatment in these patients. The prejudice against the use of angiotenzin-converting enzyme inhibitors by patients with aortic stenosis is changing. The cautious use of angiotenzin-converting enzyme inhibition by patients with concomitant hypertension, coronary artery disease, and heart failure seems appropriate. Definite evidence from large clinical trials is awaited.

  9. Nonsteroidal antiinflammatory drugs are associated with increased aortic stiffness

    Directory of Open Access Journals (Sweden)

    Martin Claridge

    2005-07-01

    Full Text Available Martin Claridge1, Simon Hobbs1, Clive Quick2, Nick Day3, Andrew Bradbury1, Teun Wilmink11Department of Vascular Surgery, University of Birmingham, Birmingham Heartlands Hospital Birmingham, UK; 2Department of Surgery, Hinchingbrooke Hospital, Huntingdon, UK; 3Department of Epidemiology and Biostatistics, University of Cambridge, Cambridge, UKObjectives: Nonsteroidal antiinflammatory drugs (NSAIDS have been shown to retard aneurysm growth in animal models. In vitro studies have shown an inhibitory effect of NSAIDS on matrix metalloproteinase-9, interleukin-1β, and IL-6 mediated arterial wall elastolysis. The aim of this study was to investigate the effects of NSAIDs on arterial stiffness, a surrogate marker of elastolysis.Methods: 447 subjects enrolled in a community-based abdominal aortic aneurysm (AAA screening program were assessed for age, blood pressure, smoking status, and drug history. Aortic diameter and stiffness were measured by M-Mode ultrasound. The concentration of the amino-terminal propeptide of type III procollagen was used as a proxy measurement of type III collagen turnover.Results: NSAID ingestion was significantly (p = 0.006 associated with increased aortic wall stiffness after adjusting for age, aortic diameter, blood pressure, and smoking status. No such effect was seen for β-blockers, calcium channel antagonists, nitrates, angiotensin-converting enzyme inhibitors, diuretics, or antiplatelet agents.Discussion: These novel data show that NSAIDS are associated with increased aortic stiffness, possibly through the effects of cytokine mediated elastolysis. This in turn may prevent aortic expansion and the development of AAA.Keywords: nonsteroidal antiinflammatory drugs, abdominal aortic aneurysm, aortic stiffness, elastolysis

  10. Quality of life after aortic valve repair is similar to Ross patients and superior to mechanical valve replacement: A cross-sectional study

    NARCIS (Netherlands)

    P. Zacek (Pavel); T. Holubec; M. Vobornik; J. Dominik; J.J.M. Takkenberg (Hanneke); J. Harrer; J. Vojacek

    2016-01-01

    textabstractBackground: In patients after aortic valve surgery, the quality of life is hypothesized to be influenced by the type of the valve procedure. A cross-sectional study on the postoperative quality of life was carried out in patients after aortic valve-sparing surgery (with regards to the ag

  11. Meta analysis of outcomes of open surgery versus endovascular aneurysm repair for ruptured abdominal aortic aneurysms%开放手术和腔内修复术治疗腹主动脉瘤破裂的 meta 分析(附2例报告)

    Institute of Scientific and Technical Information of China (English)

    戈小川; 刘建伟

    2013-01-01

      目的比较开放手术和腔内修复术(EVAR)治疗腹主动脉瘤破裂的效果和预后的差异。方法从2例行 EVAR 治疗腹主动脉瘤破裂的经验出发,检索 EVAR 和开放手术治疗该疾病的文献报道并作 meta 分析。结果一共纳入14篇文献,均是单中心研究,大部分都是观察报告,只有1篇是随机对照试验。EVAR 组术后30天死亡率为18%(95%CI:12%~23%),开放手术组为39%(95%CI:34%~44%),两组比较差异有统计学意义(P <0.01)。EVAR 组的平均住院天数及ICU 天数比开放手术组的时间明显缩短,两组比较差异有统计学意义(P <0.05)。EVAR 组平均术中出血量也小于开放手术组(746 ml vs 3435 ml,P <0.01);但在平均术中输液(血)量、手术时间和术后并发症上,两组比较差异无统计学意义(P <0.05)。结论EVAR 治疗腹主动脉瘤破裂和开放手术比较有更低的死亡率、更短的住院时间和更少的出血量,患者术后恢复较快,但术后并发症发生率无显著性差异,而长期生存率仍不明确。%Objective To compare the result of endovascular aneurysm repair(EVAR) and open surgery for ruptured abdominal aortic aneurysms. Method From the experience of 2 patients underwent EVAR treatment of abdominal aortic aneurysm in our hospital, we retrieved the reports on EVAR and surgical treatment of ruptured abdominal aortic aneurysms and made meta-analysis literature. Results Total 14 studies were included in this study. All studies were single-center study, including 13 observational reports and a randomized controlled trial (RCT) report. The 30-day mortality of EVAR group was 18% (95% CI: 12% ~ 23%), while surgery group was 39% (95% CI: 34% ~ 44%), the difference was statistically significant (P < 0.01 ). EVAR group was significantly shorter time than surgery group on the average days in hospital and in ICU (P < 0.05). The average blood loss in EVAR group was

  12. Nonlinear Dynamics of Electrostatically Actuated MEMS Arches

    KAUST Repository

    Al Hennawi, Qais M.

    2015-05-01

    In this thesis, we present theoretical and experimental investigation into the nonlinear statics and dynamics of clamped-clamped in-plane MEMS arches when excited by an electrostatic force. Theoretically, we first solve the equation of motion using a multi- mode Galarkin Reduced Order Model (ROM). We investigate the static response of the arch experimentally where we show several jumps due to the snap-through instability. Experimentally, a case study of in-plane silicon micromachined arch is studied and its mechanical behavior is measured using optical techniques. We develop an algorithm to extract various parameters that are needed to model the arch, such as the induced axial force, the modulus of elasticity, and the initially induced initial rise. After that, we excite the arch by a DC electrostatic force superimposed to an AC harmonic load. A softening spring behavior is observed when the excitation is close to the first resonance frequency due to the quadratic nonlinearity coming from the arch geometry and the electrostatic force. Also, a hardening spring behavior is observed when the excitation is close to the third (second symmetric) resonance frequency due to the cubic nonlinearity coming from mid-plane stretching. Then, we excite the arch by an electric load of two AC frequency components, where we report a combination resonance of the summed type. Agreement is reported among the theoretical and experimental work.

  13. Effects of aortic irregularities on blood flow.

    Science.gov (United States)

    Prahl Wittberg, Lisa; van Wyk, Stevin; Fuchs, Laszlo; Gutmark, Ephraim; Backeljauw, Philippe; Gutmark-Little, Iris

    2016-04-01

    Anatomic aortic anomalies are seen in many medical conditions and are known to cause disturbances in blood flow. Turner syndrome (TS) is a genetic disorder occurring only in females where cardiovascular anomalies, particularly of the aorta, are frequently encountered. In this study, numerical simulations are applied to investigate the flow characteristics in four TS patient- related aortic arches (a normal geometry, dilatation, coarctation and elongation of the transverse aorta). The Quemada viscosity model was applied to account for the non-Newtonian behavior of blood. The blood is treated as a mixture consisting of water and red blood cells (RBC) where the RBCs are modeled as a convected scalar. The results show clear geometry effects where the flow structures and RBC distribution are significantly different between the aortas. Transitional flow is observed as a jet is formed due to a constriction in the descending aorta for the coarctation case. RBC dilution is found to vary between the aortas, influencing the WSS. Moreover, the local variations in RBC volume fraction may induce large viscosity variations, stressing the importance of accounting for the non-Newtonian effects. PMID:26104133

  14. Cephalic arch stenosis in dialysis patients: review of clinical relevance, anatomy, current theories on etiology and management.

    Science.gov (United States)

    Sivananthan, Gajan; Menashe, Leo; Halin, Neil J

    2014-01-01

    Arteriovenous hemodialysis fistulas (AVFs) serve as a lifeline for many individuals with end-stage renal failure. A common cause of AVF failure is cephalic arch stenosis. Its high prevalence compounded with its resistance to treatment makes cephalic arch stenosis important to understand. Proposed etiologies include altered flow in a fistulized cephalic vein, external compression by fascia, the unique morphology of the cephalic arch, large number of valves in the cephalic outflow tract and biochemical changes that accompany renal failure. Management options are also in debate and include angioplasty, cutting balloon angioplasty, bare metal stents, stent grafts and surgical techniques including flow reduction with minimally invasive banding as well as more invasive venovenostomy with transposition surgeries for refractory cases. In this review, the evidence for the clinical relevance of cephalic arch stenosis, its etiology and management are summarized.

  15. Clinical predictors of prosthesis-patient mismatch after aortic valve replacement for aortic stenosis

    OpenAIRE

    Luis M Astudillo; Orlando Santana; Urbandt, Pablo A.; Benjo, Alexandre M.; Lior U Elkayam; Nascimento, Francisco O.; Lamas, Gervasio A.; Joseph Lamelas

    2012-01-01

    OBJECTIVE: We sought to ascertain predictors of Patient Prosthesis Mismatch, an independent predictor of mortality, in patients with aortic stenosis using bioprosthetic valves. METHOD: We analyzed 2,107 sequential surgeries. Patient Prosthesis Mismatch was calculated using the effective orifice area of the prosthesis divided by the patient's body surface area. We defined nonsignificant, moderate, and severe Patient Prosthesis Mismatch as effective orifice area indexes of >0.85 cm2/m, 0.85-0.6...

  16. Estenose carotídea acima de 70% em pacientes no pré-operatório de cirurgia da aorta abdominal: freqüência e fatores de risco Frequency and risk factors for carotid stenosis above 70% in patients undergoing abdominal aortic surgery

    Directory of Open Access Journals (Sweden)

    André Ventura Ferreira

    2006-03-01

    Full Text Available OBJETIVO: Analisar a freqüência e os fatores de risco associados à estenose carotídea acima de 70% em pacientes que serão submetidos a cirurgias de aorta abdominal. MATERIAL E MÉTODO: Foram analisados 94 pacientes que realizaram ultra-som Doppler de carótidas no pré-operatório de cirurgias de aorta abdominal entre janeiro de 2000 e janeiro de 2003, pela disciplina de Cirurgia Vascular da Santa Casa de São Paulo. RESULTADOS: Sessenta e sete pacientes (71% eram homens. Dentre os 94 pacientes, 42 (44,6% tinham doença oclusiva aorto-ilíaca, e 52 (53,4%, aneurismas da aorta abdominal (AAA. A análise dos dados mostrou uma prevalência de estenose de carótidas acima de 70% em 8,33% dos pacientes com AAA e em 13,51% dos pacientes com doença oclusiva aorto-ilíaca, diferença esta sem significância estatística (P = 0,5. Nos pacientes que apresentavam antecedente de isquemia cerebral - acidente vascular cerebral (AVC ou ataque isquêmico transitório (AIT -, houve uma prevalência estatisticamente maior de estenose carotídea entre 70 e 99%. Outros fatores de risco para aterosclerose, como sexo masculino, diabetes, hipertensão arterial e tabagismo, não foram preditivos da presença de estenose carotídea acima de 70%. CONCLUSÃO: A freqüência de estenose da carótida acima de 70% em pacientes no pré-operatório de cirurgia de aorta foi de 9,57%, e a presença de antecedente de AVC ou AIT na história foi preditiva de estenose acima de 70% neste grupo de pacientes.OBJECTIVE: To analyze the frequency and risk factors of carotid stenosis above 70% in patients undergoing abdominal aortic reconstruction. MATERIAL AND METHOD: Ninety-four patients who underwent Doppler ultrasound preoperative screening for abdominal aortic surgery between January 2000 and January 2003 were analyzed by the Vascular Surgery Unit of the Santa Casa of São Paulo (Faculty of Medical Sciences. RESULTS: Sixty-seven (71% patients were male. Of the 94 patients, 42

  17. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... as atherosclerosis, high blood pressure, smokers, or a family history of abdominal aortic aneurysms. Today’s patient is ... be screened. In fact, patients who have a family history of aneurysm, men who are smoking over ...

  18. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... wall will actually thin out. And the big risk here is that if this gets too big ... to the aging baby boomers. Next slide. The risk factors for abdominal aortic aneurysms are males over ...

  19. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... atherosclerosis, high blood pressure, smokers, or a family history of abdominal aortic aneurysms. Today’s patient is a ... screened. In fact, patients who have a family history of aneurysm, men who are smoking over the ...

  20. Deep gluteal grounding pad burn after abdominal aortic aneurysm repair.

    Science.gov (United States)

    Sapienza, Paolo; Venturini, Luigi; Cigna, Emanuele; Sterpetti, Antonio V; Biacchi, Daniele; di Marzo, Luca

    2015-01-01

    Although skin burns at the site of grounding pad are a known risk of surgery, their exact incidence is unknown. We first report the case of a patient who presented a deep gluteal burn at the site of the grounding pad after an abdominal aortic aneurism repair, the etiology and the challenging treatment required to overcome this complication. PMID:26099000

  1. Wall shear stress indicators in abnormal aortic geometries

    Science.gov (United States)

    Prahl Wittberg, Lisa; van Wyk, Stevin; Fuchs, Laszlo; Gutmark, Ephraim; Gutmark-Little, Iris

    2015-11-01

    Cardiovascular disease, such as atherosclerosis, occurs at specific locations in the arterial tree. Characterizing flow and forces at these locations is crucial to understanding the genesis of disease. Measures such as time average wall shear stress, oscillatory shear index, relative residence time and temporal wall shear stress gradients have been shown to identify plaque prone regions. The present paper examines these indices in three aortic geometries obtained from patients whose aortas are deformed due to a genetic pathology and compared to one normal geometry. This patient group is known to be prone to aortic dissection and our study aims to identify early indicators that will enable timely intervention. Data obtained from cardiac magnetic resonance imaging is used to reconstruct the aortic arch. The local unsteady flow characteristics are calculated, fully resolving the flow field throughout the entire cardiac cycle. The Quemada model is applied to account for the non-Newtonian properties of blood, an empirical model valid for different red blood cell loading. The impact of the deformed aortic geometries is analyzed to identify flow patterns that could lead to arterial disease at certain locations.

  2. Using The Descending Aortic Wall Thickness Measured In Transesophageal Echocardiography As A Risk Marker For Aortic Dissection

    Directory of Open Access Journals (Sweden)

    Zaher Fanari

    2015-04-01

    Full Text Available Objective: The aim of this study is to estimate whether aortic wall thickness is increased in patients with Aortic dissection (AD compared to low risk control group and can be used in addition to aortic diameter as a risk marker of AD. Background: AD occurs due to pathologies that may increase thickness of the aortic wall. Transesophageal echocardiography (TEE has the ability to visualise both the thoracic aortic wall and lumen. Aortic diameter has been used to predict aortic dissection and timing of surgery, but it is not always predictive of that risk. Methods: In 48 patients with AD who underwent TEE were examined retrospectively and compared to 48 control patients with patent foramen ovale (PFO. We measured aortic diameter at different levels, intimal/medial thickness (IMT and complete wall thickness (CMT. Demographic data and cardiovascular risk factors were reviewed. The data was analysed using ANOVA and student t test. Results: (AD patients were older [mean age 66 AD vs. 51 PFO], had more hypertension, diabetes, hyperlipidemia and Coronary artery disease. Both IMT and CMT in the descending aorta were increased in AD group [(1.85 vs. 1.43 mm; P=0.03 and 2.93 vs. 2.46 mm; p=0.01. As expected the diameter of ascending aorta was also greater in AD (4.61 vs. 2.92 cm; P=0.004. Conclusions: CMT and IMT in the descending aorta detected by TEE is greater in patients with AD when compared to control and may add prognostic data to that of aortic diameter

  3. Using The Descending Aortic Wall Thickness Measured In Transesophageal Echocardiography As A Risk Marker For Aortic Dissection

    Science.gov (United States)

    Fanari, Zaher; Hammami, Sumaya; Hammami, Muhammad Baraa; Hammami, Safa; Eze-Nliam, Chete; Weintraub, William S.

    2015-01-01

    Objective The aim of this study is to estimate whether aortic wall thickness is increased in patients with Aortic dissection (AD) compared to low risk control group and can be used in addition to aortic diameter as a risk marker of AD. Background AD occurs due to pathologies that may increase thickness of the aortic wall. Transesophageal echocardiography (TEE) has the ability to visualize both the thoracic aortic wall and lumen. Aortic diameter has been used to predict aortic dissection and timing of surgery, but it is not always predictive of that risk. Methods In 48 patients with AD who underwent TEE were examined retrospectively and compared to 48 control patients with patent foramen ovale (PFO). We measured aortic diameter at different levels, intimal/medial thickness (IMT) and complete wall thickness (CMT). Demographic data and cardiovascular risk factors were reviewed. The data was analyzed using ANOVA and student t test. Results (AD) patients were older [mean age 66 AD vs. 51 PFO], had more hypertension, diabetes, hyperlipidemia and Coronary artery disease. Both IMT and CMT in the descending aorta were increased in AD group [(1.85 vs. 1.43 mm; P=0.03 and 2.93 vs. 2.46 mm; p=0.01). As expected the diameter of ascending aorta was also greater in AD (4.61 vs. 2.92 cm; P=0.004). Conclusions CMT and IMT in the descending aorta detected by TEE is greater in patients with AD when compared to control and may add prognostic data to that of aortic diameter. PMID:25984293

  4. Disseminated Mycobacterium chimaera Infection After Cardiothoracic Surgery

    Science.gov (United States)

    Tan, Nicholas; Sampath, Rahul; Abu Saleh, Omar M.; Tweet, Marysia S.; Jevremovic, Dragan; Alniemi, Saba; Wengenack, Nancy L.; Sampathkumar, Priya; Badley, Andrew D.

    2016-01-01

    Ten case reports of disseminated Mycobacterium chimaera infections associated with cardiovascular surgery were published from Europe. We report 3 cases of disseminated M chimaera infections with histories of aortic graft and/or valvular surgery within the United States. Two of 3 patients demonstrated ocular involvement, a potentially important clinical finding.

  5. Determinant factors of Yemeni maxillary arch dimensions

    Directory of Open Access Journals (Sweden)

    Nabil Muhsen Al-Zubair

    2015-01-01

    Conclusion: Measurements of palatal depth and relationships of the canines to one another and to other teeth thus had the widest ranges, implying that these dimensions are the strongest determinants of maxillary arch size.

  6. Subglottic granuloma after aortic replacement: resection via flexible bronchoscopy after an emergency tracheostomy

    OpenAIRE

    Nose, Naohiro; So, Tetsuya; Sekimura, Atsushi; Miyata, Takeaki; Yoshimatsu, Takashi

    2014-01-01

    A subglottic granuloma is one of the late-phase complications that can occur after intubation. It can cause a life-threatening airway obstruction; therefore, a rapid diagnosis and appropriate treatment plan is necessary. A 62-year-old male had undergone an emergency total arch replacement for acute aortic dissection. Postoperative ventilation support had been performed until the 15th postoperative day (POD). He was discharged from the hospital on POD 30. On POD 50, he was brought to our hospi...

  7. Is it safe to divide and ligate the left innominate vein in complex cardiothoracic surgeries?

    Science.gov (United States)

    McPhee, Arthur; Shaikhrezai, Kasra; Berg, Geoffrey

    2013-09-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether it is safe to divide the left innominate vein (LIV) in aortic arch surgery to improve access. Altogether, 228 relevant papers were found using the reported search, of which nine represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Following LIV division, the venous drainage takes place via multiple collateral systems such as the azygous/hemiazygous, the internal mammary veins, the lateral thoracic and superficial thoracoabdominal veins, vertebral venous plexus as well as the transverse sinus. The possible complications are mainly left upper limb swelling and neurological symptoms. In one case series of 14 patients, the LIV was divided and ligated to facilitate the exposure for aortic arch surgery. More than 2-year follow-up did not reveal upper limb oedema or neurological symptoms. In two cohorts of 52 patients, the LIV was ligated prior to the superior vena cava (SVC) resection for malignancy. During the mid-term follow-up, no neurological or upper limb symptoms were reported. Although in two studies with 72 and 70 patients undergoing SVC resection it was not specified how many of them had LIV ligation, no relevant complications were reported. In a report, LIV occlusion was observed in 4 patients undergoing left internal jagular vein catheterization for haemodialysis. The reported symptom was left arm swelling with no neurological problems. In a cohort of 18 patients undergoing SVC resection for malignancy and major vein reconstruction, 7 patients underwent ligation of the LIV with no neurological symptoms. It was also concluded that reconstruction of the LIV is not consistent with favourable patency. In a case series of 10 patients with central venous obstruction, collateral pathways

  8. Reoperative transapical transcatheter aortic valve replacement for central aortic regurgitation.

    Science.gov (United States)

    Zhu, Yuanjia; Kapadia, Samir; Krishnaswamy, Amar; Svensson, Lars G; Mick, Stephanie

    2016-09-01

    Paravalvular leak-related aortic regurgitation after transcatheter aortic valve replacement (TAVR) is a common complication and is associated with increased short- and long-term mortality. However, the impact of isolated central aortic regurgitation is unknown. We report a case of transapical (TA) TAVR with postprocedural central aortic regurgitation, who returned after two years with progression of regurgitation. A reoperative valve-in-valve TA-TAVR was performed. PMID:27405799

  9. Aortic regurgitation after transcatheter aortic valve replacement.

    Science.gov (United States)

    Werner, Nikos; Sinning, Jan-Malte

    2014-01-01

    Paravalvular aortic regurgitation (AR) negatively affects prognosis following transcatheter aortic valve replacement (TAVR). As transcatheter heart valves (THV) are anchored using a certain degree of oversizing at the level of the aortic annulus, incomplete stent frame expansion because of heavily annular calcifications, suboptimal placement of the prosthesis, and/or annulus-prosthesis size-mismatch can contribute to paravalvular AR with subsequent increased mortality risk. Echocardiography is essential to differentiate between transvalvular and paravalvular AR and to further elucidate the etiology of AR during the procedure. However, because echocardiographic quantification of AR in TAVR patients remains challenging, especially in the implantation situation, a multimodal approach to the evaluation of AR with use of hemodynamic measurements and imaging modalities is useful to precisely quantify the severity of AR immediately after valve deployment. "Next-generation" THVs are already on the market and first results show that paravalvular AR related to design modifications (eg, paravalvular space-fillers, full repositionability) are rarely seen in these valve types.  PMID:24632758

  10. Dilatation and Dysfunction of the Neo-aortic Root and in 76 Patients After the Ross Procedure.

    Science.gov (United States)

    Zimmermann, Corina A; Weber, Roland; Greutmann, Matthias; Dave, Hitendu; Müller, Christoph; Prêtre, René; Seifert, Burkhardt; Buechel, Emanuela Valsangiacomo; Kretschmar, Oliver; Attenhofer Jost, Christine H

    2016-08-01

    Pulmonary autograft replacement (Ross procedure) is used as an alternative to prosthetic aortic valve replacement patients with aortic valve disease. There are limited data on incidence and risk factors for dilatation and dysfunction of the neo-aortic after the Ross procedure. Ross procedure was performed in 100 patients at our institution between 1993 and 2011. In 76 patients, complete follow-up data were available. Their median age at surgery was 16 (0.4-58) years (76 % males; 95 % with congenital aortic valve disease). Median follow-up duration was 5.2 years (0.3-16.0 years). We analyzed their clinical and echocardiographic follow-up to identify possible risk factors for neo-aortic root dilatation and dysfunction. Ross procedure included reduction plasty of the native ascending aorta in 25 % of patients. During follow-up, 21 patients (28 %) developed neo-aortic root dilatation, 38 patients (50 %) dilatation oft the native ascending aorta and 7 patients (9 %) at least moderate neo-aortic regurgitation. Univariate risk factors for neo-aortic root dilatation were preoperative aortic regurgitation (p = 0.04), concomitant reduction plasty of the ascending aorta (p = 0.009) and a longer duration of follow-up (p = 0.005). Younger age at surgery was associated with dilatation of the ascending aorta (p = 0.03). Reoperation on the neo-aortic root because of severe dilatation was necessary in 6 patients (8 %), where 2 patients had at least moderate neo-aortic root regurgitation. Neo-aortic root and aortic dilatation are common after the Ross procedure. This is often combined with neo-aortic valve dysfunction. Close follow-up of these patients is mandatory.

  11. Application of the multi-planar reconstruction in endovascular treatment of type B aortic dissection

    Institute of Scientific and Technical Information of China (English)

    LI Yong-sheng; HOU Kai; XU Xin; YANG Jue; ZHU Ting; DONG Zhi-hui; YUE Jia-ning

    2013-01-01

    Background Although Multi-planar reconstruction (MPR) has been considered a diagnostic imaging technique that observes more perspectives for diseases,few people have applied it surgically.In fact,MPR is also very useful to clinical operation,especially for patients with type B aortic dissection.It helps the surgeon to locate accurately with more information about aortic dissection,so that the safety and effectiveness of operation can be improved.This study examined the application of the MPR in intraoperative DSA imaging for precise positioning by accurately obtaining a crosssection,a spin angle of the coronal plane,and a tilt angle of the sagittal plane in treatment of type B aortic dissection.Methods The conventional and the MPR approaches were compared on positioning the aortic arch for surgery.A group of 40 patients (group A) and another group of 42 patients (group B) was sampled.About the comparison of baseline characteristics,a fourfold table X2 test was conducted on gender,and two independent samples t-test was applied to age between group A and group B.Spin as well as tilt angles for group A were obtained from the patients using both approaches,and their effectiveness was compared with pair t-tests; The MPR data guided stent-grafting in this group.Stent graft placement of group B was based on the conventional approach.Percentages of proximal distributed markers as well as incidences of complications were collected from both groups after stent graft placement.They were also compared with a fourfold table X2 test.Results Gender difference was not found between group A and group B (X2=0.80,P >0.05),and age difference was not statistically significant (F=2.55,homogeneity of variance,t=-1.46,P >0.05).A significant difference was found between the conventional and the MPR approaches for spin angle (t=9.17) as well as tilt angle (t=-2.07),P <0.05.Percentage of proximal distributed markers (5.0%) of group A was significantly lower than that of group B (42

  12. A Simple Emergency Prediction Tool for Acute Aortic Dissection.

    Directory of Open Access Journals (Sweden)

    Wen Peng

    2013-10-01

    Full Text Available A simple emergency risk prediction tool should be developed for clinicians to quickly identify the prognosis of patients with acute aortic dissection.We enrolled 280 patients with acute aortic dissection admitted to emergency department between May 2010 and February 2013. Multivariate logistic regression analysis was performed to identify independent predictors of in-hospital death.The in-hospital mortality of our patients with acute aortic dissection was 32.5%, in-hospital deaths with surgery less than the survived (34.1% VS 54.5%. Multivariate analysis identified that age (≥65 years old, Type A, blood pressure (mean systolic blood pressure ≤ 90 mmHg, neutrophil percentage (≥ 80% and serum D-dimer (≥ 5.0 mg/L were significant predictors of death. With the simple emergency risk prediction tool, scores of all in-hospital deaths were ≥ 3, whereas almost all of the survivors (97.9% had scores < 15. A score of 10 offered the best threshold value, with the highest sensitivity (81.3% and specificity (86.8%.The in-hospital mortality rate of patients with acute aortic dissection is high and can be predicted. Early surgery would be beneficial for in-hospital survive. This tool should be available for clinicians in the emergency department to quickly identify the prognosis of patients with acute aortic dissection.

  13. Salmonella aortitis treated with endovascular aortic repair: a case report

    Directory of Open Access Journals (Sweden)

    Strahm Carol

    2012-08-01

    Full Text Available Abstract Introduction Salmonella is a typical cause of aortitis, which is associated with high morbidity and mortality. In infrarenal disease, besides open surgery, endovascular aortic repair as an alternative treatment has been reported. To the best of our knowledge, we report the first successful endovascular aortic repair documented by necropsy to date. Case presentation A 67-year-old Caucasian man presented with low back pain, fever and positive blood cultures for Salmonella Enteritidis. A computed tomography scan showed an enlargement and intramural hematoma of the infrarenal aortic wall; a Salmonella aortitis was suspected and antimicrobial therapy initiated. Because of substantial comorbidities, endovascular aortic repair was favored over open surgery; postoperatively the antibiotic treatment was continued for 12 months. Post-mortem there were neither macroscopic nor microscopic signs of aortitis or graft infection. Conclusions We could demonstrate by necropsy that endovascular aortic repair of infrarenal aortitis with prolonged pre- and postinterventional antibiotic therapy for 12 months was a minimally invasive alternative and should be considered in selected clinically stable patients with substantial co-morbidities.

  14. Percutaneous implantation of the CoreValve aortic valve prosthesis in patients at high risk or rejected for surgical valve replacement: Clinical evaluation and feasibility of the procedure in the first 30 patients in the AMC-UvA

    NARCIS (Netherlands)

    J. Baan; Z.Y. Yong; K.T. Koch; J.P.S. Henriques; B.J. Bouma; S.G. de Hert; J. van der Meulen; J.G.P. Tijssen; J.J. Piek; B.A.J.M. de Mol

    2010-01-01

    Objective. To report the feasibility, safety and efficacy of percutaneous aortic valve implantation (PAVI) with the CoreValve self-expanding aortic valve bioprosthesis in elderly patients with aortic valve stenosis who are rejected for surgery or have a high surgical risk.Methods. PAVI using the Cor

  15. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... conditions or other significant medical problems, the American College of Cardiology recommends aortic valve replacement for basically ... more likely we see aortic stenosis. Again, patient education is part of the evaluation and management of ...

  16. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... of that slide, that demonstrates that patients with New York Heart Association class heart failure 1 and ... right down the aortic valve and that's the new aortic valve that Dr. Streitman's placed. And you ...

  17. Minimally Invasive Aortic Valve Replacement

    Medline Plus

    Full Text Available ... to help prevent aortic stenosis? There's no prophylactic methods that anybody can take to prevent aortic stenosis ... it will be archived on the ORlive Web site and ORlive.com and, of course, a link ...

  18. Consistency of aortic distensibility and pulse wave velocity estimates with respect to the Bramwell-Hill theoretical model: a cardiovascular magnetic resonance study

    Directory of Open Access Journals (Sweden)

    De Cesare Alain

    2011-01-01

    Full Text Available Abstract Background Arterial stiffness is considered as an independent predictor of cardiovascular mortality, and is increasingly used in clinical practice. This study aimed at evaluating the consistency of the automated estimation of regional and local aortic stiffness indices from cardiovascular magnetic resonance (CMR data. Results Forty-six healthy subjects underwent carotid-femoral pulse wave velocity measurements (CF_PWV by applanation tonometry and CMR with steady-state free-precession and phase contrast acquisitions at the level of the aortic arch. These data were used for the automated evaluation of the aortic arch pulse wave velocity (Arch_PWV, and the ascending aorta distensibility (AA_Distc, AA_Distb, which were estimated from ascending aorta strain (AA_Strain combined with either carotid or brachial pulse pressure. The local ascending aorta pulse wave velocity AA_PWVc and AA_PWVb were estimated respectively from these carotid and brachial derived distensibility indices according to the Bramwell-Hill theoretical model, and were compared with the Arch_PWV. In addition, a reproducibility analysis of AA_PWV measurement and its comparison with the standard CF_PWV was performed. Characterization according to the Bramwell-Hill equation resulted in good correlations between Arch_PWV and both local distensibility indices AA_Distc (r = 0.71, p AA_Distb (r = 0.60, p Arch_PWV and both theoretical local indices AA_PWVc (r = 0.78, p AA_PWVb (r = 0.78, p Arch_PWV was well related to CF_PWV (r = 0.69, p Conclusions The present work confirmed the consistency and robustness of the regional index Arch_PWV and the local indices AA_Distc and AA_Distb according to the theoretical model, as well as to the well established measurement of CF_PWV, demonstrating the relevance of the regional and local CMR indices.

  19. [Abdominal aortic aneurysm: an uncommon presentation].

    Science.gov (United States)

    Taborda, Lúcia; Pereira, Laurinda; Amona, Eurides; Pinto, Erique Guedes; Rodrigues, Joaquim

    2011-01-01

    Most abdominal aortic aneurysms are asymptomatic, being accidentally found on physical examination or in routinely performed imaging studies. They only require surveillance (which is variable according to the aneurism size) and medical therapy in order to achieve risk factor reduction. However, in certain situations, according to the risk of aneurism rupture, elective surgery or endovascular procedure may be necessary. About 80% of the cases of aneurism rupture occur into the retroperitoneal space, with a high mortality rate. There are uncommon presentations of aneurism rupture as the aorto-caval fistula, which also require fast diagnosis and intervention. The authors present the case of a 71-year-old man, with the previous diagnosis of hypertension, acute myocardial infarction 2 months earlier (undergone primary Percutaneous Coronary Intervention) and tabagism, who was admitted at the emergency department with intense 24-hour-evolution epigastric pain. On physical examination, the Blood Pressure values measured at the lower limbs were about half the ones measured at the upper limbs and there was an abdominal pulsatile mass, with a high-intensity murmur. As the authors suspected aortic dissection, aneurysm, coarctation or thrombosis, it was done a Computed Tomography scanning with intravenous contrast, which revealed a ruptured abdominal aorta aneurysm with a mural thrombus. The doppler ultrasound confirmed the presence of a high debit aorto-caval fistula. The patient was immediately transferred to the Vascular Surgery. However he died 2 hours later, during surgery. PMID:22525642

  20. The everyday used nomenclature of the aortic root components: the tower of Babel?

    Science.gov (United States)

    Sievers, Hans-Hinrich; Hemmer, Wolfgang; Beyersdorf, Friedhelm; Moritz, Anton; Moosdorf, Rainer; Lichtenberg, Artur; Misfeld, Martin; Charitos, Efstratios I

    2012-03-01

    Modern analyses of data for scientific reporting and healthcare management purposes require standardized and consistent definitions, something which also holds true for aortic root surgery, as part of the cardiovascular surgery spectrum. The aim of the present study was to investigate the currently employed nomenclature of the aortic root components. A questionnaire was constructed on the terminology of aortic root components, providing a list of common definitions including anatomical descriptions, as well as fields for custom responses. Responses were received from 534 cardiothoracic surgeons registered at www.ctsnet.org. Remarkable variations in definitions were detected. The most unanimously accepted terms were: 'aortic leaflets', the freely moving parts (52.6% of responses); 'commissures', the distal part of the leaflet attachments plus the peripheral area of the free edges of the leaflets (52.2%); 'semi-lunar leaflet attachment', the anatomic site of leaflet attachment (58%); 'annulus', the circular line defined by the nadirs of the leaflets (38%); 'interleaflet triangle', the tissue between two leaflets and annulus (23%); 'aortic valve', the three leaflets only (55%); 'aortic root' as composed of sinuses, tissue between the leaflets, sinutubular junction, leaflets and their wall attachment (63%). The remarkable variability on the everyday-used definitions of the aortic root components can potentially lead to misinterpretation of data. More stringent adoption of consistent, standardized definitions of aortic root components is necessary in the modern era of data collection and management. PMID:22345173

  1. Superficial Palmar Arch Aneurysm after Carpal Tunnel Decompression, a Rare Complication: A Case Report

    Directory of Open Access Journals (Sweden)

    S. Gull

    2011-01-01

    Full Text Available False aneurysms of the palmar arteries are rare. They are usually associated with traumatic injuries to the hand vasculature. We present a case of superficial palmar arch aneurysm (SPAA, complicating carpal tunnel decompression which presented as a pulsatile mass at the site of previous surgery. Initial diagnosis was made on clinical examination and confirmed on doppler ultrasound (US and computed tomographic angiography (CTA. The feeding vessel of the aneurysm was subsequently occluded using coil embolization.

  2. Contemporary Management of Type B Aortic Dissection in the Endovascular Era.

    Science.gov (United States)

    Bannazadeh, Mohsen; Tadros, Rami O; McKinsey, James; Chander, Rajiv; Marin, Michael L; Faries, Peter L

    2016-04-01

    Aortic dissection (AD) is one of the most common catastrophic pathologies affecting the aorta. Anatomic classification is based on the origin of entry tear and its extension. Type A dissections originate in the ascending aorta, whereas the entry tear in Type B dissections starts distal to the left subclavian artery. The patients with aortic dissection who manifest complications such as rupture, malperfusion, aneurysmal degeneration, and intractable pain are classified as complicated AD. Risk factors for developing aortic dissection include age, male gender, and aortic wall structural abnormalities. The most common presenting symptom of acute aortic dissection is pain. Malperfusion occurs as a result of end-organ ischemia due to involvement of aortic branches from the dissecting process. This can happen in various locations causing mesenteric ischemia (mesenteric vessels), stroke (aortic arch vessels), renal failure (renal arteries), spinal ischemia, and limb ischemia (iliac or subclavian arteries). Aneurysmal degeneration is the most common complication of patients with chronic Type B dissection who are managed with medical therapy. Management of Type B aortic dissection (TBAD) remains controversial. Many groups recommend conservative therapy for newly diagnosed TBAD and reserve surgical management for patients who develop complications such as rupture, malperfusion, aneurysmal dilatation, and refractory pain. The mainstay of medical therapy includes antihypertensive medication to reduced ΔP/ ΔT by lowering blood pressure and heart rate. With the continued success of thoracic endovascular aortic repair (TEVAR), this procedure has been extended to treat TBAD in selected patients. The outcomes of TEVAR are promising, with early mortality rates from 10% to 20%. With promising results from these series, some groups recommend early TEVAR in uncomplicated TBAD to prevent future adverse events. The goals of endovascular treatment of TBAD are to cover the entry tear

  3. Efficacy analysis of endovascular aneurysm repair and open surgery repair in patients with abdominal aortic aneurysm%腹主动脉瘤腔内修复与开腹手术治疗的疗效分析

    Institute of Scientific and Technical Information of China (English)

    唐佃俊; 张健; 辛世杰; 伦语; 沈世凯; 宋建博; 姜晗; 段志泉

    2015-01-01

    Objective To analyze and compare the clinical efficacies of endovascular aneurysm repair (EVAR) and open surgery repair (OSR) in patients with abdominal aortic aneurysm (AAA).Methods The clinical data of 271 patients with AAA who received surgery at the First Hospital of China Medical University between January 2004 and December 2014 were retrospectively analyzed.Of the 271 patients,153 patients undergoing EVAR were allocated into the EVAR group and 118 patients undergoing OSR into the OSR group,respectively.All the patients underwent a primary screening of preoperative ultrasonography and were diagnosed by three-dimensional computed tomography angiography (CTA),then urgent and severe patients were confirmed by abdominal enhanced CT.The procedures of EVAR:guide wire was inserted into the abdominal arota from femoral artery incision and branched stent was placed.The procedures of OSR:AAA was resected by median abdoninal incision,thrombi and sclerosis plaques in endovascular wall were cleared,and end-to-end abdominal aortic anastomosis and end-to-side iliac aortic anastomosis were performed using Y-shaped blood vessel prosthesis.All the patients were followed up by telephone interview up to December 31,2014.The operation situation,complications at postoperative day 30,short-term complications (between postoperative 3 months and 3 years),medium-and long-term complications (more than postoperative 3 years),mortality and survival rate were observed.Measurement data with normal distribution were presented as x ± s and analyzed using the t test,and count data were analyzed using the chi-square test or Fisher exact probability.Survival curve was drawn by the Kaplan-Meier method,and survival rate was analyzed using the Log-rank test.Results All the patients were confirmed as with AAA by preoperative three-dimensional CTA.The operation time,volume of intraoperative blood loss,volume of intraoperative blood transfusion,time for out-off-bed activity,duration of hospital stay

  4. 破裂腹主动脉瘤腔内治疗与手术治疗效果比较%Comparing the effects of endovascular and open surgery repair of ruptured abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    韩万里; 戴向晨; 罗宇东; 范海伦; 冯舟; 朱杰昌; 张益伟

    2015-01-01

    Objective:To compare and analyze effects of endovascular repair (EVAR) and open surgery repair (OSR) in patients with ruptured abdominal aortic aneurysm (rAAA). Methods: Clinical data of patients with rAAA were analyzed retrospectively. Outcome parameters included mortality (intraoperation, 30 day, 6 month and 12 month), complications, reinterventions, and length of hospital stay. Results:Thirty-five consecutive patients with rAAAs were presented, 12 of whom underwent EVAR, and 23 underwent OSR. Twenty-eight males and 7 females, age from 37 to 84 years with an mean of(68.37±10.04). At baseline, There was no significant differece in age , gender , comorbidities and preoperative hemodynamic stability between the two groups (P>0.05). The intraoperation, 30 day, 6 month and 12 month mortalities were 0.0%(0 of 12), 0.0%(0 of 12), 0.0%(0 of 12), and 0.0%(0 of 8) after EVAR, compared with 17.4%(4 of 23, P=0.275), 30.4%(7 of 23, P=0.070), 34.8% (8 of 23, P=0.032), and 45.0% (9 of 20, P=0.029) after OSR, respectively. Median length of hospital stay was 11.0 days (interquartile range, 7.0~16.0) after rEVAR and 17.0 days (interquartile range, 14.0~27.0) after OSR (P=0.024). Conclusion:These data suggest that EVAR can be a first-line treatment for rAAA. However, anatomical conditions should be considered with caution. Aortouniiliac is a fast and effective way to control bleeding. Further observation of abdominal compartment syndrome is essential for EVAR.%目的:比较破裂腹主动脉瘤(rAAA)腔内治疗(EVAR)与开放手术(OSR)的治疗情况。方法:回顾性分析分别采取开放手术或腔内治疗的rAAA患者临床资料。比较两组术前一般情况、围手术期死亡率及并发症发生率、术后死亡率、术后住院时间等。结果:rAAA患者共35例,其中男28例,女7例,年龄37~84岁,平均(68.37±10.04)岁。 OSR 23例、EVAR 12例。两组在年龄、性别、合并症及术前血流动力学稳定性

  5. Variation in the Branching Pattern of the Superficial Palmar Arch

    Directory of Open Access Journals (Sweden)

    Sumalatha S

    2016-05-01

    Full Text Available In this article we describe a rare variation in the superficial palmar arch (SPA encountered during routine cadaveric dissection. SPA was formed by the superficial branches of ulnar and radial arteries which provided a proper digital branch to the ulnar side of the little finger and three common palmar digital branches to the medial four digits. Additionally a first common digital artery was seen to emerge from the radial side of SPA which further divided into the arteria princeps pollicis and arteria radialis indicis. We also found a small communicating branch between the arteria princeps pollicis and the radial artery in the anatomical snuff box. Such arterial variations in the palm due to alteration in the developmental sequence remains a crucial issue in the reconstructive hand surgeries, especially while dealing with the innovative microsurgical procedures, where these varied patterns act as pivotal points around which successful results of various advanced surgical procedures revolve.

  6. Aneurysm growth after late conversion of thoracic endovascular aortic repair

    Directory of Open Access Journals (Sweden)

    Hirofumi Kasahara

    2015-01-01

    Full Text Available A 69-year-old man underwent thoracic endovascular aortic repair of a descending aortic aneurysm. Three years later, he developed impending rupture due to aneurysmal expansion that included the proximal landing zone. Urgent open surgery was performed via lateral thoracotomy, and a Dacron graft was sewn to the previous stent graft distally with Teflon felt reinforcement. Postoperatively, four sequential computed tomography scans demonstrated that the aneurysm was additionally increasing in size probably due to continuous hematoma production, suggesting a possibility of endoleaks. This case demonstrates the importance of careful radiologic surveillance after endovascular repair, and also after partial open conversion.

  7. Outcomes After Elective Aortic Aneurysm Repair

    DEFF Research Database (Denmark)

    de la Motte, L; Jensen, L P; Vogt, K;

    2013-01-01

    OBJECTIVE: To assess outcomes after treatment for asymptomatic abdominal aortic aneurysm (AAA) in Denmark in a period when both open surgery (OR) and endoluminal repair (EVAR) have been routine procedures. METHODS: We performed a retrospective nationwide cohort study of patients treated...... for asymptomatic AAA between 2007 and 2010. Data on demographics, procedural data, perioperative complications, length of stay (LOS), 30-day reinterventions and readmissions, late aneurysm and procedure-related complications and mortality were obtained from the Danish Vascular Registry and the Danish National...

  8. Chylous Ascites after Abdominal Aortic Aneurysm Repair.

    Science.gov (United States)

    Ohki, Shinichi; Kurumisawa, Soki; Misawa, Yoshio

    2016-01-01

    A 73-year-old man was transferred for treatment of abdominal aortic aneurysm. He had no history of abdominal surgeries. Grafting between the infra-renal abdominal aorta and the bilateral common iliac arteries was performed. Proximal and distal cross clamps were applied for grafting. He developed chylous ascites on the 5th post-operative day, 2 days after initiation of oral intake. Fortunately, he responded to treatment with total parenteral hyper-alimentation for 10 days, followed by a low-fat diet. There was no recurrence of ascites. PMID:27087873

  9. The Origin of Neointimal Smooth Muscle Cells in Transplant Arteriosclerosis from Recipient Bone-marrow Cells in Rat Aortic Allograft

    Institute of Scientific and Technical Information of China (English)

    SONG Zifang; LI Wei; ZHENG Qichang; SHANG Dan; SHU Xiaogang; GUAN Siming

    2007-01-01

    In order to investigate the origin of neointimal smooth muscle cells in transplant arteriosclerosis in rat aortic allograft, sex-mismatched bone marrow transplantation was performed from male Wistar rats to female Wistar rats. Four weeks after transplantation, the aortic transplant model was established by means of micro-surgery in rats. The recipients were divided into 4 groups: female Wistar-female Wistar aortic isografts, female SD-female Wistar aortic allografts, male SD-male Wistar aortic allografts, female SD-chimera Wistar aortic allografts. Eight weeks after transplantation, aortic grafts were removed at autopsy and processed for histological evaluation and immunohistochemistry. The results indicated that excessive accumulation of α-SMA-positive smooth muscle cells resulted in significant neointima formation and vascular lumen stricture in rat aortic allografts.Neointima assay revealed that the neointimal area and NIA/MA ratio of transplanted artery were significantly increased in all of aortic allograft groups as compared with those in aortic isograft group (P<0.01). Neointimal smooth muscle cells were harvested from cryostat sections of aortic allograft by microdissection method. The Sry gene-specific PCR was performed, and the result showed that a distinct DNA band of 225 bp emerged in the male-male aortic allograft group and chimera aortic allograft group respectively, but not in the female-female aortic allograft group. It was suggested that recipient bone-marrow cells, as the origin of neointimal smooth muscle cells, contributed to the pathological neointimal hyperplasia of aortic allograft and transplant arteriosclerosis.

  10. Percutaneous Implantation of the self-expanding valve Prosthesis a patient with homozygous familial hypercholesterolemia severe aortic stenosis and porcelain aorta.

    Science.gov (United States)

    Sahiner, Levent; Asil, Serkan; Kaya, Ergün Baris; Ozer, Necla; Aytemir, Kudret

    2016-10-01

    Transcatheter aortic valve implantation (TAVI) has shown favorable outcomes in patients with severe symptomatic aortic valve stenosis who are at high surgical risk or inappropriate for open heart surgery. However, concerns exist over treating patients who have porcelain aorta and familial hypercholesterolemia, due to the potential complications of aortic root and aortic annulus. In this case report, we present a patient with familial hypercholesterolemia, symptomatic severe aortic stenosis, previous coronary artery bypass grafting and porcelain aorta, who was successfully treated with TAVI using a CoreValve. PMID:27393846

  11. An emergency visceral hybrid procedure for ruptured thoraco-abdominal aortic aneurysms

    NARCIS (Netherlands)

    E.M. von Meyenfeldt; J.M. Schnater; J.A. Reekers; R. Balm

    2009-01-01

    Rupture of a thoraco-abdominal aortic aneurysm (TAAA) is usually lethal. Patients with contained ruptures, who reach the hospital, have traditionally been subjected to open reconstructive surgery. However, especially in older patients, open surgery has a high mortality and morbidity rate. Visceral h

  12. Robotic surgery

    Science.gov (United States)

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. ...

  13. Arch Index: An Easier Approach for Arch Height (A Regression Analysis

    Directory of Open Access Journals (Sweden)

    Hironmoy Roy

    2012-04-01

    Full Text Available Background: Arch-height estimation though practiced usually in supine posture; is neither correct nor scientific as referred in literature, which favour for standing x-rays or arch-index as yardstick. In fact the standing x-rays can be excused for being troublesome in busy OPD, but an ink-footprint on simple graph-sheet can be documented, as it is easier, cheaper and requires almost no machineries and expertisation. Objective: So this study aimed to redefine the inter-relationship of the radiological standing arch-heights with the arch-index for correlation and regression so that from the later we can derive the radiographical standing arch-height values indirectly, avoiding the actual maneuver. Methods: The study involved 103 adult subjects attending at a tertiary care hospital of North Bengal. From the standing x-rays of foot, the standing navicular, talar heights were measured, and ‘normalised’ with the foot length. In parallel foot-prints also been obtained for arch-index. Finally variables analysed by SPSS software. Result: The arch-index showed significant negative correlations and simple linear regressions with standing navicular height, standing talar height as well as standing normalised navicular and talar heights analysed in both sexes separately with supporting mathematical equations. Conclusion: To measure the standing arch-height in a busy OPD, it is wise to have the foot-print first. Arch-index once get known, can be put in the equations as derived here, to predict the preferred standing arch-heights in either sex.

  14. Enhancing 4D PC-MRI in an aortic phantom considering numerical simulations

    Science.gov (United States)

    Kratzke, Jonas; Schoch, Nicolai; Weis, Christian; Müller-Eschner, Matthias; Speidel, Stefanie; Farag, Mina; Beller, Carsten J.; Heuveline, Vincent

    2015-03-01

    To date, cardiovascular surgery enables the treatment of a wide range of aortic pathologies. One of the current challenges in this field is given by the detection of high-risk patients for adverse aortic events, who should be treated electively. Reliable diagnostic parameters, which indicate the urge of treatment, have to be determined. Functional imaging by means of 4D phase contrast-magnetic resonance imaging (PC-MRI) enables the time-resolved measurement of blood flow velocity in 3D. Applied to aortic phantoms, three dimensional blood flow properties and their relation to adverse dynamics can be investigated in vitro. Emerging "in silico" methods of numerical simulation can supplement these measurements in computing additional information on crucial parameters. We propose a framework that complements 4D PC-MRI imaging by means of numerical simulation based on the Finite Element Method (FEM). The framework is developed on the basis of a prototypic aortic phantom and validated by 4D PC-MRI measurements of the phantom. Based on physical principles of biomechanics, the derived simulation depicts aortic blood flow properties and characteristics. The framework might help identifying factors that induce aortic pathologies such as aortic dilatation or aortic dissection. Alarming thresholds of parameters such as wall shear stress distribution can be evaluated. The combined techniques of 4D PC-MRI and numerical simulation can be used as complementary tools for risk-stratification of aortic pathology.

  15. Aortic outflow cannula tip design and orientation impacts cerebral perfusion during pediatric cardiopulmonary bypass procedures.

    Science.gov (United States)

    Menon, Prahlad G; Antaki, James F; Undar, Akif; Pekkan, Kerem

    2013-12-01

    Poor perfusion of the aortic arch is a suspected cause for peri- and post-operative neurological complications associated with cardiopulmonary bypass (CPB). High-speed jets from 8 to 10FR pediatric/neonatal cannulae delivering ~1 L/min of blood can accrue sub-lethal hemolytic damage while also subjecting the aorta to non-physiologic flow conditions that compromise cerebral perfusion. Therefore, we emphasize the importance of cannulation strategy and hypothesize engineering better CPB perfusion through a redesigned aortic cannula tip. This study employs computational fluid dynamics to investigate novel diffuser-tipped aortic cannulae for shape sensitivity to cerebral perfusion, in an in silico cross-clamped aortic arch model modeled with fixed outflow resistances. 17 parametrically altered configurations of an 8FR end-hole and several diffuser cone angled tips in combination with jet incidence angles toward or away from the head-neck vessels were studied. Experimental pressure-flow characterizations were also conducted on these cannula tip designs. An 8FR end-hole aortic cannula delivering 1 L/min along the transverse aortic arch was found to give rise to backflow from the brachicephalic artery (BCA), irrespective of angular orientation, for the chosen ascending aortic insertion location. Parametric alteration of the cannula tip to include a diffuser cone angle (tested up to 7°) eliminated BCA backflow for any tested angle of jet incidence. Experiments revealed that a 1 cm long 10° diffuser cone tip demonstrated the best pressure-flow performance improvement in contrast with either an end-hole tip or diffuser cone angles greater than 10°. Performance further improved when the diffuser was preceded by an expanded four-lobe swirl inducer attachment-a novel component. In conclusion, aortic cannula orientation is crucial in determining net head-neck perfusion but precise angulations and insertion-depths are difficult to achieve practically. Altering the cannula tip

  16. The murine angiotensin II-induced abdominal aortic aneurysm model: rupture risk and inflammatory progression patterns

    Directory of Open Access Journals (Sweden)

    Richard Y Cao

    2010-07-01

    Full Text Available An abdominal aortic aneurysm (AAA is an enlargement of the greatest artery in the body defined as an increase in diameter of 1.5-fold. AAAs are common in the elderly population and thousands die each year from their complications. The most commonly used mouse model to study the pathogenesis of AAA is the angiotensin II (Ang II infusion method delivered via osmotic mini-pump for 28 days. Here, we studied the site-specificity and onset of aortic rupture, characterized three-dimensional (3D images and flow patterns in developing AAAs by ultrasound imaging, and examined macrophage infiltration in the Ang II model using 65 apolipoprotein E deficient mice. Aortic rupture occurred in 16 mice (25 % and was nearly as prevalent at the aortic arch (44 % as it was in the suprarenal region (56 % and was most common within the first seven days after Ang II infusion (12 of 16; 75 %. Longitudinal ultrasound screening was found to correlate nicely with histological analysis and AAA volume renderings showed a significant relationship with AAA severity index. Aortic dissection preceded altered flow patterns and macrophage infiltration was a prominent characteristic of developing AAAs. Targeting the inflammatory component of AAA disease with novel therapeutics will hopefully lead to new strategies to attenuate aneurysm growth and aortic rupture.

  17. How I do it: transapical cannulation for acute type-A aortic dissection

    Directory of Open Access Journals (Sweden)

    Alexiou Christos

    2008-01-01

    Full Text Available Abstract Aortic dissection is the most frequently diagnosed lethal disease of the aorta. Half of all patients with acute type-A aortic dissection die within 48 hours of presentation. There is still debate as to the optimal site of arterial cannulation for establishing cardiopulmonary bypass in patients with type-A aortic dissection. Femoral artery cannulation with retrograde perfusion is the most common method but because of the risk of malperfusion of vital organs and atheroembolism related to it different sites such as the axillary artery, the innominate artery and the aortic arch are used. Cannulation of these sites is not without risks of atheroembolism, neurovascular complications and can be time consuming. Another yet to be popularised option is the transapical aortic cannulation (TAC described in this article. TAC consists of the insertion of the arterial cannula through the apex of the left ventricle and the aortic valve to lie in the sinus of Valsalva. Trans-oesophageal guidance is necessary to ensure correct placement of the cannula. TAC is an excellent method of establishing cardiopulmonary bypass as it is quick, provides a more physiological method of delivering antegrade arterial flow and is the only method to assure perfusion of the true lumen.

  18. Iatrogenic neonatal type B aortic dissection: comprehensive MRI-based diagnosis and follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Geiger, Julia; Markl, M. [University Hospital Freiburg, Department of Diagnostic Radiology and Medical Physics, Freiburg (Germany); Stiller, B.; Arnold, R. [University Hospital Freiburg, Department of Congenital Heart Disease and Pediatric Cardiology, Freiburg (Germany); Schlensak, C. [University Hospital Freiburg, Department of Cardiovascular Surgery, Freiburg (Germany)

    2011-10-15

    Neonatal aortic dissection is rare and most frequently iatrogenic. Decision making and appropriate imaging are highly challenging for pediatric cardiologists and radiologists. We present MRI and echocardiographic findings in the follow-up at 6 months of age of a boy with a conservatively treated iatrogenic neonatal aortic dissection (type B). To evaluate the morphology of the aortic arch and descending aorta, we carried out multidirectional time-resolved three-dimensional flow-analysis and contrast-enhanced MR angiography (CE-MRA). The MRI and Doppler echocardiographic results were closely comparable. Three-dimensional visualization helped assess details of blood flow acceleration and alteration caused by the dissection, and played a key role in our deciding not to treat surgically. (orig.)

  19. MDCT assessment of tracheomalacia in symptomatic infants with mediastinal aortic vascular anomalies: preliminary technical experience

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Edward Y. [Children' s Hospital Boston and Harvard Medical School, Departments of Radiology and Medicine, Pulmonary Division, Boston, MA (United States); Mason, Keira P. [Children' s Hospital Boston and Harvard Medical School, Department of Anesthesiology, Boston, MA (United States); Zurakowski, David [Children' s Hospital Boston and Harvard Medical School, Department of Orthopedic Surgery, Boston, MA (United States); Waltz, David A. [Children' s Hospital Boston and Harvard Medical School, Department of Medicine, Division of Respiratory Diseases, Boston, MA (United States); Ralph, Amy; Riaz, Farhana [Children' s Hospital Boston and Harvard Medical School, Department of Radiology, Boston, MA (United States); Boiselle, Phillip M. [Harvard Medical School, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (United States)

    2008-01-15

    Mediastinal aortic vascular anomalies are relatively common causes of extrinsic central airway narrowing in infants with respiratory symptoms. Surgical correction of mediastinal aortic vascular anomalies alone might not adequately treat airway symptoms if extrinsic narrowing is accompanied by intrinsic tracheomalacia (TM), a condition that escapes detection on routine end-inspiratory imaging. Paired inspiratory-expiratory multidetector CT (MDCT) has the potential to facilitate early diagnosis and timely management of TM in symptomatic infants with mediastinal aortic vascular anomalies. To assess the technical feasibility of paired inspiratory-expiratory MDCT for evaluating TM among symptomatic infants with mediastinal aortic vascular anomalies. The study group consisted of five consecutive symptomatic infants (four male, one female; mean age 4.1 months, age range 2 weeks to 6 months) with mediastinal aortic vascular anomalies who were referred for paired inspiratory-expiratory MDCT during a 22-month period. CT angiography was concurrently performed during the end-inspiration phase of the study. Two pediatric radiologists in consensus reviewed all CT images in a randomized and blinded fashion. The end-inspiration and end-expiration CT images were reviewed for the presence and severity of tracheal narrowing. TM was defined as {>=}50% reduction in tracheal cross-sectional luminal area between end-inspiration and end-expiration. The presence of TM was compared to the bronchoscopy results when available (n = 4). Paired inspiratory-expiratory MDCT was technically successful in all five patients. Mediastinal aortic vascular anomalies included a right aortic arch with an aberrant left subclavian artery (n = 2), innominate artery compression (n = 2), and a left aortic arch with an aberrant right subclavian artery (n = 1). Three (60%) of the five patients demonstrated focal TM at the level of mediastinal aortic vascular anomalies. The CT results were concordant with the

  20. Transfemoral Valve-in-Valve Transcatheter Aortic Valve Implantation (TAVI) in a Patient With Previous Endovascular Aortic Repair (EVAR).

    Science.gov (United States)

    Ruparelia, Neil; Panoulas, Vasileios F; Frame, Angela; Nathan, Anthony W; Ariff, Ben; Jaffer, Usman; Sutaria, Nilesh; Chukwuemeka, Andrew; Mikhail, Ghada W; Malik, Iqbal S

    2016-07-01

    A 90-year-old man presented with increasing exertional breathlessness. He had previous implantation of a Perimount bioprosthetic aortic valve (Edwards Lifesciences) and coronary artery bypass graft surgery. Due to severe transvalvular bioprosthetic regurgitation with preserved left ventricular dimensions and ejection fraction, the heart team decided on valve-in- valve transcatheter aortic valve implantation via the transfemoral route in view of the patient's prohibitively high surgical and anesthetic risk. The patient had an uncomplicated recovery and was symptomatically much improved at 3-month follow-up. PMID:27342209

  1. Análise do tratamento cirúrgico da raiz da aorta com o tubo valvulado e com a preservação da valva aórtica Analysis of aortic root surgery with composite mechanical aortic valve conduit and valve-sparing reconstruction

    Directory of Open Access Journals (Sweden)

    Ricardo Ribeiro Dias

    2010-12-01

    Full Text Available OBJETIVO: Análise comparativa dos resultados imediatos e tardios da reconstrução da raiz da aorta com o tubo valvulado e com a preservação da valva aórtica. MÉTODOS: No período de novembro de 2002 a setembro de 2009, 164 pacientes com idade média de 54 ± 15 anos, sendo 115 do sexo masculino, foram submetidos ao tratamento cirúrgico da raiz da aorta. Foram 125 tubos valvulados e 39 reconstruções da raiz da aorta com preservação da valva aórtica. Dezesseis por cento dos pacientes eram portadores de síndrome de Marfan e 4,3% apresentavam valva aórtica bivalvulada. Cento e quarenta e quatro (88% pacientes foram acompanhados durante tempo médio de seguimento de 41,1 ± 20,8 meses. RESULTADOS: A mortalidade hospitalar total foi de 4,9%; sendo 5,6% nas operações com tubo valvulado e 2,6% nas preservações da valva aórtica (POBJECTIVE: Comparative analysis of early and late results of aortic root reconstruction with aortic valve sparing operations and the composite mechanical valve conduit replacement. METHODS: From November 2002 to September 2009, 164 consecutive patients with mean age 54 ± 15 years, 115 male, underwent the aortic root reconstruction (125 mechanical valve conduit replacements and 39 valve sparing operations. Sixteen percent of patients had Marfan syndrome and 4.3% had bicuspid aortic valve. One hundred and forty-four patients (88% were followed for a mean period of 41.1 ± 20.8 months. RESULTS: The hospital mortality was 4.9%, 5.6% in operations with valved conduits and 2.6% in the valve sparing procedures (P <0.05. There was no difference neither in survival (95% CI = 86% - 96%, P= 0.1 nor in reoperation-free survival (95% CI = 85% - 90%, P = 0.29. The survival free of complications such as bleeding, thromboembolism and endocarditis were favorable to the valve sparing operations, respectively (95% CI = 70% - 95%, P = 0.001, (95% CI = 82% - 95% P = 0.03 and (95% CI = 81% - 95%, P = 0.03. Multivariate analysis

  2. Dental Arch Dimension of Malay Ethnic Group

    Directory of Open Access Journals (Sweden)

    H. A. Mohammad

    2011-01-01

    Full Text Available Problem statement: Many previous studies tried to define and put specific measurements for dental arches dimension in different ethnics groups. However, these studies may be specific to an ethnic group and cannot always be applied to other ethnic types. The aim of this study: is to obtain specific dental arch dimensions for Malaysian Malay ethnic groups and compare between both genders. Approach: Involved clinical examination, collection and analysis of 60 dental cast of Malaysian Malay subjects from pure ethnic group (30 males and 30 females, 20-24 years old. All dental landmarks were located and determined and subsequently measurements had been done according to specific points have been selected. Statistical analysis were done using t-test. Results: Dental arch dimension were established in normal occlusion for Malaysian Malay ethnic group in this study. No significant difference was observed in arch dimensions between male and female of Malaysian Malay. Conclusion: These measurement should be considered during treatment, especially in prosthodontics and orthodontics where arch dimension can be modified appreciably.

  3. Tubular Steel Arch Stabilized by Textile Membranes

    Directory of Open Access Journals (Sweden)

    Ondrej Svoboda

    2016-10-01

    Full Text Available Tubular steel arch supporting textile membrane roofing is investigated experimentally and numerically. The stabilization effects of the textile membrane on in-plane and out-of-plane behavior of the arch is of primary interest. First a model of a large membrane structure tested in laboratory is described. Prestressed membranes of PVC coated polyester fabric Ferrari® Précontraint 702S were used as a currently standard and excellent material. The test arrangement, loading and resulting load/deflection values are presented. The supporting structure consisted of two steel arch tubes, outer at edge of the membrane and inner supporting interior of the membrane roofing. The stability and strength behavior of the inner tube under both symmetrical and asymmetrical loading was monitored and is shown in some details. Second the SOFiSTiK software was employed to analyze the structural behavior in 3D, using geometrically nonlinear analysis with imperfections (GNIA. The numerical analysis, FE mesh sensitivity, the membrane prestressing and common boundary conditions are validated by test results. Finally a parametrical study concerning stability of mid arch with various geometries in a membrane structure with several supporting arches is presented, with recommendations for a practical design.

  4. Invasiveness in cardiac surgery: a question of age

    OpenAIRE

    Urso, Stefano; Sadaba, Justo Rafael

    2013-01-01

    A survey was conducted among 1644 cardiac surgeons on the surgical strategy regarding the invasiveness of the procedure they would prefer as a patient in a number of simple clinical scenarios. A total of 380 (23%) replies were received. Only in the case of aortic valve surgery, a notable preference of minimally invasive strategy was registered, as transcatheter aortic valve implantation was indicated by 49% of the respondents. Regarding the size of the incision for mitral valve surgery, there...

  5. Cadaveric aorta implantation for aortic graft infection.

    Science.gov (United States)

    Ali, Asad; Bahia, Sandeep S S; Ali, Tahir

    2016-01-01

    This case report describes a 73-year-old gentleman who underwent explantation of an infected prosthetic aorto-iliac graft and replacement with a cryopreserved thoracic and aorto-iliac allograft. The patient has been followed up a for more than a year after surgery and remains well. After elective tube graft repair of his abdominal aortic aneurysm (AAA) in 2003, he presented to our unit in 2012 in cardiac arrest as a result of a rupture of the distal graft suture line due to infection. After resuscitation he underwent aorto-bifemoral grafting using a cuff of the original aortic graft proximally. Distally the new graft was anastomosed to his common femoral arteries, with gentamicin beads left in situ. Post discharge the patient was kept under close surveillance with serial investigations including nuclear scanning, however it became apparent that his new graft was infected and that he would require aortic graft replacement, an operation with a mortality of at least 50%. The patient underwent the operation and findings confirmed a synthetic graft infection. This tube graft was explanted and a cryopreserved aorta was used to the refashion the abdominal aorta and its bifurcation. The operation required a return to theatre day one post operatively for a bleeding side branch, which was repaired. The patient went on to make a full recovery stepping down from the intensive therapy unit day 6 post operatively and went on to be discharged 32 days after his cryopreserved aorta implantation. PMID:27351624

  6. Determination of entry site for acute type A aortic dissection by initial enhanced CT-scan

    Energy Technology Data Exchange (ETDEWEB)

    Mase, Takenori; Narumiya, Chihiro; Aoyama, Takahiko; Nagata, Yoshihisa [Aichi Medical Univ., Nagakute (Japan). School of Medicine

    2002-01-01

    Acute type A aortic dissection presents a surgical emergency because conservative therapy is not effective in the majority of instances. Enhanced CT-scan of the chest is commonly available and is considered to be an optimal diagnostic method for this disease. The operative strategy is to resect the primary tear to close the entry site of the aortic dissection and replace it with a tubular Dacron graft. Therefore, the existence of the entry site is important in determining the operative procedure. Based on the numerical value of the enhanced CT-scan inspection, the present study seeks to preoperatively identify the location of the presumed entry site in aortic dissection. From May 1996 to June 1999, 21 consecutive patients (Marfan's syndrome excluded) with acute type A aortic dissection underwent surgical treatment. Nineteen patients were preoperatively examined by enhanced CT-scan: 11 men and 8 women, with a mean age of 61 years. CT-scan slices used for early diagnosis were of the ascending aorta, aortic arch, descending aorta, and thoracoabdominal aorta. The largest diameters of the whole and true lumen were measured from cross-sectional aortic images with a personal computer, and the areas of the whole and true lumen were obtained by the manual tracing method. The true ratio was calculated for the largest diameter and area of the whole lumen. The nineteen patients were divided into two groups according to the location of the entry site based on the operating views. Seven patients with the entry site in the ascending aorta were classified as group A, and twelve patients with the entry site further in the aortic arch and descending aorta were classified as group B. Comparisons were performed by non-parametric analysis. Moreover, a discriminant analysis was applied to evaluate the classification between the two groups. The ratio of the largest diameter of the true lumen in group A at the level of the ascending and descending aorta was significantly greater than

  7. Determination of entry site for acute type A aortic dissection by initial enhanced CT-scan

    International Nuclear Information System (INIS)

    Acute type A aortic dissection presents a surgical emergency because conservative therapy is not effective in the majority of instances. Enhanced CT-scan of the chest is commonly available and is considered to be an optimal diagnostic method for this disease. The operative strategy is to resect the primary tear to close the entry site of the aortic dissection and replace it with a tubular Dacron graft. Therefore, the existence of the entry site is important in determining the operative procedure. Based on the numerical value of the enhanced CT-scan inspection, the present study seeks to preoperatively identify the location of the presumed entry site in aortic dissection. From May 1996 to June 1999, 21 consecutive patients (Marfan's syndrome excluded) with acute type A aortic dissection underwent surgical treatment. Nineteen patients were preoperatively examined by enhanced CT-scan: 11 men and 8 women, with a mean age of 61 years. CT-scan slices used for early diagnosis were of the ascending aorta, aortic arch, descending aorta, and thoracoabdominal aorta. The largest diameters of the whole and true lumen were measured from cross-sectional aortic images with a personal computer, and the areas of the whole and true lumen were obtained by the manual tracing method. The true ratio was calculated for the largest diameter and area of the whole lumen. The nineteen patients were divided into two groups according to the location of the entry site based on the operating views. Seven patients with the entry site in the ascending aorta were classified as group A, and twelve patients with the entry site further in the aortic arch and descending aorta were classified as group B. Comparisons were performed by non-parametric analysis. Moreover, a discriminant analysis was applied to evaluate the classification between the two groups. The ratio of the largest diameter of the true lumen in group A at the level of the ascending and descending aorta was significantly greater than that

  8. A Retrospective Study of Combined Cardiac and Carotid Surgery

    Directory of Open Access Journals (Sweden)

    Fabrizio Sansone

    2012-08-01

    Full Text Available Introduction: A combined carotid endarterectomy (CEA and cardiac procedure has higher early risk of stroke than isolated CEA because of the widespread atherosclerosis in patients selected for simultaneous procedures. In this retrospective study, we review the results of combined coronary artery bypass grafting (CABG and carotid endarterectomy (CEA procedures. Materials and methods: Between January 2000 and December 2007, 91 patients with a mean age of 69.2+6.6 (24/67 female/male underwent combined operations (CEA-CABG on cardiopulmonary bypass (CPB as elective surgery. The study population was divided, as follows: Group A: 83 patients (91.2% had both venous and arterial revascularization; Group B: 8 patients (8.8% had total arterial revascularization. CEA was performed in case of stenosis more than 80% and always before cardiac operation. These techniques were used: standard procedure (54.8%, eversion (39.2%, patch enlargement (6%. Immediately after the vascular procedure, CABGs were performed through median sternotomy. The mean EUROscore was 6.9+2.5%. Results: All neurological complications were in the group who underwent both venous and arterial revascularization (Group A, where a proximal anastomosis was made. All complications and deaths were in group A. Six patients had stroke (6.6% and 2 had acute myocardial infarction (AMI (2.2%. There were 8 in-hospital deaths (8.8% and 1 late death (for stroke after five months. Conclusions: In our center, the incidence of stroke in simultaneous cardiovascular procedures was 5.5 times greater than in isolated cardiac or vascular procedures, which was probably related to the widespread vessels disease. An aortic cross clamp and surgical procedure on the ascending aorta are relevant risk factors for developing neurological events; much attention should be paid to aortic manipulation. In the sub-group who underwent total arterial revascularization with associated CEA procedures, we had no neurological

  9. Inflammatory aortic aneurysms

    DEFF Research Database (Denmark)

    Bitsch, M; Nørgaard, H H; Røder, O;

    1997-01-01

    operated on for abdominal aortic aneurysms without PF in the same period, served as reference group. RESULTS: Preoperative thickness of PF was assessed as > 1 cm in 11 and cm in 10 patients. Ureterolysis was performed in seven patients where the fibrosis caused ureteral obstruction. Postoperative CT...

  10. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... to repair an abdominal aortic aneurysm using a technology called an “endograft,” which is sometimes called the “ ... separate area, and it’s because of this small technology that allows you to do this. Exactly. So ...

  11. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... an abdominal aortic aneurysm. Normally this procedure takes us about 45 minutes to an hour of doctor work time, which is, I think, a fairly quick procedure to replace a major life-threatening problem in the patient’s abdomen. So you can see ...

  12. Aortic Aneurysm Repair

    Medline Plus

    Full Text Available ... the arteries, which is known as atherosclerosis, high blood pressure, smokers, or a family history of abdominal aortic ... imaging. We can integrate ultrasound imaging, the patient’s blood pressure, and so it’s a little bit like being ...

  13. Molecular and Genetic Insights into Thoracic Aortic Dilation in Conotruncal Heart Defects

    Science.gov (United States)

    Kay, W. Aaron

    2016-01-01

    Thoracic aortic dilation (AD) has commonly been described in conotruncal defects (CTDs), such as tetralogy of Fallot, double outlet right ventricle and transposition of the great arteries, and truncus arteriosus. Several theories for this have been devised, but fairly recent data indicate that there is likely an underlying histologic abnormality, similar to that seen in Marfan and other connective tissue disease. The majority of aortic dissection in the general population occurs after the age of 45 years, and there have been very few case reports of aortic dissection in CTD. Given advances in cardiac surgery and increasing survival over the past several decades, there has been rising concern that, as patients who have survived surgical correction of these defects age, there may be increased morbidity and mortality due to aortic dissection and aortic regurgitation. This review discusses the most recent developments in research into AD in CTD, including associated genetic mutations. PMID:27376074

  14. Quadricuspid aortic valve complicated with infective endocarditis: report of a case.

    Science.gov (United States)

    Mizoguchi, Hiroki; Sakaki, Masayuki; Inoue, Kazushige; Kobayashi, Yasuhiko; Iwata, Takashi; Suehiro, Yasuo; Miura, Takuya

    2014-12-01

    Congenital quadricuspid aortic valve is a rare cardiac malformation with an unknown risk of infective endocarditis. We report a case of quadricuspid aortic valve complicated with infective endocarditis. A 53-year-old Japanese woman was hospitalized with leg edema and a fever of unknown origin. Corynebacterium striatum was detected in the blood culture. Echocardiography demonstrated a quadricuspid aortic valve with vegetation and severe functional regurgitation. The condition was diagnosed as a quadricuspid aortic valve with infective endocarditis, for which surgery was performed. The quadricuspid aortic valve had three equal-sized cusps and one smaller cusp (type B according to Hurwitz classification). We dissected the vegetation and infectious focus and implanted a mechanical valve. Following the case report, we review the literature.

  15. Prosthetic valve endocarditis after transcatheter aortic valve implantation

    DEFF Research Database (Denmark)

    Olsen, Niels Thue; De Backer, Ole; Thyregod, Hans G H;

    2015-01-01

    BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an advancing mode of treatment for inoperable or high-risk patients with aortic stenosis. Prosthetic valve endocarditis (PVE) after TAVI is a serious complication, but only limited data exist on its incidence, outcome, and procedural...... risk factors. METHODS AND RESULTS: Observational single-center study of 509 consecutive patients treated with a transcatheter implanted self-expandable aortic valve prosthesis (Medtronic CoreValve). We identified 18 patients diagnosed with TAVI-PVE during a median follow-up period of 1.4 years......%) were treated conservatively and 1 with surgery. Four patients (22%) died from endocarditis or complications to treatment, 2 of those (11%) during initial hospitalization for PVE. An increased risk of TAVI-PVE was seen in patients with low implanted valve position (hazard ratio, 2.8 [1.1-7.2]), moderate...

  16. [Stanford type a acute aortic dissection with pectus excavatum].

    Science.gov (United States)

    Kuwata, Toshiyuki; Fukuda, Hirotsugu; Yoshitatsu, Masao; Yamada, Yasuyuki; Shibasaki, Ikuko; Inoue, Yuho; Hori, Takayuki; Ogawa, Hironaga; Tsuchiya, Go; Shimizu, Riha; Takei, Yusuke

    2012-11-01

    Pectus excavatum is generally an isolated abnormality of the chest wall. However, some patients have a concomitant pectus deformity and cardiac & aortic disease. Decisions must be made regarding the operative approach and whether the pectus excavatum should be corrected during the same session. We report 2 patients with acute Stanford type A aortic dissection and pectus excavatum who underwent emergency operation. In case 1, median sternotomy is an unsuitable approach for open heart surgery, since the heart and great vessels are displace into the left hemithorax. But combined sternotomy and left anterior thoracotomy provided excellent surgical exposure. In case 2, we proceeded with a leftsided costotomy of four ribs and place a normal chest retractor providing as excellent exposure as combined sternotomy and left anterior thoracotomy. A left-sided costotomy of four ribs can be performed safely, eliminating the risks of median sternotomy in acute stanford type A aortic dissection with pectus excavatum.

  17. SURGICAL MANAGEMENT OF A RARE CASE OF MARFAN SYNDROME - THE RUPTURE OF AN ABDOMINAL AORTIC ANEURYSM

    Directory of Open Access Journals (Sweden)

    L. Stoica

    2005-10-01

    Full Text Available We present a rare manifestation of the Marfan syndrome. A 33 years old woman with a 10 cm diameter juxta-renal aortic aneurysm ruptured in the retro peritoneum arrived in hemorrhagic shock. Surgery was performed in emergency by thoraco-phreno-laparatomy, the aneurysm was resected and a 20 mm Dacron tube was sutured between the origin of the renal arteries and the aortic bifurcation. Rapid thoracic aortic cross-clamping to stop the hemorrhage and good aneurismal exposure by the division of the left renal vein was the key of this successful management. The patient recovered without any complication. Rupture of the abdominal aortic aneurysm is a life threatening complication which requires a rapid diagnosis and an emergency treatment by open surgery or by endovascular stent grafting. We present the surgical strategy in our case

  18. Endovascular Repair Versus Open Surgery in Patients with Abdominal Aortic Aneurysm%腹主动脉瘤开腹手术与腔内治疗的比较

    Institute of Scientific and Technical Information of China (English)

    崔庆丰; 戴向晨; 朱理玮

    2011-01-01

    Objective To compare the therapeutic effect of endovascular aortic repair (EVAR) and open surgical repair (OSR) for treatment of abdominal aortic aneurysm. Methods Thirty-five patients with abdominal aortic aneurysm were treated by EVAR (n=14) and OSR (n=21). The patients' preoperative status, intraoperative variables, perioperative conditions, postoperative complications and survival rate were compared. Results The average age of the patients in EVAR group was older than that in OSR group (P < 0.05). the operating time,the intraoperative blood loss and intrapoerative blood transfusion were less in EVAR group than in OSR group (P < 0.01), And time observation in ICU, time for bedside activities and time to take in food were shorter in EVAR group (P< 0.01). The postoperative morbidity was lower in EVAR group (P < 0.05), but with more complications on long term follow up (P < 0.05). Conclusion EVAR is a safer and less traumatic method than OSR, and patients can recover more rapidly, it is suitable for patients of advanced age and those with more complication. OSR is suitable for younger patients and those with less complications or patients who can not undergo EVAR.%目的:比较腹主动脉瘤腔内修复术与开放手术的疗效.方法:对35例肾下型腹主动脉瘤患者分别进行开放手术( 21例)与腔内修复术(14例)治疗,比较两组术前评估、手术、围手术期及术后随访情况.结果:腔内修复组年龄较高(P<0.05),手术时间、术中出血量、输血量较开腹手术低(P< 0.01),所需营养支持、监护、卧床时间短(P< 0.01),围手术期并发症发生率低(P< 0.05),但远期并发症发生率较高(P< 0.05).结论:腹主动脉瘤腔内支架治疗较为安全,创伤更小,患者恢复速度较快,适合于高龄及合并症较多的患者.传统开放手术适于年轻、合并症少及无法行腔内修复术的患者.

  19. Open Surgical Repair for a Ruptured Abdominal Aortic Aneurysm with a Horseshoe Kidney

    OpenAIRE

    Ikeda, Akihiko; Tsukada, Toru; Konishi, Taisuke; Matsuzaki, Kanji; Jikuya, Tomoaki; HIRAMATSU, YUJI

    2015-01-01

    Horseshoe kidney is a congenital anomaly characterized by medial fusion of the bilateral kidneys. Treatment for an abdominal aortic aneurysm (AAA) with a horseshoe kidney is a technical challenge because of the complex anatomy. We report a successful open surgical repair for a ruptured AAA with a horseshoe kidney. An aortic grafting was performed with division of the renal isthmus through a transperitoneal approach. In the case of a ruptured AAA, quick open surgery is the most reliable treatm...

  20. Upper gastrointestinal obstruction secondary to aortoduodenal syndrome owing to a noninflammatory abdominal aortic aneurysm.

    LENUS (Irish Health Repository)

    Cahill, Kevin

    2012-01-31

    Aortoduodenal syndrome is a rare complication of an abdominal aortic aneurysm wherein the aneurysm sac obstructs the patient\\'s duodenum. It presents with the symptoms of an upper gastrointestinal tract obstruction and requires surgical intervention to relieve it. Previously, gastric bypass surgery was advocated, but now aortic replacement is the mainstay of treatment. We report a case of a 67-year-old woman whose aortoduodenal syndrome was successfully managed and review the literature on this topic.

  1. Diagnostic value of ultrasound, computed tomography, and angiography in ruptured aortic aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Landtman, M.; Kivisaari, L.; Bondestam, S.; Taavitsainen, M.; Standertskjoeld-Nordenstam, C.G.; Somer, K.

    1984-11-01

    Some ruptural aneurysms cause nonspecific symptoms and the patients are referred for radiological examination because of the problems of differential diagnosis from conditions such as renal colic, diverticulitis, herniated disc, aortic dissection etc. Seven such patients have been examined either with ultrasonography, computed tomography or angiography. The diagnostic methods are compared. The more recent US and CT imaging methods are sufficiently rapid and reliable for diagnostic purposes, which should improve the prognosis for patients requiring immediate surgery for ruptured aortic aneurysms.

  2. RARE CASE OF LARGE ABDOMINAL AORTIC ANEURISM WITH A BIG THROMBUS

    OpenAIRE

    Asna; Shakeel; Nalini

    2014-01-01

    The most common location of abdominal aortic aneurysms is the infrarenal portion of the aorta including its bifurcation and extending to the iliac arteries. 1 To avoid rupture, which has nearly 90% mortality, early diagnosis and surgery are essential. Acute aortic occlusion, which commonly is secondary to saddle embolus or atherosclerotic thrombosis, has tremendous morbidity and mortality. Angiographic evaluation is very essential for patients with asymptomatic abdominal ...

  3. A rare presentation of late right coronary artery spasm following aortic valve replacement

    OpenAIRE

    Alizadeh-Ghavidel, Alireza; Basiri, Hosseinali; Totonchi, Ziae; Mirmesdagh, Yalda; Jalili-Shahandashti, Farshad; Gholizadeh, Behnam

    2015-01-01

    BACKGROUND Coronary artery spasm (CAS) is defined as a reversible, sudden epicardial coronary artery stenosis that causes vessel occlusion or near occlusion. CASE REPORT In this article, we present a clinical case of CAS in a 48-year-old woman undergoing elective aortic valve replacement surgery for aortic stenosis. On the 3rd post-operative day, the patient suffered from chest pain and dyspnea. Emergent coronary angiography demonstrated a significant spasm of the ostium portion of the right ...

  4. Tratamento híbrido das doenças complexas da aorta torácica Hybrid procedures for complex thoracic aortic diseases

    Directory of Open Access Journals (Sweden)

    José Carlos Ingrund

    2010-09-01

    morbidity and mortality compared to conventional surgery. OBJECTIVES: To evaluate the technique and results of hybrid procedures for CTAD. METHODS: During two years, 12 patients with CTAD underwent hybrid procedures, including aortic arch aneurysms and acute Stanford A and B aortic dissections. All patients had formal indications to invasive treatment, and inadequate proximal landing zone (less than 20 mm. Half were male and the mean age was 55.5 years (42 to 78. At least three cardiovascular risk factors were present in 75% of patients. The average follow-up was 10.9 months (2 to 25, with periodic consultations and CT scans. RESULTS: The initial technical success was achieved in 10 patients. Bypasses of supra-aortic vessels were performed in a surgical environment and endovascular procedures in an interventional radiology facility. "Through-and-through" technique was used in six patients. Two deaths occurred in the first 30 days after the procedure. No endoprosthesis migration was observed. No patient had paraplegia, stroke, renal failure, bleeding or coagulopathy, elective or emergency surgical conversion. CONCLUSION: Hybrid treatment of CTAD is feasible, especially in high risk patients. Proper integration of surgical and endovascular techniques, in addition to clinical and radiological surveillance, makes this technique a great alternative to conventional surgery.

  5. Structure and distribution of arches in shaken hard sphere deposits

    OpenAIRE

    Pugnaloni, Luis A.; Barker, G. C.

    2003-01-01

    We investigate the structure and distribution of arches formed by spherical, hard particles shaken in an external field after they come to rest. Arches (or bridges) are formed during a computer-simulated, non-sequential deposition of the spheres after each shaking cycle. We identify these arches by means of a connectivity criterion and study their structural characteristics and spatial distribution. We find that neither the size distribution nor the shape of the arches is strongly affected by...

  6. Assessment of the effect on blood loss and transfusion requirements when adding a polyethylene glycol sealant to the anastomotic closure of aortic procedures: a case–control analysis of 102 patients undergoing Bentall procedures

    Directory of Open Access Journals (Sweden)

    Natour Ehsan

    2012-10-01

    Full Text Available Abstract Background The use of CoSeal®, a polyethylene glycol sealant, in cardiac and vascular surgery for prevention of anastomotic bleeding has been subject to prior investigations. We analysed our perioperative data to determine the clinical benefit of using polyethylene glycol sealant to inhibit suture line bleeding in aortic surgery. Methods From January 2004 to June 2006, 124 patients underwent aortic surgical procedures such as full root replacements, reconstruction and/or replacement of ascending aorta and aortic arch procedures. A Bentall procedure was employed in 102 of these patients. In 48 of these, a polyethylene glycol sealant was added to the anastomotic closure of the aortic procedure (sealant group and the other 54 patients did not have this additive treatment to the suture line (control group. Results There were no significant between-group differences in the demographic characteristics of the patients undergoing Bentall procedures. Mean EuroSCORES (European System for Cardiac Operative Risk Evaluation were 13.7 ± 7.7 (sealant group and 14.4 ± 6.2 (control group, p = NS. The polyethylene glycol sealant group had reduced intraoperative and postoperative transfusion requirements (red blood cells: 761 ± 863 versus 1248 ± 1206 ml, p = 0.02; fresh frozen plasma: 413 ± 532 versus 779 ± 834 ml, p = 0.009; and less postoperative drainage loss (985 ± 972 versus 1709 ± 1302 ml, p = 0.002. A trend towards a lower rate of rethoracotomy was observed in the sealant group (1/48 versus 6/54, p = 0.07 and there was significantly less time spent in the intensive care unit or hospital (both p = 0.03. Based on hypothesis-generating calculations, the resulting economic benefit conferred by shorter intensive care unit and hospital stays, reduced transfusion requirements and a potentially lower rethoracotomy rate is estimated at €1,943 per patient in this data analysis

  7. [Treatment of rupture of abdominal aortic aneurism in multi-field military hospital].

    Science.gov (United States)

    Beliakin, S A; Obraztsov, A V; Pinchuk, O V; Kryzhov, S N; Iamenskov, B B; Bokachev, R A; Tikhonov, P A

    2013-09-01

    For the last 5 years in the center of vascular surgery of Vishnevskiy 3rd Central Military Clinical Hospital 218 patients with abdominal aortic aneurism were treated, 96 planned surgical operations for abdominal aortic aneurism (post-operative mortality 3.1%) were performed. 11 patients underwent urgent surgical operation because of rupture of abdominal aortic aneurism. 1 of 11 patients died at the stage of laparotomy, the second patient died after clipping of ruptured aneurysm. In other 9 cases surgical operation was performed successfully. But 2 of 9 patients died in a few hours after surgery. In summary, 4 of 11 patients underwent surgical operation for rupture of abdominal aortic aneurism survived. The postoperative mortality was 63.6%. Authors gave an example of successful treatment of patient with rupture of abdominal aortic aneurism. It was concluded that successful treatment of rupture of abdominal aortic aneurism is possible only in case of well-run integration of different treatment and diagnostic departments. CT angiography is crucial for instrumental diagnostics of rupture of abdominal aortic aneurism. Successful surgical operation is impossible without organized blood supply service, refusion and donor blood. Artificial lung ventilation, extracorporal detoxication and adequate pharmacological supply help to avoid severe complications during the postoperative period, even in patients with associated pathology. PMID:24341201

  8. RARE CASE OF LARGE ABDOMINAL AORTIC ANEURISM WITH A BIG THROMBUS

    Directory of Open Access Journals (Sweden)

    Asna

    2014-04-01

    Full Text Available The most common location of abdominal aortic aneurysms is the infrarenal portion of the aorta including its bifurcation and extending to the iliac arteries. 1 To avoid rupture, which has nearly 90% mortality, early diagnosis and surgery are essential. Acute aortic occlusion, which commonly is secondary to saddle embolus or atherosclerotic thrombosis, has tremendous morbidity and mortality. Angiographic evaluation is very essential for patients with asymptomatic abdominal aortic aneurysms of 4.0-5.5 cm, and surgical intervention is required for rapidly growing or larger aneurysms. 2

  9. Long-term safety and efficacy of endovascular abdominal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Propper BW

    2013-04-01

    Full Text Available Brandon W Propper, Christopher J Abularrage Division of Vascular Surgery and Endovascular Therapy, John Hopkins Hospital, Baltimore, MD, USA Abstract: Endovascular abdominal aortic aneurysm repair (EVAR is a safe and efficacious treatment for both unruptured and ruptured abdominal aortic aneurysms. While perioperative mortality is lower with EVAR, long-term outcomes are similar between EVAR and open repair, including quality of life and cost-effectiveness. We review the long-term outcomes from the EUROSTAR registry, and DREAM, EVAR 1, and OVER trials. Keywords: EVAR, endovascular, aneurysm, aortic, outcome, long-term

  10. First direct aortic retrievable transcatheter aortic valve implantation in humans.

    Science.gov (United States)

    Chandrasekhar, Jaya; Glover, Chris; Labinaz, Marino; Ruel, Marc

    2014-11-01

    We describe 2 cases in which transcatheter aortic valve implantation was performed with a Portico prosthesis (St Jude Medical, St Paul, MN) through a direct aortic approach. In 1 of the cases, prosthesis retrieval was needed during the procedure and was essential to the successful outcome. This is the first report, to our knowledge, of direct aortic Portico prosthesis implantation, and it highlights the significance of the retrievable nature of this device. PMID:25442452

  11. The Early Variation of Left Ventricular Strain after Aortic Valve Replacement by Three-Dimensional Echocardiography.

    Directory of Open Access Journals (Sweden)

    Yongle Chen

    Full Text Available Aortic stenosis (AS and aortic incompetence (AI are common aortic valve diseases. Both may deteriorate into irreversible myocardial dysfunction and will increase the risk of sudden death. In this study, we aimed to investigate the early variation trend of left ventricular function by three-dimensional speckle tracking echocardiography (3D-STE in the patients who underwent cardiac surgeries for aortic valve disease. Twenty patients with severe aortic AS and 16 patients with severe AI were enrolled. All of them underwent the aortic valve replacement (AVR procedures. The patients' global longitudinal strain (GLS and global circumferential strain (GCS were evaluated by 3D-STE before surgery and at 1 week after surgery. In addition, GLS and GCS were followed at 1 month as well as 3 months after AVR. In AS patients, the GCS after AVR altered little both at 1 week (p = 0.562 and at 1 month (p = 0.953 compared with the data before the surgery. And it increased significantly at 3 months of follow-up observation compared to that before AVR (p<0.05. Meanwhile, GLS increased progressively after AVR and improved significantly at 3 months after surgery (p<0.05. For the AI patients, GLS as well as GCS decreased at 1 week after AVR compared to those data at baseline (p<0.05. However, these two parameters recovered at 1 month after AVR. Furthermore, GLS and GCS improved significantly at 3 months after the surgery (p<0.05. Therefore, both GLS and GCS were influenced by AVR and would be improved at 3 months after surgery both in AS patients or AI patients. GLS and GCS can be finely evaluated by 3D-STE, and they are helpful to determine the variation tendency of left ventricular function in patients with AVR.

  12. Riolan动脉弓的MSCT血管成像表现%Imaging features of Riolan arch on MSCT angiography

    Institute of Scientific and Technical Information of China (English)

    逄利博; 廖伟; 高玉颖; 杨立

    2012-01-01

    Objective To investigate imaging manifestations of Riolan arch on MSCT angiography (MSCTA). Methods Six patients with Riolan arch were collected. Three males had hypertension atherosclerosis, while 3 females had suffered from Takayasu's arteritis. MSCTA was performed (with 16-slice CT scanner in 4 cases and 64-slice scanner in 2), and abdominal pathological changes of blood vessel were observed with VR, M1P and MPR. Results The calibers of Riolan arch of the 6 cases were 3. 5—10. 0 mm, with average of (6. 7 ± 0. 4) mm. Proximal occlusion of superior mesenteric artery (SMA) was found in 2 cases of abdominal aorta atherosclerotic lesions, while Riolan arch was detected between the distal part of SMA with inferior mesenteric artery (IMA). In one case of abdominal aorta atherosclerotic lesions accompanied by abdominal aortic aneurysm, Riolan arch and inosculation arch were found between SMA and IMA with celiac trunk. Proximal occlusion of IMA was noticed in one case, with IMA distal part formed Riolan arch connecting SMA. Among 3 cases with Takayasu arteritis, stenosis of SMA was showed in 2 cases, Riolan arch formed between SMA and IMA, while SMA, IMA formed inosculation arch with celiac trunk in 1 case. Conclusion MSCTA could show the structural information of Riolan arch between SMA and IMA. Circuitous and dilated arterial arch between SMA and IMA were the characteristics of Riolan arch. The appearance of Riolan arch prompted occlusions or stenosis of SMA or IMA, suggesting the compensatory alteration of intestinal canal blood supply.%目的 探讨MSCT血管成像(MSCTA) Riolan动脉弓的影像表现.方法 收集6例Riolan动脉弓病变患者,3例男性患者为高血压动脉粥样硬化性疾病,3例女性患者均为多发性大动脉炎.采用16层(4例)、64层(2层)螺旋CT扫描行腹部CTA检查,对病变血管行VR、MIP和MPR重建.结果 6例Riolan动脉弓血管直径为3.5~10.0 mm,平均(6.7±0.4)mm.3例腹主动脉粥样硬化性病变中,肠

  13. Assembly and lifting of Pearl-Chain arches

    DEFF Research Database (Denmark)

    Halding, Philip Skov; Hertz, Kristian Dahl; Viebæk, N.E.;

    2015-01-01

    Pearl-Chain arches were invented at the Technical University of Denmark in cooporation with the company Abeo A/S. The system uses specially designed, pre-fabricated concrete elements that are post-tensioned together into an arch shape, which is then lifted into place. The arches can be used both ...

  14. Survival Comparison of Patients Undergoing Secondary Aortic Repair

    Directory of Open Access Journals (Sweden)

    Dean J. Yamaguchi

    2015-01-01

    Full Text Available Introduction. Infrarenal abdominal aortic aneurysm (AAA repair warrants lifelong surveillance. Secondary aortic intervention (SAI outcomes may be affected by the therapeutic approach. We compared short- and long-term mortality in patients who underwent SAIs after initial aortic repair, either endovascular (EVAR or open. Methods. Patients who underwent AAA repair between 1986 and 2010 were retrospectively identified in a vascular surgery database as well as those who underwent SAIs. All-cause mortality and Kaplan-Meier survival curves were calculated. Results. We identified 149 patients who underwent either open AAA repair or EVAR followed by open or endovascular SAI. Seventy-seven patients (51.7% underwent initial EVAR while 72 patients (48.3% underwent open repair. Sixty (78% initial EVAR patients underwent secondary EVAR while 17 (22% patients had an open SAI. Initial open repair patients were evenly distributed between EVAR and open SAIs. Compared to EVAR, patients who underwent initial open repair had longer intervals between primary aortic interventions (PAIs and SAIs. Multivariable-adjusted all-cause mortality was significantly higher for patients who underwent initial open AAA repair followed by EVAR when compared to patients who underwent endovascular PAI and SAI. Conclusion. Long-term mortality in patients with infrarenal aortic aneurysms who require SAI may be improved by an EVAR-first algorithm.

  15. Cosmetic Surgery

    Science.gov (United States)

    ... Body Looking and feeling your best Cosmetic surgery Cosmetic surgery Teens might have cosmetic surgery for a number ... about my body? What are the risks of cosmetic surgery? top People who have cosmetic surgery face many ...

  16. Nose Surgery

    Science.gov (United States)

    ... is as high a priority as appearance. Can Cosmetic Nasal Surgery Create A "Perfect" Nose? Aesthetic nasal surgery (rhinoplasty) ... Cover Nasal Surgery? Insurance usually does not cover cosmetic surgery. However, surgery to correct or improve breathing function, ...

  17. Cosmetic Surgery

    Science.gov (United States)

    ... Submit Home > Body Image > Cosmetic surgery Body Image Cosmetic surgery ASPS list of inappropriate candidates for surgery ... their appearance. Return to top Additional resources on cosmetic surgery Breast surgery Explore other publications and websites ...

  18. Hybrid technique for DeBakey type Ⅰ aortic dissection%DeBakeyⅠ型主动脉夹层的杂交手术治疗

    Institute of Scientific and Technical Information of China (English)

    郑先杰; 郭大乔; 张双林; 张庄; 赵爱国; 张国瑜; 张筱扬; 董彦军; 段淑敏; 符伟国

    2010-01-01

    Objective To explore the efficacy,indication and the treatment of complication of concomitant thoracic aortic replacement and endoluminal stent grafting (hybrid technique) for DeBakey type Ⅰ aortic dissection. Methods From September 2005 to June 2009,12 patients with acute DeBakey type Ⅰ aortic dissection were diagnosed by contrast-enhanced CT or MRI scan, and underwent hybrid technique.Computed tomography angiography (CTA) was performed in each patient at 2,6 months after operation to check up the post-operative course,such as ascending aortic and vascular prosthesis of aortic arch and decending aorta. The time of the post-operational follow-up was 6 -36 months. Results All patients successfully recovered from surgery procedure,no serious complication. The time of cardiopulmonary bypass was 196 -298 (264.0 ± 36.6) min,arrest time of ascending aortic was 89 -276 (213.6 ±43.8) min. All patients were discharged from hospital. Contrast-enhanced CT or MRI indicated the vascular prosthesis to been unobstructed,no endo-stent dislocation and no organ ischemia, the false lumen and thrombosis disappeared in 10 patients,but false lumen and leakage happened in 2 patients at 2 months after operation.The false lumen disappeared at 6 months after operation. Conclusions Hybrid technique for DeBakey type Ⅰ aortic dissection is satisfactory in short term effect with less invasiveness and definite safety. However,further studies are needed to evaluate its long-term outcomes.%目的 探讨DeBakey Ⅰ型主动脉夹层行升主动脉并全弓置换加降主动脉支架置入术(即杂交手术)的疗效、适应证的选择和并发症的处理.方法 2005年9月至2009年6月,经CT增强扫描或磁共振确诊DeBakey Ⅰ型主动脉夹层患者12例,均行杂交手术.术后2、6个月复查胸部CT增强扫描,了解升主动脉、主动脉弓人工血管及降主动脉血管内覆膜支架的情况.结果 12例患者全部手术成功,无严

  19. Precast Pearl-Chain concrete arch bridges

    DEFF Research Database (Denmark)

    Halding, Philip Skov; Hertz, Kristian Dahl; Schmidt, Jacob Wittrup

    2015-01-01

    A Pearl-Chain Bridge is a closed-spandrel arch bridge consisting of a number of straight pre-fabricated so called Super-Light Deck elements put together in an arch shape by post-tensioning cables. Several Pearl-Chain arches can be positioned adjacent to each other by a crane to achieve a bridge...... the technology was used. We also study other important components and details in the Pearl-Chain Bridge concept and review the effects of different types of loads. A theoretical case study of a circular 30 m span Pearl-Chain Bridge is presented showing the influence of a number of parameters: The number of post......-tensioning cables, the rise to span ratio, the height of the filling, and the height of the Super-Light Decks. We find that Pearl-Chain Bridges can be adjusted to resist specific moment loads by changing the normal force in the arch cross section by altering the above parameters. It is also found that the negative...

  20. Arch Coal focuses on its future

    International Nuclear Information System (INIS)

    Arch Coal, Inc (ACI) has emerged as the second largest US coal producer, with nearly 5000 employees producing 110 million tons of coal per year. The article discusses the company's philosophy, as stated by Steve Leer, President and CEO, and reports interviews with six other senior executives talking about policy on finances, sales, marketing, business development and operations. 8 photos

  1. Fused aortic valve without an elliptical-shaped systolic orifice in patients with severe aortic stenosis: cardiac computed tomography is useful for differentiation between bicuspid aortic valve with raphe and tricuspid aortic valve with commissural fusion

    Energy Technology Data Exchange (ETDEWEB)

    Bak, So Hyeon; Ko, Sung Min [Konkuk University School of Medicine, Departments of Radiology, Konkuk University Medical Center, Seoul (Korea, Republic of); Song, Meong Gun; Shin, Je Kyoun; Chee, Hyun Kun; Kim, Jun Suk [Konkuk University School of Medicine, Departments of Thoracic Surgery, Konkuk University Medical Center, Seoul (Korea, Republic of)

    2015-04-01

    The objective is to determine cardiac computed tomography (CCT) features capable of differentiating between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) in severe aortic stenosis (AS) patients with fused cusp and without elliptical-shaped systolic orifices. We retrospectively enrolled 53 patients who had severe AS with fused cusps and without an elliptical-shaped systolic orifice on CCT and who had undergone surgery. CCT features were analyzed using: (1) aortic valve findings including cusp size, cusp area, opening shape, midline calcification, fusion length, calcium volume score, and calcium grade; (2) diameters of ascending and descending aorta, and main pulmonary artery; and (3) rheumatic mitral valve findings. The variables were evaluated using univariate and multivariate logistic regression analyses. At surgery, 19 patients had BAV and 34 had TAV. CCT features including uneven cusp size, uneven cusp area, round-shaped systolic orifice, longer cusp fusion, and dilatation of ascending aorta were significantly associated with BAV (P < 0.05). In particular, fusion length (OR, 1.76; P = 0.001), uneven cusp area (OR, 10.46; P = 0.012), and midline calcification (OR, 0.08; P = 0.013) were strongly associated with BAV. CCT provides diagnostic clues that helps differentiate between BAV with raphe and TAV with commissural fusion in patients with severe AS. (orig.)

  2. Management of Concomitant Cancer and Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Abdullah Jibawi

    2011-01-01

    Full Text Available Background. The coexistence of neoplasm and abdominal aortic aneurysm (AAA presents a real management challenge. This paper reviews the literature on the prevalence, diagnosis, and management dilemmas of concurrent visceral malignancy and abdominal aortic aneurysm. Method. The MEDLINE and HIGHWIRE databases (1966-present were searched. Papers detailing relevant data were assessed for quality and validity. All case series, review articles, and references of such articles were searched for additional relevant papers. Results. Current challenges in decision making, the effect of major body-cavity surgery on an untreated aneurysm, the effects of major vascular surgery on the treatment of malignancy, the use of EVAR (endovascular aortic aneurysm repair as a fairly low-risk procedure and its role in the management of malignancy, and the effect of other challenging issues such as the use of adjuvant therapy, and patients informed decision-making were reviewed and discussed. Conclusion. In synchronous malignancy and abdominal aortic aneurysm, the most life-threatening lesion should be addressed first. Endovascular aneurysm repair where possible, followed by malignancy resection, is becoming the preferred initial treatment choice in most centres.

  3. Tobacco smoking and aortic aneurysm

    DEFF Research Database (Denmark)

    Sode, Birgitte F; Nordestgaard, Børge G; Grønbæk, Morten;

    2012-01-01

    BACKGROUND: We determined the predictive power of tobacco smoking on aortic aneurysm as opposed to other risk factors in the general population. METHODS: We recorded tobacco smoking and other risk factors at baseline, and assessed hospitalization and death from aortic aneurysm in 15,072 individuals...... General Population Study, respectively. According to the magnitude of the hazard ratios, tobacco consumption was the most important risk factor for hospitalization and death from aortic aneurysm, followed by male sex and hypertension in both cohorts. The population attributable risk of aortic aneurysm...... outcomes due to tobacco consumption was 64% and 47% in the Copenhagen City Heart Study and Copenhagen General Population Study, respectively, and ranked highest among population attributable risks of aortic aneurysm in both cohorts. The absolute 10-year risk for hospitalization or death from aortic...

  4. Patient values and preferences on transcatheter or surgical aortic valve replacement therapy for aortic stenosis: a systematic review

    Science.gov (United States)

    Lytvyn, Lyubov; Guyatt, Gordon H; Manja, Veena; Siemieniuk, Reed A; Zhang, Yuan; Agoritsas, Thomas; Vandvik, Per O

    2016-01-01

    Objective To investigate patients' values and preferences regarding aortic valve replacement therapy for aortic stenosis. Setting Studies published after transcatheter aortic valve insertion (TAVI) became available (2002). Participants Adults with aortic stenosis who are considering or have had valve replacement, either TAVI or via surgery (surgical aortic valve replacement, SAVR). Outcome measures We sought quantitative measurements, or qualitative descriptions, of values and preferences. When reported, we examined correlations between preferences and objective (eg, ejection fraction) or subjective (eg, health-related quality of life) measures of health. Results We reviewed 1348 unique citations, of which 2 studies proved eligible. One study of patients with severe aortic stenosis used a standard gamble study to ascertain that the median hypothetical mortality risk patients were willing to tolerate to achieve full health was 25% (IQR 25–50%). However, there was considerable variability; for mortality risk levels defined by current guidelines, 130 participants (30%) were willing to accept low-to-intermediate risk (≤8%), 224 (51%) high risk (>8–50%) and 85 (19%) a risk that guidelines would consider prohibitive (>50%). Study authors did not, however, assess participants' understanding of the exercise, resulting in a potential risk of bias. A second qualitative study of 15 patients identified the following factors that influence patients to undergo assessment for TAVI: symptom burden; expectations; information support; logistical barriers; facilitators; obligations and responsibilities. The study was limited by serious risk of bias due to authors' conflict of interest (5/9 authors industry-funded). Conclusions Current evidence on patient values and preferences of adults with aortic stenosis is very limited, and no studies have enrolled patients deciding between TAVI and SAVR. On the basis of the data available, there is evidence of variability in individual

  5. Infrarenal Aortic Occlusion

    Science.gov (United States)

    Traverso, L. W.; Baker, J. D.; Dainko, E. A.; Machleder, H. I.

    1978-01-01

    Twenty-eight patients with total occlusion of the infrarenal aorta have been seen at the UCLA Hospitals in the past 11 years. Claudication was the presenting complaint in all but one patient, with one-third having ischemic rest pain. The average age of these patients was 54 years, and their histories revealed a surprising absence of myocardial infarction, stroke, or diabetes, although 40% had essential hypertension. Heavy tobacco use, however, was characteristic of the entire group. Arteriography proved valuable in identifying and characterizing the vascular abnormalities, but posed problems in technique and interpretation. Significant distal arterial disease was detected radiographically in only 21% of these patients. Operative correction of the aortic occlusion was performed on 26 patients, 18 by aortic bypass grafts and eight by aorto-iliac endarterectomy, with one early postoperative death. Although the thrombus extended to the renal artery origins in 77% of the cases, a well-designed technical approach did not require renal artery occlusion. Using serial creatinine determinations, one case of renal insufficiency was detected which was associated with prolonged postoperative hypotension. Although the extent of distal disease was more severe in those who underwent bypass, symptoms of claudication returned earlier and were more prominent in the endarterectomy group. This recurrence of systems was not favorably altered by sympathectomy performed concomitantly with the initial procedure. Even though this condition seems to pose difficult technical obstacles and has a poor prognosis, infrarenal aortic occlusion can be successfully treated by aortic bypass, with favorable long-term results, if particular attention is paid to elements of the preoperative evaluation and the intraoperative technical requirements peculiar to this relatively uncommon disease entity. ImagesFig. 1.Fig. 2.Fig. 3. PMID:646479

  6. Melatonin reduces cardiac morbidity and markers of myocardial ischemia after elective abdominal aortic aneurism repair

    DEFF Research Database (Denmark)

    Gögenür, Ismail; Kücükakin, Bülent; Panduro Jensen, Leif;

    2014-01-01

    The aim was to examine the effect of perioperative melatonin treatment on clinical cardiac morbidity and markers of myocardial ischemia in patients undergoing elective surgery for abdominal aortic aneurism. Reperfusion injury results in increased cardiac morbidity in patients undergoing surgery...... for abdominal aortic aneurisms (AAA). A randomized, placebo-controlled, clinical trial including patients undergoing surgery for AAA was performed. The patients received by infusion over a 2-hr period either, 50 mg melatonin or placebo intra-operatively, and 10 mg melatonin or placebo orally, the first three...... found in the duration of ST-segment deviations. Melatonin treatment in the perioperative period decreased clinical cardiac morbidity as well as the occurrence of myocardial ischemia after abdominal aortic aneurism repair....

  7. Micromanaging Abdominal Aortic Aneurysms

    Directory of Open Access Journals (Sweden)

    Lars Maegdefessel

    2013-07-01

    Full Text Available The contribution of abdominal aortic aneurysm (AAA disease to human morbidity and mortality has increased in the aging, industrialized world. In response, extraordinary efforts have been launched to determine the molecular and pathophysiological characteristics of the diseased aorta. This work aims to develop novel diagnostic and therapeutic strategies to limit AAA expansion and, ultimately, rupture. Contributions from multiple research groups have uncovered a complex transcriptional and post-transcriptional regulatory milieu, which is believed to be essential for maintaining aortic vascular homeostasis. Recently, novel small noncoding RNAs, called microRNAs, have been identified as important transcriptional and post-transcriptional inhibitors of gene expression. MicroRNAs are thought to “fine tune” the translational output of their target messenger RNAs (mRNAs by promoting mRNA degradation or inhibiting translation. With the discovery that microRNAs act as powerful regulators in the context of a wide variety of diseases, it is only logical that microRNAs be thoroughly explored as potential therapeutic entities. This current review summarizes interesting findings regarding the intriguing roles and benefits of microRNA expression modulation during AAA initiation and propagation. These studies utilize disease-relevant murine models, as well as human tissue from patients undergoing surgical aortic aneurysm repair. Furthermore, we critically examine future therapeutic strategies with regard to their clinical and translational feasibility.

  8. The endovascular repair or open surgery for abdominal aortic aneurysm%高风险患者腹主动脉瘤手术与腔内治疗效果的比较

    Institute of Scientific and Technical Information of China (English)

    王伟; 郭伟; 刘小平; 尹太; 贾鑫; 张宏鹏; 杜昕

    2009-01-01

    Objective To compare the therapeutic effect of endovascular repair (EVAR) and open surgical repair(OSR) of abdominal aortic aneurysm in high-risk patients. Methods The clinical data of 55 patients from 1998 to 2008 with infrarenal abdominal aortic aneurysm who received surgical treatment were analyzed by using the customized probability index. The perioperative and short term advantages and disadvantages of OSR group (n=20) were compared with EVAR group (n=35). Results All patients in OSR group were followed up, 94% patients in EVAR group were followed up, the mean follow up time were 75 and 70 months respectively. (1) Compared to OSR group, the EVAR group had shorter operation time [(3.1±0.6) h vs (4.9±0.9) h, P<0.05], (2) EVAR group had shorter ICU and hospital stay after operation and less blood loss (P<0.01), (3) Compared to OSR group, the EVAR group had lower mortality within 30 d(2.86% vs 15%), (4)the EVAR group had lower peri-operative complications(17% vs 40%), (5) The main complications of EVAR were endoleak (8.57%), (6) The main complications of OSR was cadiovascular incidence(25%). Conclusions Endovascular treatment, indicated for AAA in high-risk patients, can cut down the perioperative incidence of cadiovascular events, mortality and complications. CPI is useful to estimate the perioperative incidence of cadiovascular events, mortality and complications, and can be used to guide the therapeutic method.%目的 比较高风险患者腹主动脉瘤(abdominal aortic aneurysm,AAA)手术治疗(opensurgical repair,OSR)与腔内治疗(endovascular aneurysm repair,EVAR)的效果,探讨高风险患者AAA治疗方式的选择.方法 利用(customized probability index,CPI)危险评分方法[1]筛选出我院1998年至2008年高风险患者55例,比较OSR组(20例)与EVAR组(35例)围手术期及术后近期结果.结果 OSR组随访率100%,平均随访6年3个月.EVAR组随访率94%,平均随访5年10个月.(1)手术时间高风险患者EVAR组(3.1±0.6)h

  9. Minimal-access median sternotomy for aortic valve replacement

    OpenAIRE

    Luciani, Giovanni Battista; Lucchese, Gianluca

    2013-01-01

    A variety of minimally-invasive approaches for aortic valve replacement (AVR) have been developed and are increasingly being utilized. The different approaches described, such as partial upper sternotomy, right parasternal thoracotomy or transverse sternotomy have the aim to decrease invasiveness and reduce surgical trauma. Whereas port access surgery with remote cannulation has the attendant risks inherent with peripheral cardiopulmonary bypass and limitations in terms of myocardial protecti...

  10. Doxycycline inhibition of proteases and inflammation in abdominal aortic aneurysms

    OpenAIRE

    Khawaja, Hazem Al-

    2011-01-01

    The aim of this thesis is to evaluate the effect of doxycycline on the proteolytic and inflammatory processes in abdominal aneurysms. This data is essential for the development of pharmaceutical strategies for the stabilization of an AAA. Such an approach could reduce the need for elective surgery and endovascular repair. It has repeatedly been shown that AAA progression and rupture is related to the failure of collagen in the aortic wall. Yet the exact mechanism underlying this failure remai...

  11. Renal failure after operation for abdominal aortic aneurysm

    DEFF Research Database (Denmark)

    Olsen, P S; Schroeder, T; Perko, M;

    1990-01-01

    Among 656 patients undergoing surgery for abdominal aortic aneurysm, 81 patients (12%) developed postoperative renal failure. Before operation hypotension and shock occurred in 88% of the patients with ruptured aneurysm, whereas none of the patients operated electively were hypotensive. Dialysis...... cases the death was caused by renal failure only or in combination with failure of other organs. Analysis of the cumulative survival shows that, if the patients survive the postoperative period, their life expectancy is comparable to that of patients without renal complications....

  12. Aortic replacement in aorto-occlusive disease: an observational study

    Directory of Open Access Journals (Sweden)

    Winter Richard K

    2008-10-01

    Full Text Available Abstract Background For many patients with aorto-occlusive disease, where stent deployment is not possible, surgery remains the only treatment option available. The aim of this study was to assess the results of aortic reconstruction surgery performed in patients with critical ischaemia. Methods All patients with critical ischaemia undergoing surgery during 1991–2004 were identified from a prospectively maintained database. Mortality data was verified against death certificate data. Demographic and clinical data were obtained from the clinical notes and the radiology database. Disease was classified as: type I – limited to aorta and common iliac arteries; type II – external iliac disease and type III combined aortic, iliac and infra-inguinal disease. Results 86 patients underwent aortic replacement surgery all of whom had critical ischaemia consisting of: type I (n = 16; type II (n = 37 and type III (n = 33. The 30-day mortality rate was 10.4%, the one-year patient survival was 80%, and the 1-year graft survival was 80%. At 2 years the actual patient survival was 73% and no additional graft losses were identified. All patients surviving 30 days reported excellent symptomatic relief. Early, complications occurred in 6 (7% patients: thrombosis within diseased superficial femoral arteries (n = 4; haemorrhage and subsequent death (n = 2. Ten (14% late complications (> 12 months occurred in the 69 surviving patients and included: anastomotic stenosis (n = 3; graft thrombosis (n = 4, graft infection (n = 3. Four patients developed claudication as a result of more distal disease in the presence of a patent graft, and 1 patient who continued smoking required an amputation for progressive distal disease. Conclusion Aortic reconstruction for patients with extensive aorto-occlussive disease provides long-standing symptomatic relief for the majority of patients. After the first year, there is continued patient attrition due to co

  13. Endovascular repair of aortic aneurysm: Preliminary results

    Directory of Open Access Journals (Sweden)

    Davidović Lazar

    2009-01-01

    Full Text Available Introduction. Endovascular aneurysm repair (EVAR has been introduced into clinical practice at the beginning of the 90's of the last century. Because of economic, political and social problems during the last 25 years, the introduction of this procedure in Serbia was not possible. Objective. The aim of this study was to present preliminary experiences and results of the Clinic for Vascular Surgery of the Serbian Clinical Centre in Belgrade in endovascular treatment of thoracic and abdominal aortic aneurysms. Methods. The procedure was performed in 33 patients (3 female and 30 male, aged from 42 to 83 years. Ten patients had a descending thoracic aorta aneurysm (three atherosclerotic, four traumatic - three chronic and one acute as a part of polytrauma, one dissected, two penetrated atherosclerotic ulcers, while 23 patients had the abdominal aortic aneurysm, one ruptured and two isolated iliac artery aneurysms. The indications for EVAR were isthmic aneurismal localisation, aged over 80 years and associated comorbidity (cardiac, pulmonary and cerebrovasular diseases, previous thoracotomy or multiple laparotomies associated with abdominal infection, idiopatic thrombocitopaenia. All of these patients had three or more risk factors. The diagnosis was established using duplex ultrasonography, angiography and MSCT. In the case of thoracic aneurysm, a Medtronic-Valiant® endovascular stent graft was implanted, while for the abdominal aortic aneurysm Medtronic-Talent® endovascular stent grafts with delivery systems were used. In three patients, following EVAR a surgical repair of the femoral artery aneurysm was performed, and in another three patients femoro-femoral cross over bypass followed implantation of aortouniiliac stent graft. Results. During procedure and follow-up period (mean 1.6 years, there were: one death, one conversion, one endoleak type 1, six patients with endoleak type 2 that disappeared during the follow-up period, one early graft

  14. GenTAC Registry Report: Gender Differences Among Individuals with Genetically-Triggered Thoracic Aortic Aneurysm and Dissection

    Science.gov (United States)

    Holmes, Kathryn W.; Maslen, Cheryl L.; Kindem, Mark; Kroner, Barbara L.; Song, Howard K.; Ravekes, William; Dietz, H.C.; Weinsaft, Jonathan W.; Roman, Mary J.; Devereux, Richard B.; Pyeritz, Reed E.; Bavaria, Joseph; Milewski, Karianna; Milewicz, Dianna; LeMaire, Scott A.; Hendershot, Tabitha; Eagle, Kim A.; Tolunay, H. Eser; Desvigne-Nickens, Patrice; Silberbach, Michael

    2013-01-01

    Previous data suggest women are at increased risk of death from aortic dissection. Therefore, we analyzed data from the GenTAC registry, the NIH-sponsored program that collects information about individuals with genetically-triggered thoracic aortic aneurysms and cardiovascular conditions. We performed cross-sectional analyses in adults with Marfan syndrome (MFS), familial thoracic aortic aneurysm or dissection (FTAAD), bicuspid aortic valve (BAV) with thoracic aortic aneurysm or dissection, and subjects under 50 years of age with thoracic aortic aneurysm or dissection (TAAD<50y). Women comprised 32% of 1449 subjects and were 21% of subjects with BAV, 34% with FTAAD, 22% with TAAD <50y, and 47% with MFS. Thoracic aortic dissections occurred with equal gender frequency yet women with BAV had more extensive dissections. Aortic size was smaller in women but was similar after controlling for BSA. Age at operation for aortic valve dysfunction, aneurysm or dissection did not differ by gender. Multivariate analysis (adjusting for age, BSA, hypertension, study site, diabetes, and subgroup diagnoses) showed that women had fewer total aortic surgeries (OR= 0.65, p < 0.01) and were less likely to receive angiotensin converting enzyme inhibitors (ACEi) (OR=0.68, p < 0.05). As in BAV, other genetically-triggered aortic diseases such as FTAAD and TAAD<50 are more common in males. In women, decreased prevalence of aortic operations and less treatment with ACEi may be due to their smaller absolute aortic diameters. Longitudinal studies are needed to determine if women are at higher risk for adverse events. PMID:23444191

  15. In-plane elastic stability of fixed parabolic shallow arches

    Institute of Scientific and Technical Information of China (English)

    CAI JianGuo; FENG Jian; CHEN Yao; HUANG LiFeng

    2009-01-01

    The nonlinear behavior of fixed parabolic shallow arches subjected to a vertical uniform load is inves-tigated to evaluate the in-plane buckling load. The virtual work principle method is used to establish the non-linear equilibrium and buckling equations. Analytical solutions for the non-linear in-plane sym-metric snap-through and antisymmetric bifurcation buckling loads are obtained. Based on the least square method, an approximation for the symmetric buckling load of fixed parabolic arch is proposedto simplify the solution process. And the relation between modified slenderness and buckling modes are discussed. Comparisons with the results of finite element analysis demonstrate that the solutions are accurate. A cable-arch structure is presented to improve the in-plane stability of parabolic arches. The comparison of buckling loads between cable-arch systems and arches only show that the effect of cables becomes more evident with the increase of arch's modified slenderness.

  16. Bicuspid aortic valve and aortic coarctation are linked to deletion of the X chromosome short arm in Turner syndrome

    Science.gov (United States)

    Bondy, Carolyn; Bakalov, Vladimir K; Cheng, Clara; Olivieri, Laura; Rosing, Douglas R; Arai, Andrew E

    2013-01-01

    Background Congenital heart disease (CHD) is a cardinal feature of X chromosome monosomy, or Turner syndrome (TS). Haploinsufficiency for gene(s) located on Xp have been implicated in the short stature characteristic of the syndrome, but the chromosomal region related to the CHD phenotype has not been established. Design We used cardiac MRI to diagnose cardiovascular abnormalities in four non-mosaic karyotype groups based on 50-metaphase analyses: 45,X (n=152); 46,X,del(Xp) (n=15); 46,X,del(Xq) (n=4); and 46,X,i(Xq) (n=14) from peripheral blood cells. Results Bicuspid aortic valves (BAV) were found in 52/152 (34%) 45,X study subjects and aortic coarctation (COA) in 19/152 (12.5%). Isolated anomalous pulmonary veins (APV) were detected in 15/152 (10%) for the 45,X study group, and this defect was not correlated with the presence of BAV or COA. BAVs were present in 28.6% of subjects with Xp deletions and COA in 6.7%. APV were not found in subjects with Xp deletions. The most distal break associated with the BAV/COA trait was at cytologic band Xp11.4 and ChrX:41,500 000. One of 14 subjects (7%) with the 46,X,i(Xq) karyotype had a BAV and no cases of COA or APV were found in this group. No cardiovascular defects were found among four patients with Xq deletions. Conclusions The high prevalence of BAV and COA in subjects missing only the X chromosome short arm indicates that haploinsufficiency for Xp genes contributes to abnormal aortic valve and aortic arch development in TS. PMID:23825392

  17. Evolution Characteristic Analysis of Pressure-arch of a Double-arch Tunnel in Water-rich Strata

    Directory of Open Access Journals (Sweden)

    C. L. Li

    2016-03-01

    Full Text Available It is of importance to analyze the morphological characterization, the evolution process and the skewed effect of pressure-arch of a double-arch tunnel in the water-rich strata. Taking a buried depth 80 m double-arch tunnel as an example, a computational model of the double-arch tunnel was built by using FLAC3D technique. Then considering some aspects including groundwater conditions, tunnel depth, construction sequences and permeability coefficients, the coupling effect of stress field and seepage field in the pressure-arch of the double-arch tunnel was analyzed. The results show that the thickness of the pressure-arch induced by step-by-step excavation and display a step-descent skewed distribution from the left to the right of the double-arch tunnel. The permeability coefficient has a significant influence on the shape and the skewed effect of the pressure arch. The excavation of the bench method has a better arching condition than that of the expanding method. The abtained results provide a basic reference for the rock reinforcement design and safety construction of double-arch tunnels in the water-rich strata.

  18. From puncture to closure of the common femoral artery in endovascular aortic repair

    DEFF Research Database (Denmark)

    Lönn, Lars; Larzon, Thomas; Van Den Berg, Jos C

    2010-01-01

    In all fields of surgery there is a trend towards less invasive procedures reducing hospital stay, complications and mortality. Open surgery in the treatment of aortic diseases is gradually less applied, and instead endovascular aortic repair - EVAR - is a widely accepted treatment modality...... of today. The traditional approach in EVAR involves surgical exposure of the femoral arteries with bilateral groin incisions. Through the groin access, and under fluoroscopy, a special insertion sheath introducer is used to position a stent graft in the desired location with the patient in general...

  19. Resultados de pacientes submetidos à cirurgia de substituição valvar aórtica usando próteses mecânicas ou biológicas Outcomes of patients subjected to aortic valve replacement surgery using mechanical or biological prostheses

    Directory of Open Access Journals (Sweden)

    Adriana Silveira de Almeida

    2011-09-01

    Full Text Available OBJETIVO: Esse estudo avalia resultados em pacientes submetidos à cirurgia para troca valvar aórtica utilizando substituto biológico ou mecânico, com poder de relevância na seleção do tipo da prótese. MÉTODOS: Foram selecionados, randomicamente, 301 pacientes submetidos à cirurgia para troca valvar aórtica entre 1990 e 2005, com seguimento máximo de 20 anos. RESULTADOS: Sobrevivência em 5, 10 e 15 anos após cirurgia utilizando substituto mecânico foi de 83,9%, 75,4% e 60,2% e, para substituto biológico, foi de 89,3%, 70,4% e 58,4%, respectivamente (P=0,939. Fatores associados com óbito foram: idade, obesidade, doença pulmonar, arritmias, eventos hemorrágicos e insuficiência valvar aórtica. Probabilidade livre de reoperação desses pacientes em 5, 10 e 15 anos após cirurgia utilizando substituto mecânico foi de 97,9%, 95,8% e 95,8% e, para bioprótese, foi de 94,6%, 91,0% e 83,3%, respectivamente (P=0,057. Fatores associados com reoperação foram: insuficiência renal, endocardite de prótese e idade. Probabilidade livre de eventos hemorrágicos em 5, 10 e 15 anos após cirurgia utilizando substituto mecânico foi de 94,5%, 91,7% e 91,7% e, para bioprótese, foi de 98,6%, 97,8% e 97,8%, respectivamente (P=0,047. Fatores associados com eventos hemorrágicos foram: insuficiência renal e prótese mecânica. CONCLUSÕES: Os autores concluíram que: 1 mortalidade foi estatisticamente semelhante entre os grupos; 2 características basais dos pacientes foram os maiores determinantes de mortalidade tardia após a cirurgia; 3 houve tendência à reoperação para o grupo com bioprótese; 4 pacientes com prótese mecânica tiveram mais eventos hemorrágicos ao longo do tempo; 5 dados encontrados no presente estudo são concordantes com a literatura atualOBJECTIVE: This paper evaluates outcomes in patients subjected to surgery for replacement of the aortic valve using biological or mechanical substitutes, where selection of the

  20. Biotechnologie des archées

    OpenAIRE

    Querellou, Joel

    2010-01-01

    La majorité des enzymes utilisées dans l’industrie provient des bactéries et des levures. Mais les conditions extrêmes dans lesquelles se développent de nombreuses espèces d’archées font que leurs constituants cellulaires possèdent des propriétés et une stabilité propices à leur utilisation en biotechnologie.

  1. Anesthetic management in endovascular treatment of aortic pathologies

    Directory of Open Access Journals (Sweden)

    Abdulmenap Güzel

    2014-06-01

    Full Text Available Objective: In this study we aimed to compare the anesthesia methods we used in the endovascular treatment of thoracic and abdominal aorta pathologies and to discuss accompanied by literature. Methods: Our study was carried out be retrospectively assessing a total of 20 patients on whom we had administered endovascular treatment for aortic aneurism and aortic dissection. The demographic features of the patients, their American Anesthesia Association (ASA scores, laboratory findings, accompanying diseases, whether they smoke, their ejection fraction and the place and type of aortic pathology was recorded. Also the surgical procedure, anesthesia method, the amounts of crystalloids, colloids and blood products used during the surgery, the anesthesia and surgery durations, complications and interventions, duration of stays in intensive care and the hospital in general and the mortality rates were recorded. All cases were provided with standard anesthesia monitoring. Results: A total of 20 (M=15, F=5 cases were included in our study. 16 of our cases were in ASA 3 risk group and 4 were in ASA 4 risk group. While patients who had been administered with thoracic endovascular aortic repair (TEVAR were all given general anesthesia, seven patients who had been administered with abdominal endovascular aortic repair (EVAR were given regional and 6 were given general anesthesia and one case was only given sedoanalgesia. While 8 of the patients administered with EVAR had hypertension all of the patients administered with TEVAR had hypertension. No significant differences were found in blood and blood product transfusions, preoperative and postoperative hemoglobin, hematocrit, urea and creatinine values between two groups. Conclusion: In EVAR and TEVAR applications general anesthesia, regional anesthesia, sedoanalgesia accompanied by local anesthesia can be successfully administered depending on the patient’s status and the location of the procedure.

  2. Variations among the primary maxillary dental arch forms using a polynominal equation model.

    Science.gov (United States)

    Tsai, Hung-Huey

    2003-01-01

    This study identifies arch symmetry and describes arch form variations in normal primary maxillary dental casts. Sixty-two percent of casts had asymmetrical arches, and 38% had symmetrical arches. Six types of arch form were identified according to the ratio of arch width to length. There were more long types than short types. The rounded and short types tended to have a more-symmetrical arch than did the long type. PMID:12739689

  3. Technological Solutions for Cardiac Surgery in the Elderly

    OpenAIRE

    Rony-Reuven Nir; Gil Bolotin

    2013-01-01

    The current review addresses contemporary technological advances in cardiac surgery performed on octogenarian patients, namely off-pump coronary artery bypass grafting (CABG), proximal anastomosis device, routine use of intraoperative epiaortic ultrasound, proximal anastomosis without clamping, transcatheter aortic valve implantation (TAVI), and brain protection during cardiac surgery.

  4. Cataract Surgery

    Science.gov (United States)

    ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center ...

  5. Neural Network in Developing Software for Indentifying Arch Form

    Directory of Open Access Journals (Sweden)

    Johan Arief Budiman

    2013-06-01

    Full Text Available The treatment of Class I malocclusion treatment is to arrange the teeth position in a good arch form. Archform consists of tooth size and arch dimension (intercanine width, canine depth, intermolar width, molardepth. Several ways are developed to describe arch form. A lot of methods usedto describe arch formqualitatively.The objectiveofthis studyistodevelop qualitative arch form diagnostic references usingartificial neural network from pre-post treatment dental cast scanning result. Pre-post orthodontictreatment dental casts (1990-2006 from Post Graduate Clinic Faculty of Dentistry University of Indonesiaand 3 other orthodontistswere gathered andscanned.Dataweremeasured usingImage Toolandanalyzedusing Stata 9.ANOVA was used to compare arch forms (square, oval, tapered and gender (male andfemale, with each component of arch dimension upper and lowerjaw, before and after treatment; and alsoarch perimeter to kinds of treatmentThe results were compiled todeterminevariables inbuildingthesoftware for analyzing arch form qualitatively.The data from190 pre-post orthodontic treatment dentalcasts consisted of42 male (22.1% and 148 female (77.9% treated without extraction (32.63%,4Premolars extraction (48.42%, Upper Premolars extraction (11.05%, atypical extraction (7.90%.Gender and allvariables from pre treatment did not influence arch form, except kinds of treatment.Therefore, only post treatment data are included for arch form analysis. The shape of arch form (square,oval and tapered can be described qualitatively by software using artificial neural network.This softwarecoulddescribe arch form with the accuracy of 76.3158%.This studyconcludedthatIntercanine width,Canine depth, Intermolar width, and molar depth were variables that influencedarch form. A softwareusing artificial neural network to describe arch formqualitatively couldbe used for diagnostic reference toClass I malocclusion orthodontic post treatment.

  6. Unoperated aortic aneurysm

    DEFF Research Database (Denmark)

    Perko, M J; Nørgaard, M; Herzog, T M;

    1995-01-01

    . No significant differences in survival for patients with dissecting and nondissecting AA were detected. In all, 132 patients (78%) died and 78 (59%) of them died of rupture. Mean time to rupture was 1,300 +/- 8 days. Cumulative 5-year hazard of rupture for the dissecting AA was twice that of the nondissecting (p......From 1984 to 1993, 1,053 patients were admitted with aortic aneurysm (AA) and 170 (15%) were not operated on. The most frequent reason for nonoperative management was presumed technical inoperability. Survivals for patients with thoracic, thoracoabdominal, and abdominal AA were comparable...

  7. Aortic valve replacement in octogenarians

    Directory of Open Access Journals (Sweden)

    Dark John H

    2007-07-01

    Full Text Available Abstract Background and Aims As our population ages and life expectancy increases the number of people aged over 80 and more referred for cardiac surgery is growing. This study sought to identify the outcome of aortic valve replacement (AVR in octogenarians. Methods 68 patients aged 80 years or more underwent AVR at the Freeman Hospital, between April 2001 and April 2004. A retrospective review of the notes and outcomes from the patients' GP and the NHS strategic tracking service was performed. 54% (37 underwent isolated AVR whilst 46% (31 underwent combined AVR and CABG. Results Follow up was 100% complete. The mean age was 83.1 ± s.d. 2.9 years, a mean gradient of 83 ± s.d. 31 mmHg and mean AVA of 0.56 cm2. The mean additive EuroSCORE was 8.6 ± s.d. 1.2, the logistic EuroSCORE mean 12.0 ± s.d. 5.9. In hospital 30 day mortality was 13 %. Survival was 80% at 1 year and 78% at 2 years. Median follow up was for 712 days. Stepwise logistic regression identified chronic obstructive airways disease as an independent predictor of mortality (p Conclusion Our study demonstrates that the operative mortality for AVR in the over eighties is good, whilst the mid to long term outcome is excellent There is a very low attrition rate with those undergoing the procedure living as long than their age matched population. This study confirms AVR is a safe, acceptable treatment for octogenarians with excellent mid term outcomes.

  8. Aortic biomechanics in hypertrophic cardiomyopathy

    Science.gov (United States)

    Badran, Hala Mahfouz; Soltan, Ghada; Faheem, Nagla; Elnoamany, Mohamed Fahmy; Tawfik, Mohamed; Yacoub, Magdi

    2015-01-01

    Background: Ventricular-vascular coupling is an important phenomenon in many cardiovascular diseases. The association between aortic mechanical dysfunction and left ventricular (LV) dysfunction is well characterized in many disease entities, but no data are available on how these changes are related in hypertrophic cardiomyopathy (HCM). Aim of the work: This study examined whether HCM alone is associated with an impaired aortic mechanical function in patients without cardiovascular risk factors and the relation of these changes, if any, to LV deformation and cardiac phenotype. Methods: 141 patients with HCM were recruited and compared to 66 age- and sex-matched healthy subjects as control group. Pulse pressure, aortic strain, stiffness and distensibility were calculated from the aortic diameters measured by M-mode echocardiography and blood pressure obtained by sphygmomanometer. Aortic wall systolic and diastolic velocities were measured using pulsed wave Doppler tissue imaging (DTI). Cardiac assessment included geometric parameters and myocardial deformation (strain and strain rate) and mechanical dyssynchrony. Results: The pulsatile change in the aortic diameter, distensibility and aortic wall systolic velocity (AWS') were significantly decreased and aortic stiffness index was increased in HCM compared to control (P < .001) In HCM AWS' was inversely correlated to age(r = − .32, P < .0001), MWT (r = − .22, P < .008), LVMI (r = − .20, P < .02), E/Ea (r = − .16, P < .03) LVOT gradient (r = − 19, P < .02) and severity of mitral regurg (r = − .18, P < .03) but not to the concealed LV deformation abnormalities or mechanical dyssynchrony. On multivariate analysis, the key determinant of aortic stiffness was LV mass index and LVOT obstruction while the role LV dysfunction in aortic stiffness is not evident in this population. Conclusion: HCM is associated with abnormal aortic mechanical properties. The severity of cardiac

  9. Transesophageal echocardiography in surgical management of pseudoaneurysm of mitral-aortic intervalvular fibrosa with aneurysms of right sinus of Valsalva and left main coronary artery

    OpenAIRE

    Shreedhar S Joshi; Arkalgud Marigowda Jagadeesh; Arul Furtado; Seetharam Bhat

    2013-01-01

    Pseudoaneurysm of mitral-aortic intervalvular fibrosa (MAIVF) is a rare complication associated with aortic and/or mitral valve surgery complicated by infective endocarditis. We report pseudoaneurysm of MAIVF in a young adult without overt cardiac disease or previous cardiac surgery. The patient had a rare combination of pseudoaneurysm of MAIVF impinging on anterior mitral leaflet causing moderate mitral regurgitation, right sinus of Valsalva aneurysm extending into interventricular septum, a...

  10. Effect of etomidate and propofol induction on hemodynamic and endocrine response in patients undergoing coronary artery bypass grafting/mitral valve and aortic valve replacement surgery on cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Ram Prasad Kaushal

    2015-01-01

    Full Text Available Introduction: The concerns for induction of anaesthesia in patients undergoing cardiac surgery include hemodynamic stability, attenuation of stress response and maintenance of balance between myocardial oxygen demand and supply. Various Intravenous anaesthetic agents like Thiopentone, Etomidate, Propofol, Midazolam, and Ketamine have been used for anesthetizing patients for cardiac surgeries. However, many authors have expressed concerns regarding induction with thiopentone, midazolam and ketamine. Hence, Propofol and Etomidate are preferred for induction in these patients. However, these two drugs have different characteristics. Etomidate is preferred for patients with poor left ventricular (LV function as it provides stable cardiovascular profile. But there are concerns about reduction in adrenal suppression and serum cortisol levels. Propofol, on the other hand may cause a reduction in systemic vascular resistance and subsequent hypotension. Thus, this study was conducted to compare induction with these two agents in cardiac surgeries. Methods: Baseline categorical and continuous variables were compared using Fisher′s exact test and student′s t test respectively. Hemodynamic variables were compared using student′s t test for independent samples. The primary outcome (serum cortisol and blood sugar of the study was compared using Wilcoxon Rank Sum test. The P value less than 0.05 was considered significant. Results: Etomidate provides more stable hemodynamic parameters as compared to Propofol. Propofol causes vasodilation and may result in drop of systematic BP. Etomidate can therefore be safely used for induction in patients with good LV function for CABG/MVR/AVR on CPB without serious cortisol suppression lasting more than twenty-four hours.

  11. Abdominal aortic grafting for spontaneous infrarenal abdominal aortic dissection.

    Science.gov (United States)

    Iwasaki, Hiroto; Shibuya, Takashi; Shintani, Takashi; Uenaka, Hisazumi; Suehiro, Shigefumi; Satoh, Hisashi

    2010-02-01

    This case report concerns a 62-year-old woman with spontaneous infrarenal abdominal aortic dissection, which developed into claudication and rest pain in the lower extremity. Multi-row detector computed tomography showed the entry site of the abdominal aortic dissection at the second lumbar artery, while the reentry site was found intraoperatively at the median sacral artery, indicating that the false lumen had progressed and compressed the true lumen. A direct approach involving grafting appears to be an effective procedure for resolving mesenteric and lower extremity hypoperfusion due to aortic dissection with a dilated false channel, even during the acute period. PMID:19879731

  12. Hybrid repair of ruptured type B aortic dissection extending into an aberrant right subclavian artery in a patient with Turner's syndrome.

    Science.gov (United States)

    Hamidian-Jahromi, Alireza; Carroll, Jonathan D; Doucet, Linda D; Zhang, Wayne W

    2013-11-01

    Turner's syndrome (TS) has been documented as the most common cause of aortic dissection in young women. However, little attention from vascular surgery has been paid to these patients. We report the first case of ruptured type B aortic dissection with aberrant right subclavian artery treated successfully with hybrid endovascular and open procedures in a patient with TS. Left carotid to subclavian artery bypass, thoracic endovascular aortic repair, and coil embolization of the aberrant right subclavian and left subclavian arteries were performed in an emergency setting. Literature on epidemiology, causes, and management options of acute aortic dissection in TS patients are reviewed and discussed. PMID:24011806

  13. Evaluation of the fit of preformed nickel titanium arch wires on normal occlusion dental arches

    OpenAIRE

    Al-Barakati, Rakhn G.; Nasser D. Alqahtani; Abdulaziz AlMadi; Sahar F. Albarakati; ALKofide, Eman A.

    2016-01-01

    Aim: To determine the fits of preformed nickel titanium (NiTi) archwires on dental arches with normal occlusion. Methods: Forty sets of upper and lower plaster models were obtained from men and women with Class I occlusions. Preformed 0.016″ × 0.022″ NiTi archwires from Rocky Mountain Orthodontics (RMO), 3 M Unitek, Ormco, and Dentaurum were evaluated in terms of their fits on dental arches from male, female, and combined cases. Data were analyzed by using fourth- and sixth-order polynomia...

  14. Recurrent respiratory infections caused by a double aortic arch: The diagnostic role of spirometry

    OpenAIRE

    Calabrese, Cecilia; Corcione, Nadia; Di Spirito, Valentina; Guarino, Carmine; Rossi, Giovanni; Domenico Gargiulo, Gaetano; Vatrella, Alessandro

    2013-01-01

    A young woman with a clinical history characterized by recurrent respiratory infections, occurring since early infancy, was referred to our hospital. When the patient was a young girl, she underwent sweat chloride test, serum analysis of immunoglobulins, and evaluation of blood lymphocyte subsets; all these diagnostic tests were normal, as well as chest X ray aside from pneumonia episodes. Skin prick tests were positive for several different allergens, and a diagnosis of allergic rhinitis was...

  15. Anatomic variations of the branches of the aortic arch in a Peruvian population

    Directory of Open Access Journals (Sweden)

    Julio Arturo Huapaya

    2015-07-01

    Full Text Available INTRODUCCIÓN Reportes previos en dos países de América del Sur encontraron una variante anatómica que no había sido reportada en el resto del mundo, lo que podría dar indicios acerca de una diferencia racial. OBJETIVO Describir las variaciones en la distribución anatómica de las ramas del arco aórtico en una población peruana. MÉTODOS Estudio retrospectivo de una serie de casos de personas en quienes se realizó una angiografía por tomografía de la aorta torácica. Se analizaron los informes que registraron la descripción de las variaciones de las ramas del arco aórtico, basados en los ocho tipos descritos por la literatura científica. RESULTADOS Se analizaron 361 informes. Se encontró que 282 pacientes (78,12% tuvieron la configuración clásica (tipo I, arco aórtico que da origen al tronco braquiocefálico, a la carótida común izquierda y a la subclavia izquierda, seguido por el tipo II (arteria carótida común izquierda como rama del tronco braquiocefálico con 41 pacientes (11,36%, y el tipo IX (un ostium común para el tronco braquiocefálico y la carótida común izquierda con 25 pacientes (6,93%. Este último y otros dos tipos resultaron ser nuevas variantes del arco aórtico. CONCLUSIÓN En esta serie de casos peruana, los tipos de arco aórtico I, II y IX fueron los más frecuentes. Adicionalmente, se encontraron otros dos tipos nuevos que no habían sido descritos en la literatura previamente. Es necesario profundizar la investigación sobre estas variantes para evaluar el factor racial en Sudamérica y una posible relación con eventos clínicos o quirúrgicos.

  16. Imaging features of double aortic arch shown by multidetector computed tomography angiography

    International Nuclear Information System (INIS)

    We present a three-dimensional reconstructed image of vascular ring in a 2.5-month-old patient, which was obtained using multidetector computed tomography (MDCT). MDCT angiography made an accurate diagnosis of this life-threatening, but correctable, anomaly in an infant with a stridor, repeated respiratory infections and episodes of apnea

  17. Anatomic variations of the branches of the aortic arch in a Peruvian population

    OpenAIRE

    Julio Arturo Huapaya; Kristhy Chávez-Trujillo; Miguel Trelles; Roy Dueñas Carbajal; Renato Ferrandiz Espadin

    2015-01-01

    INTRODUCCIÓN Reportes previos en dos países de América del Sur encontraron una variante anatómica que no había sido reportada en el resto del mundo, lo que podría dar indicios acerca de una diferencia racial. OBJETIVO Describir las variaciones en la distribución anatómica de las ramas del arco aórtico en una población peruana. MÉTODOS Estudio retrospectivo de una serie de casos de personas en quienes se realizó una angiografía por tomografía de la aorta torácica. Se analizar...

  18. In-plane elastic stability of fixed parabolic shallow arches

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    The nonlinear behavior of fixed parabolic shallow arches subjected to a vertical uniform load is inves- tigated to evaluate the in-plane buckling load. The virtual work principle method is used to establish the non-linear equilibrium and buckling equations. Analytical solutions for the non-linear in-plane sym- metric snap-through and antisymmetric bifurcation buckling loads are obtained. Based on the least square method, an approximation for the symmetric buckling load of fixed parabolic arch is proposed to simplify the solution process. And the relation between modified slenderness and buckling modes are discussed. Comparisons with the results of finite element analysis demonstrate that the solutions are accurate. A cable-arch structure is presented to improve the in-plane stability of parabolic arches. The comparison of buckling loads between cable-arch systems and arches only show that the effect of cables becomes more evident with the increase of arch’s modified slenderness.

  19. Aortic dilatation in Turner syndrome: the role of MRI in early recognition

    Energy Technology Data Exchange (ETDEWEB)

    Chalard, Francois; Ferey, Solene; Kalifa, Gabriel [Saint Vincent de Paul Hospital, Department of Paediatric Radiology, Paris Cedex 14 (France); Teinturier, Cecile [Saint Vincent de Paul Hospital, Department of Paediatric Endocrinology, Paris (France)

    2005-03-01

    Aortic dilatation and dissection are rare but important complications of Turner syndrome that increase the risk of sudden death in young patients. To assess the value of aortic MRI in patients with Turner syndrome; in particular to demonstrate early aortic dilatation. A total of 21 patients with Turner syndrome underwent MRI of the thoracic aorta with measurement of vessel diameter at four levels. Measurements were normal for age in 15 cases, two patients presented with values at the upper limit of normal and four had obvious dilatation of the ascending aorta. All were symptom free. MRI allows the non-invasive demonstration of early aortic dilatation, which may lead to earlier surgery in asymptomatic individuals. (orig.)

  20. Repair of recurrent pseudoaneurysm of the mitral-aortic intervalvular fibrosa: Role of transesophageal echocardiography

    Directory of Open Access Journals (Sweden)

    Shreedhar S Joshi

    2014-01-01

    Full Text Available Pseudoaneurysm of mitral-aortic intervalvular fibrosa (P-MAIVF is a rare cardiac surgical condition. P-MAIVF commonly occurs as a complication of aortic and mitral valve replacement surgeries. The surgical trauma during replacement of the valves weakens the avascular mitral and aortic intervalvular area. We present a case of P-MAIVF recurrence 5 years after a primary repair. Congestive cardiac failure was the presenting feature with mitral and aortic regurgitation. In view of the recurrence, the surgical team planned for a double valve replacement. The sewing rings of the two prosthetic-valves were interposed to close the mouth of the pseudoaneurysm and to provide mechanical reinforcement of the MAIVF. Intra-operative transesophageal echocardiography (TEE helped in delineating the anatomy, extent of the lesion, rupture of one of the pseudoaneurysm into left atrium and severity of the valvular regurgitation. Post-procedure TEE confirmed complete obliteration of the pseudoaneurysm and prosthetic valve function.