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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the use of cardiovascular magnetic resonance in pediatric congenital and acquired heart disease : Endorsed by The American Heart Association. J Cardiovasc Magn Reson 2022; 24:37. [PMID: 35725473 PMCID: PMC9210755 DOI: 10.1186/s12968-022-00843-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of CMR in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of CMR in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA
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52
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Patil C, Kotamraju S, Kumar P, Kollu R, Reddy M. Right Vertebral Artery Arising From Ipsilateral Common Carotid Artery With Severe Stenosis of Ostio-proximal Segment of Aberrant Right Subclavian Artery: A Rare Life-Saving Variant. Cureus 2022; 14:e25566. [PMID: 35784987 PMCID: PMC9248996 DOI: 10.7759/cureus.25566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 11/19/2022] Open
Abstract
Anomalous origins of vertebral arteries are rare vascular anomalies that are incidentally identified during computed tomography, magnetic resonance imaging, or digital subtraction angiograms. We present the case of a 45-year-old male who had gangrene of the right ring finger associated with absent radial, ulnar, and brachial artery pulses. A computed tomography angiogram of the upper limb including the arch of aorta showed an aberrant right subclavian artery having near-total stenosis at the origin. An anomalous origin of the right vertebral artery from the right common carotid artery was also noted. This incidental variant anomaly of the vertebral artery was vital in this case as it spared the posterior cerebral circulation from vascular insufficiency complications. It is also important for future head and neck endovascular interventions to avoid inadvertent arterial injury.
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53
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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the Use of Cardiac Magnetic Resonance in Pediatric Congenital and Acquired Heart Disease: Endorsed by The American Heart Association. Circ Cardiovasc Imaging 2022; 15:e014415. [PMID: 35727874 PMCID: PMC9213089 DOI: 10.1161/circimaging.122.014415] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Cardiovascular magnetic resonance has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of cardiovascular magnetic resonance in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of cardiovascular magnetic resonance in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, (M.A.F.).,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, (M.A.F.)
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA, (S.A.)
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA, (C.B.)
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA, (L.B.)
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA, (T.C.)
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA, (T.J.)
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK, (V.M.)
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA, (M.T.)
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA (C.W.)
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54
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Georges G, Philippon F, Champagne J, Albert E, O’Hara GE. Leadless Pacemaker Implantation in a Patient with Hypoplasia of the Left Brachiocephalic Vein. CJC Open 2022; 4:810-812. [PMID: 36148256 PMCID: PMC9486864 DOI: 10.1016/j.cjco.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/22/2022] [Indexed: 12/01/2022] Open
Abstract
Venous anomalies are typically asymptomatic and may be discovered unexpectedly at the time of implantation of a cardiac implantable electronic device. We report a case of leadless pacemaker implantation in a patient with hypoplasia of the left brachiocephalic vein who had previously undergone multiple interventions for relapsing right-sided breast cancer. The prevalence and etiology of this anatomic variant remain unknown. However, awareness of its existence may prevent complications during left-sided interventions. such as placement of a central venous line or a cardiac implantable electronic device. Alternative diagnostics and implantation strategies are discussed.
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Affiliation(s)
- Gabriel Georges
- Division of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Quebec, Canada
- Corresponding author: Dr Gabriel Georges, Cardiac Surgery Division, Quebec Heart and Lung Institute, Laval University, 2725 Ch Ste-Foy, Québec, Québec G1V 4G5, Canada. Tel.: +1-418-656-8711 x 0932.
| | - François Philippon
- Division of Electrophysiology, Quebec Heart and Lung Institute, Quebec, Quebec, Canada
| | - Jean Champagne
- Division of Electrophysiology, Quebec Heart and Lung Institute, Quebec, Quebec, Canada
| | - Elisabeth Albert
- Division of Radiology, Quebec Heart and Lung Institute, Quebec, Quebec, Canada
| | - Gilles E. O’Hara
- Division of Electrophysiology, Quebec Heart and Lung Institute, Quebec, Quebec, Canada
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55
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Aydin MM, Yalçinkaya M. Frequency of Congenital Aortic Arch Anomaly in COVID-19 Patients. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2022; 68:413-416. [PMID: 35442373 DOI: 10.1590/1806-9282.20211180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/20/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the frequency of aortic arch anomaly in COVID-19 patients and to determine whether it will be included in the risk classification. METHODS The study was retrospectively conducted in a third-level hospital by scanning the contrast-enhanced thoracic computed tomography and thoracic computed tomography angiography examinations of patients who received PCR (+), hospitalization, and known COVID pneumonia between March 2020 and July 2021. The study consists of 88 cases and 88 control groups. RESULTS The study found that the frequency of aortic arch anomaly was higher in patients with COVID-19 pneumonia and in male patients with bovine-type anomaly. CONCLUSIONS The higher prevalence of bovine arch anomaly in COVID patients may be considered a risk factor for COVID-19 in individuals with this type of vascular anomaly.
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Affiliation(s)
- Mehmet Maruf Aydin
- University of Health Sciences, Samsun Training and Research Hospital, Department of Radiology - Samsun, Turkey
| | - Mirsad Yalçinkaya
- University of Health Sciences, Samsun Training and Research Hospital, Department of Radiology - Samsun, Turkey
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56
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Evaluation of aortic arch morphologies by computed tomographic angiography in Turkish population. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:167-175. [PMID: 36168567 PMCID: PMC9473601 DOI: 10.5606/tgkdc.dergisi.2022.22474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/23/2022] [Indexed: 11/21/2022]
Abstract
Background: The aim of this study was to evaluate the aortic arch morphologies in the Turkish population using the computed tomography angiography technique.
Methods: Between August 2009 and August 2019, a total of 2,037 (1,003 males, 1,034 females; mean age: 52.8±20.3 years; range, 3 months to 100 years) thoracic computed tomography angiography scans were retrospectively analyzed. The findings were classified as described previously in the literature. The prevalence of aortic arch morphologies and possible relationship with sex were analyzed. The prevalence of variations reported in previous studies was compared with the current study.
Results: The normal aortic arch pattern (type A), observed in 1,562 cases (76.7%), was determined statistically significantly more in males than females (p<0.05). The most common variation, bovine aortic arch (type B1) which observed in a total of 315 cases (15.5%), was determined statistically significantly more in females than males (p<0.05). The second most frequent variation, in which the left vertebral artery originates directly from the aortic arch (type C1) was detected in 97 cases (4.7%). There was also observed to be aberrant right subclavian artery in 21 cases (1%), right-sided aortic arch variation in seven cases (0.4%), and double aortic arch anomaly in four cases (0.1%). In terms of the reported frequency of type B variation, a significant difference was determined between the current and previous studies in Türkiye (p<0.05).
Conclusion: With the largest sample size to date, this study provides comparative information about the prevalence of aortic arch patterns in the Turkish population.
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57
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A Rare Case Report: Tetralogy of Fallot, Right Aortic Arch, Isolated Left Subclavian from Patent Ductus Arteriosus, Neonatal Aortopulmonary Window, and Hypoplastic Right Pulmonary Artery. JTCVS Tech 2022; 14:191-194. [PMID: 35967219 PMCID: PMC9366297 DOI: 10.1016/j.xjtc.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
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58
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Allardyce H, Shepherd E, Bailey EL. Anatomical variation of the aorta in the West of Scotland - A population with high cardiovascular disease burden. Implications for stent design and deployment. J Anat 2022; 242:112-120. [PMID: 35301720 PMCID: PMC9773165 DOI: 10.1111/joa.13652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/07/2022] [Accepted: 02/28/2022] [Indexed: 12/25/2022] Open
Abstract
The prevalence and complexity of cardiovascular disease (CVD) in the West of Scotland are high with the aortic arch and abdominal aorta, particularly at increased risk of cardiovascular pathology. Stent deployment can be key in preventing further cardiovascular events, however, current stent design does not account for complex advanced CVD in these areas. This cadaveric study aimed to provide anatomical measurements requested by manufacturers to improve stent design and deployment in this target population. Nine cadavers (six females and three males; age range = 82.7 ± 10.4 years) from the West of Scotland were dissected to expose the aortic arch and abdominal aorta. Digital callipers and protractors were used to collect data on vessel diameters (including taper), branch spacing, angles and presence of collaterals. CVD was present in all cadavers and ranged from mild plaque presence to aortic dissections. One possessed a bovine aortic arch variation. Supra-aortic vessels were approximately equally spaced, but the left common carotid had the most acute branching angle. Angulation of the arch from the coronal plane positively correlated with a deviation of the left subclavian artery (LSA) from the sternal midline (Spearman's coefficient r = 0.82, p = 0.01) which may impact surgical access. The origin of the vertebral artery on the LSA was also highly variable. The diameter of the descending aorta decreased along its length from the aortic hiatus to superior mesenteric by 21 ± 10% indicating a high degree of taper. The artery of Adamkiewicz was present in 33% and additional renal collaterals were present in 22%. 66% had tortuous vessels in the abdominal region. These results highlight the need for more data to aid the refinement of stent-graft design and deployment methods to ensure successful surgical intervention in this population.
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Affiliation(s)
- Hazel Allardyce
- College of Medicine, Veterinary Medicine, Dentistry and Life SciencesUniversity of GlasgowGlasgowUK,School of Medicine, Medical Sciences & NutritionUniversity of Aberdeen, Institute of Medical SciencesAberdeenUK
| | - Ellis Shepherd
- College of Medicine, Veterinary Medicine, Dentistry and Life SciencesUniversity of GlasgowGlasgowUK
| | - Emma L. Bailey
- College of Medicine, Veterinary Medicine, Dentistry and Life SciencesUniversity of GlasgowGlasgowUK
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59
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Kamona A, Fox A, Semionov A. Horseshoe adrenal gland associated with retro-aortic right diaphragmatic crus and several vascular variants: Report of two cases. Radiol Case Rep 2022; 17:1568-1572. [PMID: 35282322 PMCID: PMC8914094 DOI: 10.1016/j.radcr.2022.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 11/30/2022] Open
Abstract
Horseshoe adrenal gland (HA) refers to congenital fusion of the adrenal glands across the midline - a rare anatomical variant often found in association with other congenital anomalies. Here we report 2 cases of HA associated with retro-aortic course of the right diaphragmatic crus, yet another rare anatomical variant, in a 61 your-old male and a 69-year-old female, who underwent CT examinations for unrelated reasons. Both patients also had additional vascular and vertebral anomalies. To the best of our knowledge, this is the first report to document association of 2 rare congenital anomalies: HA and retro-aortic right diaphragmatic crus.
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60
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Kang K, Wang S, Xiong F, Kai J, Wang J, Li B. Esophageal cancer with a double aortic arch: a case report and literature review. J Cardiothorac Surg 2022; 17:33. [PMID: 35277193 PMCID: PMC8915513 DOI: 10.1186/s13019-022-01774-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Double aortic arch (DAA) is an extremely rare vascular malformation, even more so when coexisting with esophageal cancer. METHODS We report a new case of DAA with esophageal cancer recently seen at our Thoracic Tumor Clinic and review cases of DAA coexisting with esophageal cancer reported in the literature of English language from 2010 to 2020. The purposes of our literature review were to explore how to best achieve radical esophagectomy while reducing postoperative complications. The clinical manifestations, diagnostic method, surgical approach, reconstruction route, and the extent of lymphadenectomy of esophageal cancer with DAA were analyzed in detail. RESULTS AND CONCLUSION For such patients, 3D computed tomography is necessary for preoperative diagnosis. The surgical approach should consider factors such as the location of the tumor in the esophagus and whether the tumor is surrounded by DAA, as well as the position of the descending aorta and the requirements for the surgical field for lymphadenectomy. If esophageal reconstruction is required, the retrosternal route is preferred. We recommend that only patients with positive results of intraoperative frozen biopsy of recurrent laryngeal nerve lymph nodes should undergo three-field lymphadenectomy, which may be the best method to achieve radical esophagectomy for middle and lower esophageal cancers with DAA while minimizing postoperative complications.
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Affiliation(s)
- Kai Kang
- Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, 430079, China
| | - Sheng Wang
- Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, 430079, China
| | - Fei Xiong
- Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, 430079, China.
| | - Jindan Kai
- Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, 430079, China.
| | - Jianjian Wang
- Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, 430079, China
| | - Binfeng Li
- Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, 430079, China
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61
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Intravascular ultrasound guided transcatheter electrosurgical revascularization of an interrupted aortic arch. J Cardiol Cases 2022; 26:56-58. [DOI: 10.1016/j.jccase.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/06/2022] [Accepted: 02/19/2022] [Indexed: 11/18/2022] Open
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62
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Miller SM, Madueme PC, Wearden PD, Nelson JS. Aortic arch atresia in Williams syndrome. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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63
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Ballout AA, Schneider JR, Patel AV, Patsalides A. Subclavian steal phenomena in right-sided aortic arch with isolated left subclavian artery as demonstrated by quantitative-MRA. Neuroradiol J 2022; 35:539-540. [PMID: 35220833 PMCID: PMC9437495 DOI: 10.1177/19714009211059116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Right-sided aortic arch with an isolated left subclavian artery is a very rare congenital anatomical variant that can lead to subclavian steal syndrome. We present a case of an asymptomatic patient who was incidentally found to have this variant on CT angiography with QMRA evidence of retrograde flow in the left vertebral artery consistent with subclavian steal phenomena. Since patients often remain asymptomatic until their compensatory mechanisms become compromised later in life, serial monitoring using non-invasive hemodynamic studies such as QMRA may guide treatment.
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Affiliation(s)
- Ahmad A Ballout
- Departments of Neurology, 5799Northwell Health, and 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA
| | - Julia R Schneider
- Departments of Neurology, 5799Northwell Health, and 232890Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, NY, USA
| | - Anand V Patel
- Department of Neurology, 12338University of Texas Medical Branch, Galveston, TX, USA
| | - Athos Patsalides
- Departments of Neurological Surgery, 24945North Shore University Hospital, Manhasset, NY, USA
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Recommendations in pre-procedural imaging assessment for TAVI intervention: SIC-SIRM position paper part 2 (CT and MR angiography, standard medical reporting, future perspectives). LA RADIOLOGIA MEDICA 2022; 127:277-293. [PMID: 35129758 DOI: 10.1007/s11547-021-01434-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
Non-invasive cardiovascular imaging owns a pivotal role in the preoperative assessment of patient candidates for transcatheter aortic valve implantation (TAVI), providing a wide range of crucial information to select the patients who will benefit the most and have the procedure done safely. This document has been developed by a joined group of experts of the Italian Society of Cardiology and the Italian Society of Medical and Interventional Radiology and aims to produce an updated consensus statement about the pre-procedural imaging assessment in candidate patients for TAVI intervention. The writing committee consisted of members and experts of both societies who worked jointly to develop a more integrated approach in the field of cardiac and vascular radiology. Part 2 of the document will cover CT and MR angiography, standard medical reporting, and future perspectives.
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65
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Miwa K, Iwai S, Nagashima T. Coarctation of Aorta with Circumflex Aorta: Risk of Bronchial Compression and Recoarctation. Ann Thorac Surg 2022; 114:e461-e463. [DOI: 10.1016/j.athoracsur.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/26/2022] [Accepted: 02/06/2022] [Indexed: 11/01/2022]
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66
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Chen Z, Zhao H, Zhao Y, Han J, Yang X, Throckmorton A, Wei Z, Ge S, He Y. Retrograde flow in aortic isthmus in normal and fetal heart disease by principal component analysis and computational fluid dynamics. Echocardiography 2022; 39:166-177. [PMID: 35026051 DOI: 10.1111/echo.15256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/04/2021] [Accepted: 10/28/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Reverse flow Retrograde flow (RF) of blood in the aortic isthmus can be observed in different types of fetal heart disease (FHD), including abnormalities in heart structure and function. This study sought to investigate the relationship between RF and blood flow parameters, and develop a computational fluid dynamics (CFD) model to understand the mechanisms underlying this observation. MATERIAL AND METHODS A total of 281 fetuses (gestational age [GA] 26.6±.3 weeks) with FHD and 2803 normal fetuses (GA: 26.1±.1 weeks) by fetal echocardiography collected from May 2016 to December 2018. Principal component analysis (PCA) was performed to find the relationship and the CFD model reconstructed from 3D/4D spatio-temporal image correlation (STIC) images to simulate hemodynamics. RESULTS There was a significant difference in the percentages of RF between the study (80/201 (39%)) and control (29/2803 (1%)) groups (p < 0.05). The RF occur when the aorta flow rate (left heart) is reduced to 60% by CFD stimulation. Pearson correlation analysis showed significant correlations between flow rate and wall shear stress(WSS) (r = .883, p = 0.047) variables at the AI. CONCLUSION Volumetric flow rate of AO or left heart was the main component of the cause of RF. The hemodynamics of the cardiovascular system have highly complex behavior hinge on the turbulent nature of circulating blood flow.
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Affiliation(s)
- Zhuo Chen
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongkai Zhao
- School of Energy and Power Engineering, Beijing University of Aeronautics and Astronautics, Beijing, China
| | - Ying Zhao
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiancheng Han
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Yang
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Amy Throckmorton
- BioCirc Research Laboratory, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
| | - Zhenglun Wei
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Shuping Ge
- Geisinger Heart and Vascular Institute, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Yihua He
- Echocardiography Medical Center, Maternal-Fetal Medicine center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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67
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Yang SK, Zhang A, Hazany S, Huang J, Hathout GM. MR angiographic findings of aberrant right subclavian artery with agenesis of the left common carotid artery and anomalous origin of the vertebral arteries. Clin Imaging 2022; 84:31-35. [DOI: 10.1016/j.clinimag.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 11/30/2022]
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68
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Dificultăţi de diagnostic în infecţiile respiratorii recurente la copil – inelul vascular. Prezentare de caz. PEDIATRU.RO 2022. [DOI: 10.26416/pedi.65.1.2022.6338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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69
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Bae SB, Kang EJ, Choo KS, Lee J, Kim SH, Lim KJ, Kwon H. Aortic Arch Variants and Anomalies: Embryology, Imaging Findings, and Clinical Considerations. J Cardiovasc Imaging 2022; 30:231-262. [PMID: 36280266 PMCID: PMC9592245 DOI: 10.4250/jcvi.2022.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 11/22/2022] Open
Abstract
There is a wide spectrum of congenital anomalies or variations of the aortic arch, ranging from non-symptomatic variations that are mostly detected incidentally to clinically symptomatic variations that cause severe respiratory distress or esophageal compression. Some of these may be accompanied by other congenital heart diseases or chromosomal anomalies. The widespread use of multidetector computed tomography (CT) in clinical practice has resulted in incidental detection of several variations of the aortic arch in adults. Thus, radiologists and clinicians should be aware of the classification of aortic arch anomalies and carefully look for imaging features associated with a high risk of clinical symptoms. Understanding the embryological development of the aortic arch aids in the classification of various subtypes of aortic arch anomalies and variants. For accurate diagnosis and precise evaluation of aortic arch anomalies, cross-sectional imaging modalities, such as multidetector CT or magnetic resonance imaging, play an important role by providing three-dimensional reconstructed images. In this review, we describe the embryological development of the thoracic aorta and discuss variations and anomalies of the aortic arch along with their clinical implications.
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Affiliation(s)
- Sang Bin Bae
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Eun-Ju Kang
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jongmin Lee
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang Hyeon Kim
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Kyoung Jae Lim
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Heejin Kwon
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
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Schorn C, Hildebrandt N, Schneider M, Schaub S. Anomalies of the aortic arch in dogs: evaluation with the use of multidetector computed tomography angiography and proposal of an extended classification scheme. BMC Vet Res 2021; 17:387. [PMID: 34915887 PMCID: PMC8675507 DOI: 10.1186/s12917-021-03101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congenital anomalies of the aortic arch are important as they may be associated with vascular ring anomalies. The most common vascular ring anomaly in dogs is a persistent right aortic arch. However, published data of the distribution of the different types of vascular ring anomalies and other aortic arch anomalies are lacking. The objective of this retrospective descriptive study was to evaluate both the prevalence and the different types of aortic arch anomalies that can be detected using thoracic computed tomography (CT) examination. Archived thoracic CT examinations acquired between 2008 and 2020 at a single institution were retrospectively evaluated by 2 evaluators for the prevalence and type of aortic arch anomaly. Breed, age, and presenting complaint were obtained from the medical record system. RESULTS A total of 213 CT studies were evaluated; 21 dogs (21/213, 9.9%) showed a right aortic arch and a left ligamentum arteriosum with compression of the esophagus. The following incidental additional findings were detected: aberrant left subclavian artery (17/21, 76.2%), branching from the persistent ductus arteriosus (PDA) (1/21, 4.8%), left-sided brachiocephalic trunk (3/21, 14.3%), bicarotid trunk (17/21, 81.0%), double aortic arch (1/21, 4.8%). One hundred ninety two dogs (192/213, 90.1%) showed a left aortic arch without esophageal compression. The following additional abnormalities were obtained in those dogs with left aortic arch: aberrant right subclavian artery (3/192, 1.6%) without clinical signs of esophageal compression, aberrant vessel branching from the aorta into the left caudal lung lobe (2/192, 1.0%), focal dilatation of the left or right subclavian artery (2/192, 1.0%), bicarotid trunk (1/192, 0.5%). CONCLUSION Similar to previous studies an aberrant left subclavian artery is the most common additional finding in dogs with persistent right aortic arch. Newly, a left-sided brachiocephalic trunk was identified in 14.3% of the dogs with a persistent right aortic arch; no additional compression was caused by the left sided brachiocephalic trunk. Similarly, aberrant right subclavian artery can be an incidental CT finding without causing compression of the esophagus.
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Affiliation(s)
- Christiane Schorn
- Justus-Liebig University Clinic for Small Animals, Frankfurter Strasse 114, 35390, Giessen, Germany.
| | - Nicolai Hildebrandt
- Justus-Liebig University Clinic for Small Animals, Frankfurter Strasse 114, 35390, Giessen, Germany
| | - Matthias Schneider
- Justus-Liebig University Clinic for Small Animals, Frankfurter Strasse 114, 35390, Giessen, Germany
| | - Sebastian Schaub
- Justus-Liebig University Clinic for Small Animals, Frankfurter Strasse 114, 35390, Giessen, Germany
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71
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Kamel DW, Abdelhameed AM, Mohammad SA, Abbas SN. CT of cardiac and extracardiac vascular anomalies: embryological implications. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00616-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Congenital heart disease (CHD) is the most common neonatal anomaly. Extracardiac findings are commonly associated with CHD. It is mandatory to evaluate extracardiac structures for potential associated abnormalities that might impact the surgical planning for these patients. The purpose of this study was to determine the extracardiac abnormalities that could associate cardiac anomalies and to give insights into their embryological aberrations.
Results
Thirty-two pediatric patients (22 males and 10 females) underwent CT angiography to assess CHD. Diagnosis of the CHD and associated extracardiac findings were recorded and tabulated by organ system and type of CHD. Retrospective ECG-gated low-peak kilovoltage (80Kvp) technique was used on 128MDCT GE machine. Patients were diagnosed according to their CHD into four groups: chamber anomalies 90%, septal anomalies 81.3%, conotruncal anomalies 59.4%, and valvular anomalies 59.4%. Extracardiac findings were found in 28 patients (87.5%) with a total of 76 findings. Vascular findings were the most prevalent as 50 vascular findings were observed in 28 patients. Aortic anomalies were the commonest vascular anomalies. Fourteen thoracic findings were observed in 12 patients; of them lung consolidation patches were the most common and 12 abdominal findings were found in seven patients, most of findings were related to situs abnormalities.
Conclusion
Extracardiac abnormalities especially vascular anomalies are commonly associating CHD. Along with genetic basis, aberrations in dynamics of blood flow could represent possible causes of this association.
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Koziej M, Bonczar M, Ostrowski P, Piątek-Koziej K, Bonczar T, Pasternak A, Dziedzic M, Walocha J. Termination points of the facial artery-A meta-analysis. Clin Anat 2021; 35:469-476. [PMID: 34851525 DOI: 10.1002/ca.23817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/28/2021] [Accepted: 11/28/2021] [Indexed: 11/11/2022]
Abstract
The facial artery (FA) is the main artery supplying the anterior face, making this artery a very important structure to consider while performing plastic and reconstructive procedures. The literature shows discrepancies in anatomical classifications and the frequency of occurrence of individual variations. Therefore, the goal of this meta-analysis is to provide surgeons with helpful knowledge about the variety of the termination of FA. Articles with data about the termination of the FA were found in major online medical databases such as PubMed, Scopus, Embase, Web Of Science, and Cochrane Library. A total of 1346 articles were initially evaluated by two independent reviewers. Out of those, 24 articles matched the required criteria, and were used in this meta-analysis. A total of 2119 studied FAs were included in this study. The FA termination patterns were divided into five previously classified types. The data show that the FA terminates most frequently as the lateral nasal or angular artery with the prevalence for this group being 69.81% (95% confidence interval [CI]: 59.83%-78.94%). Authors believe that this is the most accurate and up to date study regarding termination patterns and the prevalence of the FA. The results of this meta-analysis could provide a helpful tool for surgeons preforming plastic and cosmetic procedures, especially when injecting dermal fillers or choosing and preforming facial flaps. Detailed anatomical knowledge about the FA may prevent potential surgical complications.
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Affiliation(s)
- Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Patryk Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Tomasz Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Artur Pasternak
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Martyna Dziedzic
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
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Moustafa SAEF, Hussein MM, Sultan AA, Bilal MMZ, El Gamal MAF, Sobh DM. Three steps approach for preoperative evaluation of tetralogy of Fallot patients: role of 128 MDCT. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021; 52:47. [DOI: 10.1186/s43055-021-00418-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/13/2021] [Indexed: 09/02/2023] Open
Abstract
Abstract
Background
Tetralogy of Fallot is the most common congenital cyanotic heart disease. Advances in surgical repair recently facilitate survival of the affected patients into adulthood with good quality of life. Despite imaging plays crucial role in diagnosis of TOF patients, no single diagnostic modality suffices for complete evaluation of TOF. Thus, different diagnostic tools should be used alone or in combination according to patient’s clinical question. This study aims to find out the agreement between the echocardiography and MDCT in evaluation of TOF patients prior to surgical repair.
Results
Three-step approach used in scanning TOF patients. Firstly, classic TOF findings, MDCT was comparable to echocardiography in overriding aorta (k = 0.6), VSD (k = 0.8), RVH (k = 0.4), and sub valvular pulmonary stenosis (k = 0.6). Echocardiography is superior to MDCT in evaluation of valvular stenosis (k = 0.4). MDCT was superior to echocardiography in supravalvular pulmonary stenosis. Secondary, surgical relevant findings, McGoon ratio calculated in 94.2%, small and major APCs in 45.5% and 28.5% respectively, PDA in 35% and anomalous coronary artery in 5.1%. Thirdly, other TOF-associated anomalies, common: ASD (34.3%) and RAA (28.3%), and persistent LSVC (10.3%). Uncommon: situs ambiguous (2.5 %), PAPVR (1.2%), and IVC anomalies (3.8%). MDCT was superior to echocardiography in surgical relevant findings and other TOF-associated anomalies.
Conclusion
MDCT is a crucial imaging tool for extra cardiac evaluation of TOF patients prior to surgical repair.
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Abstract
Vascular rings are congenital aortic arch anomalies that lead to compression of the trachea or esophagus. The goal of this review is to summarize our current recommendations for the management of patients with a diagnosis of a vascular ring. We review the history, classification methods, and epidemiology of the various types of vascular rings. We then propose a management strategy for the relatively new paradigm of fetal diagnosis, including the management of asymptomatic vascular rings. Finally, we finish with a review of the operative techniques and outcomes for the four main categories of vascular rings.
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75
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Isolated absent right pulmonary artery in an infant with 22q11 deletion. Cardiol Young 2021; 31:1850-1852. [PMID: 33879276 DOI: 10.1017/s1047951121001487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
DiGeorge syndrome is a rare spectrum of disorder affecting structures derived from third and fourth pharyngeal pouches characterised by aplasia or hypoplasia of thymus and parathyroid glands, and conotruncal anomalies. Presentation includes infants with hypocalcemic seizures, CHD, or recurrent infection. This case report illustrates a unique combination of proximal interruption of right pulmonary artery and aberrant right subclavian artery in a 3-month-old infant who was subsequently diagnosed as DiGeorge syndrome. This constellation of vascular anomalies in an infant with DiGeorge syndrome has not been previously reported in the literature.
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76
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Kloth C, Brunner H, Krumm P. [58-year-old patient with conspicuous mediastinal finding]. Dtsch Med Wochenschr 2021; 146:1389-1390. [PMID: 34670280 DOI: 10.1055/a-1624-1861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Christopher Kloth
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinikum Ulm, Ulm
| | - Horst Brunner
- Klinik für Diagnostische und Interventionelle Radiologie, Uniklinikum Ulm, Ulm
| | - Patrick Krumm
- Abteilung für Diagnostische und Interventionelle Radiologie, Uniklinik Tübingen, Tübingen
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Khasawneh RR, Kist R, Queen R, Hussain R, Coxhead J, Schneider JE, Mohun TJ, Zaffran S, Peters H, Phillips HM, Bamforth SD. Msx1 haploinsufficiency modifies the Pax9-deficient cardiovascular phenotype. BMC DEVELOPMENTAL BIOLOGY 2021; 21:14. [PMID: 34615475 PMCID: PMC8493722 DOI: 10.1186/s12861-021-00245-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/23/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Successful embryogenesis relies on the coordinated interaction between genes and tissues. The transcription factors Pax9 and Msx1 genetically interact during mouse craniofacial morphogenesis, and mice deficient for either gene display abnormal tooth and palate development. Pax9 is expressed specifically in the pharyngeal endoderm at mid-embryogenesis, and mice deficient for Pax9 on a C57Bl/6 genetic background also have cardiovascular defects affecting the outflow tract and aortic arch arteries giving double-outlet right ventricle, absent common carotid arteries and interruption of the aortic arch. RESULTS In this study we have investigated both the effect of a different genetic background and Msx1 haploinsufficiency on the presentation of the Pax9-deficient cardiovascular phenotype. Compared to mice on a C57Bl/6 background, congenic CD1-Pax9-/- mice displayed a significantly reduced incidence of outflow tract defects but aortic arch defects were unchanged. Pax9-/- mice with Msx1 haploinsufficiency, however, have a reduced incidence of interrupted aortic arch, but more cases with cervical origins of the right subclavian artery and aortic arch, than seen in Pax9-/- mice. This alteration in arch artery defects was accompanied by a rescue in third pharyngeal arch neural crest cell migration and smooth muscle cell coverage of the third pharyngeal arch arteries. Although this change in phenotype could theoretically be compatible with post-natal survival, using tissue-specific inactivation of Pax9 to maintain correct palate development whilst inducing the cardiovascular defects was unable to prevent postnatal death in the mutant mice. Hyoid bone and thyroid cartilage formation were abnormal in Pax9-/- mice. CONCLUSIONS Msx1 haploinsufficiency mitigates the arch artery defects in Pax9-/- mice, potentially by maintaining the survival of the 3rd arch artery through unimpaired migration of neural crest cells to the third pharyngeal arches. With the neural crest cell derived hyoid bone and thyroid cartilage also being defective in Pax9-/- mice, we speculate that the pharyngeal endoderm is a key signalling centre that impacts on neural crest cell behaviour highlighting the ability of cells in different tissues to act synergistically or antagonistically during embryo development.
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Affiliation(s)
- Ramada R. Khasawneh
- grid.419328.50000 0000 9225 6820Newcastle University Biosciences Institute, Centre for Life, Newcastle, NE1 3BZ UK ,grid.14440.350000 0004 0622 5497Present Address: Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Ralf Kist
- grid.419328.50000 0000 9225 6820Newcastle University Biosciences Institute, Centre for Life, Newcastle, NE1 3BZ UK ,grid.1006.70000 0001 0462 7212School of Dental Sciences, Newcastle University, Newcastle, NE2 4BW UK
| | - Rachel Queen
- grid.1006.70000 0001 0462 7212Bioinformatics Support Unit, Newcastle University, Newcastle, NE1 3BZ UK
| | - Rafiqul Hussain
- grid.1006.70000 0001 0462 7212Genomics Core Facility, Newcastle University, Newcastle, NE1 3BZ UK
| | - Jonathan Coxhead
- grid.1006.70000 0001 0462 7212Genomics Core Facility, Newcastle University, Newcastle, NE1 3BZ UK
| | - Jürgen E. Schneider
- grid.9909.90000 0004 1936 8403Biomedical Imaging, University of Leeds, Leeds, LS2 9JT UK
| | - Timothy J. Mohun
- grid.451388.30000 0004 1795 1830The Francis Crick Institute, London, NW1 1AT UK
| | - Stéphane Zaffran
- grid.5399.60000 0001 2176 4817INSERM, Marseille Medical Genetics, U1251, Aix Marseille University, Marseille, France
| | - Heiko Peters
- grid.419328.50000 0000 9225 6820Newcastle University Biosciences Institute, Centre for Life, Newcastle, NE1 3BZ UK
| | - Helen M. Phillips
- grid.419328.50000 0000 9225 6820Newcastle University Biosciences Institute, Centre for Life, Newcastle, NE1 3BZ UK
| | - Simon D. Bamforth
- grid.419328.50000 0000 9225 6820Newcastle University Biosciences Institute, Centre for Life, Newcastle, NE1 3BZ UK
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Cohen-Mussali S, Leon M, Ramírez-Cerda C, Cobos-Gonzalez E, Valdes-Flores J. Hybrid Procedure for Coexistence of Coarctation of the Aorta and Aberrant Right Subclavian Artery: A Case Report and Review of the Literature. Vasc Endovascular Surg 2021; 56:190-195. [PMID: 34569376 DOI: 10.1177/15385744211048309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Coarctation of the aorta (CoA) can either present alone as an isolated condition or in association with other aortic arch or cardiac anomalies. One percent of patients with CoA have concomitant an aberrant right subclavian artery (ARSA). Purpose: We report the case of a 35-year-old woman with uncontrolled hypertension who was found to have CoA and ARSA. Results: The patient was treated successfully using a hybrid procedure comprising ARSA ligation and subclavian to carotid transposition, followed by thoracic endovascular aortic repair. Conclusions: Patients with CoA should be carefully studied, considering the possible coexistence of other congenital aortic arch defects, such as ARSA. Hybrid repair is a safe and effective approach for this condition.
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Affiliation(s)
| | - Monica Leon
- 61188Centro Medico ABC, Ciudad de Mexico, Mexico
| | | | - Ernesto Cobos-Gonzalez
- 61188Centro Medico ABC, Ciudad de Mexico, Mexico.,Hospital Diomed, Ciudad de Mexico, Mexico
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79
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Mantri SS, Raju B, Jumah F, Rallo MS, Nagaraj A, Khandelwal P, Roychowdhury S, Kung D, Nanda A, Gupta G. Aortic arch anomalies, embryology and their relevance in neuro-interventional surgery and stroke: A review. Interv Neuroradiol 2021; 28:489-498. [PMID: 34516323 PMCID: PMC9326868 DOI: 10.1177/15910199211039924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Congenital aortic arch anomalies are commonly encountered during neurointerventional procedures. While some anomalies are identified at an early age, many are incidentally discovered later in adulthood during endovascular evaluations or interventions. Proper understanding of the normal arch anatomy and its variants is pivotal to safely navigate normal aortic arch branches and to negotiate the catheter through anomalies during neurointerventional procedures. This is particularly relevant in the increasingly "transradial first" culture of neurointerventional surgery. Moreover, some of these anomalies have a peculiar predilection for complications including aneurysm formation, dissection, and rupture during the procedure. Therefore, an understanding of these anomalies, their underlying embryological basis and associations, and pattern of circulation will help endovascular neurosurgeons and interventional radiologists navigate with confidence and consider relevant pathologic associations that may inform risk of cerebrovascular disease. METHODS Here, we present a brief review of the basic embryology of the common anomalies of the aortic arch along with their neurological significances and discuss, through illustrative cases, the association of aortic arch anomalies with cerebral vascular pathology. CONCLUSIONS Understanding the aortic arch anomalies and its embryological basis is essential to safely navigate the cerebral vascular system during neurointerventional surgeries.
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Affiliation(s)
- Shilpa S Mantri
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Bharath Raju
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Fareed Jumah
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Michael S Rallo
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Anmol Nagaraj
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Priyank Khandelwal
- Department of Neurosurgery, 242612New Jersey Medical School & University Hospital, USA
| | - Sudipta Roychowdhury
- Department of Neuroradiology, 12287 Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - David Kung
- Department of Neurosurgery, 242612New Jersey Medical School & University Hospital, USA
| | - Anil Nanda
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
| | - Gaurav Gupta
- Department of Neurosurgery, 43982Rutgers-Robert Wood Johnson Medical School & University Hospital, USA
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Belkouchi L, Outznit M, El Harras Y, Allali N, Chat L, El Haddad S. Balanced Double Aortic Arch Causing Acute Tracheal Compression. Glob Pediatr Health 2021; 8:2333794X211039649. [PMID: 34485623 PMCID: PMC8411611 DOI: 10.1177/2333794x211039649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/25/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Lina Belkouchi
- Children Hospital of Rabat, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco
| | - Mustapha Outznit
- Children Hospital of Rabat, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco
| | - Yahya El Harras
- Children Hospital of Rabat, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco
| | - Nazik Allali
- Children Hospital of Rabat, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco
| | - Latifa Chat
- Children Hospital of Rabat, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco
| | - Siham El Haddad
- Children Hospital of Rabat, Ibn Sina University Hospital, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco
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81
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Ahmed AN, Abozeed M, Aziz MU, Singh SP. Role of computed tomography in adult congenital heart disease: A review. J Med Imaging Radiat Sci 2021; 52:S88-S109. [PMID: 34483084 DOI: 10.1016/j.jmir.2021.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/30/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022]
Abstract
Due to advances in cardiac surgery, perioperative care and transcatheter interventions, the majority of infants with congenital heart disease (CHD) now survive and reach adulthood. Transthoracic Echocardiography (TTE) is considered the primary imaging modality in evaluation of patients with CHD. However, in adults it can be limited due to several reasons. Although cardiac magnetic resonance (CMR) is extremely useful in evaluating cardiac morphology and function, it is not widely available, takes a long time to obtain images, and cannot be done in severely ill patients or patients that have claustrophobia. Due to high spatial and temporal resolution, isotropic imaging fast imaging and wide availability, multidetector computed tomography (MDCT) has emerged as an excellent alternative modality in the evaluation of adult congenital heart disease (ACHD). It can be performed on patients with hardware and those with claustrophobia, due to shorter image acquisition time. In this article, the commonly encountered congenital heart disorders in adults are reviewed, whether incidentally discovered on a computed tomography (CT), on a CT done to evaluate sequela of unknown CHD, or known treated CHD. To appropriately perform and evaluate CT imaging for postoperative correction or palliation congenital heart disease in adults, the imager should know the detailed cardiac anatomy, details of the operative technique used, and be familiar with the common short and long term post-operative complications.
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Affiliation(s)
- Asmaa Naguib Ahmed
- The University of Alabama at Birmingham, Department of Diagnostic Radiology, 619 South 19th Street, Birmingham, AL JTN370, United States.
| | - Mostafa Abozeed
- The University of Alabama at Birmingham, Department of Diagnostic Radiology, 619 South 19th Street, Birmingham, AL JTN370, United States
| | - Muhammad Usman Aziz
- The University of Alabama at Birmingham, Department of Diagnostic Radiology, 619 South 19th Street, Birmingham, AL JTN370, United States
| | - Satinder P Singh
- The University of Alabama at Birmingham, Department of Diagnostic Radiology, 619 South 19th Street, Birmingham, AL JTN370, United States
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Murakami AN, Croti UA, Cajueiro FCM, Arteaga G, Pike RB, Moscardini AC, Marchi CHD, Cardoso MRR, Santos FCGB, Borim BC. Isolated Coarctation Repair in Neonates and Infants Through Left Thoracotomy: Short-Term Outcomes. Braz J Cardiovasc Surg 2021; 36:461-467. [PMID: 34617427 PMCID: PMC8522329 DOI: 10.21470/1678-9741-2020-0554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction End-to-end anastomosis and extended end-to-end anastomosis are typically
used as surgical approaches to coarctation of the aorta (CoAo) with access
at the subclavian artery or an interposition graft. The objective of this
study is to analyze the impact of surgical and anatomical characteristics
and techniques on early outcomes after surgical treatment of CoAo without
cardiopulmonary bypass through left thoracotomy. Methods This is a quantitative, observational, and cross-sectional analysis of
patients who underwent repair of CoAo between July 1, 2010 and December 31,
2017. Seventy-two patients were divided into three groups according to age:
34 in group A (≤ 30 days), 24 in group B (31 days to one year), and
14 in group C (≥ 1 year to 18 years). Results Aortic arch hypoplasia was associated in 30.8% of the cases, followed by
ventricular septal defect (13.2%). The preductal location was more frequent
in group A (73.5%), ductal in group B (41.7%), and postductal in group C
(71.4%). Long coarcted segment was predominant in groups A and C (61.8% and
71.4%, respectively) and localized in group B (58.3%). Extended end-to-end
anastomosis technique was prevalent (68%), mainly in group A (91.2%).
Mortality in 30 days was 1.4%. Conclusion Most of the patients were children under one year of age, and extended
end-to-end anastomosis was the most used technique, secondary to arch
hypoplasia. Further, overall mortality was low in spite of moderate
morbidity in the first 30 postoperative days.
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Affiliation(s)
- Alexandre Noboru Murakami
- Cardiology Surgery Department, Serviço de Cirurgia Cardíaca do Norte do Paraná, Universidade Estadual de Londrina (UEL), Londrina, Paraná, Brazil
| | - Ulisses Alexandre Croti
- Pediatric Cardiology and Cardiovascular Surgery Department, Serviço de Cardiologia e Cirurgia Cardiovascular Pediátrica de São José do Rio Preto, Hospital da Criança e Maternidade de São José do Rio Preto, Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME) and Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Francisco Candido Monteiro Cajueiro
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Grace Arteaga
- Department of Pediatric and Adolescent Medicine, Children's Center, Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Roxann Barnes Pike
- Department of Pediatric and Adolescent Medicine, Children's Center, Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Airton Camacho Moscardini
- Pediatric Cardiology and Cardiovascular Surgery Department, Serviço de Cardiologia e Cirurgia Cardiovascular Pediátrica de São José do Rio Preto, Hospital da Criança e Maternidade de São José do Rio Preto, Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME) and Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Carlos Henrique De Marchi
- Pediatric Cardiology and Cardiovascular Surgery Department, Serviço de Cardiologia e Cirurgia Cardiovascular Pediátrica de São José do Rio Preto, Hospital da Criança e Maternidade de São José do Rio Preto, Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME) and Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Mariana Ribeiro Rodero Cardoso
- Pediatric Cardiology and Cardiovascular Surgery Department, Serviço de Cardiologia e Cirurgia Cardiovascular Pediátrica de São José do Rio Preto, Hospital da Criança e Maternidade de São José do Rio Preto, Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME) and Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Fernando Cesar Gimenes Barbosa Santos
- Pediatric Cardiology and Cardiovascular Surgery Department, Serviço de Cardiologia e Cirurgia Cardiovascular Pediátrica de São José do Rio Preto, Hospital da Criança e Maternidade de São José do Rio Preto, Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME) and Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Bruna Cury Borim
- Pediatric Cardiology and Cardiovascular Surgery Department, Serviço de Cardiologia e Cirurgia Cardiovascular Pediátrica de São José do Rio Preto, Hospital da Criança e Maternidade de São José do Rio Preto, Fundação Faculdade Regional de Medicina de São José do Rio Preto (FUNFARME) and Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
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83
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Right arch with prostaglandin-dependent coarctation and aberrant left carotid artery in a 22q11.2 deletion infant. Cardiol Young 2021; 31:1350-1352. [PMID: 33618783 DOI: 10.1017/s1047951121000561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Right aortic arch in association with coarctation of the aorta and vascular ring is a rare anatomy. We present an infant with chromosome 22q11.2 deletion, who had the right aortic arch with retroesophageal aberrant left subclavian artery and left internal carotid artery. The left external carotid artery and right common carotid artery originated together from the ascending aorta as a bovine branch. The infant also had severe coarctation, which was prostaglandin dependent.
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84
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Han J, Zhang Y, Gu X, Liu X, Sun L, Zhao Y, Wang J, He Y. The Differential Diagnosis of Double Aortic Arch and Right Aortic Arch with Mirror-Image Branches in the Fetus: A Potential Novel Method. Pediatr Cardiol 2021; 42:1405-1409. [PMID: 34258648 DOI: 10.1007/s00246-021-02625-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/21/2021] [Indexed: 11/29/2022]
Abstract
The objective of this study was to explore a new method for the differential diagnosis between fetal double aortic arch (DAA) and right aortic arch with mirror-image branches (RAA-MB). Clinical data and prenatal echocardiographic features of the DAA (n = 22) and RAA-MB (n = 65) confirmed by postnatal or autopsy findings were analyzed retrospectively. The angles between the two aortic arches in the DAA group and between the right aortic arch and the mirror branch were measured. The differences between the two groups and differential diagnosis value of the angles were compared and analyzed based on the receiver operating characteristic curve. The proportion of left-sided ductal arteriosus (100%) was higher in the DAA group than that (32.3%) in the RAA-MB group, (P < 0.05). The proportion of conotruncal anomalies is higher in the RAA-MB group (64.6%) than in the DAA group (18.2%) (P < 0.05). There was a significant difference in the angles between the groups (DAA: 50.3° ± 8.3° vs. RAA-MB: 82.9° ± 13.8°) (P < 0.01). When the cutoff value was 62.8°, the sensitivity and specificity of the differential diagnosis were 95.5% and 96.9%, respectively. Distinguishing the angle measurement between DAA and RAA-MB is helpful in prenatal prognosis. We recommend a cutoff value of 62.8°.
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Affiliation(s)
- Jiancheng Han
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University; Beijing Key Laboratory of Maternal-Fetus Medicine in Fetal Heart Disease (BZ0308), No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Ye Zhang
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University; Beijing Key Laboratory of Maternal-Fetus Medicine in Fetal Heart Disease (BZ0308), No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Xiaoyan Gu
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University; Beijing Key Laboratory of Maternal-Fetus Medicine in Fetal Heart Disease (BZ0308), No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Xiaowei Liu
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University; Beijing Key Laboratory of Maternal-Fetus Medicine in Fetal Heart Disease (BZ0308), No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Lin Sun
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University; Beijing Key Laboratory of Maternal-Fetus Medicine in Fetal Heart Disease (BZ0308), No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Ying Zhao
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University; Beijing Key Laboratory of Maternal-Fetus Medicine in Fetal Heart Disease (BZ0308), No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Jingyi Wang
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University; Beijing Key Laboratory of Maternal-Fetus Medicine in Fetal Heart Disease (BZ0308), No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, People's Republic of China
| | - Yihua He
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University; Beijing Key Laboratory of Maternal-Fetus Medicine in Fetal Heart Disease (BZ0308), No. 2, Anzhen Road, Chaoyang District, Beijing, 100029, People's Republic of China.
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85
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Fetal Blood Flow and Genetic Mutations in Conotruncal Congenital Heart Disease. J Cardiovasc Dev Dis 2021; 8:jcdd8080090. [PMID: 34436232 PMCID: PMC8397097 DOI: 10.3390/jcdd8080090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/19/2022] Open
Abstract
In congenital heart disease, the presence of structural defects affects blood flow in the heart and circulation. However, because the fetal circulation bypasses the lungs, fetuses with cyanotic heart defects can survive in utero but need prompt intervention to survive after birth. Tetralogy of Fallot and persistent truncus arteriosus are two of the most significant conotruncal heart defects. In both defects, blood access to the lungs is restricted or non-existent, and babies with these critical conditions need intervention right after birth. While there are known genetic mutations that lead to these critical heart defects, early perturbations in blood flow can independently lead to critical heart defects. In this paper, we start by comparing the fetal circulation with the neonatal and adult circulation, and reviewing how altered fetal blood flow can be used as a diagnostic tool to plan interventions. We then look at known factors that lead to tetralogy of Fallot and persistent truncus arteriosus: namely early perturbations in blood flow and mutations within VEGF-related pathways. The interplay between physical and genetic factors means that any one alteration can cause significant disruptions during development and underscore our need to better understand the effects of both blood flow and flow-responsive genes.
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86
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Kumar NA, Usman N, Rajan K, Gaude YK. Esophageal Cancer and Double Aortic Arch: Right-Sided Thoracoscopic Esophagectomy and Reconstruction. J Gastrointest Cancer 2021; 52:355-358. [PMID: 32728992 DOI: 10.1007/s12029-020-00469-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Naveena An Kumar
- Department of Surgical Oncology, Manipal Comprehensive Cancer Care Center, Kasturba, Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India.
| | - Nawaz Usman
- Department of Surgical Oncology, Manipal Comprehensive Cancer Care Center, Kasturba, Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
| | - Keshava Rajan
- Department of Surgical Oncology, Manipal Comprehensive Cancer Care Center, Kasturba, Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
| | - Yogesh K Gaude
- Department of Anesthesiology, Kasturba Medical College, Manipal Academy of Higher, Education (MAHE), Manipal, Karnataka, 576104, India
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87
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Rao GN, Sainudeen SS, Mohamed S, Alkuwari ME, Alkhulaifi AM, Carr CS. Right aortic arch with mirror image branching found incidentally during coronary surgery. SAGE Open Med Case Rep 2021; 9:2050313X211030014. [PMID: 34290869 PMCID: PMC8274131 DOI: 10.1177/2050313x211030014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 06/16/2021] [Indexed: 11/21/2022] Open
Abstract
Right aortic arch with a left innominate (brachiocephalic) artery with mirror image branching (RAMI) is a rare congenital anomaly, and it is unusual to diagnose it in adulthood. There are very few cases of cardiac surgery being performed for acquired cardiac disease on a congenital RAMI patient. We present a patient who had an incidental finding of a RAMI anomaly found during coronary artery bypass surgery. Post-operatively computerised tomography showed both his congenital lesions and his bypass grafts.
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Affiliation(s)
- Girish N Rao
- Department of Cardiothoracic Surgery, Heart Hospital, Doha, Qatar
| | | | - Samah Mohamed
- Department of Radiology, Heart Hospital, Doha, Qatar
| | | | | | - Cornelia S Carr
- Department of Cardiothoracic Surgery, Heart Hospital, Doha, Qatar
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88
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Kanwal D, Khalil S, Attia K, Fam M, Arakkal M. Kommerell’s diverticulum with right-sided aortic arch and anomalous origin of neck vessels: Uncommon imaging finding in neonate with cyanosis. BJR Case Rep 2021; 7:20200173. [PMID: 35047193 PMCID: PMC8749396 DOI: 10.1259/bjrcr.20200173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/25/2021] [Accepted: 04/13/2021] [Indexed: 11/05/2022] Open
Abstract
Kommerell diverticulum is a rare developmental anomaly of aortic arch. It is most frequently seen with right-sided aortic arch and aberrant left subclavian artery or ligamentum arteriosum, which have a significant role in completing a vascular ring. However, aberrant origin of neck vessels along with it is not commonly seen. The signs and symptoms vary depending on the severity. The paediatric patients usually present early due to compression of mediastinal structures such as trachea or oesophagus.
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Affiliation(s)
- Darakhshan Kanwal
- Department of Radiology, Al Qassimi Women and children Hospital, Sharjah, United Arab Emirates
| | - Safaa Khalil
- Department of Radiology, Al Qassimi Women and children Hospital, Sharjah, United Arab Emirates
| | - Khaled Attia
- Department of Radiology, Al Kuwait Hospital, Sharjah, United Arab Emirates
| | - Maged Fam
- Department of Radiology, Al Qassimi Hospital, Sharjah, United Arab Emirates
| | - Mohammad Arakkal
- Department of Radiology, Al Qassimi Hospital, Sharjah, United Arab Emirates
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89
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Saran N, Pochettino A. Management of Coarctation and Aortic Arch Anomalies in the Adult. Semin Thorac Cardiovasc Surg 2021; 33:1061-1068. [PMID: 34091017 DOI: 10.1053/j.semtcvs.2021.04.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/08/2021] [Accepted: 04/28/2021] [Indexed: 11/11/2022]
Abstract
Congenital Aortic arch malformations are rare in adults. Often they present with hypertension or tracheoesophageal compression. The involved anatomy is dependent on the sidedness of the aortic arch and the variable development of the primitive pharyngeal arches. Sternotomy and thoracotomy are usually required for surgical repair, while need for circulatory arrest is not uncommon. With caution and adequate planning, surgery can be carried out with satisfactory results.
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Affiliation(s)
- Nishant Saran
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester
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90
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Charbonneau P, Fabre D, Le Bret E, Mercier O, Crutu A, Haulon S, Fadel É. A Ten-year Single-center Surgical Experience With Symptomatic Complete Vascular Rings. Ann Vasc Surg 2021; 78:70-76. [PMID: 34175416 DOI: 10.1016/j.avsg.2021.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/17/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Limited data exist on the management of complete vascular rings (CVR) in adults. We reviewed our institution's surgical experience in the management of these patients. METHODS Between 2010 and 2019, all adult patients that underwent a thoracotomy for a CVR repair were identified. We performed a retrospective medical record review of these patients to characterize their demographics and outcomes. RESULTS Among the 5 patients identified (3 females, 2 males; Mean age 50 ± 9 years), anatomic variants were right arch and Kommerell diverticulum (KD) in 3 (60%) and double aortic arch in 2 (40%) patients. Indications for operation included dysphagia in 4 (80%), respiratory symptoms in 3 (60%) and aneurysmal KD in 1 (20%) patient. Two right aortic arch exclusion, 1 ligamentum arteriosum (LA) division, 1 LA division combined with a KD resection and 2 aortic reconstructions with interposition Dacron graft under partial cardiopulmonary bypass, were performed. Two carotid-subclavian artery transpositions prior to the thoracotomy were done. The postoperative length of stay was 10.0 (IQR 7.3-14.8) days. One reoperation for chylothorax and 1 for symptoms recurrence were performed for the same patient. Over a follow-up period of 1.4 (IQR 0.4-7.0) years, no mortality or major postoperative complications occurred. At their last follow-up visit, all patients reported no related remaining symptoms, except for persisting mild asthma in 1 patient. CONCLUSIONS Open repair of CVR in adults can be performed safely with low complication rate. Symptoms improved in all patients after definitive repair.
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Affiliation(s)
- Philippe Charbonneau
- Department of Thoracic and Vascular Surgery, Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France.
| | - Dominique Fabre
- Department of Thoracic and Vascular Surgery, Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Emmanuel Le Bret
- Department of Thoracic and Vascular Surgery, Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery, Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Adrian Crutu
- Department of Thoracic and Vascular Surgery, Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Stéphan Haulon
- Department of Thoracic and Vascular Surgery, Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
| | - Élie Fadel
- Department of Thoracic and Vascular Surgery, Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris Saclay, Paris, France
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91
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Pereira AR, Grangeiro CHP, Pereira LC, Leão LL, Guarato JCC. OCULO-AURICULO-VERTEBRAL SPECTRUM ASSOCIATED WITH ABERRANT SUBCLAVIAN ARTERY IN AN INFANT WITH RECURRENT RESPIRATORY DISTRESS. REVISTA PAULISTA DE PEDIATRIA 2021; 40:e2020153. [PMID: 34076202 PMCID: PMC8240622 DOI: 10.1590/1984-0462/2022/40/2020153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/17/2020] [Indexed: 11/23/2022]
Abstract
Objective: To describe an infant with craniofacial microsomia and recurrent respiratory distress associated with aberrant right subclavian artery in order to review its most frequent congenital anomalies and alert the pediatrician to its rarer and more severe complications. Case description: This case report involves an 18-month-old male infant, only son of non-consanguineous parents. At birth, the child presented craniofacial dysmorphisms (facial asymmetry, maxillary and mandibular hypoplasia, macrostomia, grade 3 microtia, and accessory preauricular tag) restricted to the right side of the face. Additional tests showed asymmetric hypoplasia of facial structures and thoracic hemivertebrae. No cytogenetic or cytogenomic abnormalities were identified. The patient progressed to several episodes of respiratory distress, stridor, and nausea, even after undergoing gastrostomy and tracheostomy in the neonatal period. Investigation guided by respiratory symptoms identified compression of the esophagus and trachea by an aberrant right subclavian artery. After surgical correction of this anomaly, the infant has not presented respiratory symptoms and remains under multidisciplinary follow-up, seeking rehabilitation. Comments: Craniofacial microsomia presents a wide phenotypic variability compared to both craniofacial and extracraniofacial malformations. The latter, similarly to the aberrant right subclavian artery, is rarer and associated with morbidity and mortality. The main contribution of this case report was the identification of a rare anomaly, integrating a set of malformations of a relatively common condition, responsible for a very frequent complaint in pediatric care.
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92
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Liu Y, Zhang H, Ren J, Cao A, Guo J, Liu B, Bao M, Zheng C. Persistent fifth aortic arch: a single-center experience, case series. Transl Pediatr 2021; 10:1566-1572. [PMID: 34295771 PMCID: PMC8261588 DOI: 10.21037/tp-20-433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/06/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Persistent fifth aortic arch (PFAA) is an extremely rare congenital cardiovascular malformation and there is limited data in the literature. The objective of this study is to enhance our understanding and diagnosis of PFAA from echocardiography and computed tomography angiography (CTA) findings, and to evaluate the application of echocardiography in the diagnosis of PFAA. METHODS We retrospectively reviewed five cases of PFAA diagnosed from October 2016 to September 2019 at the Affiliated Children's Hospital of Capital Institute of Pediatrics. We described their diagnosis by echocardiography and CTA findings, and medical history. RESULTS Five cases of PFAA were identified in the study. Patients aged from 3 to 48 months and weighed from 4 to 12 kg presented different clinical symptoms upon clinical examination. All the patients completed a primary echocardiographic assessment; however, the first two patients were misdiagnosed by echocardiography and was confirmed by supplemental CTA while the other three patients were directly diagnosed by echocardiography. Surgery was necessary for three patients, two of whom accepted and one refused. The other two patients only needed a follow-up assessment, which showed good results. CONCLUSIONS The clinical manifestation of PFAA in our patient population was atypical, and their diagnosis depended on the use of echocardiography. In the case of uncertainty, the final diagnosis was confirmed by CTA. Although the nomenclature and embryonic origin of PFAA remains controversial, the accurate diagnosis of aortic arch abnormalities and associated malformations are imperative for time-sensitive treatments.
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Affiliation(s)
- Yuanyuan Liu
- Division of Cardiology, the Affiliated Children's Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Hui Zhang
- Division of Cardiac Surgery, the Affiliated Children's Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Jun Ren
- Division of Cardiology, the Affiliated Children's Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Aimei Cao
- Division of Cardiology, the Affiliated Children's Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Jinghui Guo
- Division of Cardiology, the Affiliated Children's Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Bo Liu
- Division of Cardiology, the Affiliated Children's Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Min Bao
- Division of Cardiology, the Affiliated Children's Hospital of Capital Institute of Pediatrics, Beijing, China
| | - Chunhua Zheng
- Division of Cardiology, the Affiliated Children's Hospital of Capital Institute of Pediatrics, Beijing, China
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93
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Haranal M, Srimurugan B, Sivalingam S. Circumflex aorta: An uncharted territory. Asian Cardiovasc Thorac Ann 2021; 30:217-225. [PMID: 33957784 DOI: 10.1177/02184923211015092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Vascular rings are aortic arch anomalies with a spectrum of manifestations ranging from asymptomatic lesions detected incidentally to an acute presentation secondary to tracheo-esophageal compression. Circumflex retro-esophageal aortic arch is an extreme form of true vascular ring. It remains an uncharted territory to many surgeons. METHODS A comprehensive search of peer reviewed journals was completed based on the key words, "Circumflex aorta," "Circumflex retro-esophageal aorta" and "circumflex arch" using Google scholar, Scholars Portal Journals and PubMed. The reference section for each article found was searched to obtain additional articles. Literature on the circumflex aorta was reviewed starting from the embryogenesis to the latest management strategies. RESULTS Right circumflex aorta is more prevalent compared to left circumflex aorta. It can occur in isolation or in association with other intracardiac lesions. Mainly presents in children, however reported in adults too. The presentation may vary from asymptomatic lesion to acute respiratory distress secondary to airway compression. Computerized tomography (CT) and magnetic resonance imaging (MRI) are important tools in delineating the vascular anatomy. Aortic uncrossing is the definitive procedure. However, the role of concomitant tracheobronchopexy is emerging. Native tissue-to-tissue anastomosis is commonly preferred, but cases of extra-anatomic grafts are reported. CONCLUSION Circumflex aorta is amenable to complete repair. Preoperative delineation of anatomy is important for successful surgical outcome. Division of the retro-esophageal segment is crucial in relieving the compressive symptoms. In addition, tracheobronchopexy is helpful in addressing residual tracheomalacia but this accounts for a high-risk surgery.
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Affiliation(s)
- Maruti Haranal
- Department of Cardiac Surgery, National Heart Institute, Kuala Lumpur, Malaysia
| | - Balaji Srimurugan
- Department of Pediatric Cardiac Surgery, Amrita Institute of Medical Sciences, Kochi, India
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94
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Goo HW, Siripornpitak S, Chen SJ, Lilyasari O, Zhong YM, Latiff HA, Maeda E, Kim YJ, Tsai IC, Seo DM. Pediatric Cardiothoracic CT Guideline Provided by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group: Part 2. Contemporary Clinical Applications. Korean J Radiol 2021; 22:1397-1415. [PMID: 33987995 PMCID: PMC8316776 DOI: 10.3348/kjr.2020.1332] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/27/2021] [Accepted: 01/31/2021] [Indexed: 12/14/2022] Open
Abstract
The use of pediatric cardiothoracic CT for congenital heart disease (CHD) was traditionally limited to the morphologic evaluation of the extracardiac thoracic vessels, lungs, and airways. Currently, the applications of CT have increased, owing to technological advancements in hardware and software as well as several dose-reduction measures. In the previously published part 1 of the guideline by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group, we reviewed the prerequisite technical knowledge for clinical applications in a user-friendly and vendor-specific manner. Herein, we present the second part of our guideline on contemporary clinical applications of pediatric cardiothoracic CT for CHD based on the consensus of experts from the Asian Society of Cardiovascular Imaging CHD Study Group. This guideline describes up-to-date clinical applications effectively in a systematic fashion.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Suvipaporn Siripornpitak
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Shyh Jye Chen
- Department of Medical Imaging, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - Oktavia Lilyasari
- Department of Cardiology and Vascular Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Yu Min Zhong
- Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai, China
| | - Haifa Abdul Latiff
- Pediatric and Congenital Heart Centre, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Eriko Maeda
- Department of Radiology, The University of Tokyo, Tokyo, Japan
| | - Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - I Chen Tsai
- Congenital Heart Disease Study Group Member of the Asian Society of Cardiovascular Imaging, Taichung, Taiwan
| | - Dong Man Seo
- Department of Cardiothoracic Surgery, Ewha Womans University Seoul Hospital, Seoul, Korea
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95
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Pang Y, Yu Y, Deng X, Liu Q, Yan J, Gao X. Chromosome 22q11.21 and 11p15.4 microdeletions confirmed by high-throughput sequencing analysis in one patient with asymmetric cry syndrome: Case report and review of the literature. Clin Case Rep 2021; 9:e04072. [PMID: 34084494 PMCID: PMC8142403 DOI: 10.1002/ccr3.4072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 11/06/2022] Open
Abstract
Healthcare providers treating newborns with asymmetric cry syndrome should consider 22q11.2 microdeletion within the differential diagnosis list and order appropriate genetic testing.
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Affiliation(s)
- Yonghong Pang
- Neonatal Medical CenterXuzhou Maternity and Child Health HospitalXuzhouChina
| | - Yang Yu
- Neonatal Medical CenterXuzhou Maternity and Child Health HospitalXuzhouChina
| | - Xiaoyi Deng
- Neonatal Medical CenterXuzhou Maternity and Child Health HospitalXuzhouChina
| | - Qian Liu
- Neonatal Medical CenterXuzhou Maternity and Child Health HospitalXuzhouChina
| | - Junmei Yan
- Neonatal Medical CenterXuzhou Maternity and Child Health HospitalXuzhouChina
| | - Xiangyu Gao
- Department of NeonatologyChildren Diagnosis and Treatment Center of Xuzhou Hospital Affiliated to Southeast UniversityXuzhouChina
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96
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Patel RAG, White CJ. Brachiocephalic and subclavian stenosis: Current concepts for cardiovascular specialists. Prog Cardiovasc Dis 2021; 65:44-48. [PMID: 33744380 DOI: 10.1016/j.pcad.2021.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 03/13/2021] [Indexed: 01/07/2023]
Abstract
Brachiocephalic and subclavian artery stenoses are less common manifestations of peripheral arterial disease (PAD) compared to lower extremity PAD. However, even among asymptomatic patients, a diagnosis of PAD portends worse long-term mortality. Symptoms may include subclavian steal syndrome and arm claudication. Among patients with internal mammary coronary bypass grafts, symptoms may include those of myocardial ischemia. Symptomatic subclavian stenosis can be readily treated using endovascular techniques with durable outcomes.
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Affiliation(s)
- Rajan A G Patel
- Department of Cardiology, John Ochsner Heart & Vascular Institute, Ochsner Medical Center and Ochsner Clinical School, University of Queensland, Australia.
| | - Christopher J White
- Department of Cardiology, John Ochsner Heart & Vascular Institute, Ochsner Medical Center and Ochsner Clinical School, University of Queensland, Australia
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97
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Kitamura Y, Sakata H, Ezura M, Ishida T, Endo H, Inoue T, Tominaga T. Carotid artery stenting in a patient with an incidentally found double aortic arch: A case report. Interv Neuroradiol 2021; 27:722-726. [PMID: 33673756 DOI: 10.1177/15910199211001717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Double aortic arch is a type of congenital vascular ring, which rarely presents in adults. Herein, we report a case of carotid artery stenting (CAS) accompanied by an incidentally found double aortic arch. A 77-year-old man presented with bilateral severe carotid artery stenosis. The patient underwent truncal 3D-computed tomography angiography (CTA) to evaluate the access route before CAS, which lead to the diagnosis of an asymptomatic double aortic arch. Referring to the 3D-CTA images, a guiding catheter was successfully navigated to the targeted common carotid artery via the transfemoral approach despite the challenging, complex anatomy of the aortic arch. CAS was performed in both carotid arteries under distal balloon protection, without any neurological deficits. Considering the possible presence of anatomical variants such as double aortic arch, preoperative evaluation of the access route would be efficient for prospective CAS patients.
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Affiliation(s)
- Yuki Kitamura
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Hiroyuki Sakata
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Masayuki Ezura
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Tomohisa Ishida
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Hidenori Endo
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Takashi Inoue
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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98
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The Clinical Spectrum of Kommerell's Diverticulum in Adults with a Right-Sided Aortic Arch: A Case Series and Literature Overview. J Cardiovasc Dev Dis 2021; 8:jcdd8030025. [PMID: 33652796 PMCID: PMC7996811 DOI: 10.3390/jcdd8030025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/13/2021] [Accepted: 02/22/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Kommerell's diverticulum is a rare vascular anomaly characterized as an outpouch at the onset of an aberrant subclavian artery. In the variant of a right-sided aortic arch, the trachea and esophagus are enclosed dorsally by the arch. In the configuration of an aberrant left subclavian artery, a Kommerell's diverticulum and persisting ductus arteriosus or ductal ligament enclose the lateral side, forming a vascular ring which may result in (symptomatic) esophageal or tracheal compression. Spontaneous rupture of an aneurysmatic Kommerell's diverticulum has also been reported. Due to the rarity of this condition and underreporting in the literature, the clinical implications of a Kommerell's diverticulum are not well defined. CASE SUMMARY We describe seven consecutive adult patients with a right-sided aortic arch and an aberrant course of the left subclavian artery (arteria lusoria), and a Kommerell's diverticulum, diagnosed in our tertiary hospital. One patient had severe symptoms related to the Kommerell's diverticulum and underwent surgical repair. In total, two of the patients experienced mild non-limiting dyspnea complaints and in four patients the Kommerell's diverticulum was incidentally documented on a computed tomography (CT) scan acquired for a different indication. The size of the Kommerell's diverticulum ranged from 19 × 21 mm to 30 × 29 mm. In the six patients that did not undergo surgery, a strategy of periodic follow-up with structural imaging was pursued. No significant growth of the Kommerell's diverticulum was observed and none of the patients experienced an acute aortic syndrome to date. DISCUSSION Kommerell's diverticulum in the setting of a right-sided aortic arch with an aberrant left subclavian artery is frequently associated with tracheal and esophageal compression and this may result in a varying range of symptoms. Guidelines on management of Kommerell's diverticulum are currently lacking. This case series and literature overview suggests that serial follow-up is warranted in adult patients with a Kommerell's diverticulum with small dimensions and no symptoms, however, that surgical intervention should be considered when patients become symptomatic or when the diameter exceeds 30 mm in the absence of symptoms.
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99
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Kim S, Jeon KN, Bae K. Aberrant Left Subclavian Artery-Esophageal Fistula in a Patient with a Prolonged Use of Nasogastric Tube: A Case Report and Literature Review. Diagnostics (Basel) 2021; 11:diagnostics11020195. [PMID: 33525727 PMCID: PMC7911238 DOI: 10.3390/diagnostics11020195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 01/06/2023] Open
Abstract
Arterial-esophageal fistula is a rare but potentially fatal complication. Right aortic arch with aberrant left subclavian artery is a rare congenital vascular anomaly that can cause esophageal compression, particularly when the proximal portion of the aberrant subclavian artery forms a Kommerell's diverticulum. Prolonged use of a nasogastric tube can cause pressure necrosis of the esophagus. We report a patient with massive gastrointestinal bleeding secondary to aberrant left subclavian artery-esophageal fistula after a prolonged use of nasogastric tube. A high index of suspicion is essential for better prognosis when a patient with congenital aortic arch anomaly shows upper gastrointestinal hemorrhage.
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Affiliation(s)
- Sungbin Kim
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Korea; (S.K.); (K.B.)
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
| | - Kyung Nyeo Jeon
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Korea; (S.K.); (K.B.)
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
- Correspondence: ; Tel.: +82-55-214-3896
| | - Kyungsoo Bae
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju 52727, Korea; (S.K.); (K.B.)
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon 51472, Korea
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100
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Verma M, Pandey NN, Chandrashekhara SH, Kumar S, Ramakrishnan S. Anomalous origin of left subclavian artery from ascending aorta in a right aortic arch: A case report with review of literature. J Card Surg 2021; 36:1130-1133. [PMID: 33442902 DOI: 10.1111/jocs.15323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/28/2020] [Accepted: 01/01/2021] [Indexed: 11/28/2022]
Abstract
We present a case of an 11-year-old boy with a double-outlet right ventricle and a right-sided aortic arch showing anomalous origin of the left subclavian artery from the ascending aorta as the first branch. This case highlights the importance of knowledge of this aberrant anatomy before planning any surgical or endovascular intervention.
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Affiliation(s)
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - S H Chandrashekhara
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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