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Journal of Cardiothoracic Surgery Sep 2021Persistent fifth aortic arch (PFAA) is a rare anomaly often associated with aortic coarctation or interruption, and various surgical techniques for this anomaly have...
BACKGROUND
Persistent fifth aortic arch (PFAA) is a rare anomaly often associated with aortic coarctation or interruption, and various surgical techniques for this anomaly have been reported. Herein, we show a case of an infant with PFAA and severe aortic coarctation.
CASE PRESENTATION
A 41-day-old female infant was admitted for sustained fever. Initially, the patient was diagnosed with bacterial meningitis, and echocardiography showed PFAA with severe aortic coarctation. Because the patient presented progressive oliguria and metabolic acidosis, she was transferred for emergency cardiac surgical intervention. The aortic arch was reconstructed using end-to-side anastomosis between the fifth aortic arch and the descending aorta without any artificial conduit or patching material.
CONCLUSIONS
PFAA with aortic coarctation can be repaired by various surgical methods. Among them, our surgical approach is easy and effective, has growth potential, and an additional surgery is not needed.
Topics: Anastomosis, Surgical; Aorta, Thoracic; Aortic Coarctation; Cardiac Surgical Procedures; Echocardiography; Female; Humans; Infant
PubMed: 34583714
DOI: 10.1186/s13019-021-01664-y -
Journal of Cardiothoracic Surgery Apr 2019The right aortic arch and aortic coarctation are rare congenital anomalies with the incidence of 0.1% and 0.03-0.04%. We present a case report of a 51-year-old woman...
BACKROUND
The right aortic arch and aortic coarctation are rare congenital anomalies with the incidence of 0.1% and 0.03-0.04%. We present a case report of a 51-year-old woman with the right aortic arch with aberrant left subclavian artery and coarctation of the aorta with post-stenotic aneurysm.
CASE PRESENTATION
Resection of the coarctation and aneurysm with replacement by tubular prosthesis was performed on partial cardiopulmonary bypass via femoral vessels.
CONCLUSION
Partial cardiopulmonary bypass is an applicable method for ensuring the perfusion of the distal part of the body and an aberrant left subclavian artery is not a contraindication of this technique.
Topics: Aorta, Thoracic; Aortic Aneurysm; Aortic Coarctation; Blood Vessel Prosthesis Implantation; Cardiopulmonary Bypass; Cardiovascular Abnormalities; Female; Humans; Middle Aged; Subclavian Artery; Tomography, X-Ray Computed
PubMed: 30940154
DOI: 10.1186/s13019-019-0878-y -
The Journal of Thoracic and... Jul 2017
Topics: Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Humans
PubMed: 28233556
DOI: 10.1016/j.jtcvs.2017.01.026 -
The Journal of Physiology Apr 19711. A method is described for isolation of the aortic arch and right subclavian-carotid angle in situ in the rabbit and perfusion with Krebs-Henseleit solution or blood...
1. A method is described for isolation of the aortic arch and right subclavian-carotid angle in situ in the rabbit and perfusion with Krebs-Henseleit solution or blood under controlled conditions of pressure and temperature.2. The characteristics of the baroreceptors of the aortic arch and right subclavian-carotid angle were studied by recording from single or few-fibre preparations of the left and right aortic nerves respectively. Curbes were plotted to show the relationship between the frequency of baroreceptor impulse activity and intra-aortic pressure during non-pulsatile perfusion under steady-state conditions.3. The aortic arch and right subclavian-carotid angle baroreceptors were found to have similar characteristics. Three types of response of the baroreceptors at the threshold pressure to a steady intra-aortic pressure are described.4. Increasing the intra-aortic pressure increased the frequency of impulses in fibres previously active and caused recruitment of other fibres in multi-fibre preparations. The relationship was linear at low pressures and a point of inflexion occurred at higher pressures in the majority of fibres.5. Lowering the temperature of the perfusate reduced the impulse frequency at any given pressure.6. The curves obtained during stepwise increases and decreases in intra-aortic arch pressure were dissimilar, particularly at the lower end of the pressure range. This phenomenon is probably due to properties of the arterial wall.7. When the aortic arch preparation was excised, changes occurred in the shape of the impulse frequency-pressure curves from baroreceptors in both areas. The point of inflexion was elevated and a higher percentage of fibres failed to reach a point of inflexion in the pressure range studied.
Topics: Action Potentials; Animals; Aorta, Thoracic; Cold Temperature; Elasticity; Perfusion; Pressoreceptors; Pressure; Rabbits; Subclavian Artery
PubMed: 5579635
DOI: 10.1113/jphysiol.1971.sp009428 -
Journal of the American College of... Mar 1993This study was conducted to evaluate the incidence and etiology of hypertension and aortic arch gradients during exercise in patients who have apparent good coarctation...
OBJECTIVES
This study was conducted to evaluate the incidence and etiology of hypertension and aortic arch gradients during exercise in patients who have apparent good coarctation repair assessed at rest.
BACKGROUND
The reported incidence of recurrent aortic arch obstruction (rest gradient > 20 mm Hg) after previous successful surgical repair varies from 0% to 60% and usually is associated with recurrent stenosis at the site of surgical repair.
METHODS
Maximal treadmill exercise with Doppler echocardiographic gradient estimation was performed in 28 patients with a good coarctation repair at rest (normal blood pressure and arch gradient < 20 mm Hg) who had isolated coarctation repair a mean of 7.8 years previously.
RESULTS
Eight (29%) developed systolic hypertension for age and a mean Doppler gradient of 45 +/- 13 mm Hg. At cardiac catheterization, the rest peak to peak systolic gradient (6 +/- 6 to 28 +/- 7 mm Hg, p < 0.001), peak systolic instantaneous gradient (16 +/- 11 to 48 +/- 9 mm Hg, p < 0.01) and cardiac index (3.5 +/- 0.7 to 5.9 +/- 1.1 liters/m per m2, p < 0.001) all increased during isoproterenol infusion. Angiographic systolic aortic arch measurements proximal to the innominate artery, left common carotid artery, left subclavian artery and the narrowest dimension at the coarctation repair site demonstrated hypoplasia at the left common carotid artery (11.8 +/- 1.7 vs. 16.7 +/- 2.9 mm/m2, p < 0.01) and left subclavian artery (11.6 +/- 1.7 vs. 15.4 +/- 3.1 mm/m2, p < 0.05) compared with findings in 10 patients with normal aortograms. Transverse aortic arch ratios were also smaller in the eight patients with abnormal findings. Preoperative angiographic ratios were not predictive of late postoperative findings.
CONCLUSIONS
Exercise testing detects hypertension and arch gradients in patients with a good coarctation repair as assessed at rest. The hypertension and arch "obstruction" appear to be related to discrepancies in the growth of the transverse aortic arch proximal to the repair site, rather than a "recoarctation" of the aorta.
Topics: Adolescent; Analysis of Variance; Aorta; Aorta, Thoracic; Aortic Coarctation; Aortography; Blood Pressure; Child; Echocardiography, Doppler; Exercise Test; Follow-Up Studies; Hemodynamics; Humans; Hypertension; Incidence; Recurrence
PubMed: 8450148
DOI: 10.1016/0735-1097(93)90360-d -
Annals of Thoracic and Cardiovascular... Feb 2021Spontaneous rupture of the thoracic aorta is rare. We present a 76-year-old man who developed spontaneous rupture of the aortic arch associated with massive periaortic...
Spontaneous rupture of the thoracic aorta is rare. We present a 76-year-old man who developed spontaneous rupture of the aortic arch associated with massive periaortic hematoma and hypovolemic shock. Because the site of rupture could not be identified, emergency hybrid endovascular aortic repair to shield a long segment of the aorta was performed according to the extent and density of periaortic hematoma on axial CT scans. His blood pressure improved just after deployment of the endograft. Rapid diagnosis by CT and prompt control of aortic hemorrhage by endografting salvaged this patient. Three-dimensional (3D) volume-rendered CT images are useful for identifying the site of aortic rupture, but may not be available in an emergency.
Topics: Aged; Aorta, Thoracic; Aortic Rupture; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Emergencies; Endovascular Procedures; Humans; Male; Rupture, Spontaneous; Stents; Treatment Outcome
PubMed: 29899177
DOI: 10.5761/atcs.cr.18-00020 -
Interactive Cardiovascular and Thoracic... Oct 2021Even though preoperative diagnostics have improved significantly, intraoperative surprises may still occur especially in the case of complex congenital heart disease. An...
Even though preoperative diagnostics have improved significantly, intraoperative surprises may still occur especially in the case of complex congenital heart disease. An instance of such a complex congenital heart disease is a hypoplastic left heart syndrome with a right-sided aortic arch. In this case report, we present 1 patient with such a complex and unexpected anatomy, as well as a possible way to overcome the obstacles.
Topics: Aorta, Thoracic; Humans; Hypoplastic Left Heart Syndrome; Situs Inversus
PubMed: 34117495
DOI: 10.1093/icvts/ivab165 -
European Journal of Cardio-thoracic... Jun 2024Left ventricular outflow tract obstruction (LVOTO) is a major cause of morbidity and mortality in infants with interrupted aortic arch (IAA). Left Ventricular Outflow...
OBJECTIVES
Left ventricular outflow tract obstruction (LVOTO) is a major cause of morbidity and mortality in infants with interrupted aortic arch (IAA). Left Ventricular Outflow Tract (LVOT) development may be flow-mediated, thus IAA morphology may influence LVOT diameter and subsequent reintervention. We investigated the association of IAA morphology [type and presence of aortic arch aberrancy (AAb)] with LVOT diameter and reintervention.
METHODS
All surgical patients with IAA (2001-2022) were reviewed at a single institution. We compared IAA-A versus IAA-B; IAA with aortic AAb versus none; IAA-B with aberrant subclavian (AAbS) artery versus others. Primary outcomes included LVOT diameter (mm), LVOTO at discharge (≥50 mmHg), and LVOT reintervention.
RESULTS
Seventy-seven infants (mean age 10 ± 19 days) were followed for 7.6 (5.5-9.7) years. Perioperative mortality was 3.9% (3/77) and long-term mortality was 5.2% (4/77). Out of 51 IAA-B (66%) and 22 IAA-A (31%) patients, 30% (n = 22) had AAb. Smaller LVOT diameter was associated with IAA-B [IAA-A: 5.40 (4.68-5.80), IAA-B: 4.60 (3.92-5.50), P = 0.007], AAb [AAb: 4.00 (3.70-5.04) versus none: 5.15 (4.30-5.68), P = 0.006], and combined IAA-B + AAbS [IAA-B + AAbS: 4.00 (3.70-5.02) versus other: 5.00 (4.30-5.68), P = 0.002]. The likelihood of LVOTO was higher among AAb [N = 6 (25%) vs N = 1 (2%), P = 0.004] and IAA-B + AAbS [N = 1 (2%) vs N = 6 (30%), P = 0.002]. Time-to-event analysis showed a signal towards increased LVOT reintervention in IAA-B + AAbS (P = 0.11).
CONCLUSIONS
IAA-B and AAb are associated with small LVOT diameter and early LVOTO, especially in combination. This may reflect lower flow in the proximal arch during development. Most reinterventions occur in IAA-B + AAbS, hence these patients should be carefully considered for LVOT intervention at the time of initial repair.
Topics: Humans; Aorta, Thoracic; Ventricular Outflow Obstruction; Female; Infant, Newborn; Male; Retrospective Studies; Infant; Heart Ventricles
PubMed: 38814803
DOI: 10.1093/ejcts/ezae220 -
Arquivos Brasileiros de Cardiologia Feb 2021
Topics: Aorta, Thoracic; Aortic Arch Syndromes; Female; Humans; Pregnancy; Prenatal Diagnosis; Vascular Ring
PubMed: 33566994
DOI: 10.36660/abc.20190310 -
The Journal of Thoracic and... Jun 2005We sought to review our experience with infants and children with anatomically complete vascular rings (ie, double aortic arch and right aortic arch with left...
OBJECTIVE
We sought to review our experience with infants and children with anatomically complete vascular rings (ie, double aortic arch and right aortic arch with left ligamentum) and define perioperative trends in diagnostic imaging, operative techniques, and clinical outcomes.
METHODS
From 1946 through 2003, 209 patients (113 with double aortic arch and 96 with right aortic arch) underwent surgical repair. Mean and median ages at the time of the operation were as follows: double aortic arch, 1.4 +/- 2.4 years and 0.75 years, respectively; right aortic arch, 2.7 +/- 3.9 years and 0.9 years, respectively. Fourteen (14.6%) patients with right aortic arch had an associated Kommerell diverticulum. Cardiac diagnoses were present in 26 (12.4%) of 209 patients.
RESULTS
There has been no operative mortality since 1959. In the past 30 years, mean hospital stay decreased from 8 to 3 days. Primary means of diagnosis has shifted from barium swallow and angiography to computed tomographic scanning or magnetic resonance imaging. In the past 10 years, 73% of patients had preoperative or intraoperative bronchoscopy. The technique of operation has shifted to a muscle-sparing left thoracotomy without routine chest drainage. In 7 recent patients with right aortic arch and a Kommerell diverticulum, the diverticulum was resected, and the left subclavian artery was transferred to the left carotid artery as a primary procedure.
CONCLUSIONS
At our institution, computed tomographic scanning has replaced barium swallow as the diagnostic procedure of choice for vascular ring evaluation. We recommend both preoperative bronchoscopy and echocardiography. Use of a muscle-sparing thoracotomy without routine chest drainage has decreased mean hospital stay. For patients with a right aortic arch and associated Kommerell diverticulum, we recommend diverticulum resection with left subclavian artery transfer to the left carotid artery.
Topics: Aorta, Thoracic; Child, Preschool; Female; Humans; Infant; Male; Postoperative Complications; Vascular Surgical Procedures
PubMed: 15942575
DOI: 10.1016/j.jtcvs.2004.10.044