Sample records for aortic arch vessels

  1. Supravalvular aortic stenosis in adult with anomalies of aortic arch vessels and aortic regurgitation (United States)

    Valente, Acrisio Sales; Alencar, Polyanna; Santos, Alana Neiva; Lobo, Roberto Augusto de Mesquita; de Mesquita, Fernando Antônio; Guimarães, Aloyra Guedis


    The supravalvular aortic stenosis is a rare congenital heart defect being very uncommon in adults. We present a case of supravalvular aortic stenosis in adult associated with anomalies of the aortic arch vessels and aortic regurgitation, which was submitted to aortic valve replacement and arterioplasty of the ascending aorta with a good postoperative course. PMID:24598962

  2. 3D Computer Simulations of Pulsatile Human Blood Flows in Vessels and in the Aortic Arch: Investigation of Non-Newtonian Characteristics of Human Blood

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    Sultanov, Renat A; Engelbrekt, Brent; Blankenbecler, Richard


    Methods of Computational Fluid Dynamics are applied to simulate pulsatile blood flow in human vessels and in the aortic arch. The non-Newtonian behaviour of the human blood is investigated in simple vessels of actual size. A detailed time-dependent mathematical convergence test has been carried out. The realistic pulsatile flow is used in all simulations. Results of computer simulations of the blood flow in vessels of two 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 widely used method in literature: a simple Newtonian approximation. A significant increase of the strain rate and, as a result, wall sear stress distribution, is found in the region of the aortic arch. We consider this result as theoretical evidence that supports existing clinical observations and those models not using non-Newtonian treatment underestimate the risk of disru...

  3. Mycotic Aneurysm of the Aortic Arch

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    Ji Hye Seo


    Full Text Available A mycotic aneurysm of the thoracic aorta is rare. We report a case of mycotic aneurysm that developed in the aortic arch. An 86-year-old man was admitted with fever and general weakness. Blood culture yielded methicillin-resistant Staphylococcus aureus. Chest X-ray showed an enlarged aortic arch, and computed tomography scan revealed an aneurysm in the aortic arch. The patient was treated only with antibiotics and not surgically. The size of the aneurysm increased rapidly, resulting in bronchial obstruction and superimposed pneumonia. The patient died of respiratory failure.

  4. Contrast-enhanced magnetic resonance angiography of persistent fifth aortic arch in children

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    Zhong, Yumin; Zhu, Ming; Sun, Aimin; Li, Yuhua [Shanghai Jiao Tong University School of Medicine, Department of Radiology, Shanghai Children' s Medical Center, Shanghai (China); Jaffe, Richard B. [Primary Children' s Medical Center, Department of Medical Imaging, Salt Lake City, UT (United States); Gao, Wei [Shanghai Jiao Tong University School of Medicine, Department of Cardiology, Shanghai Children' s Medical Center, Shanghai (China)


    Cine angiography and echocardiography have been utilized to diagnose congenital aortic arch anomalies. However, the visualization of great vessels by echocardiography is limited, while cine angiography requires cardiac catheterization with ionizing radiation. Contrast-enhanced magnetic resonance angiography (MRA) is a noninvasive modality suitable for visualization of congenital aortic arch anomalies. To evaluate the utility of contrast-enhanced MRA in the diagnosis of persistent fifth aortic arch, a rare congenital aortic arch anomaly, and to compare the diagnostic accuracy of MRA with that of echocardiography and cine angiography. In four pediatric patients, contrast-enhanced MRA studies were performed for diagnosing persistent fifth aortic arch. The findings of MRA were compared with echocardiographic findings and confirmed by cine angiography and operation. Transthoracic surface echocardiography noted an aberrant vessel arising from the ascending aorta in two of four patients; the etiology of this vessel was uncertain. In the other two patients a diagnosis of coarctation was made. Of the four patients, only one was diagnosed with interruption of the aortic arch. Contrast-enhanced MRA clarified uncertain echocardiographic findings, enabling the correct diagnosis of persistent fifth aortic arch with fourth aortic arch interruption in all four patients. Contrast-enhanced MRA is a safe, accurate, and fast imaging technique for the evaluation of persistent fifth aortic arch and may obviate the need for conventional cine angiography. Cardiac catheterization may be reserved for some types of complicated congenital heart disease and for obtaining hemodynamic information. (orig.)

  5. Complete interruption of the aortic arch

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    Park, Sung Hak; Park, In Kyu; Lee, Won Hwa; Kim, Yong Joo; Kang, Duk Sik; Lee, Jong Tae [Kyungpook National University College of Medicine, Taegu (Korea, Republic of)


    Complete interrupture of the aortic arch is one of the least common cardiac malformation. In this condition, continuity between the ascending and descending protions of the aorta is not present, and the descending aorta is supplied through a reversing patent ductus arteriosus. In the majority of the patients a ventricular septal defect is present. Authors have experienced a case of the complete interruption of aortic arch, interruption between the left carotid and the left subclavian artery.

  6. Multislice CT angiography of interrupted aortic arch

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    Yang, Dong Hyun; Goo, Hyun Woo [Asan Medical Center, Department of Radiology and Research Institute of Radiology, Seoul (Korea); Seo, Dong-Man; Yun, Tae-Jin; Park, Jeong-Jun [Asan Medical Center, University of Ulsan College of Medicine, Department of Paediatric Cardiac Surgery, Seoul (Korea); Park, In-Sook; Ko, Jae Kon; Kim, Young Hwee [Asan Medical Center, University of Ulsan College of Medicine, Department of Paediatric Cardiology, Seoul (Korea)


    Interrupted aortic arch (IAA) is defined as complete luminal and anatomic discontinuity between the ascending and descending aorta. Because almost all patients with IAA become critically ill during the neonatal period, they should undergo urgent corrective surgery. This clinical urgency necessitates a fast and accurate noninvasive diagnostic method. Although echocardiography remains the primary imaging tool for this purpose, it is not always sufficient for planning surgical correction of IAA, principally due to a limited acoustic window and the inexperience of imagers. In this context, multislice CT angiography is regarded as an appropriate imaging technique complementary to echocardiography because it is fast, accurate, and objective for the diagnosis of IAA. In this article we describe what cardiac radiologists should know about IAA in their clinical practice, including clinicopathological features, CT features with contemporary surgical methods and postoperative complications, and differentiation from coarctation of the aorta and aortic arch atresia. (orig.)

  7. Recurrent Pneumonia due to Double Aortic Arch

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    I. Sedighi


    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

  8. Aortic arch blunt injury in front-seat passenger. (United States)

    Türkmen, Nursel; Eren, Bülent; Aydin, Şule Akköse


    Aortic arch blunt injury has highly lethal nature. Because the physical examination findings are subtle, immediate medical evaluation is very important. The case was a 72-year-old woman. Massive haemorrhage in the left haemotorax, contusion area in the left lung and a traumatic transection of the distal aortic arch was observed during autopsy. We described intersting autopsy case of aortic arch blunt injury.

  9. Right aortic arch with coarctation in Chinese children

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    Ming, Zhu; Aimin, Sun [Shanghai Children' s Medical Center, Department of Radiology, Shanghai (China)


    Because of the rarity of right aortic arch coarctation there are few reports of large groups of patients. To characterize the frequency and type of right aortic arch coarctation in a large group of pediatric patients. From June 1997 through May 2007, 11,276 consecutive children with congenital heart disease underwent multidetector CT (MDCT), MRI or angiocardiography examination. All children with a right aortic arch or coarctation were reviewed. Right aortic arch coarctation was found in 11 children representing 0.1% of the total group of 11,276 children, 1.7% of 658 children with native coarctations and 2.3% of 473 children with a right aortic arch. Among the 11 patients, 6 had long-segment narrowing and 7 had an aberrant left subclavian artery. MDCT, MRI and angiocardiography are reliable imaging techniques for the diagnosis of right aortic arch and coarctation. Our findings showed that the pattern of right aortic arch coarctation was different from that of left aortic arch coarctation, suggesting that they are different etiological entities. The pivotal role possibly played by flow dynamics in the development of right aortic arch coarctation is discussed. (orig.)

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

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    Julia Massaad; Kelly Crawford


    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.

  11. Adult presentation with vascular ring due to double aortic arch. (United States)

    Kafka, Henryk; Uebing, Anselm; Mohiaddin, Raad


    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.

  12. Blood flow characteristics in the aortic arch (United States)

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


    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.

  13. A case of neonatal arterial thrombosis mimicking interrupted aortic arch. (United States)

    Gürsu, Hazım Alper; Varan, Birgül; Oktay, Ayla; Özkan, Murat


    Neonatal arterial thrombosis is a very rare entity with clinical findings resembling coarctation of aorta or interrupted aortic arch. A two day-old male newborn was admitted to a different hospital with difficulty in sucking and sleepiness. On echocardiographic examination, a diagnosis of interrupted aortic arch was made and he was treated with prostoglandin E2. When the patient presented to our center, physical examination revealed that his feet were bilaterally cold. The pulses were not palpable and there were ecchymotic regions in the lower extremities. Echocardiography ruled out interrupted aortic arch. Computerized tomographic angiography revealed a large thrombosis and total occlusion of the abdominal aorta. Since there was no response to treatment with tissue plasminogen activator, we performed thrombectomy. Homozygous Factor V Leiden and Methylenetetrahydrofolate reductase mutations were found in this patient. Neonatal aortic thrombosis which is observed very rarely and fatal should be considered in the differential diagnosis of coarctation of aorta and interrupted aortic arch.

  14. Right circumflex retro-oesophageal aortic arch with coarctation of a high-positioned right arch

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    Ahn, Kyung-Sik; Yong, Hwan Seok; Woo, Ok Hee; Kang, Eun-Young [Korea University Guro Hospital, Department of Radiology, Seoul (Korea); Lee, Joo-Won [Korea University Guro Hospital, Department of Paediatrics, Seoul (Korea)


    We present a rare case of right circumflex retro-oesophageal aortic arch with coarctation of a high-positioned right arch. A 7-month-old boy presented with a cardiac murmur. Cardiac situs was normal and there was no evidence of an intracardiac shunt or patent ductus arteriosus. MR aortography revealed a right aortic arch that was high-positioned, tortuous and narrowed. This right aortic arch crossed the midline behind the oesophagus and continued as a left-sided descending aorta. The left common carotid and subclavian arteries arose from a large branching vascular structure that derived from the top of the left-sided descending aorta. The right common carotid artery arose from the ascending aorta. The proximal portion of the right common carotid artery showed very severe stenosis and poststenotic dilatation. The right subclavian artery originated distal to the narrowed and tortuous segment of the aortic arch. (orig.)

  15. Video-assisted thoracoscopic left lower lobectomy in a patient with lung cancer and a right aortic arch

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    Wada Hideyuki


    Full Text Available Abstract A right aortic arch is a rare congenital anomaly, with a reported incidence of around 0.1%. A patient with a right aortic arch underwent video-assisted thoracic surgery left lower lobectomy and mediastinal lymph node dissection for squamous cell carcinoma. There was no aortic arch or descending aorta in the left thoracic cavity, but the esophagus. There was no anomaly in the location or branching of the pulmonary vessels, the bronchi, and the lobulation of the lungs. The vagus nerve was found at the level of the left pulmonary artery. The arterial ligament was found between the left subclavian artery and the left pulmonary artery. The recurrent laryngeal nerve was recurrent around the left subclavian artery. A Kommerell diverticulum was found at the origin of the left subclavian artery. The patient experienced no complications. We conclude that video-assisted thoracoscopic lobectomy with mediastinal dissection is feasible for treating lung cancer with a right aortic arch.

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

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    S. Sabouri


    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.

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

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    Mahnken, Andreas H., E-mail: [University Hospital Giessen and Marburg, Philipps University of Marburg, Department of Diagnostic Radiology (Germany); Hoffman, Andras; Autschbach, Ruediger; Damberg, Anneke L. M., E-mail: [University Hospital RWTH Aachen, Department of Thoracic, Cardiac and Vascular Surgery (Germany)


    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.

  18. Management of hypoplastic aortic arch associated with neonatal coarctation. (United States)

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


    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)

  19. Carotid stenting through the right brachial approach for left internal carotid artery stenosis and bovine aortic arch configuration

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    Montorsi, Piero; Galli, Stefano; Ravagnani, Paolo; Ghulam Ali, Sarah; Trabattoni, Daniela; Fabbiocchi, Franco; Lualdi, Alessandro; Ballerini, Giovanni; Andreini, Daniele; Pontone, Gianluca; Annoni, Andrea; Bartorelli, Antonio L. [Institute of Cardiology University of Milan, Centro Cardiologico Monzino, IRCCS, Milan (Italy)


    Unfavorable complex anatomy or congenital anomalies of supra-aortic vessel take-off may increase carotid artery stenting (CAS) procedural difficulties and complications through the femoral route. We assessed the feasibility, safety, and efficacy of CAS through the right brachial approach in patients in whom left internal carotid artery stenosis and bovine aortic arch configuration were identified with computed tomography (CT) angiography. Bovine configuration of the aortic arch and left carotid artery stenosis were easily identified by CT angiography and successfully treated through the right brachial approach technique. (orig.)

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

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


    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.

  1. Right-sided aortic arch with Kommerell′s aneurysm

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    Sanjay Orathi Patangi


    Full Text Available We present a case report of a 55-year-old lady who presented with progressive dysphagia and was diagnosed with a Kommerell′s aneurysm and a right-sided aortic arch. This case report outlines our management strategy and the challenges encountered during the perioperative period in a patient with this rare anomaly.

  2. Effect of aging on the configurational change of the aortic arch

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    Atsuhiro Kojima


    Full Text Available We explored the relationship between aging and the configuration of the aortic arch using computed tomography angiography (CTA. We retrospectively reviewed CTA obtained in 140 cases. The configuration of the aortic arch was categorized into three types based on the criteria mentioned by Madhwal et al., and the relationships between each configuration and patient characteristics were analyzed. Anomalies of the aortic arch were also explored. Twenty patients had a type-1 aortic arch (mean age, 56.1 years, 30 patients had a type-2 aortic arch (mean age, 66.3 years, and 89 patients had a type-3 aortic arch (mean age, 71.7 years. The mean age of patients with a type-3 aortic arch was significantly higher than that of patients with a type-1 aortic arch. No significant correlations between the type of aortic arch and other factors, such as smoking habit, were seen. The configuration of the aortic arch in our study appears to be significantly affected by the age of the patients.

  3. Antenatal evaluation of fetal interrupted aortic arch type B

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    Ali Babacan


    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.

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

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


    @@ 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. [Relationship between aortic arch shape and blood pressure response after coarctation repair]. (United States)

    Ou, P; Mousseaux, E; Auriacombe, L; Pédroni, E; Balleux, F; Sidi, D; Bonnet, D


    The mechanisms of secondary hypertension after repair of coarctation of the aorta are not well understood. Abnormalities of the architecture of the aortic arch and their consequences on blood pressure have not been studied. In order to study the relationship between abnormalities or aortic arch architecture and resting blood pressure ninety-four patients without re-coarctation were followed up prospectively from 1997 to 2004 (mean age 16.9 +/- 8.1 years; mean weight 57.5 +/- 18.3 Kg; interval since surgery 16.3 +/- 5.4 years). All underwent MRI angiography of the thoracic aorta which enabled the abnormalities to be classified in 3 groups: gothic arch, crenellated arch and roman arch. Twenty-four patients (25.5%) were hypertensive and 70 (74.4%) normotensive. There were 40 gothic arches (42.5%). 14 crenellated arches (15%) and 40 roman arches (42.5%). Gothic arches were more commonly observed in the hypertensive patients (18/40, [45%, 95% CI 31-62]) than the crenellated arches (4/14, [28.5%, 95% CI 7-48]) or the roman arches (2/40, [5%, 95% CI 2-12]). Only the gothic arch was independently correlated with hypertension on multivariate analysis. The authors conclude that gothic deformation of the aortic arch is an independent predictive factor of hypertension in patients operated for coarctation with an excellent result on the isthmic region. Patients with a gothic appearance of their aortic arch should be followed up closely.

  6. Axillary artery counter-current aortography in the newborn with aortic arch obstruction

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    Lau, K.C.; Lo, R.N.S.; Leung, M.P.


    13 newborn infants with aortic coarctation were evaluated by counter-current aortographic technique. The right radial or brachial artery approach (2 cases in each group) did not give successful aortic arch imaging while the right axiallary artery approach resulted in adequate imaging in each of 9 cases investigated. In 2, the axillary artery was transiently weakened but returned to normal within 24 hours. No other complications were encountered. Axillary artery counter-current aortography is a safe and relatively non-invasive procedure which can be used to image the aortic arch in the newborn babies when other non-invasive diagnosis of aortic arch obstruction is tentative. (orig.).

  7. Importance of stent-graft design for aortic arch aneurysm repair

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    C Singh


    Full Text Available Aneurysm of the aorta is currently treated by open surgical repair or endovascular repair. However, when the aneurysm occurs in regions between the aortic arch and proximal descending aorta, it can be a complex pathology to treat due to its intricate geometry. When complex aortic aneurysms are treated with the conventional procedures, some of the patients present with significant post-operative complications and high mortality rate. Consequently, a clinically driven hybrid innovation known as the frozen elephant trunk procedure was introduced to treat complex aortic aneurysms. Although this procedure significantly reduces mortality rate and operating time, it is still associated with complications such as endoleaks, spinal cord ischemia, renal failure and stroke. Some of these complications are consequences of a mismatch in the biomechanical behaviour of the stent-graft device and the aorta. Research on complex aneurysm repair tended to focus more on the surgical procedure than the stent-graft design. Current stent-graft devices are suitable for straight vessels. However, when used to treat aortic aneurysm with complex geometry, these devices are ineffective in restoring the normal biological and biomechanical function of the aorta. A stent-graft device with mechanical properties that are comparable with the aorta and aortic arch could possibly lead to fewer post-operative complications, thus, better outcome for patients with complex aneurysm conditions. This review highlights the influence stent-graft design has on the biomechanical properties of the aorta which in turn can contribute to complications of complex aneurysm repair. Design attributes critical for minimising postoperative biomechanical mismatch are also discussed.

  8. [Interrupted aortic arch in a 68-year-old female with hypertension]. (United States)

    Benincasa, Susanna; Fineschi, Massimo; Ceccherini, Claudio; Pierli, Carlo


    Interrupted aortic arch (IAA) is a rare congenital malformation of the aorta and aortic arch. We report the case of a 68-year-old female with hypertension and poor control of blood pressure levels. She was diagnosed with aortic coarctation by aortography during young age. A double access angiography was performed that showed a type A IAA, a rare condition in adults that may cause hypertension.

  9. 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

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


    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.)

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

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


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

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    Eshraghi N


    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.

  12. 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)


    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.)

  13. Novel technique for arch and visceral artery debranching using ascending aortic inflow. (United States)

    Mussa, Firas F; Walkes, Jon-Cecil; Lumsden, Alan B; Reardon, Michael J


    Aortic arch aneurysms extending proximally to the left subclavian artery have traditionally been approached through a median sternotomy and a staged elephant trunk procedure requiring a left thoracotomy or thoracoabdominal incision. We describe a novel technique for repair of such aneurysms in a single-stage, hybrid approach using bypass grafts arising from the ascending aorta to all arch and upper abdominal visceral arteries followed by endovascular exclusion of the aortic aneurysm.

  14. Goldenhar syndrome with right circumflex aortic arch, severe coarctation and vascular ring in a twin pregnancy

    Directory of Open Access Journals (Sweden)

    Elaheh Malakan Rad


    Full Text Available Goldenhar syndrome (GS or oculo-auriculo-vertebral dysplasia (OAVD, involves a wide variety of organ systems. Cardiovascular anomalies are among the frequent malformations. The purpose of this report is to introduce a male case of a dizygotic twin pregnancy with GS and right circumflex aortic arch (RCAA, severe coarctation, hypoplastic aortic arch, aberrant right subclavian artery, vascular ring, bilateral renal artery stenosis, and mild Dandy-Walker syndrome. The embryology of RCAA and coarctation is revisited.

  15. Goldenhar syndrome with right circumflex aortic arch, severe coarctation and vascular ring in a twin pregnancy


    Elaheh Malakan Rad


    Goldenhar syndrome (GS) or oculo-auriculo-vertebral dysplasia (OAVD), involves a wide variety of organ systems. Cardiovascular anomalies are among the frequent malformations. The purpose of this report is to introduce a male case of a dizygotic twin pregnancy with GS and right circumflex aortic arch (RCAA), severe coarctation, hypoplastic aortic arch, aberrant right subclavian artery, vascular ring, bilateral renal artery stenosis, and mild Dandy-Walker syndrome. The embryology of RCAA and co...

  16. Goldenhar syndrome with right circumflex aortic arch, severe coarctation and vascular ring in a twin pregnancy. (United States)

    Rad, Elaheh Malakan


    Goldenhar syndrome (GS) or oculo-auriculo-vertebral dysplasia (OAVD), involves a wide variety of organ systems. Cardiovascular anomalies are among the frequent malformations. The purpose of this report is to introduce a male case of a dizygotic twin pregnancy with GS and right circumflex aortic arch (RCAA), severe coarctation, hypoplastic aortic arch, aberrant right subclavian artery, vascular ring, bilateral renal artery stenosis, and mild Dandy-Walker syndrome. The embryology of RCAA and coarctation is revisited.

  17. Goldenhar syndrome with right circumflex aortic arch, severe coarctation and vascular ring in a twin pregnancy (United States)

    Rad, Elaheh Malakan


    Goldenhar syndrome (GS) or oculo-auriculo-vertebral dysplasia (OAVD), involves a wide variety of organ systems. Cardiovascular anomalies are among the frequent malformations. The purpose of this report is to introduce a male case of a dizygotic twin pregnancy with GS and right circumflex aortic arch (RCAA), severe coarctation, hypoplastic aortic arch, aberrant right subclavian artery, vascular ring, bilateral renal artery stenosis, and mild Dandy-Walker syndrome. The embryology of RCAA and coarctation is revisited. PMID:25298700

  18. Ductal Stent Implantation in Tetralogy of Fallot with Aortic Arch Abnormality (United States)

    Ergul, Yakup; Saygi, Murat; Ozyilmaz, Isa; Guzeltas, Alper; Odemis, Ender


    Stenting of patent ductus arteriosus is an alternative to palliative cardiac surgery in newborns with duct-dependent or decreased pulmonary circulation; however, the use of this technique in patients with an aortic arch abnormality presents a challenge. Tetralogy of Fallot is a congenital heart defect that is frequently associated with anomalies of the aortic arch and its branches. The association is even more common in patients with chromosome 22q11 deletion. We present the case of an 18-day-old male infant who had cyanosis and a heart murmur. After an initial echocardiographic evaluation, the patient was diagnosed with tetralogy of Fallot and right-sided aortic arch. The pulmonary annulus and the main pulmonary artery and its branches were slightly hypoplastic; the ductus arteriosus was small. Conventional and computed tomographic angiograms revealed a double aortic arch and an aberrant left subclavian artery. The right aortic arch branched into the subclavian arteries and continued into the descending aorta, whereas the left aortic arch branched into the common carotid arteries and ended with the patent ductus arteriosus. After evaluation of the ductal anatomy, we implanted a 3.5 × 15-mm coronary stent in the duct. Follow-up injections showed augmented pulmonary flow and an increase in oxygen saturation from 65% to 94%. The patient was also found to have chromosome 22q11 deletion. PMID:26175649

  19. Selective cerebro-myocardial perfusion in complex congenital aortic arch pathology: a novel technique. (United States)

    De Rita, Fabrizio; Lucchese, Gianluca; Barozzi, Luca; Menon, Tiziano; Faggian, Giuseppe; Mazzucco, Alessandro; Luciani, Giovanni Battista


    Simultaneous cerebro-myocardial perfusion has been described in neonatal and infant arch surgery, suggesting a reduction in cardiac morbidity. Here reported is a novel technique for selective cerebral perfusion combined with controlled and independent myocardial perfusion during surgery for complex or recurrent aortic arch lesions. From April 2008 to April 2011, 10 patients with arch pathology underwent surgery (two hypoplastic left heart syndrome [HLHS], four recurrent arch obstruction, two aortic arch hypoplasia + ventricular septal defect [VSD], one single ventricle + transposition of the great arteries + arch hypoplasia, one interrupted aortic arch type B + VSD). Median age was 63 days (6 days-36 years) and median weight 4.0 kg (1.6-52). Via midline sternotomy, an arterial cannula (6 or 8 Fr for infants) was directly inserted into the innominate artery or through a polytetrafluoroethylene (PTFE) graft (for neonates cerebro-myocardial perfusion was 39 ± 18 min (17-69). Weaning from cardiopulmonary bypass was achieved without inotropic support in three and with low dose in seven patients. One patient required veno-arterial extracorporeal membrane oxygenation. Four patients, body weight cerebro-myocardial perfusion is feasible in patients with complex or recurrent aortic arch disease, starting from premature newborn less than 2.0 kg of body weight to adults. The technique is as safe as previously reported methods of cerebro-myocardial perfusion and possibly more versatile.

  20. Development of the human aortic arch system captured in an interactive three-dimensional reference model. (United States)

    Rana, M Sameer; Sizarov, Aleksander; Christoffels, Vincent M; Moorman, Antoon F M


    Variations and mutations in the human genome, such as 22q11.2 microdeletion, can increase the risk for congenital defects, including aortic arch malformations. Animal models are increasingly expanding our molecular and genetic insights into aortic arch development. However, in order to justify animal-to-human extrapolations, a human morphological, and molecular reference model would be of great value, but is currently lacking. Here, we present interactive three-dimensional reconstructions of the developing human aortic arch system, supplemented with the protein distribution of developmental markers for patterning and growth, including T-box transcription factor TBX1, a major candidate for the phenotypes found in patients with the 22q11.2 microdeletion. These reconstructions and expression data facilitate unbiased interpretations, and reveal previously unappreciated aspects of human aortic arch development. Based on our reconstructions and on reported congenital anomalies of the pulmonary trunk and tributaries, we postulate that the pulmonary arteries originate from the aortic sac, rather than from the sixth pharyngeal arch arteries. Similar to mouse, TBX1 is expressed in pharyngeal mesenchyme and epithelia. The endothelium of the pharyngeal arch arteries is largely negative for TBX1 and family member TBX2 but expresses neural crest marker AP2α, which gradually decreases with ongoing development of vascular smooth muscle. At early stages, the pharyngeal arch arteries, aortic sac, and the dorsal aortae in particular were largely negative for proliferation marker Ki67, potentially an important parameter during aortic arch system remodeling. Together, our data support current animal-to-human extrapolations and future genetic and molecular analyses using animal models of congenital heart disease. © 2013 Wiley Periodicals, Inc.

  1. Abnormal aortic arch morphology in Turner syndrome patients is a risk factor for hypertension. (United States)

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


    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.

  2. 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


    [ 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.

  3. Aortic arch thrombectomy in a 2.8 kilogram neonate--a case report and review of the literature. (United States)

    Omeje, Ikenna; Ram, Awat; Kostolny, Martin


    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.

  4. The origin and significance of secondary flows in the aortic arch. (United States)

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


    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.

  5. 57. Growth of left ventricular outflow tract after repair of ventricular septal defect and aortic arch obstruction

    Directory of Open Access Journals (Sweden)

    Abdulraouf Jijeh


    Conclusion: There is significant LVOT growth expected after repair of VSD and aortic arch obstruction. Small aortic valve and LVOT at diagnosis of those cases are not correlating with the need of surgical reintervention for LVOT obstruction.

  6. Role of aortic arch vascular mechanics in cardiovagal baroreflex sensitivity. (United States)

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


    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.

  7. Critical thrombotic obstruction of transverse aortic arch in a neonate

    Directory of Open Access Journals (Sweden)

    Karunakar Vadlamudi


    Full Text Available A 3-day-old neonate presented with features suggestive of coarctation of aorta. Echocardiography showed a large organized thrombus in the transverse arch causing obstruction to theaortic arch and carotids with partial recanalization. Patient underwent surgical thromboendarterectomy with arch reconstruction. The evaluation did not reveal any hematological abnormalities and suspected to be due to fetal thromboembolism. Patient improved well, and no neurological deficits were observed during follow-up.

  8. Surgical management of a hypoplastic distal aortic arch and coarctation of aorta in a patient with Klippel-Feil syndrome, ascending aortic aneurysm and bicuspid aortic valve. (United States)

    Sabol, Frantisek; Kolesar, Adrián; Toporcer, Tomás; Bajmoczi, Milan


    Klippel-Feil syndrome has been associated with cardiovascular malformations, but only 3 cases have been reported to be associated with aortic coarctation and surgical management is not defined. A 51-year old woman with Klippel-Feil syndrome associated with an aneurysm of the ascending aorta, hypoplastic aortic arch and aortic coarctation at the level of the left subclavian artery presented with shortness of breath 2 years after diagnosis. Imaging identified interim development of a 7.2-cm aneurysm at the level of the aortic coarctation. She underwent surgical repair with a Dacron interposition graft under hypothermic circulatory arrest. She continues to do well 18 months following repair.

  9. Right aortic arch with aberrant left innominate artery: MR imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Midiri, M. [Istituto di Radiologia, Policlinico Universitario, Bari (Italy); Finazzo, M.; Lagalla, R.; De Maria, M. [Istituto di Radiologia ``Pietro Cignolini``, Policlinico Universitario, Palermo (Italy); Pilato, M. [Reparto di Cardiochirurgia, Palermo (Italy)


    A rare case of a 60-year-old man with a right aortic arch and aberrant left innominate artery is presented. This case had an unusual clinical presentation. The dysphagia appeared suddenly in adulthood, whereas vascular rings, when symptomatic, usually manifest early in childhood.To our knowledge, MR imaging findings of this anomaly have never been reported. The diagnosis was made by MR imaging and confirmed by surgery. Magnetic resonance imaging can replace angiography in the assessment of the aortic arch anomalies. (orig.) With 4 figs., 11 refs.

  10. Cardiogenic shock due to coronary artery disease associated with interrupted aortic arch

    Directory of Open Access Journals (Sweden)

    Luís Alberto Oliveira Dallan


    Full Text Available Acute pulmonary edema is a serious event. Its occurrence in association with interrupted aortic arch and coronary heart disease is rare. Recently, an old patient developed cardiogenic shock and acute pulmonary edema due to acute coronary insufficiency, associated with interrupted aortic arch. The coronary angiography revealed occlusion of the right coronary artery and 95% obstruction in the left main coronary artery, associated with interruption of the descending aorta. Coronary artery bypass graft was performed, without extracorporeal circulation, to the anterior descending coronary artery. We discuss the initial management, given the seriousness of the case.

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

    Directory of Open Access Journals (Sweden)

    Isao Watanabe


    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.

  12. [Application of multiple-branch prostheses in reconstruction of the aortic arch in DeBakey Type I aortic dissection]. (United States)

    Cherniavskiĭ, A M; Alsov, S A; Marchenko, A V; Smolianinov, K A; Sizov, G G; Zotov, A S


    Over the period from January 2002 to March 2005, a total of 78 patients were operated on for DeBakey type I aortic dissection. Of these, five patients underwent prosthetic reconstruction of the aortic arch and brachiocephalic arteries (BCA), performed with the help of the Dacron prosthesis Gelweave four-branch plexus Vascutek. The major indication for using this prosthesis was the extending of the dissection into the BC As, with various degree of obstruction thereof. The overwhelming majority of the patients were men (80 %). The patients' average age amounted to 44.3+/-5.6 years (ranging from 36 to 57 years). In three cases, the aortic dissection was of chronic course, with acute and subacute dissection being diagnosed in the remaining two cases. The median-sternotomy access, and additional approaches to the left and right common carotid arteries were used in order to carry out prosthetic reconstruction of the ascending branch, aortic arch, right subclavian artery, right common carotid artery (CCA) and left CCA with the help of the multiple-branch prosthesis. Protection of the brain consisted of craniocerebral hypothermia, hypothermal circulatory arrest in a combination with retrograde cerebral perfusions through the vena cava superior. The duration of the circulatory arrest averagely amounted to 59.2+/-4 min, with the mean time of artificial circulation equalling 230.6+/-19.7 min, and the time of aortic occlusion was 193.1+/-11 minutes. None of the patients developed either neurological or haemorrhagic complications postoperatively. Hence, the surgical technique using multiple-branch prostheses for prosthetic reconstruction of the aortic arch in type I aortic dissection with BCA obstruction proved to be effective and safe.

  13. 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

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

    NARCIS (Netherlands)

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


    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

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

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    Vučurević Goran


    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.

  16. Common variable immunodeficiency syndrome with right aortic arch: a case report

    Directory of Open Access Journals (Sweden)

    Erbay Riza


    Full Text Available Abstract Background Common variable immunodificiency syndrome predominantly affects adults. It is characterized by low production of all the major classes of immunoglobulins. We report a case of common variable immunodeficiency syndrome with right aortic arch. An association of right-sided arch and common variable immunodificiency syndrome has not been previously reported. Case presentation A 41-year-old female patient presented with a history of recurrent pneumonia, sinusitis, otitis media, diarrhoea, cystitis since childhood. Biochemical and immunocytochemical analysis revealed common variable immunodeficiency syndrome and radiological evaluation confirmed right aortic arch and aberrant left subclavian artery. Conclusion Common variable immunodeficiency syndrome syndrome is a clinical entity that should be kept in mind in patients with recurrent infections of different sites.

  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


    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. 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


    @@ 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.

  19. 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)


    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.)

  20. 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


    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.

  1. Magnetic resonance imaging of coarctation of the aorta and postoperative interrupted aortic arch

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    Kakizawa, Hideyuki; Tanaka, Takashi; Takada, Osamu; Nakayama, Shingo; Ogata, Hiroshi; Zuguchi, Masayuki (Tohoku Univ., Sendai (Japan). School of Medicine)


    ECG-gated MRI was performed at 1.5 T on 9 patients with coarctation of the aorta and restensis of the aorta after previous aortoplasty for coarctation of the aorta or interrupted aortic arch. The age of the patients ranged from 7 days to 3.3 years. MRI was more useful in assessing the severity of stenosis than echocardiography. Four patients had balloon dilation angioplasty for restenosis of the aorta. MRI was also useful in deciding the appropriate balloon size for angioplasty, and follow up after treatment. However, MRI could not always visualize the whole lesion in one slice, especially when the course of the aortic arch was not on the same plane. (author).

  2. Left-Sided Patent Ductus Arteriosus in a Right-Sided Aortic Arch

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    Ming-Yen Ng


    Full Text Available We present a 31-year-old female with repaired tetralogy of Fallot (TOF and right-sided aortic arch (RAA with left-sided patent ductus arteriosus (PDA originating from the left brachiocephalic artery. This is a rare finding but most common site for a PDA in TOF and a RAA. To the best of our knowledge, this is the first demonstration of this rare finding on MRI in the literature.

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

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    M.Y. Mubarak


    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. Hybrid palliation of interrupted aortic arch in a high-risk neonate

    Directory of Open Access Journals (Sweden)

    Karimi Mohsen


    Full Text Available We report a case of a high-risk neonate with interrupted aortic arch (IAA and ventricular septal defect who underwent a successful hybrid palliative procedure using a ductal stent and bilateral branch pulmonary artery banding. This case represents not only a successful use of hybrid approach in high-risk neonates with IAA, but also introduces an alternative and safe access for ductal stent insertion through the right ventricular infundibulum.

  5. Retrograde cerebral perfusion (RCP) in aortic arch surgery: efficacy and possible mechanisms of brain protection. (United States)

    Bavaria, J E; Pochettino, A


    Retrograde cerebral perfusion (RCP) was first introduced to treat air embolism during cardiopulmonary bypass (CPB). Its use was reintroduced to extend the safety of hypothermic circulatory arrest (HCA) during operations involving an open aortic arch. RCP seems to prevent cerebral rewarming during HCA. Both clinical and animal data suggest that RCP provides between 10% and 30% of baseline cerebral blood flow when administered through the superior vena cava (SVC) at jugular pressures of 20 to 25 mm Hg. RCP flows producing jugular venous pressures higher than 30 mm Hg may cause cerebral edema. Cerebral blood flow generated by RCP is able to sustain some cerebral metabolic activity, yet is not able to fully meet cerebral energy demands even at temperatures of 12 degrees to 18 degrees C. RCP may further prevent embolic events during aortic arch surgery when administered at moderate jugular vein pressures (RCP, when applied during aortic arch reconstruction, may extend the safe HCA period and improve morbidity and mortality, especially when HCA times are more than 60 minutes. RCP applied in patients and severe carotid and brachiocephalic occlusive disease may be ineffective, and caution is in order when RCP times are greater than 90 minutes.

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

    Genovese, Katia; Humphrey, Jay D


    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. Biomechanical implications of excessive endograft protrusion into the aortic arch after thoracic endovascular repair. (United States)

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


    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.

  8. Aortic root and proximal aortic arch replacement (performed by a left-handed surgeon). (United States)

    Carrel, Thierry


    We present our standard technique of composite graft replacement performed by a left-handed surgeon. This procedure is performed with a 30-day mortality comparable to that of elective isolated aortic valve replacement.

  9. Central retinal artery occlusion following laser treatment for ocular ischemic aortic arch syndrome

    Directory of Open Access Journals (Sweden)

    Shah, Payal J.


    Full Text Available Objective: Ocular ischemic syndrome is a rare blinding condition generally caused by disease of the carotid artery. We describe a 69-year-old female with a 50 pack-year smoking history with aortic arch syndrome causing bilateral ocular ischemic syndrome. Methods: The patient presented with progressive visual loss and temple pain. Slit lamp biomicroscopy revealed bilateral iris neovascularization. This finding prompted a cardiovascular work up. Panretinal photocoagulation with retrobulbar block was performed in the right eye. Results: A temporal artery biopsy was negative. The carotid duplex sound showed only a 1–39% stenosis. MRA revealed a more proximal occlusion of the aortic branch for which she underwent subclavian carotid bypass surgery. At the one month follow up, the right eye suffered profound vision loss secondary to a central retinal artery occlusion. Conclusion: Ocular neovascularization may be one of the clinical manifestations of aortic arch syndrome. This case also illustrates the limitations of relying solely on carotid duplex ultrasound testing. We caution against overly aggressive panretinal photocoagulation utilizing retrobulbar anesthesia.

  10. Persistent fifth arch anomalies - broadening the spectrum to include a variation of double aortic arch vascular ring

    Energy Technology Data Exchange (ETDEWEB)

    Newman, Beverley; Chan, Frandics [Stanford Children' s Hospital and Stanford University, Department of Radiology, Stanford, CA (United States); Hanneman, Kate [University of Toronto, Department of Medical Imaging, Toronto, ON (Canada)


    Fifth arch anomalies are rare and complex and frequently misdiagnosed or mistaken for other entities. We report a double arch vascular ring that is thought to consist of right fourth arch and left fifth arch components, a previously undescribed persistent fifth arch variant. The currently recognized spectrum and classification of fifth arch vascular anomalies are expanded along with illustrative images to justify the proposed changes. Reviewing and expanding the classification of fifth arch anomalies to include a double arch ring variant will promote recognition, correct diagnosis and appropriate management of these anomalies. (orig.)

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

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    Yamada, Shigeki, E-mail: [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: [Department of Neurosurgery, Kishiwada Municipal Hospital, Osaka (Japan); Ogata, Hideki, E-mail: [Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka (Japan); Watanabe, Yoshihiko, E-mail: [Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka (Japan); Oshima, Marie, E-mail: [Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, Tokyo (Japan); Miyake, Hidenori, E-mail: [Department of Neurosurgery, Hamamatsu Rosai Hospital, Shizuoka (Japan)


    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.

  12. A rare association of interrupted aortic arch type C and microdeletion 22q11.2. (United States)

    Cuturilo, Goran; Drakulic, Danijela; Stevanovic, Milena; Jovanovic, Ida; Djukic, Milan; Miletic-Grkovic, Slobodanka; Atanaskovic-Markovic, Marina


    Microdeletion 22q11.2 is associated with a variety of findings, and the most common are cardiac defects. It is very frequently associated with interrupted aortic arch (IAA) type B and very rarely with type A and type C. Here we report the first case of IAA type C associated with 22q11.2 deletion in Serbia and, to the best of our knowledge, the fourth case described worldwide so far. By this report we would like to point out that all patients with IAA type C who have additional features specific for 22q11.2 microdeletion syndrome should be screened for the presence of this deletion.

  13. 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


    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

  14. Isolation of the Left Innominate Artery with a Right Aortic Arch in a 76 year-old Man: A Case Report

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    Kim, Young Tong; Jou, Sung Shick; Bae, Won Kyung [Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of)


    Isolation of the left innominate artery is a rare anomaly and is usually combined with a right side aortic arch. Most patients are neonates or children with congenital heart disease. We report the MDCT findings of a right aortic arch and isolation of the left innominate artery in a 76-year-old man without congenital heart disease

  15. Dopplersonographic diagnosis of subclavian steal in infants with coarctation of the aorta and interrupted aortic arch. [Comparison with angiocardiographic findings

    Energy Technology Data Exchange (ETDEWEB)

    Deeg, K.H.; Singer, H.


    In two newborns with severe coarctation of the aorta and interrupted aortic arch, subclavian-steal was shown by angiocardiography. In both children pulsed doppler recordings were obtained in the cerebral arteries: Normal forward flow during systole and diastole could be shown in the anterior cerebral arteries, both internal carotid arteries, the basilar artery and the right vertebral artery. In the left vertebral artery in both infants a negative flow indicating backflow from the brain could be shown. Pulsed doppler sonography of the flow in the vertebral arteries is a non invasive method for diagnosis of subclavian steal in infants with coarctation of the aorta and interrupted aortic arch.

  16. Medical image of the week: atherosclerotic aneurysm of aortic arch and descecnding thoracic aorta

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    Parasram M


    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 ...

  17. 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


    @@ 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.

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

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    Roberto Chiesa


    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

  19. Isolated left brachiocephalic artery with the right aortic arch: A rare differential of large patent ductus arteriosus (United States)

    Dubey, Gajendra; Gupta, Saurabh Kumar; Kothari, Shyam Sundar


    We report a case of isolation of the left brachiocephalic artery with the right aortic arch in a 9-year-old male child masquerading as large patent ductus arteriosus with left-to-right shunt. We have emphasized the subtle clinical findings which served as clues to the diagnosis. PMID:28163435

  20. Right Aortic Arch with a Retroesophageal Left Subclavian Artery and an Anomalous Origin of the Pulmonary Artery from the Aorta (United States)

    Jeon, Chang-Seok; Shim, Man-shik; Yang, Ji-Hyuk; Jun, Tae-Gook


    We report the case of a newborn with a rare anatomic variation: a right aortic arch with a retroesophageal left subclavian artery and an anomalous origin of the pulmonary artery from the aorta. This variation was diagnosed using echocardiography and computed tomography, and we treated the condition surgically. PMID:28180103

  1. Clinical and biochemical outcomes for additive mesenteric and lower body perfusion during hypothermic circulatory arrest for complex total aortic arch replacement surgery. (United States)

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


    Surgical repair of transverse aortic arch aneurysms frequently employ hypothermia and antegrade cerebral perfusion as protective strategies during circulatory arrest. However, prolonged mesenteric and lower limb ischemia can lead to significant lactic acidosis and end organ dysfunction, which remains a significant cause of post-operative morbidity and mortality. We report our experience with additive warm mesenteric and lower body perfusion (1-3 L/min, 30°C) in addition to continuous cerebral and myocardial perfusion in 5 patients who underwent total aortic arch replacement with trifurcated head vessel re-implantation and distal elephant trunk reconstruction. Concomitant surgical procedures included re-operations (2), aortic root operations (2), coronary artery bypass (2) and descending thoracic aortic replacement (1). Serum lactate levels demonstrated a rapid decline from a peak 9.9 ± 2.6 post circulatory arrest to 3.4 ± 2.0 in the intensive care unit (ICU). The lowest serum bicarbonate levels were 19.3 ± 3.5 mmol/L, intra-operatively, which normalized to 28.4 ± 2.4 mmol/L on return to the ICU. The lowest pH levels were 7.25 ± 0.10, corrected to 7.43 ± 0.04 on return to the ICU. Mean cardiopulmonary bypass and aortic cross-clamp times were 361 ± 104 and 253 ± 85 minutes, respectively. Mean cerebral and lower body circulatory arrest times were 0 (0) and 50 ± 35 minutes, respectively. The mean time required for systemic rewarming was 95 ± 66 minutes. There were no in-hospital mortalities and no patient experienced any neurological, mesenteric, renal or lower limb ischemic complications. Two patients required mechanical ventilation >24 hours, and one patient returned for reoperation for bleeding. Median intensive care unit and total hospital lengths of stay were 5 and 16 days, respectively. Our results suggest early serum lactate clearance, normalization of acidosis, and metabolic recovery when utilizing a simultaneous cerebral perfusion and warm body

  2. "Squid-capture" modified in situ stent-graft fenestration technique for aortic arch aneurysm repair. (United States)

    Hongo, Norio; Miyamoto, Shinji; Shuto, Rieko; Wada, Tomoyuki; Kamei, Noritaka; Sato, Aiko; Matsumoto, Shunro; Kiyosue, Hiro; Mori, Hiromu


    An 83-year-old female was found to have an fusiform aneurysm in the aortic arch. She was deemed to be a high surgical risk; therefore, endovascular stent-graft placement followed by revascularization of the brachiocephalic trunk using in situ stent-graft fenestration was considered. However, the safe application of fenestration was deemed difficult due to the tortuosity of the brachiocephalic artery. The patient was successfully treated with the aid of the "squid-capture" technique, which consists of deployment of the stent-graft in a snare wire loop that was advanced from the brachiocephalic artery and fenestration of the stent-graft with the support of the loop. A follow-up exam revealed complete sealing of the aneurysm without any complications. The squid-capture technique allows for the safe and secure puncture of the graft.

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

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    Ana Rita Abrão


    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.

  4. Ramos do arco aórtico de bubalinos Branches of the aortic arch of buffaloes

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    Leandro Marcel Fernandes Cortellini


    Full Text Available Os ramos do arco aórtico (Arcus aortae em bubalinos foram investigados neste trabalho. Assim, foram dissecadas as artérias oriundas desse arco previamente injetadas com solução corada de látex Neoprene 650â (Du Pont do Brasil S.A. em 20 fetos dessa espécie, machos e fêmeas com idades entre 4 e 8 meses de gestação. Em 80% dos casos, observou-se que o tronco braquiocefálico (Truncus brachiocephalicus emite a artéria subclávia (Arteria subclavia esquerda, artérias carótidas comuns (Arteria carotis communis esquerda e direita, sem caracterizar tronco bicarotídeo (Truncus bicaroticus, e a artéria subclávia direita. As artérias subclávias direita e esquerda originam em comum o tronco costocervical (Truncus costocervicalis, a artéria cervical superficial (Arteria cervicalis superficialis, artérias axilares (Arteria axillaris e artéria torácica interna (Arteria thoracica interna. Em 20% dos casos, o tronco braquiocefálico origina a artéria subclávia esquerda em comum ao tronco costocervical esquerdo; em seguida, emite a artéria carótida comum esquerda e termina trifurcando-se em artéria carótida comum direita, artéria subclávia direita e tronco costocervical direito, sendo que as artérias subclávias direita e esquerda têm origem comum com as artérias cervical superficial, axilar e torácica interna, com a presença do tronco bicarotídeo, característico dos bovinos.The branches of the aortic arch (Arcus aortae of buffaoes were investigated in this study. Therefore, dissections were procedeed in previously injected arteries (using coloured Neoprene latex 650â - Du Pont do Brasil S.A. of 20 buffalo foetuses, theses males and females between four and eight months of gestation . In 80% of the cases it was observed that the brachiocephalic trunk (Truncus brachiocephalicus gives off the left subclavian artery, (Arteria subclavia the right and left common carotid arteries (Arteria carotis communis - being absent the

  5. Sustained maternal hyperoxygenation improves aortic arch dimensions in fetuses with coarctation (United States)

    Zeng, Shi; Zhou, Jiawei; Peng, Qinghai; Deng, Wen; Zhang, Ming; Zhao, Yili; Wang, Tao; Zhou, Qichang


    The aim was to investigate the impact of maternal hyperoxygenation (HO) on cardiac dimensions in fetuses with isolated Coarctation (CoA). Fetal echocardiography was performed serially in 48 fetuses with CoA and gestation age matched normal fetues. The Z-scores for the mitral valve (MV), tricuspid valve (TV), aortic valve (AV), ascending aorta (AAo), isthmus, pulmonary valve (PV), main pulmonary artery (MPA), and descending aorta (DAo) were measured and compared among normal fetuses, CoA fetuses with oxygen and CoA fetuses with air. In the group with oxygen, 6 L/min oxygen was administered to the mother using a face mask. Regression analyses were performed to identify potential factors for HO outcome. The left heart dimension Z-scores increased gradually during HO therapy periods, especially at 4 weeks after oxygen therapy (P < 0.05). As for the case group with air, the left heart dimension remained unchanged. The duration of HO was associated with aortic arch Z-scores (adjusted R2 = 0.199, 0.60 for AAO and isthmus, respectively). Sustained maternal middle-flow oxygenation can be safely used to improve left heart dimensions in fetuses with isolated CoA. The duration of HO were associated with treatment outcome. These findings may provide useful information for developing novel treatment strategies. PMID:27982102

  6. 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)


    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.)

  7. 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)


    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.

  8. Pulmonary artery stenosis caused by a large aortic arch pseudoaneurysm detected 10 years after a minor trauma

    Directory of Open Access Journals (Sweden)

    Jalal Zamani


    Full Text Available Pseudoaneurysm of aorta is a rare condition usually seen after aortic surgeries or serious accidents. Here we report a 60 years old man without any previous medical condition who presented with non-specific symptoms and underwent different investigations for more than 1 year, until the presence of a continuous murmur raised suspicion toward his cardiovascular system. In echocardiographic and computed tomography (CT angiographic studies a large pseudoaneurysm of aortic arch with compression effect on pulmonary artery was detected. At this stage he remembered having suffered a minor trauma 10 years ago. He finally underwent operation and his aortic wall was repaired successfully with a patch. This case highlights the importance of thorough history taking and physical examination in patients irrespective of symptoms and high index of suspicion to detect this life-threatening condition.

  9. In vitro flow investigations in the aortic arch during cardiopulmonary bypass with stereo-PIV. (United States)

    Büsen, Martin; Kaufmann, Tim A S; Neidlin, Michael; Steinseifer, Ulrich; Sonntag, Simon J


    The cardiopulmonary bypass is related to complications like stroke or hypoxia. The cannula jet is suspected to be one reason for these complications, due to the sandblast effect on the vessel wall. Several in silico and in vitro studies investigated the underlying mechanisms, but the applied experimental flow measurement techniques were not able to address the highly three-dimensional flow character with a satisfying resolution. In this work in vitro flow measurements in a cannulated and a non-cannulated aortic silicone model are presented. Stereo particle image velocimetry measurements in multiple planes were carried out. By assembling the data of the different measurement planes, quasi 3D velocity fields with a resolution of~1.5×1.5×2.5 mm(3) were obtained. The resulting velocity fields have been compared regarding magnitude, streamlines and vorticity. The presented method shows to be a suitable in vitro technique to measure and address the three-dimensional aortic CPB cannula flow with a high temporal and spatial resolution.

  10. 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:; 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: [Guy' s and St. Thomas' NHS Trust, Vascular Surgery (United Kingdom)


    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.

  11. 主动脉弓部手术的护理体会%Nursing experience of aortic arch operation

    Institute of Scientific and Technical Information of China (English)



    Objective To summarize the nursing experience of aortic arch operation. Methods 27 patients underwent aortic arch operation from Jan 2007 to Apr 2012 were enrolled to the study. Clinical datum were collected and analyse the work points of operation. Results 5 cases dead, abandoning treatment in 1 case, 18 cases survived after operation (including 1 case underwent re-operation, 2 cases repeatedly hospitalized due to internal fistula and hemoglobinuria) , 1 case need life care. The dead cases have nothing to do with nursing. Conclusion Aortic arch operation requires deep hypothermic circulatory arrest, lasts longer, with higher mortality, so for nursing staff in operation room, it need more theoretical basis, skilled cooperation and flexibility.%目的 总结主动脉弓部手术的护理体会.方法 回顾性选取我院2007年1月~2012年4月所行的主动脉弓部手术27例,收集相关临床资料,分析术前、术中,巡回、器械护士的工作要点.结果 27例手术均成功实施.结论 主动脉弓部手术需要深低温停循环,手术时间长,病死率高,需要手术室护理人员更扎实的理论基础,更熟练的配合,更灵活的应变能力.

  12. Senile Calcification of the Trachea, Aortic Arch, and Mitral Annulus: An Incidental Finding on Chest X-Ray. (United States)

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


    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).

  13. Fabrication of a compliant phantom of the human aortic arch for use in Particle Image Velocimetry (PIV experimentation

    Directory of Open Access Journals (Sweden)

    Hütter Larissa


    Full Text Available Compliant phantoms of the human aortic arch can mimic patient specific cardiovascular dysfunctions in vitro. Hence, phantoms may enable elucidation of haemodynamic disturbances caused by aortic dysfunction. This paper describes the fabrication of a thin-walled silicone phantom of the human ascending aorta and brachiocephalic artery. The model geometry was determined via a meta-analysis and modelled in SolidWorks before 3D printing. The solid model surface was smoothed and scanned with a 3D scanner. An offset outer mould was milled from Ebalta S-Model board. The final phantom indicated that ABS was a suitable material for the internal model, the Ebalta S-Model board yielded a rough external surface. Co-location of the moulds during silicone pour was insufficient to enable consistent wall thickness. The resulting phantom was free of air bubbles but did not have the desired wall thickness consistency.

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

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


    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.

  15. Analysis of early and long-term outcomes of acute type A aortic dissection according to the new international aortic arch surgery study group recommendations. (United States)

    Colli, Andrea; Carrozzini, Massimiliano; Galuppo, Marco; Comisso, Marina; Toto, Francesca; Gregori, Dario; Gerosa, Gino


    To evaluate predictors of early and long-term outcomes of surgical repair of acute Type A aortic dissection. Retrospective single-centre study evaluating patients surgically treated between 1998 and 2013. Clinical follow-up was performed. Complications were classified according to the International Aortic Arch Surgery Study Group recommendations. Statistical analysis included univariate and multivariate analysis of preoperative and operative data. One hundred eighty-five patients were evaluated. The follow-up was complete for 180 patients (97 %). Mean age was 63 years, 82 % had a DeBakey type I aortic dissection, 18 % a type II. Eleven patients (6 %) died intraoperatively, 119 of the remaining (68 %) had postoperative complications. Thirty-day mortality was 21 % (38 patients). Average ICU and hospital stay were 6 and 14 days, respectively. During a mean follow-up time of 6 ± 4 years we observed 44 deaths (31 %). Twenty patients (14 %) needed late thoracic aorta reoperation. Results from the multivariate analysis are as follows. Thirty-day mortality was associated with abdominal pain at presentation (p < 0.01). The incidence of postoperative complications was related to older age at intervention (p < 0.01) and longer cross-clamp time (p < 0.01). Mortality at follow-up was significantly increased by older age at intervention (p < 0.01), with a logarithmic growth after 60 years, female sex (p < 0.01), preoperative limb ischemia (p = 0.02) and DHCA (p < 0.01). The surgical results of type A aortic dissection are affected by age at intervention with a logarithmic increase of late mortality in patients older than 60 years.

  16. 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)


    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

  17. Diagnosis of aortic coarctation combined with hypoplastic aortic arch by echocardiography%超声心动图诊断主动脉缩窄合并主动脉弓发育不良的价值

    Institute of Scientific and Technical Information of China (English)

    郑春华; 王春燕; 邓风平; 刘湘君; 唐秀杰; 潘广玉; 李洪银; 吴清玉


    Objective To study the diagnosis accuracy and features of echocardiography on aortic coarctation combined with hypoplastic aortic arch. Methods The echocardiographic characteristics of seven patients who were diagnosed as aortic coarctation combined with hypoplastic aortic arch were analyzed and compared with results of cardiac catheterization, CT scan and operation. The diagnostic features of echocardiography were summarized. Results Besides the echocardiographic characteristics of aortic coarctation,other specific echocardiographic characteristics of hypoplastic aortic arch were:distinct stenoses of transverse and decsending part of aortic arch were visualized in supra-sternal long-axis view; the range of hypoplastic part started from innominate artery beginning or left common carotid artery beginning; the ratio of diameter of hypoplastic aortic arch over that of descending aorta at diaphragm was less than 0. 5; the blood flow speed detected by Doppler at the site of aortic coarctation was in the normal range. The echocardiographic characteristics of the aortic coarctation combined with hypoplastic aortic arch were correspondent to the results of cardiac catheterization, CT scan and operation results. Conclusions There is high accuracy of echocardiography in diagnosis of aortic coarctation combined with hypoplastic aortic arch. Hypoplastic aortic arch should be paid more attention in diagnosis of aortic coarctation.%目的 探讨超声心动图诊断主动脉缩窄合并主动脉弓发育不良的准确性.方法 分析7例主动脉缩窄合并主动脉弓发育不良患儿的二维超声图像,并与心血管造影,心脏CT及手术结果对比分析,总结其诊断要点.结果 除主动脉缩窄的超声表现外,超声特异表现为:胸骨上凹主动脉弓长轴切面可见主动脉横弓部及弓降部明显变窄.发育不良的范围可自无名动脉起始后或左颈总动脉起始后;发育不良主动脉弓的内径/膈肌

  18. 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.


    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

  19. Aortic arch replacement with a beating heart: a simple method using continuous 3-way perfusion. (United States)

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


    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.

  20. Left thoracoscopic two-stage repair of tracheoesophageal fistula with a right aortic arch and a vascular ring (United States)

    Oshima, Kazuo; Uchida, Hiroo; Tainaka, Takahisa; Tanano, Akihide; Shirota, Chiyoe; Yokota, Kazuki; Murase, Naruhiko; Shirotsuki, Ryo; Chiba, Kosuke; Hinoki, Akinari


    A right aortic arch (RAA) is found in 5% of neonates with tracheoesophageal fistulae (TEF) and may be associated with vascular rings. Oesophageal repairs for TEF with an RAA via the right chest often pose surgical difficulties. We report for the first time in the world a successful two-stage repair by left-sided thoracoscope for TEF with an RAA and a vascular ring. We switched from right to left thoracoscopy after finding an RAA. A proximal oesophageal pouch was hemmed into the vascular ring; therefore, we selected a two-stage repair. The TEF was resected and simple internal traction was placed into the oesophagus at the first stage. Detailed examination showed the patent ductus arteriosus (PDA) completing a vascular ring. The subsequent primary oesophago-oesophagostomy and dissection of PDA was performed by left-sided thoracoscope. Therefore, left thoracoscopic repair is safe and feasible for treating TEF with an RAA and a vascular ring. PMID:27143697

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

    Energy Technology Data Exchange (ETDEWEB)

    Frydrychowicz, Alex [University Hospital Schleswig-Holstein, Clinic for Radiology and Nuclear Medicine, Luebeck (Germany); Berger, Alexander; Russe, Maximilian F.; Bock, Jelena [University Hospital Freiburg, Department of Radiology, Medical Physics, Freiburg (Germany); Munoz del Rio, Alejandro [University of Wisconsin - Madison, Departments of Radiology and Medical Physics, Madison, WI (United States); Harloff, Andreas [University Hospital Freiburg, Department of Neurology and Clinical Neurophysiology, Freiburg (Germany); Markl, Michael [University Hospital Freiburg, Department of Radiology, Medical Physics, Freiburg (Germany); Northwestern University, Departments of Radiology and Biomedical Engineering, Chicago, IL (United States)


    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.)

  2. Self-Expandable Stent for Repairing Coarctation of the Left-Circumferential Aortic Arch with Right-sided Descending Aorta and Aberrant Right Subclavian Artery with Kommerell's Aneurysm. (United States)

    Khajali, Zahra; Sanati, Hamid Reza; Pouraliakbar, Hamidreza; Mohebbi, Bahram; Aeinfar, Kamran; Zolfaghari, Reza


    Endovascular treatment offers a great advantage in the management of main arteries stenoses. However, simultaneous presence of a group of anomalies may complicate the situation. Here we present a case of 21-year-old man with aortic coarctation. Radiographic imaging and angiography demonstrated aortic coarctation of the left-circumferential aortic arch, right-sided descending aorta, and Kommerell's diverticulum at the origin of right subclavian artery. These anomalies have rarely been reported to concurrently exist in the same case and the treatment is challenging. Percutaneous treatment for repair of aortic coarctation was successfully performed with deployment of self-expanding nitinol stents. Follow-up demonstrated the correction of blood pressure and improvement of the symptoms. It appears that deployment of self-expandable nitinol stents present a viable option for the management of coarcted aorta in patients having all or some of these anomalies together.

  3. 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


    by ultrasound were evaluated.Results Left lock,a “U”shaped vascular structure,were found in 15 cases.One case of fetal aortic arch was surrounded by a “O”shaped package.Three cases of right aortic arch showed fetal left artery catheter and brachiocephalic artery ima-ging branch.Echocardiography mainly for arterial catheter in three vessel trachea view did not show up.Artery catheter,in front of the trachea,did not form the vascular ring.Nineteen cases of right aortic arch were exam-ined by fetal karyotype analysis.Three patients with trisomy 18-karyotype presented ventricular septal defect, single artium,three tricuspid atresia,pulmonary artery stenosis.Four cases with trisomy 18-karyotype presen-ted ventricular septal defect,complete atrioventricular canal,single artium,double outlet right ventricle,pul-monary artery stenosis in atresia.Three cases with trisomy 21 -karyotype showed single ventricle,single atri-um.One case was with tetralogy of Fallot and one case with dextrocardia,aortic stenosis,accompanied by 22q 1 1.2.Conclusion In prenatal ultrasound screening,we should pay attention to three vessels-trachea view on ultrasound image,which can improve the detection rate of right aortic arch.Fetal right aortic arch and triso-my 18-,trisomy 21 -,chromosomal diseases are substantially correlated.Further analysis of chromosome kary-otype is needed to exclude chromosomal lesions,so as to achieve the purpose of prenatal and postnatal care.

  4. An unusual case of multiple aortic abnormalities: total occlusion of aortic arch, left external iliac artery, and bicuspid aortic valve in a 21-year-old man. (United States)

    Tanindi, Asli; Tavil, Yusuf; Mutluay, Ruya; Taktak, Hacer; Cengel, Atiye


    An unusual case of total occlusion of aorta just distal to the left subclavian artery, bicuspid aortic valve, and occluded left external iliac artery in a 21-year-old man who was admitted with headache and severe hypertension is presented. We wish to report this case because so far there have been none reported with such multiple aortic abnormalities, although several documented cases of isolated total occlusion of aorta exist. Our patient underwent a successful surgical correction, i.e., patch plasty to the coarcted segment and end to side - end to side aortal-aortal bypass with Dacron graft.

  5. A Rare Case of Pulmonary Atresia with Ventricular Septal Defect with a Right Sided Aortic Arch and a Calcified Pulmonary AVM Presenting in an Adult without Cyanosis

    Directory of Open Access Journals (Sweden)

    Devendra V. Kulkarni


    Full Text Available Pulmonary atresia with ventricular septal defect (PA-VSD with pulmonary arterial supply arising from the aorta representing large MAPCAs associated with a right sided aortic arch is an uncommon anomaly. Most of the patients succumb to severe respiratory compromise or congestive cardiac failure very early. We report the clinical details and imaging findings of a case of PA-VSD with a right sided aortic arch and a calcified pulmonary arteriovenous malformation (AVM in a 21-year-old postpartum female with no previous episodes of cyanosis who was diagnosed as having a cardiac anomaly on echocardiography when she presented with breathlessness during the 8th month of the pregnancy.

  6. Hybrid repair of penetrating aortic ulcer associated with right aortic arch and aberrant left innominate artery arising from aneurysmal Kommerell's diverticulum with simultaneous repair of bilateral common iliac artery aneurysms. (United States)

    Guo, Yuanyuan; Yang, Bin; Cai, Hongbo; Jin, Hui


    We present the first case of a hybrid endovascular approach to a penetrating aortic ulcer on the left descending aorta with a right aortic arch and aberrant left innominate artery arising from an aneurysmal Kommerell's diverticulum. The patient also had bilateral common iliac artery aneurysms. The three-step procedure consisted of a carotid-carotid bypass, followed by endovascular exclusion of the ulcer and the aneurysmal Kommerell's diverticulum, and then completion by covering the iliac aneurysms. The patient had no complications at 18 months after surgery. In such rare configurations, endovascular repair is a safe therapeutic option.

  7. 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


      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.

  8. 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


    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

  9. 主动脉弓滑动成形术治疗婴幼儿主动脉缩窄并主动脉弓发育不良的临床研究%Clinical study of aortic arch sliding aortoplasty in surgical repair of infants with coarctation of the aorta and hypoplastic aortic arch

    Institute of Scientific and Technical Information of China (English)

    熊红燕; 朱海龙; 孙国成; 魏东明; 俞世强


    目的:总结运用主动脉弓滑动成形术治疗婴幼儿主动脉缩窄合并主动脉弓发育不良的临床经验。方法回顾性分析2013年1月至2015年5月间采用主动脉弓滑动成形术治疗主动脉缩窄合并主动脉弓发育不良患儿8例的临床资料。患儿年龄(7.0±5.4)个月(2~21个月),体重(6.6±1.7)kg (4~10 kg),男性6例,女性2例。均经胸骨正中切口在深低温体外循环和选择性脑灌注下,一期完成手术。根据患儿主动脉病理解剖的不同,主动脉弓滑动成形方法略有不同,以达到最好的解剖矫治效果。结果8例患儿均成功完成手术。全组无死亡,未出现肾功能障碍及神经系统功能并发症。术后定期随访(16.0±5.6)个月(6~20个月),末次随访患者下肢收缩压均高于上肢收缩压(8.9±3.2) mmHg (0~15 mmHg)(1 mmHg=0.133 kPa),未发现再狭窄。结论主动脉弓滑动成形术治疗婴幼儿主动脉缩窄合并主动脉弓发育不良具有良好的近中期效果。%Objective To summarize the clinical experiences of aortic arch sliding aortoplasty in surgical repair of infants with coarctation of the aorta and hypoplastic aortic arch.MethodsEight patients with coarctation of the aorta and hypoplastic aortic arch who underwent surgical repair by aortic arch sliding aortoplasty from January 2013 to May 2015 were retrospectively analyzed. The patients' age was (7±5.4) months (2~21 months) and weight was (6.6±1.7) kg (4~10 kg). Six of them were male and two of them were female. All the operations were performed through median sternotomy under deep hypothermia cardiopulmonary bypass with selective cerebral perfusion. According to the pathological anatomy of aortic arch, the techniques were different to reach optimal anatomical repair.ResultsAll patients were repaired successfully. There was no mortality or major complication such as renal dysfunction or nervous system complications

  10. 主动脉缩窄或主动脉弓中断合并心内畸形一期修复%One-stage repair of aortic coarctation or interrupted aortic arch associated with cardiac anomalies through median sternotomy

    Institute of Scientific and Technical Information of China (English)

    方敏华; 朱洪玉; 汪曾炜; 王辉山; 李新民; 宋恒昌


    目的 探讨采用经胸骨正中切口一期修复主动脉缩窄(CoA)或主动脉弓中断(IAA)合并心内畸形的治疗效果.方法 2002年7月至2009年6月,经胸骨正中切口行降主动脉远端和主动脉弓下缘端侧吻合术一期修复CoA或IAA合并心内畸形病儿43例,其中CoA 34例,IAA 9例(A型6例、B型3例),合并心内畸形包括室间隔缺损42例、动脉导管未闭34例、房间隔缺损12例、主动脉瓣下隔膜狭窄5例、二尖瓣关闭不全2例,右心室双出口1例.结果 手术死亡1例,为术后肺动脉高压和严重低心排血量综合征者.术后并发症包括严重低心排血量综合征3例,低氧血症6例,肺部炎症11例,肺不张14例,声音嘶哑19例,室上性心动过速23例.8例失访.34例随访3个月~5年,生活质量明显改善,心脏超声心动图和CT检查显示吻合口无明显再缩窄发生.结论 经胸骨正中切口,采用主动脉远端和主动脉弓下缘端侧吻合技术一期修复CoA或IAA合并心内畸形的手术早、中期效果良好,能明显减少术后再狭窄.%Objective Study the management and outcomes of one-stage repair of aortic coarctation or interrupted aortic arch associated with cardiac anomalies through median sternotomy.Methods From July 2002 to June 2009,43 patients with aortic coarctation(34 cases)or interrupted aortic arch(9 cases)and associated with cardiac anomalies underwent one-stage repair.There were 27 males and 16 females.The age ranged from 5 months to 9 years and the body weight from 3.5 kg to 29.0 kg.The associated cardiac anomalies included ventricular septal defect in 42 patients,patent ductus arterious in 34,secundum atrial septal defect in 12,subaortic stenesis in 5,mitral valve regurgitation in 2 and double outlet of right vantricule in 1.All patients underwent one-stage repair through median sternotomy.The aortic continuity was reestablished by direct anastomosis between the descending aortic segment and aortic arch.Results There

  11. MDCT and 3D evaluation of type 2 hypoplastic pulmonary artery sling associated with right lung agenesis, hypoplastic aortic arch, and long segment tracheal stenosis. (United States)

    Lee, Edward Y


    The early diagnosis and complete anatomic evaluation of pulmonary artery sling, a congenital vascular anomaly in which left pulmonary artery arises from the right pulmonary artery, is paramount for proper patient management, because patients with this disorder frequently have other congenital anomalies resulting in high morbidity and mortality. Until recently, pulmonary artery sling in the neonate has been established with standard radiologic imaging studies such as plain radiographs, barium swallow studies, fluoroscopy-guided airway studies, and echocardiograms. However, with the development and widespread availability of multidetector computed tomography, pulmonary artery sling is increasingly evaluated with this newer technology. This case report presents a rare incidence of type 2 hypoplastic pulmonary artery sling in a neonate associated with right lung agenesis, hypoplastic aortic arch, and long segment tracheal stenosis. Multidetector computed tomography combined with 3-dimensional evaluation was particularly helpful in making a correct diagnosis of the complicated anatomic anomalies found in this case.

  12. 主动脉弓三分支覆膜支架在Stanford A型急性主动脉夹层外科治疗中的应用%The application of triple branches aortic arch stent-graft placement in the surgical treatment of acute Stanford type A aortic dissection

    Institute of Scientific and Technical Information of China (English)

    华菲; 沈振亚; 余云生; 叶文学; 黄浩岳


    was transected near the base of the innominate artery.From the incision, the triple-branched stent graft was implantated into the true lumen of the arch,descending aorta and the aorta bifurcation vessel. The transected stump of the ascending aorta was anastomosis to the proximal of the branched blood vessel prosthesis.Results Cardiopulmonary bypass time was (186 ±38) min,cross clamp time was (101 ±27) min,and average selective cerebral perfusion and lower body arrest time was ( 39 ± 11 ) min.The in-hospital mortality was zero.One patient of transient postoperative neurologic dysfunction, one of acute renal failure, one of transient limbs disturbance, one of secondary thoracotomy operation, one of gastrointestinal hemorrhage and one of postoperative chylothorax were observed.CT angiography rechecked showed the position of the vascular stent were satisfactory and the blood flow of arterial branches stents were lucid .The false lumen of the aortic arch and descending aorta closed with thrombus or shrinked.Conclusions The patients required aortic arch to be reconstructed which had no main tearing of intima in the arch may be best candidates for this technique.Open triple-branched stent graft placement combined ascending aorta replacement is an effective means for aortic arch reconstruction in acute Stanford type A aortic dissection.

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

    Directory of Open Access Journals (Sweden)

    Ishizaka Toru


    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.

  14. Early Diagnosis and Repair of Double Saccular Aneurysms of the Aortic Arch Associated With Aortic Coarctation in an Infant With Loeys-Dietz Syndrome. (United States)

    Ilyin, Vladimir N; Kornoukhov, O Ju; Khovrin, Valery V; Kryukov, Vladislav A; Valitova, Asia A; Ilina, Maria V


    Multiple saccular aneurysms of the thoracic aorta in neonates and infants are exceedingly rare. An association of these aneurysms with Loeys-Dietz syndrome (LDS) in older age-groups is well known. This case report describes the diagnosis and subsequent successful repair of aortic coarctation associated with double saccular aneurysms of the thoracic aorta in patient with LDS during the first year of life.

  15. Surgical repair of left-sided cervical aortic arch aneurysm%左颈位主动脉弓动脉瘤的外科治疗

    Institute of Scientific and Technical Information of China (English)

    郑铁; 朱俊明; 孙立忠; 钟永亮; 齐瑞东; 程力剑; 葛翼鹏; 陈雷; 刘巍; 里程楠; 邢晓燕


    目的:总结颈位主动脉弓(cervical aortic arch,CAA)动脉瘤的外科治疗方法及术后早中期效果。方法2010年1月至2014年12月,收治22例CAA动脉瘤患者,均为左位CAA。其中男6例,女16例,年龄(34.09±13.14)岁。术前合并主动脉假性狭窄9例,高血压3例,主动脉瓣反流、Stanford B型主动脉夹层、大脑中动脉瘤各1例。所有患者均采用人工血管替换术行主动脉弓重建。4例(4/22,18.18%)经胸骨正中切口,中度低温停循环、选择性顺行脑灌注下手术,其中同期行主动脉瓣置换术1例;18例(18/22,81.82%)经左后外侧第4肋间切口手术,其中10例体外循环辅助下实施手术,8例直接阻断下手术。结果全组平均呼吸机辅助(13.05±4.73) h,ICU停留(19.14±8.08) h。术后二次开胸止血1例,切口延迟愈合1例,一过性肝功能不全1例。无院内死亡。术后19例随访平均34.73个月,失访3例。随访期间无死亡。结论 CAA动脉瘤患者应积极手术治疗。根据CAA动脉瘤的位置、类型以及合并的其他近端心血管疾病,选择个体化的手术切口、辅助技术及手术方法,一期行主动脉弓重建手术治疗CAA动脉瘤可获得满意的临床效果。%Objective To summarize our experience of surgical repair for cervical aortic arch(CAA) aneurysm and eval-uate early and midterm results of these patients.Methods From January 2010 to December 2014, 22 patients with left-sided CAA aneurysm admitted in our center.There were 6 male and 16 female patients with a mean age of(34.09 ±13.14) years. Comorbidities included pseudocoarctation in 9 patients, hypertension in 4 patients, and aortic valve insufficiency, Stanford type B aortic dissection and middle cerebral artery aneurysm each had 1 patient.All of the patients underwent surgical aortic arch re-construction using artificial graft replacement.Among them, 4(4/22, 18.18%) were

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

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


    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. The use of a new hybrid stentgraft for the repair of extensive thoracic aortic aneurysms with the frozen elephant trunk method – first Polish experiences


    Zembala, Michał; Krasoń, Marcin; Hrapkowicz, Tomasz; Przybylski, Roman; Filipiak, Krzysztof; Borowicz, Marcin; Niklewski, Tomasz; Głowacki, Jan; Wolny, Tomasz; Nadziakiewicz, Paweł; Walas, Ryszard; Zembala, Marian


    The frozen elephant trunk (FET) technique is a modification of the traditional elephant trunk method, which was introduced by Borst in 1983 in order to treat extensive thoracic aortic aneurysms. The crux of the new method is the different type of aortic prosthesis, consisting of a Dacron part (with or without branches leading to the arterial vessels which exit the aortic arch) and a port for extracorporeal circulation with a self-expanding nitinol stentgraft. This combination enables a comple...

  18. 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


    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.

  19. 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


    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.

  20. 经右侧桡动脉入路支架成形术治疗牛角型或Ⅲ型主动脉弓合并颈动脉狭窄%Treatment of bovine type and type Ⅲ aortic arch carotid stenosis with stent angioplasty via the right radial approach

    Institute of Scientific and Technical Information of China (English)

    许岗勤; 王子亮; 汪勇锋; 梁晓东; 李立; 李天晓


    Objective To investigate the feasibility and safety of the treatment of type Ⅲ aortic arch right carotid stenosis and bovine type aortic arch left carotid stenosis with stent angioplasty via the right radial approach.Methods From September 2015 to February 2016,the clinical data of 16 patients with type Ⅲ aortic arch right carotid stenosis and bovine type aortic arch left carotid stenosis treated with carotid stent angioplasty via the radial approach at the Cerebrovascular Interventional Therapy Center,Henan Provincial People's Hospital were analyzed retrospectively,including operation success rate,cardio-cerebrovascular complications,and radial artery puncture complications.All 16 patients were treated with endovascular treatment via right radial approach.The coaxial technique was used for guiding catheter to the super-select target vessels.From January 2014 to December 2015,20 patients with type Ⅲ aortic arch right carotid stenosis and bovine type aortic arch left carotid stenosis treated with carotid stent operation were selected at the same time.The ray irradiation time between the two groups were compared.The follow-up time was 3 months.Results The surgical success rate of the 16 patients was 100%.Three patients had decreased blood pressure and heart rate during the operation.None of them had radial artery occlusion or severe cardio-cerebrovascular events.The ray irradiation time (9.94 ± 0.97 min) in patients with carotid artery stenosis stenting via the radial approach was less than those via the femoral artery approach(11.51 ± 1.39 min).There was significant difference (P =0.001).Conclusion The success rate of the type Ⅲ aortic arch right carotid and bovine type aortic arch left carotid stenosis with stent angioplasty via the right radial approach is high,safe and feasible.%目的 探讨经右侧桡动脉入路支架成形术治疗牛角型主动脉弓或Ⅲ型主动脉弓合并颈动脉狭窄的可行性及安全性.方法 回顾性分析2015

  1. Aortic stiffness is associated with cardiac function and cerebral small vessel disease in patients with type 1 diabetes mellitus: assessment by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Elderen, Saskia G.C. van; Brandts, A.; Westenberg, J.J.M.; Grond, J. van der; Buchem, M.A. van; Kroft, L.J.M.; Roos, A. de [Leiden University Medical Center, Department of Radiology, Leiden (Netherlands); Tamsma, J.T.; Romijn, J.A.; Smit, J.W.A. [Leiden University Medical Center, Department of Endocrinology, Leiden (Netherlands)


    To evaluate, with the use of magnetic resonance imaging (MRI), whether aortic pulse wave velocity (PWV) is associated with cardiac left ventricular (LV) function and mass as well as with cerebral small vessel disease in patients with type 1 diabetes mellitus (DM). We included 86 consecutive type 1 DM patients (49 male, mean age 46.9 {+-} 11.7 years) in a prospective, cross-sectional study. Exclusion criteria included aortic/heart disease and general MRI contra-indications. MRI of the aorta, heart and brain was performed for assessment of aortic PWV, as a marker of aortic stiffness, systolic LV function and mass, as well as for the presence of cerebral white matter hyperintensities (WMHs), microbleeds and lacunar infarcts. Multivariate linear or logistic regression was performed to analyse the association between aortic PWV and outcome parameters, with covariates defined as age, gender, mean arterial pressure, heart rate, BMI, smoking, DM duration and hypertension. Mean aortic PWV was 7.1 {+-} 2.5 m/s. Aortic PWV was independently associated with LV ejection fraction (ss= -0.406, P = 0.006), LV stroke volume (ss=-0.407, P = 0.001), LV cardiac output (ss= -0.458, P = 0.001), and with cerebral WMHs (P < 0.05). There were no independent associations between aortic stiffness and LV mass, cerebral microbleeds or lacunar infarcts. Aortic stiffness is independently associated with systolic LV function and cerebral WMHs in patients with type 1 DM. (orig.)

  2. An unusual case of left aberrant innominate artery with right aortic arch: evaluation with high-resolution CT

    Energy Technology Data Exchange (ETDEWEB)

    Calcagni, Giulio [University Rene Descartes-Paris 5, Department of Pediatric Cardiology, Hopital Necker Enfants Malades, Paris (France); Gesualdo, Francesco; Brunelle, Francis; Ou, Phalla [University Rene Descartes-Paris 5, Department of Pediatric Radiology, Hopital Necker Enfants Malades, Paris Cedex 15 (France)


    A left aberrant innominate (brachiocephalic) artery is an angiographically well-known entity that may cause tracheal compression. We report a male newborn who was admitted for further investigation of a prenatally suspected major vessel anomaly. High-resolution CT was used to completely assess the abnormal anatomy and the relationship with the airway, as well as to guide the surgical approach for its correction. (orig.)

  3. 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


    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

  4. High arch (United States)

    Pes cavus; High foot arch ... High foot arches are much less common than flat feet. They are more likely to be caused ... difficult to fit into shoes. People who have high arches most often need foot support. A high ...

  5. 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


    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

  6. Imaging Features of Angiocardiography in Interruption of Aortic Arch%主动脉弓离断的心血管造影影像分析

    Institute of Scientific and Technical Information of China (English)

    彭辽河; 魏崇健; 乔英; 闫小仿


    Objective To analyze the imaging features of angiography in interruption of aortic arch (IAA).Materials and Methods Eight patients underwent right and left ventricle angiography as well as descending aorta angiopraphy via the femoral artery and vein.The ascending aorta angiography was subsequently performed through the right carotid artery in 3 eases,and 3 patients performed ascending aorta angiography through the right ventrieular septal defect.Results No blood flow was detected between the ascending and descending aorta in all cases.The angiography revealed aorta stenosis in 7 cases,aorta expansion in 1 case,the link between the tip of descending aorta and the patent duetns arteriosns in 7 cases,the link between descending aorta and subclavian artery in 1 case.All the 8 cases coexisted with inner-heart malformation,including ventricular septal defect in 5, patent ductus arteriosus and pulmonary arterial hypertension in 2, double outlet of right ventricle and patent ductus arteriosus and pulmonary arterial hypertension in 2, tetralogy of Fallot in 1 case.Conclusion The angiocardiography is an important method for early diagnosis and surgical therapy strategy.%目的 分析主动脉弓离断(interruption of aortic arch,IAA)患者的心血管造影影像,提高对本病的认识和诊断准确性.资料与方法 8例患者均经股动脉、股静脉穿刺插管,行右心室、左心室、降主动脉造影.其中3例经右颈总动脉穿刺插管行升主动脉造影;3例从右心室经室间隔缺损至升主动脉造影.结果 8例升主动脉与降主动脉之间均无血流连续.升主动脉细小7例,升主动脉扩张1例,降主动脉顶端与未闭的动脉导管连接7例,降主动脉与右锁骨下动脉连接1例.8例均合并心内畸形,其中室间隔缺损+动脉导管未闭并肺动脉高压5例,右室双出口+动脉导管未闭并肺动脉高压2例,法乐四联症1例.结论 心血管造影是IAA确诊的重要方法,能够为IAA的早期有效

  7. 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


    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.

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

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


    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.

  9. [Coarctation of the aorta with aortic arch hypoplasia in newborn with partial trisomy 11q associated to 4q interstitial deletion]. (United States)

    Palano, G M; Licata, F; Carpinato, C; Sottile, F; Sciuto, R; Mattina, T; Distefano, G


    This article reports the case of newborn with multiple dimorphisms (microcephaly, hypertelorism, wide and flat nasal bridge, small nose, long philtrum, microretrognathia, malformed and low-set ears, short neck, redundant nuchal skin, genital anomalies), admitted in the hospital after two days from delivery for torpor, poor food and cyanosis. Babies were affected, at color-Doppler echocardiography, by coarctation of the aorta (CoA) with aortic arch hypoplasia. CoA is often associated to genetic and environmental factors that interact frequently. In this study the anamnestic absence of teratogen noxae and the presence of facial and genital anomalies suggest a genetic study to provide appropriate genetic information to parents. G-banding chromosomic analysis revealed a 46, XX der 4t(4;11) karyotype with partial 11q trisomy confirmed with FISH chromosome painting 4;11 and with FISH subtelomere specific 4(p/q)11(p/q). These techniques showed that derivative chromosome 4 was constituted by chromosome 4 with partial deletion in the q35 region and by 11q21 translocation. This rare anomaly is often inherited by an unbalanced segregation of a balanced translocation, present in one of the two parents. In the present study, the father carried a t(4q;11q) balanced translocation. A CGH-array analysis was executed to the child for the breakpoints definition. As 11q trisomy cases reported in literature are still few, this case can contribute to improve our knowledge on the genotype-phenotype correlation in this rare genetic anomaly.

  10. Tratamento cirúrgico dos aneurismas e dissecções do arco aórtico Surgical treatment of aneurysms and dissections of the aortic arch

    Directory of Open Access Journals (Sweden)



    Full Text Available No período de jan/1990 a mar/1999, foram realizados 354 operações para tratamento de lesões da aorta torácica em nosso Serviço. Destas, 47 foram relacionadas a procedimentos no arco aórtico; 31 (66,0% pacientes eram do sexo masculino e a idade variou de 26 a 74 anos (m = 54,9 ± 10,9. A dissecção aórtica foi responsável pela indicação cirúrgica em 33 (70,2% pacientes e os aneurismas fusiformes ou saculares em 14 (29,8%. A operação foi indicada em caráter de urgência em 10 (21,3% pacientes, havendo 4 casos com sinais de rotura; 11 (23,4% pacientes já haviam sido submetidos a operação cardíaca prévia. O acesso cirúrgico foi a esternotomia mediana (42 casos ou a toracotomia esquerda ou bilateral (5 casos. Hipotermia profunda com parada circulatória (PC foi empregada em 97,8% dos casos com o tempo PC variando de 15 a 60 minutos (m = 30,6 ± 12,6. A técnica do tipo hemiarco anterior foi empregada em 19 (40,4% pacientes, o hemiarco posterior em 5 (10,6%, a substituição total em 18 (38,3%, plastia em 4 (8,5% e derivação extra-anatômica em 1 (2,1%. Foram realizados os seguintes procedimentos concomitantes: substituição da aorta ascendente por conduto valvulado (15, revascularização miocárdica (9, tromba de elefante (5 e troca valvar aórtica (3. A mortalidade hospitalar foi de 12,3% (6 pacientes sendo a complicação não fatal mais freqüente a insuficiência respiratória (7 casos. A análise dos fatores determinantes de mortalidade hospitalar demonstraram tendência estatística para idade acima de 60 anos (p = 0,17 e para portadores de dissecção aguda (p = 0,07. Dos 41 pacientes que receberam alta, 39 foram seguidos por um período de 1 mês a 9 anos. Houve 3 óbitos, sendo 1 por AVC e 2 em reoperações, necessárias em 5 pacientes. A sobrevida de 9 anos é de 80,85%.From Jan/1990 to Mar/1999 we performed 354 operations on the thoracic aorta in our hospital. Among these, 47 procedures involved the aortic arch

  11. 快速成型技术制备仿生主动脉弓模型的研究%Preliminary study on rapid prototyping to prepare biomimetic model of aortic arch

    Institute of Scientific and Technical Information of China (English)

    陈鹏飞; 严中亚; 申运华; 陈向东; 邓克学


    目的 创建与人体解剖结构一致的仿真主动脉弓三维快速成型模型,探讨其对促进规划和执行主动脉弓外科手术的帮助,为构建个体化人工血管支架及3D打印生物组织或器官进行前期准备.方法 对正常成年男性进行胸部CT扫描,获得该男子主动脉弓原始CT数据(DICOM),通过Mimics 10.01软件对DICOM数据处理,分割出主动脉弓的区域,计算主动脉弓三维立体模型,导出三维模型数据文件(STL文件),最后通过3D打印机打印出主动脉弓三维模型.结果 基于CT获得的胸部解剖结构的数据,通过MIMICS 10.01软件进行处理并导出STL格式文件后,可直接用3D打印机打印出与人体主动脉弓解剖结构基本一致的主动脉弓模型(比例1∶1).结论 快速成型技术制备的主动脉弓模型对手术规划有临床意义,有助于构建个体化人工血管支架及3D打印生物组织或器官.%Objective To create an anatomical correct 3D rapid prototyping (RP) model for a volunteer' s aortic arch and investigate the significance of aortic arch model for surgical planning.To make the early preparations for the mannufacture of individualize artificial vascular stents and 3D printing with biological tissue or organ.Methods Based on the extracted 3D contour image from volunteer' s chest CT data,the custom-made artificial aortic arch was designed with mimics 10.01 software and form 3D printing STL file.And then a aortic arch model was printed out by 3D printer.Results The data acquired by CT scanner can be rapidly prototyped after being edited with Mimics 10.01 software and directly used by 3D printing system to construct a aortic arch model (1∶1).Conclusion The artificial 3D aortic arch model has significance in surgical planning and great help for the mannufacture of individualize artificial vascular stents and 3D printing with biological tissue or organ.

  12. Inhibition of aortic vessel adenosine diphosphate degradation by cadmium and mercury. (United States)

    Togna, G; Dolci, N; Caprino, L


    The effects of cadmium and mercury on ADP breakdown by vessel walls were investigated. These metals reduce the ADP clearance promoted by arterial tissue. This effect could be attributed to the inhibition of vessel wall ADP-ase enzyme, which plays an important role in the genesis of thrombotic phenomena.

  13. The use of a new hybrid stentgraft for the repair of extensive thoracic aortic aneurysms with the frozen elephant trunk method - first Polish experiences. (United States)

    Zembala, Michał; Krasoń, Marcin; Hrapkowicz, Tomasz; Przybylski, Roman; Filipiak, Krzysztof; Borowicz, Marcin; Niklewski, Tomasz; Głowacki, Jan; Wolny, Tomasz; Nadziakiewicz, Paweł; Walas, Ryszard; Zembala, Marian


    The frozen elephant trunk (FET) technique is a modification of the traditional elephant trunk method, which was introduced by Borst in 1983 in order to treat extensive thoracic aortic aneurysms. The crux of the new method is the different type of aortic prosthesis, consisting of a Dacron part (with or without branches leading to the arterial vessels which exit the aortic arch) and a port for extracorporeal circulation with a self-expanding nitinol stentgraft. This combination enables a complete one-stage treatment of the pathologies within the arch and the proximal segment of the descending aorta; moreover, it facilitates the performance of a two-stage hybrid treatment of extensive thoracic aortic aneurysms involving a significant part of the descending aorta. This article presents the cases of four patients with extensive aortic disease, who were implanted with Thoraflex prostheses (Vascutek, Scotland).

  14. The use of a new hybrid stentgraft for the repair of extensive thoracic aortic aneurysms with the frozen elephant trunk method – first Polish experiences (United States)

    Krasoń, Marcin; Hrapkowicz, Tomasz; Przybylski, Roman; Filipiak, Krzysztof; Borowicz, Marcin; Niklewski, Tomasz; Głowacki, Jan; Wolny, Tomasz; Nadziakiewicz, Paweł; Walas, Ryszard; Zembala, Marian


    The frozen elephant trunk (FET) technique is a modification of the traditional elephant trunk method, which was introduced by Borst in 1983 in order to treat extensive thoracic aortic aneurysms. The crux of the new method is the different type of aortic prosthesis, consisting of a Dacron part (with or without branches leading to the arterial vessels which exit the aortic arch) and a port for extracorporeal circulation with a self-expanding nitinol stentgraft. This combination enables a complete one-stage treatment of the pathologies within the arch and the proximal segment of the descending aorta; moreover, it facilitates the performance of a two-stage hybrid treatment of extensive thoracic aortic aneurysms involving a significant part of the descending aorta. This article presents the cases of four patients with extensive aortic disease, who were implanted with Thoraflex prostheses (Vascutek, Scotland). PMID:26335241

  15. The experience of cardiopulmonary bypass management of aortic arch surgery in neonates%新生儿主动脉弓手术的体外循环管理体会

    Institute of Scientific and Technical Information of China (English)

    吴永红; 孙善权; 姚仕文; 孔娟娟


    目的:探讨新生儿主动脉弓离断(IAA)或主动脉缩窄(CoA)合并其它心内畸形的一期矫治手术的体外循环管理。方法2014年9月至2015年7月手术治疗主动脉弓离断或缩窄合并其它心内畸形新生儿14例,其中主动脉缩窄6例,主动脉弓离断8例。平均年龄17(3~30) d。平均体重3.06(2.1~4.2)kg。均经胸骨正中切口在深低温体外循环下行一期矫治手术。结果14例新生患儿均顺利完成手术,顺利脱离体外循环,平均体外循环时间141(66~410) min,平均停循环时间17(15~30)min,平均阻断时间60(32~134)min,辅助时间69(28~284)min。其中有2例延迟关胸,14例手术开放后均尿量满意,无需进行改良超滤,无需放腹膜透析。结论新生儿的体外循环管理,尤其是深低温停循环的体外循环管理,从做好预充液的调整到体外循环的全程控制,会对手术结局起到非常重要的作用,患者有更好的转归。%Objective The aim of the study was to examine the management and the experience of cardiopulmonary bypass ( CPB) in one stage repair of interrupted aortic arch or aortic coarctation with intracardiac defects in neonates. Methods One stage re⁃pair were performed in 14 neonates with interrupted aortic arch( IAA) or aortic coarctation( CoA) with other intracardiac defects from September 2014 to July 2015. The cases included 6 neonates with aortic coarctation of aortic arch and 8 with IAA. Median age was 17 (3-30) days. Median weight was 3.06(2.1-4.2)kg. Results Deep hypothermia circulatory arrest(DHCA) was used in all cases. The median CPB time 141(66-410) min, median DHCA time was 17(15-30) min, and aortic cross clamping time was 60(32-134)min, and continuous CPB time 69(28-284)min. All the cases were weaned from CPB successfully without modified ultrafiltration and perito⁃neal dialysis. The postoperative complication occurred in 2 cases with

  16. Colaterais do arco aórtico no gambá (Didelphis albiventris Collaterals of the aortic arch in opossun (Didelphis albiventris

    Directory of Open Access Journals (Sweden)

    Sueli Hoff Reckziegel


    the right common carotid artery and the right subclavian artery. There was not a braquiocephalic trunk in 4 cases (14.28%, so it was first originated at the right subclavian artery and after the bicarotid trunk. The right subclavian artery and the right common carotid artery were originated from the braquiocephalic trunk in one case (3.57%, being the left common carotid artery originated directly from the aorta artery. The left subclavian artery originated directly from the aortic arch in all cases.

  17. Diagnostic value of CT in congenital disorders of the great vessels

    Energy Technology Data Exchange (ETDEWEB)

    Yamada, Zenju; Morooka, Nobuhiro; Watanabe, Shigeru; Masuda, Yoshiaki; Inagaki, Yoshiaki (Chiba Univ. (Japan). School of Medicine); Yoshida, Hideo


    Computed tomographic (CT) studies of the cardiovascular system were performed on 850 cases at our institute during the last five years. The aorta was clearly demonstrated by CT from the aortic root to the bifurcation of the iliac artery, and in most cases the main aortic branches including the coronary, brachiocephalic, common carotid, subclavian, celiac, superior mesenteric, renal and iliac arteries were satisfactorily evaluated. Therefore CT renders us encouraging to detect the abnormality of these arteries. This paper described the CT finings of congenital anomalies of the great vessels in 14 patients with 16 anomalies including two cases of l-corrected transposition of the great vessels, two of double aortic arch, one of aneurysm of the sinus of Valsalva, six of patent ductus arteriosus (PDA) and five of right-sided descending aorta, two of which had double aortic arch aforementioned and the remaining three had dextrocardia. The diagnosis of these abnormalities except for PDA were made only by CT. For instance, l-corrected transposition of the great vessels was diagnosed easily by observing the side-to-side relationship of the great vessels, the aorta is situated to the left and anterior to the pulmonary artery. In the case of double aortic arch, not only the left and right aortic arch, but also the degree of narrowing as well as compression of the trachea and esophagus were well evaluated. The diagnosis of aneurysm of the sinus of Valsalva was made by the characteristically marked dilatation of the aorta at the level of sinus of Valsalva on CT. Only in one case of PDA, the ductus connecting the descending aorta to the left pulmonary artery was demonstrated by CT. Plain CT was well tolerable, but enhanced CT was much more informative to detect cardiovascular abnormalities, and moreover, dynamic CT was rewarding in the detailed evaluation of blood flow in the cardiovascular system.

  18. 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


    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

  19. 胸降主动脉瘤伴主动脉右弓右降手术的护理配合%Nursing cooperation in the operation of descending thoracic aortic aneurysm with right-sided aortic arch and right-sided descending aorta

    Institute of Scientific and Technical Information of China (English)

    李红; 翟跃军; 赵子英


    目的 探讨临床少见的右位主动脉弓、右位降主动脉、胸降主动脉瘤外科手术中的护理配合,以提高手术配合质量,减少手术相关并发症的发生.方法 针对8例行右弓、右降胸降主动脉瘤手术的病例进行术前准备、麻醉配合、体位管理和皮肤保护、术中配合、术后交接等护理配合.结果 8例患者于术后4~7 h清醒,无左上肢缺血、无皮肤压伤感染等护理问题.结论 术前心理护理、麻醉配合、正确的体位摆放以及充分显露术野和娴熟的手术配合是确保手术顺利进行的关键因素之一.%Objective To discuss the nursing cooperation in operation of right-sided aortic arch, rightsided descending aorta, descending thoracic aortic aneurysm, to provide basis for high quality of operative cooperation and complication reducing. Methods To carry out preoperative preparation, anesthesia cooperation, body position management, skin protection, operative cooperation, postoperative relay in 8 patients underwent operation of right-sided aortic arch, right-sided descending aorta, descending thoracic aortic aneurysm. Results 8 patients got consciousness 4 ~ 7 hours post operation, there were no left upper limb ischemia and compression injury infection. Conclusions Preoperative mental nursing, anesthesia cooperation,correct body position, sufficient surgery field exposure and expert operative cooperation are the key factors of success operation.

  20. Vessel asymmetry as an additional diagnostic tool in the assessment of abdominal aortic aneurysms.

    LENUS (Irish Health Repository)

    Doyle, Barry J


    OBJECTIVE: Abdominal aortic aneurysm (AAA) rupture is believed to occur when the local mechanical stress exceeds the local mechanical strength of the wall tissue. On the basis of this hypothesis, the knowledge of the stress acting on the wall of an unruptured aneurysm could be useful in determining the risk of rupture. The role of asymmetry has previously been identified in idealized AAA models and is now studied using realistic AAAs in the current work. METHODS: Fifteen patient-specific AAAs were studied to estimate the relationship between wall stress and geometrical parameters. Three-dimensional AAA models were reconstructed from computed tomography scan data. The stress distribution on the AAA wall was evaluated by the finite element method, and peak wall stress was compared with both diameter and centerline asymmetry. A simple method of determining asymmetry was adapted and developed. Statistical analyses were performed to determine potential significance of results. RESULTS: Mean von Mises peak wall stress +\\/- standard deviation was 0.4505 +\\/- 0.14 MPa (range, 0.3157-0.9048 MPa). Posterior wall stress increases with anterior centerline asymmetry. Peak stress increased by 48% and posterior wall stress by 38% when asymmetry was introduced into a realistic AAA model. CONCLUSION: The relationship between posterior wall stress and AAA asymmetry showed that excessive bulging of one surface results in elevated wall stress on the opposite surface. Assessing the degree of bulging and asymmetry that is experienced in an individual AAA may be of benefit to surgeons in the decision-making process and may provide a useful adjunct to diameter as a surgical intervention guide.

  1. Ultrasound studying in ascending aorta and aortic arch plaque in patients with the stroke%脑卒中患者升主动脉及主动脉弓斑块的超声研究

    Institute of Scientific and Technical Information of China (English)

    隗冬梅; 何文; 程晓雯; 刘晓峰


    目的 探讨利用超声检查脑卒中患者升主动脉和主动脉弓斑块的意义.方法 52例经核磁共振或电子计算机X射线断层扫描技术证实脑内存在急性或亚急性栓塞灶的患者,经食管和经胸超声心动图分别检测升主动脉和主动脉弓.了解出现在升主动脉和主动脉弓的斑块情况.结果 经胸超声心动图发现斑块位于升主动脉者18例,共20个斑块;经食管超声心动图发现斑块位于升主动脉者23例,共27个斑块.经胸和经食管超声心动图同时发现斑块位于升主动脉者16例,共18个斑块,其中不稳定斑块5个.经胸超声心动图发现斑块位于主动脉弓者29例,共43个斑块;经食管超声心动图发现斑块位于主动脉弓者40例,共58个斑块.经胸和经食管超声心动图同时发现斑块位于主动脉弓者25例,共35个斑块,其中不稳定斑块18个.经食管超声心动图发现的斑块数量多于经胸超声心动图.结论 结合经食管超声心动图,可以避免经胸超声心动图图像显示不清的缺点,提高急性脑卒中患者大血管病变的阳性检出率,并有助于斑块性质的描述,为急性脑卒中患者血管源性栓子来源提供依据.%Objective To investigate the plaque in ascending aorta and aortic arch by ultrasound in patients with the stroke. Methods Fifty-two patients with magnetic resonance ( MR) or X-ray computer tomography (CT) confirmed the presence of acute or subacute stroke, looking from the ascending aorta and aortic arch of vascular plaque by transesophageal and transthoracic echocardiography. The ascending aorta and aortic arch plaques were detected. Results There were 18 cases with a total of 20 plaques in the ascending aorta found by transthoracic echocardiography. There were 23 cases with a total of 27 plaques in the ascending aorta found by transesophageal echocardiography. There were 16 cases with a total of 18 plaques in the ascending aorta found by transthoracic and

  2. 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


    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.

  3. Medical image of the week: aortic ring

    Directory of Open Access Journals (Sweden)

    Wong C


    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 ...

  4. Risk Factor Analysis of Delayed Recovery of Consciousness after Aortic Arch Surgery%主动脉弓部手术后苏醒延迟的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    崔辉敏; 李庆国; 王强; 王东进


    Objective To determine risk factors of delayed recovery of consciousness after aortic arch surgery under deep hypothermic circulatory arrest (DHCA) and antegrade selective cerebral perfusion (ASCP). Methods We retrospectively analyzed clinical data of 113 patients who underwent aortic arch surgery under DHCA+ASCP in the Affiliated Drum Tower Hospital, Medical School of Nanjing University from October 2004 to April 2012. According to whether they regained consciousness within 24 hours after surgery, all the 113 patients were divided into normal group (73 patients including 55 males and 18 females with their average age of 48.1 ± 10.9 years) and delayed recovery group (40 patients including 29 males and 11 females with their average age of 52.2 ±11.4 years). Risk factors of delayed recovery of consciousness after surgery were evaluated by univariate analysis and multivariate logistic regression analysis. Results Nine patients (8.0%) died postoperatively, including 5 patients with multi-organ failure, 2 patients with heart failure, 1 patient with mediastinal infection, and 1 patient with pulmonary hemorrhage. There were 7 deaths (17.5%) in the delayed recovery group and 2 deaths (2.7%) in the normal group, and the in-hospital mortality of the delayed recovery group was significant- ly higher than that of the normal group (P=0.016). A total of 94 patients (including 65 patients in the normal group and 29 patients in the delayed recovery group) were followed up for 4-95 months. Eight patients (including 5 patients in the normal group and 3 patients in the delayed recovery group) died during follow-up, including 2 patients with stroke, 3 patients with heart failure, 2 patients with pulmonary hemorrhage and 1 patient with unknown cause. Ten patients were lost during follow-up. Univariate analysis showed that age(P=0.042), hypertension(P=0.017), emergency surgery (P=0.001), cardiopu-lmonary bypass (CPB) time (P=0.007), aortic cross-clamp time (P=0.021), and blood

  5. Self-gated CINE MRI for combined contrast-enhanced imaging and wall-stiffness measurements of murine aortic atherosclerotic lesions.

    Directory of Open Access Journals (Sweden)

    Brigit den Adel

    Full Text Available BACKGROUND: High-resolution contrast-enhanced imaging of the murine atherosclerotic vessel wall is difficult due to unpredictable flow artifacts, motion of the thin artery wall and problems with flow suppression in the presence of a circulating contrast agent. METHODS AND RESULTS: We applied a 2D-FLASH retrospective-gated CINE MRI method at 9.4T to characterize atherosclerotic plaques and vessel wall distensibility in the aortic arch of aged ApoE(-/- mice after injection of a contrast agent. The method enabled detection of contrast enhancement in atherosclerotic plaques in the aortic arch after I.V. injection of micelles and iron oxides resulting in reproducible plaque enhancement. Both contrast agents were taken up in the plaque, which was confirmed by histology. Additionally, the retrospective-gated CINE method provided images of the aortic wall throughout the cardiac cycle, from which the vessel wall distensibility could be calculated. Reduction in plaque size by statin treatment resulted in lower contrast enhancement and reduced wall stiffness. CONCLUSIONS: The retrospective-gated CINE MRI provides a robust and simple way to detect and quantify contrast enhancement in atherosclerotic plaques in the aortic wall of ApoE(-/- mice. From the same scan, plaque-related changes in stiffness of the aortic wall can be determined. In this mouse model, a correlation between vessel wall stiffness and atherosclerotic lesions was found.

  6. 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


    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.

  7. Tratamento cirúrgico da compressão do esôfago por anomalia do arco aórtico: relato de caso Surgical treatment of esophagus compression by aortic arch anomaly: case report

    Directory of Open Access Journals (Sweden)

    Ivo Richter


    Full Text Available Paciente adulta, portadora de anomalia vascular congênita do arco aórtico com formação de anel envolvendo traqueia e esôfago, com compressão deste e conseqüente disfagia progressiva. A abordagem cirúrgica foi realizada por toracotomia lateral direita, com ressecção do divertrículo de Kommerell, secção do ligamento arterioso e ligadura simples da artéria subclávia, com regressão total dos sintomas. Não foi observada síndrome de roubo da subclávia ou isquemia do membro superior esquerdo. Os autores discutem o tipo de abordagem e cirurgia para tratamento desta rara anomalia.An adult patient presenting a congenital vascular anomaly of the aortic arch and ring formation, surrounding trachea and esophagus, by compression of the latest was complaining of progressive dysphagia. A surgical approach was performed by right lateral thoracotomy with ressection of the Kommerell diverticulum, section of the arterious ligament and single ligation of the subclavian artery which was followed by total regression of the symptoms. No subclavian steal syndrome or ischemia was observed on the left upper limb. The authors discuss the manner of approach and surgical treatment of this rare anomaly.

  8. 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


    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

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

    LENUS (Irish Health Repository)

    O' Sullivan, Katie E


    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.

  10. 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


    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.


    Institute of Scientific and Technical Information of China (English)

    WEI Lan; WEN Gong-bi; TAN Wen-chang


    A numerical analysis of the steady/pulsatile flow and macromolecular (such as LDL and Albumin) transport in curved blood vessels was carried out. The computational results predict that the vortex of the secondary flow is time-dependent in the aortic arch.The concentration of macromolecule concentrates at the region of sharp curve, and the wall concentration at the outer part is higher than that at the inner part. Atherosclerosis and thrombosis are prone to develop in such regions with sharp flow.

  12. Aortic insufficiency (United States)

    ... page, please enable JavaScript. Aortic insufficiency is a heart valve disease in which the aortic valve does not close ... aortic insufficiency Images Aortic insufficiency References Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil ...

  13. Aortoplasty with pulmonary autograft patch for coarctation of the aorta combined with hypoplastic aortic arch in infant%自体肺动脉补片主动脉弓成形治疗婴儿主动脉缩窄合并弓发育不良

    Institute of Scientific and Technical Information of China (English)

    鲁亚南; 刘锦纷; 徐志伟; 苏肇伉; 丁文祥


    目的 探讨缩窄段切除加自体肺动脉补片主动脉弓成形治疗婴儿主动脉缩窄合并主动脉弓发育不良的方法和效果.方法 2007年5月至2009年12月,14例主动脉缩窄合并主动脉弓发育不良病婴行主动脉缩窄段切除加自体肺动脉补片主动脉弓成形手术,其中男9例,女5例;年龄23天至17个月,中位值4.33月龄;平均体重(6.14±2.36)kg.所有病婴均诊断为合并室间隔缺损的主动脉缩窄,同时存在主动脉弓发育不良.手术在深低温体外循环下完成,其中8例采用选择性脑灌注技术,6例停循环.主动脉成形采用新鲜的自体肺动脉补片.同期修补合并的室间隔缺损.结果 围术期死于循环衰竭1例.13例生存,其中1例合并低心排血量综合征,经相应治疗恢复.术后超声心动图检查主动脉弓无残余梗阻.随访4个月至3年.超声心动图示主动脉弓压力阶差均<16 mm Hg(1 mm Hg=0.133 kPa),随访期间主动脉弓降部血流速度与出院时无明显变化.CT扫描显示主动脉弓几何构形正常;术后半年原左主支气管受压者症状明显改善或完全消失.无主动脉夹层动脉瘤发生.结论 缩窄段切除加自体肺动脉补片主动脉弓成形是治疗婴儿主动脉缩窄合并主动脉弓发育不良理想的手术方法.%Objective To discuss the operative techniques and results of coarctation resection plus aortoplasty with pulmonary autograft patch for coarctation of the aorta combined with hypoplastic aortic arch in infant.Methods Between May 2007 and Dec 2009,14 cases including 9 males and 5 females with caorctation of the aorta and hypoplastic aortic arch underwent coarctation resection plus aortoplasty with pulmonary autograft patch in our hospital.The age ranged from 23 days to 17 months,with a median of 4.33 months.The mean body weight was (6.14 ±2.36) kg.All patients were diagnosed as aortic coarctation combined with VSD and hypoplastic aortic arch.The surgery was performed

  14. 'In parallel' interconnectivity of the dorsal longitudinal anastomotic vessels requires both VEGF signaling and circulatory flow. (United States)

    Zygmunt, Tomasz; Trzaska, Sean; Edelstein, Laura; Walls, Johnathon; Rajamani, Saathyaki; Gale, Nicholas; Daroles, Laura; Ramírez, Craig; Ulrich, Florian; Torres-Vázquez, Jesús


    Blood vessels deliver oxygen, nutrients, hormones and immunity factors throughout the body. To perform these vital functions, vascular cords branch, lumenize and interconnect. Yet, little is known about the cellular, molecular and physiological mechanisms that control how circulatory networks form and interconnect. Specifically, how circulatory networks merge by interconnecting 'in parallel' along their boundaries remains unexplored. To examine this process we studied the formation and functional maturation of the plexus that forms between the dorsal longitudinal anastomotic vessels (DLAVs) in the zebrafish. We find that the migration and proliferation of endothelial cells within the DLAVs and their segmental (Se) vessel precursors drives DLAV plexus formation. Remarkably, the presence of Se vessels containing only endothelial cells of the arterial lineage is sufficient for DLAV plexus morphogenesis, suggesting that endothelial cells from the venous lineage make a dispensable or null contribution to this process. The discovery of a circuit that integrates the inputs of circulatory flow and vascular endothelial growth factor (VEGF) signaling to modulate aortic arch angiogenesis, together with the expression of components of this circuit in the trunk vasculature, prompted us to investigate the role of these inputs and their relationship during DLAV plexus formation. We find that circulatory flow and VEGF signaling make additive contributions to DLAV plexus morphogenesis, rather than acting as essential inputs with equivalent contributions as they do during aortic arch angiogenesis. Our observations underscore the existence of context-dependent differences in the integration of physiological stimuli and signaling cascades during vascular development.

  15. Aortic outflow cannula tip design and orientation impacts cerebral perfusion during pediatric cardiopulmonary bypass procedures. (United States)

    Menon, Prahlad G; Antaki, James F; Undar, Akif; Pekkan, Kerem


    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. Debranching Solutions in Endografting for Complex Thoracic Aortic Dissections

    Energy Technology Data Exchange (ETDEWEB)

    Goksel, Onur Selcuk, E-mail: [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)


    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.

  17. Aortic dissection (United States)

    ... linked to aortic dissection include: Bicuspid aortic valve Coarctation (narrowing) of the aorta Connective tissue disorders (such ... failure Aneurysm Aortic insufficiency Blood clots Cardiac tamponade Coarctation of the aorta Hardening of the arteries High ...

  18. 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: [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)


    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)

  19. 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


    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.

  20. 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)


    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.

  1. Uremia modulates the phenotype of aortic smooth muscle cells

    DEFF Research Database (Denmark)

    Madsen, Marie; Pedersen, Annemarie Aarup; Albinsson, Sebastian


    of moderate uremia in ApoE(-/-) mice increased atherosclerosis in the aortic arch en face 1.6 fold (p = 0.04) and induced systemic inflammation. Based on histological analyses of aortic root sections, uremia increased the medial area, while there was no difference in the content of elastic fibers or collagen...

  2. Unilateral lung agenesis--detrimental roles of surrounding vessels. (United States)

    Chou, An-Kou; Huang, Shu-Chien; Chen, Shyh-Jye; Huang, Pei-Ming; Wang, Jou-Kou; Wu, Mei-Hwan; Chen, Yih-Sharng; Chang, Chung-I; Chiu, Ing-Sh; Wu, En-Ting


    Unilateral lung agenesis is a rare congenital defect and could be associated with multiple abnormalities. The patients usually have poor long-term outcomes especially in those with right lung agenesis. We reviewed the 10-year experience in our hospital to describe special clinical features and try to delineate the causes of poor outcomes. From 1995 to 2005, 14 patients less than 18 years of age with unilateral lung agenesis (4 with left agenesis, 10 with right agenesis) were enrolled. Medical records reviewed included diagnosis, presentation, chromosome anomalies, cardiovascular anomalies and interventions, outcomes. We found that the mechanisms of severe airway disease in right lung agenesis included (1) trachea compression by the aortic arch, (2) the presence of "pseudo-ring-sling complex," (3) distended pulmonary artery due to left to right shunt which impinged the only bronchus, and finally (4) the persistent LSVC that restricts the growth of trachea. The etiologies of airway complication in left lung agenesis included anomalous aortic arch compression on trachea and the coexisting heart disease with significant left to right shunt, which impinged on the bronchus. In conclusion, unilateral lung agenesis has frequently associated airway problems due to its surrounding vessels. Satisfactory airway intervention remains challenging. This disease still requires great effort to improve patient outcomes.

  3. 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


    @@ 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.

  4. Bentall术联合全弓置换及支架象鼻手术治疗危重Debakey Ⅰ型主动脉夹层动脉瘤%Bentall operation combined with total arch replacement and stented elephant trunk implantation for serious Debakey I aortic dissecting aneurysm

    Institute of Scientific and Technical Information of China (English)

    谷天祥; 王春; 张玉海; 修宗谊; 房勤; 喻磊; 师恩祎


    Objective To summarize the clinical experience of Bentall operation combined with total arch replacement and stented elephant trunk implantation for serious Debakey I aortic dissecting aneurysrm Methods Twelve patients with serious Debakey I aortic dissecting aneurysm underwent surgical treatment from January 2005 to December 2007.There were 10 male and 2 female with the mean age of (40.1±9.5)years old.There were acute aortic dissection in 9 cases,chronic aortic dissection in 3 cases.The inner diameter of aorta was(5.3±1.8)cm. There were Mafan syndrome in 4 cases,aortic regurgitation in all cases,severely persistent chest pain in 9 eases,acute left heart failure in 8 cases,and cardiac tamponade in 4 cases.Bentall operations eombined with total arch replacement and stented elephant trunk implantation were performed by using deep hypothermic circulatory arrest and antegrade selective cerebral perfusion in all cases.Results Urgent surgery underwent in 9 cases.The mean interval between the onset of aortic dissection and the accomplishment of surgery wag(41.0±15.9)hours.Cardiopulmonary bypass time was(191±26)min,average cross clamp time was(134±31)min,and average deep hypothermie circulatory arrest time was(50.0±14.5)min One patient died in hospital.The time stayed in ICU was 3 to 27 d Mental disorder in 6 eases,hemiparalysis in 1 case,amputation in 1 case,hemorrhage of anastomosis in 1 ease.hemorrhage of alimentary tract in 1 cage,and pleural effusion in 4 cases were recorded.Eleven cases were followed-up for 8 weeks to 36 months.There were no bending of the stents and no obstruction in the vascular prosthesis.No re-operation was needed.One case died 6 months postoperatively.Conclusion Bentall operation combined with total arch replacement and stented elephant trunk implantation is safe and effective for serious Debakey I aortic dissecting aneurysm,while good organs protection and consummate cardiopulmonary bypass were taken.%目的 总结Bentall术同期全弓

  5. Left testicular artery arching over the ipsilateral renal vein

    Institute of Scientific and Technical Information of China (English)

    Munekazu Naito; Hayato Terayama; Yoichi Nakamura; Shogo Hayashi; Takayoshi Miyaki; Masahiro Itoh


    Aim: To report two cases of the left testicular artery arching over the left renal vein (LRV) before running downward to the testis. Methods: The subjects were obtained from two Japanese cadavers. During the student course of gross-anatomical dissection, the anatomical relationship between the testicular vessels and the renal vein was specifically observed. Results: The arching left testicular artery arose from the aorta below the LRV and made a loop around the LRV, which appeared to be mildly compressed between the arching artery and the psoas major muscle.Conclusion: Clinically, compression of the LRV between the abdominal aorta and the superior mesenteric artery occasionally induces LRV hypertension, resulting in varicocele, orthostatic protenuria and hematuria. Considering that the incidence of a left arching testicular artery is higher than that of a right one, an arching left artery could be an additional cause of LRV hypertension.

  6. Intraoral gothic arch tracing. (United States)

    Rubel, Barry; Hill, Edward E


    In order to create optimum esthetics, function and phonetics in complete denture fabrication, it is necessary to record accurate maxillo-mandibular determinants of occlusion. This requires clinical skill to establish an accurate, verifiable and reproducible vertical dimension of occlusion (VDO) and centric relation (CR). Correct vertical relation depends upon a consideration of several factors, including muscle tone, inter-dental arch space and parallelism of the ridges. Any errors made while taking maxillo-mandibular jaw relation records will result in dentures that are uncomfortable and, possibly, unwearable. The application of a tracing mechanism such as the Gothic arch tracer (a central bearing device) is a demonstrable method of determining centric relation. Intraoral Gothic arch tracers provide the advantage of capturing VDO and CR in an easy-to-use technique for practitioners. Intraoral tracing (Gothic arch tracing) is a preferred method of obtaining consistent positions of the mandible in motion (retrusive, protrusive and lateral) at a comfortable VDO.

  7. Preliminary study on MSCTA technique to determine the shape of aortic arch and its clinical significance%多层螺旋CT血管造影技术判断主动脉弓形态及临床意义的探讨

    Institute of Scientific and Technical Information of China (English)

    王学廷; 董致成; 冯丽; 潘为领


    Objective:Using multi-slice spiral CT angiography (MSCTA) technique in evaluating aortic arch form, and to explore the clinical significance.Methods: retrospective analysis of our hospital from 2010 November to 2013 March for cervical and thoracic 256CTA examination in 240 cases without significant vascular disease, no local space occupying disease subjects images, including 147 cases of male, female 93 cases, age 44 ~ 71 years old, the average age is 51.8 years old. Application of CT software respectively measure the internal diameter of carotid artery, brachiocephalic trunk opening to the aortic arch top vertical distance, typing.Results: In 240 patients, 116 cases of type I, 48.33%; II type in 80 cases, accounting for 33.33%; 44 cases of type III, 18.33%. Group statistics according to different age, found that in young group (≤ 45 years) a total of 32 cases, including 24 cases of type I, 75% type II, 8 cases, accounting for 25%, type III in 0 cases, accounting for 0%; the middle-aged group (46 ~ 59 years old) in 104 cases, including 60 cases of type I, 57.69%, II type in 40 cases, accounting for 38.46%, type III in 4 cases, accounting for 3.84%; aged group (≥60 years) in 104 cases, type I in 32 cases, accounting for 30.76%, type II in 32 cases, accounting for 30.76%, 40 cases of type III, 38.46%.Conclusion: MSCTA technology on the morphology of aortic arch judgment accurate, relevant data were examined by MSCTA to obtain the aortic arch diseases before interventional therapy and data, will have the vital significance to neural interventional radiology doctors.%目的:利用多层螺旋CT血管造影(MSCTA)技术评价主动脉弓形态,并探讨其临床意义。方法:回顾性分析行颈胸部联合256CTA检查的240例无重要血管性疾病、无局部占位性疾病的受检者图像,其中男性147例、女性93例,年龄44岁~71岁,平均年龄51.8岁。应用CT测量软件分别测量颈总动脉内径、头臂干开口至主动脉

  8. Unexpected death caused by rupture of a dilated aorta in an adult male with aortic coarctation. (United States)

    Leth, Peter Mygind; Knudsen, Peter Thiis


    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 arch without dissection combined with aortic coarctation. The patient, a 46-year-old man, was found dead at home. PMCT showed haemopericardium and dilatation of the ascending aorta and the aortic arch. This appearance led to the mistaken interpretation that the images represented a dissecting aneurysm. The autopsy showed instead a thin-walled and floppy dilatation of the ascending aorta and aortic arch with a coarctation just proximal to the ligamentum arteriosum. A longitudinal tear was found in the posterior aortic wall just above the valves. Blood in the surrounding soft tissue intersected with a large haematoma (1000ml) in the pericardial sac. Cardiac hypertrophy (556g) was observed in the patient, though no other cardiovascular abnormalities were found. Histological analysis showed cystic medial necrosis of the ascending aortic wall. A ruptured aneurysmal dilatation of the ascending aorta 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.

  9. 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


    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

  10. Influence of surgical implantation angle of left ventricular assist device outflow graft and management of aortic valve opening on the risk of stroke in heart failure patients (United States)

    Chivukula, V. Keshav; McGah, Patrick; Prisco, Anthony; Beckman, Jennifer; Mokadam, Nanush; Mahr, Claudius; Aliseda, Alberto


    Flow in the aortic vasculature may impact stroke risk in patients with left ventricular assist devices (LVAD) due to severely altered hemodynamics. Patient-specific 3D models of the aortic arch and great vessels were created with an LVAD outflow graft at 45, 60 and 90° from centerline of the ascending aorta, in order to understand the effect of surgical placement on hemodynamics and thrombotic risk. Intermittent aortic valve opening (once every five cardiac cycles) was simulated and the impact of this residual native output investigated for the potential to wash out stagnant flow in the aortic root region. Unsteady CFD simulations with patient-specific boundary conditions were performed. Particle tracking for 10 cardiac cycles was used to determine platelet residence times and shear stress histories. Thrombosis risk was assessed by a combination of Eulerian and Lagrangian metrics and a newly developed thrombogenic potential metric. Results show a strong influence of LVAD outflow graft angle on hemodynamics in the ascending aorta and consequently on stroke risk, with a highly positive impact of aortic valve opening, even at low frequencies. Optimization of LVAD implantation and management strategies based on patient-specific simulations to minimize stroke risk will be presented

  11. Heartbeat-related displacement of the thoracic aorta in patients with chronic aortic dissection type B: Quantification by dynamic CTA

    Energy Technology Data Exchange (ETDEWEB)

    Weber, Tim F. [University of Heidelberg, Department of Diagnostic and Interventional Radiology, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany)], E-mail:; Ganten, Maria-Katharina [German Cancer Research Center, Department of Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg (Germany)], E-mail:; Boeckler, Dittmar [University of Heidelberg, Department of Vascular and Endovascular Surgery, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany)], E-mail:; Geisbuesch, Philipp [University of Heidelberg, Department of Vascular and Endovascular Surgery, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany)], E-mail:; Kauczor, Hans-Ulrich [University of Heidelberg, Department of Diagnostic and Interventional Radiology, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany)], E-mail:; Tengg-Kobligk, Hendrik von [German Cancer Research Center, Department of Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg (Germany)], E-mail:


    Purpose: The purpose of this study was to characterize the heartbeat-related displacement of the thoracic aorta in patients with chronic aortic dissection type B (CADB). Materials and methods: Electrocardiogram-gated computed tomography angiography was performed during inspiratory breath-hold in 11 patients with CADB: Collimation 16 mm x 1 mm, pitch 0.2, slice thickness 1 mm, reconstruction increment 0.8 mm. Multiplanar reformations were taken for 20 equidistant time instances through both ascending (AAo) and descending aorta (true lumen, DAoT; false lumen, DAoF) and the vertex of the aortic arch (VA). In-plane vessel displacement was determined by region of interest analysis. Results: Mean displacement was 5.2 {+-} 1.7 mm (AAo), 1.6 {+-} 1.0 mm (VA), 0.9 {+-} 0.4 mm (DAoT), and 1.1 {+-} 0.4 mm (DAoF). This indicated a significant reduction of displacement from AAo to VA and DAoT (p < 0.05). The direction of displacement was anterior for AAo and cranial for VA. Conclusion: In CADB, the thoracic aorta undergoes a heartbeat-related displacement that exhibits an unbalanced distribution of magnitude and direction along the thoracic vessel course. Since consecutive traction forces on the aortic wall have to be assumed, these observations may have implications on pathogenesis of and treatment strategies for CADB.

  12. Asendan Desendan Aortic Bypass: Atan Kalpte Mediyan Sternotomi Yoluyla Onarim

    Directory of Open Access Journals (Sweden)

    Muhammet Akyuz


    Full Text Available We report the case of a 9-month-old patient presenting for redo aortic arch surgery because of recoarctation. In present case, ascending-to-descending aortic bypass via median sternotomy was performed without cardiopulmonary bypass with good result. In spite of the fact that the different surgical and intervention treatment options of aortic coarctation are quite satisfactory, a certain group of patients need reoperation because of recoarctation. The recoarctation repair of the aorta with the extra-anatomic aortic bypass is considered a low-risk procedure with high success rate.

  13. [Chronic type A aortic dissection associated with Turner syndrome; report of a case]. (United States)

    Tanaka, Hideyuki; Kozaki, Tomofumi; Kume, Masazumi; Miyamoto, Shinji


    Aortic dissection is a critical but rare complication of Turner syndrome. This report describes a case of chronic aortic dissection in a patient with Turner syndrome. A 54-year-old woman, suffering from mild back pain for 1 month, was referred to our hospital with a diagnosis of Stanford type A chronic aortic dissection and a bicuspid aortic valve with moderate regurgitation. Computed tomography revealed aortic dissection, involving all arch branches, extending from the ascending to the abdominal aorta. The true lumen of the brachial artery was nearly obstructed by the thrombosed false lumen. Elective aortic arch repair and aortic valve replacement were successfully performed. The patient was diagnosed with 45, XO Turner syndrome after surgery. Taking aortopathy of Turner syndrome into consideration, surveillance of the residual aorta was performed. No rapidly progressive dilatation of the residual aorta was detected during the 6 years' follow-up.

  14. Unreliability of aortic size index to predict risk of aortic dissection in a patient with Turner syndrome (United States)

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


    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

  15. 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


    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

  16. 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...

  17. 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


    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...... valve stenosis (AS) who are considered at high risk for surgical aortic valve replacement. In this report, we describe the combined surgical and catheter-based treatment of an extensive TAA and AS. To our knowledge, this is the first report of hybrid TAA repair combined with TAVR.......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...

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

    Directory of Open Access Journals (Sweden)

    Andreas Habertheuer


    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.

  19. How to Perfuse: Concepts of Cerebral Protection during Arch Replacement (United States)

    Habertheuer, Andreas; Wiedemann, Dominik; Kocher, Alfred; Laufer, Guenther; Vallabhajosyula, Prashanth


    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. PMID:26713319

  20. Clarifying the anatomy of the fifth arch artery

    Directory of Open Access Journals (Sweden)

    Saurabh Kumar Gupta


    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. High-pitch dual-source CT angiography of supra-aortic arteries: assessment of image quality and radiation dose

    Energy Technology Data Exchange (ETDEWEB)

    Korn, A.; Fenchel, M.; Bender, B.; Danz, S.; Ernemann, U. [Department of Diagnostic und Interventional Neuroradiology, Tuebingen (Germany); Thomas, C.; Ketelsen, D.; Claussen, C.D.; Heuschmid, M. [Department of Diagnostic und Interventional Radiology, Tuebingen (Germany); Moonis, G. [Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA (United States); Krauss, B. [Siemens AG, Imaging and Therapy Division, Forchheim (Germany); Brodoefel, H. [Department of Diagnostic und Interventional Radiology, Tuebingen (Germany); Beth Israel Deaconess Medical Center, Department of Radiology, Boston, MA (United States); Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA (United States)


    High-pitch CT angiography (CTA) is a recent innovation that allows significant shortening of scan time with volume coverage of 43 mm per second. The aim of our study was to assess this technique in CTA of the head and neck. CTA of supra-aortic arteries was performed in 50 patients using two acquisition protocols: conventional single-source 64-slice (pitch 1.2) and high-pitch dual-source 128-slice CT (pitch 3.2). Subjective and objective image quality of supra-aortic vessel ostia as well as intra- and extra-cranial segments was retrospectively assessed by blinded readers and radiation dose compared between the two protocols. Conventional and high-pitch CTA achieved comparable signal-to-noise ratios in arterial (54.3 {+-} 16.5 versus 57.3 {+-} 14.8; p = 0.50) and venous segments (15.8 {+-} 6.7 versus 18.9 {+-} 8.9; p = 0.21). High-pitch scanning was, however, associated with sharper delineation of vessel contours and image quality significantly improved at the level of supra-aortic vessel ostia (p < 0.0001) as well as along the brachiocephalic trunk (p < 0.0001), the subclavian arteries (p < 0.0001), proximal common carotid arteries (p = 0.01), and vertebral V1 segments (p < 0.0001). Using the high-pitch mode, the dose-length product was reduced by about 35 % (218.2 {+-} 30 versus 141.8 {+-} 20 mGy x cm). Due to elimination of transmitted cardiac motion, high-pitch CTA of the neck improves image quality in the proximity of the aortic arch while significantly lowering radiation dose. The technique thus qualifies as a promising alternative to conventional spiral CTA and may be particularly useful for identification of ostial stenosis. (orig.)

  2. Extracellular-purine metabolism in blood vessels (part I). Extracellular-purine level in blood of patients with abdominal aortic aneurysm. (United States)

    Lecka, Joanna; Molski, Stanislaw; Komoszynski, Michal


    Adenosine and adenosine derivatives are the main regulators of purinoceptors (P1 and P2) mediated hemostasis and blood pressure. Since impaired hemostasis and high blood pressure lead to atherosclerosis and to the development of aneurysm, in this study we tested and compared the concentration of extracellular purines (e-purines) in the blood in of patients having abdominal aortic aneurysm with that from healthy volunteers. Whereas adenine nucleosides and nucleotides level in human blood plasma was analysed using reverse phase high performance liquid chromatography (HPLC), cholesterol concentration was estimated by an enzymatic assay. We did not find any correlation between e-purines concentration and the age of healthy volunteers. Furthermore, the sum level of e-purines (ATP, ADP, AMP, adenosine, and inosine) in the control group did not exceed 70 microM, while it was nearly two-fold higher in the blood of patients having abdominal aortic aneurysm, (123 microM). In a special case of people with Leriche Syndrome, a disease characterized by deep atherosclerotic changes, the e-purines level had further increased. Additionally, we also report typical atherosclerotic changes in the aorta using histological assays as well as total cholesterol rise. The significant rise in cholesterol concentration in the blood of the patients with abdominal aortas aneurysm, compared with the control groups, was not unique since 23% of the healthy people also exceeded the normal level of cholesterol. Therefore, our results strongly indicate that the estimation of e-purines concentration in the blood may serve as another indicator of atherosclerosis and warrant further consideration as a futuristic diagnostic tool.

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

    Directory of Open Access Journals (Sweden)

    Han Qing-qi


    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.

  4. 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


    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.

  5. 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


    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


    Directory of Open Access Journals (Sweden)

    Jyothi K C


    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.

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

    Institute of Scientific and Technical Information of China (English)

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


    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

  8. Aortic stenosis (United States)

    ... Images Aortic stenosis Heart valves References Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil ... ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/ ...

  9. Endovascular repair for abdominal aortic aneurysm followed by type B dissection. (United States)

    Shingaki, Masami; Kato, Masaaki; Motoki, Manabu; Kubo, Yoji; Isaji, Toshihiko; Okubo, Nobukazu


    An 86-year-old man with an abdominal aortic aneurysm was diagnosed with type B aortic dissection accompanied by a patent false lumen that started at the distal arch of the thoracic aorta and terminated at the left common iliac artery. Meticulous preoperative assessment detected 3 large intimal tears in the descending aorta, abdominal aortic aneurysm, and left common iliac artery. We performed single-stage thoracic and abdominal endovascular aneurysm repair and concomitant axillary-axillary bypass. The abdominal aortic aneurysm with type B aortic dissection was successfully treated using a single-stage endovascular stent graft, without any complications due to the careful preoperative examinations.

  10. Aortic reconstruction with bovine pericardial grafts

    Directory of Open Access Journals (Sweden)

    Silveira Lindemberg Mota


    Full Text Available INTRODUCTION: Glutaraldehyde-treated crimped bovine pericardial grafts are currently used in aortic graft surgery. These conduits have become good options for these operations, available in different sizes and shapes and at a low cost. OBJECTIVE:To evaluate the results obtained with bovine pericardial grafts for aortic reconstruction, specially concerning late complications. METHOD: Between January 1995 and January 2002, 57 patients underwent different types of aortic reconstruction operations using bovine pericardial grafts. A total of 29 (50.8% were operated on an urgent basis (mostly acute Stanford A dissection and 28 electively. Thoracotomy was performed in three patients for descending aortic replacement (two patients and aortoplasty with a patch in one. All remaining 54 underwent sternotomy, cardiopulmonary bypass and aortic resection. Deep hypothermia and total circulatory arrest was used in acute dissections and arch operations. RESULTS: Hospital mortality was 17.5%. Follow-up was 24.09 months (18.5 to 29.8 months confidence interval and complication-free actuarial survival curve was 92.3% (standard deviation ± 10.6. Two patients lately developed thoracoabdominal aneurysms following previous DeBakey II dissection and one died from endocarditis. One "patch" aortoplasty patient developed local descending aortic pseudoaneurysm 42 months after surgery. All other patients are asymptomatic and currently clinically evaluated with echocardiography and CT scans, showing no complications. CONCLUSION: Use of bovine pericardial grafts in aortic reconstruction surgery is adequate and safe, with few complications related to the conduits.

  11. Abdominal Aortic Aneurysm (AAA) (United States)

    ... News Physician Resources Professions Site Index A-Z Abdominal Aortic Aneurysm (AAA) Abdominal aortic aneurysm (AAA) occurs when atherosclerosis ... an abdominal aortic aneurysm treated? What is an abdominal aortic aneurysm? The aorta, the largest artery in the body, ...

  12. The ARCHES Project (United States)

    Motch, C.; Arches Consortium


    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

  13. [Modern aortic surgery in Marfan syndrome--2011]. (United States)

    Kallenbach, K; Schwill, S; Karck, M


    Marfan syndrome is a hereditary disease with a prevalence of 2-3 in 10,000 births, leading to a fibrillin connective tissue disorder with manifestations in the skeleton, eye, skin, dura mater and in particular the cardiovascular system. Since other syndromes demonstrate similar vascular manifestations, but therapy may differ significantly, diagnosis should be established using the revised Ghent nosology in combination with genotypic analysis in specialized Marfan centres. The formation of aortic root aneurysms with the subsequent risk of acute aortic dissection type A (AADA) or aortic rupture limits life expectancy in patients with Marfan syndrome. Therefore, prophylactic replacement of the aortic root needs to be performed before the catastrophic event of AADA can occur. The goal of surgery is the complete resection of pathological aortic tissue. This can be achieved with excellent results by using a (mechanically) valved conduit that replaces both the aortic valve and the aortic root (Bentall operation). However, the need for lifelong anticoagulation with Coumadin can be avoided using the aortic valve sparing reimplantation technique according to David. The long-term durability of the reconstructed valve is favourable, and further technical improvements may improve longevity. Although results of prospective randomised long-term studies comparing surgical techniques are lacking, the David operation has become the surgical method of choice for aortic root aneurysms, not only at the Heidelberg Marfan Centre. Replacement of the aneurysmal dilated aortic arch is performed under moderate hypothermic circulatory arrest combined with antegrade cerebral perfusion using a heart-lung machine, which we also use in thoracic or thoracoabdominal aneurysms. Close post-operative follow-up in a Marfan centre is pivotal for the early detection of pathological changes on the diseased aorta.

  14. Infected abdominal aortic aneurysm due to Morganella morganii: CT findings. (United States)

    Kwon, Oh Young; Lee, Jong Seok; Choi, Han Sung; Hong, Hoon Pyo; Ko, Young Gwan


    An infected aortic aneurysm, or mycotic aneurysm, is a rare arterial dilatation due to destruction of the infected vessel wall. Common pathogens resulting in an infected aortic aneurysm are Salmonella and Clostridium species, as well as Staphylococcus aureus; Morganella morganii, on the other hand, is very rare. An infected abdominal aortic aneurysm has tendencies to grow rapidly and to rupture. The mortality rate is high in patients undergoing emergent surgical intervention. We report the case of a 65-year-old man who presented with an infected abdominal aortic aneurysm caused by M. morganii. A high index of suspicion and imaging tests are necessary in order to diagnose an infected aortic aneurysm.

  15. 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


    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.

  16. Double arch mirror study (United States)

    Vukobratovich, D.; Hillman, D.


    The development of a method of mounting light weight glass mirrors for astronomical telescopes compatible with the goals of the Shuttle Infrared Telescope Facility (SIRTF) was investigated. A 20 in. diameter double arch lightweight mirror previously fabricated was modified to use a new mount configuration. This mount concept was developed and fabricated. The mounting concept of the double mounting mirror is outlined. The modifications made to the mirror, fabrication of the mirror mount, and room temperature testing of the mirror and mount and the extension of the mirror and mount concept to a full size (40 in. diameter) primary mirror for SIRTF are discussed.

  17. Aortic coarctation, aneurysm, and ventricular dysfunction in an asymptomatic infant. (United States)

    García, Ana I; Aguilar, Juan M; García, Enrique


    Aortic arch coarctation with post-coarctation aneurysm is rare in infants. We present the case of an asymptomatic 3-month-old infant with severe left ventricular dysfunction in this setting. The patient underwent surgical repair, and the left ventricular ejection fraction improved to recovery the 4th post-operative month.

  18. Endovascular treatment of late thoracic aortic aneurysms after surgical repair of congenital aortic coarctation in childhood.

    Directory of Open Access Journals (Sweden)

    Robert Juszkat

    Full Text Available BACKGROUND: In some patients, local surgery-related complications are diagnosed many years after surgery for aortic coarctation. The purposes of this study were: (1 to systematically evaluate asymptomatic adults after Dacron patch repair in childhood, (2 to estimate the formation rate of secondary thoracic aortic aneurysms (TAAs and (3 to assess outcomes after intravascular treatment for TAAs. METHODS: This study involved 37 asymptomatic patients (26 female and 11 male who underwent surgical repair of aortic coarctation in the childhood. After they had reached adolescence, patients with secondary TAAs were referred to endovascular repair. RESULTS: Follow-up studies revealed TAA in seven cases (19% (including six with the gothic type of the aortic arch and mild recoarctation in other six (16%. Six of the TAA patients were treated with stentgrafts, but one refused to undergo an endovascular procedure. In three cases, stengrafts covered the left subclavian artery (LSA, in another the graft was implanted distally to the LSA. In two individuals, elective hybrid procedures were performed with surgical bypass to the supraaortic arteries followed by stengraft implantation. All subjects survived the secondary procedures. One patient developed type Ia endoleak after stentgraft implantation that was eventually treated with a debranching procedure. CONCLUSIONS: The long-term course of clinically asymptomatic patients after coarctation patch repair is not uncommonly complicated by formation of TAAs (particularly in individuals with the gothic pattern of the aortic arch that can be treated effectively with stentgrafts. However, in some patients hybrid procedures may be necessary.

  19. Aortic Blood Flow Reversal Determines Renal Function: Potential Explanation for Renal Dysfunction Caused by Aortic Stiffening in Hypertension. (United States)

    Hashimoto, Junichiro; Ito, Sadayoshi


    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.

  20. [Acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult - 2014 AS SMC Guidelines on the classification and diagnosis of aortic diseases]. (United States)

    Gavorník, Peter; Dukát, Andrej; Gašpar, Ľudovít


    In addition to organovascular arterial ischemic diseases (cardiovascular, vasculovascular, neurovascular, extre-mitovascular, renovascular, genitovascular, bronchopulmovascular, mesenteriovascular, osteoarthromusculovascular, dermovascular, oculovascular, otovascular, stomatovascular etc.), aortic diseases contribute to the wide spectrum of arterial diseases: aortic aneurysms (AA), acute aortic syndromes (AAS) including aortic dissection (AD), intramural haematoma (IMH), penetrating atherosclerotic ulcer (PAU) and traumatic aortic injury (TAI), pseudoaneurysm, aortic rupture, atherosclerosis, vasculitis as well as genetic diseases (e.g. Turner syndrome, Marfan syndrome, Ehlers-Danlos syndrome) and congenital abnormalities including the coarctation of the aorta (CoA). Similarly to other arterial diseases, aortic diseases may be diagnosed after a long period of subclinical development or they may have an acute presentation. Acute aortic syndrome is often the first sign of the disease, which needs rapid diagnosis and decisionmaking to reduce the extremely poor prognosis. Key clinical-etiology-anatomy-patophysiology (CEAP) diagnostic aspects of aortic diseases are discussed in this document (project Vessels).

  1. Using ArchE in the Classroom: One Experience (United States)


    displaying the new itinerary The team initially adopted the Model-View-Controller ( MVC ) architecture as the top-level architecture . The...CMU/SEI-2007-TN-001 Software Architecture Technology Initiative Unlimited distribution subject to the copyright. This report was prepared...SOFTWARE ENGINEERING INSTITUTE | v vi | CMU/SEI-2007-TN-001 Abstract The Architecture Expert (ArchE) tool serves as a software architecture

  2. Bicuspid Aortic Valve (United States)


    aortic valvular disease, endocarditis, ascending aortic aneurysm and aortic dissection.1-4 There is also an association of BAV with coarctation of...for aortic aneurysm , patients with BAV appear to have additional risks for aortic disease. Nistri et al.12 reported significant aortic root...Congenital heart disease in patients with Turner’s syndrome. Italian study group for Turner syndrome (ISGTS). J Pediatr 1998; 133:688-692. 7. Schmid

  3. Aortic Stenosis. (United States)

    Bakaeen, Faisal G; Rosengart, Todd K; Carabello, Blase A


    This issue provides a clinical overview of aortic stenosis, focusing on screening, diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  4. Aortic root, not valve, calcification correlates with coronary artery calcification in patients with severe aortic stenosis

    DEFF Research Database (Denmark)

    Henein, Michael; Hällgren, Peter; Holmgren, Anders


    BACKGROUND: The underlying pathology in aortic stenosis (AS) and coronary artery stenosis (CAS) is similar including atherosclerosis and calcification. We hypothesize that coronary artery calcification (CAC) is likely to correlate with aortic root calcification (ARC) rather than with aortic valve...... calcification (AVC), due to tissue similarity between the two types of vessel rather than with the valve leaflet tissue. MATERIAL AND METHODS: We studied 212 consecutive patients (age 72.5 ± 7.9 years, 91 females) with AS requiring aortic valve replacement (AVR) in two Heart Centers, who underwent multidetector...... cardiac CT preoperatively. CAC, AVC and ARC were quantified using Agatston scoring. Correlations were tested by Spearman's test and Mann-Whitney U-test was used for comparing different subgroups; bicuspid (BAV) vs tricuspid (TAV) aortic valve. RESULTS: CAC was present in 92%, AVC in 100% and ARC in 82...

  5. The protective effects of edaravone to cerebral ischemia reperfusion injury during aortic arch replacement surgery%依达拉奉对主动脉弓部手术深低温停循环脑缺血再灌注损伤的保护作用

    Institute of Scientific and Technical Information of China (English)

    赵文度; 卿恩明; 卢家凯; 程卫平; 邱莉


    Objective:To investigate the protective effects of edaravone to cerebral ischemia reperfusion injury for patients undergoing deep hypothermic circulatory arrest (DHCA) during great artery surgery. Methods; A total of 60 patients undergoing total aortic arch replacement combined with elephant trunk implantation from to were recruited. They were randomly divided into two groups; edaravone group (Group Y, n = 30) received edaravone 0. 5 mg/kg in normal solution, and control group (Croup C, n =30) received placebo. Two groups were inducted and maintained by the same anesthetic medications. During the operation, the anesthesia medications were dosed in the same way. Blood samples were collected from intrajugular vein for determination of serum levels of super oxide dismutase ( SOD), malondialdehyde ( MDA) , neuron-specific cenolase( NSE) and total antioxidant capacity (TAOC) at following 6 time-points, before the beginning of surgery (T1) , after cessation of DHCA for 5min after (T2), 1h (T3), 2h (T4) ,6h (T5) and 24h (T6). Results: There were no significant differences in serum levels of SOD ,MDA ,NSE and TAOC between the two groups at point of T1 The serum levels of NSE., MDA and TAOC were significantly increased at points after cessation of DHCA ( T2-5 ) compared to the value at point of T1. SOD activity and TAOC at points of cessation of DHCA (T2-5) were significantly higher in the experimental group than those in the control group(P <0.05 or 0.01). The serum levels of NSE and MDA after cessation of DHCA (T2-5) were significantly lower in the experiment group than those in the control group( P < 0.05, P < 0. 01). Conclusion; Edaravone can attenuate cerebral injury during aorticsurgery with DHCA. Edaravone used in aortic surgery with DHCA can eliminate OFR effectively, protect the activity of SOD, increase the activity of TAOC and decrease production of MDA, which can reduce the cerebral ischemia-reperfusion injury and attenuate cerebral injury. Therefore, edaravone

  6. Aortic valve bypass

    DEFF Research Database (Denmark)

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


    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...

  7. Vessel Operating Units (Vessels) (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains data for vessels that are greater than five net tons and have a current US Coast Guard documentation number. Beginning in1979, the NMFS...

  8. Fluid dynamics of aortic root dilation in Marfan syndrome

    CERN Document Server

    Querzoli, Giorgio; Espa, Stefania; Costantini, Martina; Sorgini, Francesca


    Aortic root dilation and propensity to dissection are typical manifestations of the Marfan Syndrome (MS), a genetic defect leading to the degeneration of the elastic fibres. Dilation affects the structure of the flow and, in turn, altered flow may play a role in vessel dilation, generation of aneurysms, and dissection. The aim of the present work is the investigation in-vitro of the fluid dynamic modifications occurring as a consequence of the morphological changes typically induced in the aortic root by MS. A mock-loop reproducing the left ventricle outflow tract and the aortic root was used to measure time resolved velocity maps on a longitudinal symmetry plane of the aortic root. Two dilated model aortas, designed to resemble morphological characteristics typically observed in MS patients, have been compared to a reference, healthy geometry. The aortic model was designed to quantitatively reproduce the change of aortic distensibility caused by MS. Results demonstrate that vorticity released from the valve ...

  9. New technique for single-staged repair of aortic coarctation and coexisting cardiac disorder. (United States)

    Korkmaz, Askin Ali; Guden, Mustafa; Onan, Burak; Tarakci, Sevim Indelen; Demir, Ali Soner; Sagbas, Ertan; Sarikaya, Tugay


    The management of adults with aortic coarctation and a coexisting cardiac disorder is still a surgical challenge. Single-staged procedures have lower postoperative morbidity and mortality rates than do 2-staged procedures. We present our experience with arch-to-descending aorta bypass grafting in combination with intracardiac or ascending aortic aneurysm repair.From October 2004 through April 2010, 5 patients (4 men, 1 woman; mean age, 45.8 ± 9.4 yr) underwent anatomic bypass grafting of the arch to the descending aorta through a median sternotomy and concomitant repair of an intracardiac disorder or an ascending aortic aneurysm. Operative indications included coarctation of the aorta in all cases, together with severe mitral insufficiency arising from damaged chordae tendineae in 2 patients, ascending aortic aneurysm with aortic regurgitation in 2 patients, and coronary artery disease in 1 patient. Data from early and midterm follow-up were reviewed.There was no early or late death. Follow-up was complete for all patients, and the mean follow-up period was 34.8 ± 18 months (range, 18 mo-5 yr). All grafts were patent. No late graft-related sequelae or reoperations were observed.For single-staged repair of aortic coarctation with a coexistent cardiac disorder, we propose arch-to-descending aorta bypass through a median sternotomy as an alternative for selected patients.

  10. Theory of Arched Structures Strength, Stability, Vibration

    CERN Document Server

    Karnovsky, Igor A


    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.

  11. Atherosclerotic Aortic Plaques Detected by Transesophageal Echocardiography

    Institute of Scientific and Technical Information of China (English)

    赵云; 朱文玲; 倪超; 郭丽琳; 曾勇; 方理刚


    Objective To evaluate the predictive value of atherosclerotic aortic plaques in coronary artery disease (CAD) Methods In 50patients with suspected coronary artery disease, transesophageal echocardiography was performed to examine their thoracic aortas 2 weeks before or after coronary angiography. In the cases of coronary angiography studied, stenosis of the coronary artery ≥ 50 % was considered to be due to coronary artery disease,whereas the thickness of the intima ≥ 1.3 mm was taken to be the criteria for the presence of an atherosclerotic aortic plaque on the transesophageal echocardiographic test. Results Among the 50 patients, 37 cases were diagnosed as CAD and 13 cases were considered to be normal. The plaques of the thoracic aorta were observed in 34cases in the CAD group and 3 cases in the normal group. The sensitivity and specificity of aortic plaques for CAD were 91.9 % and 76.9%, respectively. The positive and negative predictive values of the aortic plaques for CAD were 91.9% and 76.9%, respectively. The accuracy was 88.0%. 80 percent of the patients with single- yes sel disease had thoracic aortic plaques, 92 percent of the patients with two-vessel disease and 100 percent of the patients with three-vessel disease had thoracic aortic plaques. There was a significant difference in the thickness of aortic intimas between the normal group and the CAD group. Conclusions Detectingatherosclerotic plaques in the thoracic aorta with transesophageal echocardiography may be of great value in predicting the presence and extent of coronary artery disease.

  12. Arch bridges – unlocking their potential


    Long, Adrian; Nanukuttan, Sreejith


    Arch bridges are strong, durable, aesthetically pleasing and require little maintenance but very few have been built since the early 1900s. However, this trend has changed as more than 60 FlexiArch bridges have been installed since the system was launched in 2007. The FlexiArch uses precast concrete voussoirs, requires neither corrodible reinforcement, nor centring, can be installed in hours and is contractor friendly. Details of this innovative method of construction and installation of arch...

  13. Pregnancy with aortic dissection in Ehler-Danlos syndrome. Staged replacement of the total aorta (10-year follow-up). (United States)

    Babatasi, G; Massetti, M; Bhoyroo, S; Khayat, A


    Pregnancy complicated by aortic dissection in patients with hereditary disorder of connective tissue presents interesting considerations including management of caesarean section with the unexpected need for cardiac surgery in emergency. Generalizations can be made on management principles with long-term follow-up requiring an aggressive individualized approach by a multidisciplinary team. A 33-year-old parturient presenting an aortic dissection at 37 weeks gestation required prompt diagnosis of Ehlers-Danlos syndrome in combination with correct surgical therapy resulted in the survival of both the mother and infant. During the 10-year follow-up, multiple complex dissection required transverse aortic arch and thoracoabdominal aortic replacement.

  14. Value of CT angiography in anterior circulation large vessel occlusive stroke: Imaging findings, pearls, and pitfalls

    Energy Technology Data Exchange (ETDEWEB)

    Power, Sarah, E-mail: [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); McEvoy, Sinead H., E-mail: [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Cunningham, Jane, E-mail: [Department of Radiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Ti, Joanna P., E-mail: [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Looby, Seamus, E-mail: [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); O' Hare, Alan, E-mail: [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Williams, David, E-mail: [Department of Geriatrics and Stroke Medicine, Royal College of Surgeons in Ireland (RCSI) and Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Brennan, Paul, E-mail: [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland); Thornton, John, E-mail: [Department of Neuroradiology, Beaumont Hospital, P.O. Box 1297, Beaumont Rd, Dublin 9 (Ireland)


    Highlights: • Site of occlusion determines potential collateralization routes and impacts outcome. • Multifocality of arterial occlusion is common, seen in approximately 20% of cases. • ICA false occlusion sign can be seen in setting of ICA stenosis or carotid T occlusion. • False patency sign: hyperdense thrombus/calcified occlusive plaque misinterpreted as patent vessel. • Additional abnormalities on CTA may infer stroke mechanism or alter decision making. - Abstract: Hyperacute stroke imaging is playing an increasingly important role in determining management decisions in acute stroke patients, particularly patients with large vessel occlusive stroke who may benefit from endovascular intervention. CT angiography (CTA) is an important tool in the work-up of the acute stroke patient. It reliably detects large occlusive thrombi in proximal cerebral arteries and is a quick and highly accurate method in identifying candidates for endovascular stroke treatment. In this article we review the imaging findings on CTA in acute large vessel occlusive stroke using a pictorial case based approach. We retrospectively reviewed CTA studies in 48 patients presenting with acute anterior circulation large vessel occlusive stroke who were brought for intra-arterial acute stroke intervention. We discuss and illustrate patterns of proximal intracranial arterial occlusion, collateralization to the occluded territory, as well as reviewing some important pearls, pitfalls and teaching points in CTA assessment of the acute stroke patient. Performed from the level of the aortic arch CTA also gives valuable information regarding the state of other vessels in the acute stroke patient, identifying additional significant vascular stenoses or occlusions, and as we illustrate, can demonstrate other clinically significant findings which may impact on patient management and outcome.

  15. Aortic Annular Enlargement during Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Selman Dumani


    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.

  16. Aortic aneurysm repair - endovascular (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 ...

  17. Abdominal aortic aneurysm (United States)

    ... this page: // Abdominal aortic aneurysm To use the sharing features on this page, ... blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aorta becomes ...

  18. 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:; 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)


    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)

  19. Aortic Coarctation Diagnosed During Pregnancy in a Woman With Repaired Tetralogy of Fallot. (United States)

    Jalal, Zakaria; Iriart, Xavier; Thambo, Jean-Benoit


    Aortic coarctation is thought to be a rare condition in patients with tetralogy of Fallot. We report the case of a 26 year old woman presenting with systemic hypertension at 17 weeks of pregnancy after repair of tetralogy of Fallot in childhood. Echocardiography and magnetic resonance imaging revealed right aortic arch with severe isthmic coarctation. Her blood pressure was controlled medically during the rest of her pregnancy, and delivery was uneventful. Successful transcatheter placement of a covered stent at the level of the coarctation was performed after delivery. To our knowledge, this is the first reported case of aortic coarctation diagnosed in an adult patient late after repair of tetralogy of Fallot.

  20. Repair of Late Retrograde Type A Aortic Dissection After TEVAR: Causes and Management. (United States)

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


    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.

  1. Endothelium in the pharyngeal arches 3, 4 and 6 is derived from the second heart field. (United States)

    Wang, Xia; Chen, Dongying; Chen, Kelley; Jubran, Ali; Ramirez, AnnJosette; Astrof, Sophie


    Oxygenated blood from the heart is directed into the systemic circulation through the aortic arch arteries (AAAs). The AAAs arise by remodeling of three symmetrical pairs of pharyngeal arch arteries (PAAs), which connect the heart with the paired dorsal aortae at mid-gestation. Aberrant PAA formation results in defects frequently observed in patients with lethal congenital heart disease. How the PAAs form in mammals is not understood. The work presented in this manuscript shows that the second heart field (SHF) is the major source of progenitors giving rise to the endothelium of the pharyngeal arches 3 - 6, while the endothelium in the pharyngeal arches 1 and 2 is derived from a different source. During the formation of the PAAs 3 - 6, endothelial progenitors in the SHF extend cellular processes toward the pharyngeal endoderm, migrate from the SHF and assemble into a uniform vascular plexus. This plexus then undergoes remodeling, whereby plexus endothelial cells coalesce into a large PAA in each pharyngeal arch. Taken together, our studies establish a platform for investigating cellular and molecular mechanisms regulating PAA formation and alterations that lead to disease.

  2. Giant Aneursym of the Ascending Aorta 37 Years after Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Fabrizio Sansone


    Full Text Available Giant ascending aorta aneurysms (AAA, which are larger than 10 cm, are rare. We hereby present the case of a giant AAA of about 13 cm, incidentally detected several years after aortic valve replacement and treated according to the Cabrol technique without postoperative complications. [Arch Clin Exp Surg 2013; 2(2.000: 129-131

  3. Medical image of the week: acute aortic dissection

    Directory of Open Access Journals (Sweden)

    Desai H


    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 ...

  4. Comparison between different plantar arch



    The longitudinal plantar arch (LPA) perform biomechanics functions in the foot. The aim of this study was to compare the relationship between different index to measure the LPA of the foot. The arc index, Staheli index, Viladot classification and Feiss line were compared. In the transversal study, the experimental samples were soccer players females with age between 13 to 19 years. The measure were performed by plantigraphy, with out Feiss line. Although non significant the higher agreement w...

  5. 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.


    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.

  6. Surgical Management of Ascending Aortic Aneurysm and Its Complications

    Directory of Open Access Journals (Sweden)

    Sisira Sran


    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.

  7. Extensive spinal epidural hematoma: a rare complication of aortic coarctation

    Energy Technology Data Exchange (ETDEWEB)

    Zizka, J.; Elias, P.; Michl, A. [Dept. of Radiology, Charles University Hospital, Hradec Kralove (Czech Republic); Harrer, J. [Dept. of Cardiac Surgery, Charles University Hospital, Hradec Kralove (Czech Republic); Cesak, T. [Dept. of Neurosurgery, Charles University Hospital, Hradec Kralove (Czech Republic); Herman, A. [1. Dept. of Internal Medicine, Charles University Hospital, Hradec Kralove (Czech Republic)


    Development of collateral circulation belongs among the typical signs of aortic coarctation. Cerebral or spinal artery aneurysm formation with increased risk of subarachnoid hemorrhage represent the most common neurovascular complication of this disease. We report a case of a 20-year-old sportsman who developed acute non-traumatic paraplegia as a result of extensive spinal epidural hemorrhage from collateral vessels accompanying aortic coarctation which was unrecognized up to that time. To the best of our knowledge, acute spinal epidural hematoma as a complication of aortic coarctation has not been previously reported. (orig.)

  8. Palliative stent graft placement combined with subsequent open surgery for retrograde ascending dissection intra-thoracic endovascular aortic repair


    Zhu, Kai; Lai, Hao; Guo, Changfa; Li, Jun; Wang, Chunsheng


    Thoracic endovascular aortic repair (TEVAR) is an effective strategy for type B dissection. Retrograde ascending dissection (RAD) intra-TEVAR is a rare complication on clinic. In this case, a 48-year-old Chinese man with Stanford type B aortic dissection suffered acute RAD during the TEVAR. And palliative stent grafts placement was performed in a local hospital, which earned the time for transfer and subsequent total arch replacement surgery in Zhongshan Hospital Fudan University. This report...

  9. Myocardial revascularization with both internal thoracic arteries 25 years after delayed repair for aortic coarctation. (United States)

    Gaudino, Mario; Farina, Piero; Cammertoni, Federico; Massetti, Massimo


    Aortic coarctation has been reported to cause alterations in the internal thoracic arteries that make these vessels unsuitable to be used as grafts for myocardial revascularization, especially if coarctation repair was performed in adulthood. This is the first reported bilateral internal thoracic grafting for myocardial revascularization in a patient who had undergone aortic coarctation repair 25 years earlier.

  10. Reproducibility of ECG-gated Ultrasound Diameter Assessment of Small Abdominal Aortic Aneurysms

    DEFF Research Database (Denmark)

    Bredahl, K; Eldrup, N; Meyer, C


    No standardised ultrasound procedure to obtain reliable growth estimates for abdominal aortic aneurysms (AAA) is currently available. We investigated the feasibility and reproducibility of a novel approach controlling for a combination of vessel wall delineation and cardiac cycle variation....

  11. Revisiting impressions using dual-arch trays. (United States)

    Small, Bruce W


    Making routine perfect impressions is the goal of any restorative dentist. Using dual-arch trays is an easy, repeatable way to accomplish that goal, as long as each step is done before the next and each step is performed perfectly. This column reviewed several articles that support the metal dual-arch concept and provided some clinical tips that might help restorative dentists. The dual-arch technique does have its limits and is meant for one or two teeth in a quadrant when there are other teeth to occlude with. Also, if the case involves anterior guidance, a full-arch impression maybe advisable.

  12. Endovascular treatment of thoracic aortic diseases

    Directory of Open Access Journals (Sweden)

    Davidović Lazar


    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

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

    Energy Technology Data Exchange (ETDEWEB)

    Debl, K.; Buchner, S.; Heinicke, N.; Riegger, G.; Luchner, A. [Klinik und Poliklinik fuer Innere Medizin II, Universitaetsklinikum Regensburg (Germany); Djavidani, B.; Poschenrieder, F.; Feuerbach, S. [Inst. fuer Roentgendiagnostik, Universitaetsklinikum Regensburg (Germany); Schmid, C.; Kobuch, R. [Klinik und Poliklinik fuer Herz-, Thorax- und herznahe Gefaesschirurgie, Universitaetsklinikum Regensburg (Germany)


    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 cm{sup 2} vs. 8.7 {+-} 2.3 cm{sup 2}, 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.)

  14. 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


    . 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

  15. 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)


    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.)

  16. Tympanic ossicles and pharyngeal arches. (United States)

    Whyte, J; Cisneros, A; Yus, C; Fraile, J; Obón, J; Vera, A


    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.

  17. Flow in an Aortic Coarctation (United States)

    Loma, Luis; Miller, Paul; Hertzberg, Jean


    Coarctation of the aorta is a congenital cardiovascular defect that causes a constriction in the descending thoracic aorta. To gain a better understanding of the cause of post-surgical problems, a rigid glass and a compliant in vitro model of the aortic arch and descending aorta with a coarctation were constructed. Near-physiologic compliance was obtained using a silicone elastomer. Stereoscopic PIV was used to obtain 3D velocity maps. Results show a high speed turbulent jet formed at the exit of the coarctation. Flow in the rigid model was significantly different from in the compliant model. In the rigid model, the jet was symmetric, creating a toroidal recirculation area. In the compliant model, the jet was directed towards the medial wall, inducing flow reversal only at the lateral wall. Peak velocities and turbulence intensities were higher in the rigid model, however shear rate values in the compliant model were significantly above both the rigid model and normal in vivo values at the medial wall. In both models the reattachment region fluctuated, creating oscillatory shear.

  18. Measurement of the aortic diameter in the asymptomatic Korean population: Assessment with multidetector CT

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Hwan; Lee, Whal; Choi, Hyuck Jae; Kim, Dae Jin; Park, Eun Ah; Chung, Jin Wook; Park, Jae Hyung [Dept. of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of)


    To determine normal reference values for aortic diameters in asymptomatic Korean adults. Three hundred adults without signs or symptoms of cardiovascular diseases were enrolled in this study. Aortic diameters were measured at nine predetermined levels on CT images. Aortic diameter measurements were adjusted for body surface area. Analysis of data was performed with regard to age, sex, weight, height and hypertension. Aortic diameters were 2.99 ± 0.57 cm at the ascending aorta, 2.54 ± 0.35 cm at the transverse aortic arch, 2.36 ± 0.35 cm at the proximal descending thoracic aorta (DTA), 2.23 ± 0.37 cm at the mid DTA, 2.17 ± 0.38 cm at the distal DTA, 2.16 ± 0.37 cm at the thoracoabdominal junction, 2.10, 00B1, 0.35 cm at the level of the celiac axis, 1.94, 00B1, 0.36 cm at the suprarenal aorta, 1.58 ± 0.24 cm at the aortic bifurcation. Men had slightly larger diameters than women (p < 0.05). All diameters increased with age and hypertension, with statistical significance (p < 0.01). And all aortic diameters increased with height (p < 0.05) except at the level of the aortic arch (p = 0.056), and increased with weight (p < 0.05) except at the level of the suprarenal aorta (p = 0.067). Male sex, higher weight and height, age and hypertension are associated with larger aortic diameters in asymptomatic Korean adults.

  19. Occlusal stability in shortened dental arches. (United States)

    Witter, D J; Creugers, N H; Kreulen, C M; de Haan, A F


    Shortened dental arches consisting of anterior and premolar teeth have been shown to meet oral functional demands. However, the occlusal stability may be at risk as a result of tooth migration. The aim of this nine-year study was to investigate occlusal stability in shortened dental arches as a function over time. Occlusal stability indicators were: 'interdental spacing', 'occlusal contacts of anterior teeth in Intercuspal Position', 'overbite', 'occlusal tooth wear', and 'alveolar bone support'. Subjects with shortened dental arches (n = 74) were compared with subjects with complete dental arches (controls, n = 72). Repeated-measurement regression analyses were applied to assess age-dependent variables in the controls and to relate the occlusal changes to the period of time since the treatment that led to the shortened dental arches. Compared with complete dental arches, shortened dental arches had similar overbite and occlusal tooth wear. They showed more interdental spacing in the premolar regions, more anterior teeth in occlusal contact, and lower alveolar bone scores. Since the differences remained constant over time, we conclude that shortened dental arches can provide long-term occlusal stability. Occlusal changes were self-limiting, indicating a new occlusal equilibrium.

  20. Cryosurgical effects on growing vessels. (United States)

    Ladd, A P; Rescorla, F J; Baust, J G; Callahan, M; Davis, M; Grosfeld, J L


    Cryosurgical treatment of unresectable hepatic malignancies has proven beneficial in adults. Concerns regarding its use in children include the effect on growth and the risk of injury to adjacent structures. To test the effect of cryoablation on adjacent vascular structures in a growing animal, liquid nitrogen cryoablation was performed on a juvenile murine model. Sprague Dawley rats underwent double freeze-thaw cryoablation of the abdominal aorta with interposed liver tissue. Serial sacrifices were performed over 120 days. Comparisons were made with sham-operated controls. Overall, animal growth paralleled that of sham controls through all time points. Gross examination of aortic diameter also showed similar growth in vessel size between the groups. Histologic analysis demonstrated injury after cryoablation with smooth muscle cell vacuolization, followed by cell death. Aortic media layer collapse resulted from cellular loss, however, elastin fiber composition was maintained. Aortic patency was preserved despite evidence of cellular injury and aortic wall remodeling. An associated thermal sink effect on the opposing wall was identified. After cryoablation adjacent to the abdominal aorta in adolescent rats, vascular patency is maintained and animal growth and structural function is preserved, despite cellular injury and wall compression. These observations suggest that cryoablation may be a useful treatment adjunct in young subjects.

  1. Aneurismas da aorta Aortic aneurysms

    Directory of Open Access Journals (Sweden)

    Januário M Souza


    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

  2. [Late paraparesis as a postoperative complication in a patient undergoing the repair of a double aortic aneurysm]. (United States)

    Bonome González, C; Alvarez Refojo, F; Fernández Carballal, F; Rodríguez Alvarez, R


    We report a case of a fifty-seven (57)-years old man undergoing elective surgery of a thoracoabdominal and aortoiliac aneurysm in a single surgical time. The patients is operated undergoing general anesthetic combined with thoracic epidural blockade, and it was done two aortic cross-clamping: one to five cm of the aortic arch and the other to the infrarenal level. The most important intraoperative complications were during the thoracic aortic cross-clamping and the most important postoperative complication was related 48 hours later, to paraparesis after a hypotension episode what improved with rehabilitation treatment.

  3. Ischemic stroke secondary to aortic dissection following rifle butt recoil chest injury: a case report. (United States)

    Rao, Mamatha; Panduranga, Prashanth; Al-Mukhaini, Mohammed; Al-Jufaili, Mahmood; Valiath, John


    Ischemic stroke secondary to aortic dissection is not uncommon. We present a patient with left hemiplegia secondary to Stanford type A aortic dissection extending to the supra-aortic vessels, which was precipitated by rifle butt recoil chest injury. The diagnosis of aortic dissection was delayed due to various factors. Finally, the patient underwent successful Bentall procedure with complete resolution of symptoms. This case emphasizes the need for caution in the use of firearms for recreation and to take precautions in preventing such incidents. In addition, this case illustrates the need for prompt cardiovascular physical examination in patients presenting with stroke.

  4. 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: [University Hospital of Lille, Cardiovascular and Interventional Radiology (France); Moreno, Ramiro, E-mail: [Rangueil University Hospital, Department of Radiology (France); Negre-Salvayre, Anne, E-mail: [INSERM, UMR 1048, I2MC (France); Nicoud, Franc, E-mail: [CNRS, UMR 5149 I3M, CC 051, University Montpellier II (France); Pruvo, Jean Pierre, E-mail: [University Hospital of Lille, Cardiovascular and Interventional Radiology (France); Haulon, Stephan, E-mail: [University Hospital of Lille, Department of Vascular Surgery (France); Rousseau, Hervé, E-mail: [Rangueil University Hospital, Department of Radiology (France)


    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.

  5. 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


    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.

  6. Aortic aneurysm and diverticulum of Kommerell: a dreadful concomitance

    Directory of Open Access Journals (Sweden)

    Fernando Peixoto Ferraz de Campos


    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.

  7. Catalase overexpression in aortic smooth muscle prevents pathological mechanical changes underlying abdominal aortic aneurysm formation. (United States)

    Maiellaro-Rafferty, Kathryn; Weiss, Daiana; Joseph, Giji; Wan, William; Gleason, Rudolph L; Taylor, W Robert


    The causality of the associations between cellular and mechanical mechanisms of abdominal aortic aneurysm (AAA) formation has not been completely defined. Because reactive oxygen species are established mediators of AAA growth and remodeling, our objective was to investigate oxidative stress-induced alterations in aortic biomechanics and microstructure during subclinical AAA development. We investigated the mechanisms of AAA in an angiotensin II (ANG II) infusion model of AAA in apolipoprotein E-deficient (apoE(-/-)) mice that overexpress catalase in vascular smooth muscle cells (apoE(-/-)xTg(SMC-Cat)). At baseline, aortas from apoE(-/-)xTg(SMC-Cat) exhibited increased stiffness and the microstructure was characterized by 50% more collagen content and less elastin fragmentation. ANG II treatment for 7 days in apoE(-/-) mice altered the transmural distribution of suprarenal aortic circumferential strain (quantified by opening angle, which increased from 130 ± 1° at baseline to 198 ± 8° after 7 days of ANG II treatment) without obvious changes in the aortic microstructure. No differences in aortic mechanical behavior or suprarenal opening angle were observed in apoE(-/-)xTg(SMC-Cat) after 7 days of ANG II treatment. These data suggest that at the earliest stages of AAA development H(2)O(2) is functionally important and is involved in the control of local variations in remodeling across the vessel wall. They further suggest that reduced elastin integrity at baseline may predispose the abdominal aorta to aneurysmal mechanical remodeling.

  8. Study on Structure of Arched Longitudinal Beams of Deep Water Wharf

    Institute of Scientific and Technical Information of China (English)


    High-pile and beam-slab quays have been widely used after several years development. They are mature enough to be one of the most important structural types of wharves in China coastal areas. In order to accommodate large tonnage vessels, wharves should be constructed in deep water gradually. However, conventional high-pile and beam-slab structures are hard to meet the requirements of large deep-water wharf. According to arch's stress characteristics, a new type of wharf with catenary arched longitudinal beams is presented in this paper. The new wharf structure can make full use of arch's overhead crossing and reinforced concrete compression resistance, improve the interval between transverse bents greatly, and decrease underwater construction quantity. Thus, the construction cost cab be reduced. Take the third phase project of the Yangshan Deep-water Port for example, comparative analysis on catenary arched longitudinal beams and conventional longitudinal beams has been made. The result shows that with the same wharf length and width, the same loads and same longitudinal beam moment, catenary arch structure can improve the interval between bents up to 28 m, decrease the number of piles and underwater construction quantity.

  9. Successful treatment for acute aortic dissection in pregnancy---bentall procedure concomitant with cesarean section

    Directory of Open Access Journals (Sweden)

    Xu Demin


    Full Text Available Abstract Acute aortic type A dissection is a life-threatening disease that requires immediate surgical intervention. When dissection occurs during pregnancy, it is of high risk for both the mother and the fetus. In this study, we reported two cases of acute aortic dissection in late pregnancy at 28 weeks and 32 weeks of gestation respectively. After the two patients underwent a cesarean section and delivered a baby, we performed composite graft replacement of the aortic valve, aortic root and ascending aorta, with re-implantation of the coronary arteries into the graft (Bentall procedure instead of repairing the arch with deep hypothermia and circulation arrest. Both mothers and children survived and recovered well.

  10. Nonlinear Dynamics of Electrostatically Actuated MEMS Arches

    KAUST Repository

    Al Hennawi, Qais M.


    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.

  11. In-Plane Elastic Buckling of Arch

    Institute of Scientific and Technical Information of China (English)

    剧锦三; 郭彦林


    The in-plane elastic buckling behavior of arches is investigated using a new finite-element approach for the nonlinear analysis. The linear buckling, nonlinear primary buckling, and secondary bifurcation buckling behavior of arches are compared taking into account the large deformation and the effects of initial geometric imperfections or perturbations. The theoretical investigation emphasizes the nonlinear secondary bifurcation buckling behavior for a full span uniformly distributed load. The efficiency of compact method for tracing secondary buckling path is shown through several examples. Finally, a new structural design, which prevents the secondary bifurcation buckling by adding some crossed cables across the arch, is proposed to improve the limit load carrying capacity.

  12. Non-anatomical implantation of supra-aortic branches for customizing the standard form of Thoraflex™ hybrid prosthesis to a patient's anatomical requirements. (United States)

    Urbanski, Paul P; Irimie, Vadim; Zembala, Michal


    Frozen elephant trunk technique represents a valuable therapeutic option for patients with extensive pathology of thoracic aorta. Thoraflex™ hybrid prosthesis (Vascutek, Terumo, Inchinnan, UK) is one of the commercially available devices in which a stent graft is combined with branched vascular tube mimicking the aortic arch anatomy. Owing to the sewing collar between the stented and unstented portions, this hybrid prosthesis offers a valuable addition to the surgical armamentarium for patients with huge thoracic aorta aneurysms, in whom the aortic diameter exceeds the diameter of available stent grafts. However, the standard factory form of the quadrifurcated arch prosthesis does not always fit to the patient's anatomy and demands a deviation from the anatomical anastomosing of the branches with the respective supra-aortic arteries. A technique of non-anatomical implantation of supra-aortic arteries for customizing the standard form of the Thoraflex prosthesis is described, which facilitates the surgery without limiting the functionality of this hybrid prosthesis.

  13. Histopathological study of congenital aortic valve malformations in 32 children

    Institute of Scientific and Technical Information of China (English)

    HUANG Ping; WANG Hongwei; LI Yanping; CHENG Peixuan; LIU Qingjun; ZHANG Zhenlu; LIU Jianying


    malformations.Histopathologically,the leaflets of aortic valve are mainly myxomatous,thickening with unequal size,irregular shape (coiling and prolapse edge),reduced collagen fiber,rupture of elastic fibers,without small vessel proliferation and inflammatory cell infiltration,fibrosis and calcification rarely seen.

  14. Determinant factors of Yemeni maxillary arch dimensions

    Directory of Open Access Journals (Sweden)

    Nabil Muhsen Al-Zubair


    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.

  15. Successful Anticoagulation Therapy for Antiphospholipid Syndrome with Mobile Aortic Thrombi (United States)

    Park, Hyun Oh; Moon, Seong Ho; Kim, Jong Woo; Byun, Joung Hun; Kim, Sung Hwan; Yang, Jun Ho; Lee, Chung-Eun; Kim, Jong-Duk


    Hypercoagulable states have been associated with aortic thrombosis. Antiphospholipid syndrome (APS) is one of the commonest types of acquired thrombophilia. We report the case of successful anticoagulation management in an APS patient with mobile thrombi within the aorta. A 58-year-old male patient presented to the emergency department (ED) with right-sided hemiparesis. His first symptoms were noted approximately 12–16 hours before presentation to the ED. Magnetic resonance imaging of the brain showed acute embolic infarction of the left frontal and parietotemporal lobes. Transesophageal echocardiography (TEE) and computed tomography angiography (CTA) demonstrated mobile thrombi attached to the wall of the ascending aorta and aortic arch. The patient was diagnosed with APS based on positivity of anti-beta-2 glycoprotein 1 antibodies, and was initiated on anticoagulation therapy. Repeated TEE and CTA revealed complete resolution of the thrombi after 12 days of treatment; the patient was discharged well. PMID:28042559

  16. Effects of aortic irregularities on blood flow. (United States)

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


    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.

  17. Fractionally Integrated Models With ARCH Errors


    Hauser, Michael A.; Kunst, Robert M.


    Abstract: We introduce ARFIMA-ARCH models which simultaneously incorporate fractional differencing and conditional heteroskedasticity. We develop the likelihood function and a numerical estimation procedure for this model class. Two ARCH models - Engle- and Weiss-type - are explicitly treated and stationarity conditions are derived. Finite-sample properties of the estimation procedure are explored by Monte Carlo simulation. An application to the Standard & Poor 500 Index indicates existence o...

  18. Custom Fenestration Templates for Endovascular Repair of Juxtarenal Aortic Aneurysms (United States)

    Leotta, Daniel F.; Starnes, Benjamin W.


    Physician-modified endovascular grafts, with fenestrations added to accommodate major branch vessels, provide a means for endovascular treatment of abdominal aortic aneurysms that are adjacent to the renal arteries. Manual measurements of vessel origin locations from CT images, however, take time and can lead to errors in the positions of the fenestrations. To make the fenestration process faster and more accurate, we have developed a procedure to create custom templates that serve as patient-specific guides for graft fenestration. We use a 3D printer to create a clear rigid sleeve that replicates the patient’s aorta and includes holes placed precisely at the locations of the branch vessels. The sleeve is slipped over the graft, the locations of the openings are marked with a pen, and the fenestrations are created after removing the sleeve. Custom fenestration templates can potentially save procedural costs and make minimally-invasive aortic aneurysm repair available to more patients. PMID:25864045

  19. Aortic Valve Disease (United States)

    ... that is safest for you based on your individual symptoms and circumstances. Recovery Recovery Most aortic valve ... is safe to do so. You should anticipate spending several days, but likely not more than a ...

  20. Bicuspid aortic valve (United States)

    ... aortic disease. In: Otto CM, Bonow RO, eds. Valvular Heart Disease: A Companion to Braunwald's Heart Disease . 4th ed. ... PA: Elsevier Saunders; 2014:chap 13. Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil ...

  1. Aortic Valve Regurgitation (United States)

    ... inside your heart that involves heart valves. Rheumatic fever. Rheumatic fever — a complication of strep throat and once a ... the United States — can damage the aortic valve. Rheumatic fever is still prevalent in developing countries but rare ...

  2. Aortic Valve Stenosis (United States)

    ... evaluation of aortic stenosis in adults. Accessed April 29, 2014. Mohty D, ... Valvular heart disease in elderly adults. Accessed May 2, 2014. Bonow RO, ...

  3. Histology of a Marfan aorta 4.5 years after personalized external aortic root support. (United States)

    Pepper, John; Goddard, Martin; Mohiaddin, Raad; Treasure, Tom


    In 2008, a 26-year old man had personalized external aortic root support (PEARS) with a macroporous mesh. He was the 16th of 46 patients to have this operation. He had a typical Marfan habitus. His mother died of this disease as did his brother, with an aortic dissection. The patient himself died suddenly 4.5 years after his PEARS operation. At autopsy, there was no blood in the pericardium. The coronary orifices and proximal arteries were normal. His bicuspid aortic valve was minimally regurgitant as it was prior to operation and remained throughout follow-up. Macroscopically the implanted mesh was embedded in the adventitia and not separable from the aortic wall. Microscopically it was fully incorporated with collagen fibres as has been seen in our animal studies. The unsupported aortic arch showed some focal fragmentation of elastic fibres and a mild increase in mucopolysaccharides consistent with Marfan syndrome. These appearances were not present in the supported aortic root, which had the histological appearance of a normal aorta. He was the first patient to die with an implant. The histological appearances suggest the possibility that the incorporated support of the aortic root allowed recovery of the microstructure of the media.

  4. Stanford-A acute aortic dissection, inflammation, and metalloproteinases: a review. (United States)

    Cifani, Noemi; Proietta, Maria; Tritapepe, Luigi; Di Gioia, Cira; Ferri, Livia; Taurino, Maurizio; Del Porto, Flavia


    Acute aortic dissection (AAD) is a life-threatening disease with an incidence of about 2.6-3.6 cases per 100,000/year. Depending on the site of rupture, AAD is classified as Stanford-A when the ascending aortic thoracic tract and/or the arch are involved, and Stanford-B when the descending thoracic aorta and/or aortic abdominal tract are targeted. It was recently shown that inflammatory pathways underlie aortic rupture in both type A and type B Stanford AAD. An immune infiltrate has been found within the middle and outer tunics of dissected aortic specimens. It has also been observed that the recall and activation of macrophages inside the middle tunic are key events in the early phases of AAD. Macrophages are able to release metalloproteinases (MMPs) and pro-inflammatory cytokines which, in turn, give rise to matrix degradation and neoangiogenesis. An imbalance between the production of MMPs and MMP tissue inhibitors is pivotal in the extracellular matrix degradation underlying aortic wall remodelling in dissections occurring both in inherited conditions and in atherosclerosis. Among MMPs, MMP-12 is considered a specific marker of aortic wall disease, whatever the genetic predisposition may be. The aim of this review is, therefore, to take a close look at the immune-inflammatory mechanisms underlying Stanford-A AAD.

  5. 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. (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


    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.

  6. What Lies behind the Ischemic Stroke: Aortic Dissection?

    Directory of Open Access Journals (Sweden)

    Turgut Deniz


    Full Text Available Introduction. Some cases with aortic dissection (AD could present with various complaints other than pain, especially neurological and cardiovascular manifestations. AD involving the carotid arteries could be associated with many clinical presentations, ranging from stroke to nonspecific headache. Case Report. A 71-year-old woman was admitted to emergency department with vertigo which started within the previous one hour and progressed with deterioration of consciousness following speech disorder. On arrival, she was disoriented and uncooperative. Diffusion magnetic resonance imaging (MRI of brain was consistent with acute ischemia in the cerebral hemisphere. Fibrinolytic treatment has been planned since symptoms started within two hours. Echocardiography has shown the dilatation of ascending aorta with a suspicion of flap. Computed tomography (CT angiography has been applied and intimal flap has been detected which was consistent with aortic dissection, intramural hematoma of which was reaching from aortic arch to bilateral common carotid artery. Thereafter, treatment strategy has completely changed and surgical invention has been done. Conclusion. In patients who are admitted to the emergency department with the loss of consciousness and stroke, inadequacy of anamnesis and carotid artery involvement of aortic dissection should be kept in mind.

  7. Wall shear stress indicators in abnormal aortic geometries (United States)

    Prahl Wittberg, Lisa; van Wyk, Stevin; Fuchs, Laszlo; Gutmark, Ephraim; Gutmark-Little, Iris


    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.

  8. [Inflammatory abdominal aortic aneurysm]. (United States)

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


    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.

  9. Hemodynamic predictors of aortic dilatation in bicuspid aortic valve by velocity-encoded cardiovascular magnetic resonance

    Directory of Open Access Journals (Sweden)

    Ramamurthy Senthil


    Full Text Available Abstract Background Congenital Bicuspid Aortic Valve (BAV is a significant risk factor for serious complications including valve dysfunction, aortic dilatation, dissection, and sudden death. Clinical tools for identification and monitoring of BAV patients at high risk for development of aortic dilatation, an early complication, are not available. Methods This paper reports an investigation in 18 pediatric BAV patients and 10 normal controls of links between abnormal blood flow patterns in the ascending aorta and aortic dilatation using velocity-encoded cardiovascular magnetic resonance. Blood flow patterns were quantitatively expressed in the angle between systolic left ventricular outflow and the aortic root channel axis, and also correlated with known biochemical markers of vessel wall disease. Results The data confirm larger ascending aortas in BAV patients than in controls, and show more angled LV outflow in BAV (17.54 ± 0.87 degrees than controls (10.01 ± 1.29 (p = 0.01. Significant correlation of systolic LV outflow jet angles with dilatation was found at different levels of the aorta in BAV patients STJ: r = 0.386 (N = 18, p = 0.048, AAO: r = 0.536 (N = 18, p = 0.022, and stronger correlation was found with patients and controls combined into one population: SOV: r = 0.405 (N = 28, p = 0.033, STJ: r = 0.562 (N = 28, p = 0.002, and AAO r = 0.645 (N = 28, p Conclusions The results of this study provide new insights into the pathophysiological processes underlying aortic dilatation in BAV patients. These results show a possible path towards the development of clinical risk stratification protocols in order to reduce morbidity and mortality for this common congenital heart defect.

  10. Transvenous digital subtraction angiography (DSA) of the thoracic aorta after surgical correction of aortic coarctation

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    Arlart, I.P.; Hamann, H.; Stenz, R.


    25 patients (normotensive n = 19, hypertensive n = 6) underwent DSA control following corrective surgery of a coarcatation of the thoracic aorta to exclude vascular complications. Simultaneously pressure gradients were determined between upper and lower extremities using the doppler-sonography. DSA was diagnostic in all patients. 2 cases showed a patch-dependent dilatation, in 1 case an anastomotic aneurysm could be demonstrated. In 6 patients with hypoplastic aortic arch and 2 patients with a slight reduction of the diameter in the anastomotic region a pathological pressure-gradient was measured. In these patients the ratio of aortic arch rsp. anastomosis/descending aorta was reduced in diameter (< 0,66) and area (< 44). Hypertension could not be related to pressure gradients or vascular disorders.

  11. Unilateral axillary arch with two slips entrapping neurovascular bundle in axilla and its innervation by the median nerve

    Directory of Open Access Journals (Sweden)

    Somayaji SN


    Full Text Available Axillary arch is an additional muscle bundle of various dimensions extending usually from the latissimus dorsi in the posterior fold of the axilla, to the pectoralis major or other neighboring muscles and bones. In the present case presence of such unusual axillary arch innervated by the median nerve has been reported. During routine dissection of axilla region in one of the upper limbs, the occurrence of axillary arch was observed. The muscle fibers were arising from the belly of latissimus dorsi and were getting inserted to the tendon of coracobrachilais and lateral lip of bicipital groove. As it passed through the axilla it divided into 2 slips, enclosing the axillary vessels and nerves related to them. The fleshy fibers of the axillary arch were innervated by 2 small twigs from the median nerve. Though the occurrence of the axillary arch is very common, axillary arch with 2 slips getting innervated by the median nerve is not been reported so far. Further, a detailed literature review was done and the surgical and clinical importance of the case was discussed.

  12. Automatic aorta segmentation and valve landmark detection in C-arm CT: application to aortic valve implantation. (United States)

    Zheng, Yefeng; John, Matthias; Liao, Rui; Boese, Jan; Kirschstein, Uwe; Georgescu, Bogdan; Zhou, S Kevin; Kempfert, Jörg; Walther, Thomas; Brockmann, Gernot; Comaniciu, Dorin


    C-arm CT is an emerging imaging technique in transcatheter aortic valve implantation (TAVI) surgery. Automatic aorta segmentation and valve landmark detection in a C-arm CT volume has important applications in TAVI by providing valuable 3D measurements for surgery planning. Overlaying 3D segmentation onto 2D real time fluoroscopic images also provides critical visual guidance during the surgery. In this paper, we present a part-based aorta segmentation approach, which can handle aorta structure variation in case that the aortic arch and descending aorta are missing in the volume. The whole aorta model is split into four parts: aortic root, ascending aorta, aortic arch, and descending aorta. Discriminative learning is applied to train a detector for each part separately to exploit the rich domain knowledge embedded in an expert-annotated dataset. Eight important aortic valve landmarks (three aortic hinge points, three commissure points, and two coronary ostia) are also detected automatically in our system. Under the guidance of the detected landmarks, the physicians can deploy the prosthetic valve properly. Our approach is robust under variations of contrast agent. Taking about 1.4 seconds to process one volume, it is also computationally efficient.

  13. Study on hemodynamics in patient-specific thoracic aortic aneurysm

    Institute of Scientific and Technical Information of China (English)


    The objective of this study is to investigate the hemodynamics in patient-specific thoracic aortic aneurysm and discuss the reason for formation of aortic plaque.A 3-Dimensional pulsatile blood flow in thoracic aorta with a fusiform aneurysm and 3 main branched vessels was studied numerically with the average Reynolds number of 1399 and the Womersley number of 19.2.Based on the clinical 2-Dimensional CT slice data,the patient-specific geometry model was constructed using medical image process software.Un...

  14. Hybrid aortic endovascular repair with one stage supra-aortic branch or tliac artery revascularization%一期杂交手术治疗弓部和胸腹段主动脉病变

    Institute of Scientific and Technical Information of China (English)

    郑月宏; 蔡念; 邓鸿儒; 郭昌宇; Rui Furtado


    Objective Repair of aortic arch aneurysm is technically demanding and usually requiring complex circulatory management. Operative morbidity and mortality may be prohibitive with traditional surgical intervention. We described our experience with 5 hybrid endovascular procedure for aorta repair with different kinds of bypass followed by concomitant placement of stent graft in the aorta. Methods We retrospectively reviewed the clinical data of 5 consecutive patients presenting with aortic aneurysm or dissection from 2007 to 2008 treated by the hybrid aorta repair. Complete surgical rerouting of the supra-aortic vessels was followed by endovascular repair of aortic arch aneurysm with a Zenith TX2 stent graft. Hybrid left carotid-subclavian bypass with Zenith stent graft deployment covering the ostium of the LSA was performed in a Debakey type Ⅲ aortic dissection case. Procedures were successfully completed with exclusion of the aortic aneurysm. All stent grafts were deployed retrograde from the femoral artery in these patients. Results Technical success with complete aneurysmal exclusion was achieved in all patients (100%). At a follow-up period of 2-10 months, there was no incidence of endoleak. Documented perioperative neurelogic events did not occurred in all patients. Postoperatively one patient suffered from ARDS and cardiac failure and recovered. One patient died of myocardial infarction. Conclusions Hybrid arch repair provides an alternative to patients otherwise considered prohibitively high risk for traditional open arch and thoracoabdominal aorta repair.%目的 总结单中心手术结合微创的杂交技术,同期治疗弓部、胸腹段主动脉病变的经验.方法 回顾性分析2007年6月至2008年5月在澳门仁伯爵综合医院应用杂交技术,同期治疗主动脉病变5例的临床资料.其中胸降主动脉瘤累及半弓合并夹层1例,弓降主动脉瘤1例,DebarkeyⅢ型急性主动脉夹层1例,累及双侧髂总、髂内

  15. Arch Index: An Easier Approach for Arch Height (A Regression Analysis

    Directory of Open Access Journals (Sweden)

    Hironmoy Roy


    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.

  16. Screening for Abdominal Aortic Aneurysm (United States)

    Understanding Task Force Recommendations Screening for Abdominal Aortic Aneurysm The U.S. Preventive Services Task Force (Task Force) has issued a final recommendation statement on Screening for Abdominal Aortic Aneurysm. This final ...

  17. Abdominal aortic aneurysm repair - open (United States)

    ... this page: // Abdominal aortic aneurysm repair - open To use the sharing features on this page, please enable JavaScript. Open abdominal aortic aneurysm repair is surgery to fix a widened part ...

  18. Tubular Steel Arch Stabilized by Textile Membranes

    Directory of Open Access Journals (Sweden)

    Ondrej Svoboda


    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.

  19. Dental Arch Dimension of Malay Ethnic Group

    Directory of Open Access Journals (Sweden)

    H. A. Mohammad


    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.

  20. Intra-aortic balloon clamp for safe resternotomy in a patient with a giant aneurysm of sinuses of Valsalva. (United States)

    Zembala, Michal Oscar; Filipiak, Krzysztof; Niklewski, Tomasz; Przybylski, Roman


    Despite advances in surgical techniques and postoperative medical management, the mortality rates for cardiac reoperations remain high. The risk is most commonly associated with failed resternotomy complicated by fatal injury to the myocardium or its structures. This short case report documents the first use of an endoluminal balloon occlusive device in order to prevent aneurysmal sack damage and coronary vessel injury in a patient with a giant aortic aneurysm after failed aortic surgery. The safe aortic occlusion allowed for closed-chest cardioplegia delivery and subsequent aortic unloading, thus facilitating a difficult but uneventful resternotomy.

  1. [Congenital aortic stenosis]. (United States)

    Yamaguchi, M


    Recent advances in and controversies concerning the management of children with congenital valvular aortic stenosis are discussed. In neonates with critical aortic stenosis, improved survival has recently been reported after surgical open valvotomy and balloon valvuloplasty, although it is difficult at this point to compare the results of the two procedures and determine their differential indications. Good results have also been achieved after extended aortic valvuloplasty for recurrent aortic stenosis and/or insufficiency, but the length of follow-up in these patients is still short. The technique first reported in 1991 for bilateral enlargement fo a small annulus permits the insertion of an aortic valve 3-4 sizes larger than the native annulus. It entails no risk of distorting the mitral valve, damaging the conduction system or important branches of the coronary arteries, or resulting in left ventricular dysfunction. The Ross procedure is now widely applied in the West, with reports of early mortality rates of less than 5% and event-free survival rates of 80-90% during follow-up of 4-8 years. Longer follow-up and continued careful evaluation are required to resolve the issue of possible dilatation and subsequent neoaortic valve dysfunction and pulmonary stenosis due to allograft degeneration after pulmonary autograft root replacement in children.

  2. Flow-sensitive in-vivo 4D MR imaging at 3T for the analysis of aortic hemodynamics and derived vessel wall parameters; Die Analyse aortaler Haemodynamik und Gefaesswandparameter mittels fluss-sensitiver in-vivo 4D-MRT bei 3 Tesla

    Energy Technology Data Exchange (ETDEWEB)

    Frydrychowicz, A.; Markl, M.; Stalder, A.F.; Bock, J.; Bley, T.A.; Berger, A.; Russe, M.F.; Hennig, J.; Langer, M. [Freiburg Univ. (Germany). Abt. Roentgendiagnostik; Harloff, A. [Freiburg Univ. (Germany). Abt. Klinische Neurologie und Neurophysiologie; Schlensak, C. [Freiburg Univ. (Germany). Abt. Herz- und Gefaesschirurgie


    Modern phase contrast MR imaging at 3 Tesla allows the depiction of 3D morphology as well as the acquisition of time-resolved blood flow velocities in 3 directions. In combination with state-of-the-art visualization and data processing software, the qualitative and quantitative analysis of hemodynamic changes associated with vascular pathologies is possible. The 4D nature of the acquired data permits free orientation within the vascular system of interest and offers the opportunity to quantify blood flow and derived vessel wall parameters at any desired location within the data volume without being dependent on predefined 2D slices. The technique has the potential of overcoming the limitations of current diagnostic strategies and of implementing new diagnostic parameters. In light of the recent discussions regarding the influence of the wall shear stress and the oscillatory shear index on the genesis of arteriosclerosis and dilatative vascular processes, flow-sensitive 4D MRI may provide the missing diagnostic link. Instead of relying on experience-based parameters such as aneurysm size, new hemodynamic considerations can deepen our understanding of vascular pathologies. This overview reviews the underlying methodology at 3T, the literature on time-resolved 3D MR velocity mapping, and presents case examples. By presenting the pre- and postoperative assessment of hemodynamics in a thoracic aortic aneurysm and the detailed analysis of blood flow in a patient with coarctation we underline the potential of time-resolved 3D phase contrast MR at 3T for hemodynamic assessment of vascular pathologies, especially in the thoracic aorta. (orig.)

  3. Characterization of the vessel geometry, flow mechanics and wall shear stress in the great arteries of wildtype prenatal mouse.

    Directory of Open Access Journals (Sweden)

    Choon Hwai Yap

    Full Text Available INTRODUCTION: Abnormal fluid mechanical environment in the pre-natal cardiovascular system is hypothesized to play a significant role in causing structural heart malformations. It is thus important to improve our understanding of the prenatal cardiovascular fluid mechanical environment at multiple developmental time-points and vascular morphologies. We present such a study on fetal great arteries on the wildtype mouse from embryonic day 14.5 (E14.5 to near-term (E18.5. METHODS: Ultrasound bio-microscopy (UBM was used to measure blood velocity of the great arteries. Subsequently, specimens were cryo-embedded and sectioned using episcopic fluorescent image capture (EFIC to obtain high-resolution 2D serial image stacks, which were used for 3D reconstructions and quantitative measurement of great artery and aortic arch dimensions. EFIC and UBM data were input into subject-specific computational fluid dynamics (CFD for modeling hemodynamics. RESULTS: In normal mouse fetuses between E14.5-18.5, ultrasound imaging showed gradual but statistically significant increase in blood velocity in the aorta, pulmonary trunk (with the ductus arteriosus, and descending aorta. Measurement by EFIC imaging displayed a similar increase in cross sectional area of these vessels. However, CFD modeling showed great artery average wall shear stress and wall shear rate remain relatively constant with age and with vessel size, indicating that hemodynamic shear had a relative constancy over gestational period considered here. CONCLUSION: Our EFIC-UBM-CFD method allowed reasonably detailed characterization of fetal mouse vascular geometry and fluid mechanics. Our results suggest that a homeostatic mechanism for restoring vascular wall shear magnitudes may exist during normal embryonic development. We speculate that this mechanism regulates the growth of the great vessels.

  4. Aortic valve replacement

    DEFF Research Database (Denmark)

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


    mortality were collected. Group analysis by patient geographic distribution and by annular diameter of the prosthesis utilized was conducted. Patients with a manufacturer's labeled prosthesis size > or = 21 mm were assigned to the 'large' aortic size subset, while those with a prosthesis size ... assigned to the 'small' aortic size subset. Effective orifice area indices were calculated for all patients to assess the geographic distribution of patient-prosthesis mismatch. Univariable and multivariable logistic regression analyses adjusting for possible confounding variables were performed. RESULTS...... differences in the distribution of either gender or BSA. In the multivariable model, south European patients were seven times more likely to receive a smaller-sized aortic valve (OR = 6.5, 95% CI = 4.82-8.83, p

  5. Robotic aortic surgery. (United States)

    Duran, Cassidy; Kashef, Elika; El-Sayed, Hosam F; Bismuth, Jean


    Surgical robotics was first utilized to facilitate neurosurgical biopsies in 1985, and it has since found application in orthopedics, urology, gynecology, and cardiothoracic, general, and vascular surgery. Surgical assistance systems provide intelligent, versatile tools that augment the physician's ability to treat patients by eliminating hand tremor and enabling dexterous operation inside the patient's body. Surgical robotics systems have enabled surgeons to treat otherwise untreatable conditions while also reducing morbidity and error rates, shortening operative times, reducing radiation exposure, and improving overall workflow. These capabilities have begun to be realized in two important realms of aortic vascular surgery, namely, flexible robotics for exclusion of complex aortic aneurysms using branched endografts, and robot-assisted laparoscopic aortic surgery for occlusive and aneurysmal disease.

  6. [Stanford type a acute aortic dissection with pectus excavatum]. (United States)

    Kuwata, Toshiyuki; Fukuda, Hirotsugu; Yoshitatsu, Masao; Yamada, Yasuyuki; Shibasaki, Ikuko; Inoue, Yuho; Hori, Takayuki; Ogawa, Hironaga; Tsuchiya, Go; Shimizu, Riha; Takei, Yusuke


    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.

  7. Simulation of bifurcated stent grafts to treat abdominal aortic aneurysms (AAA)

    CERN Document Server

    Egger, Jan; Freisleben, Bernd


    In this paper a method is introduced, to visualize bifurcated stent grafts in CT-Data. The aim is to improve therapy planning for minimal invasive treatment of abdominal aortic aneurysms (AAA). Due to precise measurement of the abdominal aortic aneurysm and exact simulation of the bifurcated stent graft, physicians are supported in choosing a suitable stent prior to an intervention. The presented method can be used to measure the dimensions of the abdominal aortic aneurysm as well as simulate a bifurcated stent graft. Both of these procedures are based on a preceding segmentation and skeletonization of the aortic, right and left iliac. Using these centerlines (aortic, right and left iliac) a bifurcated initial stent is constructed. Through the implementation of an ACM method the initial stent is fit iteratively to the vessel walls - due to the influence of external forces (distance- as well as balloonforce). Following the fitting process, the crucial values for choosing a bifurcated stent graft are measured, ...

  8. Infolding of covered stents used for aortic coarctation: report of two cases. (United States)

    Wan, Andrea W; Lee, Kyong-Jin; Benson, Lee N


    Covered stents have been used for the treatment of aortic coarctation to protect the arterial wall during dilation. Early results have shown them to be safe and effective. We report two cases of infolding of the proximal edge of a covered aortic coarctation stent. Management required implantation of a second stent. Poor stent apposition to the vessel wall and/or recoil may allow conditions for these events to occur.

  9. How I do it: transapical cannulation for acute type-A aortic dissection

    Directory of Open Access Journals (Sweden)

    Alexiou Christos


    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.

  10. The murine angiotensin II-induced abdominal aortic aneurysm model: rupture risk and inflammatory progression patterns

    Directory of Open Access Journals (Sweden)

    Richard Y Cao


    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.

  11. 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)


    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.)

  12. Automatic aorta segmentation and valve landmark detection in C-arm CT for transcatheter aortic valve implantation. (United States)

    Zheng, Yefeng; John, Matthias; Liao, Rui; Nöttling, Alois; Boese, Jan; Kempfert, Jörg; Walther, Thomas; Brockmann, Gernot; Comaniciu, Dorin


    Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure to treat severe aortic valve stenosis. As an emerging imaging technique, C-arm computed tomography (CT) plays a more and more important role in TAVI on both pre-operative surgical planning (e.g., providing 3-D valve measurements) and intra-operative guidance (e.g., determining a proper C-arm angulation). Automatic aorta segmentation and aortic valve landmark detection in a C-arm CT volume facilitate the seamless integration of C-arm CT into the TAVI workflow and improve the patient care. In this paper, we present a part-based aorta segmentation approach, which can handle structural variation of the aorta in case that the aortic arch and descending aorta are missing in the volume. The whole aorta model is split into four parts: aortic root, ascending aorta, aortic arch, and descending aorta. Discriminative learning is applied to train a detector for each part separately to exploit the rich domain knowledge embedded in an expert-annotated dataset. Eight important aortic valve landmarks (three hinges, three commissures, and two coronary ostia) are also detected automatically with an efficient hierarchical approach. Our approach is robust under all kinds of variations observed in a real clinical setting, including changes in the field-of-view, contrast agent injection, scan timing, and aortic valve regurgitation. Taking about 1.1 s to process a volume, it is also computationally efficient. Under the guidance of the automatically extracted patient-specific aorta model, the physicians can properly determine the C-arm angulation and deploy the prosthetic valve. Promising outcomes have been achieved in real clinical applications.

  13. Precast Pearl-Chain concrete arch bridges

    DEFF Research Database (Denmark)

    Halding, Philip Skov; Hertz, Kristian Dahl; Schmidt, Jacob Wittrup


    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......, and gives a large positive bending moment below the load and a smaller negative bending moment in the unloaded side. When the Pearl-Chain Bridge concept is compared to other pre-fabricated arch bridge solutions we find a number of advantages when using Pearl-Chain Bridges: Straight elements, combination...

  14. Unoperated aortic aneurysm

    DEFF Research Database (Denmark)

    Perko, M J; Nørgaard, M; Herzog, T M;


    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...... hypertension were predictive of mortality, whereas...

  15. Dilatation of the aneurysmal sac after total arch replacement. (United States)

    Watanuki, Hirotaka; Ogino, Hitoshi; Matsuda, Hitoshi; Minatoya, Kenji; Sasaki, Hiroaki; Fukuda, Tetsuya; Kitamura, Soichiro


    In our institution, total arch replacement for distal arch aneurysms is performed through a median sternotomy with antegrade selective cerebral perfusion. The distal anastomosis to the completely transected descending aorta is made through the aneurysmal sac. We report on three interesting cases presenting late dilatation of the aneurysmal sac due to collateral flow after total arch replacement.

  16. Assembly and lifting of Pearl-Chain arches

    DEFF Research Database (Denmark)

    Halding, Philip Skov; Hertz, Kristian Dahl; Viebæk, N.E.


    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...

  17. The clinical application of multi-slice spiral CT angiography in abdominal aortic disease

    Institute of Scientific and Technical Information of China (English)


    Objective: To evaluate the clinical application of multi-slice spiral CT angiography(MSCTA) in the assessment of abdominal aortic disease. Methods: Fifty-four patients underwent multi-slice spiral CT angiography of abdomen. Contrast agent (Omnipaque 300 I g/L) 1.5 ml/kg was injected and the injection rate was 3 ml/s. The delay time was determined by bolus tracking technique,Tll level abdominal aorta was set as the target vessel and the threshold was 180-200 Hu, slice width was 3 mm and with a pitch of 4-6.Original data were transferred to working-station to perform functional reconstruction. Results: Ten cases were normal, twenty-eight cases were abdominal aortic aneurysms, five abdominal aortic dissecting aneurysms (Debakay type Ⅲ ) and eleven aortic sclerosis. SSD showed the body of aneurysm and the relationship between aneurysm and adjacent blood vessel, MIP better displayed calcification of blood vessel wall and condition of the stent, MPR demonstrated true and false lumen, rupture site of abdominal aorta intima and mural thrombus. Conclusion: MSCTA axial and reconstruction image can show the extent of abdominal aortic disease and the relationship with adjacent blood vessels. It is a safe, simple and non-invasive examination method.

  18. 经胸骨正中切口一期矫治主动脉缩窄或主动脉弓中断合并心内畸形%Single-stage repair of coarctation of aorta or interrupted arch and associated intracardiac defects through median sternotomy

    Institute of Scientific and Technical Information of China (English)

    张辉; 程沛; 侯嘉; 李磊; 刘虎; 罗毅


    Objedtve To summarize the experience of single-stage repair of coarctation of aorta(CoA) or interrupted aortic arch (IAA)and associated intracardiac defects through median stemotomy.Methods From Jan 2007 to Jul 2008,a total of 24 pa-tients with CoA or IAA and associated intracardisc defects were surgically repaired in single-stage through median stermotomy,inchud-ing 9 coanctation of aorta,12 coarctation with aortic arch hypoplasia,and 3 interrupted aorlic arch,.The associated intracardiac de-fects were Taussing-Bing anomaly 4,non-restricted VSD 22,subaortic stenosis 1 and pulmonary vein stenosis 1.The age ranged form 1 to 99 months (average 16 months) and the body weight ranged from 4 to 19 kg(average 9.3 kg).Aortic arch reconstruction was performed by hypothermic continuous low flow bypass using regional perfusion for all patients.Three patients with LAA and 9 patients with CoA underwent end-to-end ansetomosis.Of the 12 patients with coarctation and aortic arch hyipoplasia,8 patiellts underwent ex-tended end-to-end anastomosis,2 patients underwent end-to-side anastomosis and 2 patients underwent aortoplasfy.Results 2 cases were dead. One infant with Taussig-Bing type heart was dead of severe infection after 47 days postoperative,the other one who associ-ated with LAA and VSD dead of pulmonary hypertension crisis due to pneumonia after 15 days postoperative.No patient presented neu-rdogieal complication and renal insufficiency during the perioperation.2 cases presented recurrent respiratory problem.During the 18months follow-up,no patient presented with recoarctation except one with pressure gradient more than 20 mm Hg.Conclusion Pa-tients with coarctation of aorta or interrupted aortic arch and associsted intracardisc defects should be surgically treated as early as pos-sible when diagnosis was mode.Single-stage sortic arch reconstruction through median stemotomy using continuous regional perfusion is an effective and safe procedurd.Sufficient resection of ductus

  19. Palliative stent graft placement combined with subsequent open surgery for retrograde ascending dissection intra-thoracic endovascular aortic repair. (United States)

    Zhu, Kai; Lai, Hao; Guo, Changfa; Li, Jun; Wang, Chunsheng


    Thoracic endovascular aortic repair (TEVAR) is an effective strategy for type B dissection. Retrograde ascending dissection (RAD) intra-TEVAR is a rare complication on clinic. In this case, a 48-year-old Chinese man with Stanford type B aortic dissection suffered acute RAD during the TEVAR. And palliative stent grafts placement was performed in a local hospital, which earned the time for transfer and subsequent total arch replacement surgery in Zhongshan Hospital Fudan University. This report suggests that the palliative strategy may be an option for RAD in some specific situation.

  20. Open triple-branched stent graft applied to patient of acute type a aortic dissection with Aberrant Right Subclavian Artery


    Guo, Changfa; Zhu, Kai; Xu, Demin; Wang, Chunsheng


    A 57-year-old Chinese male patient presented with Standford type A aortic dissection with an aberrant right subclavian artery (ARSA). At operation, the ascending aorta was replaced by a mono–branch vascular prosthesis with the branch bypassing to the ARSA; the triple-branched stent graft was inserted into the true lumen of the arch and proximal descending aorta (covering the origin of the ARSA) with each sidearm graft being positioned into the aortic branches; and then its proximal end was su...

  1. Palliative stent graft placement combined with subsequent open surgery for retrograde ascending dissection intra-thoracic endovascular aortic repair (United States)

    Zhu, Kai; Guo, Changfa; Li, Jun


    Thoracic endovascular aortic repair (TEVAR) is an effective strategy for type B dissection. Retrograde ascending dissection (RAD) intra-TEVAR is a rare complication on clinic. In this case, a 48-year-old Chinese man with Stanford type B aortic dissection suffered acute RAD during the TEVAR. And palliative stent grafts placement was performed in a local hospital, which earned the time for transfer and subsequent total arch replacement surgery in Zhongshan Hospital Fudan University. This report suggests that the palliative strategy may be an option for RAD in some specific situation. PMID:25590002


    Directory of Open Access Journals (Sweden)



    Full Text Available A 60 year old male patient presented with hoarseness of voice lasting for 2 months. First he was examined by the otorhinolaryngologist of our hospital, who noticed absence of movements of the left vocal cord. Chest X-ray showed a large opacity in the left upper zone and the patient was referred to the pulmonologist. His general physical examination was unremarkable not having any stigmata of Marfan's or Ehler Danlos syndrome. On chest auscultation, a systolic flow murmur was audible and there was decreased breath sound in the left infraclavicular area. Bronchoscopy revealed absence of movement of left vocal cord. His trans-thoracic echocardiography revealed degenerative aortic and mitral valve disease with mild aortic regurgitation and mild mitral regurgitation with dilated aortic aneurysm. A contrast enhanced CT scan of thorax and CT Angio Aortogram revealed fusiform aneurysmal dilatation of the arch of aorta with diameter of 6.2 cm over a length of 12.3 cm showing intraluminal partial thrombus with wall calcification. The patient was advised to undergo surgery. However, after detailed discussion with him and his family, they decided for medical management in view of his advanced age

  3. [Minimally invasive cardiac surgery for aortic valve disease]. (United States)

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


    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.

  4. Post-stenotic aortic dilatation

    Directory of Open Access Journals (Sweden)

    Jahangiri Marjan


    Full Text Available Abstract Aortic stenosis is the most common valvular heart disease affecting up to 4% of the elderly population. It can be associated with dilatation of the ascending aorta and subsequent dissection. Post-stenotic dilatation is seen in patients with AS and/or aortic regurgitation, patients with a haemodynamically normal bicuspid aortic valve and following aortic valve replacement. Controversy exists as to whether to replace the aortic root and ascending aorta at the time of aortic valve replacement, an operation that potentially carries a higher morbidity and mortality. The aetiology of post-stenotic aortic dilatation remains controversial. It may be due to haemodynamic factors caused by a stenotic valve, involving high velocity and turbulent flow downstream of the stenosis, or due to intrinsic pathology of the aortic wall. This may involve an abnormality in the process of extracellular matrix remodelling in the aortic wall including inadequate synthesis, degradation and transport of extracellular matrix proteins. This article reviews the aetiology, pathology and management of patients with post-stenotic aortic dilatation.

  5. Reactor vessel


    Makkee, M.; Kapteijn, F.; Moulijn, J.A


    A reactor vessel (1) comprises a reactor body (2) through which channels (3) are provided whose surface comprises longitudinal inwardly directed parts (4) and is provided with a catalyst (6), as well as buffer bodies (8, 12) connected to the channels (3) on both sides of the reactor body (2) and comprising connections for supplying (9, 10, 11) and discharging (13, 14, 15) via the channels (3) gases and/or liquids entering into a reaction with each other and substances formed upon this reactio...

  6. CT in nontraumatic acute thoracic aortic disease: typical and atypical features and complications. (United States)

    Castañer, Eva; Andreu, Marta; Gallardo, Xavier; Mata, Josep Maria; Cabezuelo, María Angeles; Pallardó, Yolanda


    Thoracic aortic dissection is the most frequent cause of aortic emergency, and unless it is rapidly diagnosed and treated, the result is death. Helical computed tomography (CT) permits the diagnosis of acute aortic dissection with a sensitivity and specificity of nearly 100%. This imaging modality also enables differentiation between proximal aortic dissection (type A in the Stanford classification) and distal aortic dissection (Stanford type B), which are treated differently and have different prognoses. In 70% of patients in whom nontraumatic acute thoracic aortic dissection is diagnosed after evaluation with helical CT, scans show the typical signs of aortic dissection, with rupture and displacement of the intima. CT also can depict other pathologic entities with similar clinical manifestations, such as intramural hematoma and penetrating atherosclerotic ulcer. Awareness of the different radiologic appearances of these disease entities is essential for differential diagnosis. More than one-third of patients with aortic dissection show signs and symptoms indicative of systemic involvement. Because branch-vessel involvement may increase morbidity and mortality, in this group of patients it is important to evaluate the entire aorta so as to determine the distal extent of the dissection and detect any systemic involvement.

  7. Familial Thoracic Aortic Aneurysm with Dissection Presenting as Flash Pulmonary Edema in a 26-Year-Old Man

    Directory of Open Access Journals (Sweden)

    Sabry Omar


    Full Text Available We are reporting a case of familial thoracic aortic aneurysm and dissection in a 26-year-old man with no significant past medical history and a family history of dissecting aortic aneurysm in his mother at the age of 40. The patient presented with cough, shortness of breath, and chest pain. Chest X-ray showed bilateral pulmonary infiltrates. CT scan of the chest showed a dissection of the ascending aorta. The patient underwent aortic dissection repair and three months later he returned to our hospital with new complaints of back pain. CT angiography showed a new aortic dissection extending from the left carotid artery through the bifurcation and into the iliac arteries. The patient underwent replacement of the aortic root, ascending aorta, total aortic arch, and aortic valve. The patient recovered well postoperatively. Genetic studies of the patient and his children revealed no mutations in ACTA2, TGFBR1, TGFBR2, TGFB2, MYH11, MYLK, SMAD3, or FBN1. This case report focuses on a patient with familial TAAD and discusses the associated genetic loci and available screening methods. It is important to recognize potential cases of familial TAAD and understand the available screening methods since early diagnosis allows appropriate management of risk factors and treatment when necessary.

  8. 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


    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.

  9. Tobacco smoking and aortic aneurysm

    DEFF Research Database (Denmark)

    Sode, Birgitte F; Nordestgaard, Børge G; Grønbæk, Morten


    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......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...

  10. Perioperative Nursing of Patients with DeBakey Ⅰ Aorta Dissection Following Artifical Blood Vessel Replacement%DeBakey Ⅰ型主动脉夹层人工血管置换术围术期护理体会

    Institute of Scientific and Technical Information of China (English)

    潘洁; 周雁荣


    目的 探讨主动脉夹层患者人工血管置换术的围术期护理.方法 总结我科2008年1月~2009年11月18例DeBakey Ⅰ型主动脉夹层患者围术期的观察与护理经验.结果 本组14例行全主动脉弓替换,其中10例于降主动脉真腔内释放象鼻支架,行升主动脉及主动脉弓4分叉人工血管置换、主动脉瓣成形术,4例完成Bentall手术并弓部岛状吻合替换;另外4例行弓部成形术.术前做好健康教育及心理护理,给予镇静、止痛、制动,保持排便通畅及控制高血压等;术后密切观察病情,严格控制高血压,预防出血、感染及栓塞等并发症.本组1例因手术时间长术后死于多器官功能衰竭,1例术后出现截瘫,余16例未发生相关并发症.结论 主动脉夹层手术是心血管外科高难、复杂手术,术后并发症较多,病死率高,围术期护理是保证患者手术成功、术后恢复的重要环节.%Objective To investigate the perioperation care of patients with DeBakey Ⅰ Aorta dissection undergone artifical blood vessel replacement.Methods Data of observation and perioperative nursing experiences of 18 patients with DeBakey Ⅰ Aorta Dissection were summaried.Results 14 cases were replaced with aortic arch, among whom 10 cases were inserted with braces in descending aotra, and received artifical blood vessel replacement of ascending aotra and aortic arch divarication and also aortic value plastic operation; 4 cases received Bentall operation and arch insula anastomoses; 4 cases received arch plastic operation.Before operation, health education and psychology treatment were given to all the patients.Pain ,blood pressure, heart rate were controlled; after operation, we monitored the vital signs, prevented postoperative complications,such as hypertension hemorrhage, infection and embolism.One patient died of multifunctional failure of organs because of prolonged operational time and one patient was paralyzed and the other 16 patients

  11. [Traumatic and iatrogenic lesions of abdominal vessels]. (United States)

    Farah, I; Tarabula, P; Voirin, L; Magne, J L; Delannoy, P; Gattaz, F; Guidicelli, H


    Gravity of abdominal vessels traumatisms is secondary to multiple factors. It depends on the type of injured vessels, aetiology and associated lesions. Between September 1984 and March 1995, 22 abdominal vessel traumatisms in 16 patients (mean age: 39 years) were treated. At surgical exploration, 4 aortic and 2 renal vein lesions, 7 iliac artery and 3 renal artery contusions, 2 superior mesenteric artery dissections; 3 infra-renal vena cava ruptures and 1 superior mesenteric vein dilaceration were found. All lesions were caused by penetrant wounds secondary to firearm or blade injury or secondary to injuries due to ski or traffic accidents. In 5 cases, lesions were iatrogenic. There was no mortality in the post-operative period, 14 patients out of the 16 patients operated on have been followed during a period from 1 to 120 months.

  12. Evolution Characteristic Analysis of Pressure-arch of a Double-arch Tunnel in Water-rich Strata

    Directory of Open Access Journals (Sweden)

    C. L. Li


    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.

  13. Ruptured abdominal aortic aneurysm. (United States)

    Sachs, T; Schermerhorn, M


    Ruptured abdominal aortic aneurysm (AAA) continues to be one of the most lethal vascular pathologies we encounter. Its management demands prompt and efficient evaluation and repair. Open repair has traditionally been the mainstay of treatment. However, the introduction of endovascular techniques has altered the treatment algorithm for ruptured AAA in most major medical centers. We present recent literature and techniques for ruptured AAA and its surgical management.

  14. Infrarenal Aortic Occlusion (United States)

    Traverso, L. W.; Baker, J. D.; Dainko, E. A.; Machleder, H. I.


    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

  15. Dissolution vessel

    Energy Technology Data Exchange (ETDEWEB)

    Natsume, Tomohiro; Fujioka, Tsunaaki


    A basket for containing sheared fuel pieces of spent fuel assemblies in a dissolving vessel main body has many apertures for keeping the concentration of a dissolving liquid at the inner side and the outer side of the basket uniformly. Secured neutron absorbers such as boron stainless and hafnium are appended to one or both surfaces of the basket. Partitioning members are disposed in the basket, and the partitioning members are formed in a lattice-like shape. The partitioning members are also made of secured neutron absorbers such as boron stainless and hafnium. The inside dimension of each division (lattice distance) is determined to about 15cm. Then, it is no more necessary to add soluble neutron absorbers such as gadolinium nitrate to a dissolution solution such as nitric acid thereby enabling to reduce the amount of radioactive wastes. (I.N.)

  16. CT of thoracic aortic aneurysms. (United States)

    Posniak, H V; Olson, M C; Demos, T C; Benjoya, R A; Marsan, R E


    Aneurysms of the thoracic aorta are most often the result of arteriosclerotic disease. Other causes include degeneration of the medial layer of the aortic wall, either idiopathically or due to genetic disorders such as Marfan syndrome; aortic dissection; trauma; syphilis and other bacterial infection; noninfective aortitis; and congenital anomaly. We review normal anatomy of the aorta and discuss our technique and interpretation of computed tomography (CT) in the evaluation of the thoracic aorta. We illustrate the CT appearance of different types of aortic aneurysms as well as discuss the use of CT for assessing complications of aneurysms, for postoperative follow-up, and in the differentiation of aortic aneurysm from a paraaortic mass.

  17. Micromanaging Abdominal Aortic Aneurysms

    Directory of Open Access Journals (Sweden)

    Lars Maegdefessel


    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.

  18. Fenestrated endovascular aortic repair for juxtarenal abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    GUO Wei; ZHANG Hong-peng; LIU Xiao-ping; JIA Xin; XIONG Jiang; MA Xiao-hui


    Background Endovascular stent-graft with fenestration can improve proximal sealing in patients with juxtarenal abdominal aortic aneurysm (JAAA).The purpose of this study was to describe our primary experience and evaluate the safety and efficacy of fenestrated device for JAAA in high-risk patients.Methods Between March 2011 and May 2012,nine male patients (mean age,(79.6±8.6) years) with asymptomatic JAAAs underwent elective deployment of the Zenith fenestrated stent-grafts at a single institution.All patients were treated in the hybrid operating room under general anesthesia.Follow-up computed tomography angiography (CTA) was routinely performed before discharge,at 3,6,and 12 months and annually thereafter.Results Procedural success was achieved in all cases.Total sixteen small fenestrations,two large fenestrations and eight scallops were used.Intra-operative complications occurred in four patients,which included one proximal type Ⅰ endoleak,two type Ⅱ endoleaks,and one renal artery dissection.The mean hospital stay was (8.9±1.4) days,mean blood loss was (360.5±46.8) ml,and mean iodinated contrast volume was (230.6±58.3) ml.The mean follow-up time was (7.6±4.2) months.The visceral graft patency was 100% until now.One patient had an increase of serum creatinine of more than 30%,but did not require dialysis.No patients died,no stent fractured,and migration were diagnosed during the follow-up.Conclusions The early results of fenestrated device for high-risk patients with complex JAAAs are satisfactory.However,long-term fenestrated graft durability and branch vessel patency remain to be determined.

  19. 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


    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.

  20. Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Disease

    DEFF Research Database (Denmark)

    Mylotte, Darren; Lefevre, Thierry; Søndergaard, Lars


    BACKGROUND: Limited information exists describing the results of transcatheter aortic valve (TAV) replacement in patients with bicuspid aortic valve (BAV) disease (TAV-in-BAV). OBJECTIVES: This study sought to evaluate clinical outcomes of a large cohort of patients undergoing TAV-in-BAV. METHODS...

  1. [Role of computational fluid dynamics in thoracic aortic diseases research: technical superiority and application prospect]. (United States)

    Li, Weihao; Shen, Chenyang; Zhang, Xiaoming; Zhang, Tao


    Computational fluid dynamics (CFD) technology has the potential to simulate normal or pathologic aortic blood flow changes of mechanical properties and flow field, thereby helping researchers understand and reveal the occurrence, development and prognosis of aortic disease. In aortic diseases research, the initial conditions of CFD numerical simulation has experienced a developed process from idealization (forward engineering), rigid vessel wall, uniform cross-sections, laminar flow and stable blood flow towards personalization (reverse engineering), elastic vessel wall (fluid-solid coupling technique), cone-shaped diminishing cross-sections, turbulent flow, pulsatile blood flow. In this review, the research status, the technical superiority and application prospect of CFD technology were discussed with examples in following three major application areas: (1) dynamics characteristic and mechanical properties in normal thoracic aorta; (2) occurrence, advance and disruptive risk predicting in thoracic aortic aneurysm; (3) therapeutic effect and aneurysmal dilatation simulation in thoracic aortic dissection. For the future, the CFD technology may profoundly put an influence on the awareness to aortic diseases and treatment strategies.

  2. Aortic root geometry in aortic stenosis patients (a SEAS substudy)

    DEFF Research Database (Denmark)

    Bahlmann, Edda; Nienaber, Christoph A; Cramariuc, Dana


    AIMS: To report aortic root geometry by echocardiography in a large population of healthy, asymptomatic aortic stenosis (AS) patients in relation to current vendor-specified requirements for transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: Baseline data in 1481 patients...... with asymptomatic AS (mean age 67 years, 39% women) in the Simvastatin Ezetimibe in AS study were used. The inner aortic diameter was measured at four levels: annulus, sinus of Valsalva, sinotubular junction and supracoronary, and sinus height as the annulo-junctional distance. Analyses were based on vendor......-specified requirements for the aortic root geometry for current available prostheses, CoreValve and Edwards-Sapien. The ratio of sinus of Valsalva height to sinus width was 1:2. In multivariate linear regression analysis, larger sinus of Valsalva height was associated with older age, larger sinus of Valsalva diameter...

  3. Bicuspid aortic valve and aortic coarctation are linked to deletion of the X chromosome short arm in Turner syndrome (United States)

    Bondy, Carolyn; Bakalov, Vladimir K; Cheng, Clara; Olivieri, Laura; Rosing, Douglas R; Arai, Andrew E


    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

  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


    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. 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)


    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.)

  6. In-plane elastic stability of fixed parabolic shallow arches

    Institute of Scientific and Technical Information of China (English)


    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.

  7. Accuracy of impressions obtained with dual-arch trays. (United States)

    Wöstmann, Bernd; Rehmann, Peter; Balkenhol, Markus


    This study aimed to analyze the accuracy resulting from dual-arch impressions when compared to conventional impressions in complex preparations (ie, inlay and partial crown). One hundred eighty impressions were made using two different dual-arch trays; conventional trays served as the control. The accuracy of the dies obtained (Fuji-Rock EP, GC Europe) was assessed indirectly from the change of 59 transversal dimensions. Statistical analysis (t test, analysis of variance) revealed that less rigid dual-arch trays performed better than rigid ones. Though the inlay preparation was more difficult to reproduce with dual-arch trays, it can be concluded that the accuracy obtainable with nonrigid dual-arch trays is comparable to impressions taken from full-arch trays.

  8. Asymptotics of the QMLE for General ARCH(q) Models

    DEFF Research Database (Denmark)

    Kristensen, Dennis; Rahbek, Anders Christian


    Asymptotics of the QMLE for Non-Linear ARCH Models Dennis Kristensen, Columbia University Anders Rahbek, University of Copenhagen Abstract Asymptotic properties of the quasi-maximum likelihood estimator (QMLE) for non-linear ARCH(q) models -- including for example Asymmetric Power ARCH and log......-ARCH -- are derived. Strong consistency is established under the assumptions that the ARCH process is geometrically ergodic, the conditional variance function has a finite log-moment, and finite second moment of the rescaled error. Asymptotic normality of the estimator is established under the additional assumption...... that certain ratios involving the conditional variance function are suitably bounded, and that the rescaled errors have little more than fourth moment. We verify our general conditions, including identification, for a wide range of leading specific ARCH models....

  9. Anatomic variations of the branches of the aortic arch in a Peruvian population

    Directory of Open Access Journals (Sweden)

    Julio Arturo Huapaya


    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.

  10. Collaterals branches of the aortic arch and its main rami in rabbit (Oryctolagus cuniculus)


    Souza, Fernanda de; Bavaresco, Andréia Zechin; Campos, Rui


    Neste trabalho, sistematizaram-se os ramos colaterais do arco aórtico e suas principais ramifi cações, utilizando 30 coelhos da raça Nova Zelândia. O sistema arterial foi preenchido com látex corado em vermelho através da aorta torácica no sentido contrário ao fl uxo sanguíneo e fi xado em uma solução aquosa de formaldeído a 20%. Os ramos colaterais do arco aórtico foram o tronco braquiocefálico e a artéria subclávia esquerda. O tronco braquiocefálico emitiu as artérias carótidas comuns esque...

  11. Valve-in-Valve Replacement Using a Sutureless Aortic Valve (United States)

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


    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. Therapeutic Prospect of Adipose-Derived Stromal Cells for the Treatment of Abdominal Aortic Aneurysm

    NARCIS (Netherlands)

    Parvizi, Mojtaba; Harmsen, Martin C.


    Aneurysm refers to the dilation of the vessel wall for more than 50%. Abdominal aortic aneurysm (AAA) refers to the dilation and weakening of all three layers of the abdominal aorta, which mostly occur infrarenally. The population aged above 50 years is at risk of AAA development, while a familiar h

  13. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

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


    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....

  14. Vessel Operator System (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Operator cards are required for any operator of a charter/party boat and or a commercial vessel (including carrier and processor vessels) issued a vessel permit from...

  15. Vessel Activity Record (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Vessel Activity Record is a bi-weekly spreadsheet that shows the status of fishing vessels. It records whether fishing vessels are fishing without an observer...

  16. Abdominal aortic aneurysm and histological, clinical, radiological correlation. (United States)

    Rodella, Luigi Fabrizio; Rezzani, Rita; Bonomini, Francesca; Peroni, Michele; Cocchi, Marco Angelo; Hirtler, Lena; Bonardelli, Stefano


    To date, the pathogenesis of abdominal aortic aneurism (AAA) still remains unclear. As such, the aim of this study was to evaluate changes of the aortic structure during AAA. We analysed the microscopic frame of vessels sections, starting from the primum movens leading to abnormal dilatation. AAA samples were collected and processed through various staining methods (Verhoeff-Van Gieson, Masson Goldner, Sirius Red). Subsequently, the vessel morphology and collagenic web of the tunica media and adventitia were determined and the amount of type I and type III collagen was measured. We also applied immune-histochemistry markers for CD34 and PGP 9.5 in order to identify vascular and nerve structures in the aorta. Immune-positivity quantification was used to calculate the percentage of the stained area. We found increasing deposition of type I collagen and reduced type III collagen in both tunica media and adventitia of AAA. The total amount of vasa vasorum, marked with CD34, and nerva vasorum, marked with PGP 9.5, was also higher in AAA samples. Cardiovascular risk factors (blood pressure, dyslipidemia, cigarette smoking) and radiological data (maximum aneurism diameter, intra-luminal thrombus, aortic wall calcification) increased these changes. These results suggest that the tunica adventitia may have a central role in the pathogenesis of AAA as clearly there are major changes characterized by rooted inflammatory infiltration. The presence of immune components could explain these modifications within the framework of the aorta.

  17. Mathematical model of a moment-less arch. (United States)

    Lewis, W J


    This paper presents a mathematical model for predicting the geometrical shapes of rigid, two-pin, moment-less arches of constant cross section. The advancement of this work lies in the inclusion of arch self-weight and the ability to produce moment-less arch forms for any span/rise ratio, and any ratio of uniformly distributed load per unit span, w, to uniformly distributed arch weight per unit arch length, q. The model is used to derive the shapes of two classical 'moment-less' arch forms: parabolic and catenary, prior to demonstrating a general case, not restricted by the unrealistic load assumptions (absence of q, in the case of a parabolic form, or no w, in the case of a catenary arch). Using the same value of span/rise ratio, and w/q>1, the behaviour of the moment-less and parabolic arches under permanent loading, (w+q), is analysed. Results show the former to be developing much lower stresses than its parabolic rival, even when there are relatively small differences in the two geometries; for a medium span/rise ratio of 4 and w/q=2, differences in the parabolic and moment-less arch geometries would, in practical terms, be viewed as insignificant, but the stresses in them are different.

  18. An Electrostatically Actuated MEMS Arch Band-Pass Filter

    Directory of Open Access Journals (Sweden)

    Hassen M. Ouakad


    Full Text Available This work presents an investigation of the dynamics of micromachined arches resonators and their potential to be utilized as band-pass filters. The arches are actuated by a DC electrostatic load superimposed to an AC harmonic load. The dynamic response of the arch is studied analytically using a Galerkin-based reduced-order model when excited near its fundamental and third natural frequencies. Several simulation results are presented demonstrating interesting jumps and snap-through behavior of the arches and their attractive features for uses as band-pass filters, such as their sharp roll-off from pass bands to stop bands and their flat response.

  19. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis

    DEFF Research Database (Denmark)

    Siontis, George C M; Praz, Fabien; Pilgrim, Thomas


    AIMS: In view of the currently available evidence from randomized trials, we aimed to compare the collective safety and efficacy of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) across the spectrum of risk and in important subgroups. METHODS AND RESULTS...

  20. [Aortic valve replacement for the small aortic annulus]. (United States)

    Oshima, H; Usui, A; Akita, T; Ueda, Y


    Aortic valve surgery for the small aortic annulus is still challenging for surgeons. Recently, the new types of high performance prosthesis have been developed and the chance of an aortic root enlargement (ARE) is decreasing. In this study, we propose the ideal strategy of the aortic surgery for the small aortic annulus. We analyzed the clinical records of 158 patients who underwent aortic valve replacement from August 1999 to October 2005 in our institution. The small aortic annulus was observed in 38 patients (24%). Fourteen patients of this group underwent ARE. Patient-prosthesis mismatch (PPM) was less frequently observed in patients with ARE compared to those without ARE. The additional time required for ARE was not considerable, and neither ischemic time nor cardiopulmonary bypass time was significantly prolonged by ARE. In conclusion, we have to select a prosthesis with sufficient orifice area to avoid PPM, otherwise we should choose an option of ARE. For this consideration, we definitely need the chart that demonstrates the relationship between the nominal size of various types of prostheses and the size of a patient's annulus that those prostheses actually fit.

  1. 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


    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.

  2. A Functional Version of the ARCH Model

    CERN Document Server

    Hormann, Siegfried; Reeder, Ron


    Improvements in data acquisition and processing techniques have lead to an almost continuous flow of information for financial data. High resolution tick data are available and can be quite conveniently described by a continuous time process. It is therefore natural to ask for possible extensions of financial time series models to a functional setup. In this paper we propose a functional version of the popular ARCH model. We will establish conditions for the existence of a strictly stationary solution, derive weak dependence and moment conditions, show consistency of the estimators and perform a small empirical study demonstrating how our model matches with real data.

  3. A Binomial Integer-Valued ARCH Model. (United States)

    Ristić, Miroslav M; Weiß, Christian H; Janjić, Ana D


    We present an integer-valued ARCH model which can be used for modeling time series of counts with under-, equi-, or overdispersion. The introduced model has a conditional binomial distribution, and it is shown to be strictly stationary and ergodic. The unknown parameters are estimated by three methods: conditional maximum likelihood, conditional least squares and maximum likelihood type penalty function estimation. The asymptotic distributions of the estimators are derived. A real application of the novel model to epidemic surveillance is briefly discussed. Finally, a generalization of the introduced model is considered by introducing an integer-valued GARCH model.

  4. Aortic biomechanics in hypertrophic cardiomyopathy (United States)

    Badran, Hala Mahfouz; Soltan, Ghada; Faheem, Nagla; Elnoamany, Mohamed Fahmy; Tawfik, Mohamed; Yacoub, Magdi


    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

  5. Low-flow aortic stenosis in asymptomatic patients: valvular-arterial impedance and systolic function from the SEAS Substudy

    DEFF Research Database (Denmark)

    Cramariuc, Dana; Cioffi, Giovanni; Rieck, Ashild E


    OBJECTIVES: This study sought to assess the impact of valvuloarterial impedance on left ventricular (LV) myocardial systolic function in asymptomatic aortic valve stenosis (AS). BACKGROUND: In atherosclerotic AS, LV global load consists of combined valvular and arterial resistance to LV ejection...... Ezetimibe in Aortic Stenosis) study evaluating placebo-controlled combined simvastatin and ezetimibe treatment in AS were used to assess LV global load as valvuloarterial impedance and LV myocardial function as stress-corrected midwall shortening. The study population was divided into tertiles of global...... preserved. (An Investigational Drug on Clinical Outcomes in Patients With Aortic Stenosis [Narrowing of the Major Blood Vessel of the Heart]; NCT00092677)....

  6. Three-dimensional measurement of foot arch in preschool children

    Directory of Open Access Journals (Sweden)

    Chang Hsun-Wen


    Full Text Available Abstract Background The prevalence of flexible flatfoot is high among preschool-aged children, but the effects of treatment are inconclusive due to the unclear definitions of normal flatfoot. To date, a universally accepted evaluation method of the foot arch in children has not been completely established. Our aims of this study were to establish a new method to evaluate the foot arch from a three dimensional perspective and to investigate the flexibility of the foot arch among children aged from two to six. Methods A total of 44 children aged from two to six years of age were put into five age groups in this study. The navicular height was measured with one leg standing, and both feet were scanned separately in both sitting and one leg standing positions to compute the foot arch volume. The arch volume index, which represents the ratio of the difference in volume between sitting and one leg standing positions to the volume when sitting was calculated to demonstrate the flexibility of the foot arch. The differences of measured parameters between each aged group were analyzed by one-way ANOVA. Results The arch volumes when sitting and standing were highly correlated with the navicular height. The navicular height ranged from 15.75 to 27 mm, the arch volume when sitting ranged from 6,223 to 11,630 mm3, and the arch volume when standing from 3,111 to 7,848 mm3 from two to six years of age. The arch volume index showed a declining trend as age increased. Conclusion This study is the first to describe the foot arch with volume perspective in preschool-aged children. The foot arch volume was highly correlated with the navicular height. Research results show both navicular height index and arch volume index gradually increase with age from two to six. At the same time the arch also becomes rigid with age from two to six. These results could be applied for clinical evaluation of the foot arch and post-treatment evaluation.

  7. Thrombus Volume Change Visualization after Endovascular Abdominal Aortic Aneurysm Repair (United States)

    Maiora, Josu; García, Guillermo; Macía, Iván; Legarreta, Jon Haitz; Boto, Fernando; Paloc, Céline; Graña, Manuel; Abuín, Javier Sanchez

    A surgical technique currently used in the treatment of Abdominal Aortic Aneurysms (AAA) is the Endovascular Aneurysm Repair (EVAR). This minimally invasive procedure involves inserting a prosthesis in the aortic vessel that excludes the aneurysm from the bloodstream. The stent, once in place acts as a false lumen for the blood current to travel down, and not into the surrounding aneurysm sac. This procedure, therefore, immediately takes the pressure off the aneurysm, which thromboses itself after some time. Nevertheless, in a long term perspective, different complications such as prosthesis displacement or bloodstream leaks into or from the aneurysmatic bulge (endoleaks) could appear causing a pressure elevation and, as a result, increasing the danger of rupture. The purpose of this work is to explore the application of image registration techniques to the visual detection of changes in the thrombus in order to assess the evolution of the aneurysm. Prior to registration, both the lumen and the thrombus are segmented

  8. Lowering plasma cholesterol levels halts progression of aortic valve disease in mice (United States)

    Miller, Jordan D.; Weiss, Robert M.; Serrano, Kristine M.; Brooks, Robert M.; Berry, Christopher J.; Zimmerman, Kathy; Young, Stephen G.; Heistad, Donald D.


    Background Treatment of hyperlipidemia produces functional and structural improvements in atherosclerotic vessels. However, the effects of treating hyperlipidemia on the structure and function of the aortic valve has been controversial, and any effects could be confounded by pleiotropic effects of hypolipidemic treatment. The goal of this study was to determine whether reducing elevated plasma lipid levels with a “genetic switch” in Reversa mice (Ldlr−/−/Apob100/100/Mttpfl/fl/Mx1Cre+/+) reduces oxidative stress, reduces proosteogenic signaling, and retards the progression of aortic valve disease. Methods and Results After 6 months of hypercholesterolemia, Reversa mice exhibited increases in superoxide, lipid deposition, myofibroblast activation, calcium deposition, and pro-osteogenic protein expression in the aortic valve. Maximum aortic valve cusp separation, as judged by echocardiography, was not altered. During an additional 6 months of hypercholesterolemia, superoxide levels, valvular lipid deposition, and myofibroblast activation remained elevated. Furthermore, calcium deposition and pro-osteogenic gene expression became more pronounced and the aortic cusp separation decreased from 0.85 ± 0.04 to 0.70 ± 0.04 mm (mean ± SE; p < 0.05). Rapid normalization of cholesterol levels at 6 months of age (by inducing expression of Cre recombinase) normalized aortic valve superoxide levels, decreased myofibroblast activation, reduced valvular calcium burden, suppressed pro-osteogenic signaling cascades, and prevented the reductions in aortic valve cusp separation. Conclusions Collectively, these data indicate that reducing plasma lipid levels by genetic inactivation of the mttp gene in hypercholesterolemic mice with early aortic valve disease normalizes oxidative stress, reduces pro-osteogenic signaling, and halts the progression of aortic valve stenosis. PMID:19433756

  9. The Medium-Term Effects of Treatment for Mild Aortic Recoarctation

    DEFF Research Database (Denmark)

    Grøndahl, Camilla; Pedersen, Thais Almeida Lins; Hjortdal, Vibeke Elisabeth


    OBJECTIVE: To assess medium-term effects of treatment for mild to moderate recoarctation in an adult population. DESIGN: We identified all patients who had coarctation repair between 1965 and 1985 in our institution. They were all (n = 156) invited to a thorough outpatient examination, which...... > .05), and maximum flow velocity in the distal aortic arch decreased (2.8 ± 0.5 m/s vs 2.1 ± 0.4 m/s, P coarctation gradient was significantly reduced (15 ± 7 mm Hg vs 5 ± 9 mm Hg, P coarctation site was increased (11 ± 3 mm vs 15 ± 3 mm, P

  10. Defect in Posterior Arch of Atlas in Myelomeningocele

    NARCIS (Netherlands)

    G. Blaauw (Gerhard)


    textabstractThe posterior arches of the cervical vertebrae of 30 children who died with a myelomeningocele in the lower thoracic, lumbar or sacral region were examined; in 70 per cent of these cases a defect was found in the posterior arch of the atlas, which was bridged by a firm fibrous band. Alté

  11. Level-ARCH Short Rate Models with Regime Switching

    DEFF Research Database (Denmark)

    Christiansen, Charlotte

    This paper introduces regime switching volatility into level- ARCH models for the short rates of the US, the UK, and Germany. Once regime switching and level effects are included there are no gains from including ARCH effects. It is of secondary importance exactly how the regime switching is spec...

  12. Twin - Arch technique. Revival of the "edgewise -Technique"?

    Directory of Open Access Journals (Sweden)

    Jacob Karp


    The SNB – Bracket brings a new dimension into the orthodontic world which is most apparent in extraction cases. Its Teflon – like material has a very low friction coefficient thus, reducing the treatment time considerably. Through the use of low dimensioned arch wires, the Twin – Arch Technique becomes a Light – wire system and simultaneously provides good anchorage and torque control.

  13. Modelling subset multivariate ARCH model via the AIC principle

    Institute of Scientific and Technical Information of China (English)


    In this paper we consider the problem of identifying a parsimonious subset multivariate ARCH model based on the AIC principle. The proposed approach can reduce the number of parameters in the final ARCH specification and allows for non-constant correlations between the components. Some simulation results illustrate the viability of the proposed procedure.

  14. Full-scale load tests of Pearl-Chain arches

    DEFF Research Database (Denmark)

    Halding, Philip Skov; Hertz, Kristian Dahl; Schmidt, Jacob Wittrup


    , pre-fabricated, composite, lightweight, concrete deck elements (SL-Decks), that are post-tensioned together into an arch shape. The two Pearl-Chain arches, each with a span of 13m and a rise of 1m, were placed on a post tensioned bearing plate prepared in advance. The aches are tested with load...

  15. Thoracic aortic aneurysm: A rare cause of elevated hemidiaphragm

    Directory of Open Access Journals (Sweden)

    Md Arshad Ejazi


    Full Text Available Phrenic nerve palsy causing hemidiaphragm paralysis is a very uncommon feature of thoracic aortic aneurysm. In one case, a 30 year male complained of chronic dull aching chest pain, and hoarseness of voice; posteroanterior view chest radiograph revealed large spherical radiopacity on the left upper lung zone with smooth lobulated margin with elevated left hemidiaphragm. On Colour Doppler sonography, lesion was anechoic on gray scale sonography but on Doppler analysis revealed intense internal vascularity within it with characteristic "Ying Yang" sign. The finding favor the vascular origin of the lesion and a diagnosis of an arterial aneurysm was made Contrast-enhanced computed tomography (CT of the thorax revealed a large well defined spherical lesion of 8 × 10 cm size with smooth well defined margin arising from the aortic arch and attenuation of impending rupture or dissection were lesion on immediate post contrast and delayed scan was similar to that of aorta. Left hemidiaphragm elevation was explained by the gross mass effect of the aneurysm causing right phrenic nerve palsy.

  16. Percutaneous Zenith endografting for abdominal aortic aneurysms. (United States)

    Heyer, Kamaldeep S; Resnick, Scott A; Matsumura, Jon S; Amaranto, Daniel; Eskandari, Mark K


    A completely percutaneous approach to infrarenal abdominal aortic aneurysm (AAA) endografting has the theoretic benefits of being minimally invasive and more expedient. Our goal was to demonstrate the utility of this approach using a suprarenal fixation device and a suture-mediated closure system. We conducted a single-institution, retrospective review of 14 patients who underwent percutaneous AAA repair with the Zenith device between August 2003 and March 2007. Immediate and delayed access-related outcomes were examined over a mean follow-up of 12.1+/-2.0 months. Mean AAA size was 5.6 cm. Immediate arterial closure and technical success rate was 96% (27/28 vessels). One immediate hemostatic failure required open surgical repair. Over follow-up, one vessel required operative repair for new-onset claudication. No other immediate or delayed complications (thrombosis, pseudoaneurysm, infection, or deep venous thrombosis) were detected. A percutaneous approach for the treatment of AAA has several advantages over femoral artery cutdown but also has its own unique set of risks in the immediate and late postoperative period. Ultimately, the "preclose technique" can be safely applied for the Zenith device despite its large-bore delivery system.

  17. Limitation of imaging in identifying iatrogenic aortic coarctation following thoracic endovascular aortic repair. (United States)

    Thakkar, Rajiv N; Thomaier, Lauren; Qazi, Umair; Verde, Franco; Malas, Mahmoud B


    A 21-year-old male suffered blunt trauma from a motor vehicle accident causing thoracic aorta tear. The smallest available stent graft was deployed. Definitive repair was later performed using a 22 × 22 × 116 mm Talent Thoracic Stent Graft. The postoperative course was uneventful. Seventeen months later, he presented with dizziness, chest pain, acute renal failure, malignant hypertension, and troponin elevation. Computed tomography (CT) angiogram and transesophageal echocardiogram did not reveal any dissection, stent stenosis or collapse. Cardiac catheterization showed normal coronary arteries but a 117 mm Hg gradient across the stent graft. Iatrogenic coarctation of the aorta was confirmed with a second measurement during arch angiogram. A Palmaz stent was deployed over the distal end of the previous stent graft with complete resolution of symptoms and gradual normalization of kidney function. This case report demonstrates a need for wider availability and selecting appropriate stent graft in treating traumatic aortic injuries in young patients. It is the first case report of the inability of current imaging modalities in confirming stent collapse. Pressure gradient is a useful tool in confirming stent collapse when clinical scenario does not match CT findings.

  18. Seismic multi-arch structures in East China

    Institute of Scientific and Technical Information of China (English)


    In previous papers (Wencai, 2002, 2003), the author has analyzed the deep seismic reflection profiles along some of the Mesozoic plutons in East China, and has pointed out that the crustal structures around these intrusions usually correlate with a special seismic fabric called the seismic multi-arch structure. This paper will continue to show main characteristics of the seismic multi-arch structures and discuss their relationship with mantle-origin magmatism and the lithospheric thinning process. Calibration of seismic reflectors in Chinese continental drilling sites shows that small-scale arch-like reflectors can be generated by fractured eclogites or other plutons, they do not belong to the multi-arch structure specially discussed in the paper. The multi-arch structure is characterized by several arch-like reflectors distributed in both the upper and lower crust with granitoid plutons or stocks exposed on the surface, which do not have obvious negative Europium anomalies. Based on the distribution pattern of arch reflectors, the multi-arch magmatic structures can be divided into three main types, namely the simple vertical combination type, the spread arch magmatic structure and the arch-bouquet structure. All of them correlate to mantle-origin magmatism, but occur in different places. The spread arch magmatic structures occur within a Mesozoic/Cenozoic rift zone with very thin and hot lithosphere. The vertical combination type of the multi-arch structures occurred near the rift zones where lithosphere was thin and hot. The arch-bouquet magmatic structures occur far from the rift zones where the lithosphere is not hot. The continental rifting acted as the late episode of the lithospheric thinning process seeing that the rift zones usually coincide with the thinnest parts of the lithosphere in East China. In different locations within the lithospheric thinning areas, mantle-origin magmatic activities have different characteristics, which might generate different

  19. Atlantoaxial stabilization using multiaxial C-1 posterior arch screws. (United States)

    Donnellan, Michael B; Sergides, Ioannis G; Sears, William R


    The authors present a novel technique of atlantoaxial fixation using multiaxial C-1 posterior arch screws. The technique involves the insertion of bilateral multiaxial C-1 posterior arch screws, which are connected by crosslinked rods to bilateral multiaxial C-2 pars screws. The clinical results are presented in 3 patients in whom anomalies of the vertebral arteries, C-1 lateral masses, and/or posterior arch of C-1 presented difficulty using existing fixation techniques with transarticular screws, C-1 lateral mass screws, or posterior wiring. The C-1 posterior arch screws achieved solid fixation and their insertion appeared to be technically less demanding than that of transarticular or C-1 lateral mass screws. This technique may reduce the risk of complications compared with existing techniques, especially in patients with anatomical variants of the vertebral artery, C-1 lateral masses, or C-1 posterior arch. This technique may prove to be an attractive fixation option in patients with normal anatomy.

  20. Effect of Obesity on Arch Index in Young Adults

    Directory of Open Access Journals (Sweden)

    Sneha Sameer Ganu


    Full Text Available Background: Excessive increases in weight bearing forces caused by obesity may negatively affect the lower limbs and feet but minimal research has examined the long-term loading effects of obesity on the musculoskeletal system, particularly in reference to the feet. Objectives: The purpose of the study was to investigate the effect of obesity on medial longitudinal arch of foot in young adults. Method: 60 subjects, 30 obese & 30 non obese were assessed for height & weight using standard technique. Radiographic images under static condition were used for calculating the arch index. Result: The arch index of obese subjects was significantly lower than the non obese subjects & there is a negative correlation between the BMI & the arch index. Conclusion: These results suggests that obesity lowers the medial longitudinal arch of foot.

  1. Abdominal aortic aneurysms

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal


    Although the number of elective operations for abdominal aortic aneurysms (AAA) is increasing, the sex- and age-standardised mortality rate of AAAs continues to rise, especially among men aged 65 years or more. The lethality of ruptured AAA continues to be 80-95%, compared with 5-7% by elective....... The acceptance rate was 77%, and 95% accept control scans. Furthermore, persons at the highest risk of having an AAA attend screening more frequently. We found that 97% of the interval cases developed from aortas that initially measured 2.5-2.9 cm - i.e. approx. only 5% attenders need re-screening at 5-year...... methods for measuring the degree of wall calcification must be developed and validated....

  2. Endovascular Management of Extra-cranial Supra-aortic Vascular Injuries

    Energy Technology Data Exchange (ETDEWEB)

    Almazedi, Bahir, E-mail:; Lyall, Harpreet; Bhatnagar, Priya [Leeds and West Yorkshire Radiology Academy, Leeds General Infirmary (United Kingdom); Kessel, David; McPherson, Simon; Patel, Jai V.; Puppala, Sapna [The Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Department of Vascular and Interventional Radiology (United Kingdom)


    Supra-aortic vessel injuries are uncommon but can be life-threatening and surgically challenging. Trauma to these vessels may be blunt or penetrating, including iatrogenic trauma following the insertion of central venous lines, which may be preventable. Recent advances in technology have resulted in endovascular therapy becoming a common first-line treatment, and interventional radiologists now play a major role in the management of these vascular injuries. We review the literature on the endovascular management of these types of injuries and describe a spectrum of case-based extra-cranial supra-aortic vascular injuries managed at our institution and the range of imaging appearances, including active contrast extravasation, traumatic vessel occlusion, true aneurysms, pseudoaneurysms, and arteriovenous fistulae.


    NARCIS (Netherlands)



    Two patients with a quadricuspid aortic valve are described, one of them with concomitant juxtaposed coronary orifices facing the right hand facing sinus. The etiology and incidence of this congenital anomaly will be discussed.

  4. Transcatheter Aortic Heart Valve Thrombosis

    DEFF Research Database (Denmark)

    Hansson, Nicolaj C; Grove, Erik L; Andersen, Henning R;


    BACKGROUND: There is increasing focus on transcatheter heart valve (THV) thrombosis. However, there are limited data on incidence, clinical implications and predisposing factors of THV thrombosis following transcatheter aortic valve replacement (TAVR). OBJECTIVES: We assessed the incidence...

  5. Adult thoracic and abdominal aortic

    Directory of Open Access Journals (Sweden)

    Randa O. Kaddah


    Conclusion: Aortic COA could be found in any segment of the aorta. Proper identification of the anatomical details and pressure gradient studies are important factors affecting the plan of management.

  6. Minimally invasive aortic valve replacement

    DEFF Research Database (Denmark)

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


    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....... The 30-day mortality rate for the 98 patients was zero, although 14 of the 98 mini-sternotomies had to be converted to complete sternotomies intraoperatively due to technical problems. Such conversion doubled the operative time over that of the planned full sternotomies. In the group of patients whose...... 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...

  7. Thoracic and abdominal aortic diameters in a general population: MRI-based reference values and association with age and cardiovascular risk factors

    Energy Technology Data Exchange (ETDEWEB)

    Mensel, Birger; Hesselbarth, Lydia; Wenzel, Michael; Kuehn, Jens-Peter; Hegenscheid, Katrin [University Medicine Greifswald, Institute of Diagnostic Radiology and Neuroradiology, Greifswald (Germany); Doerr, Marcus [University Medicine Greifswald, Department of Internal Medicine, Greifswald (Germany); DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald (Germany); Voelzke, Henry [University Medicine Greifswald, Institute for Community Medicine, Greifswald (Germany); DZHK (German Center for Cardiovascular Research), partner site Greifswald, Greifswald (Germany); Lieb, Wolfgang [Christian Albrechts University, Institute of Epidemiology, Kiel (Germany); Lorbeer, Roberto [Ludwig-Maximilians-University Hospital, Institute of Clinical Radiology, Munich (Germany)


    To generate reference values for thoracic and abdominal aortic diameters determined by magnetic resonance imaging (MRI) and analyse their association with cardiovascular risk factors in the general population. Data from participants (n = 1759) of the Study of Health in Pomerania were used for analysis in this study. MRI measurement of thoracic and abdominal aortic diameters was performed. Parameters for calculation of reference values according to age and sex analysis were provided. Multivariable linear regression models were used for determination of aortic diameter-related risk factors, including smoking, blood pressure (BP), high-density lipoprotein cholesterol (HDL-C). For the ascending aorta (β = -0.049, p < 0.001), the aortic arch (β = -0.061, p < 0.001) and the subphrenic aorta (β = -0.018, p = 0.004), the body surface area (BSA)-adjusted diameters were lower in men. Multivariable-adjusted models revealed significant increases in BSA-adjusted diameters with age for all six aortic segments (p < 0.001). Consistent results for all segments were observed for the positive associations of diastolic BP (β = 0.001; 0.004) and HDL (β = 0.035; 0.087) with BSA-adjusted aortic diameters and for an inverse association of systolic BP (β = -0.001). Some BSA-adjusted median aortic diameters are smaller in men than in women. All diameters increase with age, diastolic blood pressure and HDL-C and decrease as systolic BP increases. (orig.)

  8. Evolution of surgical therapy for Stanford acute type A aortic dissection. (United States)

    Chiu, Peter; Miller, D Craig


    Acute type A aortic dissection (AcA-AoD) is a surgical emergency associated with very high morbidity and mortality. Unfortunately, the early outcome of emergency surgical repair has not improved substantially over the last 20 years. Many of the same debates occur repeatedly regarding operative extent and optimal conduct of the operation. The question remains: are patients suffering from too large an operation or too small? The pendulum favoring routine aortic valve resuspension, when feasible, has swung towards frequent aortic root replacement. This already aggressive approach is now being challenged with the even more extensive valve-sparing aortic root replacement (V-SARR) in selected patients. Distally, open replacement of most of the transverse arch is best in most patients. The need for late aortic re-intervention has not been shown to be affected by more extensive distal operative procedures, but the contemporary enthusiasm for a distal frozen elephant trunk (FET) only seems to build. It must be remembered that the first and foremost goal of the operation is to have an operative survivor; additional measures to reduce late morbidity are secondary aspirations. With increasing experience, true contraindications to emergency surgical operation have dwindled, but patients with advanced age, multiple comorbidities, and major neurological deficits do not fare well. The endovascular revolution, moreover, has spawned innovative options for modern practice, including ascending stent graft and adaptations of the old flap fenestration technique. Despite the increasingly complex operations and ever expanding therapies, this life-threatening disease remains a stubborn challenge for all cardiovascular surgeons. Development of specialized thoracic aortic teams and regionalization of care for patients with AcA-AoD offers the most promise to improve overall results.

  9. [New aspects in aortic valve disease]. (United States)

    Tornos, P


    Renewed interest for aortic valve disease has evolved in recent years. Aortic valve replacement has become the second most frequent cause of cardiac surgery, following coronary bypass surgery. In addition, the etiologic and physiopathologic knowledge of this disorder has improved. In the present paper we analyze three aspects of the disease which are, at present, the subject of study and controversy: first, we discuss the possible relationship between degenerative aortic stenosis and atherosclerosis; second, the involvement of the aortic root in cases of bicuspid aortic valve; and third, the surgical indications in asymptomatic patients with either aortic stenosis or regurgitation.

  10. Image-Based Computational Fluid Dynamics in Blood Vessel Models: Toward Developing a Prognostic Tool to Assess Cardiovascular Function Changes in Prolonged Space Flights (United States)

    Chatzimavroudis, George P.; Spirka, Thomas A.; Setser, Randolph M.; Myers, Jerry G.


    One of NASA's objectives is to be able to perform a complete, pre-flight, evaluation of cardiovascular changes in astronauts scheduled for prolonged space missions. Computational fluid dynamics (CFD) has shown promise as a method for estimating cardiovascular function during reduced gravity conditions. For this purpose, MRI can provide geometrical information, to reconstruct vessel geometries, and measure all spatial velocity components, providing location specific boundary conditions. The objective of this study was to investigate the reliability of MRI-based model reconstruction and measured boundary conditions for CFD simulations. An aortic arch model and a carotid bifurcation model were scanned in a 1.5T Siemens MRI scanner. Axial MRI acquisitions provided images for geometry reconstruction (slice thickness 3 and 5 mm; pixel size 1x1 and 0.5x0.5 square millimeters). Velocity acquisitions provided measured inlet boundary conditions and localized three-directional steady-flow velocity data (0.7-3.0 L/min). The vessel walls were isolated using NIH provided software (ImageJ) and lofted to form the geometric surface. Constructed and idealized geometries were imported into a commercial CFD code for meshing and simulation. Contour and vector plots of the velocity showed identical features between the MRI velocity data, the MRI-based CFD data, and the idealized-geometry CFD data, with less than 10% differences in the local velocity values. CFD results on models reconstructed from different MRI resolution settings showed insignificant differences (less than 5%). This study illustrated, quantitatively, that reliable CFD simulations can be performed with MRI reconstructed models and gives evidence that a future, subject-specific, computational evaluation of the cardiovascular system alteration during space travel is feasible.


    Energy Technology Data Exchange (ETDEWEB)

    Vormelker, P


    Two high-pressure bioassay vessels failed at the Savannah River Site during a microwave heating process for biosample testing. Improper installation of the thermal shield in the first failure caused the vessel to burst during microwave heating. The second vessel failure is attributed to overpressurization during a test run. Vessel failure appeared to initiate in the mold parting line, the thinnest cross-section of the octagonal vessel. No material flaws were found in the vessel that would impair its structural performance. Content weight should be minimized to reduce operating temperature and pressure. Outer vessel life is dependent on actual temperature exposure. Since thermal aging of the vessels can be detrimental to their performance, it was recommended that the vessels be used for a limited number of cycles to be determined by additional testing.

  12. Symptomatic obstruction of the brachiocephalic and left subclavian arteries obscured by aortic stenosis. (United States)

    Hashim, Peter W; Assi, Roland; Grecu, Loreta; Dardik, Alan


    Stenosis or occlusion of the brachiocephalic artery represents an uncommon cause of cerebrovascular insufficiency. We report a patient with combined brachiocephalic and left subclavian obstruction with clinical manifestations of lightheadedness, syncope, and left-sided weakness who remained misdiagnosed essentially because of symmetrical pressures in the upper extremities. Aortic valve replacement for aortic stenosis failed to provide symptomatic relief. Eventual stenting of the brachiocephalic trunk resolved the patient's symptoms. Our report highlights the diagnostic challenges in this case of bilateral supraaortic vessel disease and shows that equal upper extremity pressures do not rule out brachiocephalic artery obstruction.

  13. Description of dental arch form using the Fourier series. (United States)

    Valenzuela, A Patricia; Pardo, Marco A; Yezioro, Salomon


    The aim of this study was to describe the form of the human superior dental arch using Fourier transformations. Forty models made in dental stone from impressions of the maxillary dental arch were used to obtain the reference data, which were expressed in Cartesian coordinates, from the mesovestibular cuspid vertices of molar teeth, vestibular cuspid of premolars, and incisal edge. Fourth-grade equations and Fourier series were calculated from these data. The results indicate that Fourier series more precisely express the form and size of different dental arches, with mixed or permanent dentition, than fourth-grade equations. Details of the mathematical procedure and the precision obtained were provided.

  14. Valva aórtica bicúspide: fundamentos teóricos e clínicos para substituição simultânea da aorta ascendente Bicuspid aortic valve: theoretical and clinical aspects of concomitant ascending aorta replacement

    Directory of Open Access Journals (Sweden)

    Mauro Paes Leme De Sá


    and vessels of the aortic arch. Previous studies have shown that patients with normal BAV or slight dysfunction may present with dilation of the aortic root. The hemodynamic changes caused by BAV without stenosis or insufficiency seem to be an insufficient explanation for these findings. Several mechanisms have been proposed to explain the molecular and hystological aspects of this disease. We found a reduced fibrillin-1 content in both ascending aorta and pulmonary trunk as a possible cause. Histologically, the ascending aorta can present cystic medial necrosis and elastic fragmentation, similar to Marfan's disease. Some authors concluded that many patients, mainly those with aortic regurgitation, should have the aortic valve and the ascending aorta replaced at the same procedure, even if a mild dilatation (45 mm is present in patients with BAV if life expectancy is anticipated to be greater than 10 years to prevent further aneurysms or ruptures.

  15. Abdominal aortic aneurysm repair - open - discharge (United States)

    ... this page: // Abdominal aortic aneurysm repair - open - discharge To use the sharing features ... References Orandi BJ, Black JH. Open repair of abdominal aortic aneurysms. In: Cameron JL, Cameron AM, eds. Current Surgical ...

  16. Multi-detector CT angiography for the assessment of anterior spinal artery and artery of Adamkiewicz patency in patients suspected of having thoracic aortic pathology

    Institute of Scientific and Technical Information of China (English)

    Shaohong ZHAO; Laura Logan; Pamela Schraedley; Geoffrey D.Rubin


    Objective To evaluate the visualization of the anterior spinal artery (ASA) and the artery of Adamkiewicz (AKA) as well as the affecting factors for the detection rate using multidetector row CT (MDCT). Methods Ninety-nine consecutive patients (31 women and 68 men; age range, 25-90 years; average age 61.3 years) with suspicion for thoracic aortic lesions necessitating surgical intervention (31 aortic aneurysm, 45 dissection, 5 intramural hematoma, and 18 normal), underwent 16-slice MDCT angiography from the aortic arch to the aortic bifurcation. Transverse sections, multiplanar reformations (MPR) and thin maximum intensity projections (MIP) were used to assess the ASA and AKA. The level of the ASA and AKA origins and CT acquisition parameters were recorded. The contrast-to-noise ratio (CNR) of the image, an index of the mass of the T11 body (vertebral mass index), the subcutaneous fat thickness,and the CT value within the aortic arch and at the T11 level were measured. The detection of the ASA and AKA was evaluated relative to the acquisition parameters, scan characteristics, and aortic lesion type. Differences were assessed with Wilcoxon rank-sum and t tests. Results The ASA was visualized in 51 patients (52%) and the AKA in 18 patients (18 %). The ASA was identified in 36/67 (54%)patients with 1.25 mm thickness and in15/32 (47%) patients with 2.5-3.0 mm thickness. This difference did not achieve significance (P=0.13). The detection rate of the ASA and the AKA was influenced by vertebral mass index and the CNR (P<0.05). The amount of subcutaneous fat affected the detection rate of the ASA (P<0.05) but not the AKA. In CT scans with ASA detection, the mean CT values in the aorta at the arch and at T11 were 360 and 358 HU, respectively; whereas in CT scans without ASA detection, the CT values in the aorta at the arch and at T11 were lower (297 and 317 HU, respectively; both P<0.05). Conclusion The ASA and AKA were less frequently detected in our cohorts than

  17. Management of bicuspid aortic valve with or without involvement of ascending aorta and aortic root. (United States)

    Neragi-Miandoab, S


    Patients with a bicuspid aortic valve (BAV) constitute a heterogeneous population with variable clinical presentation and complications. More than 50% of the patients who require aortic valve replacement have a BAV, a condition that may be associated with dilation of ascending aorta and aortic insufficiency caused by cusp disease or aortic root pathology. Of the potential BAV-related complications, dilation of the aortic root and ascending aorta are among the most serious. The dilation of ascending aorta and aortic root have been the subject of controversy. Whereas some surgeons believe that the dilation of the aorta is caused by the hemodynamic properties of the BAV, others believe that the dilation of the aortic root is secondary to genetic defects associated with the BAV. Management of a BAV should be tailored to each patient's clinical condition. The surgical approach varies from aortic valve replacement to combined aortic valve and root replacement to aortic-valve-sparing root replacement.

  18. Abdominal aortic feminism. (United States)

    Mortimer, Alice Emily


    A 79-year-old woman presented to a private medical practice 2 years previously for an elective ultrasound screening scan. This imaging provided the evidence for a diagnosis of an abdominal aortic aneurysm (AAA) to be made. Despite having a number of recognised risk factors for an AAA, her general practitioner at the time did not follow the guidance set out by the private medical professional, that is, to refer the patient to a vascular specialist to be entered into a surveillance programme and surgically evaluated. The patient became symptomatic with her AAA, was admitted to hospital and found to have a tender, symptomatic, 6 cm leaking AAA. She consented for an emergency open AAA repair within a few hours of being admitted to hospital, despite the 50% perioperative mortality risk. The patient spent 4 days in intensive care where she recovered well. She was discharged after a 12 day hospital stay but unfortunately passed away shortly after her discharge from a previously undiagnosed gastric cancer.

  19. Probabilistic retinal vessel segmentation (United States)

    Wu, Chang-Hua; Agam, Gady


    Optic fundus assessment is widely used for diagnosing vascular and non-vascular pathology. Inspection of the retinal vasculature may reveal hypertension, diabetes, arteriosclerosis, cardiovascular disease and stroke. Due to various imaging conditions retinal images may be degraded. Consequently, the enhancement of such images and vessels in them is an important task with direct clinical applications. We propose a novel technique for vessel enhancement in retinal images that is capable of enhancing vessel junctions in addition to linear vessel segments. This is an extension of vessel filters we have previously developed for vessel enhancement in thoracic CT scans. The proposed approach is based on probabilistic models which can discern vessels and junctions. Evaluation shows the proposed filter is better than several known techniques and is comparable to the state of the art when evaluated on a standard dataset. A ridge-based vessel tracking process is applied on the enhanced image to demonstrate the effectiveness of the enhancement filter.

  20. Guam Abandoned Vessel Inventory (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — NOAA Abandoned Vessel Project Data for Guam. Abandoned vessels pose a significant threat to the NOAA Trust resources through physical destruction of coral habitats...

  1. Vessel Arrival Info - Legacy (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The Vessel Arrival Info is a spreadsheet that gets filled out during the initial stage of the debriefing process by the debriefer. It contains vessel name, trip...

  2. Florida Abandoned Vessel Inventory (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — NOAA Abandoned Vessel Project Data for Florida. Abandoned vessels pose a significant threat to the NOAA Trust resources through physical destruction of coral...

  3. The assessment of crowding without the need to record arch perimeter. Part I: Arches with acceptable alignment. (United States)

    Battagel, J M


    A simplified, mathematically determined technique for calculating arch perimeter (the overlap method) is described and its validity in determining an accurate assessment of crowding is tested. Indices, expressed in millimetres of crowding or spacing, were computed for both the whole arch and the labial segment alone. Study casts of 36 individuals with clinically acceptable lower arches were used to validate the method. The degree of crowding or spacing calculated was compared with a "clinical' assessment of each arch, in which the irregularity was measured directly using a steel ruler. Various calculation schemes were tested. Depending on exactly how the overlap was determined, the results varied slightly. Although the arches showed acceptable alignment, it was preferable to include a strategy for normalizing the positions of any rotated teeth before the overlaps were calculated. Repositioning any bucco-lingually displaced teeth into the line of the arch, however, was not useful. For the complete arch good agreement with the clinical assessment was reached on 31 occasions and for the labial segment, all but one appraisals were within 0.5 mm of each other. In the remaining instances (five complete arches and one labial segment), the degree of crowding or spacing was between 0.5 and 1 mm of the clinical assessment. Considering that clinical measurement of minor degrees of crowding and spacing cannot be precise, these results were considered acceptable. The method was easy to use, relying only on the recording of mesio-distal tooth widths and was acceptably reproducible. The technique would therefore appear to provide a valid yet simple research tool with which to record the degree of crowding. Its ability to cope with irregular and crowded arches will be the subject of a subsequent review.

  4. A comparative study of inter-abutment distance of dies made from full arch dual-arch impression trays with those made from full arch stock trays: An in vitro study

    Directory of Open Access Journals (Sweden)

    Reddy Jagan


    Full Text Available Objectives: The dual-arch impression technique is convenient in that it makes the required maxillary and mandibular impressions, as well as the inter-occlusal record in one procedure. The accuracy of inter-abutment distance in dies fabricated from dual-arch impression technique remains in question because there is little information available in the literature. Materials and Methods: This study was conducted to evaluate the accuracy of inter-abutment distance in dies obtained from full arch dual-arch trays with those obtained from full arch stock metal trays. Results and Conclusion: The metal dual-arch trays showed better accuracy followed by the plastic dual-arch and stock dentulous trays, respectively, though statistically insignificant. The pouring sequence did not have any effect on the inter-abutment distance statistically, though pouring the non-working side of the dual-arch impression first showed better accuracy.

  5. Open aortic surgery after thoracic endovascular aortic repair. (United States)

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


    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.

  6. Aortic or Mitral Valve Replacement With the Biocor and Biocor Supra (United States)


    Aortic Valve Insufficiency; Aortic Valve Regurgitation; Aortic Valve Stenosis; Aortic Valve Incompetence; Mitral Valve Insufficiency; Mitral Valve Regurgitation; Mitral Valve Stenosis; Mitral Valve Incompetence

  7. 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


    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

  8. Successful resuscitation from two cardiac arrests in a female patient with critical aortic stenosis, severe mitral regurgitation and coronary artery disease

    Directory of Open Access Journals (Sweden)

    Mijušković Dragan


    Full Text Available Introduction. The incidence of sudden cardiac death in patients with severe symptomatic aortic stenosis is up to 34% and resuscitation is described as highly unsuccessful. Case report. A 72-year-old female patient with severe aortic stenosis combined with severe mitral regurgitation and three-vessel coronary artery disease was successfully resuscitated following two in-hospital cardiac arrests. The first cardiac arrest occurred immediately after intraarterial injection of low osmolar iodinated agent during coronary angiography. Angiography revealed 90% occlusion of the proximal left main coronary artery and circumflex branch. The second arrest followed induction of anesthesia. Following successful open-chest resuscitation, aortic valve replacement, mitral valvuloplasty and three-vessel aortocoronary bypass were performed. Postoperative pericardial tamponade required surgical revision. The patient recovered completely. Conclusion. Decision to start resuscitation may be justified in selected patients with critical aortic stenosis, even though cardiopulmonary resuscitation in such cases is generally considered futile.

  9. Aortic root replacement with a pulmonary autograft

    NARCIS (Netherlands)

    R.B. Hokken (Raymond)


    textabstractAortic valve disease in the pediatric age group is usually a consequence of congenital aortic stenosis, which may be isolated or may be a part of an anomaly of the left ventricular outflow tract or the aortic root. Management of these patients is difficult. Neonates and infants with seve

  10. ALICE HMPID Radiator Vessel

    CERN Multimedia


    View of the radiator vessels of the ALICE/HMPID mounted on the support frame. Each HMPID module is equipped with 3 indipendent radiator vessels made out of neoceram and fused silica (quartz) windows glued together. The spacers inside the vessel are needed to stand the hydrostatic pressure.

  11. Nonstationary ARCH and GARCH with t-distributed Innovations

    DEFF Research Database (Denmark)

    Pedersen, Rasmus Søndergaard; Rahbek, Anders

    Consistency and asymptotic normality are established for the maximum likelihood estimators in the nonstationary ARCH and GARCH models with general t-distributed innovations. The results hold for joint estimation of (G)ARCH effects and the degrees of freedom parameter parametrizing the t-distribut......Consistency and asymptotic normality are established for the maximum likelihood estimators in the nonstationary ARCH and GARCH models with general t-distributed innovations. The results hold for joint estimation of (G)ARCH effects and the degrees of freedom parameter parametrizing the t......-distribution. With T denoting sample size, classic square-root T-convergence is shown to hold with closed form expressions for the multivariate covariances....

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


    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


    Tabata, Minoru


    Minimally invasive aortic valve replacement (MIAVR) is defined as aortic valve replacement avoiding full sternotomy. Common approaches include a partial sternotomy right thoracotomy, and a parasternal approach. MIAVR has been shown to have advantages over conventional AVR such as shorter length of stay and smaller amount of blood transfusion and better cosmesis. However, it is also known to have disadvantages such as longer cardiopulmonary bypass and aortic cross-clamp times and potential complications related to peripheral cannulation. Appropriate patient selection is very important. Since the procedure is more complex than conventional AVR, more intensive teamwork in the operating room is essential. Additionally, a team approach during postoperative management is critical to maximize the benefits of MIAVR.

  14. Comparison of arch forms between Turkish and North American

    Directory of Open Access Journals (Sweden)

    Ahmet A. Celebi


    Full Text Available ABSTRACT Objective: The aim of this study was to clarify the morphological differences in the mandibular arches of Turkish and North American white subjects. Methods: The sample included 132 Turkish (34 Class I, 58 Class II, and 40 Class III and 160 North American (60 Class I, 50 Class II, and 50 Class III subjects. The most facial portion of 13 proximal contact areas was digitized from photocopied images of patients' mandibular dental arches. Clinical bracket points were calculated for each tooth based on mandibular tooth thickness data. Four linear and two proportional measurements were taken. The subjects were grouped according to arch form types (tapered, ovoid and square in order to have frequency distribution compared between ethnic groups in each Angle classification. Results: The Turkish group showed significantly lower molar depth and more significant molar width-depth (W/D ratio in all three Angle classifications. On the other hand, the Turkish group also showed a significantly larger intercanine width in Class III malocclusion and intermolar width in Class II malocclusion. The most frequent arch forms seen were the ovoid arch form in the Turkish group and the tapered form in the white group. Conclusions: Our results demonstrate that when treating Turkish patients, one should expect to use preformed ovoid arch form orthodontic wires in a significant percentage of patients.

  15. Comparison of arch forms between Turkish and North American (United States)

    Celebi, Ahmet A.; Keklik, Hakan; Tan, Enes; Ucar, Faruk I.


    ABSTRACT Objective: The aim of this study was to clarify the morphological differences in the mandibular arches of Turkish and North American white subjects. Methods: The sample included 132 Turkish (34 Class I, 58 Class II, and 40 Class III) and 160 North American (60 Class I, 50 Class II, and 50 Class III) subjects. The most facial portion of 13 proximal contact areas was digitized from photocopied images of patients' mandibular dental arches. Clinical bracket points were calculated for each tooth based on mandibular tooth thickness data. Four linear and two proportional measurements were taken. The subjects were grouped according to arch form types (tapered, ovoid and square) in order to have frequency distribution compared between ethnic groups in each Angle classification. Results: The Turkish group showed significantly lower molar depth and more significant molar width-depth (W/D) ratio in all three Angle classifications. On the other hand, the Turkish group also showed a significantly larger intercanine width in Class III malocclusion and intermolar width in Class II malocclusion. The most frequent arch forms seen were the ovoid arch form in the Turkish group and the tapered form in the white group. Conclusions: Our results demonstrate that when treating Turkish patients, one should expect to use preformed ovoid arch form orthodontic wires in a significant percentage of patients. PMID:27275615

  16. [Supra-aortic trunks occlusive disease: three different treatment approaches]. (United States)

    Dias, P; Almeida, P; Sampaio, S; Silva, A; Leite-Moreira, A; Pinho, P; Roncon de Albuquerque, R


    Unlike carotid bifurcation atherosclerotic stenosis, supra-aortic trunks (SAT) occlusive disease is rare and its revascularization uncommon, accouting for less than 10% of the operations performed on the extracranial brain-irrigating arteries. There are three different treatment approaches: transthoracic, extra-anatomic cervical and endovascular. Endovascular repair is gaining popularity as first-line therapy for proximal lesions with favorable anatomy because of its low morbidity and rare mortality. Extra-anatomic bypass is a safe and durable reconstruction and should be considered in patients with single vessel disease, with cardiopulmonary high-risk or with limited life expectancy. If cardiac surgery is needed, central transthoracic reconstruction is preferable, and the two procedures should be combined. The long-term patency of bypasses with aortic origin, specially when multiple vessels are involved, is superior to other repair techniques. We present three clinical cases that illustrate each of these therapeutic strategies: central brachiocephalic revascularization and synchronous cardiac surgery in a patient with complex SAT atherosclerosis disease; subclavian-carotid transposition for disabling upper limb claudication; and subclavian artery stenting for subclavian-steal syndrome. Surgical approach selection should be based on the individual patient's anatomy and operative risk.

  17. Aortic and Cardiac Structure and Function Using High-Resolution Echocardiography and Optical Coherence Tomography in a Mouse Model of Marfan Syndrome (United States)

    Lee, Ling; Cui, Jason Z.; Cua, Michelle; Esfandiarei, Mitra; Sheng, Xiaoye; Chui, Winsey Audrey; Xu, Michael Haoying; Sarunic, Marinko V.; Beg, Mirza Faisal; van Breemen, Cornelius; Sandor, George G. S.


    Marfan syndrome (MFS) is an autosomal-dominant disorder of connective tissue caused by mutations in the fibrillin-1 (FBN1) gene. Mortality is often due to aortic dissection and rupture. We investigated the structural and functional properties of the heart and aorta in a [Fbn1C1039G/+] MFS mouse using high-resolution ultrasound (echo) and optical coherence tomography (OCT). Echo was performed on 6- and 12-month old wild type (WT) and MFS mice (n = 8). In vivo pulse wave velocity (PWV), aortic root diameter, ejection fraction, stroke volume, left ventricular (LV) wall thickness, LV mass and mitral valve early and atrial velocities (E/A) ratio were measured by high resolution echocardiography. OCT was performed on 12-month old WT and MFS fixed mouse hearts to measure ventricular volume and mass. The PWV was significantly increased in 6-mo MFS vs. WT (366.6 ± 19.9 vs. 205.2 ± 18.1 cm/s; p = 0.003) and 12-mo MFS vs. WT (459.5 ± 42.3 vs. 205.3 ± 30.3 cm/s; pMarfan patients including significant aortic dilation, central aortic stiffness, LV systolic and diastolic dysfunction. This is the first demonstration of the direct measurement in vivo of pulse wave velocity non-invasively in the aortic arch of MFS mice, a robust measure of aortic stiffness and a critical clinical parameter for the assessment of pathology in the Marfan syndrome. PMID:27824871

  18. Relationships between retinal arteriole anatomy and aortic geometry and function and peripheral resistance in hypertensives. (United States)

    Rosenbaum, David; Kachenoura, Nadjia; Koch, Edouard; Paques, Michel; Cluzel, Philippe; Redheuil, Alban; Girerd, Xavier


    Microvascular remodeling and large artery stiffness are key determinants of cardiovascular hemodynamics and can now be studied with new non-invasive methods. Our objective was to study the relationships between retinal arteriole anatomy and aortic geometry and function and peripheral resistance (total peripheral resistance (TPR)) in hypertensives. In 80 subjects (age 52±13 years; 53% males; including 23 normotensives and 57 hypertensives, among which 29 were uncontrolled hypertensives), we used: (1) the new non-invasive RTX1 adaptive optics (AO) camera (Imagine Eyes, Orsay, France) to measure the wall-to-lumen ratio (WLR) on retinal microvasculature; (2) cardiovascular magnetic resonance (CMR) imaging to assess aortic stiffness, geometry and cardiac output; and (3) the validated SphymoCor Xcel device to measure central blood pressure (BP) and carotido-femoral pulse wave velocity (Cf-PWV). TPR was calculated as the central mean BP/cardiac output ratio. WLR and TPR were significantly higher and aortic distensibility was significantly lower in hypertensives. Aortic dilation and arch elongation were found in uncontrolled hypertensives. In the univariate analysis, WLR was positively correlated with central BP (PTPR (PTPR (P=0.002) independent of age, BMI, gender, antihypertensive treatments, aortic diameter and central SBP. As expected, age was the major correlate of ascending aorta distensibility and Cf-PWV. New non-invasive vascular imaging methods are complementary for the detection of the deleterious effects of aging or high BP on large and small arteries. AO examination could represent a useful tool for the study and follow-up of microvasculature anatomical changes.

  19. Transfemoral transcatheter aortic valve implantation in a patient with a severe aortic stenosis and cardiogenic shock requiring intra-aortic balloon pump support. (United States)

    Chodór, Piotr; Wilczek, Krzysztof; Przybylski, Roman; Świątkowski, Andrzej; Głowacki, Jan; Kalarus, Zbigniew; Zembala, Marian


    The following paper presents a patient with severe aortic stenosis and severely reduced left ventricular ejection fraction with intra-aortic balloon pump counterpulsation support, who underwent transfemoral aortic valve implantation of a CoreValve prosthesis.

  20. Transfemoral transcatheter aortic valve implantation in a patient with a severe aortic stenosis and cardiogenic shock requiring intra-aortic balloon pump support


    Chodór, Piotr; Wilczek, Krzysztof; Przybylski, Roman; Świątkowski, Andrzej; Głowacki, Jan; Kalarus, Zbigniew; Zembala, Marian


    The following paper presents a patient with severe aortic stenosis and severely reduced left ventricular ejection fraction with intra-aortic balloon pump counterpulsation support, who underwent transfemoral aortic valve implantation of a CoreValve prosthesis.

  1. Customizable engineered blood vessels using 3D printed inserts. (United States)

    Pinnock, Cameron B; Meier, Elizabeth M; Joshi, Neeraj N; Wu, Bin; Lam, Mai T


    Current techniques for tissue engineering blood vessels are not customizable for vascular size variation and vessel wall thickness. These critical parameters vary widely between the different arteries in the human body, and the ability to engineer vessels of varying sizes could increase capabilities for disease modeling and treatment options. We present an innovative method for producing customizable, tissue engineered, self-organizing vascular constructs by replicating a major structural component of blood vessels - the smooth muscle layer, or tunica media. We utilize a unique system combining 3D printed plate inserts to control construct size and shape, and cell sheets supported by a temporary fibrin hydrogel to encourage cellular self-organization into a tubular form resembling a natural artery. To form the vascular construct, 3D printed inserts are adhered to tissue culture plates, fibrin hydrogel is deposited around the inserts, and human aortic smooth muscle cells are then seeded atop the fibrin hydrogel. The gel, aided by the innate contractile properties of the smooth muscle cells, aggregates towards the center post insert, creating a tissue ring of smooth muscle cells. These rings are then stacked into the final tubular construct. Our methodology is robust, easily repeatable and allows for customization of cellular composition, vessel wall thickness, and length of the vessel construct merely by varying the size of the 3D printed inserts. This platform has potential for facilitating more accurate modeling of vascular pathology, serving as a drug discovery tool, or for vessel repair in disease treatment.

  2. Genetic and Epigenetic Regulation of Aortic Aneurysms (United States)

    Kim, Ha Won


    Aneurysms are characterized by structural deterioration of the vascular wall leading to progressive dilatation and, potentially, rupture of the aorta. While aortic aneurysms often remain clinically silent, the morbidity and mortality associated with aneurysm expansion and rupture are considerable. Over 13,000 deaths annually in the United States are attributable to aortic aneurysm rupture with less than 1 in 3 persons with aortic aneurysm rupture surviving to surgical intervention. Environmental and epidemiologic risk factors including smoking, male gender, hypertension, older age, dyslipidemia, atherosclerosis, and family history are highly associated with abdominal aortic aneurysms, while heritable genetic mutations are commonly associated with aneurysms of the thoracic aorta. Similar to other forms of cardiovascular disease, family history, genetic variation, and heritable mutations modify the risk of aortic aneurysm formation and provide mechanistic insight into the pathogenesis of human aortic aneurysms. This review will examine the relationship between heritable genetic and epigenetic influences on thoracic and abdominal aortic aneurysm formation and rupture. PMID:28116311

  3. Aortic Root Enlargement or Sutureless Valve Implantation?

    Directory of Open Access Journals (Sweden)

    Nikolaos G. Baikoussis


    Full Text Available Aortic valve replacement (AVR in patients with a small aortic annulus is a challenging issue. The importance of prosthesis–patient mismatch (PPM post aortic valve replacement (AVR is controversial but has to be avoided. Many studies support the fact that PPM has a negative impact on short and long term survival. In order to avoid PPM, aortic root enlargement may be performed. Alternatively and keeping in mind that often some comorbidities are present in old patients with small aortic root, the Perceval S suturelles valve implantation could be a perfect solution. The Perceval sutureless bioprosthesis provides reasonable hemodynamic performance avoiding the PPM and providing the maximum of aortic orifice area. We would like to see in the near future the role of the aortic root enlargement techniques in the era of surgical implantation of the sutureless valve (SAVR and the transcatheter valve implantation (TAVI.

  4. Aortic Wall Injury Related to Endovascular Therapy for Aortic Coarctation. (United States)

    Tretter, Justin T; Jones, Thomas K; McElhinney, Doff B


    Aortic wall complications can occur in unrepaired aortic coarctation (CoA) and after surgical repair or endovascular treatment. This review summarizes the available literature and current understanding of aortic wall injury (AWI) surrounding the management of CoA, focusing specifically on acute and follow-up AWI after endovascular treatment. There have been 23 reported cases of aortic rupture after endovascular treatment for CoA, including angioplasty alone, bare metal stenting, and primary covered stent therapy. Even if these published cases represent only a minority of ruptures that have actually occurred, the incidence is substantially <1%. The incidence of acute aneurysm formation was 0% to 13% after angioplasty, 0% to 5% after bare metal stent placement, and <1% after covered stent placement. The reported incidence and natural history of both acute and new AWI during follow-up after endovascular therapy for CoA varies considerably, likely secondary to ascertainment and reporting biases and inconsistent definitions. Although important AWI after endovascular treatment of CoA seems to be declining in frequency with increasing experience and improving technology, it remains one of the most important potential adverse outcomes. Long-term surveillance for new AWI and monitoring of existing AWI is mandatory, with institution of appropriate treatment when necessary. A central research focus in this population should be determination of the appropriate treatment for both native and recurrent CoA across various ages with regard to limiting recurrent CoA and preventing associated aortic wall complications, in addition to determining the appropriate treatment of various AWI. Consistent definitions and reporting are necessary to truly understand the incidence of, risk factors for, and measures protective against AWI after angioplasty or stent implantation for CoA.

  5. Remodelling of the aortic root in severe tricuspid aortic stenosis: implications for transcatheter aortic valve implantation

    Energy Technology Data Exchange (ETDEWEB)

    Stolzmann, Paul; Desbiolles, Lotus; Scheffel, Hans; Leschka, Sebastian; Marincek, Borut; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Knight, Joseph; Kurtcuoglu, Vartan; Poulikakos, Dimos [Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, ETH Zurich (Switzerland); Maier, Willibald [University Hospital Zurich, Cardiovascular Center, Zurich (Switzerland); Plass, Andre [University Hospital Zurich, Clinic for Cardiovascular Surgery, Zurich (Switzerland)


    Detailed knowledge of aortic root geometry is a prerequisite to anticipate complications of transcatheter aortic valve (TAV) implantation. We determined coronary ostial locations and aortic root dimensions in patients with aortic stenosis (AS) and compared these values with normal subjects using computed tomography (CT). One hundred consecutive patients with severe tricuspid AS and 100 consecutive patients without valvular pathology (referred to as the controls) undergoing cardiac dual-source CT were included. Distances from the aortic annulus (AA) to the left coronary ostium (LCO), right coronary ostium (RCO), the height of the left coronary sinus (HLS), right coronary sinus (HRS), and aortic root dimensions [diameters of AA, sinus of Valsalva (SV), and sino-tubular junction(STJ)] were measured. LCO and RCO were 14.9 {+-} 3.2 mm (8.2-25.9) and 16.8 {+-} 3.6 mm (12.0-25.7) in the controls, 15.5 {+-} 2.9 mm (8.8-24.3) and 17.3 {+-} 3.6 mm (7.3-26.0) in patients with AS. Controls and patients with AS had similar values for LCO (P = 0.18), RCO (P = 0.33) and HLS (P = 0.88), whereas HRS (P < 0.05) was significantly larger in patients with AS. AA (r = 0.55,P < 0.001), SV (r = 0.54,P < 0.001), and STJ (r = 0.52,P < 0.001) significantly correlated with the body surface area in the controls; whereas no correlation was found in patients with AS. Patients with AS had significantly larger AA (P < 0.01) and STJ (P < 0.01) diameters when compared with the controls. In patients with severe tricuspid AS, coronary ostial locations were similar to the controls, but a transverse remodelling of the aortic root was recognized. Owing to the large distribution of ostial locations and the dilatation of the aortic root, CT is recommended before TAV implantation in each patient. (orig.)

  6. Spectrum of Aortic Valve Abnormalities Associated with Aortic Dilation Across Age Groups in Turner Syndrome (United States)

    Olivieri, Laura J.; Baba, Ridhwan Y.; Arai, Andrew E.; Bandettini, W. Patricia; Rosing, Douglas R.; Bakalov, Vladimir; Sachdev, Vandana; Bondy, Carolyn A.


    Background Congenital aortic valve fusion is associated with aortic dilation, aneurysm and rupture in girls and women with Turner syndrome (TS). Our objective was to characterize aortic valve structure in subjects with TS, and determine the prevalence of aortic dilation and valve dysfunction associated with different types of aortic valves. Methods and Results The aortic valve and thoracic aorta were characterized by cardiovascular magnetic resonance imaging in 208 subjects with TS in an IRB-approved natural history study. Echocardiography was used to measure peak velocities across the aortic valve, and the degree of aortic regurgitation. Four distinct valve morphologies were identified: tricuspid aortic valve (TAV) 64%(n=133), partially fused aortic valve (PF) 12%(n=25), bicuspid aortic valve (BAV) 23%(n=47), and unicuspid aortic valve (UAV) 1%(n=3). Age and body surface area (BSA) were similar in the 4 valve morphology groups. There was a significant trend, independent of age, towards larger BSA-indexed ascending aortic diameters (AADi) with increasing valve fusion. AADi were (mean +/− SD) 16.9 +/− 3.3 mm/m2, 18.3 +/− 3.3 mm/m2, and 19.8 +/− 3.9 mm/m2 (p<0.0001) for TAV, PF and BAV+UAV respectively. PF, BAV, and UAV were significantly associated with mild aortic regurgitation and elevated peak velocities across the aortic valve. Conclusions Aortic valve abnormalities in TS occur with a spectrum of severity, and are associated with aortic root dilation across age groups. Partial fusion of the aortic valve, traditionally regarded as an acquired valve problem, had an equal age distribution and was associated with an increased AADi. PMID:24084490

  7. Simulations of blood flow in patient-specific aortic dissections with a deformable wall model (United States)

    Baeumler, Kathrin; Vedula, Vijay; Sailer Karmann, Anna; Marsden, Alison; Fleischmann, Dominik


    Aortic dissection is a life-threatening condition in which blood penetrates into the vessel wall, creating a second flow channel, often requiring emergency surgical repair. Up to 50% of patients who survive the acute event face late complications like aortic dilatation and eventual rupture. Prediction of late complications, however, remains challenging. We therefore aim to perform accurate and reliable patient-specific simulations of blood flow in aortic dissections, validated by 4D-Flow MRI. Among other factors, this is a computational challenge due to the compliance of the vessel walls and the large degree of membrane deformation between the two flow channels. We construct an anatomic patient-specific model from CT data including both flow channels and the membrane between them. We then run fluid structure interaction simulations using an arbitrary Lagrangian-Eulerian (ALE) formulation within a multiscale variational framework, employing stabilized finite element methods. We compare hemodynamics between a rigid and a deformable wall model and examine membrane dynamics and pressure differences between the two flow channels. The study focuses on the computational and modeling challenges emphasizing the importance of employing a deformable wall model for aortic dissections.

  8. Exact monitoring of aortic diameters in Marfan patients without gadolinium contrast: intraindividual comparison of 2D SSFP imaging with 3D CE-MRA and echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Veldhoen, Simon [University Medical Center Wuerzburg, Department of Diagnostic and Interventional Radiology, Bavaria (Germany); University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Behzadi, Cyrus; Derlin, Thorsten; Henes, Frank Oliver; Adam, Gerhard; Bannas, Peter [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Rybczinsky, Meike; Kodolitsch, Yskert von; Sheikhzadeh, Sara [University Medical Center Hamburg-Eppendorf, Department of General and Interventional Cardiology, Hamburg (Germany); Bley, Thorsten Alexander [University Medical Center Wuerzburg, Department of Diagnostic and Interventional Radiology, Bavaria (Germany)


    To assess whether ECG-gated non-contrast 2D steady-state free precession (SSFP) imaging allows for exact monitoring of aortic diameters in Marfan syndrome (MFS) patients using non-ECG-gated contrast-enhanced 3D magnetic resonance angiography (CE-MRA) and echocardiography for intraindividual comparison. Non-ECG-gated CE-MRA and ECG-gated non-contrast SSFP at 1.5 T were prospectively performed in 50 patients. Two readers measured aortic diameters on para-sagittal images identically aligned with the aortic arch at the sinuses of Valsalva, sinotubular junction, ascending/descending aorta and aortic arch. Image quality was assessed on a three-point scale. Aortic root diameters acquired by echocardiography were used as reference. Intra- and interobserver variances were smaller for SSFP at the sinuses of Valsalva (p = 0.002; p = 0.002) and sinotubular junction (p = 0.014; p = 0.043). Image quality was better in SSFP than in CE-MRA at the sinuses of Valsalva (p < 0.0001), sinotubular junction (p < 0.0001) and ascending aorta (p = 0.02). CE-MRA yielded higher diameters than SSFP at the sinuses of Valsalva (mean bias, 2.5 mm; p < 0.0001), and comparison with echocardiography confirmed a higher bias for CE-MRA (7.2 ± 3.4 mm vs. SSFP, 4.7 ± 2.6 mm). ECG-gated non-contrast 2D SSFP imaging provides superior image quality with higher validity compared to non-ECG-gated contrast-enhanced 3D imaging. Since CE-MRA requires contrast agents with potential adverse effects, non-contrast SSFP imaging is an appropriate alternative for exact and riskless aortic monitoring of MFS patients. (orig.)

  9. Basal longitudinal strain predicts future aortic valve replacement in asymptomatic patients with aortic stenosis

    DEFF Research Database (Denmark)

    Carstensen, Helle Gervig; Larsen, Linnea Hornbech; Hassager, Christian


    of myocardial dysfunction and predictors of outcome in asymptomatic aortic stenosis. Aortic stenosis and ischaemic heart disease share risk factors and longitudinal function can be severely reduced in both conditions, why some of the previous findings of impaired regional longitudinal function in asymptomatic...... aortic stenosis could in fact be explained by silent ischaemic heart disease. METHODS AND RESULTS: Prospective follow-up of 104 asymptomatic patients with moderate-severe aortic stenosis defined as an aortic valve area ...: In contrast to GLS, reduced BLS is a significant predictor of future AVR in asymptomatic patients with aortic stenosis, independently of clinical characteristics, conventional echocardiographic measures, and coronary pathology....

  10. Statins for aortic valve stenosis

    Directory of Open Access Journals (Sweden)

    Luciana Thiago

    Full Text Available ABSTRACT BACKGROUND: Aortic valve stenosis is the most common type of valvular heart disease in the USA and Europe. Aortic valve stenosis is considered similar to atherosclerotic disease. Some studies have evaluated statins for aortic valve stenosis. OBJECTIVES: To evaluate the effectiveness and safety of statins in aortic valve stenosis. METHODS: Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, MEDLINE, Embase, LILACS - IBECS, Web of Science and CINAHL Plus. These databases were searched from their inception to 24 November 2015. We also searched trials in registers for ongoing trials. We used no language restrictions. Selection criteria: Randomized controlled clinical trials (RCTs comparing statins alone or in association with other systemic drugs to reduce cholesterol levels versus placebo or usual care. Data collection and analysis: Primary outcomes were severity of aortic valve stenosis (evaluated by echocardiographic criteria: mean pressure gradient, valve area and aortic jet velocity, freedom from valve replacement and death from cardiovascular cause. Secondary outcomes were hospitalization for any reason, overall mortality, adverse events and patient quality of life. Two review authors independently selected trials for inclusion, extracted data and assessed the risk of bias. The GRADE methodology was employed to assess the quality of result findings and the GRADE profiler (GRADEPRO was used to import data from Review Manager 5.3 to create a 'Summary of findings' table. MAIN RESULTS: We included four RCTs with 2360 participants comparing statins (1185 participants with placebo (1175 participants. We found low-quality evidence for our primary outcome of severity of aortic valve stenosis, evaluated by mean pressure gradient (mean difference (MD -0.54, 95% confidence interval (CI -1.88 to 0.80; participants = 1935; studies = 2, valve area (MD -0.07, 95% CI -0.28 to 0.14; participants = 127; studies = 2

  11. MCP-1 promotes mural cell recruitment during angiogenesis in the aortic ring model. (United States)

    Aplin, Alfred C; Fogel, Eric; Nicosia, Roberto F


    Rings of rat or mouse aorta embedded in collagen gels produce angiogenic outgrowths in response to the injury of the dissection procedure. Aortic outgrowths are composed of branching endothelial tubes and surrounding mural cells. Mural cells emerge following endothelial sprouting and gradually increase during the maturation of the neovessels. Treatment of aortic cultures with angiopoietin-1 (Ang-1), an angiogenic factor implicated in vascular maturation and remodeling, stimulates the mural cell recruitment process. Ang-1 induces expression of many cytokines and chemokines including monocyte chemotactic protein-1 (MCP-1). Inhibition of p38 MAP kinase, a signaling molecule required for mural cell recruitment, blocks Ang1-induced MCP-1 expression. Recombinant MCP-1 dose-dependently increases mural cell number while an anti-MCP-1 blocking antibody reduces it. In addition, antibody mediated neutralization of MCP-1 abrogates the stimulatory effect of Ang-1 on mural cell recruitment. Aortic rings from genetically modified mice deficient in MCP-1 or its receptor CCR2 have fewer mural cells than controls. MCP-1 deficiency also impairs the mural cell recruitment activity of Ang-1. Our studies indicate that spontaneous and Ang1-induced mural cell recruitment in the aortic ring of model of angiogenesis are in part mediated by MCP-1. These results implicate MCP-1 as one of the mediators of mural cell recruitment in the aortic ring model, and suggest that chemokine pathways may contribute to the assembly of the vessel wall during the angiogenesis response to injury.

  12. Loss of function mutation in LOX causes thoracic aortic aneurysm and dissection in humans. (United States)

    Lee, Vivian S; Halabi, Carmen M; Hoffman, Erin P; Carmichael, Nikkola; Leshchiner, Ignaty; Lian, Christine G; Bierhals, Andrew J; Vuzman, Dana; Mecham, Robert P; Frank, Natasha Y; Stitziel, Nathan O


    Thoracic aortic aneurysms and dissections (TAAD) represent a substantial cause of morbidity and mortality worldwide. Many individuals presenting with an inherited form of TAAD do not have causal mutations in the set of genes known to underlie disease. Using whole-genome sequencing in two first cousins with TAAD, we identified a missense mutation in the lysyl oxidase (LOX) gene (c.893T > G encoding p.Met298Arg) that cosegregated with disease in the family. Using clustered regularly interspaced short palindromic repeats (CRISPR)/clustered regularly interspaced short palindromic repeats-associated protein-9 nuclease (Cas9) genome engineering tools, we introduced the human mutation into the homologous position in the mouse genome, creating mice that were heterozygous and homozygous for the human allele. Mutant mice that were heterozygous for the human allele displayed disorganized ultrastructural properties of the aortic wall characterized by fragmented elastic lamellae, whereas mice homozygous for the human allele died shortly after parturition from ascending aortic aneurysm and spontaneous hemorrhage. These data suggest that a missense mutation in LOX is associated with aortic disease in humans, likely through insufficient cross-linking of elastin and collagen in the aortic wall. Mutation carriers may be predisposed to vascular diseases because of weakened vessel walls under stress conditions. LOX sequencing for clinical TAAD may identify additional mutation carriers in the future. Additional studies using our mouse model of LOX-associated TAAD have the potential to clarify the mechanism of disease and identify novel therapeutics specific to this genetic cause.

  13. Pressure vessel design manual

    CERN Document Server

    Moss, Dennis R


    Pressure vessels are closed containers designed to hold gases or liquids at a pressure substantially different from the ambient pressure. They have a variety of applications in industry, including in oil refineries, nuclear reactors, vehicle airbrake reservoirs, and more. The pressure differential with such vessels is dangerous, and due to the risk of accident and fatality around their use, the design, manufacture, operation and inspection of pressure vessels is regulated by engineering authorities and guided by legal codes and standards. Pressure Vessel Design Manual is a solutions-focused guide to the many problems and technical challenges involved in the design of pressure vessels to match stringent standards and codes. It brings together otherwise scattered information and explanations into one easy-to-use resource to minimize research and take readers from problem to solution in the most direct manner possible. * Covers almost all problems that a working pressure vessel designer can expect to face, with ...

  14. 3D Modeling of Murine Abdominal Aortic Aneurysms: Quantification of Segmentation and Volumetric Reconstruction


    Sarmiento, Paula A; Adelsperger, Amelia R; Goergen, Craig J.


    Abdominal Aortic Aneurysms (AAA) cause 5,900 deaths in the United States each year. Surgical intervention is clinically studied by non-invasive techniques such as computed tomography and magnetic resonance imaging. However, three-dimensional (3D) ultrasound imaging has become an inexpensive alternative and useful tool to characterize aneurysms, allowing for reconstruction of the vessel, quantification of hemodynamics through computational fluid dynamics (CFD) simulation, and possible predicti...

  15. Elastic responses of underground circular arches considering dynamic soil-structure interaction: A theoretical analysis (United States)

    Chen, Hai-Long; Jin, Feng-Nian; Fan, Hua-Lin


    Due to the wide applications of arches in underground protective structures, dynamic analysis of circular arches including soil-structure interactions is important. In this paper, an exact solution of the forced vibration of circular arches subjected to subsurface denotation forces is obtained. The dynamic soil-structure interaction is considered with the introduction of an interfacial damping between the structure element and the surrounding soil into the equation of motion. By neglecting the influences of shear, rotary inertia and tangential forces and assuming the arch incompressible, the equations of motion of the buried arches were set up. Analytical solutions of the dynamic responses of the protective arches were deduced by means of modal superposition. Arches with different opening angles, acoustic impedances and rise-span ratios were analyzed to discuss their influences on an arch. The theoretical analysis suggests blast loads for elastic designs and predicts the potential failure modes for buried protective arches.

  16. Feasibility of imaging superficial palmar arch using micro-ultrasound, 7T and 3T magnetic resonance imaging (United States)

    Pruzan, Alison N; Kaufman, Audrey E; Calcagno, Claudia; Zhou, Yu; Fayad, Zahi A; Mani, Venkatesh


    AIM To demonstrate feasibility of vessel wall imaging of the superficial palmar arch using high frequency micro-ultrasound, 7T and 3T magnetic resonance imaging (MRI). METHODS Four subjects (ages 22-50 years) were scanned on a micro-ultrasound system with a 45-MHz transducer (Vevo 2100, VisualSonics). Subjects’ hands were then imaged on a 3T clinical MR scanner (Siemens Biograph MMR) using an 8-channel special purpose phased array carotid coil. Lastly, subjects’ hands were imaged on a 7T clinical MR scanner (Siemens Magnetom 7T Whole Body Scanner) using a custom built 8-channel transmit receive carotid coil. All three imaging modalities were subjectively analyzed for image quality and visualization of the vessel wall. RESULTS Results of this very preliminary study indicated that vessel wall imaging of the superficial palmar arch was feasible with a whole body 7T and 3T MRI in comparison with micro-ultrasound. Subjective analysis of image quality (1-5 scale, 1: poorest, 5: best) from B mode, ultrasound, 3T SPACE MRI and 7T SPACE MRI indicated that the image quality obtained at 7T was superior to both 3T MRI and micro-ultrasound. The 3D SPACE sequence at both 7T and 3T MRI with isotropic voxels allowed for multi-planar reformatting of images and allowed for less operator dependent results as compared to high frequency micro-ultrasound imaging. Although quantitative analysis revealed that there was no significant difference between the three methods, the 7T Tesla trended to have better visibility of the vessel and its wall. CONCLUSION Imaging of smaller arteries at the 7T is feasible for evaluating atherosclerosis burden and may be of clinical relevance in multiple diseases. PMID:28298968

  17. Quantifying Turbulent Kinetic Energy in an Aortic Coarctation with Large Eddy Simulation and Magnetic Resonance Imaging (United States)

    Lantz, Jonas; Ebbers, Tino; Karlsson, Matts


    In this study, turbulent kinetic energy (TKE) in an aortic coarctation was studied using both a numerical technique (large eddy simulation, LES) and in vivo measurements using magnetic resonance imaging (MRI). High levels of TKE are undesirable, as kinetic energy is extracted from the mean flow to feed the turbulent fluctuations. The patient underwent surgery to widen the coarctation, and the flow before and after surgery was computed and compared to MRI measurements. The resolution of the MRI was about 7 × 7 voxels in axial cross-section while 50x50 mesh cells with increased resolution near the walls was used in the LES simulation. In general, the numerical simulations and MRI measurements showed that the aortic arch had no or very low levels of TKE, while elevated values were found downstream the coarctation. It was also found that TKE levels after surgery were lowered, indicating that the diameter of the constriction was increased enough to decrease turbulence effects. In conclusion, both the numerical simulation and MRI measurements gave very similar results, thereby validating the simulations and suggesting that MRI measured TKE can be used as an initial estimation in clinical practice, while LES results can be used for detailed quantification and further research of aortic flows.

  18. Decreased expression of fibulin-4 in aortic wall of aortic dissection. (United States)

    Huawei, P; Qian, C; Chuan, T; Lei, L; Laing, W; Wenlong, X; Wenzhi, L


    In this research, we will examine the expression of Fibulin-4 in aortic wall to find out its role in aortic dissection development. The samples of aortic wall were obtained from 10 patients operated for acute ascending aortic dissection and five patients for chronic ascending aortic dissection. Another 15 pieces of samples from patients who had coronary artery bypass were as controls. The aortic samples were stained with aldehyde magenta dyeing to evaluate the arrangement of elastic fibers. The Fibulin-4 protein and mRNA expression were both determined by Western blot and realtime quantitative polymerase chain reaction. Compared with the control group, both in acute and chronic ascending aortic dissection, elastic fiber fragments increased and the expression of fibulin-4 protein significantly decreased (P= 0.045 < 0.05). The level of fibulin-4 mRNA decreased in acute ascending aortic dissection (P= 0.034 < 0.05), while it increased in chronic ascending aortic dissection (P=0.004 < 0.05). The increased amounts of elastic fiber fragments were negatively correlated with the expression of fibulin-4 mRNA in acute ascending aortic dissection. In conclusion, in aortic wall of ascending aortic dissection, the expression of fibulin-4 protein decreased and the expression of fibulin-4 mRNA was abnormal. Fibulin-4 may play an important role in the pathogenesis of aortic dissection.

  19. Maury Journals - German Vessels (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — German vessels observations, after the 1853 Brussels Conference that set International Maritime Standards, modeled after Maury Marine Standard Observations.

  20. NCSX Vacuum Vessel Fabrication

    Energy Technology Data Exchange (ETDEWEB)

    Viola, M. E.; Brown, T.; Heitzenroeder, P.; Malinowski, F.; Reiersen, W.; Sutton, L.; Goranson, P.; Nelson, B.; Cole, M.; Manuel, M.; McCorkle, D.


    The National Compact Stellarator Experiment (NCSX) is being constructed at the Princeton Plasma Physics Laboratory (PPPL) in conjunction with the Oak Ridge National Laboratory (ORNL). The goal of this experiment is to develop a device which has the steady state properties of a traditional stellarator along with the high performance characteristics of a tokamak. A key element of this device is its highly shaped Inconel 625 vacuum vessel. This paper describes the manufacturing of the vessel. The vessel is being fabricated by Major Tool and Machine, Inc. (MTM) in three identical 120º vessel segments, corresponding to the three NCSX field periods, in order to accommodate assembly of the device. The port extensions are welded on, leak checked, cut off within 1" of the vessel surface at MTM and then reattached at PPPL, to accommodate assembly of the close-fitting modular coils that surround the vessel. The 120º vessel segments are formed by welding two 60º segments together. Each 60º segment is fabricated by welding ten press-formed panels together over a collapsible welding fixture which is needed to precisely position the panels. The vessel is joined at assembly by welding via custom machined 8" (20.3 cm) wide spacer "spool pieces." The vessel must have a total leak rate less than 5 X 10-6 t-l/s, magnetic permeability less than 1.02μ, and its contours must be within 0.188" (4.76 mm). It is scheduled for completion in January 2006.

  1. Characterization of the cephalic arch and location of stenosis (United States)

    Bennett, Shelby; Hammes, Mary S.; Blicharski, Tom; Watson, Sydeaka; Funaki, Brian


    Purpose The purpose of this study is to accurately characterize the cephalic arch segments into four domains and to enable more specific evaluation of cephalic arch stenosis (CAS) and determine the frequency of stenosis in each domain. Methods After Institutional Review Board (IRB) approval, a retrospective chart review was done to define a population of patients receiving hemodialysis who developed CAS as apparent on clinically indicated radiologic imaging. A standardized approach was devised to categorize four domains of the cephalic arch. Domain I was defined as the peripheral portion of the arch and Domain IV was the distal portion of the cephalic vein near termination with the axillary vein. The magnitude of stenosis as measured by percentage was determined and compared in the four domains. Results The most frequent location for stenosis was found in domain IV when compared with domains II or I (p<0.01). The magnitude of stenosis differed across all domains (p<0.001) with the least common place for CAS in domain I. Treatment of CAS included angioplasty in all, thrombectomy in eight, and stent placement in five. Conclusions CAS occurs most commonly in the terminal portion of the arch. Four standardized domains have been defined; future work will validate these findings and determine the best intervention for each domain. PMID:25198819

  2. Three-dimensional stiffness of the carpal arch. (United States)

    Gabra, Joseph N; Li, Zong-Ming


    The carpal arch of the wrist is formed by irregularly shaped carpal bones interconnected by numerous ligaments, resulting in complex structural mechanics. The purpose of this study was to determine the three-dimensional stiffness characteristics of the carpal arch using displacement perturbations. It was hypothesized that the carpal arch would exhibit an anisotropic stiffness behavior with principal directions that are oblique to the conventional anatomical axes. Eight (n=8) cadavers were used in this study. For each specimen, the hamate was fixed to a custom stationary apparatus. An instrumented robot arm applied three-dimensional displacement perturbations to the ridge of trapezium and corresponding reaction forces were collected. The displacement-force data were used to determine a three-dimensional stiffness matrix using least squares fitting. Eigendecomposition of the stiffness matrix was used to identify the magnitudes and directions of the principal stiffness components. The carpal arch structure exhibited anisotropic stiffness behaviors with a maximum principal stiffness of 16.4±4.6N/mm that was significantly larger than the other principal components of 3.1±0.9 and 2.6±0.5N/mm (pcarpal tunnel which is accounted for by the stiff transverse ligaments that tightly bind distal carpal arch. The minimal principal stiffness is attributed to the less constraining articulation between the trapezium and scaphoid. This study provides advanced characterization of the wrist׳s three-dimensional structural stiffness for improved insight into wrist biomechanics, stability, and function.

  3. 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


    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.

  4. Classification of the height and flexibility of the medial longitudinal arch of the foot

    DEFF Research Database (Denmark)

    Nilsson, Mettte Kjaergaard; Friis, Rikke; Michaelsen, Maria Skjoldahl


    BACKGROUND: The risk of developing injuries during standing work may vary between persons with different foot types. High arched and low arched feet, as well as rigid and flexible feet, are considered to have different injury profiles, while those with normal arches may sustain fewer injuries......-off values presented in this study can be used to categorize people performing standing work into groups of different foot arch types. The results of this study are important for investigating a possible link between arch height and arch movement and the development of injuries....

  5. [Surgical technique of aortic valve replacement for small aortic annulus in elderly patients]. (United States)

    Hata, T; Fujiwara, K; Furukawa, H; Tsushima, Y; Yoshitaka, H; Kuinose, M; Minami, H; Ishida, A; Tamura, K; Totsugawa, T; Kanemitsu, H; Ozawa, M


    Recent reports have shown that aortic valve replacement in elderly patients over 65 years with atherosclerotic aortic stenosis and a small aortic annulus is possible by using a small sized bioprosthesis (Carpentier-Edwards pericardial valve). Here we present out surgical technique. Firstly, the native calcified aortic valve was removed completely to gain total exposure of the surrounding aortic root and sinus of Valsalva like Bentall procedure. Secondly, a small sized bioprosthesis was implanted with intermittent noneverting mattress 2-0 sutures with spaghetti and small polytetrafluoroethylene (PTFE) felt. Aortic annulus is the dilated by inserting Hegar dilator sizing from 25 to 27 mm. Therefore, aortic valve replacement for small aortic annulus in intra- or supra-annular position should be easily accomplished. Good surgical results and hemodynamic state were achieved in 25 consecutive cases using this technique.

  6. Aortic endograft sizing in trauma patients with hemodynamic instability

    NARCIS (Netherlands)

    Jonker, Frederik H. W.; Verhagen, Hence J. M.; Mojibian, Hamid; Davis, Kimberly A.; Moll, Frans L.; Muhs, Bart E.


    Objectives: To investigate changes in aortic diameter in hemodynamically unstable trauma patients and the implications for sizing of thoracic endovascular aortic repair (TEVAR) in patients with traumatic thoracic aortic injury (TTAI). Methods: We retrospectively evaluated all trauma patients that we

  7. Game model of safety monitoring for arch dam deformation

    Institute of Scientific and Technical Information of China (English)


    Arch dam deformation is comprehensively affected by water pressure,temperature,dam’s structural behavior and material properties as well as other factors.Among them the water pressure and temperature are external factors(source factors) that cause dam deformation,and dam’s structural behavior and material properties are the internal factors of deformation(resistance factors).The dam deformation is the result of the mutual game playing between source factors and resistance factors.Therefore,resistance factors of structure and materials that reflect resistance character of arch dam structure are introduced into the traditional model,where structure factor is embodied by the flexibility coefficient of dam body and the maximum dam height,and material property is embodied by the elastic modulus of dam.On the basis of analyzing the correlation between dam deformation and resistance factors,the game model of safety monitoring for arch dam deformation is put forward.

  8. In-Plane MEMS Shallow Arch Beam for Mechanical Memory

    Directory of Open Access Journals (Sweden)

    Md Abdullah Al Hafiz


    Full Text Available We demonstrate a memory device based on the nonlinear dynamics of an in-plane microelectromechanical systems (MEMS clamped–clamped beam resonator, which is deliberately fabricated as a shallow arch. The arch beam is made of silicon, and is electrostatically actuated. The concept relies on the inherent quadratic nonlinearity originating from the arch curvature, which results in a softening behavior that creates hysteresis and co-existing states of motion. Since it is independent of the electrostatic force, this nonlinearity gives more flexibility in the operating conditions and allows for lower actuation voltages. Experimental results are generated through electrical characterization setup. Results are shown demonstrating the switching between the two vibrational states with the change of the direct current (DC bias voltage, thereby proving the memory concept.

  9. In-Plane MEMS Shallow Arch Beam for Mechanical Memory

    KAUST Repository

    Hafiz, Md Abdullah Al


    We demonstrate a memory device based on the nonlinear dynamics of an in-plane microelectromechanical systems (MEMS) clamped–clamped beam resonator, which is deliberately fabricated as a shallow arch. The arch beam is made of silicon, and is electrostatically actuated. The concept relies on the inherent quadratic nonlinearity originating from the arch curvature, which results in a softening behavior that creates hysteresis and co-existing states of motion. Since it is independent of the electrostatic force, this nonlinearity gives more flexibility in the operating conditions and allows for lower actuation voltages. Experimental results are generated through electrical characterization setup. Results are shown demonstrating the switching between the two vibrational states with the change of the direct current (DC) bias voltage, thereby proving the memory concept.

  10. Indexing aortic valve area by body surface area increases the prevalence of severe aortic stenosis

    DEFF Research Database (Denmark)

    Jander, Nikolaus; Gohlke-Bärwolf, Christa; Bahlmann, Edda


    To account for differences in body size in patients with aortic stenosis, aortic valve area (AVA) is divided by body surface area (BSA) to calculate indexed AVA (AVAindex). Cut-off values for severe stenosis are......To account for differences in body size in patients with aortic stenosis, aortic valve area (AVA) is divided by body surface area (BSA) to calculate indexed AVA (AVAindex). Cut-off values for severe stenosis are...


    NARCIS (Netherlands)

    Beukers, A.; De Jong, T.


    Abstract of WO 9717570 (A1) The invention is directed to a wheel-shaped pressure-resistant vessel for gaseous, liquid or liquefied material having a substantially rigid shape, said vessel comprising a substantially continuous shell of a fiber-reinforced resin having a central opening, an inner l

  12. Correlating first- and second-rib fractures noted on spine computed tomography with major vessel injury. (United States)

    Khosla, Ankaj; Ocel, Joseph; Rad, Arash Ehteshami; Kallmes, David F


    First- and second-rib fractures diagnosed on plain radiographs have been associated with traumatic aortic injury. We examined whether such fractures diagnosed on computed tomography (CT), which is of greater sensitivity than plain radiograms for rib fractures, are associated with traumatic vascular injury. We identified 1,894 patients who had undergone a chest CT angiogram with indication of trauma between 2005 and 2008. Among these, 185 patients were selected at random. The main mechanism of injury was motor vehicle accident or a fall. The patients were divided into two groups: patients with first- and/or second-rib fractures and those without. Proportions of patients with major vessel injury noted on CT angiography were compared between groups. Information regarding displacement of the fracture, location of the fracture, detection upon plain film, and gender of the patients was also evaluated and correlated with incidence of major vessel injury. Fisher's test and χ2 analysis were used to determine significance of the data. Incidence of major vessel injury was similar between patients with and without first- and/or second-rib fractures (7% vs. 9%, respectively; p = 0.59). No subset of type of rib fracture was associated with greater incidence of aortic injury. First- and second-fractures are not associated with greater incidence of aortic injury. Thus, the previous axiom that first- and second-rib fractures should result in increased examination for aortic injury may not hold true.

  13. Optical silencing of C. elegans cells with arch proton pump.

    Directory of Open Access Journals (Sweden)

    Ayako Okazaki

    Full Text Available BACKGROUND: Optogenetic techniques using light-driven ion channels or ion pumps for controlling excitable cells have greatly facilitated the investigation of nervous systems in vivo. A model organism, C. elegans, with its small transparent body and well-characterized neural circuits, is especially suitable for optogenetic analyses. METHODOLOGY/PRINCIPAL FINDINGS: We describe the application of archaerhodopsin-3 (Arch, a recently reported optical neuronal silencer, to C. elegans. Arch::GFP expressed either in all neurons or body wall muscles of the entire body by means of transgenes were localized, at least partially, to the cell membrane without adverse effects, and caused locomotory paralysis of worms when illuminated by green light (550 nm. Pan-neuronal expression of Arch endowed worms with quick and sustained responsiveness to such light. Worms reliably responded to repeated periods of illumination and non-illumination, and remained paralyzed under continuous illumination for 30 seconds. Worms expressing Arch in different subsets of motor neurons exhibited distinct defects in the locomotory behavior under green light: selective silencing of A-type motor neurons affected backward movement while silencing of B-type motor neurons affected forward movement more severely. Our experiments using a heat-shock-mediated induction system also indicate that Arch becomes fully functional only 12 hours after induction and remains functional for more than 24 hour. CONCLUSIONS/SGNIFICANCE: Arch can be used for silencing neurons and muscles, and may be a useful alternative to currently widely used halorhodopsin (NpHR in optogenetic studies of C. elegans.

  14. Transcatheter aortic valve replacement for bicuspid aortic stenosis 13years post heart transplant. (United States)

    Julien, Maureen B; Desai, Nimesh; Brozena, Susan; Herrmann, Howard C


    Despite the widespread use of transcatheter aortic valve replacement (TAVR) for moderate and high-risk patients with severe aortic stenosis, it is utilized less frequently in patients with bicuspid aortic valves (BAV). Orthotopic heart transplant (OHT) donors tend to be younger and may have undiagnosed BAV. We present a case of successful TAVR in a patient with BAV thirteen years after OHT.

  15. Transcatheter valve-in-valve implantation due to severe aortic regurgitation in a degenerated aortic homograft

    DEFF Research Database (Denmark)

    Olsen, Lene Kjaer; Engstrøm, Thomas; Søndergaard, Lars


    a successful valve-in-valve implantation of a CoreValve aortic valve prosthesis through the right subclavian artery in a case of severe aortic regurgitation within a degenerated aortic homograft. The case exemplifies the possibilities of expanding the indications for TAVI, as well as other vascular access...

  16. New-onset atrial fibrillation after surgical aortic valve replacement and transcatheter aortic valve implantation

    DEFF Research Database (Denmark)

    Jørgensen, Troels Højsgaard; Thygesen, Julie Bjerre; Thyregod, Hans Gustav;


    Surgical aortic valve replacement (SAVR) and, more recently, transcatheter aortic valve implantation (TAVI) have been shown to be the only treatments that can improve the natural cause of severe aortic valve stenosis. However, after SAVR and TAVI, the incidence of new-onset atrial fibrillation...

  17. New-Onset Atrial Fibrillation After Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Implantation

    DEFF Research Database (Denmark)

    Jørgensen, Troels Højsgaard; Thygesen, Julie Bjerre; Thyregod, Hans Gustav;


    Surgical aortic valve replacement (SAVR) and, more recently, transcatheter aortic valve implantation (TAVI) have been shown to be the only treatments that can improve the natural cause of severe aortic valve stenosis. However, after SAVR and TAVI, the incidence of new-onset atrial fibrillation...

  18. Aortic valvuloplasty of calcific aortic stenosis with monofoil and trefoil balloon catheters: practical considerations

    NARCIS (Netherlands)

    S. Plante (Sylvain); M.J.B.M. van den Brand (Marcel); L.C.P. van Veen; C. di Mario (Carlo); C.E. Essed; K.J. Beatt (Kevin); P.W.J.C. Serruys (Patrick)


    textabstractIn order to evaluate the relation between balloon design (monofoil, trefoil) and valvular configuration, experimental aortic valvuloplasty was performed in four post-mortem hearts with calcific aortic stenosis of various morphology. The degree of obstruction of the aortic orifice was ass

  19. The Efficacy of Autologous Femoropopliteal Vein Reconstruction for Primary Aortic and Aortic Graft Infection

    NARCIS (Netherlands)

    Dirven, M.; Jagt, M.F.P. van der; Barendregt, W.B.; Vliet, D. van der


    BACKGROUND: The objective of our study was to analyze the efficacy of autologous superficial femoropopliteal vein reconstruction for primary aortic or aortic graft infection. METHODS: We performed a retrospective analysis of 14 patients treated for an infected aortic prosthesis or primary infected a

  20. Planning and Analysis of an Arched Indoor Stadium

    Directory of Open Access Journals (Sweden)

    Alice T V


    Full Text Available This paper deals with planning and designing of a multilevel indoor stadium with hanging table tennis court and Olympic standard swimming pool. In order to support the large span the stadium is designed as an arched structure. The materials for the construction are chosen so as to have a minimum carbon di-oxide foot print. Static and earthquake analysis were done by using STAAD.Pro V8i. The paper also does a comparison between arched structure and plane frame structure.

  1. Full-arch milled titanium implant bridge: technical report. (United States)

    Peché, Wendy-Ann; Van Vuuren, Ludwig Jansen; Park, Chae


    The manufacturing of full-arch fixed implant-supported bridges with the use of the traditional lost wax technique remains a technical challenge. Distortion of the alloy during casting and subsequent heating cycles during porcelain build-up causes numerous problems. Fracturing of porcelain on large restorations is difficult and costly to restore. The fitting problems can be eliminated by utilising CAD/CAM technology in the manufacturing of long-span or full-arch titanium bridges. Repair of damaged porcelain can be simplified with the use of discrete, individually-removable crowns on the bridge.

  2. Aneurysm of the superficial palmar arch: a case report. (United States)

    Estrella, Emmanuel P; Lee, Ellen Y


    Aneurysms of the hand are uncommon lesions. The most common location is the ulnar artery. We present a case of a young female who consulted us for a hand mass with a history of trauma to the hand. Pre-operative arteriogram showed a superficial palmar arch aneurysm. The mass was excised and the arch was reconstructed using a reversed Y-shaped vein graft. Fourteen months after surgery, there was no recurrence of the aneurysm and the patient only reported occasional cold intolerance.

  3. Numerical study of free-fall arches in hopper flows (United States)

    Lin, P.; Zhang, S.; Qi, J.; Xing, Y. M.; Yang, L.


    Beverloo's law describes the flow rate of grains discharging from hoppers, where the assumption of a free-fall arch (FFA) is very useful in understanding the physical picture of this process. The FFA has been observed in previous experiments but a clear systematic study of the FFA is still necessary. In this paper, dense granular flow in hoppers was studied by numerical simulations, in attempts to explore the free-fall region and its boundary. Generally, the numerical simulation results support the free-fall arch assumption, although the statistical description of the FFA is not exactly equivalent to its strict definition.

  4. Screening for aortic aneurysm after treatment of coarctation. (United States)

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


    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

  5. Low-gradient aortic stenosis. (United States)

    Clavel, Marie-Annick; Magne, Julien; Pibarot, Philippe


    An important proportion of patients with aortic stenosis (AS) have a 'low-gradient' AS, i.e. a small aortic valve area (AVA <1.0 cm(2)) consistent with severe AS but a low mean transvalvular gradient (<40 mmHg) consistent with non-severe AS. The management of this subset of patients is particularly challenging because the AVA-gradient discrepancy raises uncertainty about the actual stenosis severity and thus about the indication for aortic valve replacement (AVR) if the patient has symptoms and/or left ventricular (LV) systolic dysfunction. The most frequent cause of low-gradient (LG) AS is the presence of a low LV outflow state, which may occur with reduced left ventricular ejection fraction (LVEF), i.e. classical low-flow, low-gradient (LF-LG), or preserved LVEF, i.e. paradoxical LF-LG. Furthermore, a substantial proportion of patients with AS may have a normal-flow, low-gradient (NF-LG) AS: i.e. a small AVA-low-gradient combination but with a normal flow. One of the most important clinical challenges in these three categories of patients with LG AS (classical LF-LG, paradoxical LF-LG, and NF-LG) is to differentiate a true-severe AS that generally benefits from AVR vs. a pseudo-severe AS that should be managed conservatively. A low-dose dobutamine stress echocardiography may be used for this purpose in patients with classical LF-LG AS, whereas aortic valve calcium scoring by multi-detector computed tomography is the preferred modality in those with paradoxical LF-LG or NF-LG AS. Although patients with LF-LG severe AS have worse outcomes than those with high-gradient AS following AVR, they nonetheless display an important survival benefit with this intervention. Some studies suggest that transcatheter AVR may be superior to surgical AVR in patients with LF-LG AS.

  6. Aortic dilatation in children with systemic hypertension. (United States)

    Gupta-Malhotra, Monesha; Devereux, Richard B; Dave, Archana; Bell, Cynthia; Portman, Ronald; Milewicz, Diana


    The aim of the study was to determine the presence of aortic dilatation in hypertensive children, the prevalence of which is 4% to 10% in hypertensive adults. Prospectively enrolled multiethnic children, untreated for their hypertension, underwent an echocardiogram to exclude congenital heart disease and evaluate for end-organ damage and aortic size. The aorta was measured in the parasternal long-axis view at three levels: the sinus of Valsalva, supra-tubular junction, and the ascending aorta. Aortic dilatation was determined by z-score >2 at any one of the levels measured. Hypertension was defined as blood pressure above the 95th percentile based on the Fourth Working Group criteria confirmed by 24-hour ambulatory blood pressure monitoring. Among 142 consecutive hypertensive children (median age, 14 years; 45% females) aortic dilatation was detected in 2.8% (95% confidence interval, 1%-7%; median age, 16 years; 100% females). Children with aortic dilatation, when compared with those without, had significantly more aortic valve insufficiency (P = .005) and left ventricular hypertrophy (P = .018). Prevalence of aortic dilatation was 2.8% and was associated with significantly more aortic insufficiency and left ventricular hypertrophy in comparison to those without aortic dilatation.

  7. Aortic dissection: magnetic resonance imaging. (United States)

    Amparo, E G; Higgins, C B; Hricak, H; Sollitto, R


    Fifteen patients with suspected or known aortic dissection were imaged with magnetic resonance (MR). Thirteen of these patients were eventually shown to have dissection. In most instances the diagnosis was established by aortography and/or computed tomography (CT) prior to the MR study. Surgical proof (6/13) and/or aortographic proof (10/13) were available in 11/13 patients with aortic dissection. MR demonstrated the intimal flap and determined whether the dissection was type A or type B. In addition, MR: differentiated between the true and false lumens; determined the origins of the celiac, superior mesenteric, and renal arteries from the true or false lumen in the cases where the dissection extended into the abdominal aorta (8/12); allowed post-surgical surveillance of the dissection; and identified aortoannular ectasia in the three patients who had Marfan syndrome. In addition to the 13 cases with dissection, there were two cases in whom the diagnosis of dissection was excluded by MR. Our early experience suggests that MR can serve as the initial imaging test in clinically suspected cases of aortic dissection and that the information provided by MR is sufficient to manage many cases. Additionally, MR obviates the use of iodinated contrast media.

  8. A prospective, randomised trial of transapical transcatheter aortic valve implantation vs. surgical aortic valve replacement in operable elderly patients with aortic stenosis

    DEFF Research Database (Denmark)

    Nielsen, Hans Henrik Møller; Klaaborg, Kaj E; Nissen, Henrik


    In a prospective randomised trial we aimed to compare transapical transcatheter aortic valve implantation (a-TAVI) with surgical aortic valve replacement (SAVR) in operable elderly patients.......In a prospective randomised trial we aimed to compare transapical transcatheter aortic valve implantation (a-TAVI) with surgical aortic valve replacement (SAVR) in operable elderly patients....

  9. Effects of Aortic Irregularities on the Blood Flow (United States)

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


    Cardiovascular defects characterized by geometrical anomalies of the aorta and its effect on the blood flow are investigated. The flow characteristics change with the aorta geometry and the rheological properties of the blood. Flow characteristics such as wall shear stress often play an important role in the development of vascular disease. In the present study, blood is considered to be non-Newtonian and is modeled using the Quemada model, an empirical model that is valid for different red blood cell loading. Three patient-specific aortic geometries are studied using Large Eddy Simulations (LES). The three geometries represent malformations that are typical in patients populations having a genetic disorder called Turner syndrome. The results show a highly complex flow with regions of recirculation that are enhanced in two of the three aortas. Moreover, blood flow is diverted, due to the malformations, from the descending aorta to the three side branches of the arch. The geometry having an elongated transverse aorta has larger areas of strong oscillatory wall shear stress.

  10. The role of cardiovascular magnetic resonance in the assessment of severe aortic stenosis and in post-procedural evaluation following transcatheter aortic valve implantation and surgical aortic valve replacement. (United States)

    Musa, Tarique Al; Plein, Sven; Greenwood, John P


    Degenerative aortic stenosis (AS) is the most common valvular disease in the western world with a prevalence expected to double within the next 50 years. International guidelines advocate the use of cardiovascular magnetic resonance (CMR) as an investigative tool, both to guide diagnosis and to direct optimal treatment. CMR is the reference standard for quantifying both left and right ventricular volumes and mass, which is essential to assess the impact of AS upon global cardiac function. Given the ability to image any structure in any plane, CMR offers many other diagnostic strengths including full visualisation of valvular morphology, direct planimetry of orifice area, the quantification of stenotic jets and in particular, accurate quantification of valvular regurgitation. In addition, CMR permits reliable and accurate measurements of the aortic root and arch which can be fundamental to appropriate patient management. There is a growing evidence base to indicate tissue characterisation using CMR provides prognostic information, both in asymptomatic AS patients and those undergoing intervention. Furthermore, a number of current clinical trials will likely raise the importance of CMR in routine patient management. This article will focus on the incremental value of CMR in the assessment of severe AS and the insights it offers following valve replacement.

  11. Influence of space of double row piles on soil arching effect

    Directory of Open Access Journals (Sweden)

    Zhao bo


    Full Text Available FLAC3d software, based on continuous theory, is used to analysis influence of space of double row piles on soil arching effect. The result shows that different from single row pile, double row piles will produce soil arching effect at front pile and rear pile severally, this phenomenon is called multiple soil arching effect; the residual load of front of front row pile will increase,the soil arch zone and the soil arching effect will decrease with the continuous increase of double row pile spacing.At the same time the soil arching effect of rear pile decreases, while the soil arching effect of front pile increases and finally the soil arching effect between front pile and rear pile will be equal.

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

    LENUS (Irish Health Repository)

    Ridgway, P F


    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.

  13. Confinement Vessel Dynamic Analysis

    Energy Technology Data Exchange (ETDEWEB)

    R. Robert Stevens; Stephen P. Rojas


    A series of hydrodynamic and structural analyses of a spherical confinement vessel has been performed. The analyses used a hydrodynamic code to estimate the dynamic blast pressures at the vessel's internal surfaces caused by the detonation of a mass of high explosive, then used those blast pressures as applied loads in an explicit finite element model to simulate the vessel's structural response. Numerous load cases were considered. Particular attention was paid to the bolted port connections and the O-ring pressure seals. The analysis methods and results are discussed, and comparisons to experimental results are made.

  14. The changes in various hydroxyproline fractions in aortic tissue of rabbits are closely related to the progression of atherosclerosis

    Directory of Open Access Journals (Sweden)

    Alhomida AS


    Full Text Available Abstract Background The most important function of collagen and elastin is to induce several mechanical parameters which are known to play a dominant role in governing mechanical properties of the blood vessels. The aortic tissue of rabbit is one of the important sources of collagen and elastin. The effects of high fat diet (HFD on the hydroxyproline (Hyp fractions in serum and aortic tissues of rabbits and collagen content in the aortic tissues of rabbits have not been documented before. The present study was undertaken to investigate the changes in Hyp fractions in serum and aortic tissues of rabbits and collagen content in the aortic tissues of rabbits during the progression of atherosclerosis. The atherosclerotic model used in this study was the New Zealand white rabbit (male; 12 weeks old. Twenty five rabbits were individually caged, and divided into control group (NOR; n = 10 and HFD group (CHO; n = 15. The control group was fed (100 g/day of normal (NOR diet for a period of 15 weeks. The HFD group was fed normal diet supplemented with 1.0% cholesterol plus 1.0% olive oil (100 g/day for the same period of time. Results We found that the TC, LDLC, and TG (mg/dl were significantly (p Conclusions These results suggest that percentage decrease in various Hyp fractions in aortic tissue of HFD rabbits are closely related to percentage decrease of collagen content in aortic tissues of HFD rabbits. These results also suggest that it may be possible to use the changes in various Hyp fractions in aortic tissues of rabbits as an important risk factor during the progression of atherosclerosis.

  15. Aortic valve replacement for aortic stenosis with a small aortic annulus in a patient having Werner's syndrome and liver cirrhosis. (United States)

    Sogawa, M; Kasuya, S; Yamamoto, K; Koshika, M; Oguma, F; Hayashi, J


    Werner's syndrome is a rare genetic disease characterized by premature aging and scleroderma-like involvement of the skin. We report a case of aortic valve replacement for severely calcified aortic valve stenosis with a small annulus in a patient suffering from Werner's syndrome and liver cirrhosis

  16. Effect of Curcumin on Angiogenesis in Aortic Ring Model of the Wistar Rat

    Directory of Open Access Journals (Sweden)

    J Baharara


    Full Text Available Introduction: Tumeric is a plant with both food and medical properties by which Curcumin is derived from. It has various pharmacological effects. Angiogenesis, a dynamic process of endothelial cells proliferation in order to develop new blood vessels from the previous ones, affects a wide range of physiological and pathological processes such as tumor growth and metastasis. In this study, anti angiogenic effects of Cucumin were investigated in aortic ring of Wistar rats. Methods: In this experimental study, Aortic ring was cut up in to 1 mm pieces and cultured in collagen matrix. After three days, sprouting angiogenesis were observed, and then aortic rings were treated with Curcumin at concentration of 25, 50 and 100 µg/ml. Effects of treatment in all cases were photographed and then investigated by invert microscope. Lengths of vessels were measured by Image J software. Moreover, the study data were analyzed using SPSS in significant level of P0.05.In fact, average length and number of blood vessels in experimental group 1 demonstrated no significant difference compared with control group, though in the experimental group 2 (79.45±3.2mm, (12±1.3 and 3 (38.93±1.1mm, (8±1.1 significant differences were observed (P<0.05(. Conclusion: The results proposed that the Curcumin had dose-dependent inhibitory effects on angiogenesis in rat aortic ring Therefore, it can be introduced as an appropriate candidate in order to study angiogenesis and related diseases.

  17. Visualization of soil arching in flexible piled embankments

    Indian Academy of Sciences (India)

    Tuğba Eskışar


    Piled embankments rely on soil arching, but, when geogrid reinforcements are used, membrane action within the reinforcement contributes to load distribution. The arching of soil in unreinforced and reinforced piled embankments is evaluated in this study. A small-scale test apparatus is used to model the settlement up to 5 mm in an embankment with four pile elements. Visual inspection of the soil settlement and soil-reinforcement interaction is important to explain the mechanism of arching. In this study, X-ray Computed Tomography (CT) method was used as a non-destructive technique. The arching of soil between the piles was observed in the case of rigid piles and in the case of flexible piles with grid type of reinforcement. The load carrying capacity increased up to 33% in the case of geogrid reinforcement, and the differential settlement decreased around 35%, proving the efficiency of piled embankments with geogrid reinforcements. It is also shown that, using X-ray CT method and visualization techniques provides a better understanding of soil behavior in a reinforced embankment with the flexible pile foundation system.

  18. Dental arch diameters and relationships to oral habits. (United States)

    Aznar, T; Galán, A F; Marín, I; Domínguez, A


    The objective was to analyze variations in dental arch width in relation to oral habits. Maxillary and mandibular intercanine and intermolar distance were determined in relation to certain oral habits in 1297 children (ages 3 to 6 years). After an oral examination, the parents of each child completed a questionnaire about oral habits, including the use of a dummy or a bottle (or both), finger sucking, mouth breathing, breast- or bottle-feeding, and duration of these habits. Data were subjected to statistical analysis by the chi-square test for qualitative variables and analysis of variance for quantitative variables with homogeneous variances. Statistical significance was P habits, the maxillary intercanine distance was less in children who used a dummy, especially one of a round design (P = .003). The maxillary intercanine distance was also less in children who breathed through their mouth (P = .002). In most cases, dummy use and mouth breathing were associated with a reduction in the intercanine distance in the maxillary arch. A dummy habit leads to a reduction in maxillary arch width, and mouth breathing causes a reduction in the size of both arches.

  19. ArchDB 2014: structural classification of loops in proteins (United States)

    Bonet, Jaume; Planas-Iglesias, Joan; Garcia-Garcia, Javier; Marín-López, Manuel A.; Fernandez-Fuentes, Narcis; Oliva, Baldo


    The function of a protein is determined by its three-dimensional structure, which is formed by regular (i.e. β-strands and α-helices) and non-periodic structural units such as loops. Compared to regular structural elements, non-periodic, non-repetitive conformational units enclose a much higher degree of variability—raising difficulties in the identification of regularities, and yet represent an important part of the structure of a protein. Indeed, loops often play a pivotal role in the function of a protein and different aspects of protein folding and dynamics. Therefore, the structural classification of protein loops is an important subject with clear applications in homology modelling, protein structure prediction, protein design (e.g. enzyme design and catalytic loops) and function prediction. ArchDB, the database presented here (freely available at, represents such a resource and has been an important asset for the scientific community throughout the years. In this article, we present a completely reworked and updated version of ArchDB. The new version of ArchDB features a novel, fast and user-friendly web-based interface, and a novel graph-based, computationally efficient, clustering algorithm. The current version of ArchDB classifies 149,134 loops in 5739 classes and 9608 subclasses. PMID:24265221


    Directory of Open Access Journals (Sweden)

    Liliana Ioana Vâţă


    Full Text Available The main purpose of the study was to highlight the causes that may lead to reduction of arches: early loss of deciduous teeth, with consecutive dental drifting on the arch, followed by narrowing of the space necessary for the eruption of successional teeth, caries of the deciduous teeth or ectopic eruption of the first permanent molars. The mesial position of M1 had a frequency of 19.31% of the total number of analysed cases; maximum frequencies have been registered for the localization on the lower arch; M1 ectopia has rarely occurred on the studied batch; the frequency of lateral group mesial position was of 10.34% on the studied batch, registering maximum values for the localisation on the upper arch. The early loss of deciduous teeth was identified in almost 30% of the analysed cases, while the reduction of the space necessary for the eruption of successional teeth was registered in almost 39% of cases, space narrowing resulting both from the caries of deciduous teeth and from their early loss.


    Directory of Open Access Journals (Sweden)

    Subhankar Chakraborty


    Full Text Available The functional importance of hand is revealed by its rich vascularity contributed by superficial and deep palmar arches (SPA and DPA.Superficial palmar arch is located superficial to flexor tendons, and deep palmar arch deep to lumbrical muscles. Variations are found more often in SPA than DPA, later being more or less constant. During routine undergraduate dissection, we observed, unilateral incomplete SPA being formed by superficial palmar branches of ulnar and radial artery in the right hand of a male cadaver. These two arteries remained independent without anastomosis forming incomplete arch (SPA.The superficial branch of ulnar artery entered hand superficial to flexor retinaculum and supplied middle, ring and little finger by three branches. The superficial branch of radial artery via its two branches supplied index finger and thumb. Classical SPA formation was seen on left side. The presence of an incomplete SPA as in this case is a potential danger in RA harvesting for CABG.Variations in SPA play a pivotal role in microvascular surgical procedures of hand, RAinterventions and arterial graft applications.

  2. Arch Venture Partners' investment considerations for CBRNE products and opportunities (United States)

    Crandell, K.; Lazarus, S.; Gardner, P. J.


    ARCH is interested in building leading, highly-valued companies from leading research. Toward that end we value innovations created by the leading researchers in the world, many of which are funded to solve critical scientific challenges including those in the instrumentation and CBRNE area. The most important CBRNE innovations we have seen at ARCH are breakthroughs involving significant unaddressed technology risk and have the potential for broad proprietary intellectual property as a result. The model ARCH has evolved in instrumentation is to look for a breakthrough innovation, with strong intellectual property and continue to strengthen the patent estate through the life of the company. ARCH looks to build companies around leading interdisciplinary scientific and engineering teams, and we favor platform technology that can be applied to multiple market applications both commercial and government. As part of a strategy to build a great company, addressing important CBRNE challenges can help a company strengthen its technical team and its IP estate. This supports a focus on early low volume markets on the way toward addressing a fuller portfolio of applications. Experienced Venture Capitalists can help this process by identifying important executive talent, partners and applications, offering financial syndication strength, and helping shape the company's strategy to maximize the ultimate value realized.

  3. Aortic annuloplasty with aortic root reconstruction to prevent patient-prosthesis mismatch. (United States)

    Hopkins, Richard A


    Part of the ongoing argument concerning patient-prosthesis mismatch (PPM) following aortic valve replacement (AVR) is due to the perception that aortic annulus enlargement procedures increase the risk and technical difficulty of aortic valve surgery. Here, an aortic root reconstruction that involves enlargement of the annulus and tailoring of the aortic root to accommodate larger stented prostheses is presented that has been personally performed in 196 patients with no technique-related surgical deaths or complications, and thus can be carried out without additional risk. This aortic root enlargement aortoplasty and annuloplasty method can be calibrated to all AVRs involving stented manufactured prostheses when these are deemed the prosthesis of choice for the patient with a relatively small annulus and/or aortic root, severe left ventricular hypertrophy, compromised LV function or a very active lifestyle, to achieve predicted EOA values > or = 1.00 cm2/m2.

  4. [Unicuspid Aortic Valve Stenosis Combined with Aortic Coarctation;Report of a Case]. (United States)

    Kubota, Takehiro; Wakasa, Satoru; Shingu, Yasushige; Matsui, Yoshiro


    Unicuspid aortic valve in an adult is extremely rare. In addition, 90% of the patients with aortic coarctation are reported to die before the age 50. A 60-year-old woman was admitted to our hospital for further examination of exertional dyspnea which had begun one year before. She had been under medical treatment for hypertension since early thirties, and had been also diagnosed with moderate aortic stenosis at 50 years of age. She was at 1st diagnosed with aortic coarctation combined with bicuspid aortic valve stenosis. The aortic valve was then found unicuspid and was replaced under cardiopulmonary bypass with perfusion to both the ascending aorta and the femoral artery. Repair of aortic coarctation was performed 3 months later through left thoracotomy without extracorporeal circulation due to the rich collateral circulation. She had no postoperative complications, and hypertension as well as ankle-brachial index improved to the normal levels.

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  11. Cheboygan Vessel Base (United States)

    Federal Laboratory Consortium — Cheboygan Vessel Base (CVB), located in Cheboygan, Michigan, is a field station of the USGS Great Lakes Science Center (GLSC). CVB was established by congressional...

  12. Maury Journals - US Vessels (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — U.S. vessels observations, after the 1853 Brussels Conference that set International Maritime Standards, modeled after Maury Marine Standard Observations.

  13. Coastal Logbook Survey (Vessels) (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set contains catch (landed catch) and effort for fishing trips made by vessels that have been issued a Federal permit for the Gulf of Mexico reef fish,...

  14. 2011 Vessel Density (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Automatic Identification Systems (AIS) are a navigation safety device that transmits and monitors the location and characteristics of many vessels in U.S. and...

  15. 2013 Vessel Density (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Automatic Identification Systems (AIS) are a navigation safety device that transmits and monitors the location and characteristics of many vessels in U.S. and...

  16. 2011 Cargo Vessel Density (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Automatic Identification Systems (AIS) are a navigation safety device that transmits and monitors the location and characteristics of many vessels in U.S. and...

  17. 2013 Cargo Vessel Density (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Automatic Identification Systems (AIS) are a navigation safety device that transmits and monitors the location and characteristics of many vessels in U.S. and...

  18. High Performance Marine Vessels

    CERN Document Server

    Yun, Liang


    High Performance Marine Vessels (HPMVs) range from the Fast Ferries to the latest high speed Navy Craft, including competition power boats and hydroplanes, hydrofoils, hovercraft, catamarans and other multi-hull craft. High Performance Marine Vessels covers the main concepts of HPMVs and discusses historical background, design features, services that have been successful and not so successful, and some sample data of the range of HPMVs to date. Included is a comparison of all HPMVs craft and the differences between them and descriptions of performance (hydrodynamics and aerodynamics). Readers will find a comprehensive overview of the design, development and building of HPMVs. In summary, this book: Focuses on technology at the aero-marine interface Covers the full range of high performance marine vessel concepts Explains the historical development of various HPMVs Discusses ferries, racing and pleasure craft, as well as utility and military missions High Performance Marine Vessels is an ideal book for student...

  19. 2013 Tanker Vessel Density (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Automatic Identification Systems (AIS) are a navigation safety device that transmits and monitors the location and characteristics of many vessels in U.S. and...

  20. 2013 Passenger Vessel Density (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Automatic Identification Systems (AIS) are a navigation safety device that transmits and monitors the location and characteristics of many vessels in U.S. and...