Aortic dissection involving a right-sided aortic arch(RAA)is extremely rare with an incidence in adults of 0.04%to 0.1%^([1]).Thoracic aortic dissection associated with RAA is even a more uncommon and life-threatening...Aortic dissection involving a right-sided aortic arch(RAA)is extremely rare with an incidence in adults of 0.04%to 0.1%^([1]).Thoracic aortic dissection associated with RAA is even a more uncommon and life-threatening condition.For complicated aortic dissection,conventional open surgical repair is considered a standard therapy^([2]).However,in such cases,endovascular repair has emerged as the procedure展开更多
BACKGROUND Aortic arch stenting is continuously emerging as a safe and effective option to alleviate aortic arch stenosis and arterial hypertension.CASE SUMMARY We present a 15-year-old girl with aortic arch hypoplasi...BACKGROUND Aortic arch stenting is continuously emerging as a safe and effective option to alleviate aortic arch stenosis and arterial hypertension.CASE SUMMARY We present a 15-year-old girl with aortic arch hypoplasia who had undergone implantation of an uncovered 22 mm Cheatham-Platinum stent due to severe(native)aortic arch stenosis.On follow-up seven months later,she presented a significant re-stenosis of the aortic arch.A second stent(LD Max 26 mm)was implanted and both stents were dilated up to 16 mm.After an initially unremarkable post-interventional course,the patient presented with hoarseness five days after the intervention.MRI and CT scans ruled out an intracranial pathology,as well as thoracic hematoma,arterial dissection,and aneurysm around the intervention site.Laryngoscopy confirmed left vocal fold paresis attributable to an injury to the left recurrent laryngeal nerve(LRLN)during aortic arch stenting,as the nerve loops around the aortic arch in close proximity to the area of the implanted stents.Following a non-invasive therapeutic approach entailing regular speech therapy,the patient recovered and demonstrated no residual clinical symptoms of LRLN palsy after six months.CONCLUSION Left recurrent laryngeal nerve palsy is a rare complication of aortic arch stenting not previously reported.展开更多
BACKGROUND A cervical aortic arch(CAA)refers to a high-riding aortic arch(AA)that often extends above the level of the clavicle.This condition is very rare,with an incidence of less than 1/10000.CASE SUMMARY A 29-year...BACKGROUND A cervical aortic arch(CAA)refers to a high-riding aortic arch(AA)that often extends above the level of the clavicle.This condition is very rare,with an incidence of less than 1/10000.CASE SUMMARY A 29-year-old woman was admitted to the otolaryngology department of our hospital for repeated bilateral purulent nasal discharge for the prior 3 mo.The patient was diagnosed with chronic sinusitis and chronic rhinitis at admission.A preoperative noncontrast chest computed tomography scan showed a high-riding,tortuous AA extending to the mid-upper level of the first thoracic vertebra with local cystic dilatation.A further computed tomography angiography examination showed that the brachiocephalic trunk,left common carotid artery,left vertebral artery(LVA)(slender),and left subclavian artery sequentially branched off of the aorta from the proximal end to the distal end of the AA.The proximal end of the right subclavian artery(RSCA)was tortuous and dilated.The AA showed tumorlike local expansion,with a maximum diameter of approximately 4 cm.After consultation with the department of cardiac macrovascular surgery,the patient was diagnosed with left CAA with aneurysm formation and an anomalous RSCA and LVA and was transferred to that department.The patient underwent AA aneurysm resection and artificial blood vessel replacement under general anesthesia and cardiopulmonary bypass.No abnormality was found during the 2-mo follow-up after discharge.CONCLUSION A CAA is a rare congenital anomaly of vascular development.The present unique case of CAA with aneurysm formation and an anomalous RSCA and LVA enriches existing CAA data.展开更多
BACKGROUND Interrupted aortic arch(IAA)is a rare congenital heart disease defined by an interruption of the lumen and anatomical continuity between the ascending and descending major arteries.It is usually found withi...BACKGROUND Interrupted aortic arch(IAA)is a rare congenital heart disease defined by an interruption of the lumen and anatomical continuity between the ascending and descending major arteries.It is usually found within a few hours or days of birth.Without surgery,the chances of survival are low.If IAA patients have an effective collateral circulation established,they can survive into adulthood.However,IAA in adults is extremely rare,with few reported cases.CASE SUMMARY A 27-year-old woman presented with a 6-year history of progressively worsening shortness of breath and chest tightness on exertion.She had cyanotic lips and clubbing of the fingers.A transthoracic echocardiogram revealed an enlarged heart and dilation of the main pulmonary artery.There was an abnormal 9 mm passage between the descending aorta and pulmonary artery.The ventricular septal outflow tract had a 14 mm defect.Doppler ultrasound suggested a patent ductus arteriosus and computed tomographic angiography showed the absence of the aortic arch.The diagnoses were ventricular septal defect,patent ductus arteriosus,and definite interruption of the aortic arch.Although surgical correction was recommended,the patient declined due to the surgical risks and was treated with medications to reduce pulmonary artery pressure and treat heart failure.Her condition has been stable for 12 mo of follow-up.CONCLUSION Although rare,IAA should be considered in adults with refractory hypertension or unexplained congestive heart failure.展开更多
BACKGROUND Aortic coarctation(CoA)is usually confused with interrupted aortic arch(IAA),especially adult type A interrupted aortic arch,due to their similar anatomical location.Although the main difference between the...BACKGROUND Aortic coarctation(CoA)is usually confused with interrupted aortic arch(IAA),especially adult type A interrupted aortic arch,due to their similar anatomical location.Although the main difference between them is whether arterial lumen exhibits continuity or not,the clinical manifestations are similar and connection exists between them.Adult type A IAA is considered as an extreme form of CoA,which is complete discontinuity of aortic function and lumen caused by degenerative arterial coarctation.This paper reports two cases(interrupted aortic arch and severe aortic coarctation)to analyze the difference and similarity between them.CASE SUMMARY The two cases of patients presented with hypertension for many years.Computed tomography angiography showed that the aortic arch and descending aorta were discontinuous or significantly narrowed with extensive collateral flow.The IAA patient refused surgical treatment and blood pressure could be controlled with drugs.While the CoA patient underwent stent implantation because of uncontrollable hypertension,the blood flow recovered smoothly and the blood pressures at both ends of the stenosis returned to normal after surgery.CONCLUSION Adult type A IAA and CoA have difference and similarity,and type A IAA is associated with CoA to a certain extent.The treatment method should be chosen based on the patient's clinical symptoms rather than the severity of the lesion.展开更多
Background:Double aortic arch(DAA)with distal left-sided aortic arch atresia(LAAA)can form complete vascular ring by ligamentum connection.We aimed to introduce an uncommon DAA-LAAA diagnosis and treatment by the mini...Background:Double aortic arch(DAA)with distal left-sided aortic arch atresia(LAAA)can form complete vascular ring by ligamentum connection.We aimed to introduce an uncommon DAA-LAAA diagnosis and treatment by the minimally invasive surgical technique(MIST).Methods:We retrospectively reviewed 7 cases of DAA-LAAA that were treated from January 2017 to July 2021.All infant patients underwent surgical repair by minimally invasive surgical technique.Mean follow-up was 14.43 months(range,5–21 months).Results:There were seven patients with DAA-LAAA,including six males and one female.Median age was 19.29 months(range,9.0–29.0 months).Median weight was 11.30 kg(range,9.6–13.0 kg).Three patients were found severe tracheal compression by cardiac computed tomography angiography(cCTA).Six patients with isolated DAA-LAAA were performed operations through left subaxillary minithoracotomy,and one patient with ventricular septal defect(VSD)was performed operation concurrently under the cardiopulmonary bypass(CPB)through right subaxillary minithoracotomy.All patients had symptom improvement in the postoperative period and discharged successfully.Follow-up data showed good results in short-term.Conclusions:We introduce a new surgical pathway for DAA-LAAA treatment with good symptomatic relief in short-term.MIST is a safe,feasible and economical approach for infant patients.展开更多
Background:To establish a canine model of aortic arch aneurysm that is suitable for research on new devices and techniques applied to the aortic arch.Materials and methods:Fifteen mongrel dogs underwent surgery.The au...Background:To establish a canine model of aortic arch aneurysm that is suitable for research on new devices and techniques applied to the aortic arch.Materials and methods:Fifteen mongrel dogs underwent surgery.The autologous pericardial patch was sewn on the aortotomy site in the anterior wall of the aortic arch.The animals were followed up for 3 months postoperatively.Computed tomography angiography was used to visualize and measure the aneurysm model.Hematoxylin and eosin staining was used to observe the histological characteristics of the aneurysm model.Changes in aneurysm diameter over time were analyzed using analysis of variance.Results:One dog died of hemorrhage during surgery.Fourteen dogs survived the surgical procedure.Two of them died on the first postoperative day because of ruptures at the suturing margin.The diameter of the aneurysm model was twice as large as that of the aortic arch.There was no significant change in the maximum diameter of the aneurysm model during the follow-up period.Conclusions:We established a controllable and stable aortic arch aneurysm model created with an autologous pericardium patch.The aneurysm model can be used to research endoleaks after thoracic endovascular aortic repair and new endovascular techniques can be applied to the aortic arch.展开更多
Hemangiopericytoma is clinically rare and easily confused with meningioma.Right-sided aortic arch is also a rare disease of congenital cardiovascular variability.The intracranial hemangiopericytoma associated with the...Hemangiopericytoma is clinically rare and easily confused with meningioma.Right-sided aortic arch is also a rare disease of congenital cardiovascular variability.The intracranial hemangiopericytoma associated with the right-sided aortic arch has not been reported in the literature.We are here to register a case of right aortic arch concurrent with intracranial hemangiopericytoma;the patient was initially thought to be a simple meningioma,but he was eventually diagnosed as a hemangiopericytoma with right aortic arch and multiple intracranial vascular stenosis and malformation.Whether there was a genetic correlation between the two provides a potential research direction for us.Therefore,the diagnosis and treatment of some rare diseases should be a more comprehensive analysis and evaluation.Adequate examination and accurate diagnosis are crucial,which will directly affect the efficacy of surgery and the prognosis of patients.展开更多
Aortic arch aneurysms are rarely isolated entities, and most frequently associated with either ascending or descending aorta pathologies. Association with aortic valve stenosis is uncommon and traditional surgical tre...Aortic arch aneurysms are rarely isolated entities, and most frequently associated with either ascending or descending aorta pathologies. Association with aortic valve stenosis is uncommon and traditional surgical treatment is always challenging. Here we report a minimally invasive and endovascular management of these two pathologies in a 89-year-old man with LAD-stented ischemic cardiomyopathy. We describe our initial therapeutic strategy, per procedure difficulties and final management of this challenging case. Finally, we discuss the different therapeutic options for the endovascular treatment of aortic arch aneurysm associated with aortic valve stenosis.展开更多
Objective To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey Ⅰ thoracic aortic dissection. Methods From January 2006 to Oct...Objective To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey Ⅰ thoracic aortic dissection. Methods From January 2006 to October 2010,101 cases of DeBakeyⅠaortic dissection were treated by modified total arch replacement and stent elephant trunk technique,in which emergencey surgery were performed on 73 cases. There were 76 male and 25展开更多
Objective Reviewing the experience in diagnosis and treatment of cases with aorta-pulmonary septal defect and aortic origin of right pulmonary artery complicated with interruption of aortic arch. Methods Clinical data...Objective Reviewing the experience in diagnosis and treatment of cases with aorta-pulmonary septal defect and aortic origin of right pulmonary artery complicated with interruption of aortic arch. Methods Clinical data from medical records for 5 patients (4 boys and 1 girl,age from 1 to 18 years on admission) who had been treated in Wuhan Asia Heart Hospital between 2005 and 2009展开更多
Objective To discuss the operative techniques and results of coarctation resection plus aortoplasty with pulmonary autograft patch for coarctation of the aorta combined with hypoplastic aortic arch in infant. Methods ...Objective To discuss the operative techniques and results of coarctation resection plus aortoplasty with pulmonary autograft patch for coarctation of the aorta combined with hypoplastic aortic arch in infant. Methods Between May 2007 and Dec 2009,14 cases including 9 males and 5 females with coarctation of the aorta and hypoplastic aortic arch underwent coarctation resection plus aortoplasty with pulmonary autograft patch in展开更多
The purpose of this study was to evaluate the value of multi-detector computed tomography (MDCT) angiography for the diagnosis of congenital aortic arch anomalies and present the radiological images of congenital aort...The purpose of this study was to evaluate the value of multi-detector computed tomography (MDCT) angiography for the diagnosis of congenital aortic arch anomalies and present the radiological images of congenital aortic arch anomalies in Chinese children. MDCT angiography and transthoracic echocardiography (TTE) were applied for the diagnosis of congenital aortic arch anomalies in 362 Chinese children between May 2006 and December 2011 (age ranges from 5 days to 12 years; mean age, 3.3 years). Surgery and/or catheter angiography (CA) were conducted in all patients to confirm the final diagnosis. In the 362 Chinese children with congenital heart anomalies, congenital aortic arch anomalies were definitely diagnosed in 198 children and 164 children ruled out by operation and/or (CA). Among the 198 children with anomalies, coarctation of aorta (CoA), interruption of aortic arch (IAA), right aortic arch, aberrant right subclavian artery and double aortic arch were diagnosed in 134, 32, 20, 10 and 2 children respectively, and there were 6 cases with uncommon congenital aortic arch anomalies: 2 had double aortic arch including 1 with five branches of the aortic arch, 2 had isolation of the right subclavian artery with two patent ductus arteriosus (PDA), 1 had an isolation of the common carotid artery with a PDA, and 1 had double PDA with a single ventricle and pulmonary artery atresia. Among the 32 children with IAA, 28 were of type A, and 4 were of type B. The diagnostic sensitivity, specificity and accuracy of MDCT angiography for congenital aortic arch anomalies were 100% (198/198), 98% (161/164) and 99% (359/362), respectively. The diagnostic sensitivity, specificity and accuracy of TTE were 92% (182/198), 81% (133/164) and 87% (315/362), respectively. In conclusion, MDCT angiography is a reliable, noninvasive imaging technique for the diagnosis of congenital aortic arch anomalies in children. Sometimes, even more information can be obtained from this technique than from conventional angiography.展开更多
The three-dimensional (3D) lattice Boltzmann models,3DQ15,3DQ19 and 3DQ27,under different wall boundary conditions and lattice resolutions have been investigated by simulating Poiseuille flow in a circular cylinder fo...The three-dimensional (3D) lattice Boltzmann models,3DQ15,3DQ19 and 3DQ27,under different wall boundary conditions and lattice resolutions have been investigated by simulating Poiseuille flow in a circular cylinder for a wide range of Reynolds numbers.The 3DQ19 model with improved Fillippova and Hanel (FH) curved boundary condition represents a good compromise between computational efficiency and reliability.Blood flow in an aortic arch is then simulated as a typical haemodynamic application.Axial and secondary fluid velocity and effective wall shear stress profiles in a 180 bend are obtained,and the results also demonstrate that the lattice Boltzmann method is suitable for simulating the flow in 3D large-curved vessels.展开更多
Right-sided aortic arch with aberrant left subclavian artery (RAA/ALSC) is the second most common mediastinal complete vascular ring. Adult presentation of dysphagia lusoria due to a RAA/ALSC is uncommon with fewer th...Right-sided aortic arch with aberrant left subclavian artery (RAA/ALSC) is the second most common mediastinal complete vascular ring. Adult presentation of dysphagia lusoria due to a RAA/ALSC is uncommon with fewer than 25 cases reported in the world literature. The left lateral portion of this vascular ring is not a vessel, but an atretic ductus arteriosus, the ligamentum arteriosum, which has been identified in different cases as the major cause of tracheo-esophageal impingement. Surgical division of the ligamentum arteriosum allows the vessels to assume a less constricting pattern decreasing dysphagic symptoms. Clear visualization of the ligamentum arteriosum by diagnostic imaging has not been obtained in previously reported cases. We demonstrated, using magnetic resonance imaging, the location and the complete course of a left-sided ligamentum arteriosum in a patient with adult-onset dysphagia due to a RAA/ALSC with a small Kommerell' s diverticulum, providing, during the same session, a complete assessment of both mediastinal vascular abnormalities and esophageal impingement sites.展开更多
<strong>Objectives:</strong> To describe our technique for the implantation of the Thoraflex Hybrid prosthesis for replacement of the aortic arch in a safe and reproducible way. <strong>Materials:<...<strong>Objectives:</strong> To describe our technique for the implantation of the Thoraflex Hybrid prosthesis for replacement of the aortic arch in a safe and reproducible way. <strong>Materials:</strong> Thoraflex<span style="font-size:12.0pt;line-height:107%;font-family:;" "="">™</span> Hybrid Plexus Device (Terumo Aortic).<strong> Design:</strong> Drawing on our own experience over the past 4 years in the management of acute type A aortic dissection, we have distilled the essentials of our “Frozen Elephant Trunk” technique which have led us through our own learning curve to the improved management of this taxing condition. <strong>Method/ Results:</strong> Small extension of the median sternotomy incision along the medial border of sternocleidomastoid muscle. End to side graft anastomosis near the origin of the left subclavian artery during cooling on bypass towards 20 degrees. Attention to cardiac protection and maintenance of cerebral perfusion during the shortened corporeal arrest period. Excellent results in 24 consecutive AAAD patients with just one hospital mortality. <strong>Conclusions:</strong> We believe we are entering a new phase in the treatment of AAAD, facilitated by the availability of a hybrid prosthesis which combines expanding stent technology with familiar surgical graft material. Our particular management of the left subclavian artery and of the cerebral circulation during implantation has contributed to an expeditious and reproducible method of treating dissection within the arch of the aorta and beyond.展开更多
INTERRUPTED aortic arch(IAA)is a rare congenital malformation that occurs in 5.8 per million live births.1IAA was thought to be incompatible with life once the ductus arteriosus closed.However,if extensive collateral ...INTERRUPTED aortic arch(IAA)is a rare congenital malformation that occurs in 5.8 per million live births.1IAA was thought to be incompatible with life once the ductus arteriosus closed.However,if extensive collateral circulation is present at birth survival is possible.We report an unusual case of IAA,who was treated successfully with extra-anatomic aortic repair under deep hypothermia circulatory arrest.展开更多
We present a case of the right aortic arch with kommerell diverticulum (KD) and aberrant left subclavian artery in a symptomatic 50-year-old patient with a calcification in the presumed attachment site of the ligament...We present a case of the right aortic arch with kommerell diverticulum (KD) and aberrant left subclavian artery in a symptomatic 50-year-old patient with a calcification in the presumed attachment site of the ligamentum arteriosum (LA) to the KD. In another 30-year-old male patient, the entire course of a calcified LA was demonstrated using multidetector row computed tomography.展开更多
The interrupted aortic arch (IAA) is rare congential heart defect and entails a very poor prognosis without surgical treatment. We describe a young adult patient with IAA associated with severe pulmonary hypertension ...The interrupted aortic arch (IAA) is rare congential heart defect and entails a very poor prognosis without surgical treatment. We describe a young adult patient with IAA associated with severe pulmonary hypertension and discuss the perioperative anesthetic management of single-stage surgical correction in this patient. Preoperative anesthetic preparation with better understanding of the malformation, intraoperative hemodynamic monitoring, and adequate alveolar ventilation in the perioperative period were all important factors contributing to a successful outcome.展开更多
文摘Aortic dissection involving a right-sided aortic arch(RAA)is extremely rare with an incidence in adults of 0.04%to 0.1%^([1]).Thoracic aortic dissection associated with RAA is even a more uncommon and life-threatening condition.For complicated aortic dissection,conventional open surgical repair is considered a standard therapy^([2]).However,in such cases,endovascular repair has emerged as the procedure
文摘BACKGROUND Aortic arch stenting is continuously emerging as a safe and effective option to alleviate aortic arch stenosis and arterial hypertension.CASE SUMMARY We present a 15-year-old girl with aortic arch hypoplasia who had undergone implantation of an uncovered 22 mm Cheatham-Platinum stent due to severe(native)aortic arch stenosis.On follow-up seven months later,she presented a significant re-stenosis of the aortic arch.A second stent(LD Max 26 mm)was implanted and both stents were dilated up to 16 mm.After an initially unremarkable post-interventional course,the patient presented with hoarseness five days after the intervention.MRI and CT scans ruled out an intracranial pathology,as well as thoracic hematoma,arterial dissection,and aneurysm around the intervention site.Laryngoscopy confirmed left vocal fold paresis attributable to an injury to the left recurrent laryngeal nerve(LRLN)during aortic arch stenting,as the nerve loops around the aortic arch in close proximity to the area of the implanted stents.Following a non-invasive therapeutic approach entailing regular speech therapy,the patient recovered and demonstrated no residual clinical symptoms of LRLN palsy after six months.CONCLUSION Left recurrent laryngeal nerve palsy is a rare complication of aortic arch stenting not previously reported.
文摘BACKGROUND A cervical aortic arch(CAA)refers to a high-riding aortic arch(AA)that often extends above the level of the clavicle.This condition is very rare,with an incidence of less than 1/10000.CASE SUMMARY A 29-year-old woman was admitted to the otolaryngology department of our hospital for repeated bilateral purulent nasal discharge for the prior 3 mo.The patient was diagnosed with chronic sinusitis and chronic rhinitis at admission.A preoperative noncontrast chest computed tomography scan showed a high-riding,tortuous AA extending to the mid-upper level of the first thoracic vertebra with local cystic dilatation.A further computed tomography angiography examination showed that the brachiocephalic trunk,left common carotid artery,left vertebral artery(LVA)(slender),and left subclavian artery sequentially branched off of the aorta from the proximal end to the distal end of the AA.The proximal end of the right subclavian artery(RSCA)was tortuous and dilated.The AA showed tumorlike local expansion,with a maximum diameter of approximately 4 cm.After consultation with the department of cardiac macrovascular surgery,the patient was diagnosed with left CAA with aneurysm formation and an anomalous RSCA and LVA and was transferred to that department.The patient underwent AA aneurysm resection and artificial blood vessel replacement under general anesthesia and cardiopulmonary bypass.No abnormality was found during the 2-mo follow-up after discharge.CONCLUSION A CAA is a rare congenital anomaly of vascular development.The present unique case of CAA with aneurysm formation and an anomalous RSCA and LVA enriches existing CAA data.
文摘BACKGROUND Interrupted aortic arch(IAA)is a rare congenital heart disease defined by an interruption of the lumen and anatomical continuity between the ascending and descending major arteries.It is usually found within a few hours or days of birth.Without surgery,the chances of survival are low.If IAA patients have an effective collateral circulation established,they can survive into adulthood.However,IAA in adults is extremely rare,with few reported cases.CASE SUMMARY A 27-year-old woman presented with a 6-year history of progressively worsening shortness of breath and chest tightness on exertion.She had cyanotic lips and clubbing of the fingers.A transthoracic echocardiogram revealed an enlarged heart and dilation of the main pulmonary artery.There was an abnormal 9 mm passage between the descending aorta and pulmonary artery.The ventricular septal outflow tract had a 14 mm defect.Doppler ultrasound suggested a patent ductus arteriosus and computed tomographic angiography showed the absence of the aortic arch.The diagnoses were ventricular septal defect,patent ductus arteriosus,and definite interruption of the aortic arch.Although surgical correction was recommended,the patient declined due to the surgical risks and was treated with medications to reduce pulmonary artery pressure and treat heart failure.Her condition has been stable for 12 mo of follow-up.CONCLUSION Although rare,IAA should be considered in adults with refractory hypertension or unexplained congestive heart failure.
文摘BACKGROUND Aortic coarctation(CoA)is usually confused with interrupted aortic arch(IAA),especially adult type A interrupted aortic arch,due to their similar anatomical location.Although the main difference between them is whether arterial lumen exhibits continuity or not,the clinical manifestations are similar and connection exists between them.Adult type A IAA is considered as an extreme form of CoA,which is complete discontinuity of aortic function and lumen caused by degenerative arterial coarctation.This paper reports two cases(interrupted aortic arch and severe aortic coarctation)to analyze the difference and similarity between them.CASE SUMMARY The two cases of patients presented with hypertension for many years.Computed tomography angiography showed that the aortic arch and descending aorta were discontinuous or significantly narrowed with extensive collateral flow.The IAA patient refused surgical treatment and blood pressure could be controlled with drugs.While the CoA patient underwent stent implantation because of uncontrollable hypertension,the blood flow recovered smoothly and the blood pressures at both ends of the stenosis returned to normal after surgery.CONCLUSION Adult type A IAA and CoA have difference and similarity,and type A IAA is associated with CoA to a certain extent.The treatment method should be chosen based on the patient's clinical symptoms rather than the severity of the lesion.
基金This study was supported by the CAMS Innovation Fund for Medical Sciences(CIFMS)[2020-I2M-C&T-A-009]the National Key R&D Program of China[2017YFC1308100].
文摘Background:Double aortic arch(DAA)with distal left-sided aortic arch atresia(LAAA)can form complete vascular ring by ligamentum connection.We aimed to introduce an uncommon DAA-LAAA diagnosis and treatment by the minimally invasive surgical technique(MIST).Methods:We retrospectively reviewed 7 cases of DAA-LAAA that were treated from January 2017 to July 2021.All infant patients underwent surgical repair by minimally invasive surgical technique.Mean follow-up was 14.43 months(range,5–21 months).Results:There were seven patients with DAA-LAAA,including six males and one female.Median age was 19.29 months(range,9.0–29.0 months).Median weight was 11.30 kg(range,9.6–13.0 kg).Three patients were found severe tracheal compression by cardiac computed tomography angiography(cCTA).Six patients with isolated DAA-LAAA were performed operations through left subaxillary minithoracotomy,and one patient with ventricular septal defect(VSD)was performed operation concurrently under the cardiopulmonary bypass(CPB)through right subaxillary minithoracotomy.All patients had symptom improvement in the postoperative period and discharged successfully.Follow-up data showed good results in short-term.Conclusions:We introduce a new surgical pathway for DAA-LAAA treatment with good symptomatic relief in short-term.MIST is a safe,feasible and economical approach for infant patients.
基金supported by the Henan medical science and technology research projects(222102310014 and LGHJ20200058)。
文摘Background:To establish a canine model of aortic arch aneurysm that is suitable for research on new devices and techniques applied to the aortic arch.Materials and methods:Fifteen mongrel dogs underwent surgery.The autologous pericardial patch was sewn on the aortotomy site in the anterior wall of the aortic arch.The animals were followed up for 3 months postoperatively.Computed tomography angiography was used to visualize and measure the aneurysm model.Hematoxylin and eosin staining was used to observe the histological characteristics of the aneurysm model.Changes in aneurysm diameter over time were analyzed using analysis of variance.Results:One dog died of hemorrhage during surgery.Fourteen dogs survived the surgical procedure.Two of them died on the first postoperative day because of ruptures at the suturing margin.The diameter of the aneurysm model was twice as large as that of the aortic arch.There was no significant change in the maximum diameter of the aneurysm model during the follow-up period.Conclusions:We established a controllable and stable aortic arch aneurysm model created with an autologous pericardium patch.The aneurysm model can be used to research endoleaks after thoracic endovascular aortic repair and new endovascular techniques can be applied to the aortic arch.
文摘Hemangiopericytoma is clinically rare and easily confused with meningioma.Right-sided aortic arch is also a rare disease of congenital cardiovascular variability.The intracranial hemangiopericytoma associated with the right-sided aortic arch has not been reported in the literature.We are here to register a case of right aortic arch concurrent with intracranial hemangiopericytoma;the patient was initially thought to be a simple meningioma,but he was eventually diagnosed as a hemangiopericytoma with right aortic arch and multiple intracranial vascular stenosis and malformation.Whether there was a genetic correlation between the two provides a potential research direction for us.Therefore,the diagnosis and treatment of some rare diseases should be a more comprehensive analysis and evaluation.Adequate examination and accurate diagnosis are crucial,which will directly affect the efficacy of surgery and the prognosis of patients.
文摘Aortic arch aneurysms are rarely isolated entities, and most frequently associated with either ascending or descending aorta pathologies. Association with aortic valve stenosis is uncommon and traditional surgical treatment is always challenging. Here we report a minimally invasive and endovascular management of these two pathologies in a 89-year-old man with LAD-stented ischemic cardiomyopathy. We describe our initial therapeutic strategy, per procedure difficulties and final management of this challenging case. Finally, we discuss the different therapeutic options for the endovascular treatment of aortic arch aneurysm associated with aortic valve stenosis.
文摘Objective To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey Ⅰ thoracic aortic dissection. Methods From January 2006 to October 2010,101 cases of DeBakeyⅠaortic dissection were treated by modified total arch replacement and stent elephant trunk technique,in which emergencey surgery were performed on 73 cases. There were 76 male and 25
文摘Objective Reviewing the experience in diagnosis and treatment of cases with aorta-pulmonary septal defect and aortic origin of right pulmonary artery complicated with interruption of aortic arch. Methods Clinical data from medical records for 5 patients (4 boys and 1 girl,age from 1 to 18 years on admission) who had been treated in Wuhan Asia Heart Hospital between 2005 and 2009
文摘Objective To discuss the operative techniques and results of coarctation resection plus aortoplasty with pulmonary autograft patch for coarctation of the aorta combined with hypoplastic aortic arch in infant. Methods Between May 2007 and Dec 2009,14 cases including 9 males and 5 females with coarctation of the aorta and hypoplastic aortic arch underwent coarctation resection plus aortoplasty with pulmonary autograft patch in
基金supported by the Natural Science Foundation of Hubei Province (No. 2012FFB04422)
文摘The purpose of this study was to evaluate the value of multi-detector computed tomography (MDCT) angiography for the diagnosis of congenital aortic arch anomalies and present the radiological images of congenital aortic arch anomalies in Chinese children. MDCT angiography and transthoracic echocardiography (TTE) were applied for the diagnosis of congenital aortic arch anomalies in 362 Chinese children between May 2006 and December 2011 (age ranges from 5 days to 12 years; mean age, 3.3 years). Surgery and/or catheter angiography (CA) were conducted in all patients to confirm the final diagnosis. In the 362 Chinese children with congenital heart anomalies, congenital aortic arch anomalies were definitely diagnosed in 198 children and 164 children ruled out by operation and/or (CA). Among the 198 children with anomalies, coarctation of aorta (CoA), interruption of aortic arch (IAA), right aortic arch, aberrant right subclavian artery and double aortic arch were diagnosed in 134, 32, 20, 10 and 2 children respectively, and there were 6 cases with uncommon congenital aortic arch anomalies: 2 had double aortic arch including 1 with five branches of the aortic arch, 2 had isolation of the right subclavian artery with two patent ductus arteriosus (PDA), 1 had an isolation of the common carotid artery with a PDA, and 1 had double PDA with a single ventricle and pulmonary artery atresia. Among the 32 children with IAA, 28 were of type A, and 4 were of type B. The diagnostic sensitivity, specificity and accuracy of MDCT angiography for congenital aortic arch anomalies were 100% (198/198), 98% (161/164) and 99% (359/362), respectively. The diagnostic sensitivity, specificity and accuracy of TTE were 92% (182/198), 81% (133/164) and 87% (315/362), respectively. In conclusion, MDCT angiography is a reliable, noninvasive imaging technique for the diagnosis of congenital aortic arch anomalies in children. Sometimes, even more information can be obtained from this technique than from conventional angiography.
基金Project supported by the National Natural Science Foundation of China(Grant No10274006)Education Ministry of China(Grant No03011)
文摘The three-dimensional (3D) lattice Boltzmann models,3DQ15,3DQ19 and 3DQ27,under different wall boundary conditions and lattice resolutions have been investigated by simulating Poiseuille flow in a circular cylinder for a wide range of Reynolds numbers.The 3DQ19 model with improved Fillippova and Hanel (FH) curved boundary condition represents a good compromise between computational efficiency and reliability.Blood flow in an aortic arch is then simulated as a typical haemodynamic application.Axial and secondary fluid velocity and effective wall shear stress profiles in a 180 bend are obtained,and the results also demonstrate that the lattice Boltzmann method is suitable for simulating the flow in 3D large-curved vessels.
文摘Right-sided aortic arch with aberrant left subclavian artery (RAA/ALSC) is the second most common mediastinal complete vascular ring. Adult presentation of dysphagia lusoria due to a RAA/ALSC is uncommon with fewer than 25 cases reported in the world literature. The left lateral portion of this vascular ring is not a vessel, but an atretic ductus arteriosus, the ligamentum arteriosum, which has been identified in different cases as the major cause of tracheo-esophageal impingement. Surgical division of the ligamentum arteriosum allows the vessels to assume a less constricting pattern decreasing dysphagic symptoms. Clear visualization of the ligamentum arteriosum by diagnostic imaging has not been obtained in previously reported cases. We demonstrated, using magnetic resonance imaging, the location and the complete course of a left-sided ligamentum arteriosum in a patient with adult-onset dysphagia due to a RAA/ALSC with a small Kommerell' s diverticulum, providing, during the same session, a complete assessment of both mediastinal vascular abnormalities and esophageal impingement sites.
文摘<strong>Objectives:</strong> To describe our technique for the implantation of the Thoraflex Hybrid prosthesis for replacement of the aortic arch in a safe and reproducible way. <strong>Materials:</strong> Thoraflex<span style="font-size:12.0pt;line-height:107%;font-family:;" "="">™</span> Hybrid Plexus Device (Terumo Aortic).<strong> Design:</strong> Drawing on our own experience over the past 4 years in the management of acute type A aortic dissection, we have distilled the essentials of our “Frozen Elephant Trunk” technique which have led us through our own learning curve to the improved management of this taxing condition. <strong>Method/ Results:</strong> Small extension of the median sternotomy incision along the medial border of sternocleidomastoid muscle. End to side graft anastomosis near the origin of the left subclavian artery during cooling on bypass towards 20 degrees. Attention to cardiac protection and maintenance of cerebral perfusion during the shortened corporeal arrest period. Excellent results in 24 consecutive AAAD patients with just one hospital mortality. <strong>Conclusions:</strong> We believe we are entering a new phase in the treatment of AAAD, facilitated by the availability of a hybrid prosthesis which combines expanding stent technology with familiar surgical graft material. Our particular management of the left subclavian artery and of the cerebral circulation during implantation has contributed to an expeditious and reproducible method of treating dissection within the arch of the aorta and beyond.
文摘INTERRUPTED aortic arch(IAA)is a rare congenital malformation that occurs in 5.8 per million live births.1IAA was thought to be incompatible with life once the ductus arteriosus closed.However,if extensive collateral circulation is present at birth survival is possible.We report an unusual case of IAA,who was treated successfully with extra-anatomic aortic repair under deep hypothermia circulatory arrest.
文摘We present a case of the right aortic arch with kommerell diverticulum (KD) and aberrant left subclavian artery in a symptomatic 50-year-old patient with a calcification in the presumed attachment site of the ligamentum arteriosum (LA) to the KD. In another 30-year-old male patient, the entire course of a calcified LA was demonstrated using multidetector row computed tomography.
文摘The interrupted aortic arch (IAA) is rare congential heart defect and entails a very poor prognosis without surgical treatment. We describe a young adult patient with IAA associated with severe pulmonary hypertension and discuss the perioperative anesthetic management of single-stage surgical correction in this patient. Preoperative anesthetic preparation with better understanding of the malformation, intraoperative hemodynamic monitoring, and adequate alveolar ventilation in the perioperative period were all important factors contributing to a successful outcome.
