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Bahar A, Gunawan A, Pranata J, Muhammadiah FF, Kohar RC. Persistent double dorsal aorta in patient with cavernous sinus thrombosis: A case report. Radiol Case Rep 2024; 19:1064-1067. [PMID: 38229601 PMCID: PMC10789926 DOI: 10.1016/j.radcr.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 01/18/2024] Open
Abstract
Persistent double dorsal aorta is a rare congenital anomaly of the descending aorta in which the descending aorta is divided into 2 lumens below the ligamentum arteriosum. There are only a few cases reported to date. A 52-year-old female presented with right ptosis since 2 months prior. Neurological examination was significant for cavernous sinus syndrome in the right eye. Digital subtraction angiography revealed right cavernous sinus thrombosis and an incidental finding of double lumen descending aorta, with separation of the second lumen at the level of the thoracic aorta. Computed tomography angiography confirmed a type 2 persistent double dorsal aorta. Persistent double dorsal aorta consists of 2 types. Type 1 is the complete separation of the 2 descending aorta and type 2 is the double lumen descending aorta separated by a dividing septum. Multiplanar 3D reconstruction Computed tomography angiography or magnetic resonance angiography is important to differentiate between this anomaly and acquired conditions such as aortic dissection. In persistent double dorsal aorta, both lumens constitute the true lumen, and branch into the visceral arteries before ending up as the right and left common iliac arteries, respectively, while in aortic dissection, one is a false lumen and does not give a branch to visceral vessels. Persistent double dorsal aorta is a rare congenital anomaly of descending aorta which manifests as 2 separate aorta or 2 lumens of aorta separated by a dividing septum. Knowledge of this anomaly is paramount for interventional neuroradiologists to distinguish it from acquired lesions.
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Affiliation(s)
- Ashari Bahar
- Department of Neurology, Faculty of Medicine, Hasanuddin University, Indonesia
- Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia
| | - Anthony Gunawan
- Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia
| | - Jambri Pranata
- Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia
| | | | - Ricky Cik Kohar
- Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia
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2
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Peng L, Zhao L, Zhang X, Zhang Y, Ding M, Lin Z, Jiang H, Huang Y, Gao B, Wei W. Feasibility and accuracy of noninvasive continuous hemoglobin monitoring using transesophageal photoplethysmography in porcine model. BMC Anesthesiol 2024; 24:53. [PMID: 38321377 PMCID: PMC10845655 DOI: 10.1186/s12871-024-02435-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/26/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Continuous and noninvasive hemoglobin (Hb) monitoring during surgery is essential for anesthesiologists to make transfusions decisions. The aim of this study was to investigate the feasibility and accuracy of noninvasive and continuous Hb monitoring using transesophageal descending aortic photoplethysmography (dPPG) in porcine model. METHODS Nineteen landrace pigs, aged 3 to 5 months and weighing 30 to 50 kg, were enrolled in this study. A homemade oximetry sensor, including red (660 nm) and infrared (940 nm) lights, was placed in the esophagus for dPPG signal detection to pair with the corresponding reference Hb values (Hbi-STAT) measured by blood gas analysis. The decrease and increase changes in Hb concentration were achieved by hemodilution and transfusion. Metrics, including alternating current (AC), direct current (DC), and AC/DC for both red and infrared light were extracted from the dPPG signal. A receiver operating characteristic (ROC) curve was built to evaluate the performance of dPPG metrics in predicting the Hb "trigger threshold" of transfusion (Hb < 60 g/L and Hb > 100 g/L). Agreement and trending ability between Hb measured by dPPG (HbdPPG) and by blood gas analysis were analyzed by Bland-Altman method and polar plot graph. Error grid analysis was also performed to evaluate clinical significance of HbdPPG measurement. RESULTS The dPPG signal was successfully detected in all of the enrolled experimental pigs, without the occurrence of a continuous loss of dPPG signal for 2 min during the entire measurement. A total of 376 pairs of dPPG signal and Hbi-STAT were acquired. ACred/DCred and ACinf/DCinf had moderate correlations with Hbi-STAT, and the correlation coefficients were 0.790 and 0.782, respectively. The areas under the ROC curve for ACred/DCred and ACinf/DCinf in predicting Hbi-STAT < 60 g/L were 0.85 and 0.75, in predicting Hbi-STAT > 100 g/L were 0.90 and 0.83, respectively. Bland-Altman analysis and polar plot showed a small bias (1.69 g/L) but a wide limit of agreement (-26.02-29.40 g/L) and a poor trend ability between HbdPPG and Hbi-STAT. Clinical significance analysis showed that 82% of the data lay within the Zone A, 18% within the Zone B, and 0% within the Zone C. CONCLUSION It is feasible to establish a noninvasive and continuous Hb monitoring by transesophageal dPPG signal. The ACred/DCred extracted from the dPPG signal could provide a sensitive prediction of the Hb threshold for transfusion. The Hb concentration measured by dPPG signal has a moderate correlation with that measured by blood gas analysis. This animal study may provide an experimental basis for the development of bedside HbdPPG monitoring in the future.
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Affiliation(s)
- Ling Peng
- Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Long Zhao
- Department of Cardiovascular Surgery, The Third People's Hospital of Chengdu, 82 Qing Long Xiang, Chengdu, 610041, China
| | - Xue Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Yi Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Meng Ding
- Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Zhibin Lin
- Department of Physics, Sichuan University, Chengdu, 610064, China
| | - Hao Jiang
- Department of Physics, Sichuan University, Chengdu, 610064, China
| | - Yuchen Huang
- Department of Physics, Sichuan University, Chengdu, 610064, China
| | - Bo Gao
- Department of Physics, Sichuan University, Chengdu, 610064, China
| | - Wei Wei
- Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China.
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Bracamonte J, Truong U, Wilson J, Soares J. Correction of phase offset errors and quantification of background noise, signal-to-noise ratio, and encoded-displacement uncertainty on DENSE MRI for kinematics of the descending thoracic and abdominal aorta. Magn Reson Imaging 2024; 106:91-103. [PMID: 38092083 PMCID: PMC10842810 DOI: 10.1016/j.mri.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/10/2023] [Indexed: 12/19/2023]
Abstract
Displacement encoding with stimulated echoes (DENSE) MRI is a phase contrast technique that allows the encoding of tissue displacement into the phase of the magnetic resonance signal. Recent developments in this technique allow the imaging of relatively thin structures such as the aortic wall. Quantifying background noise associated to DENSE MRI is required to assess the uncertainty of derived displacement measurements and for the design and implementation of adequate noise-reduction techniques. Although noise and error management of cardiac DENSE MRI has been previously studied, developments for aortic applications are scarce. Herein, we evaluate the noise and uncertainty of DENSE MRI scans at three different locations along the descending aorta: the distal aortic arch (DAA), the descending thoracic aorta (DTA), and infrarenal abdominal aorta (IAA). Additionally, we analyze three datasets from in vitro validation experiments with polyvinyl alcohol phantoms. We implement and evaluate the effectiveness of an offset-error correction algorithm and noise filtering techniques on DENSE MRI for aortic motion applications. Our results show that the phase signal of pixels composing the static background was normally distributed, centered on average at 0.003 ± 0.02 rad and - 0.02 ± 0.024 rad for each phase directions, suggesting that background noise is random, isotropic, and DENSE MRI has little offset errors. However, background signal noise significantly increased with elapsed time of the cardiac cycle; and was spatially heterogeneous consistently increased towards the anterior space. Background noise showed no significant differences between the 3 aortic locations and the in vitro experiments. However, SNR depended on the displacement of the region of interest, in consequence it was found significantly larger at DAA (16.7 ± 8.5, p = 0.003) and DTA (15.4 ± 7.6, p = 0.008) than at the IAA (8.0 ± 4.1), but not significantly different than the SNR of in vitro experiments (8.0 ± 3.7), and had an overall average of 13 ± 7. The applied methods significantly reduced the offset error and effect of noise on the estimation of encoded displacements. Finally, this analysis suggests that the implemented DENSE MRI protocol is adequate to assess the motion of healthy human aortas. However, the relative effect of noise increased considerably on the analysis of an ageing or diseased aortas with impaired mobility, calling for further analyses on pathologically stiffened aortas.
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Affiliation(s)
- Johane Bracamonte
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Uyen Truong
- Department of Pediatrics, Division of Cardiology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - John Wilson
- Department of Biomedical Engineering and Pauley Heart Center, Virginia Commonwealth University, VA, USA
| | - Joao Soares
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, USA.
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Hagedorn MN, Meisenbacher K, Skrypnik D, Bischoff MS, Böckler D. Standing the test of time: total aortic remodeling 13 years after TEVAR for acute type B aortic dissection. Indian J Thorac Cardiovasc Surg 2024; 40:86-90. [PMID: 38125333 PMCID: PMC10728030 DOI: 10.1007/s12055-023-01586-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 12/23/2023] Open
Abstract
Long-term outcome after thoracic endovascular aortic repair (TEVAR) of acute type B aortic dissection (aTBAD) is still underreported in current literature. This case report shows persistence of aortic remodeling without secondary complication or need of reintervention 13 years after TEVAR. A 45-year-old woman was referred to the emergency room with aTBAD. Due to early diameter progression in combination with therapy-refractory pain and uncontrolled hypertension, TEVAR was performed. Hereafter, the patient showed complete remodeling of the descending thoracic aorta without persistent false lumen perfusion in this segment and with stable true and false lumen diameter in the untreated abdominal segment for a 13-year period. No aortic-related reintervention was needed. With contemporary devices and adapted therapy, TEVAR seems able to treat complex thoracic disease. Long-term follow-up (FU) is mandatory to monitor the efficacy and durability of endovascular treatment in aortic disease.
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Affiliation(s)
- Matthias Niklas Hagedorn
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Denis Skrypnik
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Moritz Sebastian Bischoff
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
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5
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Reineke D, Makaloski V, Schoenhoff F, Siepe M. Treatment of infected hybrid arch prosthesis with self-assembled bovine elephant trunk grafts. Eur J Cardiothorac Surg 2023; 63:7019964. [PMID: 36723164 DOI: 10.1093/ejcts/ezad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/11/2023] [Indexed: 02/02/2023]
Abstract
Graft infections are associated with severe morbidity and mortality. The widespread use of the frozen elephant technique increases the incidence of complex aortic patients to suffer from graft infections. Surgery of these patients is challenging. Removal of the stent graft portion of the frozen elephant technique prosthesis via sternotomy carries the risk of irreparable damage to the descending aorta. There is currently no single-stage surgical strategy that allows for the removal of all infected material apart from a hemi-clamshell approach. This approach is technically demanding and associated with significant morbidity and mortality. This results in conservative treatment in a substantial number of patients. Pericardial tube grafts have shown to be an excellent option in treating graft infections in various aortic segments with promising results concerning freedom of re-infection and survival. We report a single-stage, trans-sternal approach to remove all infected materials and simultaneously treat the descending aorta to prevent aortic catastrophe in 2 consecutive cases.
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Affiliation(s)
- David Reineke
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Vladimir Makaloski
- Department of Vascular Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Florian Schoenhoff
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Matthias Siepe
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
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6
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García-Galindo A, Agujetas R, López-Mínguez JR, Ferrera C. Assessment of valve implantation in the descending aorta as an alternative for aortic regurgitation patients not treatable with conventional procedures. Biomech Model Mechanobiol 2022; 22:575-591. [PMID: 36550245 PMCID: PMC10097802 DOI: 10.1007/s10237-022-01665-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Aortic Regurgitation (AR) produces the entrance of an abnormal amount of blood in the left ventricle. This disease is responsible for high morbidity and mortality worldwide and may be caused by an aortic valve dysfunction. Surgical and transcatheter aortic valve replacement (TAVR) are the current options for treating AR. They have replaced older procedures such as Hufnagel's one. However, some physicians have reconsidered this procedure as a less aggressive alternative for patients not eligible for surgical or TAVR. Although Hufnagel suggested a 75% regurgitation reduction when a valve is placed in the descending aorta, a quantification of this value has not been reported. METHODS In this paper, CFD/FSI numerical simulation is conducted on an idealized geometry. We quantify the effect of placing a bileaflet mechanical heart valve in the descending aorta on a moderate-severe AR case. A three-element Windkessel model is employed to prescribe pressure outlet boundary conditions. We calculate the resulting flow rates and pressures at the aorta and first-generation vessels. Moreover, we evaluate several indices to assess the improvement due to the valve introduction. RESULTS AND CONCLUSIONS Regurgitation fraction (RF) is reduced from 37.5% (without valve) to 18.0% (with valve) in a single cardiac cycle. This reduction clearly shows the remarkable efficacy of the rescued technique. It will further ameliorate the left ventricle function in the long-term. Moreover, the calculations show that the implantation in that location introduces fewer incompatibilities' risks than a conventional one. The proposed methodology can be extended to any particular conditions (pressure waveforms/geometry) and is designed to assess usual clinical parameters employed by physicians.
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Affiliation(s)
- A García-Galindo
- Departamento de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Científica Avanzada (ICCAEx), Universidad de Extremadura, E-06006, Badajoz, Spain
| | - R Agujetas
- Departamento de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Científica Avanzada (ICCAEx), Universidad de Extremadura, E-06006, Badajoz, Spain
| | - J R López-Mínguez
- Sección de Cardiologıa Intervencionista, Servicio de Cardiologıa, Hospital Universitario de Badajoz, Avda. de Elvas s/n, E-06006, Badajoz, Spain
| | - C Ferrera
- Departamento de Ingeniería Mecánica, Energética y de los Materiales and Instituto de Computación Científica Avanzada (ICCAEx), Universidad de Extremadura, E-06006, Badajoz, Spain.
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7
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Caixal G, Althoff T, Garre P, Alarcón F, NuñezGarcia M, Benito EM, Borras R, Perea RJ, Prat-González S, Gunturiz C, Sanchez P, Olivas D, Tolosana JM, Arbelo E, Roca-Luque I, Brugada J, Sitges M, Guasch E, Mont L. Proximity to the descending aorta predicts regional fibrosis in the adjacent left atrial wall: aetiopathogenic and prognostic implications. Europace 2021; 23:1559-1567. [PMID: 33975341 DOI: 10.1093/europace/euab107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Left atrial (LA) fibrosis is present in patients with atrial fibrillation (AF) and can be visualized by magnetic resonance imaging with late gadolinium enhancement (LGE-MRI). Previous studies have shown that LA fibrosis is not randomly distributed, being more frequent in the area adjacent to the descending aorta (DAo). The objective of this study is to analyse the relationship between fibrosis in the atrial area adjacent to the DAo and the distance to it, as well as the prognostic implications of this fibrosis. METHODS AND RESULTS Magnetic resonance imaging with late gadolinium enhancement was obtained in 108 patients before AF ablation to analyse the extent of LA fibrosis and the distance DAo-to-LA. A high-density electroanatomic map was performed in a subgroup of 16 patients to exclude the possibility of an MRI artifact. Recurrences after ablation were analysed at 1 year of follow-up. The extent of atrial fibrosis in the area adjacent to the DAo was inversely correlated with the distance DAo-to-LA (r = -0.34, P < 0.001). This area had the greatest intensity of LGE [image intensity ratio (IIR) 1.14 ± 0.15 vs. 0.99 ± 0.16; P < 0.001] and also the lowest voltage (1.07 ± 0.86 vs. 1.54 ± 1.07 mV; P < 0.001) and conduction velocity (0.65 ± 0.06 vs. 0.96 ± 0.57 mm/ms; P < 0.001). The extent of this regional fibrosis predicted recurrence after AF ablation [hazard ratio (HR) 1.02, 95% CI 1.01-1.03; P = 0.01], however total fibrosis did not (HR = 1.01, 95% CI 0.97-1.06, P = 0.54). CONCLUSIONS Atrial fibrosis was predominantly located in the area adjacent to the DAo, and increased with the proximity between the two structures. Furthermore, this regional fibrosis better predicted recurrence after AF ablation than total atrial fibrosis.
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Affiliation(s)
- Gala Caixal
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain
| | - Till Althoff
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Department of Cardiology and Angiology, Charité-University Medicine Berlin, Charité Campus Mitte, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Paz Garre
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain
| | - Francisco Alarcón
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta NuñezGarcia
- Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Eva Maria Benito
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain
| | - Roger Borras
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain
| | - Rosario J Perea
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain
| | - Susana Prat-González
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Clara Gunturiz
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Paula Sanchez
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Dahyr Olivas
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - J Maria Tolosana
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Arbelo
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Ivo Roca-Luque
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Brugada
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Sitges
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Eduard Guasch
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Lluis Mont
- Unitat de Fibril.lació Auricular (UFA), Institut Clínic Cardiovascular (ICCV), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBABS), Barcelona, Catalonia, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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8
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Cullen P, Brereton RJ, Mathur MN. Post-Dissection Single-Stage Arch and Descending Aorta Replacement via Clamshell Incision. Heart Lung Circ 2021; 30:e68-e71. [PMID: 33589400 DOI: 10.1016/j.hlc.2020.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
Residual dissections after type A repairs are common and can result in aneurysm formation. Surgery is complex and considered high risk, particularly if there is arch involvement. A single-stage "arch-first" technique via clamshell incision is an excellent option in certain circumstances and herein we detail a variation of this approach using a trifurcated graft.
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Affiliation(s)
- Paul Cullen
- Cardiothoracic Surgical Unit, North Shore Private Hospital, Sydney, NSW, Australia
| | - R John Brereton
- Cardiothoracic Surgical Unit, North Shore Private Hospital, Sydney, NSW, Australia
| | - Manu N Mathur
- Cardiothoracic Surgical Unit, North Shore Private Hospital, Sydney, NSW, Australia.
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9
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Kohler C, Wyss TR, Mertineit N, Makaloski V, Schmidli J. Emergent open conversion for stent-graft deployment failure in a ruptured thoracic aneurysm. J Vasc Surg Cases Innov Tech 2020; 7:180-182. [PMID: 33748558 PMCID: PMC7966836 DOI: 10.1016/j.jvscit.2020.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) is the standard of care for ruptured thoracic aortic aneurysms. A 92-year-old man had presented in stable condition but with acute severe back pain. Computed tomography revealed a ruptured thoracic aortic aneurysm. TEVAR (Valiant; Medtronic Vascular, Santa Rosa, Calif) into zone 2 with intentional coverage of the left subclavian artery was planned. After release of the stent-graft body, proximal release of the bare springs was impossible. Troubleshooting techniques were applied; but tip capture could not be released. Emergent conversion to open repair was performed. Intraoperative device deployment failure in TEVAR is rare. The findings from the present report have demonstrated the advantages of having in-house cardiac surgery backup available.
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Affiliation(s)
- Corinne Kohler
- Department of Cardiovascular Surgery, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas R Wyss
- Department of Cardiovascular Surgery, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nando Mertineit
- Division of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vladimir Makaloski
- Department of Cardiovascular Surgery, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Juerg Schmidli
- Department of Cardiovascular Surgery, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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10
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Son SA, Jung H, Cho JY. Long-term outcomes of intervention between open repair and endovascular aortic repair for descending aortic pathologies: a propensity-matched analysis. BMC Surg 2020; 20:266. [PMID: 33143659 PMCID: PMC7607549 DOI: 10.1186/s12893-020-00923-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The long-term complication rates of open repair and thoracic endovascular aortic repair (TEVAR) have not yet been determined. Therefore, this study aimed to compare the long-term outcomes and aortic reintervention rates between open repair and TEVAR in patients with descending thoracic aortic pathologies. METHODS Between January 2002 and December 2017, 230 patients with descending thoracic aortic pathologies underwent surgery. Of these, 136 patients were included in this retrospective study: 45 patients (10, 2, and 33 with dissection, penetrating atherosclerotic ulcer, and pseudoaneurysm, respectively) underwent open repair and 91 patients (27, 1, and 63 with dissection, penetrating atherosclerotic ulcer, and pseudoaneurysm, respectively) underwent TEVAR. The primary end points were in-hospital mortality, and short-term complications. The secondary end points were long-term mortality and reintervention rates. Based on the propensity score matching (PSM), 35 patients who underwent open repair were matched to 35 patients who underwent TEVAR (ratio = 1:1). RESULTS The mean follow-up period was 70.2 ± 51.9 months. Shorter intensive care unit and hospital stay were seen in the TEVAR group than in the open repair group before and after PSM (p < 0.001 and p < 0.001, respectively). However, in-hospital mortality, and spinal cord ischemia were not significantly different among the two groups (before PSM: p = 0.068 and p = 0.211, respectively; after PSM: p = 0.303 and p = 0.314, respectively). The cumulative all-cause death and aorta-related death showed no significant differences between the two groups (before PSM: p = 0.709 and p = 0.734, respectively; after PSM: p = 0.888 and p = 0.731, respectively). However, aortic reintervention rates were higher in the TEVAR group than in the open repair group before and after PSM (p = 0.006 and p = 0.013, respectively). CONCLUSION The TEVAR group was superior in short-term recovery outcomes but had higher reintervention rates compared to the open repair group. However, there were no significant differences in long-term survival between the two groups.
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Affiliation(s)
- Shin-Ah Son
- Trauma Center, Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Hanna Jung
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea
| | - Joon Yong Cho
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea.
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11
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Minami T, Uchida K, Yasuda S, Cho T, Matsuki Y, Nemoto H, Kobayashi Y, Kasama K, Machida D, Masuda M. Veno-arterio-pulmonary-arterial extracorporeal membrane oxygenation in descending aortic surgery. Gen Thorac Cardiovasc Surg 2020; 69:727-730. [PMID: 33094365 DOI: 10.1007/s11748-020-01518-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/11/2020] [Indexed: 10/23/2022]
Abstract
Hypoxia during one-lung ventilation is a significant problem in descending aortic surgery via left thoracotomy. Veno-arterio-pulmonary-arterial extracorporeal membrane oxygenation (VAPa-ECMO), which consists of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and an additional arterial branch to perfuse a pulmonary artery (Pa), is useful.
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Affiliation(s)
- Tomoyuki Minami
- Cardiovascular Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Shota Yasuda
- Cardiovascular Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Tomoki Cho
- Cardiovascular Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Yusuke Matsuki
- Cardiovascular Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Hiroko Nemoto
- Cardiovascular Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Yoshiyuki Kobayashi
- Cardiovascular Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Keiichiro Kasama
- Cardiovascular Surgery, Yokohama Municipal Citizen's Hospital, 56 Okazawa-cho, Hodogaya-ku, Yokohama, Kanagawa, 240-8555, Japan
| | - Daisuke Machida
- Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-004, Japan
| | - Munetaka Masuda
- Cardiovascular Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.,Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-004, Japan
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12
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Nishimura Y, Honda K, Yuzaki M, Tajima K, Nakamura R, Nakanishi Y, Kaneko M, Agematsu K, Nagashima M. Serum Cystatin C Level as a Biomarker of Aortic Plaque in Patients with an Aortic Arch Aneurysm. J Atheroscler Thromb 2020; 28:506-513. [PMID: 32848109 PMCID: PMC8193777 DOI: 10.5551/jat.57091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Aim:
During surgery for an aortic arch aneurysm, aortic plaque in the descending aorta should be evaluated, but there are currently no suitable biomarkers for it. Surgeons should be especially aware of cerebral embolism from femoral perfusion and of peripheral embolism from stent graft deployment. Cystatin C is a known useful marker of renal dysfunction with a role as a biomarker for severity of coronary artery disease. In the absence of a suitable biomarker for aortic plaque in the descending aorta, we examine cystatin C as a candidate.
Methods:
In all, 75 patients who underwent surgery for an aortic arch aneurysm were enrolled. They were divided into two groups, depending on whether they had chronic kidney disease or not. The serum cystatin C value and creatinine value were evaluated preoperatively. The aortic plaque volume ratio and components in the descending aorta were calculated from preoperative enhanced computed tomography.
Results:
The soft plaque volume ratio was higher in patients with chronic kidney disease than in patients without it. Cystatin C positively correlated with the total aortic plaque volume ratio in all cases, and it positively correlated with the soft plaque volume ratio in both groups. Creatinine had no correlation with any type of plaque volume ratio in either group. In patients without chronic kidney disease, the soft plaque volume ratio was higher in patients with higher cystatin C levels than in patients with normal levels.
Conclusion:
The preoperative serum cystatin C level could be a biomarker of aortic plaque in the descending aorta in patients with an aortic arch aneurysm.
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Affiliation(s)
- Yoshiharu Nishimura
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University
| | - Kentaro Honda
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University
| | - Mitsuru Yuzaki
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University
| | - Kouji Tajima
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University
| | - Ryo Nakamura
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University
| | - Yasuka Nakanishi
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University
| | - Masahiro Kaneko
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University
| | - Kouta Agematsu
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University
| | - Mitsugi Nagashima
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University
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13
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Papneja K, Laks J, Szabo AB, Grosse-Wortmann L. Low descending aorta flow is associated with adverse feeding outcomes in neonates with small left-sided structures. Int J Cardiovasc Imaging 2020; 37:269-273. [PMID: 32740880 DOI: 10.1007/s10554-020-01958-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/27/2020] [Indexed: 11/25/2022]
Abstract
Feeding intolerance and necrotizing enterocolitis (NEC) cause significant morbidity in neonates with duct-dependent systemic circulations. Whether these complications are associated with low blood flow to the bowel is unproven. The aim of this study was to determine whether low descending aortic (DAO) flow is associated with adverse feeding outcomes in neonates with small left-sided structures, including borderline left ventricle and hypoplastic left heart syndrome (HLHS). The cardiac magnetic resonance (CMR) imaging studies and abdominal Doppler ultrasound profiles prior to any cardiac interventions in neonates with small left-sided structures were analyzed. Descending aortic flows, indexed to body surface area, were collected. Medical charts were reviewed for a composite outcome of feeding intolerance and/or NEC. Among the 51 enrolled study patients (mean age 4.6, SD 4.5 days), 13 experienced the composite outcome (feeding intolerance in 13, NEC in 2). The mean DAO flow in patients who experienced the composite outcome was 0.89 L/min/m2 (SD 0.33 L/min/m2), compared to 1.23 L/min/m2 (SD 0.41 L/min/m2) in those that did not (p = 0.007). A DAO flow of 0.91 L/min/m2 identified patients who experienced feeding intolerance or NEC with a sensitivity of 61% and a specificity of 76%. Doppler ultrasound metrics of DAO flow did not correlate with DAO flow or predict adverse feeding outcomes. Low DAO flow is associated with adverse outcomes, including feeding intolerance and NEC, in neonates with small left-sided structures. Heightened clinical vigilance towards feeding complications in patients with low DAO flow is recommended.
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Affiliation(s)
- Koyelle Papneja
- The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Division of Pediatric Cardiology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA, USA
| | - Jessica Laks
- The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Adrienn B Szabo
- The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Lars Grosse-Wortmann
- The Labatt Family Heart Centre, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
- Division of Cardiology, Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, ORE, USA.
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Yin O, Woods A, Koos B, DeVore G, Afshar Y. Central hemodynamics are associated with fetal outcomes in pregnancies of advanced maternal age. Pregnancy Hypertens 2019; 19:67-73. [PMID: 31923879 DOI: 10.1016/j.preghy.2019.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/17/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Age is a known risk factor for both maternal cardiovascular disease and adverse outcomes in pregnancy. We aimed to characterize the hemodynamic profiles in pregnancies of advanced maternal age (AMA) and correlate these with fetal outcomes. STUDY DESIGN This was a prospective observational study of pregnancies undergoing antenatal testing. Maternal hemodynamics were measured non-invasively using an imaging probe at the descending aorta and the Uscom BP + arm cuff utilizing pulse pressure wave analysis. The Wilcoxon rank-sum test, Fisher's exact test, and Spearman rank correlation test were used for statistical analysis in R. MAIN OUTCOME MEASURES Hemodynamic measurements, neonatal birthweight. RESULTS Twenty-one AMA and twenty-four control patients were enrolled. Mean age ± SD was 39 ± 3.22 in the AMA cohort and 28 ± 4.32 in the control cohort (p < 0.001). AMA patients were evaluated at a later gestational age (36 4/7 weeks) compared to control (34 1/7 weeks, p = 0.02). Between groups, there was no difference in BMI, race, hypertensive disease, diabetes, asthma, drug use, or indication for antenatal testing. 38% (AMA) and 37% (control) had hypertensive disorders of pregnancy. In AMA patients but not control patients, cardiac output (r = 0.52, p = 0.01), systemic vascular resistance (r = -0.53, p = 0.01), and systemic vascular resistance index (r = -0.62, p = 0.002) were significantly correlated with neonatal birthweight percentile. CONCLUSIONS Hemodynamic alterations consistent with a low output, high resistance cardiovascular circuit were associated with lower birthweight in AMA, but not in control pregnancies.
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Affiliation(s)
- Ophelia Yin
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, United States
| | - Allison Woods
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, United States
| | - Brian Koos
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, United States
| | - Greggory DeVore
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, United States
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, United States.
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15
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Zoulati M, Bakkali T, Aghoutane N, Lyazidi Y, Chtata H, Taberkant M. [Acute post-trauma dissection of the descending thoracic aorta]. J Med Vasc 2019; 44:367-373. [PMID: 31761303 DOI: 10.1016/j.jdmv.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 08/03/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Traumatic injury to the descending thoracic aorta other than the isthmus is rare, and little known. Acute post-trauma rupture may occur in a context of multiple or rarely unique localizations. CASE REPORT We report the case of a young man who was the victim of multiple injuries with an isolated rupture of the descending thoracic aorta. Early diagnosis and adapted endovascular treatment led to favorable outcome. CONCLUSION In 90% of cases, acute post-trauma rupture of the aorta in a single localization involve the isthmus. Rupture of the descending aorta is more exceptional but must not be missed. The pathophysiological mechanism and appropriate management are discussed in light of a review of the literature.
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Affiliation(s)
- M Zoulati
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc.
| | - T Bakkali
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - N Aghoutane
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - Y Lyazidi
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - H Chtata
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
| | - M Taberkant
- Service de chirurgie vasculaire, hôpital militaire d'instruction Mohammed V, Hay Riad, Rabat, Maroc
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16
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Guala A, Teixido-Tura G, Dux-Santoy L, Granato C, Ruiz-Muñoz A, Valente F, Galian-Gay L, Gutiérrez L, González-Alujas T, Johnson KM, Wieben O, Sao Avilés A, Evangelista A, Rodriguez-Palomares J. Decreased rotational flow and circumferential wall shear stress as early markers of descending aorta dilation in Marfan syndrome: a 4D flow CMR study. J Cardiovasc Magn Reson 2019; 21:63. [PMID: 31607265 PMCID: PMC6791020 DOI: 10.1186/s12968-019-0572-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 08/28/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diseases of the descending aorta have emerged as a clinical issue in Marfan syndrome following improvements in proximal aorta surgical treatment and the consequent increase in life expectancy. Although a role for hemodynamic alterations in the etiology of descending aorta disease in Marfan patients has been suggested, whether flow characteristics may be useful as early markers remains to be determined. METHODS Seventy-five Marfan patients and 48 healthy subjects were prospectively enrolled. In- and through-plane vortexes were computed by 4D flow cardiovascular magnetic resonance (CMR) in the thoracic aorta through the quantification of in-plane rotational flow and systolic flow reversal ratio, respectively. Regional pulse wave velocity and axial and circumferential wall shear stress maps were also computed. RESULTS In-plane rotational flow and circumferential wall shear stress were reduced in Marfan patients in the distal ascending aorta and in proximal descending aorta, even in the 20 patients free of aortic dilation. Multivariate analysis showed reduced in-plane rotational flow to be independently related to descending aorta pulse wave velocity. Conversely, systolic flow reversal ratio and axial wall shear stress were altered in unselected Marfan patients but not in the subgroup without dilation. In multivariate regression analysis proximal descending aorta axial (p = 0.014) and circumferential (p = 0.034) wall shear stress were independently related to local diameter. CONCLUSIONS Reduced rotational flow is present in the aorta of Marfan patients even in the absence of dilation, is related to aortic stiffness and drives abnormal circumferential wall shear stress. Axial and circumferential wall shear stress are independently related to proximal descending aorta dilation beyond clinical factors. In-plane rotational flow and circumferential wall shear stress may be considered as an early marker of descending aorta dilation in Marfan patients.
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Affiliation(s)
- A. Guala
- Hospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - G. Teixido-Tura
- Hospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - L. Dux-Santoy
- Hospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - C. Granato
- Hospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - A. Ruiz-Muñoz
- Hospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - F. Valente
- Hospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - L. Galian-Gay
- Hospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - L. Gutiérrez
- Hospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - T. González-Alujas
- Hospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - K. M. Johnson
- Departments of Medical Physics & Radiology, University of Wisconsin – Madison, Madison, WI USA
| | - O. Wieben
- Departments of Medical Physics & Radiology, University of Wisconsin – Madison, Madison, WI USA
| | - A. Sao Avilés
- Hospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - A. Evangelista
- Hospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain
| | - J. Rodriguez-Palomares
- Hospital Universitari Vall d’Hebron, Department of Cardiology. CIBER-CV. Vall d’Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain
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Kumari S, Deka D, Dadhwal V, Perumal V. Correlation of fetal blood vessel Doppler measurements with fetal anemia among Rhesus isoimmunized pregnancies after two intrauterine transfusions. Int J Gynaecol Obstet 2019; 146:218-222. [PMID: 31004522 DOI: 10.1002/ijgo.12825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/25/2018] [Accepted: 04/16/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess the correlation between fetal blood vessel Doppler measurements and fetal anemia among Rhesus isoimmunized pregnancies after two intrauterine transfusions as a potential guide to therapy. METHODS A prospective observational study was conducted among 30 women who attended a single hospital in India between April 2, 2015 and October 30, 2016. The participants underwent a third intrauterine transfusion based on a middle cerebral artery (MCA) peak systolic velocity (PSV) of greater than 1.50 multiples of the median (MoM). Cordocentesis was performed before the third intrauterine transfusion and hematocrit values correlated with the blood vessel Doppler measurements. RESULTS The MCA PSV MoM and fetal hematocrit MoM had a correlation coefficient of -0.43 (95% confidence interval -0.68 to 0.08; P=0.017). The sensitivity, specificity, positive predictive value, and negative predictive value were 68%, 57%, 83%, and 33%, respectively. The descending aorta PSV δ and fetal hematocrit δ had a correlation coefficient of -0.54 (95% confidence interval -0.75 to -0.23; P=0.001). An area under the curve of 0.80 (standard error 0.085; P=0.017) had 87% sensitivity and 57% specificity for diagnosing fetal anemia. CONCLUSION The descending aorta PSV could offer a useful diagnostic adjunct to MCA PSV after two intrauterine transfusions.
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Affiliation(s)
- Sarita Kumari
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Dipika Deka
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vatsla Dadhwal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - Vanamail Perumal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
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18
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Hammel JM. Supplemental Perfusion Techniques for Aortic Arch Reconstruction, With Emphasis on Direct Cannulation of the Descending Aorta. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2019; 22:14-20. [PMID: 31027558 DOI: 10.1053/j.pcsu.2019.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/26/2019] [Indexed: 06/09/2023]
Abstract
The established techniques of deep hypothermia with circulatory arrest and regional cerebral perfusion expose infants and children to additional physiologic stress and deleterious effects which may adversely affect the outcome of operations involving reconstruction of the aortic arch. Alternative techniques to supplement perfusion support are an area of innovation today. The most effective adjunct for somatic perfusion during arch reconstruction is direct cannulation of the innominate artery and the descending aorta, with full flow at mild hypothermia distributed throughout the entire body just as it is during routine, single cannulation surgery with an intact aorta. Detailed facilitating techniques for descending aortic cannulation are discussed.
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Affiliation(s)
- James M Hammel
- Cardiothoracic Surgery, Children's Hospital and Medical Center, Omaha, Nebraska.
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Bech-Hanssen O, Polte CL, Svensson F, Johnsson ÅA, Lagerstrand KM, Cederbom U, Gao SA. Pulsed-Wave Doppler Recordings in the Proximal Descending Aorta in Patients with Chronic Aortic Regurgitation: Insights from Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2018; 31:304-313.e3. [PMID: 29290484 DOI: 10.1016/j.echo.2017.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The pulsed-wave Doppler recording in the descending aorta (PWDDAO) is one of the parameters used in grading aortic regurgitation (AR) severity. The aim of the present study was to investigate the assessment of chronic AR by PWDDAO with insights from cardiovascular magnetic resonance (CMR). METHODS This prospective study comprised 40 patients investigated with echocardiography and CMR within 4 hours either prior to valve surgery (n = 23) or as part of their follow-up (n = 17) due to moderate or severe AR. End-diastolic flow velocity (EDFV) and the diastolic velocity time integral (dVTI) were measured. The appearance of diastolic forward flow (DFF) was noted. Phase-contrast flow rate curves were obtained in the DAO. RESULTS Twenty-five patients had severe and eight had moderate AR by echocardiography (seven were indeterminate). The EDFV was below the recommended threshold (>20 cm/sec) in 13 patients (52%) with severe AR. Lowering the EDFV threshold (>13 cm/sec) and with a dVTI threshold >13 cm showed negative likelihood ratios of 0.27 and 0.09, respectively. Detection of DFF with PWDDAO identified a nonuniform velocity profile by CMR with positive and negative likelihood ratios of 7.0 and 0.19, respectively. The relation between EDFV and DAO regurgitant volume (DAO-RVolCMR) was strong in patients without (R = 0.88) and weak in patients with DFF (R = 0.49). The DAO-RVolCMR as a percent of the total RVolCMR decreased with increasing ascending aorta (AAO) size and increased with increasing AR severity. CONCLUSIONS Our findings suggest that PWDDAO provides semiquantitative parameters useful to assess chronic AR severity. The limitations are related to nonuniform velocity contour and variable degree of lower body contribution, which depends on AR severity but also on the AAO size.
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Affiliation(s)
- Odd Bech-Hanssen
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Christian L Polte
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Radiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Frida Svensson
- the Department of Diagnostic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åse A Johnsson
- Department of Radiology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kerstin M Lagerstrand
- the Department of Diagnostic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulf Cederbom
- Department of Clinical Physiology, Northern Älvsborg County Hospital, Trollhättan, Sweden
| | - Sinsia A Gao
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Ling P, Quan G, Siyuan Y, Bo G, Wei W. Can the descending aortic stroke volume be estimated by transesophageal descending aortic photoplethysmography? J Anesth 2017; 31:337-344. [PMID: 28349203 DOI: 10.1007/s00540-017-2338-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 03/14/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of this study was to investigate the ability of transesophageal photoplethysmography detected from the descending aorta (dPPG) for predicting low descending aortic stroke volume (dSV) level in cardiac surgical patients. METHODS Fifteen patients scheduled for elective cardiac surgery were enrolled in our study. A transesophageal echocardiography (TEE) probe with an attached oximetry sensor was placed into the esophagus for paired dPPG signal and descending aortic Doppler blood flow signal acquisition. Metrics, including alternating current (AC), direct current (DC), area under the curve (AUC) and width (W), were extracted from the dPPG signals. The TEE-measured dSV, which was defined as the blood flow through the descending aorta during a cardiac cycle, was chosen as the standard reference. A receiver operating characteristic (ROC) curve was built to evaluate the performance of dPPG metrics in predicting low dSV level, and dSV measuring agreement between TEE and dPPG was analyzed by the Bland-Altman method. RESULTS A total of 644 paired dPPG and Doppler signals of the descending aorta were acquired. Significant correlations were found between the dPPG metrics and TEE-measured dSV, and the correlation coefficients between TEE-measured dSV and AUC or AC were 0.64 and 0.66, respectively. AUC and AC values obviously decreased with the reduction of dSV level among the three groups (<20 mL, from 20-40 mL, and >40 mL). The areas under the ROC curve for AUC and AC in predicting low dSV level (<20 mL) were 0.85 and 0.88, respectively. Bland-Altman plot showed a small bias (0.02 mL) but a wide limit of agreement (-18.62 to 18.66 mL) in dSV measurement between dPPG and Doppler technology. CONCLUSIONS The AC and AUC extracted from the dPPG signal provided a sensitive and qualitative prediction for dSV level. The dSV value could not be accurately measured by dPPG metrics. TRIAL REGISTRATION Chinese Clinical Trials Register Identifier: ChiCTR-OCS-12002789.
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Affiliation(s)
- Peng Ling
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Gong Quan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yu Siyuan
- Department of Anesthesiology, Children's Hospital, Chongqing Medical University, Chongqing, People's Republic of China
| | - Gao Bo
- Department of Physics, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Wei Wei
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
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Anthonissen N, Menting T, Verkroost M, Morshuis W. Angiosarcoma of the Descending Aorta, Diagnostic Difficulties. EJVES Short Rep 2016; 32:4-6. [PMID: 28856306 PMCID: PMC5576002 DOI: 10.1016/j.ejvssr.2016.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 04/13/2016] [Accepted: 04/17/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction Primary angiosarcomas of the aorta are rare and because of their non-specific presentation, the initial diagnosis is often very difficult. Report A 66 year old woman, initially suffering from night sweats and general malaise, is presented. A computerized tomography (CT) scan was performed which showed a filling defect of the descending aorta. This defect later caused embolic occlusion of the celiac vessels. The patient underwent surgical resection of the filling defect of the descending aorta and an embolectomy of the celiac vessels. The defect was histopathologically diagnosed as an angiosarcoma. The clinical presentation, diagnostic pitfalls, histopathological diagnosis, and the therapeutic management are discussed. Discussion In this case report, the importance of carefully diagnosing an angiosarcoma is highlighted as the consequences could be rapid metastasization or embolization. An angiosarcoma of the descending aorta was diagnosed, which is a rare malignancy. This malignancy is very hard to diagnose therefore long-term survival is uncertain. This malignancy is very aggressive for both local and distant recurrence. This case report reflects the difficulty in diagnosing this malignancy. It also shows the rapid progression of this disease.
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Affiliation(s)
- N Anthonissen
- Department of Cardiothoracic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - T Menting
- Department of Vascular Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - M Verkroost
- Department of Cardiothoracic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - W Morshuis
- Department of Cardiothoracic Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
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22
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Petrini J, Yousry M, Eriksson P, Björk HM, Rickenlund A, Franco-Cereceda A, Caidahl K, Eriksson MJ. Intima-media thickness of the descending aorta in patients with bicuspid aortic valve. Int J Cardiol Heart Vasc 2016; 11:74-79. [PMID: 28616529 PMCID: PMC5441363 DOI: 10.1016/j.ijcha.2016.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 03/11/2016] [Accepted: 03/19/2016] [Indexed: 11/23/2022]
Abstract
Objective A bicuspid aortic valve (BAV) is associated with accelerated aortic valve disease (AVD) and abnormalities in aortic elasticity. We investigated the intima-media thickness of the descending aorta (AoIMT) in patients with AVD with or without an ascending aortic aneurysm (AscAA), in relation to BAV versus tricuspid aortic valve (TAV) phenotype, type of valve disease, cardiovascular risk factors, and single-nucleotide polymorphisms (SNPs) with a known association with carotid IMT. Methods and results 368 patients (210 with BAV, 158 with TAV,); mean age 64 ± 13 years) were examined using transesophageal echocardiography (TEE) before valvular and/or aortic surgery. No patient had a coronary disease (CAD). The AoIMT was measured on short-axis TEE images of the descending aorta using a semi-automated edge-detection technique. AoIMT was univariately (P < 0.05) related to age, blood pressure, smoking, creatinine, highly sensitive C-reactive protein, HDL, valve hemodynamics and BAV. In the TAV subgroup it was also associated with the rs200991 SNP. Using multivariate regression analysis, age was the main determinant for AoIMT (P < 0.001), followed by male gender (P = 0.02), BAV was no longer a significant predictor of AoIMT. AoIMT was still related to the rs200991 SNP in TAV (P = 0.034), and to creatinine in BAV (P = 0.019), when other variables were accounted for. Conclusions Intima-media thickness of the descending aorta is not affected by aortic valve morphology (BAV/TAV); age is the main determinant of AoIMT. Genetic markers (SNPs) known to influence IMT in the carotid artery seem to correlate to IMT in the descending aorta only in patients with TAV.
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Affiliation(s)
- Johan Petrini
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Physiology, Södersjukhuset, Sweden
| | - Mohamed Yousry
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Departments of Clinical Physiology, Sweden.,Faculty of Medicine, Suez Canal University, Egypt
| | - Per Eriksson
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hanna M Björk
- Atherosclerosis Research Unit, Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anette Rickenlund
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Departments of Clinical Physiology, Sweden
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Cardiothoracic Surgery, Karolinska University Hospital, Sweden
| | - Kenneth Caidahl
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Departments of Clinical Physiology, Sweden
| | - Maria J Eriksson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Departments of Clinical Physiology, Sweden
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Jaroszewski D, Ewais M, DeValeria P, Gotway M, Craig Miller D. Descending aortic replacement after Nuss for pectus excavatum in a Marfan patient-Case report. Int J Surg Case Rep 2016; 21:16-9. [PMID: 26895112 DOI: 10.1016/j.ijscr.2016.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/29/2016] [Accepted: 01/29/2016] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The Nuss procedure for pectus excavatum (PE) repair has been successfully performed in Marfan syndrome (MFS) patients however there is concern for future risk of aortic dilation/rupture and need for emergent access with support bars in place. CASE PRESENTATION We present a 45 year-old male with MFS that required descending aortic replacement shortly after modified Nuss repair. DISCUSSION The majority of MFS patients have severe PE and repair with the Nuss procedure is not uncommon. The risk for life threatening aortic dilation, dissection, or rupture in such patients is a concern when utilizing this technique. Our work has been reported in line with the CARE criteria. CONCLUSION Nuss repair should be considered in MFS patients with technique modifications and careful consideration of future risk of aortic dilation and rupture.
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Menon A, Ganguly G, Kaushik R, Joshi VS, Johri S. Post-traumatic 'transection' of the aorta. Med J Armed Forces India 2016; 71:S418-21. [PMID: 26858475 DOI: 10.1016/j.mjafi.2014.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 11/14/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- A Menon
- Senior Adviser (Surgery & CT Surg), Military Hospital (Cardio Thoracic Centre), Pune 411 040, India
| | - G Ganguly
- Brig (Med), MB Area, Jabalpur, Madhya Pradesh 482 001, India
| | - R Kaushik
- Consultant & Head (Surgery & CT Surg), Military Hospital (Cardio Thoracic Centre), Pune 411 040, India
| | - V S Joshi
- Senior Adviser (Surgery & CT Anaes), Military Hospital (Cardio Thoracic Centre), Pune 411 040, India
| | - S Johri
- MG Med (Command), HQ (Central Command), Lucknow 226002, India
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Affiliation(s)
- Martin Czerny
- University Heart Center Freiburg Bad Krozingen, Freiburg, Germany
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26
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Urbanski PP, Bougioukakis P, Deja MA, Diegeler A, Irimie V, Lenos A, Zembala MO. Open aortic arch surgery in chronic dissection with visceral arteries originating from different lumens. Eur J Cardiothorac Surg 2015; 49:1382-90. [PMID: 26518381 DOI: 10.1093/ejcts/ezv386] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/21/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Surgical management of chronic aortic dissection is controversial, especially when the dissection extends into the abdominal aorta in which the visceral arteries originate from different lumens and is combined with aortic arch pathology necessitating surgery. The aim of the study was to evaluate the results of open surgery in this complex aortic pathology. METHODS Between June 2002 and 2015, a total of 17 patients (median age 57, range 32-76 years) necessitating complete arch replacement presented complex chronic dissection of the thoraco-abdominal aorta with the visceral arteries originating from different lumens. Fourteen patients (82%) had had previous cardiac surgery, which was performed on the proximal aorta in all but one because of acute type A dissection. Nine patients without considerable dilatation of the descending aorta received aortic arch replacement with distal resection of the dissection membrane, and 8 patients with progressive dilatation of the thoracic aorta underwent aortic arch and descending aorta replacement via clamshell approach. RESULTS No early (defined as 30-day, 90-day and in-hospital period) deaths, strokes or spinal cord injuries occurred. Only 1 patient (6%) presented temporary neurological dysfunctions (delirium, agitation), which resolved completely before discharge, and an injury of the recurrent laryngeal nerve was documented in 2 patients (12%). Temporary dialysis was necessary in 1 case. The follow-up was complete for all patients. All but one patient, who died due to leukaemia 23 months after surgery, were alive at the last follow-up (median duration 33 months, range 2-118 months). No patient needed a reoperation or an intervention on the thoracic and/or abdominal aorta. Moreover, no noticeable progression of the chronic dissection in the downstream aorta was documented in any patient. CONCLUSIONS The results after conventional aortic arch repair with distal resection of the dissection membrane and, if necessary, with replacement of the progressively dilated chronic dissected thoracic aorta can offer excellent results in experienced hands and, therefore, this technique may be considered as a preferable option for surgical treatment of chronic aortic dissection with involvement of the aortic arch and the visceral arteries originating from different lumens.
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Affiliation(s)
| | | | - Marek A Deja
- Cardiovascular Clinic, Medical University of Silesia, Katowice, Poland
| | - Anno Diegeler
- Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | - Vadim Irimie
- Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
| | | | - Michal O Zembala
- Department of Cardiovascular Surgery and Transplantology, Silesian Center for Heart Diseases, Zabrze, Poland
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Ziganshin BA, Elefteriades JA. Finger-Thumb Technique for Elephant Trunk Retrieval. Aorta (Stamford) 2013; 1:286-8. [PMID: 26798708 DOI: 10.12945/j.aorta.2013.13-064] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 12/17/2013] [Indexed: 11/18/2022]
Abstract
In this report we present a brief video illustrating the "Finger-Thumb Technique" that we have used extensively at our institution for elephant trunk retrieval during second stage elephant trunk procedures. Although only safe in experienced hands, this technique is a viable option in the arsenal of a cardiothoracic surgeon, especially in cases when proximally surrounding a massively enlarged aorta is unappealing.
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Affiliation(s)
- Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut, USA
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Varzaly J, Chaudhuri K, Crouch G, Edwards J. E-VITA Jotec open hybrid stent graft system for the treatment of complex thoracic aortic aneurysm and dissection--a four year experience. Heart Lung Circ 2013; 23:e77-9. [PMID: 24021235 DOI: 10.1016/j.hlc.2013.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 07/02/2013] [Accepted: 08/08/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The management of complex aortic aneurysms and dissections involving both the aortic arch and descending aorta include operations associated with significant risks of mortality and morbidity. The advent of hybrid systems such as the E-VITA Jotec open hybrid stent graft system (E-VITA) provides the advantage of single stage repair with follow up repair of any remaining downstream aneurysm and dissection being easier to manage. METHODS Herein we report a series of seven cases utilising E-VITA over a four year period. RESULTS The average patient age was 66.9 years of age (range: 55-78 years). The average cardiopulmonary bypass and circulatory arrest times were 237.14 min and 47.83 min. There was one operative mortality. Follow up as far as three years revealed good results with few complications. CONCLUSION The E-VITA is a feasible management option in the treatment of complex aortic aneurismal disease and dissections. It allows treatment of patients that may have previously not been considered suitable for two-stage surgical procedure.
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Affiliation(s)
- Jason Varzaly
- Cardiothoracic Surgery Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
| | - Krish Chaudhuri
- Cardiothoracic Surgery Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Gareth Crouch
- Cardiothoracic Surgery Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - James Edwards
- Cardiothoracic Surgery Department, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Nozdrzykowski M, Etz CD, Luehr M, Garbade J, Misfeld M, Borger MA, Mohr FW. Optimal treatment for patients with chronic Stanford type B aortic dissection: endovascularly, surgically or both? Eur J Cardiothorac Surg 2013; 44:e165-74; discussion e174. [PMID: 23761415 DOI: 10.1093/ejcts/ezt291] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Patients with chronic Stanford type B aortic dissections (TBAD) are traditionally treated medically, but some of the affected thoracic and thoracoabdominal aortic segments progress to large aneurysms with a significant risk of rupture. The purpose of this study is to retrospectively evaluate, with an 'all-comers' approach, the survival and the outcome of patients following thoracic endovascular aortic repair (TEVAR) or conventional open surgery for chronic TBAD as a first-line therapy or a secondary option after failed medical treatment. METHODS Between January 2000 and May 2010, 80 consecutive patients (59 males, median age 63, inter-quartile range (IQR) 55-69) suffering from chronic TBAD were treated at our institution. Thirty-three were treated medically (Group A, median age: 65, IQR: 58.5-71.5), 32 received TEVAR (Group B, median age: 62, IQR: 54-67.5) and 15 patients underwent conventional open surgery (Group C, median age: 61, IQR: 54-66). The median follow-up was 42 months (range: 0.1-124.7) and 100% complete. RESULTS There were no significant differences with regard to age, gender and associated comorbidities between the treatment groups. The overall hospital mortality for chronic TBAD was 6.3% (n = 5); in-hospital mortalities for Groups A, B and C were 3.0, 6.2 and 13.4%, respectively. The incidence of major complications, such as paraplegia, malperfusion, renal failure and cardiac arrhythmia, did not significantly differ between the three groups. Postoperative stroke occurred more often after conventional open surgery (Group C: 13.3%; P = 0.07). Reintervention for TBAD pathology was required in Groups A, B and C in 12.1, 28.1 and 0%, respectively (P = 0.03). Secondary open surgery post-TEVAR was required in 7 cases (21.8%) with no postoperative paraplegia. CONCLUSIONS Open surgery for extensive thoracic and thoracoabdominal repair in chronic TBAD may be performed with acceptable early and mid-term outcomes. TEVAR for aortic complications in patients with chronic dissection may be successfully performed as a first-stage procedure in order to stabilize the patient and serve as a 'bridge' to secondary open surgery. However, close surveillance is mandatory for the timely detection of aneurysm enlargement, malperfusion or impending rupture after TEVAR.
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Affiliation(s)
- Michal Nozdrzykowski
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
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