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Journal of Cardiac Surgery Jan 2022To report early clinical outcomes of the frozen elephant trunk (FET) technique for the treatment of complex aortic diseases after transition from conventional elephant...
BACKGROUND AND AIM OF THE STUDY
To report early clinical outcomes of the frozen elephant trunk (FET) technique for the treatment of complex aortic diseases after transition from conventional elephant trunk.
METHODS
A single-center, retrospective study of patients who underwent hybrid aortic arch and FET repair for aortic arch and/or proximal descending aortic aneurysms, acute and chronic Stanford type A aortic dissection with arch and/or proximal descending involvement, Stanford type B acute and chronic aortic dissections with retrograde aortic arch involvement.
RESULTS
Between December 2017 and May 2020, 70 consecutive patients (62.7 ± 10.6 years, 59 male) were treated: 41 (58.6%) for emergent conditions and 29 (41.4%) for elective. Technical success was 100%. In-hospital mortality was 14.2% (n = 12, 17.1% emergent vs. 10.3% elective, P = NS); 2 (2.9%) major strokes; 1 (1.4%) spinal cord injury. Mean follow-up was 12.5 months (interquartile range, 3.7-22.3). Overall survival at 3, 6, 12, and 24 months was 90% (95% confidence interval [CI], 83.2-97.3), 85.6% (95% CI, 77.7-94.3), 79.1% (95% CI, 69.9-89.5), 75.6% (95% CI, 65.8-86.9) and 73.5% (95% CI, 63.3-85.3). There were no aortic re-interventions and no distal stent graft-induced new entry (dSINE); 5 patients with residual type B dissection underwent TEVAR completion.
CONCLUSIONS
In a real-world setting, FET with Thoraflex Hybrid demonstrated feasibility and good clinical outcomes, even in emergent setting. Our implant technique optimize cerebral perfusion reporting good results in terms of neurological complications. Techniques to perfect the procedure and to reduce remaining risks, and consensus on considerations such as standardized cerebral protection need to be reported.
Topics: Aortic Dissection; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Humans; Male; Retrospective Studies
PubMed: 34662451
DOI: 10.1111/jocs.16086 -
Journal of Cardiothoracic Surgery May 2022The optimal treatment for aortic thrombus remains to be determined, but surgical treatment is indicated when there is a risk for thromboembolism.
BACKGROUND
The optimal treatment for aortic thrombus remains to be determined, but surgical treatment is indicated when there is a risk for thromboembolism.
CASE PRESENTATION
A 47-year-old male presented with weakness in his left arm upon awakening. Contrast-enhanced computed tomography and transesophageal echocardiography revealed a mobile pedunculated object suggestive of a thrombus arising from the ascending aorta and extending to the left common carotid artery. It was removed under hypothermic circulatory arrest and direct cannulation of the left carotid artery to avoid carotid thromboembolism. Histopathological examination revealed that the object was a thrombus. The patient had an uneventful postoperative course and was discharged 9 days after surgery.
CONCLUSION
When a thrombus in the aortic arch extends to the neck arteries, direct cannulation of the neck arteries with selective cerebral perfusion via cervical incision is a useful technique.
Topics: Aorta, Thoracic; Carotid Artery, Common; Humans; Male; Middle Aged; Perfusion; Thromboembolism; Thrombosis
PubMed: 35505355
DOI: 10.1186/s13019-022-01843-5 -
Journal of Cardiothoracic Surgery Dec 2022Here we report a case of patients with mixed ground glass opacity in the left lung combined with congenital right aortic arch, which is only present in 0.01-0.1% of...
BACKGROUND
Here we report a case of patients with mixed ground glass opacity in the left lung combined with congenital right aortic arch, which is only present in 0.01-0.1% of adults.
CASE PRESENTATION
A 60-year-old woman was referred to our department with a mixed ground-glass opacity (GGO) in the upper lobe of her left lung. She had congenital right aortic arch, and the left pulmonary artery was absent. Enhanced chest computed tomography, pulmonary perfusion imaging, and three-dimensional reconstruction were performed to confirm the blood supply in the left lung and the exact location of the GGO. Because of the unusual left pulmonary vascular structure, wedge resection was performed to prevent massive hemorrhage. The final pathological examination revealed that the mixed GGO was a well-differentiated pulmonary adenocarcinoma.
CONCLUSION
The surgical options should be evaluated carefully in view of the complications and the prognosis of the patient, when ground glass opacity is combined with congenital cardiovascular anomalies.
Topics: Humans; Adult; Female; Middle Aged; Lung Neoplasms; Pulmonary Artery; Aorta, Thoracic; Lung; Adenocarcinoma of Lung
PubMed: 36550506
DOI: 10.1186/s13019-022-02037-9 -
BMJ Case Reports Apr 2021An aortic arch floating thrombus is a rare cause of embolic ischaemic cerebral infarction. Previously, thrombolysis or mechanical thrombectomy has been used to treat...
An aortic arch floating thrombus is a rare cause of embolic ischaemic cerebral infarction. Previously, thrombolysis or mechanical thrombectomy has been used to treat acute cerebral infarction in this context; however, combination therapy using both modalities is yet to be published. The optimal management of aortic arch floating thrombi is debated. Endovascular removal, thrombolysis, vitamin K antagonists and recently, direct oral anticoagulants have been utilised to treat aortic arch floating thrombi. Herein, we highlight the case of a patient presenting with dense hemiparesis, dysphasia and chest pain. CT imaging revealed a left middle cerebral artery thrombus and concurrent aortic arch floating thrombus. He was successfully treated with acute thrombolysis and subsequent mechanical thrombectomy of the cerebral thrombus resulting in resolution of his neurological symptoms. Repeat imaging demonstrated persistence of the aortic arch floating thrombus despite thrombolysis. The aortic arch floating thrombus was managed successfully with direct oral anticoagulant therapy.
Topics: Aorta, Thoracic; Humans; Infarction; Male; Thrombectomy; Thrombolytic Therapy; Thrombosis; Treatment Outcome
PubMed: 33879460
DOI: 10.1136/bcr-2020-238707 -
The Journal of Thoracic and... Sep 2011Bicuspid aortic valve is frequently associated with underlying aortopathy. Data support an aggressive approach to replacement of the ascending aorta. However, the...
OBJECTIVES
Bicuspid aortic valve is frequently associated with underlying aortopathy. Data support an aggressive approach to replacement of the ascending aorta. However, the natural history of the unreplaced aortic arch is unknown, and some have advocated routine replacement of the proximal arch in this setting.
METHODS
We identified patients with bicuspid aortic valve undergoing repair or replacement of the ascending aorta with or without aortic valve replacement or root replacement between January 1988 and December 2007 at our institution. Follow-up was by review of clinical records and postal questionnaire.
RESULTS
Of 470 patients identified, 48 patients had hemiarch or total arch replacement and were excluded. Of the remaining 422 patients, 227 had separate aortic valve replacement or repair and ascending aortoplasty (76) or ascending aortic graft replacement (175), 107 a valved conduit, 40 a homograft root, and 21 a valve-sparing root replacement. The mean age was 56 ± 15 years, and 80% were male. Follow-up was up to 17 (median 4.2) years. There were 23 (5.5%) late reoperations, of which none were for arch dilatation. Survival at 1, 5, 10, and 12 years was 96.5%, 89.6%, 77.7%, and 74.0%. Freedom from late reoperation was 98.7%, 94.1%, 81.0%, and 81.0%. Paired echocardiographic measurements of aortic arch diameter (n = 58) were 33.3 mm preoperatively versus 31.9 mm postoperatively (P = .135) at a mean 4 years.
CONCLUSIONS
Progressive dilatation of the aortic arch leading to reoperation after repair of ascending aortic aneurysm in patients with bicuspid aortic valve is uncommon. A selective approach to transverse aortic arch replacement is appropriate.
Topics: Adult; Aged; Aorta, Thoracic; Aortic Aneurysm; Aortic Valve; Aortic Valve Insufficiency; Aortic Valve Stenosis; Dilatation, Pathologic; Female; Heart Valve Diseases; Humans; Male; Middle Aged; Multivariate Analysis; Reoperation; Retrospective Studies; Ultrasonography
PubMed: 21071042
DOI: 10.1016/j.jtcvs.2010.08.086 -
BMC Cardiovascular Disorders Apr 2017The right-sided aortic arch (RAA) is a rare congenital defect of the aorta. The aim of the study was to assess the occurrence of RAA in diagnoses performed by the...
BACKGROUND
The right-sided aortic arch (RAA) is a rare congenital defect of the aorta. The aim of the study was to assess the occurrence of RAA in diagnoses performed by the University Radiology Department and analyze the frequency of concomitant vascular abnormalities.
METHODS
The database of the Radiology Department was retrospectively analyzed between January 2008 and May 2016 with the keyword "right aortic arch". Twenty patients with this diagnosis were identified from a total of 11,690 CT examinations of the chest area, 19,623 CT examinations of brain-supplying vessels, and 1863 MRI examinations of the heart and aortic arch or brain-supplying arteries. The type of aortic arch, the occurrence of Kommerell's diverticulum and possible other vascular abnormalities, such as stenosis, kinking or occlusion, were then investigated.
RESULTS
The analysis identified nine patients with type I and 11 patients with type II RAA. Eight of the 11 type II patients presented Kommerell's diverticulum. Concomitant vascular abnormalities were detected in four patients with type II RAA. In two cases, the right common carotid artery (RCCA) was narrowed by up to 80%, with steal phenomenon confirmed in one of them. In the second coincident right subclavian artery (RSA) stenosis was depicted. In two other cases, the aberrant left subclavian arteries (ALSA) were found to be narrowed at the level of origin by up to 70%. One patient was found with type B aortic dissection including ALSA and Kommerell's diverticulum.
CONCLUSIONS
Our observations indicate that concomitant vascular abnormalities may occur more often than reported in literature. Patients diagnosed with type II RAA should be examined with Doppler ultrasonography to identify coincident vascular disorders, especially stenosis of the common carotid arteries or subclavian arteries.
Topics: Adolescent; Adult; Aged; Aorta, Thoracic; Child; Computed Tomography Angiography; Diagnosis, Differential; Diagnostic Imaging; Female; Follow-Up Studies; Humans; Magnetic Resonance Angiography; Male; Middle Aged; Retrospective Studies; Ultrasonography, Doppler; Vascular Malformations; Young Adult
PubMed: 28420337
DOI: 10.1186/s12872-017-0536-z -
Annals of Cardiac Anaesthesia 2023Williams-Beuren syndrome is a rare genetic malformation with predilection for supravalvular aortic stenosis. Apart from cardiovascular malformation, hypocalcemia,...
Williams-Beuren syndrome is a rare genetic malformation with predilection for supravalvular aortic stenosis. Apart from cardiovascular malformation, hypocalcemia, developmental delay, and elfin facies, challenging airway make perioperative management more eventful. Association of infective endocarditis within the aortic arch and pseudoaneurysm formation is infrequent. We, hereby report a case of pseudoaneurysm formation and infective vegetation within the aortic arch in a patient with Williams syndrome and the role of transthoracic echocardiography in its perioperative management.
Topics: Humans; Williams Syndrome; Aorta, Thoracic; Aneurysm, False; Echocardiography; Anesthetics
PubMed: 36722596
DOI: 10.4103/aca.aca_122_21 -
The American Journal of Case Reports Feb 2019BACKGROUND Kommerell diverticulum with a right-sided aortic arch is a rare congenital anatomical condition most often observed in adults. A possible etiology of the...
BACKGROUND Kommerell diverticulum with a right-sided aortic arch is a rare congenital anatomical condition most often observed in adults. A possible etiology of the subclavian artery's anomalous origin would be an abnormality in regression of the fourth primitive aortic arch during embryonic development. CASE REPORT We report on the case of a 16-year-old female patient presenting with complaints of occasional tachycardia and mild non-specific dyspnea after anxiety crises. Physical examination revealed lower amplitude of the pulses in the left upper limb compared to the right upper limb, and difference in blood pressure (BP) values of 80×60 mmHg, and 100×60 mmHg, respectively. Different radiological imaging modalities were performed to elucidate a possible vascular abnormality. Multislice detector computed tomography angiography of the thoracic aorta and supra-aortic trunks showed a right-sided aortic arch and an aberrant origin of the left subclavian artery with a retroesophageal course and dilation of its emergence (Kommerell diverticulum), as well as duplicity of the right vertebral artery (RVA). Considering the actual small diameter of the diverticulum and the absence of dysphagia or severe external esophageal compression analyzed by the esophagogram, vascular surgery was not indicated. Since complications have been described in the literature, the patient must be kept under observation in the future. CONCLUSIONS Congenital vascular alterations, including Kommerell diverticulum with right-sided aortic arch and the aberrant origin of the left subclavian artery, should be suspected in otherwise asymptomatic young patients with few clinical manifestations. Investigation with different imaging methods helps to clarify the vascular abnormalities, to support a possible surgical procedure indication, and to monitor the patients in follow-up.
Topics: Adolescent; Aorta, Thoracic; Computed Tomography Angiography; Diverticulum; Female; Humans; Multidetector Computed Tomography; Subclavian Artery; Vertebral Artery
PubMed: 30787266
DOI: 10.12659/AJCR.912053 -
Annals of Thoracic and Cardiovascular... 2014Persistent fifth aortic arch (PFAA) associated with interruption of the fourth aortic arch is a rare malformation, usually requiring surgical intervention in childhood....
Persistent fifth aortic arch (PFAA) associated with interruption of the fourth aortic arch is a rare malformation, usually requiring surgical intervention in childhood. A 51-year-old woman developed a distal aortic arch aneurysm associated with PFAA after patch aortoplasty for coarctation of the aorta at the age of 18. To our knowledge, this is the first reported case of a distal aortic arch aneurysm associated with PFAA. Residual tissues of the ductus and PFAA, which is not a definitive aortic arch, and the implanted synthetic patch may have been related to the development of the aneurysm. Graft interposition between the proximal border of PFAA and the descending aorta was performed because severe adhesions impeded the application of the fourth aortic arch as a proximal anastomotic site of the graft. Accurate diagnosis and sufficient understanding of PFAA allow an appropriate surgical treatment in childhood with a good result over the long term.
Topics: Aorta, Thoracic; Aortic Aneurysm, Thoracic; Aortic Coarctation; Aortography; Blood Vessel Prosthesis Implantation; Female; Humans; Middle Aged; Risk Factors; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures
PubMed: 23774614
DOI: 10.5761/atcs.cr.13-00013 -
Texas Heart Institute Journal Mar 2024
Topics: United States; Humans; Aorta, Thoracic; United States Food and Drug Administration
PubMed: 38483472
DOI: 10.14503/THIJ-24-8391