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Sample records for aortic arch evaluation

  1. Double aortic arch

    MedlinePlus

    ... double aortic arch may press on the windpipe (trachea) and esophagus, leading to trouble breathing and swallowing. ... to relieve pressure on the esophagus and windpipe (trachea). The surgeon ties off the smaller branch and ...

  2. Pseudoaneurysm of the aortic arch

    PubMed Central

    Lu, Yuan-Qiang; Yao, Feng; Shang, An-Dong; Pan, Jian

    2016-01-01

    Abstract Background: Pseudoaneurysm of the aortic arch is uncommonly associated with cancer, and is extremely rare in pulmonary cancer. Here, we report an unusual and successfully treated case of aortic arch pseudoaneurysm in a male patient with lung squamous cell carcinoma. Methods: A 64-year-old male patient was admitted to the Emergency Department, presenting with massive hemoptysis (>500 mL blood during the 12 hours prior to treatment). The diagnosis of aortic arch pseudoaneurysm was confirmed after inspection of computed tomographic angiography and three-dimensional reconstruction. We processed the immediate endovascular stent-grafting for this patient. Results: This patient recovered with no filling or enlargement of the pseudoaneurysm, no episodes of hemoptysis, and no neurological complications during the 4-week follow-up period. Conclusion: Herein, we compare our case with other cancer-related pseudoaneurysms in the medical literature and summarize the clinical features and treatment of this unusual case. PMID:27495079

  3. Persistent Fifth Aortic Arch with Coarctation

    PubMed Central

    Kim, Sue Hyun; Choi, Eun-Suk; Cho, Sungkyu; Kim, Woong-Han

    2016-01-01

    Persistent fifth aortic arch (PFAA) is a rare congenital anomaly of the aortic arch frequently associated with other cardiovascular anomalies, such as tetralogy of Fallot and aortic arch coarctation or interruption. We report the case of a neonate with PFAA with coarctation who successfully underwent surgical repair. PMID:26889445

  4. Cervical aortic arch and a new type of double aortic arch. Report of a case.

    PubMed Central

    Cornali, M; Reginato, E; Azzolina, G

    1976-01-01

    A case of cervical aortic arch is reported. To the best of our knowledge, it is the first to be associated with a serious intracardiac anomaly. In addition, it is part of a new type of double aortic arch, caused by failure of reabsorption of both dorsal aortic roots and persistence of the fourth right and second (or third) left branchial arches. PMID:971387

  5. Hydatid cyst involving the aortic arch.

    PubMed

    Apaydin, Anil Z; Oguz, Emrah; Zoghi, Mehdi

    2007-03-01

    We report a very rare case of primary mediastinal hydatid cyst which invaded the ascending aorta and the aortic arch which initially presented as a cranial mass. Aortic wall is a very unusual site for the hydatid cysts. To the best of our knowledge, this is the first reported case of hydatid cyst located within the aortic arch lumen. Patient underwent ascending aortic and hemiarch replacement under hypothermic circulatory arrest and removal of the cyst. Patient had an uneventful recovery and has been on follow-up. Although the literature data are very limited, we believe that the aortic procedure of choice should be graft interpositon rather than patch repair. PMID:17215134

  6. Techniques for aortic arch endovascular repair.

    PubMed

    kHONGKU, Kiattisak; Dias, Nuno; Sonesson, Bjorn; Resch, Timothy

    2016-06-01

    This article reviews endovascular strategies for aortic arch repair. Open repair remains the gold standard particularly for good risk patients. Endovascular treatment potentially offers a less invasive repair. Principles, technical considerations, devices and outcomes of each technique are discussed and summarized. Hybrid repair combines less invasive revascularization options, instead of arch replacement while extending stent-graft into the arch. Outcomes vary with regard to extent of repair and aortic arch pathologies treated. Results of arch chimney and other parallel graft techniques perhaps make it a less preferable choice for elective cases. However, they are very appealing options for urgent or bailout situations. Fenestrated stent-grafting is subjected to many technical challenges in aortic arch due to difficulties in stent-graft orientation and fenestration positioning. In situ fenestration techniques emerge to avoid these problems, but durability of stent-grafts after fenestration and ischemic consequences of temporary carotid arteries coverage raises some concern total arch repair using this technique. Arch branched graft is a new technology. Early outcomes did not meet the expectation; however the results have been improving after its learning curve period. Refining stent-graft technologies and implantation techniques positively impact outcomes of endovascular approaches. PMID:26940011

  7. Ascending Aortic Slide for Interrupted Aortic Arch Repair.

    PubMed

    Urencio, Miguel; Dodge-Khatami, Ali; Greenleaf, Chris E; Aru, Giorgio; Salazar, Jorge D

    2016-09-01

    For repair of interrupted aortic arch, unfavorable anatomy challenges a tension-free anastomosis. We describe a useful alternative surgical technique used in five neonates/infants, involving splitting the ascending aorta from the sinotubular junction to the arch origin, leftward and posterior "sliding" of the flap with anastomosis to the distal arch creating a native tissue bridge, and reconstruction with a patch. With wide interruption gaps between proximal and distal aortic portions, the ascending aortic slide is a safe and reproducible technique, providing a tension-free native tissue bridge with potential for growth, and a scaffold for patch augmentation in biventricular hearts, or for Norwood stage I in univentricular palliation. PMID:27587504

  8. Hybrid treatment of aortic arch disease

    PubMed Central

    Metzger, Patrick Bastos; Rossi, Fabio Henrique; Moreira, Samuel Martins; Issa, Mario; Izukawa, Nilo Mitsuru; Dinkhuysen, Jarbas J.; Spina Neto, Domingos; Kambara, Antônio Massamitsu

    2014-01-01

    Introduction The management of thoracic aortic disease involving the ascending aorta, aortic arch and descending thoracic aorta are technically challenging and is an area in constant development and innovation. Objective To analyze early and midterm results of hybrid treatment of arch aortic disease. Methods Retrospective study of procedures performed from January 2010 to December 2012. The end points were the technical success, therapeutic success, morbidity and mortality, neurologic outcomes, the rate of endoleaks and reinterventions. Results A total of 95 patients treated for thoracic aortic diseases in this period, 18 underwent hybrid treatment and entered in this study. The average ages were 62.3 years. The male was present in 66.7%. The technical and therapeutic success was 94.5% e 83.3%. The perioperative mortality rate of 11.1%. There is any death during one-year follow- up. The reoperation rates were 16.6% due 2 cases of endoleak Ia and one case of endoleak II. There is any occlusion of anatomic or extra anatomic bypass during follow up. Conclusion In our study, the hybrid treatment of aortic arch disease proved to be a feasible alternative of conventional surgery. The therapeutic success rates and re- interventions obtained demonstrate the necessity of thorough clinical follow-up of these patients in a long time. PMID:25714205

  9. [Single coronary artery and right aortic arch].

    PubMed

    Martínez-Quintana, Efrén; Rodríguez-González, Fayna

    2015-01-01

    Coronary anomalies are mostly asymptomatic and diagnosed incidentally during coronary angiography or echocardiography. However, they must be taken into account in the differential diagnosis of angina, dyspnea, syncope, acute myocardial infarction or sudden death in young patients. The case is presented of two rare anomalies, single coronary artery originating from right sinus of Valsalva and right aortic arch, in a 65 year-old patient with atherosclerotic coronary artery disease treated percutaneously. PMID:25304052

  10. Crater-Like Ulceration of Aortic Arch.

    PubMed

    Simon, Caterina; Calabrese, Alice; Canu, Gianluca; Merlo, Maurizio; Galletti, Lorenzo

    2014-12-01

    We report the case of a 78-year-old female who presented to our hospital with signs of hemorrhagic shock and breathlessness. A transthoracic echocardiography demonstrated pericardial effusion. Computed tomography of the chest showed a penetrating atherosclerotic ulcer of the aortic arch with an intramural hematoma of the ascending and descending aorta. Endovascular repair with stent-grafting was urgently performed and a pericardial window placement was done to reduce mediastinal bleeding. PMID:26798748

  11. Mycotic aneurysm of the aortic arch.

    PubMed

    Aliaga, L; Cobo, F; Miranda, C; Lara, J

    2000-01-01

    A 61-year-old diabetic woman presented with a mycotic aneurysm of the aortic arch, also involving the left subclavian and vertebral arteries, caused by Staphylococcus aureus. Two months before, she had suffered from staphylococcal septic arthritis in her left knee. The patient was treated with antibiotics and an emergency operation was performed involving aneurysm excision and in situ synthetic graft replacement. She died on the fourth postoperative day from hemorrhagic shock. PMID:10961533

  12. Saccular Aneurysms of the Transverse Aortic Arch

    PubMed Central

    Preventza, Ourania; Coselli, Joseph S.

    2015-01-01

    Saccular aneurysms of the aortic arch, whether single or multiple, are uncommon. The choice of repair technique is influenced by patients' comorbidities and age. Repairing saccular aneurysms with traditional open techniques can be technically demanding; therefore, endovascular technology and a variety of hybrid approaches have been developed to facilitate such repairs and, potentially, to improve clinical outcomes, especially in high-risk patients. There have been no large, randomized studies to compare the outcomes of these different treatment options in patients with single or multiple saccular aneurysms of the arch. In this review, we outline the etiology and common locations of these aneurysms, the different open, completely endovascular, and hybrid techniques used to treat them, and the treatment selection process. PMID:26798759

  13. Aortic arch vessel anomalies associated with persistent trigeminal artery.

    PubMed

    Lotfi, Mehrzad; Nabavizadeh, Seyed Ali; Foroughi, Amin Abolhasani

    2012-01-01

    Developmental anomalies of the aortic arch vessels and persistent trigeminal artery that is the most common of the four anomalous carotid-basilar anastomoses are repeatedly reported in the literature as separate entities. Herein we report a previously undescribed variant including the coexistence of persistent trigeminal artery, truncus bicaroticus and direct origin of left vertebral artery from aortic arch. PMID:22542381

  14. Growth and hemodynamics after early embryonic aortic arch occlusion*

    PubMed Central

    Lindsey, Stephanie E.; Menon, Prahlad G.; Kowalski, William J.; Shekhar, Akshay; Yalcin, Huseyin C.; Nishimura, Nozomi; Schaffer, Chris B.; Butcher, Jonathan T.; Pekkan, Kerem

    2015-01-01

    The majority of severe clinically significant forms of congenital heart disease (CHD) is associated with great artery lesions, including hypoplastic, double, right or interrupted aortic arch morphologies. While fetal and neonatal interventions are advancing, their potential ability to restore cardiac function, optimal timing, location, and intensity required for intervention remain largely unknown. We here combine computational fluid dynamics (CFD) simulations with in vivo experiments to test how individual pharyngeal arch artery hemodynamics alters as a result of local interventions to obstruct individual arch artery flow. Simulated isolated occlusions within each pharyngeal arch artery were created with image derived three-dimensional (3D) reconstructions of normal chick pharyngeal arch anatomy at Hamburger-Hamilton (HH) developmental stages HH18 and HH24. Acute flow redistributions were then computed using in vivo measured subject-specific aortic sinus inflow velocity profiles. A kinematic vascular growth-rendering algorithm was then developed and implemented to test the role of changing local wall shear stress patterns in downstream 3D morphogenesis of arch arteries. CFD simulations predicted that altered pressure gradients and flow redistributions were most sensitive to occlusion of the IVth arches. To evaluate these simulations experimentally, a novel in vivo experimental model of pharyngeal arch occlusion was developed and implemented using two-photon microscopy guided femtosecond laser based photodisruption surgery. The right IVth arch was occluded at HH18, and resulting diameter changes were followed for up to 24 hours. Pharyngeal arch diameter responses to acute hemodynamic changes were predicted qualitatively but poorly quantitatively. Chronic growth and adaptation to hemodynamic changes however were predicted in a subset of arches. Our findings suggest that this complex biodynamic process is governed through more complex forms of mechanobiological

  15. Blood flow characteristics in the aortic arch

    NASA Astrophysics Data System (ADS)

    Prahl Wittberg, Lisa; van Wyk, Stevin; Mihaiescu, Mihai; Fuchs, Laszlo; Gutmark, Ephraim; Backeljauw, Philippe; Gutmark-Little, Iris

    2012-11-01

    The purpose with this study is to investigate the flow characteristics of blood in the aortic arch. Cardiovascular diseases are associated with specific locations in the arterial tree. Considering atherogenesis, it is claimed that the Wall Shear Stress (WSS) along with its temporal and spatial gradients play an important role in the development of the disease. The WSS is determined by the local flow characteristics, that in turn depends on the geometry as well as the rheological properties of blood. In this numerical work, the time dependent fluid flow during the entire cardiac cycle is fully resolved. The Quemada model is applied to account for the non-Newtonian properties of blood, an empirical model valid for different Red Blood Cell loading. Data obtained through Cardiac Magnetic Resonance Imaging have been used in order to reconstruct geometries of the the aortic arch. Here, three different geometries are studied out of which two display malformations that can be found in patients having the genetic disorder Turner's syndrome. The simulations show a highly complex flow with regions of secondary flow that is enhanced for the diseased aortas. The financial support from the Swedish Research Council (VR) and the Sweden-America Foundation is gratefully acknowledged.

  16. Critical Transitions in Early Embryonic Aortic Arch Patterning and Hemodynamics

    PubMed Central

    Kowalski, William J.; Dur, Onur; Wang, Yajuan; Patrick, Michael J.; Tinney, Joseph P.; Keller, Bradley B.; Pekkan, Kerem

    2013-01-01

    Transformation from the bilaterally symmetric embryonic aortic arches to the mature great vessels is a complex morphogenetic process, requiring both vasculogenic and angiogenic mechanisms. Early aortic arch development occurs simultaneously with rapid changes in pulsatile blood flow, ventricular function, and downstream impedance in both invertebrate and vertebrate species. These dynamic biomechanical environmental landscapes provide critical epigenetic cues for vascular growth and remodeling. In our previous work, we examined hemodynamic loading and aortic arch growth in the chick embryo at Hamburger-Hamilton stages 18 and 24. We provided the first quantitative correlation between wall shear stress (WSS) and aortic arch diameter in the developing embryo, and observed that these two stages contained different aortic arch patterns with no inter-embryo variation. In the present study, we investigate these biomechanical events in the intermediate stage 21 to determine insights into this critical transition. We performed fluorescent dye microinjections to identify aortic arch patterns and measured diameters using both injection recordings and high-resolution optical coherence tomography. Flow and WSS were quantified with 3D computational fluid dynamics (CFD). Dye injections revealed that the transition in aortic arch pattern is not a uniform process and multiple configurations were documented at stage 21. CFD analysis showed that WSS is substantially elevated compared to both the previous (stage 18) and subsequent (stage 24) developmental time-points. These results demonstrate that acute increases in WSS are followed by a period of vascular remodeling to restore normative hemodynamic loading. Fluctuations in blood flow are one possible mechanism that impacts the timing of events such as aortic arch regression and generation, leading to the variable configurations at stage 21. Aortic arch variations noted during normal rapid vascular remodeling at stage 21 identify a

  17. Minimally Invasive Techniques for Total Aortic Arch Reconstruction

    PubMed Central

    Faulds, Jason; Sandhu, Harleen K.; Estrera, Anthony L.; Safi, Hazim J.

    2016-01-01

    The cumulative experience with endovascular aortic repair in the descending thoracic and infrarenal aorta has led to increased interest in endovascular aortic arch reconstruction. Open total arch replacement is a robust operation that can be performed with excellent results. However, it requires cardiopulmonary bypass and circulatory arrest and, therefore, may not be tolerated by all patients. Minimally invasive techniques have been considered as an alternative and include hybrid arch debranching, parallel stent graft deployment in the chimney and snorkel configurations, and complete endovascular branched reconstruction with multi-branched devices. This review discusses the evolving use of endovascular techniques in the management of aortic arch pathology and considers their relevance in an era of safe and durable open aortic arch reconstruction. PMID:27127562

  18. Minimally Invasive Techniques for Total Aortic Arch Reconstruction.

    PubMed

    Faulds, Jason; Sandhu, Harleen K; Estrera, Anthony L; Safi, Hazim J

    2016-01-01

    The cumulative experience with endovascular aortic repair in the descending thoracic and infrarenal aorta has led to increased interest in endovascular aortic arch reconstruction. Open total arch replacement is a robust operation that can be performed with excellent results. However, it requires cardiopulmonary bypass and circulatory arrest and, therefore, may not be tolerated by all patients. Minimally invasive techniques have been considered as an alternative and include hybrid arch debranching, parallel stent graft deployment in the chimney and snorkel configurations, and complete endovascular branched reconstruction with multi-branched devices. This review discusses the evolving use of endovascular techniques in the management of aortic arch pathology and considers their relevance in an era of safe and durable open aortic arch reconstruction. PMID:27127562

  19. A case of neonatal arterial thrombosis mimicking interrupted aortic arch

    PubMed Central

    Gürsu, Hazım Alper; Varan, Birgül; Oktay, Ayla; Özkan, Murat

    2015-01-01

    Neonatal arterial thrombosis is a very rare entity with clinical findings resembling coarctation of aorta or interrupted aortic arch. A two day-old male newborn was admitted to a different hospital with difficulty in sucking and sleepiness. On echocardiographic examination, a diagnosis of interrupted aortic arch was made and he was treated with prostoglandin E2. When the patient presented to our center, physical examination revealed that his feet were bilaterally cold. The pulses were not palpable and there were ecchymotic regions in the lower extremities. Echocardiography ruled out interrupted aortic arch. Computerized tomographic angiography revealed a large thrombosis and total occlusion of the abdominal aorta. Since there was no response to treatment with tissue plasminogen activator, we performed thrombectomy. Homozygous Factor V Leiden and Methylenetetrahydrofolate reductase mutations were found in this patient. Neonatal aortic thrombosis which is observed very rarely and fatal should be considered in the differential diagnosis of coarctation of aorta and interrupted aortic arch. PMID:26265897

  20. Aortic arch repair today: open repair is best for most arch lesions.

    PubMed

    Coselli, J S; Green, S Y

    2015-08-01

    The transverse aortic arch is challenging to repair by either evolving open or emerging endovascular approaches. Contemporary experience in aortic arch repair can be difficult to assess because clinical practice varies substantially among centers with regard to temperature targets for hypothermic circulatory arrest, temperature monitoring sites, circulating perfusate temperatures, cerebral perfusion monitoring techniques, perfusion catheter flow rates, cannulation sites, pH management, and protective pharmacologic agents. Repair of the aortic arch has changed substantially over the last decade; these changes appear to have substantially reduced patient risk. In general, contemporary outcomes of open aortic arch repair are good to excellent. When acute aortic dissection is absent, many centers report early mortality rates below 5%; when acute aortic dissection is present, these rates are doubled or tripled. Not unexpectedly, mortality rates for total transverse aortic arch repair with elephant trunk or frozen elephant trunk approaches are greater than those for hemiarch repair (7-17% vs. 3-4%). In contemporary reports of mixed hemiarch and total arch repairs for aortic aneurysm, several authors report early mortality rates and stroke rates below 5%. Surprisingly, mortality rates for reoperation are not unlike those for primary repair and range from 8% to 9%; however, the risk of stroke appears somewhat greater and ranges from 5% to 6%. PMID:25752255

  1. Vascular airway compression management in a case of aortic arch and descending thoracic aortic aneurysm

    PubMed Central

    Kumar, Alok; Dutta, Vikas; Negi, Sunder; Puri, G. D.

    2016-01-01

    Airway compression due to distal aortic arch and descending aortic aneurysm repair has been documented. This case of tracheal and left main stem bronchus compression due to aortic aneurysm occurred in a 42-year-old man. The airway compression poses a challenge for the anesthesiologist in airway management during aortic aneurysm repair surgery. The fiber-optic bronchoscope is very helpful in decision-making both preoperatively and postoperatively in such cases. We report a case of airway compression in a 42-year-old patient who underwent elective distal aortic arch and descending aortic aneurysm repair. PMID:27397474

  2. Vascular airway compression management in a case of aortic arch and descending thoracic aortic aneurysm.

    PubMed

    Kumar, Alok; Dutta, Vikas; Negi, Sunder; Puri, G D

    2016-01-01

    Airway compression due to distal aortic arch and descending aortic aneurysm repair has been documented. This case of tracheal and left main stem bronchus compression due to aortic aneurysm occurred in a 42-year-old man. The airway compression poses a challenge for the anesthesiologist in airway management during aortic aneurysm repair surgery. The fiber-optic bronchoscope is very helpful in decision-making both preoperatively and postoperatively in such cases. We report a case of airway compression in a 42-year-old patient who underwent elective distal aortic arch and descending aortic aneurysm repair. PMID:27397474

  3. Bare Metal Stenting for Endovascular Exclusion of Aortic Arch Thrombi

    SciTech Connect

    Mahnken, Andreas H.; Hoffman, Andras; Autschbach, Ruediger; Damberg, Anneke L. M.

    2013-08-01

    BackgroundAortic thrombi in the ascending aorta or aortic arch are rare but are associated with a relevant risk of major stroke or distal embolization. Although stent grafting is commonly used as a treatment option in the descending aorta, only a few case reports discuss stenting of the aortic arch for the treatment of a thrombus. The use of bare metal stents in this setting has not yet been described.MethodsWe report two cases of ascending and aortic arch thrombus that were treated by covering the thrombus with an uncovered stent. Both procedures were performed under local anesthesia via a femoral approach. A femoral cutdown was used in one case, and a total percutaneous insertion was possible in the second case.ResultsBoth procedures were successfully performed without any periprocedural complications. Postoperative recovery was uneventful. In both cases, no late complications or recurrent embolization occurred at midterm follow-up, and control CT angiography at 1 respectively 10 months revealed no stent migration, freely perfused supra-aortic branches, and no thrombus recurrence.ConclusionTreating symptomatic thrombi in the ascending aorta or aortic arch with a bare metal stent is feasible. This technique could constitute a minimally invasive alternative to a surgical intervention or complex endovascular therapy with fenestrated or branched stent grafts.

  4. Computed tomography angiography of hybrid thoracic endovascular aortic repair of the aortic arch.

    PubMed

    Akhtar, Nila J; Oderich, Gustavo S; Vrtiska, Terri J; Williamson, Eric E; Araoz, Philip A

    2013-05-01

    Endovascular repair of the aorta has traditionally been limited to the abdominal aorta and, more recently, the descending thoracic aorta. However, recently hybrid repairs (a combination of open surgical and endovascular repair) have made endovascular repair of the aortic arch possible. Hybrid repair of the aortic arch typically involves an open surgical debranching procedure that allows for revascularization of the aortic arch vessels and subsequent endovascular stent placement. These approaches avoid the deep hypothermic circulatory arrest required for full, open surgical repair of the aortic arch. In hybrid repairs, the stent landing zone determines which branch vessels will be covered and therefore need revascularization. This article will review the preprocedure assessment with computed tomography angiography, techniques for revascularization and postprocedure complications. PMID:23621141

  5. Persistent right aortic arch in a yearling horse.

    PubMed Central

    Butt, T D; MacDonald, D G; Crawford, W H; Dechant, J E

    1998-01-01

    A 14-month-old filly with chronic pharyngitis was diagnosed with incomplete esophageal constriction and megaesophagus due to a persistent right aortic arch. This report is unusual because clinical signs of respiratory dysfunction secondary to chronic regurgitation occurred prior to the recognition of dysphagia. PMID:9818140

  6. Branched and fenestrated options to treat aortic arch aneurysms.

    PubMed

    Maurel, Blandine; Mastracci, Tara M; Spear, Rafaelle; Hertault, Adrien; Azzaoui, Richard; Sobocinski, Jonathan; Haulon, Stephan

    2016-10-01

    Conventional surgical repair of aortic arch aneurysms using cardiopulmonary bypass and hypothermic circulatory arrest remains the gold standard, however it is associated with a substantial mortality and morbidity rate, especially in the elderly. Hybrid techniques avoid aortic cross-clamping and circulatory arrest, but are of limited use and are only applicable to selected patients. The development of new devices to treat aortic arch aneurysms endovascularly has the potential to offer a treatment modality to patients unfit for an open repair. We present the challenges specific to endovascular arch repair based on our experience and the literature available from the first experience in 1999 to the third generation graft currently commonly used. Following an initial learning curve associated with the use of the third generation arch branch device, along with careful patient selection and operator experience, early results are promising. Technical success was achieved in all cases, there was no early mortality and strokes were noted in 11%. As with branched and fenestrated technology for thoracoabdominal aneurysm repair, the use of total endovascular repair for arch pathology will require an evolution in endovascular practice and device design. However, at present, the early use of the latest generation device offers a novel approach to patients who previously had no surgical options. PMID:27332680

  7. Low Density Lipoprotein transport in the normal human aortic arch

    PubMed Central

    Soulis, JV; Dimitrakopoulou, M; Giannoglou, GD

    2014-01-01

    Background: To understand the genesis and progression of atherosclerosis is essential to elucidate the blood flow and the transport of molecules in the cardiovascular system. The purpose of this computational study is to elucidate the relationship between low wall shear stress (WSS) - high site concentration of low density lipoproteins (LDL) and atherosclerotic sites in the normal human aortic arch under physiological flow and mass transport conditions. Methods: The numerical simulation couples the flow equations with the transport equation applying realistic boundary conditions at the wall in terms of blood-side concentration. The blood is considered to be non-Newtonian fluid obeying to the power law. Suitable mass transport conditions are specified at the wall. Results: Aortic arch walls are exposed to cholesterolemic environment although the applied mass and flow conditions refer to normal human geometry and normal mass-flow conditions. The luminal surface LDL concentration varies inversely with the WSS. Regions of high LDL luminal surface concentration do not necessarily co-locate to the sites of lowest WSS. Concave sides of the aortic arch exhibit, relatively to the convex sides, elevated concentration of the LDL. The area averaged normalized LDL concentration over the entire normal aortic arch is 1.267. The daughter aortic arch vessels exhibit, relatively to the main aorta, elevated LDL concentrations. Conclusions: The near wall paths of the velocities might be the most important factor for the elevated LDL concentration at areas located either at the vicinity of bifurcations regions or at high curvature regions. Hippokratia 2014; 18 (3): 221-225. PMID:25694755

  8. Total Aortic Arch Replacement: Superior Ventriculo-Arterial Coupling with Decellularized Allografts Compared with Conventional Prostheses

    PubMed Central

    Schmack, Bastian; Korkmaz, Sevil; Li, Shiliang; Chaimow, Nicole; Pätzold, Ines; Becher, Peter Moritz; Hartyánszky, István; Soós, Pál; Merkely, Gergő; Németh, Balázs Tamás; Istók, Roland; Veres, Gábor; Merkely, Béla; Terytze, Konstantin; Karck, Matthias; Szabó, Gábor

    2014-01-01

    Background To date, no experimental or clinical study provides detailed analysis of vascular impedance changes after total aortic arch replacement. This study investigated ventriculoarterial coupling and vascular impedance after replacement of the aortic arch with conventional prostheses vs. decellularized allografts. Methods After preparing decellularized aortic arch allografts, their mechanical, histological and biochemical properties were evaluated and compared to native aortic arches and conventional prostheses in vitro. In open-chest dogs, total aortic arch replacement was performed with conventional prostheses and compared to decellularized allografts (n = 5/group). Aortic flow and pressure were recorded continuously, left ventricular pressure-volume relations were measured by using a pressure-conductance catheter. From the hemodynamic variables end-systolic elastance (Ees), arterial elastance (Ea) and ventriculoarterial coupling were calculated. Characteristic impedance (Z) was assessed by Fourier analysis. Results While Ees did not differ between the groups and over time (4.1±1.19 vs. 4.58±1.39 mmHg/mL and 3.21±0.97 vs. 3.96±1.16 mmHg/mL), Ea showed a higher increase in the prosthesis group (4.01±0.67 vs. 6.18±0.20 mmHg/mL, P<0.05) in comparison to decellularized allografts (5.03±0.35 vs. 5.99±1.09 mmHg/mL). This led to impaired ventriculoarterial coupling in the prosthesis group, while it remained unchanged in the allograft group (62.5±50.9 vs. 3.9±23.4%). Z showed a strong increasing tendency in the prosthesis group and it was markedly higher after replacement when compared to decellularized allografts (44.6±8.3dyn·sec·cm−5 vs. 32.4±2.0dyn·sec·cm−5, P<0.05). Conclusions Total aortic arch replacement leads to contractility-afterload mismatch by means of increased impedance and invert ventriculoarterial coupling ratio after implantation of conventional prostheses. Implantation of decellularized allografts preserves vascular impedance

  9. Endovascular repair of a type B aortic dissection with a right-sided aortic arch: case report

    PubMed Central

    2013-01-01

    Right-sided aortic arch is a rare anomaly, and aortic dissection involving a right-sided aortic arch is extremely rare. We report the case of a 65-year-old man with a right-sided aortic arch and a right descending aortic dissection and a stent-graft was accurately deployed without perioperative complications. There were no any complaints and complications after 18 months follow-up. The CTA demonstrated that the false lumen was largely thrombosed only with a mild type II endoleak and a mild descending aortic expansion. We feel that endovascular repair is feasible to patient of type B aortic dissection with a right-sided aortic arch. However, long-term clinical efficacy and safety have yet to be confirmed. PMID:23343010

  10. Computational Study of Growth and Remodeling in the Aortic Arch

    PubMed Central

    Alford, Patrick W.; Taber, Larry A.

    2009-01-01

    Opening angles (OAs) are associated with growth and remodeling in arteries. One curiosity has been the relatively large OAs found in the aortic arch of some animals. Here, we use computational models to explore the reasons behind this phenomenon. The artery is assumed to contain a smooth muscle/collagen phase and an elastin phase. In the models, growth and remodeling of smooth muscle/collagen depends on wall stress and fluid shear stress. Remodeling of elastin, which normally turns over very slowly, is neglected. The results indicate that OAs generally increase with longitudinal curvature (torus model), earlier elastin production during development, and decreased wall stiffness. Correlating these results with available experimental data suggests that all of these effects may contribute to the large OAs in the aortic arch. The models also suggest that the slow turnover rate of elastin limits longitudinal growth. These results should promote increased understanding of the causes of residual stress in arteries. PMID:18792831

  11. Left cervical aortic arch: diagnosis by radioisotope and ultrasound techniques

    SciTech Connect

    Camiel, M.R.; Glanz, S.; Gordon, D.H.; Weiner, R.

    1982-01-01

    Two case histories are presented of patients with a developmental variant of the heart. The condition is usually innocuous but its appearance is confusing and incorrect diagnoses are possible. Although the abnormality is usually first detected by routine chest X-ray, radionuclide angiography and sonography are more appropriate diagnostic measures. The two methods can differentiate between the cervical aortic arch and aneurysm or lung tumor. (JMT)

  12. Aneurysm of an Aberrant Right Subclavian Artery Successfully Excluded by a Thoracic Aortic Stent Graft with Supra-aortic Bypass of Three Arch Vessels

    SciTech Connect

    Munneke, Graham J. Loosemore, Thomas M.; Belli, Anna-Maria; Thompson, Matt M.; Morgan, Robert A.

    2005-06-15

    An aberrant right subclavian artery (ARSA) arising from a left-sided aortic arch is the fourth most common aortic arch anomaly. Aneurysmal dilatation of the ARSA requires treatment because of the associated risk of rupture. We present a case where supra-aortic bypass of the arch vessels was performed to facilitate exclusion of the aneurysm by a thoracic aortic stent graft.

  13. Haemodynamics in the mouse aortic arch computed from MRI-derived velocities at the aortic root.

    PubMed

    Van Doormaal, Mark A; Kazakidi, Asimina; Wylezinska, Marzena; Hunt, Anthony; Tremoleda, Jordi L; Protti, Andrea; Bohraus, Yvette; Gsell, Willy; Weinberg, Peter D; Ethier, C Ross

    2012-11-01

    Mice are widely used to investigate atherogenesis, which is known to be influenced by stresses related to blood flow. However, numerical characterization of the haemodynamic environment in the commonly studied aortic arch has hitherto been based on idealizations of inflow into the aorta. Our purpose in this work was to numerically characterize the haemodynamic environment in the mouse aortic arch using measured inflow velocities, and to relate the resulting shear stress patterns to known locations of high- and low-lesion prevalence. Blood flow velocities were measured in the aortic root of C57/BL6 mice using phase-contrast MRI. Arterial geometries were obtained by micro-CT of corrosion casts. These data were used to compute blood flow and wall shear stress (WSS) patterns in the arch. WSS profiles computed using realistic and idealized aortic root velocities differed significantly. An unexpected finding was that average WSS in the high-lesion-probability region on the inner wall was actually higher than the WSS in the low-probability region on the outer wall. Future studies of mouse aortic arch haemodynamics should avoid the use of idealized inflow velocity profiles. Lesion formation does not seem to uniquely associate with low or oscillating WSS in this segment, suggesting that other factors may also play a role in lesion localization. PMID:22764131

  14. Complex aortic arch anomaly: Right aortic arch with aberrant left subclavian artery, fenestrated proximal right and duplicated proximal left vertebral arteries—CT angiography findings and review of the literature

    PubMed Central

    Tong, Elizabeth; Hagspiel, Klaus D

    2015-01-01

    Congenital aortic arch and vertebral artery anomalies are a relatively rare finding discovered on imaging either incidentally or for evaluation of entities like dysphagia or subclavian steal. Right aortic arch is an uncommon anatomical anomaly that occurs in less than 0.1% of the population, and in half of these cases the left subclavian artery is also aberrant.1 Unilateral vertebral artery (VA) duplication is rare with an observed prevalence of 0.72% in cadavers.2 Fenestration of the VA is more common than duplication, with a prevalence of approximately 0.23%–1.95%.3,4 We describe the case of a 25-year-old female who was found to have a right aortic arch with aberrant left subclavian artery, duplicated left vertebral artery and a fenestrated right vertebral artery on CT angiography performed for evaluation of dysphagia. This combination of findings has not been reported before, to the best of our knowledge. We review the embryologic mechanism for the development of the normal aortic arch, right aortic arch, vertebral artery duplication and vertebral artery fenestration. The incidence of these entities, resultant symptoms and clinical implications are also reviewed. The increased associated incidence of aneurysm formation, dissection, arteriovenous malformations and thromboembolic events with fenestration is also discussed. PMID:26306929

  15. Results and challenges for the endovascular repair of aortic arch aneurysms.

    PubMed

    Lioupis, Christos; Abraham, Cherrie Z

    2011-09-01

    Endovascular aortic arch reconstruction provides an attractive alternative to treat aortic arch disease in high-risk patients who would otherwise be unsuitable for open repair. Success with multibranched stent grafts in the thoracoabdominal aorta along with recent advances in design such as the precurved inner nitinol cannula have simplified the endovascular reconstruction of aortic arch aneurysms with multibranched stent grafts. These devices allow for greater flexibility in conforming to difficult anatomy and preserving important side branches. During the first surgical stage, a left carotid -subclavian bypass or left subclavian artery transposition is performed. The second stage is the endovascular procedure. The device is inserted through a transfemoral approach, and crossing of the aortic valve with the device is necessary. The stent graft is deployed during brief periods of rapid pacing. Bridging from the branches to the innominate and left common carotid arteries requires a suitable covered stent. In the case of a large-diameter innominate artery, a custom-made bridging limb has to be used to ensure that adequate length and size are available. Direct flow to the innominate and left common carotid arteries do not cease for any significant time during the procedure. Initial experience with mean follow up more than 6 months is encouraging. The method is not suitable for patients with extensive atheromatous involvement of the aortic arch. Careful preoperative planning (preoperative imaging, device construction, and access issues), high endovascular skills, and appropriate imaging equipment are imperative for a successful result. Long-term follow-up is necessary to evaluate the efficacy and safety of these new devices. PMID:21821619

  16. Impending rupture in an aortic arch aneurysm by Candida infection.

    PubMed

    Minami, H; Wakita, N; Kawanishi, Y; Kitano, I; Sakata, M

    2001-03-01

    A 68-year-old man was hospitalized with the complaints of left back pain and fever. He had a history of using steroids to treat uveitis for about thirty years. Computed tomography on the chest demonstrated an impending rupture in an aortic arch aneurysm, which was consequently surgically excised. Candida albicans was identified in the wall of the aneurysm, so fluconazole and itraconazole were administered. The patient was discharged at 120 days after surgery without recrudescence of the candida. To our knowledge, this is the fifteenth case of a successfully treated aneurysm caused by candida infection. PMID:11305059

  17. Mycotic aneurysm of the distal aortic arch caused by Aspergillus.

    PubMed

    Hosono, Mitsuharu; Hattori, Koji; Shibata, Toshihiko; Sasaki, Yasuyuki; Hirai, Hidekazu; Suehiro, Shigefumi

    2006-04-01

    We describe an unusual case of a thoracic aortic aneurysm caused by Aspergillus. A 70-year-old man underwent prednisolone and Ara-C treatments for a myelodysplastic syndrome. Blood examination revealed pancytopenia. Under these treatments, an aneurysm presented at the distal aortic arch. He underwent resection of the aneurysm with a graft repair covered by a pedicled omentum flap, followed by prolonged administration of micafungin and itraconazole for a mycotic aneurysm. The postoperative course was favorable without complications. Serum C-reactive protein became negative and he was discharged 2 months after the surgery. However, 4 months after the surgery, he died from worsening of the myelodysplastic syndrome. The prognosis for patients with mycotic aneurysms is poor due to their immunocompetent condition arising from underlying diseases. Therefore, in addition to prompt treatment with antifungal agents combined with surgical debridement, control of the underlying disease is essential for improving the outcome. PMID:16642922

  18. Aortic Arch Aneurysms: Treatment with Extra anatomical Bypass and Endovascular Stent-Grafting

    SciTech Connect

    Kato, Noriyuki; Shimono, Takatsugu; Hirano, Tadanori; Mizumoto, Toru; Ishida, Masaki; Fujii, Hideki; Yada, Isao; Takeda, Kan

    2002-10-15

    Endovascular repair of thoracic aortic aneurysms is emerging as an attractive alternative to surgical graft replacement. However,patients with aortic arch aneurysms are often excluded from the target of endovascular repair because of lack of suitable landing zones, especially at the proximal ones. In this paper we describe our method for treating patients with aortic arch aneurysms using a combination of extra anatomical bypass surgery and endovascular stent-grafting.

  19. Closed injury of the aortic arch and subsequent formation of a false aneurysm.

    PubMed

    Janevski, B

    1983-01-01

    The case history of a 25-year-old man who sustained a blunt trauma to the chest in a car accident and developed a false aneurysm of the aortic isthmus is reported. The injury of the aortic arch was not initially recognized. The diagnosis was established on the chest X-rays and arteriograms obtained 1 year after the trauma. The clinical and radiological signs of closed injuries of the aortic arch are reviewed. PMID:6617430

  20. Arch to Descending Aorta Extra-anatomic Aortic Repair for Thoracic Stent Graft Infection.

    PubMed

    Gagné-Loranger, Maude; Dumont, Éric; Voisine, Pierre; Mohammadi, Siamak; Dagenais, François

    2016-01-01

    We report a case of a pedunculated mass of the aortic isthmus. The patient was treated with bilateral carotid-subclavian bypass and a stent graft to cover the thrombus within the distal arch. The postoperative course was complicated by a stent graft infection. The patient underwent graft explantation with aortic continuity using extra-anatomic bypass from the aortic arch to the distal descending aorta. PMID:26481087

  1. Aortic Arch Mycotic Aneurysm Due to Scedosporium Apiospermum Reconstructed With Homografts.

    PubMed

    Blasco-Lucas, Arnau; Reyes-Juárez, José Luis; Nazarena Pizzi, María; Permanyer, Eduard; Evangelista, Arturo; Galiñanes, Manuel

    2015-06-01

    A 39-year-old female, active parenteral drug user was diagnosed of spondylodiscitis. A computed tomography (CT) scan showed an extensive aortic arch aneurysm. A positron emission tomography (PET)-CT scan, showing significant aortic wall uptake of the tracer through the whole aortic arch and the D8-D9 intervertebral disc, allowed us to suspect an aortitis despite negative blood cultures. The aneurysm was resected and reconstructed with 2 aortic homografts. Cultures of specimens from the aortic wall were positive to the fungi Scedosporium apiospermum. A new PET-CT scan 4 months after surgery showed absence of tracer uptake both at the homografts site and intervertebral disc. PMID:26046885

  2. Long-Term Changes in the Distal Aorta after Aortic Arch Replacement in Acute DeBakey Type I Aortic Dissection

    PubMed Central

    Cho, Kwangjo; Jeong, Jeahwa; Park, Jongyoon; Yun, Sungsil; Woo, Jongsu

    2016-01-01

    Background We analyzed the long-term results of ascending aortic replacement and arch aortic replacement in acute DeBakey type I aortic dissections to measure the differences in the distal aortic changes with extension of the aortic replacement. Methods We reviewed 142 cases of acute DeBakey type I aortic dissections (1996–2015). Seventy percent of the cases were ascending aortic replacements, and 30% of the cases underwent total arch aortic replacement, which includes the aorta from the root to the beginning of the descending aorta with the 3 arch branches. Fourteen percent (20 cases) resulted in surgical mortality and 86% of cases that survived had a mean follow-up period of 6.6±4.6 years. Among these cases, 64% of the patients were followed up with computed tomography (CT) angiograms with the duration of the final CT check period of 4.9±2.9 years. Results There were 15 cases of reoperation in 13 patients. Of these 15 cases, 13 cases were in the ascending aortic replacement group and 2 cases were in the total arch aortic replacement group. Late mortality occurred in 13 cases; 10 cases were in the ascending aortic replacement group and 3 cases were in the total arch aortic replacement group. Eight patients died of a distal aortic problem in the ascending aortic replacement group, and 1 patient died of distal aortic rupture in the total arch aortic replacement group. The follow-up CT angiogram showed that 69.8% of the ascending aortic replacement group and 35.7% of the total arch aortic replacement group developed distal aortic dilatation (p=0.0022). Conclusion The total arch aortic replacement procedure developed fewer distal remnant aortic problems from dilatation than the ascending aortic replacement procedure in acute type I aortic dissections. PMID:27525235

  3. Safety profile of decellularized, cryopreserved pulmonary allografts when used in the aortic position for neonatal arch reconstruction.

    PubMed

    Knepp, Marc D; Ohye, Richard G; Gajarski, Robert J

    2011-08-01

    Cryopreserved pulmonary allograft is frequently used to reconstruct the hypoplastic aortic arch. A decellularized graft preparation is available as an alternative reconstructive material. This case series profiles our experience using this material for neonatal aortic arch reconstruction. Data from 14 patients who received decellularized pulmonary allograft (DCPA) from 2001 to 2003 included the following: diagnosis; age at implantation; perioperative complications (graft bleeding or dehiscence); intermediate-term results, including infection, recurrent arch gradient (>10 mmHg), graft calcification, or aneurysm; need for graft removal; and cause of death. Eleven (79%) patients survived their initial procedure. Median follow-up was 26 (range: 1-110) months. No early graft dehiscence was reported. No child developed aortic arch obstruction or graft calcification. Twelve patients (86%) underwent postoperative cardiac catheterizations with no measurable arch gradient. No intermediate-term aneurysm, dehiscence, or graft removal occurred. Three early deaths were due to arrhythmia, non-shunt-related hypoxia, and renal failure, and one, intermediate-term death was respiratory syncytial virus related. This series found that DCPA reconstructed arches have a low adverse event profile. No complications occurred. Because this graft material, which may be less immunogenic, has important implications for this subgroup, who are at increased future transplant risk, larger trials evaluating longer-term safety and immunogenicity are warranted. PMID:21479906

  4. Sun's procedure for complex aortic arch repair: total arch replacement using a tetrafurcate graft with stented elephant trunk implantation.

    PubMed

    Ma, Wei-Guo; Zhu, Jun-Ming; Zheng, Jun; Liu, Yong-Min; Ziganshin, Bulat A; Elefteriades, John A; Sun, Li-Zhong

    2013-09-01

    The Sun's procedure is a surgical technique proposed by Dr. Li-Zhong Sun in 2002 that integrates total aortic arch replacement using a tetrafurcated graft with implantation of a specially designed frozen elephant trunk (Cronus(®)) in the descending aorta. It is used as a treatment option for extensive aortic dissections or aneurysms involving the ascending aorta, aortic arch and the descending aorta. The technical essentials of Sun's procedure include implantation of the special open stented graft into the descending aorta, total arch replacement with a 4-branched vascular graft, right axillary artery cannulation, selective antegrade cerebral perfusion for brain protection, moderate hypothermic circulatory arrest at 25 °C, a special anastomotic sequence for aortic reconstruction (i.e., proximal descending aorta → left carotid artery → ascending aorta → left subclavian artery → innominate artery), and early rewarming and reperfusion after distal anastomosis to minimize cerebral and cardiac ischemia. The core advantage of Sun's procedure lies in the use of a unique stented graft, which has superior technical simplicity, flexibility, inherent mechanical durability and an extra centimeter of attached regular vascular graft at both ends. Since its introduction in 2003, the Sun's procedure has produced satisfactory early and long-term results in over 8,000 patients in China and more than 200 patients in South American countries. In a series of 1,092 patients, the authors have achieved an in-hospital mortality rate of 6.27% (7.98% in emergent or urgent vs. 3.98% in elective cases). Given the accumulating clinical experience and the consequent, continual evolution of surgical indications, the Sun's procedure is becoming increasingly applied/used worldwide as an innovative and imaginative enhancement of surgical options for the dissected (or aneurysmal) ascending aorta, aortic arch and proximal descending aorta, and may become the next standard treatment for type

  5. Equine pericardial roll graft replacement of infected pseudoaneurysm of the aortic arch

    PubMed Central

    2012-01-01

    Resection of the infected aorta, debridement of the surrounding tissue, in situ graft replacement, and omentopexy is the standard procedure for treating infected aortic aneurysms, but the question of which graft material is optimal is still a matter of controversy. We recently treated a patient with an infected thoracic aortic aneurysm. The aneurysm was located in the proximal aortic arch. Because the patients had previously undergone abdominal surgery, the aortic arch were replaced in situ with a branched equine pericardial roll grafts. The patient is alive and well 23 months after the operation. PMID:22583570

  6. Prenatal diagnosis of tetralogy of Fallot with a double aortic arch.

    PubMed

    Cheng, Andrew L; Pruetz, Jay D; Kung, Grace C

    2016-06-01

    In this study, we present a case of prenatally diagnosed tetralogy of Fallot with a double aortic arch, correlating images from fetal echocardiography, transthoracic echocardiography, and cardiac MRI. PMID:26983561

  7. Endovascular repair of an aortic arch pseudoaneurysm with double chimney stent grafts: a case report

    PubMed Central

    2013-01-01

    Aortic arch pseudoaneurysm is a rare condition but carries a high risk of rupture. We report a case of a 45-year-old man with aortic arch pseudoaneurysm between left common carotid artery (LCCA) and left subclavian artery (LSA), in which a endovascular stent graft combined with double chimneys covered stents were successfully placed. There were no any complaints and complications after 12 months follow-up. The CTA demonstrated thrombus formation in the pseudoaneurysm lumen, no endoleak and the aortic arch, LCCA and LSA were all patent. We feel that the combined endovascular and double chimneys may be a valuable therapeutic alternative when treating aortic arch lesion. However, long-term clinical efficacy and safety have yet to be confirmed. PMID:23577875

  8. Imaging a boa constrictor--the incomplete double aortic arch syndrome.

    PubMed

    Narayan, Rajeev L; Kanwar, Anubhav; Jacobi, Adam; Sanz, Javier

    2012-11-01

    Incomplete double aortic arch is a rare anomaly resulting from atresia rather than complete involution in the distal left arch resulting in a non-patent fibrous cord between the left arch and descending thoracic aorta. This anatomic anomaly may cause symptomatic vascular rings, leading to stridor, wheezing, or dysphagia, requiring surgical transection of the fibrous cord. Herein, we describe an asymptomatic 59 year-old man presenting for contrast-enhanced CT angiography to assess cardiac anatomy prior to radiofrequency ablation, who was incidentally found to have an incomplete double aortic arch with hypoplasia of the left arch segment and an aortic diverticulum. Recognition of this abnormality by imaging is important to inform both corrective surgery in symptomatic patients, as well as assist in the planning of percutaneous coronary and vascular interventions. PMID:22542042

  9. Resection of the Aortic Arch with Moderate Hypothermia and Temporary Circulatory Arrest

    PubMed Central

    Speir, Alan M.; Grey, Douglas P.; Cooley, Denton A.

    1982-01-01

    Resection of the aortic arch with the use of moderate hypothermia and temporary circulatory arrest was performed in a 63-year-old woman. The simplified technique is described, along with a brief review of the literature. The patient recovered uneventfully. After this manuscript was prepared, two other patients underwent successful replacement of the aortic arch for aneurysm. These cases are also summarized briefly in an illustrated table. PMID:15226933

  10. Neonatal magnetic resonance imaging in double aortic arch diagnosed prenatally by ultrasound.

    PubMed

    Trobo Marina, Duna; Bravo, Coral; Lancharro, Ángel; Gámez Alderete, Francisco; Marín, Carlos; de León-Luis, Juan

    2016-05-01

    Congenital double aortic arch (DAA) is an uncommon vascular anomaly; however, its prenatal detection is associated with congenital heart defects and chromosomal abnormalities, including 22q11 deletion. We present a case of DAA diagnosed prenatally. DAA can be diagnosed by prenatal ultrasound in the transverse three vessel-trachea view, which shows a trident image formed by a complete vascular ring and the ductus arteriosus. Postnatal magnetic resonance images in this view correlate well with prenatal ultrasound images and help in confirmation of diagnosis, evaluation of the risk of airway or esophageal compression, and planning of surgery. PMID:26979672

  11. Hybrid intervention for type A aortic arch interruption and a giant subclavian artery aneurysm in an adult.

    PubMed

    Oz, Kursad; Erek, Ersin; Yildirim, Aydin

    2016-06-01

    Interrupted aortic arch is a very rare but well-described congenital anomaly. Concomitant presentation of interrupted aortic arch and giant subclavian artery aneurysm is an unusual event in adulthood. To the best of our knowledge, hybrid intervention for type A aortic arch interruption with a giant aneurysm of the subclavian artery is an alternative approach for the management of these concomitant pathologies in adults. PMID:27071339

  12. Some mice feature 5th pharyngeal arch arteries and double-lumen aortic arch malformations.

    PubMed

    Geyer, Stefan H; Weninger, Wolfgang J

    2012-01-01

    A 5th pair of pharyngeal arch arteries (PAAs) has never been identified with certainty in mice. Murines in general are considered to not develop a 5th pair. If true, the significance of the mouse as a model for researching the genesis of malformations of the great intrathoracic arteries is limited. We aimed to investigate whether mouse embryos develop a 5th pair of PAAs and to identify malformations known to be caused by defective remodelling of the 5th PAAs. We employed the high-resolution episcopic microscopy method for creating digital volume data and three-dimensional (3D) computer models of the great intrathoracic arteries of 30 mouse embryos from days 12-12.5 post conception and 180 mouse fetuses from days 14.5 and 15.5 post conception. The 3D models of the fetuses were screened for the presence of a double-lumen aortic arch malformation. We identified such a malformation in 1 fetus. The 3D models of the embryos were analysed for the presence of 5th PAAs. Six of the 30 embryos (20%) showed a 5th PAA bilaterally, and an additional 9 (30%) showed a 5th PAA unilaterally. Our results prove that some mice do develop a 5th pair of PAAs. They also show that malformations which occur rarely in humans and result from defective remodelling of the left 5th PAA can be identified in mice as well. Thus, the mouse does represent an excellent model for researching the mechanisms driving PAA remodelling and the genesis of malformations of the great intrathoracic arteries. PMID:22287557

  13. The influence of aortic dimensions on calculated wall shear stress in the mouse aortic arch.

    PubMed

    Trachet, Bram; Swillens, Abigail; Van Loo, Denis; Casteleyn, Christophe; De Paepe, Anne; Loeys, Bart; Segers, Patrick

    2009-10-01

    In this paper, the influence of the aortic dimensions of an investigated mouse on its resulting wall shear stress (WSS) was studied. A numerical model of a mouse aortic arch was created based on a micro-CT scan of a vascular corrosion cast of an 8-week-old wild type mouse. This model was then rescaled to obtain five models with aortic root diameters corresponding to five different stages in the mouse life cycle varying from late fetal (0.7 mm) to old adult (1.5 mm). Consistent with literature, WSS values much higher than those normally encountered in humans were found. WSS was found to decrease rapidly in early life stages and to reach a plateau in adulthood, thus supporting a mediating role for WSS in arterial growth. Our results show that WSS values for mice should be interpreted very cautiously, and if possible an animal-specific geometry with animal-specific boundary conditions should be used. PMID:19221921

  14. Endovascular repair of traumatic aortic injury using a modified, commercially available endograft to preserve aortic arch branches.

    PubMed

    Kawajiri, Hidetake; Oka, Katsuhiko; Sakai, Osamu; Watanabe, Taiji; Kanda, Keiichi; Yaku, Hitoshi

    2014-05-01

    A 25-year-old woman was admitted to our hospital after being involved in a high-speed motorcycle accident. Computed tomography angiography revealed a blunt traumatic aortic injury of the lesser curvature of the distal aortic arch accompanied by splintered fractures of the seventh thoracic vertebra and left clavicle. If the pseudoaneurysm had been treated with open surgical repair, then arch replacement under cardiopulmonary bypass, which was considered to be too invasive, would have been necessary. Therefore, thoracic endovascular aortic repair (TEVAR) was preferred as a first-line treatment to prevent pulmonary complications and hemorrhaging. Because the proximal landing zone for TEVAR was insufficient, we used a modified (fenestrated) commercially available endograft to preserve the branches of the aortic arch. Postoperative computed tomography scans confirmed that the pseudoaneurysm had been excluded without the endoleaks, and the aortic arch branches were patent. The patient's postoperative course was uneventful, and she was discharged from the hospital to have surgery for a vertebral fracture on postoperative day 6. PMID:24184496

  15. [Total aortic arch replacement in Stanford type A aortic dissection using a new method of implanting the stented graft].

    PubMed

    Kiyama, Hiroshi; Kaki, Nobuaki; Shiomi, Daisuke; Shimada, Naohiro

    2012-07-01

    In surgery for Stanford type A aortic dissection (SAAD) with intimal tear in the arch or proximal descending aorta, we performed total arch replacement with frozen elephant trunk technique for the purpose of achieving complete exclusion of the entry. To reduce the circulatory arrest time, we developed a quick stent graft placement method in the proximal descending aorta. We reported the early results and assessed the efficacy of our new method. Between March 2006 and February 2010, 52 consecutive patients with SAAD were divided into 2 groups:group A consisted of 17 patients who received total arch replacement with our new method;group B consisted of 35 patients who received ascending aorta or partial arch replacement. The duration of operation and cardiopulmonary bypass were significantly longer in group A. However, the duration of circulatory arrest time and postoperative factors including hospital mortality did not differ in both groups. In group A, thrombus obliteration of the residual false lumen in the descending aorta was observed in 75% at 19.2±13.1 months postoperatively. Shrinkage of false lumen in the aortic arch occurred in 15 patients( 93.8%). There was no reoperation for the residual false lumen and late death. Total aortic arch replacement with our new method for SAAD is technically feasible without increasing the operative risk and might reduce the necessity for further operations. PMID:22750824

  16. Hydrodynamic evaluation of a new dispersive aortic cannula (Stealthflow).

    PubMed

    Goto, Takeshi; Inamura, Takao; Shirota, Minori; Fukuda, Wakako; Fukuda, Ikuo; Daitoku, Kazuyuki; Minakawa, Masahito; Ito, Kazuo

    2016-06-01

    The aim of this study was to evaluate flow from a new dispersive aortic cannula (Stealthflow) in the aortic arch using flow visualization methods. Particle image velocimetry was used to analyze flow dynamics in the mock aortic model. Flow patterns, velocity distribution, and streamlines with different shape cannulas were evaluated in a glass aortic arch model. We compared flow parameters in two different dispersive type cannulas: the Stealthflow and the Soft-flow cannula. A large vortex and regurgitant flow were observed in the aortic arch with both cannulas. With the Stealthflow cannula, a high-velocity area with a maximum velocity of 0.68 m/s appeared on the ostium of the cannula in the longitudinal plane. With the Soft-flow cannula, 'multiple jet streams, each with a velocity less than 0.60 m/s, were observed at the cannula outlet. Regurgitant flow from the cannula to the brachiocephalic artery and to the ascending aorta on the greater curvature was specific to the Soft-flow cannula. The degree of regurgitation on the same site was lower with the Stealthflow cannula than with the Soft-flow cannula. The Stealthflow cannula has similar flow properties to those of the Soft-flow cannula according to glass aortic model analysis. It generates gentle flow in the aortic arch and slow flow around the ostia of the aortic arch vessels. The Stealthflow cannula is as effective as the Soft-flow cannula. Care must be taken when the patient has thick atheromatous plaque or frail atheroma on the lesser curvature of the aortic arch. PMID:26526561

  17. Relay NBS Graft with the Plus Delivery System to Improve Deployment in Aortic Arch with Small Radius Curve

    SciTech Connect

    Ferro, Carlo; Rossi, Umberto G. Seitun, Sara; Guastavino, Andrea; Scarano, Flavio; Passerone, Gian Carlo

    2011-04-15

    The purpose of this report is to describe deployment of the Relay NBS Thoracic Stent Graft with the Plus Delivery System (Bolton Medical, Sunrise, FL) in a flexible resin arch model with a 15-mm radius curve as well as our preliminary clinical results. The Relay NBS graft with the Plus Delivery System was evaluated by way of bench testing, which was performed with stent grafts with diameters ranging from 24 to 46 mm and lengths ranging from 100 to 250 mm in flexible resin arch models with a 15-mm arch radius of curvature. The deployment sequence was analyzed. The Relay NBS graft with the Plus Delivery System was deployed in two patients, respectively, having a 6.5-cm penetrating aortic ulcer of the proximal third of the descending thoracic aorta and a DeBakey type-I aortic dissection with chronic false lumen dilatation after surgery due to an entry site at the distal thoracic aorta. Bench tests showed proper conformation and apposition of the Relay NBS graft with the Plus Delivery System in the flexible resin model. This stent graft was deployed successfully into the two patients with a correct orientation of the first stent and without early or late complications. The Relay NBS graft with the Plus Delivery System ensures an optimal conformation and apposition of the first stent in the aortic arch with a small radius of curvature.

  18. A Novel Surgical Technique for Right-Sided Interrupted Aortic Arch by Interposition of a Pulmonary Autograft Tube.

    PubMed

    Kato, Nobuyasu; Yamagishi, Masaaki; Miyazaki, Takako; Maeda, Yoshinobu; Asada, Satoshi; Hongu, Hisayuki; Yamashita, Eijiro; Yaku, Hitoshi

    2016-08-01

    Right-sided interrupted aortic arch (IAA) is a rare cardiac anomaly. In general, the right bronchus sits higher than the left bronchus, so aortic arch reconstruction with a direct anastomosis has a risk of tracheal and bronchial obstruction. This report describes the successful definitive repair of a right-sided IAA in a 2.5-kg neonate by aortic arch reconstruction with a pulmonary autograft tube (PA tube). Postoperative three-dimensional multidetector computed tomography showed the reconstructed aortic arch without airway obstruction or aortic stenosis. The use of a PA tube is a simple and useful technique for aortic arch reconstruction in patients with a high risk of tracheal andbronchial obstruction, such as right-sided IAA. PMID:27449446

  19. Elephant trunk technique for hybrid aortic arch repair.

    PubMed

    Miyamoto, Yuji

    2014-03-01

    The original elephant trunk technique was developed by Borst in 1983 for the treatment of aortic arch aneurysms. This technique reduced operative risks, but was associated with cumulative mortality rates of 6.9 % for the first stage and 7.5 % for the second stage. Patients also waited a long time between two major surgical procedures. Only 50.4 % of patients underwent the second-stage surgery, and there was a significant interval mortality rate of 10.7 %. With the advent of stent-graft techniques, two different hybrid elephant trunk techniques were developed. One technique is first-stage elephant trunk graft placement followed by second-stage endovascular completion. The conventional elephant trunk graft provides a good landing zone for the stent-graft, and endovascular completion is a useful alternative to conventional second-stage surgery. This method has few major complications, and a postoperative paraplegia rate of 1.1 %. The other technique is the frozen elephant trunk technique. This technique eliminates the need for subsequent endovascular completion, and is particularly useful for the treatment of acute type A dissection because it can achieve a secure seal. However, it is associated with a higher rate of spinal cord ischemia than other methods such as the original elephant trunk technique. The left subclavian artery (LSA) is often lost when performing a hybrid elephant trunk procedure. Revascularization of the LSA should be performed to prevent arm ischemia and neurological complications such as paraplegia or stroke, although the level of evidence for this recommendation is low. PMID:23943042

  20. Role of aortic arch vascular mechanics in cardiovagal baroreflex sensitivity.

    PubMed

    Klassen, Stephen A; Chirico, Daniele; Dempster, Kylie S; Shoemaker, J Kevin; O'Leary, Deborah D

    2016-07-01

    Cardiovagal baroreflex sensitivity (cvBRS) measures the efficiency of the cardiovagal baroreflex to modulate heart rate in response to increases or decreases in systolic blood pressure (SBP). Given that baroreceptors are located in the walls of the carotid sinuses (CS) and aortic arch (AA), the arterial mechanics of these sites are important contributors to cvBRS. However, the relative contribution of CS and AA mechanics to cvBRS remains unclear. This study employed sex differences as a model to test the hypothesis that differences in cvBRS between groups would be explained by the vascular mechanics of the AA but not the CS. Thirty-six young, healthy, normotensive individuals (18 females; 24 ± 2 yr) were recruited. cvBRS was measured using transfer function analysis of the low-frequency region (0.04-0.15 Hz). Ultrasonography was performed at the CS and AA to obtain arterial diameters for the measurement of distensibility. Local pulse pressure (PP) was taken at the CS using a hand-held tonometer, whereas AA PP was estimated using a transfer function of brachial PP. Both cvBRS (25 ± 11 vs. 19 ± 7 ms/mmHg, P = 0.04) and AA distensibility (16.5 ± 6.0 vs. 10.5 ± 3.8 mmHg(-1) × 10(-3), P = 0.02) were greater in females than males. Sex differences in cvBRS were eliminated after controlling for AA distensibility (P = 0.19). There were no sex differences in CS distensibility (5.32 ± 2.3 vs. 4.63 ± 1.3 mmHg(-1) × 10(-3), P = 0.32). The present data demonstrate that AA mechanics are an important contributor to differences in cvBRS. PMID:27122371

  1. Feasibility study on the application of fenestrated stent grafts in canine aortic arches

    PubMed Central

    Xi, Er-Ping; Zhu, Jian; Zhu, Shui-Bo; Zhang, Yu; Xu, Gui-Hua

    2015-01-01

    Objective: To validate the feasibility and effectiveness of applying fenestrated stent grafts in canine aortic arches. Methods: According to the anatomic characteristics of the aortic arches from four adult beagle dogs, a straight-type aortic coated vascular stent system from Lifetech Scientific (Shenzhen) Co., Ltd. was released in vitro, after which a square window was burnt out at the back tendon of the coated vascular stent with an electrocautery pen, and the fenestrated stent grafts were then returned in the catheter and delivery sheath, following the original release path. Endovascular aortic repair (EVAR) was then performed in the canine aorta. Immediately after surgery, digital subtraction angiography (DSA) and computed tomography (CT) angiography were conducted. On day 3, the dressing was changed, and on day 7, the stitches were removed and CT angiography was reviewed. Animal autopsies were performed 2 weeks after surgery. Results: DSA and CT angiography were conducted in 4 beagles immediately after the experiments. The CT angiography reviewed on day 7 after surgery and the animal autopsy performed two weeks after surgery both revealed that the fenestrated stent grafts were anchored in the canine aortic arch, the openings were aligned against the branch vessels above the aortic arch, and in each branch vessel, the blood flow was smooth, without any obvious internal leakage phenomena. Conclusion: An ordinary straight-type coated vascular stent, fenestrated in vitro, followed by the performance of EVAR in the canine aortic arch for in vivo stent implantation, was technically feasible. When a branch coated vascular stent cannot meet the individual needs of the wound, this technology may provide a valuable strategy for clinical thoracic aortic trauma emergencies. PMID:25785052

  2. Influences on Early and Medium-Term Survival Following Surgical Repair of the Aortic Arch

    PubMed Central

    Bashir, Mohamad; Field, Mark; Shaw, Matthew; Fok, Matthew; Harrington, Deborah; Kuduvalli, Manoj; Oo, Aung

    2014-01-01

    Objectives: It is now well established by many groups that surgery on the aortic arch may be achieved with consistently low morbidity and mortality along with relatively good survival compared to estimated natural history for a number of aortic arch pathologies. The objectives of this study were to: 1) report, compare, and analyze our morbidity and mortality outcomes for hemiarch and total aortic arch surgery; 2) examine the survival benefit of hemiarch and total aortic arch surgery compared to age- and sex-matched controls; and 3) define factors which influence survival in these two groups and, in particular, identify those that are modifiable and potentially actionable. Methods: Outcomes from patients undergoing surgical resection of both hemiarch and total aortic arch at the Liverpool Heart and Chest Hospital between June 1999 and December 2012 were examined in a retrospective analysis of data collected for The Society for Cardiothoracic Surgeons (UK). Results: Over the period studied, a total of 1240 patients underwent aortic surgery, from which 287 were identified as having undergone hemi to total aortic arch surgery under deep or moderate hypothermic circulatory arrest. Twenty three percent of patients' surgeries were nonelective. The median age at the time of patients undergoing elective hemiarch was 64.3 years and total arch was 65.3 years (P = 0.25), with 40.1% being female in the entire group. A total of 140 patients underwent elective hemiarch replacement, while 81 underwent elective total arch replacement. Etiology of the aortic pathology was degenerative in 51.2% of the two groups, with 87.1% requiring aortic valve repair in the elective hemiarch group and 64.2% in the elective total arch group (P < 0.001). Elective in-hospital mortality was 2.1% in the hemiarch group and 6.2% (P = 0.15) in the total arch group with corresponding rates of stroke (2.9% versus 4.9%, P = 0.47), renal failure (4.3% versus 6.2%, P = 0.54), reexploration for bleeding (4

  3. ``Smart'' baroreception along the aortic arch, with reference to essential hypertension

    NASA Astrophysics Data System (ADS)

    Kember, G. C.; Zamir, M.; Armour, J. A.

    2004-11-01

    Beat-to-beat regulation of heart rate is dependent upon sensing of local stretching or local “disortion” by aortic baroreceptors. Distortions of the aortic wall are due mainly to left ventricular output and to reflected waves arising from the arterial tree. Distortions are generally believed to be useful in cardiac control since stretch receptors or aortic baroreceptors embedded in the adventitia of the aortic wall, transduce the distortions to cardiovascular neural reflex pathways responsible for beat-to-beat regulation of heart rate. Aortic neuroanatomy studies have also found a continuous strip of mechanosensory neurites spread along the aortic inner arch. Although their purpose is now unknown, such a combined sensing capacity would allow measurement of the space and time dependence of inner arch wall distortions due, among other things, to traveling waves associated with pulsatile flow in an elastic tube. We call this sensing capability-“smart baroreception.” In this paper we use an arterial tree model to show that the cumulative effects of wave reflections, from many sites far downstream, have a surprisingly pronounced effect on the pressure distribution in the root segment of the tree. By this mechanism global hemodynamics can be focused by wave reflections back to the aortic arch, where they can rapidly impact cardiac control via smart baroreception. Such sensing is likely important to maintain efficient heart function. However, alterations in the arterial tree due to aging and other natural processes can lead in such a system to altered cardiac control and essential hypertension.

  4. The macroanatomical investigations on the aortic arch in porcupines (Hystrix cristata).

    PubMed

    Atalar, O; Yilmaz, S; Burma, O; Ilkay, E

    2003-12-01

    The anatomy of aortic arch in porcupine was studied. Angiography was applied to each of the three adult porcupines (two males, one female) following the injection of latex from the abdominal aorta for the examination of aortic arch. The results indicated that three arteries arose from aortic arch in porcupine. These were truncus brachiocephalicus, arteria carotis communis sinistra and arteria subclavia sinistra. The truncus brachiocephalicus in porcupine yielded arteria subclavia dextra and arteria carotis communis dextra. Truncus bicaroticus was absent. The origin of truncus costocervicalis (right) and arteria vertebralis (right) arose from a common root. Left or right axillary arteries seemed to be a continuation of subclavian arteries. The results of this study may contribute to the data in this area of science. PMID:14651485

  5. Subgross and macroscopic investigation of blood vessels originating from aortic arch in the chinchilla (Chinchilla lanigera).

    PubMed

    Ozdemir, V; Cevik-Demirkan, A; Türkmenoğlu, I

    2008-04-01

    A total of 10 adult, healthy, male chinchilla (Chinchilla lanigera) were used to investigate the vessels originating from aortic arch. Coloured latex was injected into the carotid arteries following conventional anatomical applications in all the chinchillas examined. The brachiocephalic trunk and the left subclavian artery arose from the aortic arch at the level of the second intercostal region in the thoracic cavity. The right and left subclavian arteries detached branches at the level of first intercostal region and divided into the following vessels: internal thoracic artery, dorsal scapular artery, vertebral artery, superficial cervical artery and axillar artery. The vessels originating from the aortic arch displayed some significant differences in chinchillas compared to rats, guinea pigs, rabbits, porcupines and other laboratory rodents. PMID:18005370

  6. Open aortic arch repair: state-of-the-art and future perspectives.

    PubMed

    Ouzounian, Maral; LeMaire, Scott A; Coselli, Joseph S

    2013-01-01

    Surgical procedures for the treatment of complex aortic arch pathology remain among the most challenging cardiovascular operations, incurring considerable risk for death and stroke. The purpose of this article is to describe the evolution of our approach to open repair of the aortic arch. Our arterial cannulation strategy has shifted from femoral and direct aortic to right axillary and more recently innominate artery cannulation. This transition has facilitated the administration of continuous antegrade cerebral perfusion and more moderate levels of hypothermia during complex repairs. Modifications in surgical technique, including arch reconstruction with the trifurcated graft, and the classical and frozen elephant trunk techniques have simplified the conduct of the operation. Experimental and clinical research supporting the evolution of our approach is discussed in this paper. PMID:24216527

  7. Management of an elderly patient with respiratory failure due to double aortic arch

    PubMed Central

    Ryu, Changwan; Puchalski, Jonathan; Perkins, Michael; Honiden, Shyoko

    2015-01-01

    Vascular rings are congenital malformations of the aortic arch. A double aortic arch (DAA), the most common type of vascular ring, results from the failure of the fourth embryonic branchial arch to regress, leading to an ascending aorta that divides into a left and right arch that fuse together to completely encircle the trachea and esophagus. The subsequent DAA causes compressive effects on the trachea and esophagus that typically manifests in infancy or early childhood. Adult presentations, particularly in the elderly, are exceedingly rare. Historically such patients have a long-standing history of dyspnea on exertion and dysphagia, with many assumed to have obstructive lung or intrinsic cardiac disease. We describe a case of an elderly woman who presented with respiratory failure due to DAA. In her case, surgery was not feasible and we describe our experience with airway stenting.

  8. Successful repair of a syphilitic aortic arch aneurysm accompanied by serious cerebral infarction.

    PubMed

    Sato, Katsutoshi; Chiba, Kiyoshi; Koizumi, Nobusato; Ogino, Hitoshi

    2014-01-01

    We present a 52-year-old male with a syphilitic aortic arch aneurysm accompanied by relevant extensive cerebral infarction. He was admitted to a local hospital for sudden loss of consciousness, where he was diagnosed with serious cerebral infarction. During his treatment, a multilocular aortic arch aneurysm involving the arch vessels was found incidentally. He was transferred to our hospital for surgical treatment. A preoperative routine laboratory test for syphilis was highly positive, which suggested that the aneurysm was likely caused by syphilis and the cerebral infarction was also induced by the involvement of syphilitic aortitis or arteritis. After 2 weeks of antibiotic therapy for syphilis, total arch replacement was performed successfully using meticulous brain protection with antegrade selective cerebral perfusion and deep hypothermia. He recovered without any further cerebral deficits. The pathological examination of the surgical specimen showed some characteristic changes of syphilitic aortitis. PMID:24492165

  9. Dependence of aortic arch morphogenesis on intracardiac blood flow in the left atrial ligated chick embryo.

    PubMed

    Hu, Norman; Christensen, Douglas A; Agrawal, Amit K; Beaumont, Charity; Clark, Edward B; Hawkins, John A

    2009-05-01

    Partial left atrial ligation before cardiac septation redistributes intracardiac blood flow and produces left ventricular hypoplasia in the chick. We hypothesized that redistributed intracardiac blood flow adversely alters aortic arch development. We ligated the left atrial appendage with a 10-0 nylon suture at stage 21 chick embryos, then reincubated up to stage 34. Sham embryos had a suture tied adjacent to the atrial wall, and normal controls were unoperated. We measured simultaneous atrioventricular (AV) and dorsal aortic (DAo) blood velocities from stage 24 embryos with an ultrasound pulsed-Doppler flow meter; and the left and right third and fourth aortic arch blood flow with a laser-Doppler flow meter. Ventricular and atrial cross-sectional areas were measured from sequential video fields for planimetry. Intracardiac flow patterns were imaged on video by injecting India ink into the vitelline vein. In separate embryos, radiopaque microfil was injected into the cardiovascular system for micro-CT scanning. We analyzed the morphologic characteristics of the heart at stage 34. Active AV and DAo stroke volume (mm(3)), right third and fourth aortic arch blood flow (mm(3)/s) were all decreased in ligated embryos (P < 0.05) when compared with normal and sham embryos. Ventricular end-diastolic volume versus normal and sham embryos decreased by 45% and 46%, respectively (P < 0.05). India ink injection revealed altered right aortic arch flow patterns in the ligated embryos compared with normal embryos. micro-CT imaging confirmed altered arch morphogenesis. Alterations in intracardiac blood flow disrupt both early cardiac morphogenesis and aortic arch selection. PMID:19322826

  10. Complex Cervical Aortic Arch With Hypoplasia: A Simple Solution to a Complex Problem.

    PubMed

    Rajbanshi, Bijoy G; Gautam, Navin C; Pradhan, Sidhartha; Sharma, Apurb; Ghimire, Ram K; Joyce, Lyle D

    2016-07-01

    We report a rare case of a 6-year-old boy with a complex right-sided cervical aortic arch, with retroesophageal hypoplastic transverse arch, left subclavian artery arising from the Kommerell diverticulum of the descending aorta, and a vascular ring formed by the ductus ligament. An extraanatomic ascending-to-descending aorta bypass was done through a median sternotomy along with division of the ductus ligament, without any complications and good results. PMID:27343523

  11. Selective cerebro-myocardial perfusion in complex congenital aortic arch pathology: a novel technique.

    PubMed

    De Rita, Fabrizio; Lucchese, Gianluca; Barozzi, Luca; Menon, Tiziano; Faggian, Giuseppe; Mazzucco, Alessandro; Luciani, Giovanni Battista

    2011-11-01

    Simultaneous cerebro-myocardial perfusion has been described in neonatal and infant arch surgery, suggesting a reduction in cardiac morbidity. Here reported is a novel technique for selective cerebral perfusion combined with controlled and independent myocardial perfusion during surgery for complex or recurrent aortic arch lesions. From April 2008 to April 2011, 10 patients with arch pathology underwent surgery (two hypoplastic left heart syndrome [HLHS], four recurrent arch obstruction, two aortic arch hypoplasia + ventricular septal defect [VSD], one single ventricle + transposition of the great arteries + arch hypoplasia, one interrupted aortic arch type B + VSD). Median age was 63 days (6 days-36 years) and median weight 4.0 kg (1.6-52). Via midline sternotomy, an arterial cannula (6 or 8 Fr for infants) was directly inserted into the innominate artery or through a polytetrafluoroethylene (PTFE) graft (for neonates <2.0 kg). A cardioplegia delivery system was inserted into the aortic root. Under moderate hypothermia, ascending and descending aorta were cross-clamped, and "beating heart and brain" aortic arch repair was performed. Arch repair was composed of patch augmentation in five, end-to-side anastomosis in three, and replacement in two patients. Average cardiopulmonary bypass time was 163 ± 68 min (71-310). In two patients only (one HLHS, one complex single ventricle), a period of cardiac arrest was required to complete intracardiac repair. In such cases, antegrade blood cardioplegia was delivered directly via the same catheter used for selective myocardial perfusion. Average time of splanchnic ischemia during cerebro-myocardial perfusion was 39 ± 18 min (17-69). Weaning from cardiopulmonary bypass was achieved without inotropic support in three and with low dose in seven patients. One patient required veno-arterial extracorporeal membrane oxygenation. Four patients, body weight <3.0 kg, needed delayed sternal closure. No neurologic dysfunction was noted

  12. The branching pattern of the aortic arch in the long-legged buzzard (Buteo rufinus Cretzschmar 1829).

    PubMed

    Erdoğan, Serkan; Kılınç, Mehmet

    2014-06-01

    The aim of this study was to investigate the vascular branching morphology of the aortic arch in the long-legged buzzard. For this purpose, two long-legged buzzards were evaluated in this study. The latex injection method was used to investigate the branching of the aortic arch. Two innominate brachiocephalic trunks branched continually from aortic arch caudoventral to the primary bronchi and ventral to the syrinx. The left subclavian artery gave rise to sternoclavicular, thoracic, axillary and intercostal arteries in this region. On the right side, it was observed that the right subclavian artery gave off thoracic, sternoclavicular and intercostal arteries, and the axillary artery was the branch of thoracic artery differently from the left one. Each carotid artery was continued to the middle of the neck and soon disappeared, becoming covered by the muscles of the anterior part of the neck, and entering the canal formed by the inferior spinous processes of the cervical vertebrae, within which it ran hidden, and in close contact with its fellow of the other lateral side, to near the head. This morphological study in the long-legged buzzard will elucidate the vascular organization for regional blood supply, and provide specific anatomical data. PMID:24136451

  13. Reversible cerebral vasoconstriction syndrome with multivessel cervical artery dissections and a double aortic arch.

    PubMed

    Nouh, Amre; Ruland, Sean; Schneck, Michael J; Pasquale, David; Biller, José

    2014-02-01

    Reversible cerebral vasoconstriction syndrome (RCVS) has been associated with exposure to vasoactive substances and few reports with cervical arterial dissections (CADs). We evaluated a 32-year-old woman with history of depression, migraines without aura, and cannabis use who presented with a thunderclap headache unresponsive to triptans. She was found to have bilateral occipital infarcts, bilateral extracranial vertebral artery dissections, bilateral internal carotid artery dissecting aneurysms, and extensive distal multifocal segmental narrowing of the anterior and posterior intracranial circulation with a "sausage on a string-like appearance" suggestive of RCVS. Subsequently, she was found to have a distal thrombus of the basilar artery, was anticoagulated, and discharged home with no residual deficits. We highlight the potential association of CADs and RCVS. The association of RCVS and a double aortic arch has not been previously reported. PMID:24103665

  14. When and how to replace the aortic arch for type A dissection.

    PubMed

    Di Bartolomeo, Roberto; Leone, Alessandro; Di Marco, Luca; Pacini, Davide

    2016-07-01

    Acute type A aortic dissection (AAAD) remains one of the most challenging diseases in cardiothoracic surgery and despite numerous innovations in medical and surgical management, early mortality remains high. The standard treatment of AAAD requires emergency surgery of the proximal aorta, preventing rupture and consequent cardiac tamponade. Resection of the primary intimal tear and repair of the aortic root and aortic valve are well-established surgical principles. However, the dissection in the aortic arch and descending untreated aorta remains. This injury is associated with the risk of subsequent false lumen dilatation potentially progressing to rupture, true lumen compression and distal malperfusion. Additionally, the dilatation of the aortic arch, the presence of a tear and retrograde dissection can all be considered indication for a total arch replacement in AAAD. In such cases a more aggressive strategy may be used, from the classic aortic arch operation to a single stage frozen elephant trunk (FET) technique or a two-stage approach such as the classical elephant trunk (ET) or the recent Lupiae technique. Although these are all feasible solutions, they are also complex and time demanding techniques requiring experience and expertise, with an in the length of cardiopulmonary bypass and both myocardial and visceral ischemia. Effective methods of cerebral, myocardial as well visceral protection are necessary to obtain acceptable results in terms of hospital mortality and morbidity. Moreover, a correct assessment of the anatomy of the dissection, through the preoperative angio CT scan, in addition to the clinical condition of the patients, remain the decision points for the best arch repair strategy to use in AAAD. PMID:27563552

  15. When and how to replace the aortic arch for type A dissection

    PubMed Central

    Leone, Alessandro; Di Marco, Luca; Pacini, Davide

    2016-01-01

    Acute type A aortic dissection (AAAD) remains one of the most challenging diseases in cardiothoracic surgery and despite numerous innovations in medical and surgical management, early mortality remains high. The standard treatment of AAAD requires emergency surgery of the proximal aorta, preventing rupture and consequent cardiac tamponade. Resection of the primary intimal tear and repair of the aortic root and aortic valve are well-established surgical principles. However, the dissection in the aortic arch and descending untreated aorta remains. This injury is associated with the risk of subsequent false lumen dilatation potentially progressing to rupture, true lumen compression and distal malperfusion. Additionally, the dilatation of the aortic arch, the presence of a tear and retrograde dissection can all be considered indication for a total arch replacement in AAAD. In such cases a more aggressive strategy may be used, from the classic aortic arch operation to a single stage frozen elephant trunk (FET) technique or a two-stage approach such as the classical elephant trunk (ET) or the recent Lupiae technique. Although these are all feasible solutions, they are also complex and time demanding techniques requiring experience and expertise, with an in the length of cardiopulmonary bypass and both myocardial and visceral ischemia. Effective methods of cerebral, myocardial as well visceral protection are necessary to obtain acceptable results in terms of hospital mortality and morbidity. Moreover, a correct assessment of the anatomy of the dissection, through the preoperative angio CT scan, in addition to the clinical condition of the patients, remain the decision points for the best arch repair strategy to use in AAAD. PMID:27563552

  16. In Vitro Hemodynamic Investigation of the Embryonic Aortic Arch at Late Gestation

    PubMed Central

    Pekkan, Kerem; Dasi, Lakshmi P.; Nourparvar, Paymon; Yerneni, Srinivasu; Tobita, Kimimasa; Fogel, Mark A.; Keller, Bradley; Yoganathan, Ajit

    2013-01-01

    This study focuses on the dynamic flow through the fetal aortic arch driven by the concurrent action of right and left ventricles. We created a parametric pulsatile computational fluid dynamics (CFD) model of the fetal aortic junction with physiologic vessel geometries. To gain a better biophysical understanding an in vitro experimental fetal flow loop for flow visualization was constructed for identical CFD conditions. CFD and in vitro experimental results were comparable. Swirling flow during the acceleration phase of the cardiac cycle and unidirectional flow following mid-deceleration phase were observed in pulmonary arteries (PA), head-neck vessels, and descending aorta. Right-to-left (oxygenated) blood flowed through the ductus arteriosus (DA) posterior relative to the antegrade left ventricular outflow tract (LVOT) stream and resembled jet flow. LVOT and right ventricular outflow tract flow mixing had not completed until ~3.5 descending aorta diameters downstream of the DA insertion into the aortic arch. Normal arch model flow patterns were then compared to flow patterns of four common congenital heart malformations that include aortic arch anomalies. Weak oscillatory reversing flow through the DA junction was observed only for the Tetralogy of Fallot configuration. Pulmonary Atresia and Hypoplastic Left Heart Syndrome configurations demonstrated complex, abnormal flow patterns in the PAs and head-neck vessels. Aortic Coarctation resulted in large scale recirculating flow in the aortic arch proximal to the DA. Intravascular flow patterns spatially correlated with abnormal vascular structures consistent with the paradigm that abnormal intravascular flow patterns associated with congenital heart disease influence vascular growth and function. PMID:18466908

  17. Double aortic arch as a source of airway obstruction in a child

    PubMed Central

    Das, Sambhunath; Nair, Vinitha V.; Airan, Balram

    2015-01-01

    Double aortic arch (DAA) is a congenital vascular anomaly. The diagnosis was difficult till the child was symptomatic, and other causes were ruled out. We present the interesting images of a child of respiratory distress because of tracheal compression from DAA. PMID:25566726

  18. Application of the Bolton Relay Device for Thoracic Endografting In or Near the Aortic Arch

    PubMed Central

    Riambau, Vincent

    2015-01-01

    Endovascular correction of aortic arch pathology remains a challenge, with a variety of techniques proposed over the years to minimize complications and enhance the probability of a successful result. A variety of approaches have been developed in order to deal with the aortic arch pathology and its idiosyncrasies. We review potential interventional techniques for the repair of aortic arch pathologies, beginning with conventional aortic arch surgery, followed by hybrid treatments and those along the endovascular spectrum (parallel and fenestrated endografts, scalloped endografts, and ascending and new branched endografts). We finish with an overview of all the Bolton Medical (Barcelona, Spain and Sunrise, FL, USA) thoracic platforms. Endovascular techniques show acceptable results in selected cases. Both proximal Bolton Relay configurations (with and without a bare stent) offer conformability and accuracy on deployment with very low rates of stroke. Fenestrated and scalloped designs are also useful for selected cases. Ascending and branched Bolton devices are very promising platforms for a serious, full endovascular approach to the aorta. PMID:26798752

  19. [Antegrade unilateral perfusion of the brain through the brachiocephalic trunk in operations on the aortic arch].

    PubMed

    Kozlov, B N; Panfilov, D S; Kuznetsov, M S; Ponomarenko, I V; Nasrashvili, G G; Shipulin, V M

    2016-01-01

    Presented herein is a technique of unilateral antegrade perfusion of the brain in operations on the aortic arch. The method makes it possible to perform both systemic artificial circulation and adequate physiological perfusion of the brain, promoting minimization of the number of neurological complications. PMID:27100557

  20. Prenatal diagnosis of the rare association of common arterial trunk and double aortic arch.

    PubMed

    Rock, Andrea; Eltayeb, Osama; Camarda, Joseph; Gotteiner, Nina

    2016-07-01

    Common arterial trunk with associated double aortic arch is a very rare constellation of congenital heart disease. Prenatal diagnosis allows for surgical repair prior to development of respiratory morbidity, which is otherwise described in all cases with this association. PMID:27386125

  1. [Complete repair of the interrupted aortic arch by an anterior approach. Apropos of 9 cases].

    PubMed

    Chambran, P; Planché, C; Bruniaux, J; Lacour-Gayet, F; Binet, J P

    1988-05-01

    Interrupted aortic arch is a duct-dependent heart disease, and this is why the use of prostaglandins E, which keep the ductus arteriosus open to feed the descending aorta, has transformed its formerly sombre prognosis. The authors report the cases of 9 neonates and infants presenting with interrupted aortic arch associated with ventricular septal defect who underwent total repair of the malformations under extracorporeal circulation. Five children were less than 10 years' old. The aortic lesions were of type A in 2 cases (interruption distal to the left subclavian artery) and of type B in 7 cases (interruption between the left carotid and subclavian arteries). In the second group the lesions were of type B1 in 5 cases (without retro-oesophageal right subclavian artery) and of type B2 in 2 cases (right retro-oesophageal artery distal to the interruption). There was one death (11 p. 100). So far, no child has been reoperated upon for residual aortic obstruction or reopened ventricular septal defect. This technique of total repair in one stage, with closure of the ventricular septal defect, seems to be preferable to the two-stage technique in which stage one includes, in addition to aortic arch repair, cerclage of the pulmonary artery, a procedure with numerous disadvantages and a higher overall mortality rate. PMID:3136722

  2. Externalized Guidewires to Facilitate Fenestrated Endograft Deployment in the Aortic Arch

    PubMed Central

    Joseph, George; Premkumar, Prabhu; Thomson, Viji; Varghese, Mithun; Selvaraj, Dheepak; Sahajanandan, Raj

    2016-01-01

    Purpose: To describe a precannulated fenestrated endograft system utilizing externalized guidewires to facilitate aortic arch endovascular repair and to report its use in 2 patients with challenging anatomy. Technique: For distal arch repair, a fenestration for the left subclavian artery (LSA) is made onsite in a standard thoracic endograft tailored to the patient anatomy; it is precannulated with a nitinol guidewire (NGw), which is passed from the femoral artery and externalized from the left brachial artery prior to endograft delivery system introduction over a parallel stiff guidewire. Steps are then taken to remove guidewire intertwining, prevent NGw wrapping around the delivery system, and orient the LSA fenestration superiorly when the delivery system moves into the arch. Gentle traction on the ends of the NGw during endograft deployment facilitates proper fenestration alignment. A covered stent is deployed in the LSA fenestration. The technique is illustrated in a patient with congenital coarctation of the aorta and descending aortic aneurysm. For total arch repair, endograft fenestrations are made for all 3 arch branches; the left common carotid artery (LCCA) and LSA fenestrations are each cannulated with NGws, which travel together from the femoral artery, pass through a LSA snare loop, and are exteriorized from the LCCA. After endograft deployment, the innominate artery fenestration is separately cannulated using right brachial access. Placement of a parallel externalized hydrophilic guidewire passing through the LCCA fenestration (but not the LSA snare loop) and removal of the LCCA fenestration NGw allows exteriorization of the LSA fenestration NGw from the left brachial artery by pulling the LSA snare. Covered stents are deployed in all 3 fenestrations. The technique is presented in a patient with type B aortic dissection. Conclusion: Use of the precannulated fenestrated endograft system described is feasible and has the potential to make aortic arch

  3. Open Aortic Arch Reconstruction After Coronary Artery Bypass Surgery: Worth the Effort?

    PubMed

    Quintana, Eduard; Bajona, Pietro; Schaff, Hartzell V; Dearani, Joseph A; Daly, Richard; Greason, Kevin; Pochettino, Alberto

    2016-01-01

    Open aortic arch surgery after coronary artery bypass grafting (CABG) is considered a high-risk operation. We reviewed our surgical approach and outcomes to establish the risk profile for this patient population. In methods, from 2000-2014, 650 patients underwent aortic arch surgery with circulatory arrest. Of these, 45 (7%) had previous CABG. Complete medical record was available for review including all preoperative coronary angiograms and detailed management of myocardial protection. In results, the mean interval from previous CABG to aortic arch surgery was 6.8 ± 7.1 years. At reoperation, 33 (73%) patients had hemiarch replacement and 12 (27%) had a total arch replacement. The following were the indications for surgery: fusiform aneurysm in 20 (44%), pseudoaneurysm in 6 (13%), endocarditis in 4 (9%), valvular disease in 5 (11%), and acute aortic dissection in 10 (22%). There were 6 perioperative deaths (13%) and 1 stroke (2.2%). Selective antegrade cerebral perfusion was used in 13 patients (28.9%) and retrograde perfusion in 6 (13.3%). Survival was 74%, 65%, and 52% at 1, 3, and 5-year follow-up, respectively. Only predictors of early mortality were age (odds ratio = 1.20, CI: 1.01-1.44; P = 0.04) and nonuse of retrograde cardioplegia for myocardial protection (odds ratio = 6.80, CI: 1.06-43.48; P = 0.04). Intermediate survival of these patients was significantly lower than those of a sex-matched and age-matched population (P < 0.001). In conclusion, aortic arch surgery after previous CABG can be performed with acceptable early and midterm results and low risk of stroke. Perfusion strategies and myocardial protection contribute to successful outcomes. PMID:27568130

  4. A review of the surgical management of right-sided aortic arch aneurysms.

    PubMed

    Barr, James G; Sepehripour, Amir H; Jarral, Omar A; Tsipas, Pantelis; Kokotsakis, John; Kourliouros, Antonios; Athanasiou, Thanos

    2016-07-01

    Aneurysms and dissections of the right-sided aortic arch are rare and published data are limited to a few case reports and small series. The optimal treatment strategy of this entity and the challenges associated with their management are not yet fully investigated and conclusive. We performed a systematic review of the literature to identify all patients who underwent surgical or endovascular intervention for right aortic arch aneurysms or dissections. The search was limited to the articles published only in English. We focused on presentation and critically assessed different management strategies and outcomes. We identified 74 studies that reported 99 patients undergoing surgical or endovascular intervention for a right aortic arch aneurysm or dissection. The median age was 61 years. The commonest presenting symptoms were chest or back pain and dysphagia. Eighty-eight patients had an aberrant left subclavian artery with only 11 patients having the mirror image variant of a right aortic arch. The commonest pathology was aneurysm arising from a Kommerell's diverticulum occurring in over 50% of the patients. Twenty-eight patients had dissections, 19 of these were Type B and 9 were Type A. Eighty-one patients had elective operations while 18 had emergency procedures. Sixty-seven patients underwent surgical treatment, 20 patients had hybrid surgical and endovascular procedures and 12 had totally endovascular procedure. There were 5 deaths, 4 of which were in patients undergoing emergency surgery and none in the endovascular repair group. Aneurysms and dissections of a right-sided aortic arch are rare. Advances in endovascular treatment and hybrid surgical and endovascular management are making this rare pathology amenable to these approaches and may confer improved outcomes compared with conventional extensive repair techniques. PMID:27001673

  5. Surgical management of acute type A aortic dissection: branch-first arch replacement with total aortic repair

    PubMed Central

    Galvin, Sean D.; Perera, Nisal K.

    2016-01-01

    Acute type A dissection (ATAAD) remains a morbid condition with reported surgical mortality as high as 25%. We describe our surgical approach to ATAAD and discuss the indications for adjunct techniques such as the frozen elephant trunk or complete aortic repair with endovascular methods. Arch replacement using the “branch-first technique” allows for complete root, ascending aorta, and arch replacement. A long landing zone is created for proximal endografting with a covered stent. Balloon-assisted intimal disruption and bare metal stenting of all residual dissected aorta to the level of the aortic bifurcation is then performed to obliterate the false lumen (FL) and achieve single true lumen (TL) flow. Additional branch vessel stenting is performed as required. PMID:27386413

  6. Right axillary and femoral artery perfusion with mild hypothermia for aortic arch replacement

    PubMed Central

    2014-01-01

    Objectives Aortic arch replacement is associated with increased mortality and morbidity especially in acute type-A aortic dissection. Although hypothermic circulatory arrest with selective antegrade cerebral perfusion has been widely used because of its excellent cerebral protection, its optimal perfusion characteristics are unknown. The present study investigates clinical results obtained after perfusion method modification and temperature management during cardiopulmonary bypass (CPB). Methods Between July 2010 and August 2012, 16 consecutive adult patients (mean age 50.0 yr ± 14.1 yr, range 25 yr to 73 yr, 12 males, 4 females) who presented with acute Stanford type-A aortic dissection underwent aortic arch replacement (total arch, n = 11; hemiarch, n = 5) under mild hypothermia (31.1°C ± 1.5°C) with right axillary and femoral artery perfusion. Results The mean CPB time was 201 min ± 53 min, and the mean myocardial ischemic time was 140 min ± 42 min. The mean selective cerebral perfusion time was 80 min ± 16 min, and the mean lower-body circulatory arrest time was 20 min ± 13 min. No patient death occurred within 30 post-operative days. The following details were observed: new post-operative permanent neurologic deficit in 1 patient (6.3%), temporary neurologic deficit in 2 patients (12.5%), acute renal dysfunction (creatinine level > 230 umol/L) in 3 patients (18.8%) and mechanical ventilation > 72 h in 5 patients (31.2%). Conclusions Aortic arch replacement for acute type-A aortic dissection under mild hypothermia with right axillary and femoral artery perfusion could be safely performed in the patient cohort. PMID:24885031

  7. Direct Tracheobronchopexy and Posterior Descending Aortopexy for Severe Left Mainstem Bronchomalacia Associated With Congenital Pulmonary Airway Malformation and Left Circumflex Aortic Arch.

    PubMed

    Baird, Christopher W; Prabhu, Sanjay; Buchmiller, Terry L; Smithers, Charles; Jennings, Russell

    2016-07-01

    Complex tracheobronchial obstruction and malacia can be associated with conotruncal and aortic arch anomalies. A circumflex aortic arch composed of a left aortic arch and right descending aorta is an extremely rare anomaly that can severely affect the distal trachea and mainstem bronchi, resulting in severe respiratory symptoms. We report the case of a patient with circumflex aortic arch and severe left mainstem bronchial obstruction and malacia in which the external aortic compression and residual bronchomalacia were addressed with direct bronchial and tracheal intervention. PMID:27343517

  8. Modelling and numerical simulation of the human aortic arch under in vivo conditions.

    PubMed

    García-Herrera, Claudio M; Celentano, Diego J

    2013-11-01

    This work presents the modelling and simulation of the mechanical behaviour of the human aortic arch under in vivo conditions with pressure levels within the normal and hypertension physiological range. The cases studied correspond to young and aged arteries without cardiovascular pathologies. First, the tissue of these two groups is characterised via in vitro tensile test measurements that make it possible to derive the material parameters of a hyperelastic isotropic constitutive model. Then, these material parameters are used in the simulation of young and aged aortic arches subjected to in vivo normal and hypertension conditions. Overall, the numerical results were found not only to provide a realistic description of the mechanical behaviour of the vessel but also to be useful data that allow the adequate definition of stress/stretch-based criteria to predict its failure. PMID:23371524

  9. [A case of a syndrome resembling PSP after aortic arch replacement under deep hypothermic circulatory arrest].

    PubMed

    Sakiyama, Yusuke; Michizono, Kumiko; Tomari, Shinya; Watanabe, Osamu; Nakahara, Keiichi; Takashima, Hiroshi

    2011-01-01

    A 57-year-old man presented with acute signs and symptoms mimicking PSP (bradykinesia, supranuclear ocular palsy, dysphagia, neck dystonia, and apraxic gait) on the day after a graft replacement surgery, which was performed for aortic arch aneurysm under deep hypothermic circulatory arrest (rectal temperature, 18 degrees C). Dysphagia improved temporarily, but relapsed after a few months. Symptoms did not change during 2 years of antiparkinsonian drug administration. Brain images obtained before the surgery revealed slight atrophy of the midbrain tegmentum and frontal lobes, but the patient was asymptomatic. No findings of cerebral vascular disease and hypoxic encephalopathy were observed on brain images after the surgery. These clinical features resembling PSP might have been caused by deep hypothermia and the patient's predisposition for PSP. This is the first case report in Japan of a syndrome resembling PSP that occurred after aortic arch replacement under deep hypothermic circulatory arrest. PMID:21387699

  10. Mycotic aortic arch aneurysm coexistent with constrictive pericarditis: is surgery a dangerous resort?

    PubMed

    Yu, Peter S Y; Yu, Simon C H; Chu, Cheuk-Man; Kwok, Micky W T; Lam, Yuk-Hoi; Underwood, Malcolm J; Wong, Randolph H L

    2016-08-01

    An elderly man presented with fever and evidence of Salmonella infection, and was diagnosed to have coexisting constrictive pericarditis and mycotic aneurysm of the aortic arch. Pericardiectomy was performed under cardiopulmonary bypass with good result. To avoid deep hypothermic circulatory arrest, an aorto-brachiocephalic bypass, instead of total arch replacement, was performed. This was followed by a staged carotid-carotid bypass, thoracic endovascular stent graft placement. He was subsequently treated with prolonged antibiotics, and inflammatory marker normalized afterwards. He was last seen well 2 years after the operation. Follow-up computer tomography (CT) scan at 18 months post-op showed no evidence of endoleak or fistulation. Our case demonstrated that a hybrid treatment of open pericardiectomy and aortic debranching followed by thoracic endovascular stent graft placement is feasible and associated with satisfactory mid-term outcome. PMID:27621905

  11. Mycotic aortic arch aneurysm coexistent with constrictive pericarditis: is surgery a dangerous resort?

    PubMed Central

    Yu, Peter S. Y.; Yu, Simon C. H.; Chu, Cheuk-Man; Kwok, Micky W. T.; Lam, Yuk-Hoi; Underwood, Malcolm J.

    2016-01-01

    An elderly man presented with fever and evidence of Salmonella infection, and was diagnosed to have coexisting constrictive pericarditis and mycotic aneurysm of the aortic arch. Pericardiectomy was performed under cardiopulmonary bypass with good result. To avoid deep hypothermic circulatory arrest, an aorto-brachiocephalic bypass, instead of total arch replacement, was performed. This was followed by a staged carotid-carotid bypass, thoracic endovascular stent graft placement. He was subsequently treated with prolonged antibiotics, and inflammatory marker normalized afterwards. He was last seen well 2 years after the operation. Follow-up computer tomography (CT) scan at 18 months post-op showed no evidence of endoleak or fistulation. Our case demonstrated that a hybrid treatment of open pericardiectomy and aortic debranching followed by thoracic endovascular stent graft placement is feasible and associated with satisfactory mid-term outcome. PMID:27621905

  12. Results with an Algorithmic Approach to Hybrid Repair of the Aortic Arch

    PubMed Central

    Andersen, Nicholas D.; Williams, Judson B.; Hanna, Jennifer M.; Shah, Asad A.; McCann, Richard L.; Hughes, G. Chad

    2013-01-01

    Objective Hybrid repair of the transverse aortic arch may allow for aortic arch repair with reduced morbidity in patients who are suboptimal candidates for conventional open surgery. Here, we present our results with an algorithmic approach to hybrid arch repair, based upon the extent of aortic disease and patient comorbidities. Methods Between August 2005 and January 2012, 87 patients underwent hybrid arch repair by three principal procedures: zone 1 endograft coverage with extra-anatomic left carotid revascularization (zone 1, n=19), zone 0 endograft coverage with aortic arch debranching (zone 0, n=48), or total arch replacement with staged stented elephant trunk completion (stented elephant trunk, n=20). Results The mean patient age was 64 years and the mean expected in-hospital mortality rate was 16.3% as calculated by the EuroSCORE II. 22% (n=19) of operations were non-elective. Sternotomy, cardiopulmonary bypass, and deep hypothermic circulatory arrest were required in 78% (n=68), 45% (n=39), and 31% (n=27) of patients, respectively, to allow for total arch replacement, arch debranching, or other concomitant cardiac procedures, including ascending ± hemi-arch replacement in 17% (n=8) of patients undergoing zone 0 repair. All stented elephant trunk procedures (n=20) and 19% (n=9) of zone 0 procedures were staged, with 41% (n=12) of patients undergoing staged repair during a single hospitalization. The 30-day/in-hospital rates of stroke and permanent paraplegia/paraparesis were 4.6% (n=4) and 1.2% (n=1), respectively. Three of 27 (11.1%) patients with native ascending aorta zone 0 proximal landing zone experienced retrograde type A dissection following endograft placement. The overall in-hospital mortality rate was 5.7% (n=5), however, 30-day/in-hospital mortality increased to 14.9% (n=13) due to eight 30-day out-of-hospital deaths. Native ascending aorta zone 0 endograft placement was found to be the only univariate predictor of 30-day/in-hospital mortality

  13. Thoracoscopic correction of a congenital persistent right aortic arch in a young cat

    PubMed Central

    Plesman, Rhea; Johnson, Matthew; Rurak, Sarah; Ambrose, Barbara; Shmon, Cindy

    2011-01-01

    A 9-week-old kitten was diagnosed with a congenital vascular ring anomaly by means of an esophageal contrast study. At 6 mo of age, a non-selective vascular study was used to diagnose a persistent right aortic arch (PRAA). Left-sided thoracoscopic surgery was performed, using a Liga-Sure vessel sealant device to seal and transect the ligamentum arteriosum. PMID:22467970

  14. Interrupted Aortic Arch Associated with Absence of Left Common Carotid Artery: Imaging with MDCT

    SciTech Connect

    Onbas, Omer Olgun, Hasim; Ceviz, Naci; Ors, Rahmi; Okur, Adnan

    2006-06-15

    Interrupted aortic arch (IAA) is a rare severe congenital heart defect defined as complete luminal and anatomic discontinuity between ascending and descending aorta. Although its association with various congenital heart defects has been reported, absence of left common carotid artery (CCA) in patients with IAA has not been reported previously. We report a case of IAA associated with the absence of left CCA which was clearly shown on multidetector-row spiral CT.

  15. [Interruption of the aortic arch with no patent ductus arteriosus: is survival possible?].

    PubMed

    Boukhris, M; Hakim, K; Ouarda, F; M'saad, H; Boussaada, R

    2014-03-01

    Interruption of the aortic arch is a rare congenital disease. It is defined by the complete interruption between the ascending and descending aorta. A patent ductus arteriosus is necessary to maintain flow from the pulmonary to the descending aorta. Its closure leads to a cardiovascular collapse and this malformation is therefore duct-dependent. However, in rare cases, survival remains possible even after ductus arteriosus closure. We report such a case. PMID:24457106

  16. Left-Sided Patent Ductus Arteriosus in a Right-Sided Aortic Arch

    PubMed Central

    2014-01-01

    We present a 31-year-old female with repaired tetralogy of Fallot (TOF) and right-sided aortic arch (RAA) with left-sided patent ductus arteriosus (PDA) originating from the left brachiocephalic artery. This is a rare finding but most common site for a PDA in TOF and a RAA. To the best of our knowledge, this is the first demonstration of this rare finding on MRI in the literature. PMID:25478277

  17. [Successful management of ruptured aortic arch aneurysm infected with methicillin-resistant Staphylococcus aureus].

    PubMed

    Kawahira, T; Tsukube, T; Hayashi, T; Kozawa, S; Ogawa, K

    2008-09-01

    A 64-year-old woman was admitted due to back pain and dyspnea. She was suffering from fever of unknown origin for a few weeks without aortic aneurysm by enhanced chest computed tomography (CT). Chest CT taken 1 month later revealed rupture of aortic arch aneurysm. Total arch replacement was performed with in situ grafting under selective cerebral perfusion combined with deep hypothermic circulatory arrest. Rifampicin (RFP) was sprinkled on the graft at operation and omentopexy was done 5 days after the 1st operation. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated on the culture of the aneurysmal wall, therefore, polymyxin B immobilized fiber with direct hemoperfusion (PMX-DHP) was also conducted with antibiotic therapy. Her clinical course after the 2nd operation was uneventful with no infective complication. We report a successful case of ruptured aneurysm of aortic arch infected with MRSA and review our strategy as one of feasible options without using homograft or preparative RFP-bonded vascular prosthesis. PMID:18788376

  18. Carbon Dioxide in the Aortic Arch: Coronary Effects and Implications in a Swine Study

    SciTech Connect

    Culp, William C. Porter, Thomas R.; Culp, William C.; Vonk, Brian N.

    2003-04-15

    Purpose: CO{sub 2} angiography is considered dangerous in the aortic arch where bubbles may cause critical cerebral and cardiac ischemia. We investigated CO{sub 2}distribution, physiologic effects in the heart, methods of detection and treatments. Methods: Eight pigs had CO{sub 2}and iodinated contrast arch angiograms in supine and both lateral decubitus positions. An electrocardiogram, physiologic data and cardiac ultrasound were obtained. Therapies included precordial thumps and rolls to lateral decubitus positions. Results: Supine high descending aorta CO{sub 2} injections floated retrograde up the arch during diastole and preferentially filled the right coronary artery (RCA): mean score 3.5 (of 4), in nominate artery 2.4, left coronary artery 1.2; n = 17; p = 0.0001. Aortic root injections preferentially filled the RCA when the animal was supine, left coronary in the right decubitus position, and showed a diffuse pattern in the left decubitus position. Right decubitus rolls filled both coronaries causing several lethal arrhythmias. Precordialthumps successfully cleared CO{sub 2}. Ultrasound is a sensitive detector of myocardial CO{sub 2}. Conclusion: Arch distribution of CO{sub 2} primarily involves the RCA. Diagnostic ultrasound detects cardiac CO{sub 2} well. Precordial thumps are an effective treatment.

  19. Multimodal optical measurement in vitro of surface deformations and wall thickness of the pressurized aortic arch.

    PubMed

    Genovese, Katia; Humphrey, Jay D

    2015-04-01

    Computational modeling of arterial mechanics continues to progress, even to the point of allowing the study of complex regions such as the aortic arch. Nevertheless, most prior studies assign homogeneous and isotropic material properties and constant wall thickness even when implementing patient-specific luminal geometries obtained from medical imaging. These assumptions are not due to computational limitations, but rather to the lack of spatially dense sets of experimental data that describe regional variations in mechanical properties and wall thickness in such complex arterial regions. In this work, we addressed technical challenges associated with in vitro measurement of overall geometry, full-field surface deformations, and regional wall thickness of the porcine aortic arch in its native anatomical configuration. Specifically, we combined two digital image correlation-based approaches, standard and panoramic, to track surface geometry and finite deformations during pressurization, with a 360-deg fringe projection system to contour the outer and inner geometry. The latter provided, for the first time, information on heterogeneous distributions of wall thickness of the arch and associated branches in the unloaded state. Results showed that mechanical responses vary significantly with orientation and location (e.g., less extensible in the circumferential direction and with increasing distance from the heart) and that the arch exhibits a nearly linear increase in pressure-induced strain up to 40%, consistent with other findings on proximal porcine aortas. Thickness measurements revealed strong regional differences, thus emphasizing the need to include nonuniform thicknesses in theoretical and computational studies of complex arterial geometries. PMID:25867620

  20. Current management of aortic arch lesions with hybrid procedures: a tailored approach to a progressive disease.

    PubMed

    Plichta, Ryan P; Aftab, Muhammad; Roselli, Eric E

    2016-06-01

    In the current era of cardiac and aortic surgery lines between open and endovascular approaches are becoming blurred. Hybrid techniques emerged with the availability of endovascular devices and the idea that combining open operations with a stent graft might provide a treatment option to those patients deemed too high-risk for conventional surgery. As these procedures evolved, it became clear that they still carried significant risk especially for the "inoperable" or "high-risk" patients, but they also offered new options for treating complex pathologies involving multiple segments of the aorta. Hybrid techniques not only provide the potential for less invasive aortic repair, but must be considered as an important complementary treatment option for patients with aortic disease, allowing for a potentially more effective and complete repair. The objective of this article is to review the current options for hybrid arch repair and the indications for choosing the various techniques based on pathologic presentation. PMID:26939046

  1. Aortic Arch Calcification Predicts Patency Loss of Arteriovenous Fistula in End-Stage Renal Disease Patients

    PubMed Central

    Yap, Yit-Sheung; Ting, Kai-Ting; Chi, Wen-Che; Lin, Cheng-Hao; Liu, Yi-Chun; Chuang, Wan-Long

    2016-01-01

    Aortic arch calcification (AAC) is recognized as an important cardiovascular risk factor in patients with end-stage renal disease (ESRD). The aim of the study was to evaluate the impact of AAC grade on patency rates of arteriovenous fistula (AVF) in this specific population. The data of 286 ESRD patients who had an initial AVF placed were reviewed. The extent of AAC identified on chest radiography was divided into four grades (0–3). The association between AAC grade, other clinical factors, and primary patency of AVF was then analyzed by Cox proportional hazard analysis. The multivariate analysis demonstrated that the presence of AAC grade 2 (hazard ratio (95% confidence interval): 1.80 (1.15–2.84); p = 0.011) and grade 3 (3.03 (1.88–4.91); p < 0.001), and higher level of intact-parathyroid hormone (p = 0.047) were associated with primary patency loss of AVF. In subgroup analysis, which included AVF created by a surgeon assisted with preoperative vascular mapping, only AAC grade 3 (2.41 (1.45–4.00); p = 0.001), and higher intact-parathyroid hormone (p = 0.025) level were correlated with AVF patency loss. In conclusion, higher AAC grade and intact-parathyroid hormone level predicted primary patency loss of AVF in an ESRD population. PMID:27101807

  2. Endovascular Repair of a Right-Sided Descending Thoracic Aortic Aneurysm Associated with a Right Aortic Arch and a Left Subclavian Artery Arising from a Kommerell's Diverticulum

    SciTech Connect

    Klonaris, Chris Avgerinos, Efthimios D.; Katsargyris, Athanasios; Matthaiou, Alexandros; Georgopoulos, Sotirios; Psarros, Vasileios; Bastounis, Elias

    2009-07-15

    This case report describes the endovascular repair of a right-sided descending thoracic aortic aneurysm associated with a right aortic arch and an aberrant left subclavian artery. A 76-year-old male with multiple comorbidities was incidentally found to have a right-sided descending thoracic aortic aneurysm with a maximum diameter of 6.2 cm. Additionally, there was a right aortic arch with a retroesophageal segment and separate arch branches arising in the following order: left common carotid artery, right common carotid artery, right subclavian artery, and left subclavian artery that was aberrant, arising from a Kommerrell's diverticulum. The aneurysm was successfully excluded by deployment of a Zenith TX1 36 x 32 x 20-mm stent-graft using wire traction technique via the left femoral and right brachial arteries in order to deal with two severe aortic angulations. At 18-month follow-up the patient was doing well, with aneurysm sac shrinkage to 5.9 cm and no signs of endoleak or migration. Endovascular repair of right-sided descending thoracic aortic aneurysms with a right arch and aberrant left subclavian artery is feasible, safe, and effective. In such rare configurations, which demand considerably increased technical dexterity and center experience, endovascular repair emerges as an attractive therapeutic option.

  3. [Hybrid surgical intervention in a patient with an aortic arch aneurysm and coronary artery disease].

    PubMed

    Charchan, E R; Abugov, S A; Puretsky, M V; Kim, S Yu; Skvortsov, A A; Khachatryan, Z R

    2015-01-01

    Presented herein is a clinical case report regarding the use of hybrid technology in surgical treatment of a patient with an aneurysm of the distal portion of the aortic arch and coronary artery disease. The patient underwent a hybrid operation, i.e. debranching of the aortic arch branches, exoprosthetic repair of the ascending aorta, autovenous prosthetic coronary bypass grafting of the branch of the blunt edge of the anterior interventricular artery, stenting of the ascending portion, arch and descending portion of the aorta (stent graft "Medtronic Valiant"). In doing so, we used a non-standard approach to connecting the artificial circulation unit and to choosing the place for establishing proximal anastomoses of autovenous coronary bypass grafts. The early postoperative period was complicated by the development of respiratory insufficiency requiring continuation artificial pulmonary ventilation. The duration of the hospital stay of the patient amounted to 15 days. The check-up multispiral computed tomography showed normal functioning of the reconstruction zones, the stent graft is expanded, with no leak observed. The conclusion was made that hybrid interventions may be considered as an alternative to the classical surgical treatment associated in patients of older age group with a severe course of the postoperative period and high lethality. PMID:26035581

  4. Clinical value of multi-slice spiral computed tomography angiography and three-dimensional reconstruction in the diagnosis of double aortic arch

    PubMed Central

    CHEN, XIN; QU, YANJUAN; PENG, ZHI-YUAN; LU, JINGGUO; MA, XIAOJING; HU, WENJUAN

    2014-01-01

    The aim of this study was to evaluate the clincal value of multi-slice spiral computed tomography (MSCT) in the diagnosis of double aortic arch (DAA) and analyze the associated angiography and 3D reconstruction imaging to increase the accuracy of DAA diagnosis. Clinical and imaging data from 15 patients diagnosed with DAA by MSCT were summarized and compared with the corresponding surgical observations. The DAA diagnosis by MSCT for the 15 patients was confirmed by the surgical observations. A total of 13 cases were categorized as type I (double arches are open), including nine with a larger right arch, two with a larger left arch and two with balanced arches. Two cases were categorized as type II (one atretic arch), characterized by left atretic arch. Among the 15 patients, ultrasound diagnosis succeeded in nine cases and failed in the rest. A single malformation was identified in only two cases, whereas the rest had single or multiple combination(s) of intracardiac and extracardiac malformations, including seven with different levels of tracheobronchial stenosis. MSCT was demonstrated to precisely diagnose DAA complicated by malformation and tracheobronchial stenosis. MSCT is an essential therapeutic strategy and serves as a primary method in DAA diagnosis. PMID:25009630

  5. Central retinal artery occlusion following laser treatment for ocular ischemic aortic arch syndrome

    PubMed Central

    Shah, Payal J.; Ellis, Brian; DiGiovine, Lauren R.; Hogg, Jeffery P.; Leys, Monique J.

    2015-01-01

    Objective: Ocular ischemic syndrome is a rare blinding condition generally caused by disease of the carotid artery. We describe a 69-year-old female with a 50 pack-year smoking history with aortic arch syndrome causing bilateral ocular ischemic syndrome. Methods: The patient presented with progressive visual loss and temple pain. Slit lamp biomicroscopy revealed bilateral iris neovascularization. This finding prompted a cardiovascular work up. Panretinal photocoagulation with retrobulbar block was performed in the right eye. Results: A temporal artery biopsy was negative. The carotid duplex ultrasound showed only a 1–39% stenosis. MRA revealed a more proximal occlusion of the aortic branch for which she underwent subclavian carotid bypass surgery. At the one month follow up, the right eye suffered profound vision loss secondary to a central retinal artery occlusion. Conclusion: Ocular neovascularization may be one of the clinical manifestations of aortic arch syndrome. This case also illustrates the limitations of relying solely on carotid duplex ultrasound testing. We caution against overly aggressive panretinal photocoagulation utilizing retrobulbar anesthesia.

  6. [A case of tracheo-bronchial stenosis after extended end-to-end aortic arch anastomosis for interrupted aortic arch treated with suspension of the ascending artery and pulmonary artery].

    PubMed

    Watanabe, T; Hoshino, S; Iwaya, F; Igari, T; Ono, T; Takahashi, K

    2001-02-01

    A 9-day-old boy had pulmonary artery banding and extended end-to-end aortic arch anastomosis for ventricular septal defect (VSD) and type A interrupted aortic arch. Severe dyspnea gradually developed. At 3 months of age, intracardiac repair of VSD was performed. Weaning from the ventilator was difficult. Endoscopic examination and chest CT revealed stenosis of the right and left main bronchi and compression of tracheal bifurcation and the right and left main bronchi by the ascending aorta and pulmonary artery. Suspension of the ascending aorta and pulmonary artery was performed 15 days after VSD closure. Nine days after this procedure, the patient was weaned from respirator. Postoperative course was uneventful. Bronchial stenosis may be caused from extended end-to-end aortic arch anastomosis. PMID:11211771

  7. Successful bovine arch replacement for a type A acute aortic dissection in a pregnant woman with severe haemodynamic compromise

    PubMed Central

    Nonga, Bernadette Ngo; Pasquet, Agnès; Noirhomme, Philippe; El–Khoury, Gebrine

    2012-01-01

    Acute aortic dissection is very uncommon in pregnant women and the acute type A aortic dissection carries a high mortality rate outside specialized centres. There are a few cases reported with successful outcomes for the mother and the foetus from major cardiac centres. We are reporting our first experience of acute aortic dissection during the third trimester of pregnancy in a patient with Marfan features, profound haemodynamic compromise on arrival and a bovine aortic arch. Both the mother and the baby are doing well two years postoperatively. PMID:22547559

  8. Blood flow in the rabbit aortic arch and descending thoracic aorta.

    PubMed

    Vincent, P E; Plata, A M; Hunt, A A E; Weinberg, P D; Sherwin, S J

    2011-12-01

    The distribution of atherosclerotic lesions within the rabbit vasculature, particularly within the descending thoracic aorta, has been mapped in numerous studies. The patchy nature of such lesions has been attributed to local variation in the pattern of blood flow. However, there have been few attempts to model and characterize the flow. In this study, a high-order continuous Galerkin finite-element method was used to simulate blood flow within a realistic representation of the rabbit aortic arch and descending thoracic aorta. The geometry, which was obtained from computed tomography of a resin corrosion cast, included all vessels originating from the aortic arch (followed to at least their second generation) and five pairs of intercostal arteries originating from the proximal descending thoracic aorta. The simulations showed that small geometrical undulations associated with the ductus arteriosus scar cause significant deviations in wall shear stress (WSS). This finding highlights the importance of geometrical accuracy when analysing WSS or related metrics. It was also observed that two Dean-type vortices form in the aortic arch and propagate down the descending thoracic aorta (along with an associated skewed axial velocity profile). This leads to the occurrence of axial streaks in WSS, similar in nature to the axial streaks of lipid deposition found in the descending aorta of cholesterol-fed rabbits. Finally, it was observed that WSS patterns within the vicinity of intercostal branch ostia depend not only on local flow features caused by the branches themselves, but also on larger-scale flow features within the descending aorta, which vary between branches at different locations. This result implies that disease and WSS patterns in the vicinity of intercostal ostia are best compared on a branch-by-branch basis. PMID:21593030

  9. The retrieval of atrial septal defect closure device embolized into aortic arch

    PubMed Central

    Hamur, Hikmet; Onk, Oruc Alper; Degirmenci, Husnu; Kahraman, Umit; Bakirci, Eftal Murat; Tuncer, Osman Nuri

    2016-01-01

    Summary Percutaneous atrial septal defect (ASD) closure has become an increasingly simplified procedure over the past decade. The device embolization is seen rarely but it can be fatal. Although percutaneous retrieval is feasible, surgical removal might be preferred when the endothelialization status of the device is unknown. We report a comlication of such closure in a 43-year-old woman: embolization of the ASD occluder device into aortic arch 12 months after implantation. We removed the device surgically and closed the ASD. PMID:27195195

  10. Novel temporary endovascular shunt technique to assist in situ fenestration for endovascular reconstruction of the distal aortic arch.

    PubMed

    Xiong, Jiang; Guo, Wei; Liu, Xiaoping; Jia, Xin; Ma, Xiaohui; Wang, Lijun

    2015-07-01

    Thoracic endovascular aortic repair (TEVAR) of arch pathology presents special challenges for revascularization. To obtain an anatomic reconstruction of the arch arteries, in situ fenestration with extra-anatomic bypass has been increasingly used in TEVAR. We report a case involving TEVAR for a pseudoaneurysm at zone 2 of the thoracic aorta in a 37-year-old man with the use of in situ fenestration assisted by a temporary endovascular shunt technique. PMID:24560242

  11. One-Stage Repair of an Interrupted Aortic Arch with an Aortopulmonary Window in a Premature Neonate

    PubMed Central

    Bobos, Dimitrios; Kanakis, Meletios A.; Koulouri, Sofia; Giannopoulos, Nicholas M.

    2015-01-01

    Interrupted aortic arch with an aortopulmonary window is a rare congenital entity that is associated with high morbidity and mortality, especially in premature low-birth-weight infants, and the proper timing of surgical correction remains a matter of debate. We present the case of a premature infant weighing 1.6 kg who successfully underwent one stage surgical repair to treat interrupted aortic arch with an aortopulmonary window. The therapeutic management of this patient is described below, and a review of the literature is presented. PMID:26665109

  12. Right Aortic Arch with Aplasia of the Left Brachiocephalic Trunk Presented as Systolic Blood Pressure Difference Between Upper Extremities

    PubMed Central

    Babińska, Anna; Wawrzynek, Wojciech; Kukawska-Sysio, Karolina; Skupiński, Jarosław; Nowak, Patrycja

    2016-01-01

    Summary Background The right aortic arch with mirror-image of branching arteries without coexisting congenital heart disease is a very rare anomaly. Case Report We report a case of the right-sided aortic arch with aplasia of the left brachiocephalic trunk in a 64-year-old women, presenting difference in systolic blood pressure between upper extremities. The history of the patient and angio-CT findings were described and visualized with images. Conclusions The knowledge of vascular variations is important for the clinical and therapeutic aspects. PMID:26966474

  13. [Hybrid operation for a posttraumatic saccular aneurysm of the aortic arch].

    PubMed

    Ignat'ev, I M; Volodiukhin, M Iu; Zanochkin, A V; Terekhin, S V

    2013-01-01

    The article deals with a case report of successful hybrid surgical treatment of a patient presenting with a posttraumatic large false saccular aneurysm of the aortic arch with mediastinal displacement and compression of the left recurrent laryngeal nerve and trachea. The patient was subjected to a hybrid operation, i. e., bypass grafting of the brachiocephalic trunk and the left common carotid artery with a bifurcation prosthesis from the ascending aorta through sternotomy, carotid-vertebral and carotid-subclavian bypass grafting on the left in a combination with endoprosthetic repair of the aortic arch with the stent graft Valiant Thoracic 40 × 224 mm (VAMF 4040c200TE) manufactured by the Medtronic Company. The postoperative period was uneventful followed by rather rapid rehabilitation of the patient. One month after the operation, the clinical state improved considerably. His voice restored virtually completely, and breathlessness disappeared. According to the findings of MSCT angiography, the aneurysmatic cavity is thrombosed, with the stent graft showing no evidence of either dislocation or endoleak. The bifurcation bypass graft is functioning. According to the data of duplex scanning, the anastomoses established on the neck are patent. PMID:23531669

  14. Right aortic arch with isolation of the left innominate artery in a case of double chamber right ventricle and ventricular septal defect.

    PubMed

    Mangukia, Chirantan; Sethi, Sonali; Agarwal, Saket; Mishra, Smita; Satsangi, Deepak Kumar

    2014-05-01

    Herein, we report an unusual case of right aortic arch with isolation of the left innominate artery in a case of double chamber right ventricle with ventricular septal defect. The blood supply to the innominate artery was by a collateral arising from the descending aorta. The embryological development of this anomaly can be explained by the hypothetical double aortic arch model proposed by Edwards with interruption of the arch at two levels. PMID:24987265

  15. Normothermic total arch replacement without hypothermic circulatory arrest to treat aortic distal arch aneurysm in a patient with cold agglutinin disease.

    PubMed

    Ishida, Narihiro; Takemura, Hirofumi; Shimabukuro, Katsuya; Matsuno, Yukihiro

    2011-10-01

    Cold agglutinin disease although rare, can lead to serious complications for patients undergoing cardio-thoracic surgery, especially when cardiopulmonary bypass is applied under hypothermic circulatory arrest. We describe normothermic total arch replacement without hypothermic circulatory arrest in a patient with cold agglutinin disease. The patient tolerated all procedures well and did not develop cerebral ischemia due to surgical maneuvers or thrombotic or haemolytic complications due to cold agglutinin disease. Although endovascular aortic repair is the first choice under such complex conditions, this method could also serve as an alternative strategy when endovascular aortic repair is precluded. PMID:21788303

  16. Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis

    PubMed Central

    Poon, Shi Sum; Theologou, Thomas; Harrington, Deborah; Kuduvalli, Manoj; Oo, Aung

    2016-01-01

    Background Despite recent advances in aortic surgery, acute type A aortic dissection remains a surgical emergency associated with high mortality and morbidity. Appropriate management is crucial to achieve satisfactory outcomes but the optimal surgical approach is controversial. The present systematic review and meta-analysis sought to access cumulative data from comparative studies between hemiarch and total aortic arch replacement in patients with acute type A aortic dissection. Methods A systematic review of the literature using six databases. Eligible studies include comparative studies on hemiarch versus total arch replacement reporting short, medium and long term outcomes. A meta-analysis was performed on eligible studies reporting outcome of interest to quantify the effects of hemiarch replacement on mortality and morbidity risk compared to total arch replacement. Result Fourteen retrospective studies met the inclusion criteria and 2,221 patients were included in the final analysis. Pooled analysis showed that hemiarch replacement was associated with a lower risk of post-operative renal dialysis [risk ratio (RR) =0.72; 95% confidence interval (CI): 0.56–0.94; P=0.02; I2=0%]. There was no significant difference in terms of in-hospital mortality between the two groups (RR =0.84; 95% CI: 0.65–1.09; P=0.20; I2=0%). Cardiopulmonary bypass, aortic cross clamp and circulatory arrest times were significantly longer in total arch replacement. During follow up, no significant difference was reported from current studies between the two operative approaches in terms of aortic re-intervention and freedom from aortic reoperation. Conclusions Within the context of publication bias by high volume aortic centres and non-randomized data sets, there was no difference in mortality outcomes between the two groups. This analysis serves to demonstrate that for those centers doing sufficient total aortic arch activity to allow for publication, excellent and equivalent outcomes

  17. Interruption of aortic arch in adults: surgical experience with extra-anatomic bypass.

    PubMed

    Sai Krishna, C; Bhan, Anil; Sharma, Sanjeev; Kiran, Usha; Venugopal, Panangipalli

    2005-01-01

    We reviewed our 3-year experience in treating interruption of the aorta in adult patients. Clinical profiles, surgical management, and results of early and mid-term follow-up are presented. From August 2001 through June 2003, 7 adult patients underwent an extra-anatomic bypass procedure to repair interruption of the aortic arch. Five patients underwent ventral aortic repair through a mid-sternotomy and an upper midline laparotomy, and 2 patients underwent repair through a left posterolateral thoracotomy. A bovine collagen-impregnated polyester fiber graft was used in 6 patients, and a Gore-Tex graft was interposed in 1 patient. All repairs were performed without cardiopulmonary bypass. Follow-up was complete in all patients. The mean follow-up was 1728 +/- 1 months (range, 9-31 months). No neurologic, renal, or gastrointestinal complications were noted in any patient. There was no in-hospital or late mortality or need for re-intervention. All patients were asymptomatic; however, 5 patients had mild residual hypertension. Graft patency in all the patients was confirmed by computed tomographic angiography. Interruption of the aorta is rare in adults. Ventral aortic repair through a midline approach is our preferred technique for surgical repair of this entity, because it avoids the extensive network of collateral vessels on the chest wall, enables simultaneous treatment of associated lesions, and in all likelihood reduces morbidity and mortality. PMID:16107103

  18. Use of through-and-through guidewire for delivering large stent-grafts into the distal aortic arch

    SciTech Connect

    Shammari, Muhammad Al; Taylor, Peter; Reidy, John F.

    2000-05-15

    The availability of large diameter stent-grafts is now allowing the endovascular treatment of thoracic aortic aneurysms. Most aneurysms are closely related to the distal arch and it is thus necessary to pass the delivery systems into the arch to effectively cover the proximal neck. Even with extra-stiff guidewires in position, it may still be difficult to achieve this, as a result of tortuosity at the iliac arteries and the aorta. We detail a technique where a stiff guidewire is passed from a brachial entry point through the aorta and out at the femoral arteriotomy site. This allows extra-support and may enable the delivery system to be passed further into the aortic arch than it could with just the regular guidewire position.

  19. Transposition Complex with Aortic Arch Obstruction: Outcomes of One-Stage Repair Over 10 Years.

    PubMed

    Choi, Kwang Ho; Sung, Si Chan; Kim, Hyungtae; Lee, Hyung Doo; Ban, Gil Ho; Kim, Geena; Kim, Hee Young

    2016-01-01

    The surgical management of transposition complex with aortic arch obstruction remains technically demanding due to anatomic complexity. Even in the recent surgical era, there are centers that address this anomaly with a staged strategy. This report presents our experiences with a one-stage repair of transposition complexes with aortic arch obstructions more than the last 10 years. Since 2003, 19 patients with a transposition of the great arteries (TGA, 2 patients) or a double outlet of the right ventricle (DORV, 17 patients) and aortic arch obstruction have undergone one-stage repair of their anomalies. The mean age was 6.7 ± 2.3 days, and the mean body weight was 3.4 ± 0.3 kg. The 2 patients with TGA exhibited coarctation of the aorta. The 17 patients with DORV all exhibited the Taussig-Bing type. The great artery relationships were anteroposterior in 4 patients (21.1 %). The coronary artery anatomies were usual (1LCx; 2R) in 8 patients (42.1 %). There were 2 early deaths (10.5 %). Seven patients (36.8 %) required percutaneous interventions. One patient required re-operation for pulmonary valvar stenosis and left pulmonary artery patch angioplasty. The overall survival was 84.2 %. The freedom from mortality was 83.5 % at 5 years, and the freedom from intervention was 54.4 % at 5 years. The one-stage repair of transposition complexes with aortic arch obstructions resulted in an acceptable survival rate and a relatively high incidence of postoperative catheter interventions. Postoperative catheter interventions are highly effective. Transposition complexes combined with aortic arch obstructions can be managed by one-stage repair with good early and midterm results. PMID:26358472

  20. [Total Aortic Arch Replacement by Minimally Invasive Approach in a Patient with Permanent Tracheostomy;Report of a Case].

    PubMed

    Adachi, Koichi; Yamaguchi, Atsushi; Yuri, Koichi; Matsumoto, Harunobu; Kimura, Naoyuki; Okamura, Homare; Shiraishi, Manabu; Hori, Daijirou; Adachi, Hideo

    2016-06-01

    Standard full median sternotomy for total aortic arch replacement in patients with tracheostomy has higher risks for mediastinitis and graft infection. To avoid surgical site infection, it is necessary to keep a sufficient distance between the tracheostomy and the site of surgical skin incision. We herein report a case of a 74-year-old man with permanent tracheostomy after total laryngectomy, who underwent total aortic arch replacement for an aneurysm. Antero-lateral thoracotomy in the 2nd intercostal space with lower partial sternotomy( ALPS approach) provided an enough distance between the tracheostomy and the surgical field. It also provided a good view for surgical procedure and enabled the standard setup of cardiopulmonary bypass with ascending aortic cannulation, venous drainage from the right atrium and the left ventricular venting through the upper right pulmonary vein. The operation was completed in 345 minutes and the patient was discharged on the 11th postoperative day without any complications. PMID:27246136

  1. Fatal aortotracheal fistula combined with aortoesophageal fistula in an infant with double aortic arch: a warning.

    PubMed

    Atsumi, Naotaka; Matsubara, Muneaki; Kimura, Naritaka; Terada, Masatsugu

    2015-10-01

    This report describes a 2-month-old male infant with a double aortic arch (DAA) complicated by aortoesophageal fistula (AEF) and aortotracheal fistula (ATF). He was intubated with an endotracheal tube at birth because of neonatal asphyxia. A nasogastric tube was also placed for gastric decompression and milk feeding. On the 74th day of birth, he had massive upper gastrointestinal hemorrhage associated with shock, and was referred to our hospital. Although emergent surgery controlled the bleeding from AEF, he suffered cardiac arrest due to massive bleeding from ATF 5 h after surgery, and died on the 9th postoperative day. Physicians should be aware that prolonged endotracheal and nasogastric intubation predispose to the development of not only esophageal erosion but also more lethal tracheal erosion. In addition to the importance of early diagnosis and prompt surgery for DAA, appropriate preoperative respiratory management is emphasized to prevent similar occurrences in the future. PMID:24057599

  2. Hemodynamics in the mouse aortic arch as assessed by MRI, ultrasound, and numerical modeling.

    PubMed

    Feintuch, Akiva; Ruengsakulrach, Permyos; Lin, Amy; Zhang, Ji; Zhou, Yu-Qing; Bishop, Jonathon; Davidson, Lorinda; Courtman, David; Foster, F Stuart; Steinman, David A; Henkelman, R Mark; Ethier, C Ross

    2007-02-01

    Mice are widely used to study arterial disease in humans, and the pathogenesis of arterial diseases is known to be strongly influenced by hemodynamic factors. It is, therefore, of interest to characterize the hemodynamic environment in the mouse arterial tree. Previous measurements have suggested that many relevant hemodynamic variables are similar between the mouse and the human. Here we use a combination of Doppler ultrasound and MRI measurements, coupled with numerical modeling techniques, to characterize the hemodynamic environment in the mouse aortic arch at high spatial resolution. We find that the hemodynamically induced stresses on arterial endothelial cells are much larger in magnitude and more spatially uniform in the mouse than in the human, an effect that can be explained by fluid mechanical scaling principles. This surprising finding seems to be at variance with currently accepted models of the role of hemodynamics in atherogenesis and the known distribution of atheromatous lesions in mice. PMID:17012350

  3. [Multiple brain abscesses in the territory of the vertebral-basilar artery resulting from an infected aortic arch graft].

    PubMed

    Otani, Yoshihiro; Inoue, Satoshi; Kawauchi, Satoshi; Uneda, Atsuhito; Kajitani, Takumi; Watanabe, Kyoichi; Deguchi, Kentaro; Kiriyama, Hideki; Tokunaga, Koji; Matsumoto, Kengo

    2015-03-01

    A 62-year-old man with high fever and in a state of disorientation was transferred to our hospital. One year before this transfer, he had undergone total arch replacement surgery for thoracic aortic dissection. On admission to our hospital, head MRI revealed multiple brain abscesses in the territory of the vertebral-basilar artery, and chest CT showed gas around the aortic graft, in particular, at the origin of the left subclavian artery. We diagnosed him with brain abscesses in the left vertebral-basilar artery resulting from an infected aortic graft. We immediately began administration of intravenous antibiotics. Although his blood, urine, and cerebrospinal fluid cultures were negative, fortunately, the brain abscesses and ectopic gas disappeared. Since reports of only antibiotic use for treating brain abscesses due to aortic graft infection are rare, the appropriate duration of antibiotic administration has not been established yet. Therefore, careful observation is required in this case. PMID:25748809

  4. Direct distal aortic arch graft cannulation after the elephant trunk procedure: technique for central cannulation during second-stage repair.

    PubMed

    Quintana, Eduard; Pochettino, Alberto

    2015-07-01

    Arterial cannulation after the elephant trunk (ET) procedure at the time of second-stage distal repair can be achieved through multiple routes. Common strategies for arterial perfusion at the time of second-stage aortic repair include retrograde perfusion (femoral/iliac vessels), transapical or left subclavian artery cannulation. In the event these cannulation options are not practical or advisable, we offer an alternative approach through cannulation of the distal aortic arch Dacron graft through the left thorax. Advantages include forward distal perfusion, minimal proximal ischaemic time, prevention of thromboembolic events from thrombus attached to the ET and avoidance of malperfusion syndromes. PMID:25281849

  5. Results of "elephant trunk" total aortic arch replacement using a multi-branched, collared graft prosthesis.

    PubMed

    Schneider, Stefan R B; Dell'Aquila, Angelo M; Akil, Ali; Schlarb, Dominik; Panuccio, Guiseppe; Martens, Sven; Rukosujew, Andreas

    2016-03-01

    We report on our experience with a simplified elephant trunk (ET) procedure with a multi-branched prosthesis (Vascutek(®) Siena™ Collared Graft). It consists of a proximal portion (20 cm) with prefabricated side branches, a collar and a distal portion (30 cm). The collar, which can be trimmed into any desired diameter, constitutes the suture portion to the descending aorta. Radiopaque markers in the distal portion indicate the landing zone. Between January 2011 and June 2013, 20 consecutive patients (10 women; mean age, 66 ± 9.3 years) underwent ET procedure, including 6 re-do cases. Underlying aortic diseases were acute dissection (n = 6), chronic dissection (n = 4), aneurysm (n = 8) and PAU (n = 2). Mean preoperative diameter of the descending aorta was 49.1 ± 12.9 mm (range 74.7-29.7 mm). Concomitant procedures included ascending aortic replacement in 16 patients; root replacement in 2; AVR in 2, CABG in 3 and mitral repair in 1 patient. CPB time was 263 ± 94 min; mean duration of ACP was 65 ± 14 min. Two patients died on POD 8 and 78, respectively. Major adverse events included stroke (n = 1), resternotomy for bleeding (n = 2), renal failure requiring temporary dialysis (n = 1) and recurrent nerve paresis (n = 2). After a mean follow-up of 10 ± 8 months, all discharged patients were alive. Seven patients underwent stent-graft implantation of the descending aorta and one patient underwent open descending aortic replacement. The last generation of multi-branched arch prosthesis and especially the Vascutek(®) Siena™ Collared Graft make ET procedure a reasonable treatment option even in patients with acute aortic dissection. PMID:25491933

  6. Clinical Evaluation of Efficacy of CIA and CNA Intrusion Arches

    PubMed Central

    Vora, Sambhav; Pandey, Vinisha

    2015-01-01

    Background and Objectives Excessive overbite is one of the most common problems that confront the orthodontist. Deep bite can be due to infraocclusion of posterior teeth, supraocclusion of anterior teeth or a combination of the two. Correction of same can be carried out by extrusion of molars, intrusion of incisors or by a combination of both respectively. Various intrusion arches are recommended for correcting deep bite by true intrusion of anterior teeth, Utility arches, Segmental arch, Connecticut Intrusion Arch (CIA) and Connecticut New Arch (CNA). The purpose of this study was to evaluate clinical efficacy of CIA and CNA intrusion arches. Materials and Methods Tracings recorded from pre and post-treatment lateral cephalograms of 25 patients treated by CIA (Group I) and another 25 patients treated by CNA (Group II) intrusion arches in deep bite cases after four months of treatment were analysed and findings were recorded. Statistical Analysis Paired t-test was used to compare pre and post-treatment changes within Groups I and II and unpaired t-test was used to compare treatment changes between Group I and Group II. A P-value of < 0.05 was set for statistical significance. Results Findings of this study demonstrate that an average of 1mm of intrusion takes place with CIA intrusion arch and 1.3mm with CNA intrusion arch in a period of 4 months. Both intrusion arches do not affect the position of molar in vertical or anteroposterior plane. Interpretation & Conclusion Both CIA and CNA intrusion arches are effective in bringing about intrusion of lower incisors. PMID:26501008

  7. Evaluation of the fit of preformed nickel titanium arch wires on normal occlusion dental arches

    PubMed Central

    Al-Barakati, Rakhn G.; Alqahtani, Nasser D.; AlMadi, Abdulaziz; Albarakati, Sahar F.; ALKofide, Eman A.

    2015-01-01

    Aim To determine the fits of preformed nickel titanium (NiTi) archwires on dental arches with normal occlusion. Methods Forty sets of upper and lower plaster models were obtained from men and women with Class I occlusions. Preformed 0.016″ × 0.022″ NiTi archwires from Rocky Mountain Orthodontics (RMO), 3 M Unitek, Ormco, and Dentaurum were evaluated in terms of their fits on dental arches from male, female, and combined cases. Data were analyzed by using fourth- and sixth-order polynomial equations, analysis of variance (ANOVA), and the Duncan post hoc test. Results In the upper arches, the best fit and least error were obtained with RMO Ovoid and Ormco Orthos Large archwires for male cases, but with 3 M Orthoform LA archwires for female and combined cases. In the lower arches, the best fit and least error were obtained with Ormco Orthos Large for male cases, with 3 M Orthoform LA and RMO Normal for female cases, and with 3 M Orthoform LA, RMO Normal, Ormco Orthos Large, and Ormco Orthos Small for combined cases. When both dental arches were matched, Ormco Orthos Large was the best wire for male cases. 3 M Orthoform LA was the best wire for female and combined cases. Conclusions Using an archwire form with the best fit to the dental arch should produce minimal changes in the dental arch form when NiTi wires are used and require less customization when stainless-steel wires are used. PMID:26792965

  8. Pulmonary artery stenosis caused by a large aortic arch pseudoaneurysm detected 10 years after a minor trauma

    PubMed Central

    Zamani, Jalal; Aghasadeghi, Kamran; Zarrabi, Khalil; Abdi Ardekani, Alireza; Zolghadrasli, Abdolali

    2016-01-01

    Pseudoaneurysm of aorta is a rare condition usually seen after aortic surgeries or serious accidents. Here we report a 60 years old man without any previous medical condition who presented with non-specific symptoms and underwent different investigations for more than 1 year, until the presence of a continuous murmur raised suspicion toward his cardiovascular system. In echocardiographic and computed tomography (CT) angiographic studies a large pseudoaneurysm of aortic arch with compression effect on pulmonary artery was detected. At this stage he remembered having suffered a minor trauma 10 years ago. He finally underwent operation and his aortic wall was repaired successfully with a patch. This case highlights the importance of thorough history taking and physical examination in patients irrespective of symptoms and high index of suspicion to detect this life-threatening condition. PMID:27069568

  9. Life-Threatening Postpneumonectomy Syndrome Complicated with Right Aortic Arch after Left Pneumonectomy.

    PubMed

    Karasaki, Takahiro; Tanaka, Makoto

    2015-01-01

    A 54-year-old man with right aortic arch underwent left lower lobectomy and lingular segmentectomy, followed by complete pneumonectomy, for refractory nontuberculous mycobacterial infection. Three months after the pneumonectomy, he developed acute respiratory distress. Computed tomography showed an excessive mediastinal shift with an extremely narrowed bronchus intermedius and right lower bronchus compressed between the right pulmonary artery and the right descending aorta. Soon after the nearly obstructed bronchus intermedius was observed by bronchoscopy, he began to exhibit frequent hypoxic attacks, perhaps due to mucosal edema. Emergent surgical repositioning of the mediastinum and decompression of the bronchus was indicated. After complete adhesiolysis of the left thoracic cavity was performed, to maintain the proper mediastinal position, considering the emergent setting, an open wound thoracostomy was created and piles of gauze were inserted, mildly compressing the heart and the mediastinum to the right side. Thoracoplasty was performed three months later, and he was eventually discharged without any dressings needed. Mediastinal repositioning under thoracostomy should be avoided in elective cases because of its extremely high invasiveness. However, in the case of life-threatening postpneumonectomy syndrome in an emergent setting, mediastinal repositioning under thoracostomy may be an option to save life, which every thoracic surgeon could attempt. PMID:26106501

  10. Life-Threatening Postpneumonectomy Syndrome Complicated with Right Aortic Arch after Left Pneumonectomy

    PubMed Central

    Karasaki, Takahiro; Tanaka, Makoto

    2015-01-01

    A 54-year-old man with right aortic arch underwent left lower lobectomy and lingular segmentectomy, followed by complete pneumonectomy, for refractory nontuberculous mycobacterial infection. Three months after the pneumonectomy, he developed acute respiratory distress. Computed tomography showed an excessive mediastinal shift with an extremely narrowed bronchus intermedius and right lower bronchus compressed between the right pulmonary artery and the right descending aorta. Soon after the nearly obstructed bronchus intermedius was observed by bronchoscopy, he began to exhibit frequent hypoxic attacks, perhaps due to mucosal edema. Emergent surgical repositioning of the mediastinum and decompression of the bronchus was indicated. After complete adhesiolysis of the left thoracic cavity was performed, to maintain the proper mediastinal position, considering the emergent setting, an open wound thoracostomy was created and piles of gauze were inserted, mildly compressing the heart and the mediastinum to the right side. Thoracoplasty was performed three months later, and he was eventually discharged without any dressings needed. Mediastinal repositioning under thoracostomy should be avoided in elective cases because of its extremely high invasiveness. However, in the case of life-threatening postpneumonectomy syndrome in an emergent setting, mediastinal repositioning under thoracostomy may be an option to save life, which every thoracic surgeon could attempt. PMID:26106501

  11. Moderate hypothermic circulatory arrest in total arch repair for acute type A aortic dissection: clinical safety and efficacy

    PubMed Central

    Gong, Ming; Ma, Wei-Guo; Guan, Xin-Liang; Wang, Long-Fei; Li, Jia-Chen; Lan, Feng

    2016-01-01

    Background Continued debates exist regarding the optimal temperature during hypothermic circulatory arrest (HCA) in aortic arch repair for patients with type A aortic dissection (TAAD). This study seeks to examine whether the use of moderate HCA in emergency aortic arch surgery provides comparable operative outcomes to deep HCA for patients with acute TAAD. Methods We prospectively enrolled 74 consecutive patients (mean age 47.7±9.8 years, 54 males) with acute TAAD, who underwent emergency total arch replacement and frozen elephant trunk implantation under HCA (18–28 °C) with unilateral selective antegrade cerebral perfusion (uSACP). Patients were divided into two groups based on the nasopharyngeal temperature at the initiation of HCA: deep HCA (DHCA, <20 °C) in 35 (47.3%) and moderate HCA (MHCA, 20–28 °C) in 39 (52.7%). Operative outcomes including mortality, morbidity and visceral organ functions were compared between the two groups. Results The mean times of cardiopulmonary bypass (CPB) and aortic cross-clamp were 211±54 and 238±62 minutes (P=0.053) and 118±27 and 142±45 minutes (P=0.005) in the MHCA and DHCA groups, respectively. Operative mortality did not differ between two groups (10.2% in MHCA vs. 14.3% in DHCA groups, P=0.862). Nor did the incidence of morbidities differ between the two groups (P>0.05). The temporal trend in the changes of postoperative levels of creatinine, aspartate aminotransferase, total bilirubin and lactate did not differ between two groups (P>0.05). Multivariate analysis found that the temperature during HCA (MHCA vs. DHCA) did not affect operative mortality, morbidities and neurologic complications. Instead, CPB time (in minutes) was the risk factor for operative mortality (odds ratio, 1.032; 95% confidence interval, 1.004–1.061; P=0.023). Conclusions: Moderate HCA is associated with equivalent operative mortality and morbidity and visceral organ functions compared to deep HCA in patients with acute TAAD undergoing

  12. [Mycotic Aneurysm of Distal Aortic Arch, after Total Arch Replacement with Open-stent Graft;Report of a Case].

    PubMed

    Suzuki, Kotaro; Kawahara, Yu; Masaki, Naoki; Kobayashi, Yuriko; Takahara, Shingo; Nakamura, Ken; Toyama, Shuji; Fukasawa, Manabu

    2015-05-01

    The patient was a 72-year-old man, who had undergone total arch replacement with an open-stent graft due to saccular aneurysm of distal arch, 2 years before. He was admitted to a local hospital with the complaint of high fever, and was diagnosed as having pyothorax, after computed tomography (CT) scanning. After transferred to our hospital, he was treated by drainage, and antibiotic therapy. But CT scans showed the enlargement of distal arch aneurysm, and migration of the stent graft. Urgent operation was performed. We approached to the site by a full sternotomy, and left anterolateral thoracotomy. Segment 1+2 of the left lung was resected to avoid bleeding and lung injury. Graft replacement of distal arch and descending aorta was performed on cardiopulmonary bypass, with hypothermia, selective brain perfusion and systemic circulatory arrest. To protect from recurrence of infection, the omental flap was transposed to the graft site. Until now, there is no recurrence of infection. PMID:25963790

  13. Atherosclerosis differentially affects calcium signalling in endothelial cells from aortic arch and thoracic aorta in Apolipoprotein E knockout mice

    PubMed Central

    Prendergast, Clodagh; Quayle, John; Burdyga, Theodor; Wray, Susan

    2014-01-01

    Abstract Apolipoprotein‐E knockout (ApoE−/−) mice develop hypercholesterolemia and are a useful model of atherosclerosis. Hypercholesterolemia alters intracellular Ca2+ signalling in vascular endothelial cells but our understanding of these changes, especially in the early stages of the disease process, is limited. We therefore determined whether carbachol‐mediated endothelial Ca2+ signals differ in plaque‐prone aortic arch compared to plaque‐resistant thoracic aorta, of wild‐type and ApoE−/− mice, and how this is affected by age and the presence of hypercholesterolemia. The extent of plaque development was determined using en‐face staining with Sudan IV. Tissues were obtained from wild‐type and ApoE−/− mice at 10 weeks (pre‐plaques) and 24 weeks (established plaques). We found that even before development of plaques, significantly increased Ca2+ responses were observed in arch endothelial cells. Even with aging and plaque formation, ApoE−/− thoracic responses were little changed, however a significantly enhanced Ca2+ response was observed in arch, both adjacent to and away from lesions. In wild‐type mice of any age, 1–2% of cells had oscillatory Ca2+ responses. In young ApoE−/− and plaque‐free regions of older ApoE−/−, this is unchanged. However a significant increase in oscillations (~13–15%) occurred in thoracic and arch cells adjacent to lesions in older mice. Our data suggest that Ca2+ signals in endothelial cells show specific changes both before and with plaque formation, that these changes are greatest in plaque‐prone aortic arch cells, and that these changes will contribute to the reported deterioration of endothelium in atherosclerosis. PMID:25344475

  14. Gelsolin and Progression of Aortic Arch Calcification in Chronic Hemodialysis Patients

    PubMed Central

    Chiou, Terry Ting-Yu; Liao, Shang-Chih; Kao, Yu-Yin; Lee, Wen-Chin; Lee, Yueh-Ting; Ng, Hwee-Yeong; Lee, Po-Shun; Lee, Chien-Te

    2016-01-01

    Background:Vascular calcification (VC) is a key process associated with cardiovascular mortality in dialysis patients. Gelsolin is an actin-binding protein that can modulate inflammation, correlated inversely with hemodialysis (HD) mortality and involved in bone calcification homeostasis. In this report, we aim to characterize progression in aortic arch calcification (AAC) and investigate its association with gelsolin. Methods: 184 HD patients were enrolled and their annual posterior-anterior chest X-ray films (CXR) in 2009 and 2013 were examined. The severity of AAC was classified as grade 0 to 3. Blood levels of gelsolin were measured by ELISA kits. Biographic and biochemical data at baseline were analyzed with status of AAC at baseline and changes after 4 years. Results: At baseline, 60% of the patients had detectable AAC on CXR. After 4 years, 77% had AAC. Patients with grade 1 and 2 AAC had increased risk of progression (Odds ratio [OR] 2~3, P=0.001) compared to those with grade 0 at baseline. Compared to those with no AAC, patients with AAC progression had older age, lower gelsolin, higher waist circumference and prevalence of vascular disease. Regression analysis confirmed baseline gelsolin (odds ratio 0.845, 95% confidence interval [0.734-0.974]) and waist circumference as the independent factors associated with AAC progression. Gelsolin is positively correlated with serum albumin and negatively with tumor necrosis factor-alpha. Conclusion: Our study demonstrated that HD patients with grades 1 or 2 baseline AAC are at increased risk of further progression compared to those with grade 0. We also found lower blood levels of gelsolin associated with progressive AAC. Further investigation into the mechanistic roles of gelsolin in vascular calcification may provide new understanding of this key process. PMID:26941566

  15. Hybrid Repair of Complex Thoracic Aortic Arch Pathology: Long-Term Outcomes of Extra-anatomic Bypass Grafting of the Supra-aortic Trunk

    SciTech Connect

    Lotfi, S. Clough, R. E.; Ali, T.; Salter, R.; Young, C. P.; Bell, R.; Modarai, B.; Taylor, P.

    2013-02-15

    Hybrid repair constitutes supra-aortic debranching before thoracic endovascular aortic repair (TEVAR). It offers improved short-term outcome compared with open surgery; however, longer-term studies are required to assess patient outcomes and patency of the extra-anatomic bypass grafts. A prospectively maintained database of 380 elective and urgent patients who had undergone TEVAR (1997-2011) was analyzed retrospectively. Fifty-one patients (34 males; 17 females) underwent hybrid repair. Median age was 71 (range, 18-90) years with mean follow-up of 15 (range, 0-61) months. Perioperative complications included death: 10 % (5/51), stroke: 12 % (6/51), paraplegia: 6 % (3/51), endoleak: 16 % (8/51), rupture: 4 % (2/51), upper-limb ischemia: 2 % (1/51), bypass graft occlusion: 4 % (2/51), and cardiopulmonary complications in 14 % (7/51). Three patients (6 %) required emergency intervention for retrograde dissection: (2 aortic root repairs; 2 innominate stents). Early reintervention was performed for type 1 endoleak in two patients (2 proximal cuff extensions). One patient underwent innominate stenting and revision of their bypass for symptomatic restenosis. At 48 months, survival was 73 %. Endoleak was detected in three (6 %) patients (type 1 = 2; type 2 = 1) requiring debranching with proximal stent graft (n = 2) and proximal extension cuff (n = 1). One patient had a fatal rupture of a mycotic aneurysm and two arch aneurysms expanded. No bypass graft occluded after the perioperative period. Hybrid operations to treat aortic arch disease can be performed with results comparable to open surgery. The longer-term outcomes demonstrate low rates of reintervention and high rates of graft patency.

  16. Trade in the hammer for a power driver—perspectives on the frozen elephant trunk repair for aortic arch disease

    PubMed Central

    2013-01-01

    Like a power driver for which the bit can be changed for each screw that is turned, improvement of brain protection strategies and the development of hybrid techniques have provided us with the ability to offer tailored repair options for patients with complex thoracic disease involving the arch. Variations of the frozen elephant trunk operation have been the most versatile of the newer hybrid approaches to repair complex thoracic aortic pathology. The frozen elephant trunk procedure includes the use of circulatory arrest in combination with suturing a stentgraft into the arch, and may reduce the risk of stroke and endoleaks. This article describes various methods of performing the frozen elephant trunk procedure with a focus on preoperative considerations including the etiology of disease, the time and urgency of presentation, and the indications to operate. PMID:24109573

  17. Senile Calcification of the Trachea, Aortic Arch, and Mitral Annulus: An Incidental Finding on Chest X-Ray.

    PubMed

    Hosseinzadeh Maleki, Mahmood; Kazemi, Toba; Davoody, Navid

    2015-10-27

    A 94-year-old woman presented with dizziness and hypotension of 2 days' duration. She denied any syncope, presyncope, or angina. She had received a permanent pacemaker 12 years previously for the management of complete heart block (CHB), but she failed to program it. Twelve-lead electrocardiography revealed CHB with ventricular escape rhythm (40/min), so we inserted a temporary pacemaker. Anteroposterior chest X-ray showed trachea, aortic arch, and severe mitral valve calcification. Tracheal calcification is usually seen after 40 years old without clinical importance. However, it is seen in patients with renal failure, metastases, and prolonged use of warfarin as well as in pregnancy.(1) (-) (3). PMID:26985213

  18. Right Cervical Aortic Arch and Pseudocoarctation of the Aorta Associated with Aneurysms and Steal Phenomena: US, CTA, and MRA Findings

    SciTech Connect

    Tanju, Sumru Ustuner, Evren; Erden, Ilhan; Aytac, Suat Kemal

    2007-02-15

    A 55-year-old woman presented with right cervical aortic arch with pseudocoarctation of the aorta further complicated by the presence of multiple aneurysms and a high-grade stenosis at the origin of the left subclavian trunk from the aorta causing a discrepancy in blood pressure between the right and left arms. The branching pattern and the resulting complex steal syndromes involving the left carotid and the subclavian system are unique. The computed tomography angiography, magnetic resonance angiography, and Doppler ultrasound findings are described.

  19. Association of Brachial-Ankle Pulse Wave Velocity and Cardiomegaly With Aortic Arch Calcification in Patients on Hemodialysis

    PubMed Central

    Shin, Ming-Chen Paul; Lee, Mei-Yueh; Huang, Jiun-Chi; Tsai, Yi-Chun; Chen, Jui-Hsin; Chen, Szu-Chia; Chang, Jer-Ming; Chen, Hung-Chun

    2016-01-01

    Abstract Aortic arch calcification (AoAC) is associated with cardiovascular and all-cause mortality in end-stage renal disease population. AoAC can be simply estimated with an AoAC score using plain chest radiography. The objective of this study is to evaluate the association of AoAC with brachial-ankle pulse wave velocity (baPWV) and cardiomegaly in patients who have undergoing hemodialysis (HD). We retrospectively determined AoAC and cardiothoracic ratio (CTR) by chest x-ray in 220 HD patients who underwent the measurement of baPWV. The values of baPWV were measured by an ankle-brachial index-form device. Multiple stepwise logistic regression analysis was used to identify the factors associated with AoAC score >4. Compared patients with AoAC score ≦4, patients with AoAC score >4 had older age, higher prevalence of diabetes and cerebrovascular disease, lower diastolic blood pressure, higher baPWV, higher CTR, higher prevalence of CTR ≧50%, lower total cholesterol, and lower creatinine level. After the multivariate stepwise logistic analysis, old age, cerebrovascular disease, high baPWV (per 100 cm/s, odds ratio [OR] 1.065, 95% confidence interval [CI] 1.003–1.129, P = 0.038), CTR (per 1%, OR 1.116, 95% CI 1.046–1.191, P = 0.001), and low total cholesterol level were independently associated with AoAC score >4. Our study demonstrated AoAC severity was associated with high baPWV and high CTR in patients with HD. Therefore, we suggest that evaluating AoAC on plain chest radiography may be a simple and inexpensive method for detecting arterial stiffness in HD patients. PMID:27175684

  20. Association of Brachial-Ankle Pulse Wave Velocity and Cardiomegaly With Aortic Arch Calcification in Patients on Hemodialysis.

    PubMed

    Shin, Ming-Chen Paul; Lee, Mei-Yueh; Huang, Jiun-Chi; Tsai, Yi-Chun; Chen, Jui-Hsin; Chen, Szu-Chia; Chang, Jer-Ming; Chen, Hung-Chun

    2016-05-01

    Aortic arch calcification (AoAC) is associated with cardiovascular and all-cause mortality in end-stage renal disease population. AoAC can be simply estimated with an AoAC score using plain chest radiography. The objective of this study is to evaluate the association of AoAC with brachial-ankle pulse wave velocity (baPWV) and cardiomegaly in patients who have undergoing hemodialysis (HD).We retrospectively determined AoAC and cardiothoracic ratio (CTR) by chest x-ray in 220 HD patients who underwent the measurement of baPWV. The values of baPWV were measured by an ankle-brachial index-form device. Multiple stepwise logistic regression analysis was used to identify the factors associated with AoAC score >4.Compared patients with AoAC score ≦4, patients with AoAC score >4 had older age, higher prevalence of diabetes and cerebrovascular disease, lower diastolic blood pressure, higher baPWV, higher CTR, higher prevalence of CTR ≧50%, lower total cholesterol, and lower creatinine level. After the multivariate stepwise logistic analysis, old age, cerebrovascular disease, high baPWV (per 100 cm/s, odds ratio [OR] 1.065, 95% confidence interval [CI] 1.003-1.129, P = 0.038), CTR (per 1%, OR 1.116, 95% CI 1.046-1.191, P = 0.001), and low total cholesterol level were independently associated with AoAC score >4.Our study demonstrated AoAC severity was associated with high baPWV and high CTR in patients with HD. Therefore, we suggest that evaluating AoAC on plain chest radiography may be a simple and inexpensive method for detecting arterial stiffness in HD patients. PMID:27175684

  1. Aortic arch/elephant trunk procedure with Sienna(TM) graft and endovascular stenting of thoraco-abdominal aorta for treatment of complex chronic dissection.

    PubMed

    Wong, Randolph H L; Baghai, Max; Yu, Simon C H; Underwood, Malcolm J

    2013-05-01

    Aneurismal dilatation of the remaining thoracic aorta after ascending aortic interposition grafting for type 'A' aortic dissection is not uncommon. For such complex cases, one treatment option is total arch replacement and elephant trunk procedure with the Sienna(TM) collared graft (Vascutek, Inchinnan, UK) technique followed by a staged thoracic endovascular aortic repair (TEVAR). The video illustrates our technique in a 56-year-old man with an extensive aortic arch and descending thoracic aortic dissecting aneurysm. For the 'open' procedure femoral arterial and venous cannulation was used along with systemic cooling and circulatory arrest at 22 °C. Upon circulatory arrest, the aortic arch was incised and antegrade cerebral perfusion achieved via selective cannulation to the right brachiocephalic and left common carotid artery, keeping flow rates at 10-15 mL/kg/min and perfusion pressure at 50-60 mmHg. Arch replacement with an elephant trunk component was then performed and after completion of the distal aortic anastomosis antegrade perfusion via a side-arm in the graft was started and the operation completed using a variation of the 'sequential' clamping technique to maximize cerebral perfusion. The second endovascular stage was performed two weeks after discharge. Two covered stents were landing from the elephant trunk to the distal descending thoracic aorta, to secure the distal landing a bare stent of was placed to cover the aorta just distal to the origin of the celiac axis. The left subclavian artery was embolised with fibre coils. Post TEVAR angiogram showed no endoleak Although re-operative total arch replacement and elephant trunk procedure and subsequent TEVAR remained a challenging procedure, we believe excellent surgical outcome can be achieved with carefully planned operative strategy. PMID:23977606

  2. Cardiac Surgical Repair Should Be Offered to Infants with Trisomy 18, Interrupted Aortic Arch and Ventricular Septal Defect.

    PubMed

    Kavarana, Minoo N

    2016-06-01

    The management of children born with trisomy 18 is controversial, and both providers and parents often have differing opinions. Many parents choose to terminate the pregnancy while others go forward, making decisions based on their beliefs, understanding, and physician recommendations. Physicians are similarly divided regarding treatment of these children, as some feel that aggressive treatments are futile while others defer to the parents' wishes.Interrupted aortic arch with ventricular septal defect in children with trisomy 18 presents an ethical dilemma that highlights the kinds of controversies in medical decision making facing physicians on a daily basis. Repair of interrupted aortic arch with ventricular septal defect poses a high risk to newborns with or without trisomy 18. Therefore, the option for surgery should be treated as with any routine informed consent process. Parents should be counseled about the risks, benefits, alternatives, and the likelihood of success both short and long term and be should offered a choice between surgery and palliative care. PMID:27338603

  3. Association of Ankle-Brachial Index and Aortic Arch Calcification with Overall and Cardiovascular Mortality in Hemodialysis

    PubMed Central

    Chen, Szu-Chia; Lee, Mei-Yueh; Huang, Jiun-Chi; Shih, Ming-Chen Paul; Chang, Jer-Ming; Chen, Hung-Chun

    2016-01-01

    Peripheral artery occlusive disease and vascular calcification are highly prevalent in hemodialysis (HD) patients, however the association of the combination of ankle-brachial index (ABI) and aortic arch calcification (AoAC) with clinical outcomes in patients undergoing HD is unknown. In this study, we investigated whether the combination of ABI and AoAC is independently associated with overall and cardiovascular mortality in HD patients. The median follow-up period was 5.7 years. Calcification of the aortic arch was assessed by chest X-ray. Forty-seven patients died including 24 due to cardiovascular causes during the follow-up period. The study patients were stratified into four groups according to an ABI < 0.95 or ≥0.95 and an AoAC score of >4 or ≤4 according to receiver operating characteristic curve. Those with an ABI < 0.95 and AoAC > 4 (vs. ABI ≥ 0.95 and AoAC score ≤ 4) were associated with overall (hazard ratio [HR], 4.913; 95% confidence interval [CI], 1.932 to 12.497; p = 0.001) and cardiovascular (HR, 3.531; 95% CI, 1.070 to 11.652; p = 0.038) mortality in multivariable analysis. The combination of a low ABI and increased AoAC was associated with increased overall and cardiovascular mortality in patients undergoing HD. PMID:27608939

  4. Endovascular repair of a ruptured descending thoracic aortic aneurysm in a patient with an ascending aortic aneurysm: hybrid open arch reconstruction with simultaneous thoracic stent-graft deployment within elephant trunk.

    PubMed

    Abou-Zamzam, Ahmed M; Zhang, Wayne; Wang, Nan; Razzouk, Anees

    2008-03-01

    Endovascular repair of the thoracic aorta is now widely practiced. The extension of this technique to emergent settings is in evolution. Pathology of the ascending and transverse aortic arch may preclude thoracic aortic stent grafting due to the lack of a proximal seal zone. Several hybrid open/endovascular approaches have been described. We recently encountered the difficult case of a contained rupture of a 6.8 cm descending thoracic aortic aneurysm in a 60-year-old patient with aneurysmal degeneration of the ascending and transverse aortic arch. This patient was treated with a hybrid approach of open ascending and transverse arch reconstruction along with simultaneous stent-graft repair of the descending thoracic aorta. The open repair established an excellent proximal landing zone by use of the "elephant trunk" technique. This technique also allowed direct suture fixation of the stent graft to the arch graft to prevent stent-graft migration. This hybrid surgical approach was successful and avoided the cumulative morbidity that a left thoracoabdominal approach would have added to the sternotomy. Further creative uses of these hybrid techniques will undoubtedly serve a larger role in the treatment of thoracic aortic pathology. PMID:18346569

  5. Anomalous origin of the left innominate (brachiocephalic) artery in the right aortic arch: How can it be anomalous when the left innominate artery is absent?

    PubMed Central

    Raimondi, Francesca; Bonnet, Damien; Geva, Tal; Sanders, Stephen P

    2016-01-01

    An unusual case of a rare vascular ring, which has been called right aortic arch with aberrant left innominate artery, is presented. The appearance of this case led to the realization that there is really no innominate artery present in this anomaly but only the left dorsal aorta. We present a clarification of the nature and likely development of the vessels present. PMID:27212855

  6. Left-ventricular mechanical activation and aortic-arch orientation recovered from Magneto-hydrodynamic Voltages observed in 12-lead ECGs obtained inside MRIs: A Feasibility Study

    PubMed Central

    Gregory, T. Stan; Schmidt, Ehud J.; Zhang, Shelley Hualei; Kwong, Raymond Y.; Stevenson, William G.; Murrow, Jonathan R.; Ho Tse, Zion Tsz

    2014-01-01

    Purpose To explore use of the Magnetohydrodynamic Voltage (VMHD), observed in intra-MRI 12-lead Electrocardiograms (ECG), to indicate the timing of the onset of left-ventricular mechanical activation (LVMA) and the orientation of the aortic-arch (AAO). Theory Blood flow through the aortic arch during systole, in the presence of the MRI magnetic field (B0), generates VMHD. Since the magnitude and direction of VMHD are determined by the timing and directionality of blood flow relative to B0, we hypothesized that clinically useful measures, LVMA and AAO, could be extracted from temporal and vectorial VMHD characteristics. Methods VMHD signals were extracted from 12-lead ECG traces by comparing traces obtained inside and outside the MRI scanner. VMHD was converted into the Vectorcardiogram frame of reference. LVMA was quantified in 1 subject at 1.5T and 3 subjects at 3T, and the result compared to CINE MRI. AAO was inferred for 4 subjects at 3T and compared to anatomical imaging of the aortic arch orientation in the transverse plane. Results and Conclusions A <10% error was observed in LVMA measurements, while a <3° error was observed in aortic arch orientation measurements. The temporal and vectorial nature of VMHD is useful in estimating these clinically relevant parameters. PMID:25224074

  7. A Case of an Upper Gastrointestinal Bleeding Due to a Ruptured Dissection of a Right Aortic Arch

    SciTech Connect

    Born, Christine; Forster, Andreas; Rock, Clemens; Pfeifer, Klaus-Juergen; Rieger, Johannes; Reiser, Maximilian

    2003-09-15

    We report a case of severe upper gastrointestinal hemorrhage with a rare underlying cause. The patient was unconscious when he was admitted to the hospital. No chest radiogram was performed. Routine diagnostic measures, including endoscopy, failed to reveal the origin of the bleeding, which was believed to originate from the esophagus secondary to a peptic ulcer or varices. Exploratory laparotomy added no further information, but contrast-enhanced multislice computed tomography (MSCT) of the chest showed dextroposition of the widened aortic arch with a ruptured type-B dissection and a consecutive aorto-esophageal fistula (AEF). The patient died on the day of admission. Noninvasive MSCT angiography gives rapid diagnostic information on patients with occult upper gastrointestinal bleeding and should be considered before more invasive conventional angiography or surgery.

  8. Digital-image analysis of the aortic arch's development and its variations.

    PubMed

    Gielecki, Jerzy St; Wilk, Renata; Syc, Bozena; Musiał-Kopiejka, Magdalena; Piwowarczyk-Nowak, Aneta

    2004-11-01

    The study was performed on 103 human foetuses (58 female, 45 male) spontaneously aborted at between 14 and 30 weeks of gestation. The arteries were filled with latex, preserved in formalin and then dissected under the microscope and digitalised using a camera system. The following measurements were taken with the use of special computer software: the external diameter, the length and the volume of the arch of the aorta. The increase in diameter and length in relation to age corresponded to a linear function with values ranging from 1.77 mm to 4.09 mm for the diameter and from 4.94 mm to 13.31 mm for the length. The increase in volume corresponded to a square root function with values ranging from 13.42 mm3 to 173.96 mm3. Analysis of arch of the aorta variations revealed 11 cases of a common trunk for the brachiocephalic trunk and the left common carotid artery and 7 cases with the left vertebral artery arising directly from the arch of the aorta. In 2 cases the brachiocephalic trunk was absent, the right subclavian artery branching directly from the arch of the aorta at the level of the left subclavian artery or from the descending aorta just below the arterial duct ostium. PMID:15712142

  9. A new concentric double prosthesis for sutureless, magnetic-assisted aortic arch inclusion.

    PubMed

    Cirillo, Marco

    2016-04-01

    Acute dissection of the ascending aorta is a life-threatening condition in which the aortic wall develops one or more tears of the intima associated with intramural rupture of the media layer with subsequent formation of a two lumina vessel. The remaining outer layer is just the adventitia, with high risk of complete rupture. Vital organs may be under-perfused. Mortality rate in this acute event is about 50% if an emergent surgical procedure is not performed as soon as possible to replace the tract affected by the primary rupture. Nevertheless, the emergent surgical procedure is affected by high risk of mortality or severe neurologic sequelae, due to the need for deep hypothermia and cardiocirculatory arrest and different methods of cerebral protection. If the patient survives the acute event, a frequent outcome is the establishment of a chronic aortic dissection in the remaining aorta and late chronic dissecting aneurysm, usually starting from the surgical suture itself. Traumatism of surgical stitches and of direct blood flow pressure on weak aortic wall can be important contributing factors of the chronic disease. In conclusions, the majority of these patients undergoes a high risk operation without a complete solution of the disease. We hypothesize that excluding the aortic layers from the blood direct flow and using an anastomotic technique which does not include surgical stitches could help to significantly reduce the recurrence of aortic dissection after the acute event and shorten hypothermic arrest duration. We devised a double tubular prosthesis consisting of two concentric artificial tubes between which the aortic wall is confined and excluded from direct blood flow. We also devised a magnetic assisted sutureless anastomotic technique that seals the aortic tissue between the two prostheses and avoids the perforation of the fragile aortic wall with surgical stitches. We are presenting here this new prototype and draw a few different models. Both acute and

  10. Evaluation of dental arch width and form changes after orthodontic treatment and retention with a new computerized method.

    PubMed

    Taner, Tülin Ugur; Ciger, Semra; El, Hakan; Germeç, Derya; Es, Alphan

    2004-10-01

    The purpose of this study was to evaluate longitudinal arch width and form changes and to define arch form types with a new computerized method. Maxillary and mandibular models of 21 Class II Division 1 patients were examined before treatment (T(0)), after treatment (T(1)), and an average of 3 years after retention (T(2)). Arch width measurements were made directly on scanned images of maxillary and mandibular models. Arch form changes at T(0)-T(1) and T(1)-T(2) were evaluated by superimposing the computer-generated Bezier arch curves with a computer program. Types of dental arch forms were defined by superimposing them with the pentamorphic arch system, which included 5 different types of arch forms: normal, ovoid, tapered, narrow ovoid, and narrow tapered. Maxillary arch widths were increased during orthodontic treatment. Mandibular posterior arch widths were also increased. The expansion of the mandibular arch forms was less than in the maxillary arch forms. Arch width changes were generally stable, except for reduction in maxillary and mandibular interlateral, inter-first premolar, and mandibular intercanine widths. Pretreatment maxillary arch forms were mostly tapered; mandibular arch forms were tapered and narrow tapered. In maxillary arch forms, 76% of the treatment changes were maintained. Mandibular arch form was maintained in 67% of the sample, both during treatment and after retention. In mandibular arches, 71% of orthodontically induced arch form changes were maintained. PMID:15470349

  11. Endovascular Embolization of Bronchial Artery Originating from the Upper Portion of Aortic Arch in Patients with Massive Hemoptysis

    SciTech Connect

    Jiang, Sen Sun, Xi-Wen Yu, Dong Jie, Bing

    2013-05-15

    PurposeOur experience with endovascular embolization (EVE) of the bronchial artery (BA) originating from the upper portion of the aortic arch (AA) in six patients is described.MethodsAltogether, 818 patients with hemoptysis underwent multidetector row computed tomography angiography (MDCTA) before EVE or AA angiography during EVE. Aberrant BAs originating from the upper portion of the AA were the source of massive hemoptysis in six patients (0.73 %). MDCT angiograms and/or Digital subtraction angiograms were retrospectively reviewed. Selective catheterization and embolization were performed.ResultsThe ostia of the BAs were located on the superior surface of the AA between the brachiocephalic trunk and left common carotid artery in three patients, the junction of the aorta and medial surface of the left subclavian artery in two, and the posterior wall of the upper portion of the AA in one. The six BAs comprised two common trunks, three single right sides, and one single left side. The targeted vessels were successfully catheterized and embolized by a coaxial microcatheter system using polyvinyl alcohol particles. Other pathologic BAs and nonbronchial systemic arteries also were embolized. Bleeding was immediately controlled in all patients with no recurrence of hemoptysis. No procedure-related complications occurred.ConclusionsApplication of EVE of anomalous origin of BAs in patients with hemoptysis is important, as demonstrated in the six reported patients. MDCTA before EVE or AA angiography during EVE is critical to avoid missing a rare aberrant BA originating from the upper portion of the AA.

  12. Abnormal bisubclavian trunk arising from the aortic arch determined by cadaver dissection of a native dog: A case report

    PubMed Central

    Kamali, Younes; Tadjalli, Mina

    2015-01-01

    Congenital anomalies of the great thoracic vessels have been reported in 20% of dogs and cats. In some cases, the vascular ring anomalies remain unrecognized throughout the lifetime of an animal. This report describes a case with an unusual vascular ring anomaly (VRA) that was detected during dissection on a cadaver of an approximately two-year-old male native mixed breed dog. No history of the animal’s life was available. But, good physical condition and age of the animal based on dentition indicated the anomaly was perhaps asymptomatic. Two main branches of the aorta were identified with the initial branch being a bicarotid trunk followed by a bisubclavian trunk. The left subclavian and aberrant right subclavian arteries formed a very short trunk and arose directly from the aortic arch. No dilatation cranial to the esophageal sulcus was found. To the authors' knowledge, our case is the first report of such anomalies perhaps without any clinical signs in a native dog in Iran. PMID:26893819

  13. Abnormal bisubclavian trunk arising from the aortic arch determined by cadaver dissection of a native dog: A case report.

    PubMed

    Kamali, Younes; Tadjalli, Mina

    2015-01-01

    Congenital anomalies of the great thoracic vessels have been reported in 20% of dogs and cats. In some cases, the vascular ring anomalies remain unrecognized throughout the lifetime of an animal. This report describes a case with an unusual vascular ring anomaly (VRA) that was detected during dissection on a cadaver of an approximately two-year-old male native mixed breed dog. No history of the animal's life was available. But, good physical condition and age of the animal based on dentition indicated the anomaly was perhaps asymptomatic. Two main branches of the aorta were identified with the initial branch being a bicarotid trunk followed by a bisubclavian trunk. The left subclavian and aberrant right subclavian arteries formed a very short trunk and arose directly from the aortic arch. No dilatation cranial to the esophageal sulcus was found. To the authors' knowledge, our case is the first report of such anomalies perhaps without any clinical signs in a native dog in Iran. PMID:26893819

  14. Aortic Arch Calcification Predicts the Renal Function Progression in Patients with Stage 3 to 5 Chronic Kidney Disease

    PubMed Central

    Lee, Yueh-Ting; Chou, Chia-An; Lee, Chien-Te

    2015-01-01

    Introduction. The presence of aortic arch calcification (AoAC) and cardiomegaly on chest radiography has been demonstrated as important risk factors for cardiovascular mortality in patients with chronic kidney disease (CKD). However, the interrelationship among AoAC, cardiomegaly, and renal function progression remains unclear. The aim of this study is to assess whether AoAC and cardiomegaly are independently associated with the renal function progression in patients with stages 3–5 CKD. Methods. We retrospectively determined AoAC and cardiomegaly by chest X-ray in 237 patients, followed up for at least three years without entering dialysis and classified into 4 groups according to the presence or absence of AoAC and cardiomegaly. The change in renal function was measured by the slope of estimated glomerular filtration rate (eGFR). Results. Of the 237 patients, the rate of eGFR decline was significantly higher in the group with coexistence of AoAC and cardiomegaly than any other groups. Baseline AoAC and proteinuria were independently associated with eGFR decline. AoAC were independently determined by age, eGFR slope, and cardiomegaly. Conclusions. The coexistence of AoAC and cardiomegaly is associated with faster eGFR decline. AoAC is an independent determinant of renal outcomes in patients with CKD stages 3–5. PMID:25695046

  15. Aortic arch calcification on chest X-ray combined with coronary calcium score show additional benefit for diagnosis and outcome in patients with angina

    PubMed Central

    Woo, Jong Shin; Kim, Weon; Kwon, Se Hwan; Youn, Hyo Chul; Kim, Hyun Soo; Kim, Jin Bae; Kim, Soo Joong; Kim, Woo-Shik; Kim, Kwon Sam

    2016-01-01

    Background The coronary artery calcium (CAC) and aortic arch calcification (AoAC) are individually associated with cardiovascular disease and outcome. This study investigated the predictive value of AoAC combined with CAC for cardiovascular diagnosis and outcome in patients with angina. Methods A total of 2018 stable angina patients who underwent chest X-ray and cardiac multi-detector computed tomography were followed up for four years to assess adverse events, which were categorized as cardiac death, stroke, myocardial infarction, or repeated revascularization. The extent of AoAC on chest X-ray was graded on a scale from 0 to 3. Results During the four years of follow-up, 620 patients were treated by coronary stenting and 153 (7%) adverse events occurred. A higher grade of AoAC was associated with a higher CAC score. Cox regression showed that the CAC score, but not AoAC, were associated with adverse events. In patients with CAC score < 400, AoAC showed an additive predictive value in detecting significant coronary artery disease (CAD). A gradual increases in the risk of adverse events were noted if AoAC was present in patients with similar CAC score. Conclusions As AoAC is strongly correlated with the CAC score regardless of age or gender, careful evaluation of CAD would be required in patients with AoAC on conventional chest X-rays. PMID:27103916

  16. CT and MRI in the Evaluation of Thoracic Aortic Diseases

    PubMed Central

    2013-01-01

    Computed tomography (CT) and magnetic resonance imaging (MRI) are the most commonly used imaging examinations to evaluate thoracic aortic diseases because of their high spatial and temporal resolutions, large fields of view, and multiplanar imaging reconstruction capabilities. CT and MRI play an important role not only in the diagnosis of thoracic aortic disease but also in the preoperative assessment and followup after treatment. In this review, the CT and MRI appearances of various acquired thoracic aortic conditions are described and illustrated. PMID:24396601

  17. MDCT evaluation of acute aortic syndrome (AAS).

    PubMed

    Valente, Tullio; Rossi, Giovanni; Lassandro, Francesco; Rea, Gaetano; Marino, Maurizio; Muto, Maurizio; Molino, Antonio; Scaglione, Mariano

    2016-05-01

    Non-traumatic acute thoracic aortic syndromes (AAS) describe a spectrum of life-threatening aortic pathologies with significant implications on diagnosis, therapy and management. There is a common pathway for the various manifestations of AAS that eventually leads to a breakdown of the aortic intima and media. Improvements in biology and health policy and diffusion of technology into the community resulted in an associated decrease in mortality and morbidity related to aortic therapeutic interventions. Hybrid procedures, branched and fenestrated endografts, and percutaneous aortic valves have emerged as potent and viable alternatives to traditional surgeries. In this context, current state-of-the art multidetector CT (MDCT) is actually the gold standard in the emergency setting because of its intrinsic diagnostic value. Management of acute aortic disease has changed with the increasing realization that endovascular therapies may offer distinct advantages in these situations. This article provides a summary of AAS, focusing especially on the MDCT technique, typical and atypical findings and common pitfalls of AAS, as well as recent concepts regarding the subtypes of AAS, consisting of aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer and unstable aortic aneurysm or contained aortic rupture. MDCT findings will be related to pathophysiology, timing and management options to achieve a definite and timely diagnostic and therapeutic definition. In the present article, we review the aetiology, pathophysiology, clinical presentation, outcomes and therapeutic approaches to acute aortic syndromes. PMID:27033344

  18. Preoperative evaluation of a patient for abdominal aortic aneurysm repair.

    PubMed Central

    Chonchubhair, A. N.; Cunningham, A. J.

    1998-01-01

    Coexistent cardiovascular disease is common in patients presenting for repair of aortic aneurysms. However, preoperative cardiac evaluation prior to abdominal aortic aneurysm (AAA) surgery remains contentious with significant variations in practice between countries, institutions and individual anesthetists. The following case report raises some everyday issues confronting clinical anesthetists. PMID:10604782

  19. Three-dimensional printed prototypes refine the anatomy of post-modified Norwood-1 complex aortic arch obstruction and allow presurgical simulation of the repair.

    PubMed

    Kiraly, Laszlo; Tofeig, Magdi; Jha, Neerod Kumar; Talo, Haitham

    2016-02-01

    Three-dimensional (3D) printed prototypes of malformed hearts have been used for education, communication, presurgical planning and simulation. We present a case of a 5-month old infant with complex obstruction at the neoaortic to transverse arch and descending aortic junction following the neonatal modified Norwood-1 procedure for hypoplastic left heart syndrome. Digital 3D models were created from a routine 64-slice CT dataset; then life-size solid and magnified hollow models were printed with a 3D printer. The solid model provided further insights into details of the anatomy, whereas the surgical approach and steps of the operation were simulated on the hollow model. Intraoperative assessment confirmed the anatomical accuracy of the 3D models. The operation was performed in accordance with preoperative simulation: sliding autologous flaps achieved relief of the obstruction without additional patching. Knowledge gained from the models fundamentally contributed to successful outcome and improved patient safety. This case study presents an effective use of 3D models in exploring complex spatial relationship at the aortic arch and in simulation-based planning of the operative procedure. PMID:26590304

  20. Full dimensional computer simulations to study pulsatile blood flow in vessels, aortic arch and bifurcated veins: Investigation of blood viscosity and turbulent effects.

    PubMed

    Sultanov, Renat A; Guster, Dennis

    2009-01-01

    We report computational results of blood flow through a model of the human aortic arch and a vessel of actual diameter and length. A realistic pulsatile flow is used in all simulations. Calculations for bifurcation type vessels are also carried out and presented. Different mathematical methods for numerical solution of the fluid dynamics equations have been considered. The non-Newtonian behaviour of the human blood is investigated together with turbulence effects. A detailed time-dependent mathematical convergence test has been carried out. The results of computer simulations of the blood flow in vessels of three different geometries are presented: for pressure, strain rate and velocity component distributions we found significant disagreements between our results obtained with realistic non-Newtonian treatment of human blood and the widely used method in the literature: a simple Newtonian approximation. A significant increase of the strain rate and, as a result, the wall shear stress distribution, is found in the region of the aortic arch. Turbulent effects are found to be important, particularly in the case of bifurcation vessels. PMID:19964834

  1. Aortic arch syndrome

    MedlinePlus

    ... arteries Update Date 5/20/2014 Updated by: Larry A. Weinrauch MD, Assistant Professor of Medicine, Harvard ... Health and Human Services National Institutes of Health Page last updated: 07 July 2016

  2. Hybrid procedure for a traumatic aortic rupture consisting of endovascular repair and minimally invasive arch vessel transposition without sternotomy.

    PubMed

    Ryu, Yang Gi; Choo, Suk Jung; Lim, Ju Yong; Yoon, Hyun Ki; Chung, Cheol Hyun

    2010-01-01

    Emergency surgical repair for acute traumatic aortic ruptures has been associated with a high peri-procedural mortality rate. Endovascular stent-grafting, as a less invasive procedure, has shown encouraging results. This report describes a patient with a short landing zone, who was treated by transposing the supra-aortic branch without sternotomy, followed by covered stent-grafting with an extended proximal bare portion to enhance fixation. PMID:20052360

  3. Impact of methodology and the use of allometric scaling on the echocardiographic assessment of the aortic root and arch: a study by the Research and Audit Sub-Committee of the British Society of Echocardiography.

    PubMed

    Oxborough, David; Ghani, Saqib; Harkness, Allan; Lloyd, Guy; Moody, William; Ring, Liam; Sandoval, Julie; Senior, Roxy; Sheikh, Nabeel; Stout, Martin; Utomi, Victor; Willis, James; Zaidi, Abbas; Steeds, Richard

    2014-09-01

    The aim of the study is to establish the impact of 2D echocardiographic methods on absolute values for aortic root dimensions and to describe any allometric relationship to body size. We adopted a nationwide cross-sectional prospective multicentre design using images obtained from studies utilising control groups or where specific normality was being assessed. A total of 248 participants were enrolled with no history of cardiovascular disease, diabetes, hypertension or abnormal findings on echocardiography. Aortic root dimensions were measured at the annulus, the sinus of Valsalva, the sinotubular junction, the proximal ascending aorta and the aortic arch using the inner edge and leading edge methods in both diastole and systole by 2D echocardiography. All dimensions were scaled allometrically to body surface area (BSA), height and pulmonary artery diameter. For all parameters with the exception of the aortic annulus, dimensions were significantly larger in systole (P<0.05). All aortic root and arch measurements were significantly larger when measured using the leading edge method compared with the inner edge method (P<0.05). Allometric scaling provided a b exponent of BSA(0.6) in order to achieve size independence. Similarly, ratio scaling to height in subjects under the age of 40 years also produced size independence. In conclusion, the largest aortic dimensions occur in systole while using the leading edge method. Reproducibility of measurement, however, is better when assessing aortic dimensions in diastole. There is an allometric relationship to BSA and, therefore, allometric scaling in the order of BSA(0.6) provides a size-independent index that is not influenced by the age or gender. PMID:26693286

  4. Hemodynamic evaluation of suspected severe aortic stenosis leads to a diagnosis of renal cell carcinoma.

    PubMed

    Lake, Mikhailia; Tanawuttiwat, Tanyanan; Bilsker, Martin; De Marchena, Eduardo

    2015-02-01

    The evaluation of aortic stenosis is not always straightforward. When symptoms of severe aortic stenosis are present with supporting Doppler echocardiographic or cardiac catheterization data, replacement of the aortic valve is recommended. Occasionally, Doppler- and catheter-derived data are discordant; appropriate treatment in such cases becomes less clear. We report a case in which a 66-year-old man's symptoms and Doppler data suggested severe aortic stenosis. However, heart catheterization data suggested otherwise, and ultimately it led to the diagnosis of a highly vascular renal tumor. Shunting within the tumor resulted in high cardiac output, which, in combination with a small aortic root, masqueraded as severe aortic stenosis. PMID:25873807

  5. Rhinometric evaluation of nasal cavity geometry and its relation to the upper arch transverse distance.

    PubMed

    Paiva, João Batista; Alves, Adriana Silva; Ribeiro, Annelise Nazareth Cunha; Rino Neto, José; Fantini, Solange Mongeli de

    2009-01-01

    The objective of this study was to evaluate children's respiratory patterns in the mixed dentition, by means of acoustic rhinometry, and its relation to the upper arch width development. Fifty patients were examined, 25 females and 25 males with mean age of eight years and seven months. All of them were submitted to acoustic rhinometry and upper and lower arch impressions to obtain plaster models. The upper arch analysis was accomplished by measuring the interdental transverse distance of the upper teeth, deciduous canines (measurement 1), deciduous first molars (measurement 2), deciduous second molars (measurement 3) and the first molars (measurement 4). The results showed that an increased left nasal cavity area in females means an increased interdental distance of the deciduous first molars and deciduous second molars and an increased interdental distance of the deciduous canines, deciduous first and second molars in males. It was concluded that there is a correlation between the nasal cavity area and the upper arch transverse distance in the anterior and mid maxillary regions for both genders. PMID:20027450

  6. Importance of dynamic aortic evaluation in planning TEVAR

    PubMed Central

    van Herwaarden, Joost A.; Conti, Michele; Auricchio, Ferdinando; Rampoldi, Vincenzo; Trimarchi, Santi; Moll, Frans L.

    2014-01-01

    Dynamic aortic evaluation in planning thoracic endovascular aortic repair (TEVAR) is important to provide optimal stent graft sizing. Static imaging protocols do not consider normal aortic dynamics and may lead to stent graft to aorta mismatch, causing stent graft related complications, such as type I endoleak and stent graft migration. Dynamic imaging can assist in accurate stent graft selection and sizing preoperatively, and evaluate stent graft performance during follow-up. To create new imaging technologies, integration of knowledge between diverse scientific fields is essential (i.e., engineering, informatics and medicine). Different dynamic imaging modalities, such as electrocardiographic-gated computed tomography angiography (ECG-gated CTA) and four-dimensional phase-contrast MRI (4D PC-MRI), are progressively investigated and implemented into clinical practice as important instruments in preoperative planning for TEVAR. In time, further application of dynamic imaging tools for preoperative screening and follow-up after TEVAR might lead to better outcomes for patients. The advances in dynamic imaging for evaluation of the thoracic aorta using new imaging modalities and their future perspectives are addressed in this manuscript. PMID:24967170

  7. Catheterization-Doppler discrepancies in nonsimultaneous evaluations of aortic stenosis.

    PubMed

    Aghassi, Payam; Aurigemma, Gerard P; Folland, Edward D; Tighe, Dennis A

    2005-05-01

    Prior validation studies have established that simultaneously measured catheter (cath) and Doppler mean pressure gradients (MPG) correlate closely in evaluation of aortic stenosis (AS). In clinical practice, however, cath and Doppler are rarely performed simultaneously; which may lead to discrepant results. Accordingly, our aim was to ascertain agreement between these methods and investigate factors associated with discrepant results. We reviewed findings in 100 consecutive evaluations for AS performed in 97 patients (mean age 72 +/- 10 yr) in which cath and Doppler were performed within 6 weeks. We recorded MPG, aortic valve area (AVA), cardiac output, and ejection fraction (EF) by both methods. Aortic root diameter, left ventricular end-diastolic dimension (LVIDd) and posterior wall thickness (PWT) were measured by echocardiography and gender, heart rate, and heart rhythm were also recorded. An MPG discrepancy was defined as an intrapatient difference > 10 mmHg. Mean pressure gradients by cath and Doppler were 36 +/- 22 mmHg and 37 +/- 20 mmHg, respectively (P = 0.73). Linear regression showed good correlation (r = 0.82) between the techniques. An MPG discrepancy was found in 36 (36%) of 100 evaluations; in 19 (53%) of 36 evaluations MPG by Doppler was higher than cath, and in 17 (47%) of 36, it was lower. In 33 evaluations, EF differed by >10% between techniques. Linear regression analyses revealed that EF difference between studies was a significant predictor of MPG discrepancy (P = 0.004). Women had significantly higher MPG than men by both cath and Doppler (43 +/- 25 mmHg versus 29 +/- 15 mmHg [P = 0.001]; 42 +/- 23 mmHg versus 32 +/- 15 mmHg [P = 0.014], respectively). Women exhibited discrepant results in 23 (47%) of 49 evaluations versus 13 (25%) of 51 evaluations in men (P = 0.037). After adjustment for women's higher MPG, there was no statistically significant difference in MPG discrepancy between genders (P = 0.22). No significant interactions between

  8. Diagnostic Value of Prospective Electrocardiogram-triggered Dual-source Computed Tomography Angiography for Infants and Children with Interrupted Aortic Arch

    PubMed Central

    Li, Hai-Ou; Wang, Xi-Ming; Nie, Pei; Ji, Xiao-Peng; Cheng, Zhao-Ping; Chen, Jiu-Hong; Xu, Zhuo-Dong

    2015-01-01

    Background: Accurate assessment of intra- as well as extra-cardiac malformations and radiation dosage concerns are especially crucial to infants and children with interrupted aortic arch (IAA). The purpose of this study is to investigate the value of prospective electrocardiogram (ECG)-triggered dual-source computed tomography (DSCT) angiography with low-dosage techniques in the diagnosis of IAA. Methods: Thirteen patients with suspected IAA underwent prospective ECG-triggered DSCT scan and transthoracic echocardiography (TTE). Surgery was performed on all the patients. A five-point scale was used to assess image quality. The diagnostic accuracy of DSCT angiography and TTE was compared with the surgical findings as the reference standard. A nonparametric Chi-square test was used for comparative analysis. P <0.05 was considered as a significant difference. The mean effective radiation dose (ED) was calculated. Results: Diagnostic DSCT images were obtained for all the patients. Thirteen IAA cases with 60 separate cardiovascular anomalies were confirmed by surgical findings. The diagnostic accuracy of TTE and DSCT for total cardiovascular malformations was 93.7% and 97.9% (P > 0.05), and that for extra-cardiac vascular malformations was 92.3% and 99.0% (P < 0.05), respectively. The mean score of image quality was 3.77 ± 0.83. The mean ED was 0.30 ± 0.04 mSv (range from 0.23 mSv to 0.39 mSv). Conclusions: In infants and children with IAA, prospective ECG-triggered DSCT with low radiation exposure and high diagnostic efficiency has higher accuracy compared to TTE in detection of extra-cardiac vascular anomalies. PMID:25947401

  9. Saccular Aneurysms of the Transverse Aortic Arch: Treatment Options Available in the Endovascular EraBased on a Presentation at the 2013 VEITH Symposium, November 19-23, 2013 (New York, NY, USA).

    PubMed

    Preventza, Ourania; Coselli, Joseph S

    2015-04-01

    Saccular aneurysms of the aortic arch, whether single or multiple, are uncommon. The choice of repair technique is influenced by patients' comorbidities and age. Repairing saccular aneurysms with traditional open techniques can be technically demanding; therefore, endovascular technology and a variety of hybrid approaches have been developed to facilitate such repairs and, potentially, to improve clinical outcomes, especially in high-risk patients. There have been no large, randomized studies to compare the outcomes of these different treatment options in patients with single or multiple saccular aneurysms of the arch. In this review, we outline the etiology and common locations of these aneurysms, the different open, completely endovascular, and hybrid techniques used to treat them, and the treatment selection process. PMID:26798759

  10. Noninvasive evaluation of the severity of aortic stenosis in adults.

    PubMed

    Nitta, M; Nakamura, T; Hultgren, H N; Bilisoly, J; Marquess, B

    1987-05-01

    A noninvasive point score system for the evaluation of severity of aortic stenosis (AS) was employed in a prospective study of 153 patients (mean age 64.8 +/- 0.8 years) referred from invasive studies or for the evaluation of a systolic murmur. Seven variables were recorded and scored as follows: LVH by ECG (0-2); aortic valve calcium by chest x-ray film (0-2); loudness of A2 (0-2); Q-peak of murmur (0-3); T-time of carotid pulse (0-3); ejection time (0-3); and LVH by echo (0-1). Range of the total score was 0-16. All patients had the aortic valve area (AVA) determined by cardiac catheterization. Data analysis revealed that the relation between the total score and the AVA was curvilinear with a score greater than or equal to 5 correctly identifying 100/107 (93 percent) of patients with a valve area of less than or equal to 1.0 cm2. If the patients with an AVA of less than or equal to 1.0 cm2 were considered severe and patients with a total score less than 5 were considered mild-moderate, the sensitivity, specificity, and predictive accuracy for a score greater than or equal to 5 were 93 percent, 96 percent, and 98 percent, respectively. The relation between the score and aortic valve gradient (AVG) was linear with a score of greater than or equal to 5 correctly identifying 84/88 (95 percent) with an AVG greater than or equal to 40 mm Hg. If the patients with a pressure gradient over 40 mm Hg were considered severe, the sensitivity, specificity, and predictive accuracy for a score greater than or equal to 5 were 95 percent, 72 percent, and 82 percent, respectively. It is concluded that a point score system employing seven noninvasive variables is simple and accurate in identifying patients with severe AS and would be a valuable addition to a Doppler determined gradient. PMID:3568771

  11. Outcomes of single-stage total arch replacement via clamshell incision

    PubMed Central

    2011-01-01

    Background Treatment of complex aortic pathologies involving the transverse arch with extensive involvement of the descending aorta remains a surgical challenge. Since clamshell incision provides superior exposure of the entire thoracic aorta, we evaluated the use of this technique for single-stage total arch replacement by arch vessel reconstruction. Methods The arch-first technique combined with clamshell incision was used in 38 cases of aneurysm and aortic disease in 2008 and 2009. Extensive total arch replacement was used with clamshell incision for reconstruction of arch vessels under deep hypothermic circulatory arrest. Results Overall 30-day mortality was 13%. The mean operating time was approximately 8 hours. Deep hypothermia resulted in mean CPB time exceeding 4.5 hours and mean duration of circulatory arrest was 25 minutes. The overall postoperative temporary and permanent neurologic dysfunction rates were 3% and 3% for elective and 3% and 0% for emergency surgery, respectively. All patients except the five who died in hospital were discharged without nursing care after an average post-operative hospital stay of 35 days. Conclusions The arch-first technique, combined with clamshell incision, provides expeditious replacement of the thoracic aorta with an acceptable duration of hypothermic circulatory arrest and minimizes the risk of retrograde atheroembolism by using antegrade perfusion. PMID:21933402

  12. Syphilitic aortic aneurysm presenting with upper airway obstruction.

    PubMed

    Waikittipong, Somchai

    2012-10-01

    Syphilitic aortic aneurysms are uncommon today. A rare case of syphilitic aortic arch aneurysm with successful surgical treatment is reported. A 42-year-old man presented with upper airway obstruction. Chest radiography showed a superior mediastinal mass, and computed tomography revealed a large saccular aortic arch aneurysm that compressed the trachea. Dacron graft replacement of the aortic arch was successfully performed under circulatory arrest with antegrade cerebral perfusion. PMID:23087303

  13. Pericarditis as initial manifestation of proximal aortic dissection in young patients.

    PubMed

    Bains, Suchdeep Raj; Kedia, Anita; Roldan, Carlos A

    2008-03-01

    Pericarditis was the primary manifestation of aortic dissection in these 2 young men. Both patients had no phenotypic characteristics of Marfan or Ehlers-Danlos syndrome. These patients had pleuritic chest pain and characteristic electrocardiographic changes consistent with pericarditis. However, timely performed transthoracic echocardiograms revealed proximal aortic dissection with hemopericardium noted at surgery in both cases. Although the sensitivity of transthoracic echocardiogram for proximal aortic dissection is approximately 60%, certain findings can alert the physician to the possibility of aortic dissection. Therefore, in young patients with suspected pericarditis, a timely performed transthoracic echocardiogram should include a careful evaluation of the ascending aorta and arch to rule out this lethal diagnosis. PMID:18358965

  14. Midterm follow-up dynamic echocardiography evaluation after aortic valve repair for aortic valve insufficiency.

    PubMed

    D'Ancona, Giuseppe; Amaducci, Andrea; Prodromo, John; Pirone, Francesco; Follis, Marco; Falletta, Calogero; Pilato, Michele

    2012-06-01

    We prospectively evaluated 46 patients who underwent aortic valve repair (AVR) for AV regurgitation. Rest/stress echocardiography follow-up was performed. Follow-up duration was 30.7 months, age 56 ± 14 years, ejection fraction% 57.5 ± 10.5%. Preoperative bicuspid AV was present in 14 (30.4%), leaflets calcifications in 8 (17.4%), thickening in 17 (37.0%) and prolapse in 22 (47.8%). Surgical technique included commissuroplasty (22, 47.8%), leaflet remodelling (17, 37.0%), decalcification (7, 15.2%) and raphe removal (14, 30.4%). At follow-up, rest/stress echocardiography median AV regurgitation (rest 1.0 vs. stress 1.0) and mean indexed AV area (IAVA) (rest 2.6 ± 0.74 cm(2)/m(2) vs. stress 2.8 ± 0.4 cm(2)/m(2)) were unchanged (P = ns). Mean (rest 4.7 ± 3.9 mmHg vs. stress 9.7 ± 5.8 mmHg) and peak (rest 9.5 ± 7.2 mmHg vs. stress 19.0 ± 10.5 mmHg) transvalvular gradients were significantly increased (P < 0.0001). At linear regression, there was an independent inverse correlation between commissuroplasty and AV gradients during stress (B = -9.9, P = 0.01, confidence interval= -17.7 to -2.1). Although follow-up haemodynamics of repaired AVs are satisfactory, there was a fixed IAVA and significant increase in AV gradients. We were not able to identify any pre-existing anatomical condition independently related to this non-physiological behaviour under stress. Moreover, commissuroplasty seems to prevent abnormal increase of the AV gradients. PMID:22368109

  15. Aortic stenting.

    PubMed

    Droc, Ionel; Calinescu, Francisca Blanca; Droc, Gabriela; Blaj, Catalin; Dammrau, Rolf

    2015-01-01

    The approach to aortic pathology is nowadays more and more endovascular at both thoracic and abdominal levels. Thoracic stenting has gained worldwide acceptance as first intention to treat pathologies of the descending thoracic aorta. Indications have been extended to aortic arch aneurysms and also to diseases of the ascending aorta. The current devices in use for thoracic endovascular repair (TEVAR) are Medtronic Valiant, Gore TAG, Cook Tx2 and Jotec. The choice of the endograft depends on the thoracic aortic pathology and the anatomical suitability. The technological evolution of the abdominal aortic endografts was very rapid, arriving now at the fourth generation. We report the results of 55 elective cases of endovascular abdominal aortic repair (EVAR) performed in two vascular surgical centers in Romania and Germany. The prostheses used were 16 E-vita Abdominal XT, 12 Excluder, eight Talent, seven PowerLink, three Endurant and nine custom-made, fenestrated or branched from Jotec. The mean follow-up was 18 months with CT-scan, duplex ultrasound and contrast-enhanced ultrasound. The mortality was 2%. EVAR tends to become the gold standard for abdominal aortic aneurysm repair. Technological development of the devices with lowest profile introduction systems will permit to extend the anatomical indications to new frontiers. PMID:26200430

  16. Aortic dissection.

    PubMed

    Nienaber, Christoph A; Clough, Rachel E; Sakalihasan, Natzi; Suzuki, Toru; Gibbs, Richard; Mussa, Firas; Jenkins, Michael T; Thompson, Matt M; Evangelista, Arturo; Yeh, James S M; Cheshire, Nicholas; Rosendahl, Ulrich; Pepper, John

    2016-01-01

    Aortic dissection is a life-threatening condition caused by a tear in the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation (dissection) of the layers of the aortic wall. Aortic dissection is most common in those 65-75 years of age, with an incidence of 35 cases per 100,000 people per year in this population. Other risk factors include hypertension, dyslipidaemia and genetic disorders that involve the connective tissue, such as Marfan syndrome. Swift diagnostic confirmation and adequate treatment are crucial in managing affected patients. Contemporary management is multidisciplinary and includes serial non-invasive imaging, biomarker testing and genetic risk profiling for aortopathy. The choice of approach for repairing or replacing the damaged region of the aorta depends on the severity and the location of the dissection and the risks of complication from surgery. Open surgical repair is most commonly used for dissections involving the ascending aorta and the aortic arch, whereas minimally invasive endovascular intervention is appropriate for descending aorta dissections that are complicated by rupture, malperfusion, ongoing pain, hypotension or imaging features of high risk. Recent advances in the understanding of the underlying pathophysiology of aortic dissection have led to more patients being considered at substantial risk of complications and, therefore, in need of endovascular intervention rather than only medical or surgical intervention. PMID:27440162

  17. Radionuclide angiography in evaluation of left ventricular function following aortic valve replacement

    SciTech Connect

    Santinga, J.T.; Kirsh, M.M.; Brady, T.J.; Thrall, J.; Pitt, B.

    1981-05-01

    Congestive heart failure in patients surviving aortic valve replacement has been associated with a high late mortality. To determine whether myocardial dysfunction in these patients occurred preoperatively, perioperatively, or during the early postoperative period, 19 consecutive patients undergoing aortic valve replacement using cardioplegia and hypothermia were studied by multiple-gated cardiac blood pool imaging. The resting ejection fractions for 8 patients with aortic stenosis did not show significant changes following operation. The 11 patients with aortic insufficiency has resting preoperative values of 58 +/- 15%, which fell to 38 +/- 18% immediately postoperatively (p less than 0.01), with the late values being 51 +/- 16%. Eight of 18 patients (44%) showed deterioration of regional wall motion immediately after operation, which persisted in 3 during the late evaluation. The occurrence of new perioperative regional wall motion abnormalities and persistent perioperative depression in left ventricular function in some patients suggest the need for further improvement in myocardial protection during cardiopulmonary bypass for aortic valve replacement.

  18. Computerized tomographic evaluation of aortic prosthetic graft complications

    SciTech Connect

    Kay, D.; Kalmar, J.A.

    1985-03-01

    Computerized tomography has been found to be an accurate and sensitive method of diagnosing complications of synthetic aortic grafts. Complications in this series of four cases included aortoesophageal fistula, aortoduodenal fistula, pseudoaneurysm, and retroperitoneal hematoma. 6 references, 5 figures.

  19. Evaluation of Reinforcement and Analysis of Stability of a High-Arch Dam Based on Geomechanical Model Testing

    NASA Astrophysics Data System (ADS)

    Zhang, L.; Liu, Y. R.; Yang, Q.

    2015-03-01

    Reinforcement measures are often used in high-arch dams with complicated geological foundations. The geomechanical model test is an effective method to study the global stability of arch dams and to evaluate the reinforcement effects of foundation treatments. The block masonry technique was developed to simulate the jointed rock mass, tectonic discontinuities, and reinforcement measures. A tailor-made low-strength binder and small blocks were developed to simulate the strength and deformation of the jointed rock mass and discontinuities, respectively. We applied this technique to geomechanical model tests of the Dagangshan arch dam with and without foundation reinforcements. A rupture test was conducted, and the stress and displacement distribution of the dam and abutments were recorded; the failure mechanisms and processes were explored. The reinforcement effects of the foundation treatment were evaluated by comparing the test results of the models with and without foundation reinforcements. Our analysis indicates that foundation reinforcements can improve the stress distribution, decrease deformation, prevent slides, reduce fault movement, and improve the global stability of high-arch dams.

  20. High arch

    MedlinePlus

    Pes cavus; High foot arch ... High foot arches are much less common than flat feet. They are more likely to be caused by a ... stress is placed on the section of the foot between the ankle and toes (metatarsals). This condition ...

  1. Echocardiographic evaluation of systolic left-ventricular function in infants with critical aortic stenosis before and after aortic valvotomy.

    PubMed

    Hofstetter, R; Zeike, B; Messmer, B J; von Bernuth, G

    1990-08-01

    Infants with critical aortic stenosis may have global or regional left ventricular contraction abnormalities. In order to evaluate the clinical significance of these contraction abnormalities, we examined the systolic left ventricular function before and after aortic valvotomy in 16 infants operated on between 1980 and 1987. Left ventricular free wall and septal motion were studied by cross sectional echocardiography using the apical 4-chamber view. Enddiastolic and endsystolic left ventricular frames were digitized. The relative systolic reduction of the total left ventricular area (reflecting ejection fraction) as well as of 5 left ventricular sectors (reflecting regional wall motion) was calculated and compared to previously established normal values. Before valvotomy, 8 infants had normal and the other 8 impaired left ventricular systolic wall motion. These latter infants showed hypokinesia of the apex and/or the posterolateral left ventricular wall resulting in a decreased systolic reduction of the total left ventricular area. Four of these infants had evidence of myocardial infarction on intraoperative inspection. Early after operation, the systolic reduction of the total left ventricular area was normal in all infants, and the left ventricular apex and poster-lateral wall were either normo- or hyperkinetic. Follow-up studies of all infants more than 10 months and of 7 infants more than 3 years after operation showed that the left ventricular systolic wall motion remained normal in all, irrespective of whether it was normal or abnormal preoperatively. This study suggests that left ventricular contraction abnormalities in infants with critical aortic stenosis may be reversible and thus do not constitute a contraindication against aortic valvotomy.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2237884

  2. A Simple Device for Morphofunctional Evaluation During Aortic Valve-Sparing Surgery.

    PubMed

    Leone, Alessandro; Bruno, Piergiorgio; Cammertoni, Federico; Massetti, Massimo

    2015-07-01

    Valve-sparing operations for the treatment of aortic root disease with a structurally normal aortic valve are increasingly performed as they avoid prosthesis-related complications. Short- and long-term results are critically dependent on perfect intraoperative restoration of valve anatomy and function. Residual aortic regurgitation is the main cause of early failure, and it is the most common motive for reoperation. However, intraoperative morphofunctional valve assessment requires expertise, and only transesophageal echocardiography can provide reliable information. We describe a simple, economic, reproducible hydrostatic test to intraoperatively evaluate valve competency under direct visualization. PMID:26140788

  3. Evaluation of aortic cannula jet lesions in a porcine cardiopulmonary bypass (CPB) model.

    PubMed

    Schnürer, C; Hager, M; Györi, G; Velik-Salchner, C; Moser, P L; Laufer, G; Lorenz, I H; Kolbitsch, C

    2011-02-01

    In cardiosurgery patients atherosclerotic debris displaced from the cannulation site but also from the opposite aortic wall by the "sandblast-like" effect of the high-pressure jet emanating from the cannula is a potential source of intraoperative arterial embolization and consequently postoperative neurologic dysfunction. The present study examined the extent to which shear stress exerted on the intact aortic intima by an aortic cannula jet stream can cause endothelial lesions that promote thrombogenesis and consequently thrombembolism. A single-stream, straight-tip aortic cannula was used in a porcine cardiopulmonary bypass (CPB) model. Following a 120-minute CPB pump run, a 60-minute stabilization period was allowed before sacrificing the pigs (N.=40) for histological evaluation of the ascending aorta and the brain. Opposite the cannulation site endothelial lesions (diameter: 3.81±1.3 mm; depth: 0.017±0.003 mm) were present in 22.5% (9/40) of aortic specimens. Cerebral thrombembolic lesions were not found. The present study showed that single-stream, straight-tip aortic cannulas caused jet lesions of the formerly intact aortic endothelium opposite the cannulation site in 22.5% of cases in a porcine CPB model. PMID:21224818

  4. Aortic Blood Flow Reversal Determines Renal Function: Potential Explanation for Renal Dysfunction Caused by Aortic Stiffening in Hypertension.

    PubMed

    Hashimoto, Junichiro; Ito, Sadayoshi

    2015-07-01

    Aortic stiffness determines the glomerular filtration rate (GFR) and predicts the progressive decline of the GFR. However, the underlying pathophysiological mechanism remains obscure. Recent evidence has shown a close link between aortic stiffness and the bidirectional (systolic forward and early diastolic reverse) flow characteristics. We hypothesized that the aortic stiffening-induced renal dysfunction is attributable to altered central flow dynamics. In 222 patients with hypertension, Doppler velocity waveforms were recorded at the proximal descending aorta to calculate the reverse/forward flow ratio. Tonometric waveforms were recorded to measure the carotid-femoral (aortic) and carotid-radial (peripheral) pulse wave velocities, to estimate the aortic pressure from the radial waveforms, and to compute the aortic characteristic impedance. In addition, renal hemodynamics was evaluated by duplex ultrasound. The estimated GFR was inversely correlated with the aortic pulse wave velocity, reverse/forward flow ratio, pulse pressure, and characteristic impedance, whereas it was not correlated with the peripheral pulse wave velocity or mean arterial pressure. The association between aortic pulse wave velocity and estimated GFR was independent of age, diabetes mellitus, hypercholesterolemia, and antihypertensive medication. However, further adjustment for the aortic reverse/forward flow ratio and pulse pressure substantially weakened this association, and instead, the reverse/forward flow ratio emerged as the strongest determinant of estimated GFR (P=0.001). A higher aortic reverse/forward flow ratio was also associated with lower intrarenal forward flow velocities. These results suggest that an increase in aortic flow reversal (ie, retrograde flow from the descending thoracic aorta toward the aortic arch), caused by aortic stiffening and impedance mismatch, reduces antegrade flow into the kidney and thereby deteriorates renal function. PMID:25916721

  5. Distant downstream steady-state flow studies of a mechanical heart valve: PIV study of secondary flow in a model aortic arch

    NASA Astrophysics Data System (ADS)

    Fix, Brandon R.; Popma, Christopher J.; Bulusu, Kartik V.; Plesniak, Michael W.

    2013-11-01

    Each year, hundreds of thousands of aortic and mitral heart valves are replaced with prosthetic valves. In efforts to develop a valve that does not require lifelong anticoagulation therapy, previous experimental research has been devoted to analyzing the hemodynamics of various heart valve designs, limited to the flow up to only 2 diameters downstream of the valve. Two-component, two-dimensional (2C-2D) particle image velocimetry (PIV) was used in this study to examine secondary flow velocity fields in a curved tube modeling an aorta at five locations (0-, 45-, 90-, 135-, 180-degrees). A bileaflet valve, opened to 30-, 45-, and 59-degrees, and one (no-valve) baseline condition were examined under three steady flow inflows (Re = 218, 429, 634). In particular, variations in the two-dimensional turbulent shear stresses at each cross sectional plane were analyzed. The results suggest that bileaflet valves in the aortic model produce significant turbulence and vorticity up to 5.5 downstream diameters, i.e. up to the 90-degrees location. Expanding this research towards aortic heart valve hemodynamics highlights a need for additional studies extending beyond the typical few diameters downstream to fully characterize valvular function. Supported by the NSF Grant No. CBET- 0828903 and GW Center for Biomimetics and Bioinspired Engineering.

  6. High arch

    MedlinePlus

    ... is on the back and balls of the foot (metatarsals head). Your health care provider will check to see if the high ... Call your health care provider if you suspect you are having foot pain related to high arches.

  7. MRI evaluation prior to Transcatheter Aortic Valve Implantation (TAVI): When to acquire and how to interpret.

    PubMed

    Chaturvedi, Abhishek; Hobbs, Susan K; Ling, Fred S; Chaturvedi, Apeksha; Knight, Peter

    2016-04-01

    Transcatheter Aortic Valve Implantation (TAVI) is increasingly being used in patients with severe aortic stenosis who are not candidates for surgery. ECG-gated CT angiography (CTA) plays an important role in the preoperative planning for these devices. As the number of patients undergoing these procedures increases, a subset of patients is being recognized who have contraindications to iodinated contrast medium, either due to a prior severe allergic type reaction or poor renal function. Another subgroup of patients with low flow and low gradient aortic stenosis is being recognized that are usually assessed for severity of aortic stenosis by stress echocardiography. There are contraindications to stress echocardiography and some of these patients may not be able to undergo this test. Non-contrast MRI can be a useful emerging modality for evaluating these patients. In this article, we discuss the emerging indications of non-contrast MRI in preoperative assessment for TAVI and describe the commonly used MRI sequences. A comparison of the most important measurements obtained for TAVI assessment on CTA and MRI from same subjects is included. Teaching Points • MRI can be used for preoperative assessment of aortic annulus. • MRI is an alternate to CTA when iodinated contrast is contraindicated. • Measurements obtained by non-contrast MRI are similar to contrast enhanced CTA. • MRI can be used to assess severity of aortic stenosis. PMID:26911969

  8. Macroscopic and microscopic evaluation of a new implant design supporting immediately loaded full arch rehabilitation

    PubMed Central

    Tetè, Stefano; Zizzari, Vincenzo; De Carlo, Alessandro; Sinjari, Bruna; Gherlone, Enrico

    2012-01-01

    Summary The purpose of this study is to evaluate macroscopic and microscopic appearance of a new implant design, with particular emphasis given to the type of prosthesis connection. Two dental implants of the same type (Torque Type®, WinSix®, BioSAFin. S.r.l. - Ancona, Italy), with sandblasted and acid etched surfaces (Micro Rough Surface®), but differing from each other for the prosthesis connection system, were examined by scanning electron microscope (SEM) analysis at different magnifications: TTI implant, with a hexagonal internal connection, and TTX implant, with a hexagonal external connection. SEM analysis showed that the Torque Type® implant is characterized by a truncated cone shape with tapered tips. The implant body showed a double loop thread and double pitch with blunt tips. For both types of connection, the implant neck was 0.7 mm in height with a 3% taper. This implant design may be able to guarantee osteotomic properties at the time of insertion in a surgical site suitably prepared, a facilitated screwing, thanks to the thread pitch and to the broad and deep draining grooves, thereby ensuring a good primary stability. The different connection design appears defined and precise, in order to ensure a good interface between the fixture and the prosthetic components. Therefore, this design appears to be particularly suitable in cases where a good primary stability is necessary and a precise coupling between endosseous and prosthetic components, as it allows an easy insertion of the fixture even in conditions of reduced bone availability, and in cases of immediately loaded full-arch rehabilitations. PMID:23087785

  9. Aortic angiography

    MedlinePlus

    ... with the aorta or its branches, including: Aortic aneurysm Aortic dissection Congenital (present from birth) problems AV ... Abnormal results may be due to: Abdominal aortic aneurysm Aortic dissection Aortic regurgitation Aortic stenosis Congenital (present ...

  10. Clinical Variability in Arch Wires: A Preliminary Study Evaluating Mechanical and Surface Characteristics of Two Different Sized Rectangular Stainless Steel Wires

    PubMed Central

    Vena, Alessandro; Carey, Jason; Badawi, Hisham

    2007-01-01

    Experimental characterization of arch wires has been performed in many previous studies; however with the advent of new arch wire materials being introduced, some new experimental methods and characterization are required. Since literature is available for comparison, this paper examines mechanical and physical characteristics of steel arch wires to quantify their variability in engineering terms. Furthermore, the effect of wire size on properties was evaluated using two of the most common wire sizes. Finally, manufacturing consistency was verified by testing samples from different lots. PMID:19662123

  11. Complex aortic disease: changes in perception, evaluation and management.

    PubMed

    Mastracci, Tara M; Greenberg, Roy K

    2008-12-01

    Complex aortic disease continues to have a high mortality and morbidity despite advances in medical and surgical treatment. Repair of thoracoabdominal aneurysms, treatment of patients with connective tissue disorders, and the approach to dissections of the ascending and descending aorta have evolved over time; however, the results of intervention in all but highly specialized centers remain poor. As vascular surgeons, our role must extend beyond that of the pure technician; we have been vested with the life-long care of these patients and, therefore, have a responsibility to the patient in addition the scientific community and society at large to create a strategy for management that serves all three interests justly. We will outline some of the changes in the conceptual approach that we consider important to the treatment of complex aortic disease. PMID:19084731

  12. Comparison of Commercially Available Arch Wires with Normal Dental Arch in a Group of Iranian Population

    PubMed Central

    Hedayati, Zohreh; Fakhri, Farnaz; Moshkel Gosha, Vahid

    2015-01-01

    Statement of the Problem The stability of orthodontic treatment depends on preserving the patient’s pretreatment arch form and arch size during and after treatment. Purpose This investigation was aimed to study the size and shape of Iranian mandibular dental arch and evaluate the correlation of their average dental arch with commercially available preformed rectangular nickel-titanium arch wires. Materials and Method In this study, 148 subjects were selected among students of Shiraz University of Medical Sciences. The inclusion criteria were having Angle class I in molar and canine relationships, and normal growth pattern. Intercanine and intermolar widths were measured after scanning their mandibular dental casts. Three main arch form templates; square, ovoid and tapered (Orthoform TM; 3M, Unitek, CA, USA) and 12 commercially available preformed mandibular nickel-titanium arch wires were scanned. Intercanine and intermolar widths of arch wires were compared with dental arch widths of the study samples. Arch width, arch form and the most appropriate arch wire were determined for each cast. Student’s t-test was used to compare arch widths and arch depths of male and female subjects. Coefficient of variance was used to determine the variability of indices in the study samples. Results Most preformed arch wires were wider than the average width of the normal Iranian dental arch. The most frequent arch form in Iranian population was tapered. Inter molar width was the only statistically significant variable between males and females. Conclusion Variation in available preformed arch wires does not entirely cover the range of diversity of the normal dental arch of our population. Narrow arch wires with a tapered shape are better consistent with the Iranian lower arch. PMID:26046106

  13. [DISORDERS OF LUNG FUNCTION IN THE EARLY POSTOPERATIVE PERIOD IN PATIENTS OPERATED ON THE ASCENDING AORTA WITH THE EXPANSION OF INTERVENTION ON THE AORTIC ARCH].

    PubMed

    Bokeria, L A; Nikitin, E S; Mironenko, V A; Rychin, S V; Vyganovskaya, N B; Makrushin, I M; Gordeev, S L

    2015-01-01

    Precapillary artery--arterial (bronchial artery--pulmonay artery) anastomoses, come into play in cases where the locking artery open and alveoli washed arterialized blood. Normally, these anastomoses are closed. Intrapulmonary shunts carry blood supply acinar hinder extraordinary circumstances (chronic pulmonary embolism, surgery, occurring in cardiopulmonary bypass, when the flaw of blood through the Iungs is suspended for the duration of cardiopulmonary bypass). Patients operated on the ascending aorta with the expansion of intervention on the nortic arch during the correction of pathology carry blood supply only the central nervous system. All other organs and systems at this time were protected by mild hypothermia. However, during circulatory arrest, required for correction of pathology acinar damage as a result of hypoxia, probably because there is no blood flow in the pulmonary artery and there is no blood flow in the bronchial arteries. Last, in the ordinary course of artificial circulation, capable due to arterio-arterial pulmonary anastomoses prevent hypoxic damage to acinar, not lead to persistent hypoxemia in the immediate postoperative period in these patients, as a result of violations of lung diffusion capacity. PMID:27019884

  14. [Evaluation of the timing of orthodontic arch expansion and graft in cleft lip and palate].

    PubMed

    Chang, Le; Wang, Yingnan; Liu, Hongyan

    2016-04-01

    Maxillary transverse growth is inhibited by congenital cleft, early surgical scar strain, and oppression of lipmuscles in patients with cleft lip and palate. Clinical manifestations have shown severely constricted maxilla, insufficientmaxillary width, mismatch of upper and lower dental arches, and crossbite. Alveolar bone graft and arch expansion can effectively correct the deficiency in maxillary width. This paper discusses the timing and success rate of alveolar bone graft, as wellas the relationship between alveolar bone graft and arch expansion. Secondary alveolar bone graft is optimally performed beforepermanent canine eruption, especially when the teeth have formed between half and three quarters of their roots. Rapid maxillaryexpansion prior to alveolar bone graft is beneficial because this process increases the gap of the cleft, expands bone graft, andreduces the difficulty. However, the stability of this process remains controversial. Small-scale studies have reported that rapidmaxillary expansion after alveolar bone graft can open the midpalatal suture without bone graft loss. Slow maxillary expansioncan provide continuous light forces to reconstruct the bone. However, these studies are coordinated with fixed orthodontictreatment. Further research is necessary to determine the effects of maxillary expansion on long-term stability of teeth. PMID:27337934

  15. Occlusive ascending aorta and arch atheroma treated with deep hypothermic circulatory arrest and thromboendarterectomy.

    PubMed

    O' Sullivan, Katie E; Early, Sarah A; Lawler, Leo; Hurley, John

    2013-12-01

    We describe an uncommon presentation of severely advanced aortic atherosclerosis in a 48-year old man with a history of hypertension and heavy smoking. Initial presentation with upper limb ischaemia led to the diagnosis of an aortic arch atheroma occluding 90% of the aortic lumen, managed with deep hypothermic circulatory arrest and aortic thromboendarterectomy. To our knowledge, this is the first reported case of atherosclerotic plaque resulting in aortic occlusion and requiring emergent operative intervention. PMID:23956265

  16. Occlusive ascending aorta and arch atheroma treated with deep hypothermic circulatory arrest and thromboendarterectomy

    PubMed Central

    O’ Sullivan, Katie E.; Early, Sarah A.; Lawler, Leo; Hurley, John

    2013-01-01

    We describe an uncommon presentation of severely advanced aortic atherosclerosis in a 48-year old man with a history of hypertension and heavy smoking. Initial presentation with upper limb ischaemia led to the diagnosis of an aortic arch atheroma occluding 90% of the aortic lumen, managed with deep hypothermic circulatory arrest and aortic thromboendarterectomy. To our knowledge, this is the first reported case of atherosclerotic plaque resulting in aortic occlusion and requiring emergent operative intervention. PMID:23956265

  17. The role of cardiovascular magnetic resonance in the assessment of severe aortic stenosis and in post-procedural evaluation following transcatheter aortic valve implantation and surgical aortic valve replacement.

    PubMed

    Musa, Tarique Al; Plein, Sven; Greenwood, John P

    2016-06-01

    Degenerative aortic stenosis (AS) is the most common valvular disease in the western world with a prevalence expected to double within the next 50 years. International guidelines advocate the use of cardiovascular magnetic resonance (CMR) as an investigative tool, both to guide diagnosis and to direct optimal treatment. CMR is the reference standard for quantifying both left and right ventricular volumes and mass, which is essential to assess the impact of AS upon global cardiac function. Given the ability to image any structure in any plane, CMR offers many other diagnostic strengths including full visualisation of valvular morphology, direct planimetry of orifice area, the quantification of stenotic jets and in particular, accurate quantification of valvular regurgitation. In addition, CMR permits reliable and accurate measurements of the aortic root and arch which can be fundamental to appropriate patient management. There is a growing evidence base to indicate tissue characterisation using CMR provides prognostic information, both in asymptomatic AS patients and those undergoing intervention. Furthermore, a number of current clinical trials will likely raise the importance of CMR in routine patient management. This article will focus on the incremental value of CMR in the assessment of severe AS and the insights it offers following valve replacement. PMID:27429910

  18. The role of cardiovascular magnetic resonance in the assessment of severe aortic stenosis and in post-procedural evaluation following transcatheter aortic valve implantation and surgical aortic valve replacement

    PubMed Central

    Musa, Tarique Al; Plein, Sven

    2016-01-01

    Degenerative aortic stenosis (AS) is the most common valvular disease in the western world with a prevalence expected to double within the next 50 years. International guidelines advocate the use of cardiovascular magnetic resonance (CMR) as an investigative tool, both to guide diagnosis and to direct optimal treatment. CMR is the reference standard for quantifying both left and right ventricular volumes and mass, which is essential to assess the impact of AS upon global cardiac function. Given the ability to image any structure in any plane, CMR offers many other diagnostic strengths including full visualisation of valvular morphology, direct planimetry of orifice area, the quantification of stenotic jets and in particular, accurate quantification of valvular regurgitation. In addition, CMR permits reliable and accurate measurements of the aortic root and arch which can be fundamental to appropriate patient management. There is a growing evidence base to indicate tissue characterisation using CMR provides prognostic information, both in asymptomatic AS patients and those undergoing intervention. Furthermore, a number of current clinical trials will likely raise the importance of CMR in routine patient management. This article will focus on the incremental value of CMR in the assessment of severe AS and the insights it offers following valve replacement. PMID:27429910

  19. Evaluation of facial morphology and sagittal relationship between dental arches in primary and mixed dentition

    PubMed Central

    Traldi, Aline; Valdrighi, Heloísa Cristina; de Souza, Luciane Zanin; Vedovello, Silvia Amélia Scudeler

    2015-01-01

    OBJECTIVE: To assess facial morphology (Pattern) and sagittal relationship between dental arches (Class), and establish a potential association between them and the variables sex, age and ethnicity, among schoolchildren aged between 4 and 9 years old (mean age of 6.7 years) in primary and mixed dentitions. METHODS: The sample comprised 875 children (457 males and 418 females) attending schools in Descalvado, São Paulo, Brazil. An attempt was made with a view to establish a potential association between children's morphological features with sex, age and ethnicity. RESULTS: Descriptive analysis revealed a predominance of facial Pattern I (69.9 %) and Class I (67.4 %). Statistical tests (p < 0.001) showed that Class I was more frequent among Pattern I children, whereas Class II prevailed among Pattern II, and Class III was frequent among Pattern I and III children. Ethnicity was the only variable associated with facial pattern. CONCLUSIONS: Results suggest that facial pattern and sagittal relationship between dental arches tend to be correlated. Ethnicity was associated with facial pattern, with Pattern I being the most recurrent among Caucasians and facial Pattern II being recurrent among Afro-descendant subjects. PMID:26352847

  20. Maxillary and mandibular anterior crown width/height ratio and its relation to various arch perimeters, arch length, and arch width groups

    PubMed Central

    Shahid, Fazal; Alam, Mohammad Khursheed; Khamis, Mohd Fadhli

    2015-01-01

    Objective: To investigate the maxillary and mandibular anterior crown width/height ratio and its relation to various arch perimeters, arch length, and arch width (intercanine, interpremolar, and intermolar) groups. Materials and Methods: The calculated sample size was 128 subjects. The crown width/height, arch length, arch perimeter, and arch width of the maxilla and mandible were obtained via digital calliper (Mitutoyo, Japan). A total of 4325 variables were measured. The sex differences in the crown width and height were evaluated. Analysis of variance was applied to evaluate the differences between arch length, arch perimeter, and arch width groups. Results: Males had significantly larger mean values for crown width and height than females (P ≤ 0.05) for maxillary and mandibular arches, both. There were no significant differences observed for the crown width/height ratio in various arch length, arch perimeter, and arch width (intercanine, interpremolar, and intermolar) groups (P ≤ 0.05) in maxilla and mandible, both. Conclusions: Our results indicate sexual disparities in the crown width and height. Crown width and height has no significant relation to various arch length, arch perimeter, and arch width groups of maxilla and mandible. Thus, it may be helpful for orthodontic and prosthodontic case investigations and comprehensive management. PMID:26929686

  1. Beveled reversed elephant trunk procedure for complex aortic aneurysm.

    PubMed

    Fujikawa, Takuya; Yamamoto, Shin; Sekine, Yuji; Oshima, Susumu; Kasai, Reo; Sasaguri, Shiro

    2016-03-01

    The reversed elephant trunk procedure uses an inverted graft for distal aortic replacement before aortic arch replacement in patients with mega aorta, to reduce the risk in the second stage. However, the conventional technique restricts the maximum diameter of the inverted graft to the aortic graft diameter. We employed a beveled reversed elephant trunk procedure to overcome the discrepancy between graft diameters in a 54-year-old woman with a severely twisted ascending aortic graft and enlarging chronic dissection of the aortic arch and descending thoracic aorta. The patient was discharged with a satisfactory repair and no neurologic deficit. PMID:25406402

  2. Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection.

    PubMed

    Lee, Jae-Hong; Na, Bubse; Hwang, Yoohwa; Kim, Yong Han; Park, In Kyu; Kim, Kyung-Hwan

    2016-02-01

    A 49-year-old male presented with chills and a fever. Five years previously, he underwent ascending aorta and aortic arch replacement using the elephant trunk technique for DeBakey type 1 aortic dissection. The preoperative evaluation found an esophago-paraprosthetic fistula between the prosthetic graft and the esophagus. Multiple-stage surgery was performed with appropriate antibiotic and antifungal management. First, we performed esophageal exclusion and drainage of the perigraft abscess. Second, we removed the previous graft, debrided the abscess, and performed an in situ re-replacement of the ascending aorta, aortic arch, and proximal descending thoracic aorta, with separate replacement of the innominate artery, left common carotid artery, and extra-anatomical bypass of the left subclavian artery. Finally, staged esophageal reconstruction was performed via transthoracic anastomosis. The patient's postoperative course was unremarkable and the patient has done well without dietary problems or recurrent infections over one and a half years of follow-up. PMID:26889449

  3. An in vitro evaluation of the impact of eccentric deployment on transcatheter aortic valve hemodynamics.

    PubMed

    Gunning, Paul S; Saikrishnan, Neelakantan; McNamara, Laoise M; Yoganathan, Ajit P

    2014-06-01

    Patients with aortic stenosis present with calcium deposits on the native aortic valve, which can result in non-concentric expansion of Transcatheter Aortic Valve Replacement (TAVR) stents. The objective of this study is to evaluate whether eccentric deployment of TAVRs lead to turbulent blood flow and blood cell damage. Particle Image Velocimetry was used to quantitatively characterize fluid velocity fields, shear stress and turbulent kinetic energy downstream of TAVRs deployed in circular and eccentric orifices representative of deployed TAVRs in vivo. Effective orifice area (EOA) and mean transvalvular pressure gradient (TVG) values did not differ substantially in circular and eccentric deployed valves, with only a minor decrease in EOA observed in the eccentric valve (2.0 cm(2) for circular, 1.9 cm(2) for eccentric). Eccentric deployed TAVR lead to asymmetric systolic jet formation, with increased shear stresses (circular = 97 N/m(2) vs. eccentric = 119 N/m(2)) and regions of turbulence intensity (circular = 180 N/m(2) vs. eccentric = 230 N/m(2)) downstream that was not present in the circular deployed TAVR. The results of this study indicate that eccentric deployment of TAVRs can lead to altered flow characteristics and may potentially increase the hemolytic potential of the valve, which were not captured through hemodynamic evaluation alone. PMID:24719050

  4. Canadian Cardiovascular Society/Canadian Society of Cardiac Surgeons/Canadian Society for Vascular Surgery Joint Position Statement on Open and Endovascular Surgery for Thoracic Aortic Disease.

    PubMed

    Appoo, Jehangir J; Bozinovski, John; Chu, Michael W A; El-Hamamsy, Ismail; Forbes, Thomas L; Moon, Michael; Ouzounian, Maral; Peterson, Mark D; Tittley, Jacques; Boodhwani, Munir

    2016-06-01

    In 2014, the Canadian Cardiovascular Society (CCS) published a position statement on the management of thoracic aortic disease addressing size thresholds for surgery, imaging modalities, medical therapy, and genetics. It did not address issues related to surgical intervention. This joint Position Statement on behalf of the CCS, Canadian Society of Cardiac Surgeons, and the Canadian Society for Vascular Surgery provides recommendations about thoracic aortic disease interventions, including: aortic valve repair, perfusion strategies for arch repair, extended arch hybrid reconstruction for acute type A dissection, endovascular management of arch and descending aortic aneurysms, and type B dissection. The position statement is constructed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and has been approved by the primary panel, an international secondary panel, and the CCS Guidelines Committee. Advent of endovascular technology has improved aortic surgery safety and extended the indications of minimally invasive thoracic aortic surgery. The combination of safer open surgery with endovascular treatment has improved patient outcomes in this rapidly evolving subspecialty field of cardiovascular surgery. PMID:27233892

  5. Evaluation of aortic stenosis by cardiovascular magnetic resonance imaging: comparison with established routine clinical techniques

    PubMed Central

    Kupfahl, C; Honold, M; Meinhardt, G; Vogelsberg, H; Wagner, A; Mahrholdt, H; Sechtem, U

    2004-01-01

    Objective: To evaluate whether direct planimetry of aortic valve area (AVA) by cardiac magnetic resonance (CMR) imaging is a reliable tool for determining the severity of aortic stenosis compared with transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE), and cardiac catheterisation. Methods: 44 symptomatic patients with severe aortic stenosis were studied. By cardiac catheterisation AVA was calculated by the Gorlin equation. AVA was measured with CMR from steady state free precession (true fast imaging with steady state precession) by planimetry. AVA was also determined from TOE images by planimetry and from TTE images by the continuity equation. Results: Bland-Altman analysis evaluating intraobserver and interobserver variability showed a very small bias for both (−0.016 and 0.019, respectively; n  =  20). Bias and limits of agreement between CMR and TTE were 0.05 (−0.35, 0.44) cm2 (n  =  37), between CMR and TOE 0.02 (−0.39, 0.42) cm2 (n  =  32), and between CMR and cardiac catheterisation 0.09 (−0.30, 0.47) cm2 (n  =  36). The sensitivity and specificity of CMR to detect AVA ⩽ 0.80 cm2 measured by cardiac catheterisation was 78% and 89%, of TOE 70% and 70%, and of TTE 74% and 67%, respectively. Conclusion: CMR planimetry is highly reliable and reproducible. Further, CMR planimetry had the best sensitivity and specificity of all non-invasive methods for detecting severe aortic stenosis in comparison with cardiac catheterisation. Therefore, CMR planimetry of AVA with steady state free precession is a new powerful diagnostic tool, particularly for patients with uncertain or discrepant findings by other modalities. PMID:15253962

  6. Transcatheter aortic valve implantation for failing surgical aortic bioprosthetic valve: from concept to clinical application and evaluation (part 1).

    PubMed

    Piazza, Nicolo; Bleiziffer, Sabine; Brockmann, Gernot; Hendrick, Ruge; Deutsch, Marcus-André; Opitz, Anke; Mazzitelli, Domenico; Tassani-Prell, Peter; Schreiber, Christian; Lange, Rüdiger

    2011-07-01

    With an aging population, improvement in life expectancy, and significant increase in the use of bioprosthetic valves, structural valve deterioration will become more and more prevalent. The operative mortality for an elective redo aortic valve surgery is reported to range from 2% to 7%, but this percentage can increase to more than 30% in high-risk and nonelective patients. Because transcatheter aortic valve (TAV)-in-surgical aortic valve (SAV) implantation represents a minimally invasive alternative to conventional redo surgery, it may prove to be safer and just as effective as redo surgery. Of course, prospective comparisons with a large number of patients and long-term follow-up are required to confirm these potential advantages. It is axiomatic that knowledge of the basic construction and dimensions, radiographic identification, and potential failure modes of SAV bioprostheses is fundamental in understanding key principles involved in TAV-in-SAV implantation. The goals of this paper are: 1) to review the classification, physical characteristics, and potential failure modes of surgical bioprosthetic aortic valves; and 2) to discuss patient selection and procedural techniques relevant to TAV-in-SAV implantation. PMID:21777879

  7. Evaluation of aortic regurgitation by using PC MRI: A comparison of the accuracies at different image plane locations

    NASA Astrophysics Data System (ADS)

    Kim, Byeong-Gull; Kim, Kyung-Soo; Kim, Soon-Bae; Chung, Woon-Kwan; Cho, Jae-Hwan; Park, Yong-Soon

    2012-12-01

    The goal of this study is to determine which imaging location on phase contrast magnetic resonance imaging (PC MRI) best correlates with echocardiography to enable the severity of aortic regurgitation to be accurately evaluated by using PC MRI. The subjects were 34 patients with aortic regurgitation confirmed by echocardiography and cardiac MRI. Two velocity distribution images were obtained by positioning image planes above and below the aortic valve in the PC MRI. Using the acquired images, regurgitation fractions were calculated by calculating the average forward and reverse blood flows. The severity of aortic regurgitation was then evaluated and compared with the severity as determined by using echocardiography. When image planes were positioned above the aortic valve, the regurgitation fraction obtained by using PC MRI was 44.5 ± 18.7%, and when planes were positioned below the valve, the regurgitation fraction was 34.8 ± 15.9%. Regarding agreement with echocardiographic findings, concurrence was shown to be 50% when image planes sections were positioned above the valve and 85.3% when they were positioned below the valve. The present study shows that if image planes are positioned below the valve rather than above the valve, provides as accurate evaluation of the severity of aortic regurgitation.

  8. Clinical Evaluation of Different Pre-impression Preparation Procedures of Dental Arch

    PubMed Central

    Arora, Nitin; Arora, Monika; Gupta, Naveen; Agarwal, Manisha; Verma, Rohit; Rathod, Pankaj

    2015-01-01

    Background: Bubbles and voids on the occlusal surface impede the actual intercuspation and pre-impression preparation aims to reduce the incidence of air bubbles and voids as well as influences the quality of occlusal reproduction and actual clinical intercuspation in the articulator. The study was undertaken to determine the influence of different pre-impression preparation procedures of antagonistic dental arch on the quality of the occlusal reproduction of the teeth in irreversible hydrocolloid impressions and to determine most reliable pre-impression preparation method to reduce the incidence of air bubbles. Materials and Methods: A total of 20 subjects were selected having full complement of mandibular teeth from second molar to second molar with well demarcated cusp height. 200 impressions were made with irreversible hydrocolloid material. The impressions were divided into five groups of 40 impressions each and each group had one specific type of pre-impression preparation. All the impressions were poured in die stone. A stereomicroscope with graduated eyepiece was used to count the number of bubbles on the occlusal surface of premolars and molars. The mean and standard deviations were calculated for each group. Mann–Whitney U-test was applied to find the significant difference between different groups. Results: Least bubbles were found in the group in which oral cavity was dried by saliva ejector and fluid hydrocolloid was finger painted onto the occlusal surfaces immediately before the placement of impression tray in the mouth. Conclusion: It was found that finger painting the tooth surfaces with fluid hydrocolloid immediately before the placement of loaded impression tray in the mouth was the most reliable method. The oral cavity can be cleared more easily of excess saliva by vacuum suction rather than by use of an astringent solution. PMID:26229376

  9. Multimodality imaging assessment for Thoraflex hybrid total arch replacement.

    PubMed

    Wong, Randolph Hl; Ho, Jacky Yk; Underwood, Malcolm J

    2016-06-01

    Conventionally, aortic pathologies involving the ascending, arch, and descending thoracic aorta are treated by a staged operation. The Thoraflex device is a composite 4-branched graft with a distal endovascular stent, which allows one-stage treatment of these pathologies. We describe our multimodality hybrid approach for total arch replacement using the Thoraflex device with the adjunct of intraoperative 3-dimensional transesophageal echocardiography, Endo-EYE endoscopy, and on-table aortography in a hybrid operating room. These multimodality assessments can ascertain adequate sealing of a distal aortic tear and proper opening of the endograft, and provide on-table functional assessment of false lumen hemodynamics. Early results are promising. PMID:27072867

  10. Reliability performance of titanium sputter coated Ni-Ti arch wires: mechanical performance and nickel release evaluation.

    PubMed

    Anuradha, P; Varma, N K Sapna; Balakrishnan, Avinash

    2015-01-01

    The present research was aimed at developing surface coatings on NiTi archwires capable of protection against nickel release and to investigate the stability, mechanical performance and prevention of nickel release of titanium sputter coated NiTi arch wires. Coated and uncoated specimens immersed in artificial saliva were subjected to critical evaluation of parameters such as surface analysis, mechanical testing, element release, friction coefficient and adhesion of the coating. Titanium coatings exhibited high reliability on exposure even for a prolonged period of 30 days in artificial saliva. The coatings were found to be relatively stable on linear scratch test with reduced frictional coefficient compared to uncoated samples. Titanium sputtering adhered well with the Ni-Ti substrates at the molecular level, this was further confirmed by Inductive coupled plasma emission spectroscopy (ICPE) analysis which showed no dissolution of nickel in the artificial saliva. Titanium sputter coatings seem to be promising for nickel sensitive patients. The study confirmed the superior nature of the coating, evident as reduced surface roughness, friction coefficient, good adhesion and minimal hardness and elastic modulus variations in artificial saliva over a given time period. PMID:26484557

  11. Type B Aortic Dissection with Abdominal Aortic Aneurysm Rupture 1 Year after Endovascular Repair of Abdominal Aortic Aneurysm.

    PubMed

    Daniel, Guillaume; Ben Ahmed, Sabrina; Warein, Edouard; Gallon, Arnaud; Rosset, Eugenio

    2016-05-01

    We report a patient who developed a type B aortic dissection and ruptured his aneurysmal sac 1 year after endovascular abdominal aortic aneurysm repair (EVAR), despite standard follow-up. This 79-year-old man was presented to emergency room with acute abdominal pain and an acute lower limb ischemia. Computed tomography scan showed an acute type B aortic dissection feeding the aneurysmal sac of the EVAR. The aneurysm rupture occurred during imaging. Type B aortic dissection is a rare cause of aneurysmal rupture after EVAR. The first postoperative computed tomography scan should maybe include the arch and the descending thoracic aorta to rule out an iatrogenic dissection after EVAR. PMID:26902937

  12. Three-Dimensional Evaluation of Aortic Valve Annular Shape in Children With Bicuspid Aortic Valves and/or Aortic Coarctation Compared With Controls.

    PubMed

    Chamberland, Christen R; Sugeng, Lissa; Abraham, Sharon; Li, Fangyong; Weismann, Constance G

    2015-11-01

    Bicuspid aortic valve (BAV) is the most common congenital cardiac abnormality, occurring in 1% to 2% of the general population. Adults with degenerative aortic valve (AV) disease have been shown to have an elliptical shaped AV annulus. The goal of this study was to investigate the shape of the aortic annulus in children with BAV, coarctation of the aorta (CoA) with or without BAV, and normal controls with trileaflet AVs using 3-dimensional echocardiography (3DE). We reviewed echocardiograms of children with isolated BAV (n = 40), CoA (n = 26), and controls (n = 40) that included 3DE of the AV. Eccentricity index (EI) was defined as the ratio between the smaller and larger annular dimension. ΔD was defined as the difference between the larger and smaller annular dimension. Patients with BAV had an eccentric AV annulus compared with controls (BAV EI 0.85 ± 0.05 and control EI 0.96 ± 0.03; p <0.001). Subjects with CoA also had a more eccentric annulus than controls regardless of AV morphology (CoA 0.84 ± 0.06; p <0.001). EI was not associated with somatic growth parameters or gender. Among all patients with BAV, AV dysfunction was associated with fusion of the right and noncoronary (R-N) cusps (p <0.001), but there was no association between valve dysfunction and EI. ΔD was higher in both the BAV and CoA groups compared with the control group (BAV 3.4 ± 1.9 mm, CoA 2.8 ± 1.8 mm, and control 0.6 ± 0.4 mm; p <0.001 each). Although there was no significant correlation of ΔD with age in the control group during childhood, ΔD increased with age in the BAV and CoA groups. In conclusion, children with BAV and/or CoA have an elliptical shaped AV annulus by 3DE, which is independent of age, gender, or body surface area. AV annular eccentricity may lead to inaccurate measurement of AV annular size if measured by 2DE alone. Considering AV annular eccentricity when balloon sizing the annulus before valvuloplasty may help improve interventional results in some

  13. Aortic insufficiency

    MedlinePlus

    ... Heart valve - aortic regurgitation; Valvular disease - aortic regurgitation; AI - aortic insufficiency ... BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: ...

  14. Aortic Aneurysm

    MedlinePlus

    ... chest and abdomen. There are two types of aortic aneurysm: Thoracic aortic aneurysms - these occur in the part of the aorta running through the chest Abdominal aortic aneurysms - these occur in the part of the aorta ...

  15. Aortic Aneurysm

    MedlinePlus

    ... chest and abdomen. There are two types of aortic aneurysm: Thoracic aortic aneurysms (TAA) - these occur in the part of the aorta running through the chest Abdominal aortic aneurysms (AAA) - these occur in the part of the ...

  16. Aortic insufficiency

    MedlinePlus

    Aortic valve prolapse; Aortic regurgitation ... Any condition that prevents the aortic valve from closing completely can cause this problem. When the valve doesn't close all the way, a small amount of blood comes ...

  17. Evaluation of the CritiView in pig model of abdominal aortic occlusion and graded hemorrhage

    NASA Astrophysics Data System (ADS)

    Mayevsky, A.; Preisman, S.; Willenz, P. E.; Castel, D.; Perel, A.; Givony, D.; Dekel, N.; Oren, L.; Pewzner, E.

    2009-02-01

    We hypothesize that in the presence of reduced oxygen delivery and extraction, blood flow will be redistributed in order to protect the most vital organs (e.g., brain and heart) by increasing their regional blood flow, while O2 delivery to the less vital organs (e.g., GI tract or urethral wall) will diminish. Evaluation of mitochondrial function in vivo could be done by monitoring the oxidation reduction state of the respiratory chain. Thus, the NADH redox state of less vital organs could serve as an indicator of overall O2 imbalance as well as an endpoint of resuscitation. We have therefore tested, in a pig model, a new medical device providing real time data on NADH redox state and tissue blood flow- TBF This device contains a modified three way Foley catheter with a fiber optic probe which connects the measurement unit to the tested tissue. Female pigs underwent graded hemorrhage (GH) or Aortic clamping (AC). The main effects of GH started when blood volume decreased by 30%. At 40% blood loss, minimal levels of TBF were correlated to the maximal NADH levels. The values of the 2 parameters returned to baseline after retransfusion of the shed blood. Aortic clamping led to significant decrease in TBF while NADH levels increased. After aortic declamping the parameters recovered to normal values. Due to the short length of the urethra in female pigs and the instable contact between the probe and the tissue, inconsistency of the responses was observed. Our preliminary results show that the CritiView may be a useful tool for the detection of body O2 imbalance.

  18. Impact of Endografting on the Thoracic Aortic Anatomy: Comparative Analysis of the Aortic Geometry before and after the Endograft Implantation

    SciTech Connect

    Midulla, Marco; Moreno, Ramiro; Negre-Salvayre, Anne; Nicoud, Franc; Pruvo, Jean Pierre; Haulon, Stephan; Rousseau, Hervé

    2013-03-13

    PurposeAlthough the widespread acceptance of thoracic endovascular aortic repair (TEVAR) as a first-line treatment option for a multitude of thoracic aortic diseases, little is known about the consequences of the device implantation on the native aortic anatomy. We propose a comparative analysis of the pre- and postoperative geometry on a clinical series of patients and discuss the potential clinical implicationsMethodsCT pre- and postoperative acquisitions of 30 consecutive patients treated by TEVAR for different pathologies (20 thoracic aortic aneurysms, 6 false aneurysms, 3 penetrating ulcers, 1 traumatic rupture) were used to model the vascular geometry. Pre- and postoperative geometries were compared for each patient by pairing and matching the 3D models. An implantation site was identified, and focal differences were detected and described.ResultsSegmentation of the data sets was successfully performed for all 30 subjects. Geometry differences between the pre- and postoperative meshes were depicted in 23 patients (76 %). Modifications at the upper implantation site were detected in 14 patients (47 %), and among them, the implantation site involved the arch (Z0–3) in 11 (78 %).ConclusionModeling the vascular geometry on the basis of imaging data offers an effective tool to perform patient-specific analysis of the vascular geometry before and after the treatment. Future studies will evaluate the consequences of these changes on the aortic function.

  19. Comparative evaluation of border molding, using two different techniques in maxillary edentulous arches - An in vivo study

    PubMed Central

    Yarapatineni, Rameshbabu; Vilekar, Abhishek; Kumar, J Phani; Kumar, G Ajay; Aravind, Prasad; Kumar, P Anil

    2013-01-01

    Background: This study was undertaken to compare the retention between sectional border molding using low fusing greenstick compound and single step border molding using condensation silicone (putty) impression material in three stages- A. Immediately following border molding, B. After final impression and C. With the finished permanent denture base. Materials & Methods: In this study evaluation of retentive values of sectional border molding (Group I) (custom impression trays border molded with green stick compound ) and single step border molding (Group II) ( border molding with condensation silicone (putty) impression material ). In both techniques definitive wash impression were made with light body condensation silicone and permanent denture base with heat cure polymerization resin. Results: Group II was significantly higher (mean=8011.43) than Group I (mean=5777.43) in test-A. The t-value (1.5883) infers that there was significant difference between Group I and Group II (p =0.15). Group I was significantly higher (mean=6718.57) than Group II (mean=5224.29) in test -B. The t-value (1.6909) infers that there was significant difference between Group I and Group II (p=0.17). Group II was higher (mean=4025.14) than Group I (mean=3835.07) in test -C. The t-value was 0.1239. But it was found to be statistically insignificant (p=0.005). Conclusion: Within the limitation of this clinical study border molding custom tray with low fusing green stick compound provided similar retention as compared to custom impression tray with condensation silicone in permanent denture base. How to cite this article: Yarapatineni R, Vilekar A, Kumar JP, Kumar GA, Aravind P, Kumar PA. Comparative evaluation of border molding, using two different techniques in maxillary edentulous arches - An in vivo study. J Int Oral Health 2013; 5(6):82-7 . PMID:24453450

  20. Aneurysms: thoracic aortic aneurysms.

    PubMed

    Chun, Kevin C; Lee, Eugene S

    2015-04-01

    Thoracic aortic aneurysms (TAAs) have many possible etiologies, including congenital heart defects (eg, bicuspid aortic valves, coarctation of the aorta), inherited connective tissue disorders (eg, Marfan, Ehlers-Danlos, Loeys-Dietz syndromes), and degenerative conditions (eg, medial necrosis, atherosclerosis of the aortic wall). Symptoms of rupture include a severe tearing pain in the chest, back, or neck, sometimes associated with cardiovascular collapse. Before rupture, TAAs may exert pressure on other thoracic structures, leading to a variety of symptoms. However, most TAAs are asymptomatic and are found incidentally during imaging for other conditions. Diagnosis is confirmed with computed tomography scan or echocardiography. Asymptomatic TAAs should be monitored with imaging at specified intervals and patients referred for repair if the TAAs are enlarging rapidly (greater than 0.5 cm in diameter over 6 months for heritable etiologies; greater than 0.5 cm over 1 year for degenerative etiologies) or reach a critical aortic diameter threshold for elective surgery (5.5 cm for TAAs due to degenerative etiologies, 5.0 cm when associated with inherited syndromes). Open surgery is used most often to treat asymptomatic TAAs in the ascending aorta and aortic arch. Asymptomatic TAAs in the descending aorta often are treated medically with aggressive blood pressure control, though recent data suggest that endovascular procedures may result in better long-term survival rates. PMID:25860136

  1. [Evaluation of tissue perfusion by simultaneous monitoring of aortic flow rate and capnography].

    PubMed

    Brunel, D; Muchada, R

    1991-10-26

    Ten patients under general anaesthesia were subjected to non-invasive haemodynamic monitoring, together with arterial gasometry and capnography. When enflurane was administered for maintenance anaesthesia, a 33 percent fall in aortic flow rate was observed (P less than 0.01), together with prolongation of the pre-ejection period and left ventricular pre-ejection/ejection ratio, an increase of central venous pressure and total vascular systemic resistances. The end-expiratory CO2 (Pet CO2) was reduced by 13 percent (P less than 0.05). There was no significant variation in arteriolo-alveolar CO2 difference (P(a-A)CO2). Under dobutamine (mean dose: 3.4 +/- 0.5 micrograms/kg/min), the haemodynamic parameters returned to their initial values. Pet CO2 rose above its initial level (+ 12 percent; P less than 0.05), but P(a-A)CO2 was not significantly modified. The variations of Pet CO2 were parallel with those of aortic flow rate. It is concluded that the changes in Pet CO2 observed during haemodynamic modifications could be used as markers for qualitative evaluation of tissue perfusion. PMID:1836570

  2. Combined Interventional and Surgical Treatment for Acute Aortic Type A Dissection

    SciTech Connect

    Liu Jincheng; Zhang Jinzhou Yang Jian; Zuo Jian; Zhang Jinbao; Yu Shiqiang; Chen Tao; Xu Xuezeng; Wei Xufeng; Yi Dinghua

    2008-07-15

    Surgical repair and endovascular stent-graft placement are both therapies for thoracic aortic dissection. A combination of these two approaches may be effective in patients with type A dissection. In this study, we evaluated the prognosis of this combined technique. From December 2003 to December 2006, 15 patients with type A dissection were admitted to our institute; clinical data were retrospectively reviewed. Follow-up was performed at discharge and approximately 12 months after operation. Endovascular stent-graft placement by interventional radiology and surgical repair for reconstruction of aortic arch was performed in all patients. Total arch replacement for distal arch aneurysm was carried out under deep hypothermia with circulatory arrest; antegrade-selected cerebral perfusion was used for brain protection. Four patients concomitantly received a coronary artery bypass graft. Hospital mortality rate was 6.7%; the patient died of cerebral infarction. Neurological complications developed in two patients. Multi-detector-row computed tomography scans performed before discharge revealed complete thrombosis of the false lumen in six patients and partial thrombosis in eight patients. At the follow-up examination, complete thrombosis was found in another three patients, aortic rupture, endoleaks, or migration of the stent-graft was not observed and injuries of peripheral organs or anastomotic endoleaks did not occur. For patients with aortic type A dissection, combining intervention and surgical procedures is feasible, and complete or at least partial thrombosis of the false lumen in the descending aorta can be achieved. This combined approach simplified the surgical procedures and shortened the circulatory arrest time, minimizing the necessity for further aortic operation.

  3. Utility of cardiac computed tomography for evaluation of pannus in mechanical aortic valve.

    PubMed

    Suh, Young Joo; Kim, Young Jin; Lee, Sak; Hong, Yoo Jin; Lee, Hye-Jeong; Hur, Jin; Choi, Byoung Wook; Chang, Byung-Chul

    2015-08-01

    The clinical significance of pannus detected on computed tomography (CT) has not yet been investigated. The purposes of this study were to investigate the clinical significance of pannus detected on cardiac CT in patients who underwent aortic valve replacement (AVR) with mechanical valves, and to determine predictors for pannus severity. A total of 92 patients who underwent cardiac CT and TTE and who had undergone mechanical AVR were included. The geometric orifice area (GOA), the presence of limitation of motion (LOM) and pannus were evaluated on CT. The GOA, presence of LOM, and presence and severity of pannus were compared with echocardiographic parameters. Logistic regression analysis was performed to determine the predictors for pannus severity. The GOA on CT positively correlated with effective orifice area on TTE (r = 0.733, P < 0.0001). Pannus was found in 77.2% and LOM in 14.0%. With increasing pannus severity, mean transvalvular pressure gradient (PG) was significantly higher (P < 0.0001). Patients with elevated PG showed a smaller GOA, a higher incidence of pannus, more severe pannus and LOM than patients with normal PG (P < 0.05). Small valve size (≤19 mm), Carbomedics valve, rheumatic etiology, and young age at AVR (<48.8 years) were independent predictors of moderate to severe pannus (P < 0.05). Cardiac CT is helpful in the evaluation of pannus formation in patients with mechanical aortic valves. Moderate to severe pannus formation frequently occurred in patients with small mechanical valve size, Carbomedics valves, rheumatic heart disease and young age at AVR. PMID:25990093

  4. Ambient resonance of rock arches

    NASA Astrophysics Data System (ADS)

    Starr, Alison Margaret

    Resonant frequencies of structural elements are related to fundamental material properties of mass and stiffness, and monitoring over time can thus serve as an indirect indictor of internal mechanical change. Until now, however, this methodology has not been applied to natural rock structures such as arches and towers. We evaluated the resonance characteristics of four rock arches in southeastern Utah, combining in-situ ambient vibration measurements with numerical modal analysis. At each location, we measured the spectral and polarization attributes of ambient vibrations using up to two broadband seismometers. Ambient vibration spectra measured on the arches showed clear peaks at distinct frequencies (typically between 1-10 Hz), which we interpret as resonant frequencies, as opposed to the relatively flat spectra recorded on nearby bedrock. Polarization analysis helped us identify the orientations of vibration and explore resonant mode shapes. We then verified the measured resonant frequencies through 3D finite-element numerical modal analysis, and in most cases we were able to match the fundamental along with several higher-order modes. Repeat occupation and short-term continuous ambient vibration monitoring were aimed at assessing daily and seasonal changes in resonant frequencies, which in turn may provide evidence of internal mechanical change; Mesa Arch in Canyonlands National Park served as the main focus for our repeat measurements. Results revealed that minor, reversible changes in resonant frequencies can be created by thermal effects, i.e., changes in bulk material stiffness as the arch expands and contracts on daily and seasonal time scales. No irreversible change in the resonant frequency of Mesa Arch was detected over the period of this study. Our research provides the first step towards monitoring the long-term structural health of natural rock arches as they change through time or in the wake of a damaging event. We have shown that the resonance

  5. Bronchial Aneurysms Mimicking Aortic Aneurysms: Endovascular Treatment in Two Patients

    SciTech Connect

    Vernhet, Helene; Bousquet, Claudine; Jean, Betty; Lesnik, Alvian; Durand, Gerard; Giron, Jacques; Senac, Jean Paul

    1999-05-15

    Bronchial artery dilatation and aneurysm formation is a potential complication of local inflammation, especially in bronchiectasis. When the bronchial artery has an ectopic origin from the inferior segment of the aortic arch, aneurysms may mimick aortic aneurysms. Despite this particular location, endovascular treatment is possible. We report two such aneurysms that were successfully embolized with steel coils.

  6. Expandable device type III for easy and reliable approximation of dissection layers in sutureless aortic anastomosis. Ex vivo experimental study.

    PubMed

    Nazari, Stefano

    2010-02-01

    In past years, we developed expandable devices (type I and II) for sutureless aortic anastomosis. We have now further modified the device (type III) incorporating a second expandable ring, external to the main one, which can be operated contrariwise in such a way that the aortic wall (i.e. the dissection layers) is compressed between the two expandable rings, providing full control on both the layers compression pressure and the anastomosis final diameter. The device was evaluated in ex vivo experimental models of swine aortic arch fresh samples; air-tight sealing at increasing endovascular pressures was also evaluated and compared with sealing achieved by standard suturing. Ex vivo data suggest that the present version of the device can be used easily and quickly also in elliptical, asymmetric 'oblique' anastomosis as when concavity arch is involved. Perfect air-tight sealing of the anastomosis was verified at endovascular pressures up to 150 mmHg, while standard suture cannot withstand even minimal endovascular air pressure. Compared to the previous versions, the present device is less bulky and softer, can be used also for concavity arch resection and provides full and standardizable control on dissection layers stable and sealed approximation. PMID:19933306

  7. Type A aortic dissection with cold agglutinin disease.

    PubMed

    Osada, Hiroaki; Nakajima, Hiroyuki; Shimizu, Atsushi; Nagasawa, Atsushi; Ogino, Hitoshi

    2011-08-01

    Cold agglutinin disease is an uncommon condition characterized by hemagglutination and microvascular thrombosis of red blood cells at low temperatures during cardiopulmonary bypass. We report the rare case of an ambulatory 74-year-old woman with a relatively high thermal amplitude for antibody activation. We performed aortic arch repair for type A aortic dissection using moderately hypothermic cardiopulmonary bypass and warm blood cardioplegia in a retrograde manner. This case report provides evidence that these are safe and suitable techniques for selected aortic arch repair patients with cold agglutinin disease. PMID:21801929

  8. 14-3-3 in Thoracic Aortic Aneurysms

    PubMed Central

    Chakravarti, Ritu; Gupta, Karishma; Swain, Mamuni; Willard, Belinda; Scholtz, Jaclyn; Svensson, Lars G.; Roselli, Eric E.; Pettersson, Gosta; Johnston, Douglas R.; Soltesz, Edward G.; Yamashita, Michifumi; Stuehr, Dennis; Daly, Thomas M.; Hoffman, Gary S.

    2015-01-01

    Objective Large vessel vasculitides (LVV) are a group of autoimmune diseases characterized by injury to and anatomic modifications of large vessels, including the aorta and its branch vessels. Disease etiology is unknown. This study was undertaken to identify antigen targets within affected vessel walls in aortic root, ascending aorta, and aortic arch surgical specimens from patients with LVV, including giant cell arteritis, Takayasu arteritis, and isolated focal aortitis. Methods Thoracic aortic aneurysm specimens and autologous blood were acquired from consenting patients who underwent aorta reconstruction procedures. Aorta proteins were extracted from both patients with LVV and age-, race-, and sex-matched disease controls with noninflammatory aneurysms. A total of 108 serum samples from patients with LVV, matched controls, and controls with antinuclear antibodies, different forms of vasculitis, or sepsis were tested. Results Evaluation of 108 serum samples and 22 aortic tissue specimens showed that 78% of patients with LVV produced antibodies to 14-3-3 proteins in the aortic wall (93.7% specificity), whereas controls were less likely to do so (6.7% produced antibodies). LVV patient sera contained autoantibody sufficient to immunoprecipitate 14-3-3 protein(s) from aortic lysates. Three of 7 isoforms of 14-3-3 were found to be up-regulated in aorta specimens from patients with LVV, and 2 isoforms (ε and ζ) were found to be antigenic in LVV. Conclusion This is the first study to use sterile, snap-frozen thoracic aorta biopsy specimens to identify autoantigens in LVV. Our findings indicate that 78% of patients with LVV have antibody reactivity to 14-3-3 protein(s). The precise role of these antibodies and 14-3-3 proteins in LVV pathogenesis deserves further study. PMID:25917817

  9. [Surgical aspects of acute aortic dissection].

    PubMed

    Laas, J; Heinemann, M; Jurmann, M; Borst, H G

    1992-12-01

    This paper highlights some of the surgical aspects of acute aortic dissections such as: emergency diagnosis, indications for surgery, reconstructive operative techniques, malperfusion phenomena and necessity for follow-up. Aortic dissection is caused by an intimal tear, called the "entry", and subsequent splitting of the media by the stream of blood. Two lumina are thus created, which may communicate through "re-entries". As this creates severe weakness of the aortic wall, rupture and/or dilatation are the imminent dangers of acute aortic dissection. Acute aortic dissection type A, by definition involving the ascending aorta (Figures 1 and 2), is an absolute indication for emergency surgical treatment, because its natural history shows an extremely poor outcome (Figure 3). Due to impending (intrapericardial) aortic rupture, it may be necessary to limit diagnostic procedures to a minimum. Transesophageal echocardiography is the method of choice for establishing a quick, precise and reliable diagnosis (Figure 4). In stable patients, computed tomography gives additional information about aortic diameters or sites of extrapericardial perforation. Digital subtraction angiography (DSA) shows perfusion of the lumina and dependent organs. The surgical strategy in acute aortic dissection type A aims at replacement of the ascending aorta. Reconstructive techniques have to be considered, especially in aortic valve regurgitation without annuloectasia (Figures 5 and 6). In recent times, the use of GRF tissue glue has reduced the need for teflon felt. Involvement of the aortic arch should be treated aggressively up to the point of total arch replacement in deep hypothermic circulatory arrest as part of the primary procedure (Figure 7). Malperfusion phenomena of aortic branches remain risk-factors.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1483624

  10. Quantitation of aortic and mitral regurgitation in the pediatric population: evaluation by radionuclide angiocardiography

    SciTech Connect

    Hurwitz, R.A.; Treves, S.; Freed, M.; Girod, D.A.; Caldwell, R.L.

    1983-01-15

    The ability to quantitate aortic (AR) or mitral regurgitation (MR), or both, by radionuclide angiocardiography was evaluated in children and young adults at rest and during isometric exercise. Regurgitation was estimated by determining the ratio of left ventricular stroke volume to right ventricular stroke volume obtained during equilibrium ventriculography. The radionuclide measurement was compared with results of cineangiography, with good correlation between both studies in 47 of 48 patients. Radionuclide stroke volume ratio was used to classify severity: the group with equivocal regurgitation differed from the group with mild regurgitation (p less than 0.02); patients with mild regurgitation differed from those with moderate regurgitation (p less than 0.001); and those with moderate regurgitation differed from those with severe regurgitation (p less than 0.01). The stroke volume ratio was responsive to isometric exercise, remaining constant or increasing in 16 of 18 patients. After surgery to correct regurgitation, the stroke volume ratio significantly decreased from preoperative measurements in all 7 patients evaluated. Results from the present study demonstrate that a stroke volume ratio greater than 2.0 is compatible with moderately severe regurgitation and that a ratio greater than 3.0 suggests the presence of severe regurgitation. Thus, radionuclide angiocardiography should be useful for noninvasive quantitation of AR or MR, or both, helping define the course of young patients with left-side valvular regurgitation.

  11. 3D evaluation of maxillary arches in unilateral cleft lip and palate patients treated with nasoalveolar moulding vs. Hotz's plate.

    PubMed

    Cerón-Zapata, A M; López-Palacio, A M; Rodriguez-Ardila, M J; Berrio-Gutiérrez, L M; De Menezes, M; Sforza, C

    2016-02-01

    To compare the three-dimensional changes occurring in the maxillary arch during the use of modified pre-surgical nasoalveolar moulding (PNAM) and Hotz's plate. A clinical trial including 32 children with unilateral cleft lip and palate (UCLP), 16 treated with Hotz's plate and 16 with PNAM, was performed. Impressions of the maxillary arches were taken: A. prior to pre-surgical orthopaedics, B. before cheiloplasty and C. after cheiloplasty. Models were digitised using a stereophotogrammetric instrument, and geodesic distances were calculated: anterior, canine and posterior widths of the arch, and lengths and cleft depths of the larger and shorter segments. The time and treatment effects were assessed by two-factor anova. A significant effect of treatment was found for cleft depth at the larger segment: children treated with Hotz's plate had significantly deeper cleft than children treated with PNAM. All distances significantly changed during time: the anterior and canine widths decreased, while the posterior width, the lengths and depths of the cleft segments increased. Significant treatment per time interactions was found. The anterior and canine widths reduced more with PNAM between time points A and B while Hotz's treatment was more effective between B and C. The shorter segment depth increased more between B and C with PNAM, and between A and B with Hotz's plate. During pre-surgical orthopaedics, therapy with PNAM obtained the best results in reducing the width at the anterior segment of the cleft. This treatment gave a lower increase in cleft depth than treatment with Hotz's plate. PMID:26404105

  12. Effectiveness of the Use of Near-Infrared Spectroscopy to Treat Acute Type A Aortic Dissection Complicated with Limb Ischemia: Report of a Case

    PubMed Central

    Nakajima, Kousuke; Chikazawa, Genta; Hiraoka, Arudo; Totsugawa, Toshinori; Sakaguchi, Taichi; Yoshitaka, Hidenori

    2015-01-01

    We report an effectiveness of the use of near-infrared spectroscopy to evaluate the limb perfusion, which helps to continuously measure the tissue oxygen index of bilateral legs in treating acute type A aortic dissection complicated with limb ischemia. A 62-year-old man underwent total arch replacement for acute type A aortic dissection with limb ischemia. Intraoperative retrograde true lumen perfusion via bilateral femoral arteries during cardiopulmonary bypass improved ischemic condition of bilateral legs before the resection of primary intimal tear, and the use of near-infrared spectroscopy made it possible to assess additional revascularizations to the lower limbs were required or not. PMID:26421076

  13. Uncluttered single-image visualization of the abdominal aortic vessel tree: Method and evaluation

    SciTech Connect

    Won, Joong-Ho; Rosenberg, Jarrett; Rubin, Geoffrey D.; Napel, Sandy

    2009-11-15

    Purpose: The authors develop a method to visualize the abdominal aorta and its branches, obtained by CT or MR angiography, in a single 2D stylistic image without overlap among branches. Methods: The abdominal aortic vasculature is modeled as an articulated object whose underlying topology is a rooted tree. The inputs to the algorithm are the 3D centerlines of the abdominal aorta, its branches, and their associated diameter information. The visualization problem is formulated as an optimization problem that finds a spatial configuration of the bounding boxes of the centerlines most similar to the projection of the input into a given viewing direction (e.g., anteroposterior), while not introducing intersections among the boxes. The optimization algorithm minimizes a score function regarding the overlap of the bounding boxes and the deviation from the input. The output of the algorithm is used to produce a stylistic visualization, made of the 2D centerlines modulated by the associated diameter information, on a plane. The authors performed a preliminary evaluation by asking three radiologists to label 366 arterial branches from the 30 visualizations of five cases produced by the method. Each of the five patients was presented in six different variant images, selected from ten variants with the three lowest and three highest scores. For each label, they assigned confidence and distortion ratings (low/medium/high). They studied the association between the quantitative metrics measured from the visualization and the subjective ratings by the radiologists. Results: All resulting visualizations were free from branch overlaps. Labeling accuracies of the three readers were 93.4%, 94.5%, and 95.4%, respectively. For the total of 1098 samples, the distortion ratings were low: 77.39%, medium: 10.48%, and high: 12.12%. The confidence ratings were low: 5.56%, medium: 16.50%, and high: 77.94%. The association study shows that the proposed quantitative metrics can predict a reader

  14. Uncluttered single-image visualization of the abdominal aortic vessel tree: Method and evaluation

    PubMed Central

    Won, Joong-Ho; Rosenberg, Jarrett; Rubin, Geoffrey D.; Napel, Sandy

    2009-01-01

    Purpose: The authors develop a method to visualize the abdominal aorta and its branches, obtained by CT or MR angiography, in a single 2D stylistic image without overlap among branches. Methods: The abdominal aortic vasculature is modeled as an articulated object whose underlying topology is a rooted tree. The inputs to the algorithm are the 3D centerlines of the abdominal aorta, its branches, and their associated diameter information. The visualization problem is formulated as an optimization problem that finds a spatial configuration of the bounding boxes of the centerlines most similar to the projection of the input into a given viewing direction (e.g., anteroposterior), while not introducing intersections among the boxes. The optimization algorithm minimizes a score function regarding the overlap of the bounding boxes and the deviation from the input. The output of the algorithm is used to produce a stylistic visualization, made of the 2D centerlines modulated by the associated diameter information, on a plane. The authors performed a preliminary evaluation by asking three radiologists to label 366 arterial branches from the 30 visualizations of five cases produced by the method. Each of the five patients was presented in six different variant images, selected from ten variants with the three lowest and three highest scores. For each label, they assigned confidence and distortion ratings (low∕medium∕high). They studied the association between the quantitative metrics measured from the visualization and the subjective ratings by the radiologists. Results: All resulting visualizations were free from branch overlaps. Labeling accuracies of the three readers were 93.4%, 94.5%, and 95.4%, respectively. For the total of 1098 samples, the distortion ratings were low: 77.39%, medium: 10.48%, and high: 12.12%. The confidence ratings were low: 5.56%, medium: 16.50%, and high: 77.94%. The association study shows that the proposed quantitative metrics can predict a

  15. [Emergency Thoracic Endovascular Aortic Repair of Ruptured Kommerell's Diverticulum with an Acute Aortic Dissection].

    PubMed

    Seguchi, Ryuta; Ohtake, Hiroshi; Yoshimura, Takahiro; Shintani, Yoshiko; Nishida, Yuji; Kiuchi, Ryuta; Yamaguchi, Shojiro; Tomita, Shigeyuki; Sanada, Junichiro; Matsui, Osamu; Watanabe, Go

    2016-06-01

    This case report describes emergency thoracic endovascular aortic repair (TEVAR) of a ruptured Kommerell's diverticulum associated with a type B acute aortic dissection in a patient with a right aortic arch. A 64-year-old male was admitted with symptoms of sudden paraplegia and shock. The computed tomography imaging showed right aortic arch anomaly, with mirror image branching of the major arteries. The aorta was dissected from the origin of the right subclavian artery to the terminal aorta, with a thrombosed false lumen. Rupture was found in a 6.3 cm aneurysm located in the distal arch, which was diagnosed as Kommerell's diverticulum. We performed emergency TEVAR, and the aneurysm was successfully excluded using deployment of a Gore Tag stent-graft. At 3 months' follow-up, the patient was doing well and showed shrinkage of the aneurysm was confirmed. TEVAR is considered to be a suitable procedure for an emergency aortic catastrophe even in patients with aortic anomaly. PMID:27246128

  16. A patient-specific study of type-B aortic dissection: evaluation of true-false lumen blood exchange

    PubMed Central

    2013-01-01

    Background Aortic dissection is a severe pathological condition in which blood penetrates between layers of the aortic wall and creates a duplicate channel – the false lumen. This considerable change on the aortic morphology alters hemodynamic features dramatically and, in the case of rupture, induces markedly high rates of morbidity and mortality. Methods In this study, we establish a patient-specific computational model and simulate the pulsatile blood flow within the dissected aorta. The k-ω SST turbulence model is employed to represent the flow and finite volume method is applied for numerical solutions. Our emphasis is on flow exchange between true and false lumen during the cardiac cycle and on quantifying the flow across specific passages. Loading distributions including pressure and wall shear stress have also been investigated and results of direct simulations are compared with solutions employing appropriate turbulence models. Results Our results indicate that (i) high velocities occur at the periphery of the entries; (ii) for the case studied, approximately 40% of the blood flow passes the false lumen during a heartbeat cycle; (iii) higher pressures are found at the outer wall of the dissection, which may induce further dilation of the pseudo-lumen; (iv) highest wall shear stresses occur around the entries, perhaps indicating the vulnerability of this region to further splitting; and (v) laminar simulations with adequately fine mesh resolutions, especially refined near the walls, can capture similar flow patterns to the (coarser mesh) turbulent results, although the absolute magnitudes computed are in general smaller. Conclusions The patient-specific model of aortic dissection provides detailed flow information of blood transport within the true and false lumen and quantifies the loading distributions over the aorta and dissection walls. This contributes to evaluating potential thrombotic behavior in the false lumen and is pivotal in guiding

  17. Tracheo-Bronchial Obstruction and Esophageal Perforation after TEVAR for Thoracic Aortic Rupture

    PubMed Central

    Fukui, Daisuke; Tanaka, Haruki; Komatsu, Kazunori; Ohtsu, Yoshinori; Terasaki, Takamitsu; Wada, Yuko; Takano, Tamaki; Koike, Shoichiro; Amano, Jun

    2014-01-01

    A 67-year-old man was referred to our hospital for an ascending aortic aneurysm, thoracoabdominal aortic aneurysm and aortic regurgitation. Graft repair of the thoracic aortic arch and aortic valve replacement was given priority and completed, however he developed descending aortic rupture before the second scheduled surgery, and endovascular stent grafting was performed. He subsequently developed tracheobronchial obstruction and esophageal perforation. The patient underwent urgent esophagectomy and enterostomy with continuity later reestablished. However, he died of sepsis 5 months after surgery. Despite the less invasive nature of endovascular treatment, esophageal perforation can nevertheless occur and postoperative vigilance is well warranted. PMID:25593630

  18. Arching Solar Prominence

    NASA Video Gallery

    NASA’s STEREO (Ahead) spacecraft watched as an eruptive prominence rose up and arched out in a horseshoe shape far above the Sun’s surface (Aug. 25, 2010). The image and movie show the action in a...

  19. Single-Stage Total Arch Replacement Including Resection of Kommerell Diverticulum in a Patient With Loeys-Dietz Syndrome.

    PubMed

    Ong, Chin Siang; Kasai, Yuhei; Fukushima, Souta; Hibino, Narutoshi; Magruder, Trent; Suarez-Pierre, Alejandro; Cameron, Duke; Vricella, Luca

    2016-09-01

    Loeys-Dietz syndrome (LDS) is an autosomal dominant genetic connective tissue disorder associated with aortic aneurysmal disease. Kommerell diverticulum (KD) is a rare aortic diverticulum, for which the indication for surgery and the surgical techniques remain subjects of debate. We describe our experience with a successful total aortic arch replacement including KD resection through a median sternotomy for a pediatric patient with LDS. PMID:27521346

  20. The cytotoxicity evaluation of magnetic iron oxide nanoparticles on human aortic endothelial cells

    NASA Astrophysics Data System (ADS)

    Ge, Gaoyuan; Wu, Hengfang; Xiong, Fei; Zhang, Yu; Guo, Zhirui; Bian, Zhiping; Xu, Jindan; Gu, Chunrong; Gu, Ning; Chen, Xiangjian; Yang, Di

    2013-05-01

    One major obstacle for successful application of nanoparticles in medicine is its potential nanotoxicity on the environment and human health. In this study, we evaluated the cytotoxicity effect of dimercaptosuccinic acid-coated iron oxide (DMSA-Fe2O3) using cultured human aortic endothelial cells (HAECs). Our results showed that DMSA-Fe2O3 in the culture medium could be absorbed into HAECs, and dispersed in the cytoplasm. The cytotoxicity effect of DMSA-Fe2O3 on HAECs was dose-dependent, and the concentrations no more than 0.02 mg/ml had little toxic effect which were revealed by tetrazolium dye assay. Meanwhile, the cell injury biomarker, lactate dehydrogenase, was not significantly higher than that from control cells (without DMSA-Fe2O3). However, the endocrine function for endothelin-1 and prostacyclin I-2, as well as the urea transporter function, was altered even without obvious evidence of cell injury in this context. We also showed by real-time PCR analysis that DMSA-Fe2O3 exposure resulted in differential effects on the expressions of pro- and anti-apoptosis genes of HAECs. Meanwhile, it was noted that DMSA-Fe2O3 exposure could activate the expression of genes related to oxidative stress and adhesion molecules, which suggested that inflammatory response might be evoked. Moreover, we demonstrated by in vitro endothelial tube formation that even a small amount of DMSA-Fe2O3 (0.01 and 0.02 mg/ml) could inhibit angiogenesis by the HAECs. Altogether, these results indicate that DMSA-Fe2O3 have some cytotoxicity that may cause side effects on normal endothelial cells.

  1. Single-blind randomized clinical trial to evaluate clinical and radiological outcomes after one year of immediate versus delayed implant placement supporting full-arch prostheses

    PubMed Central

    Pellicer-Chover, Hilario; Peñarrocha-Oltra, David; Bagán, Leticia; Fichy-Fernandez, Antonio J.; Canullo, Luigi

    2014-01-01

    Purpose: To evaluate and compare peri-implant health, marginal bone loss and success of immediate and delayed implant placement for rehabilitation with full-arch fixed prostheses. Material and Methods: The present study was a prospective, randomized, single-blind, clinical preliminary trial. Patients were randomized into two treatment groups. In Group A implants were placed immediately post-extraction and in Group B six months after extraction. The following control time-points were established: one week, six months and twelve months after loading. Measurements were taken of peri-implant crevicular fluid volume, plaque index, gingival retraction, keratinized mucosa, probing depth, modified gingival index and presence of mucositis. Implant success rates were evaluated for the two groups. The study sample included fifteen patients (nine women and six men) with a mean average age of 63.7 years. One hundred and forty-four implants were placed: 76 placed in healed sites and 68 placed immediately. Results: At the moment of prosthetic loading, keratinized mucosa width and probing depth were higher in immediate implants than delayed implants, with statistically significant differences. However, after six and twelve months, differences between groups had disappeared. Bone loss was 0.54 ± 0.39 mm for immediate implants and 0.66 ± 0.25 mm for delayed implants (p=0.201). No implants failed in either group. Conclusions: The present study with a short follow-up and a small sample yielded no statistically significant differences in implant success and peri-implant marginal bone loss between immediate and delayed implants with fixed full-arch prostheses. Peri-implant health showed no statistically significant differences for any of the studied parameters (crevicular fluid volume, plaque index, gingival retraction, keratinized mucosa, probing depth, modified gingival index and presence of mucositis) at the twelve-month follow-up. Key words:Immediate implants, delayed implants

  2. Morphological and Functional Evaluation of Quadricuspid Aortic Valves Using Cardiac Computed Tomography

    PubMed Central

    Song, Inyoung; Park, Jung Ah; Choi, Bo Hwa; Shin, Je Kyoun; Chee, Hyun Keun; Kim, Jun Seok

    2016-01-01

    Objective The aim of this study was to identify the morphological and functional characteristics of quadricuspid aortic valves (QAV) on cardiac computed tomography (CCT). Materials and Methods We retrospectively enrolled 11 patients with QAV. All patients underwent CCT and transthoracic echocardiography (TTE), and 7 patients underwent cardiovascular magnetic resonance (CMR). The presence and classification of QAV assessed by CCT was compared with that of TTE and intraoperative findings. The regurgitant orifice area (ROA) measured by CCT was compared with severity of aortic regurgitation (AR) by TTE and the regurgitant fraction (RF) by CMR. Results All of the patients had AR; 9 had pure AR, 1 had combined aortic stenosis and regurgitation, and 1 had combined subaortic stenosis and regurgitation. Two patients had a subaortic fibrotic membrane and 1 of them showed a subaortic stenosis. One QAV was misdiagnosed as tricuspid aortic valve on TTE. In accordance with the Hurwitz and Robert's classification, consensus was reached on the QAV classification between the CCT and TTE findings in 7 of 10 patients. The patients were classified as type A (n = 1), type B (n = 3), type C (n = 1), type D (n = 4), and type F (n = 2) on CCT. A very high correlation existed between ROA by CCT and RF by CMR (r = 0.99) but a good correlation existed between ROA by CCT and regurgitant severity by TTE (r = 0.62). Conclusion Cardiac computed tomography provides comprehensive anatomical and functional information about the QAV. PMID:27390538

  3. Aortic Disease Presentation and Outcome Associated with ACTA2 mutations

    PubMed Central

    Regalado, Ellen S.; Guo, Dongchuan; Prakash, Siddharth; Bensend, Tracy A.; Flynn, Kelly; Estrera, Anthony; Safi, Hazim; Liang, David; Hyland, James; Child, Anne; Arno, Gavin; Boileau, Catherine; Jondeau, Guillaume; Braverman, Alan; Moran, Rocio; Morisaki, Takayuki; Morisaki, Hiroko; Consortium, Montalcino Aortic; Pyeritz, Reed; Coselli, Joseph; LeMaire, Scott; Milewicz, Dianna M.

    2015-01-01

    Background ACTA2 mutations are the major cause of familial thoracic aortic aneurysms and dissections. We sought to characterize these aortic diseases in a large case series of individuals with ACTA2 mutations. Methods and Results Aortic disease, management, and outcome associated with the first aortic event (aortic dissection or aneurysm repair) were abstracted from the medical records of 277 individuals with 41 various ACTA2 mutations. Aortic events occurred in 48% of these individuals, with the vast majority presenting with thoracic aortic dissections (88%) associated with 25% mortality. Type A dissections were more common than type B dissections (54% versus 21%), but the median age of onset of type B dissections was significantly younger than type A dissections (27 years, IQR 18–41 versus 36 years, IQR 26–45). Only 12% of aortic events were repair of ascending aortic aneurysms, which variably involved the aortic root, ascending aorta and aortic arch. Overall cumulative risk of an aortic event at age 85 years was 0.76 (95% CI 0.64, 0.86). After adjustment for intra-familial correlation, gender and race, mutations disrupting p.R179 and p.R258 were associated with significantly increased risk for aortic events, whereas p.R185Q and p.R118Q mutations showed significantly lower risk of aortic events compared to other mutations. Conclusions ACTA2 mutations are associated with high risk of presentation with an acute aortic dissection. The lifetime risk for an aortic event is only 76%, suggesting that additional environmental or genetic factors play a role in expression of aortic disease in individuals with ACTA2 mutations. PMID:25759435

  4. Endovascular Treatment for Proximal Anastomotic Pseudoaneurysm after Total Arch Replacement in Behcet's Disease.

    PubMed

    Sakata, Tomoki; Ueda, Hideki; Watanabe, Michiko; Kohno, Hiroki; Tamura, Yusaku; Abe, Shinichiro; Inage, Yuichi; Ikeuchi, Hiroki; Kanda, Tomoyoshi; Fujii, Masahiko; Matsumiya, Goro

    2016-07-01

    A 17-year-old patient underwent total arch replacement for aortic arch aneurysm due to vascular Behcet's disease (BD). Follow-up computed tomography, performed 6 months after the operation, demonstrated pseudoaneurysm formation at the proximal anastomotic site. We performed endovascular treatment and used a short stent graft that was originally designed for abdominal aortic aneurysm. To avoid the occlusion of the coronary or brachiocephalic artery (BCA) due to stent graft migration, we used right ventricular rapid pacing and BCA ballooning. Thus, we believe that endovascular treatment can be used for anastomotic complications in the ascending aorta after open surgery for connective tissue disorders including BD. PMID:27174345

  5. The hemostatic disturbance in patients with acute aortic dissection: A prospective observational study.

    PubMed

    Guan, Xinliang; Li, Jiachen; Gong, Ming; Lan, Feng; Zhang, Hongjia

    2016-09-01

    Coagulopathy is still a frequent complication in the surgical treatment of acute aortic dissection. However, the physiopathology of surgically induced coagulopathy has never been systematically and comprehensively studied in patients with acute aortic dissection. The aim of the present study was to describe the perioperative hemostatic system in patients with acute aortic dissection.The 87 patients who underwent aortic arch surgery for acute Stanford type A aortic dissection from January 2013 to September 2015 were enrolled in this study. The perioperative biomarkers of hemostatic system were evaluated using standard laboratory tests and enzyme-linked immunosorbent assays (ELISAs) at 5 time points: anesthesia induction (T1), lowest nasopharyngeal temperature (T2), protamine reversal (T3), 4 hours after surgery (T4), and 24 hours after surgery (T5).The ELISAs biomarkers revealed activation of coagulation (thrombin-antithrombin III complex [TAT] and prothrombin fragment 1 + 2 [F1 + 2] were elevated), suppression of anticoagulation (antithrombin III [AT III] levels were depressed), and activation of fibrinolysis (plasminogen was decreased and plasmin-antiplasmin complex [PAP] was elevated). The standard laboratory tests also demonstrated that surgery resulted in a significant reduction in platelet counts and fibrinogen concentration.Systemic activation of coagulation and fibrinolysis, and inhibition of anticoagulation were observed during the perioperative period in patients with acute aortic dissection. Indeed, these patients exhibited consumption coagulopathy and procoagulant state perioperatively. Therefore, we believe that this remarkable disseminated intravascular coagulation (DIC)-like coagulopathy has a high risk of bleeding and may influence postoperative outcome of patients with acute aortic dissection. PMID:27603366

  6. Aortic Relative Pressure Components Derived from Four-Dimensional Flow Cardiovascular Magnetic Resonance

    PubMed Central

    Lamata, Pablo; Pitcher, Alex; Krittian, Sebastian; Nordsletten, David; Bissell, Malenka M; Cassar, Thomas; Barker, Alex J; Markl, Michael; Neubauer, Stefan; Smith, Nicolas P

    2014-01-01

    Purpose To describe the assessment of the spatiotemporal distribution of relative aortic pressure quantifying the magnitude of its three major components. Methods Nine healthy volunteers and three patients with aortic disease (bicuspid aortic valve, dissection, and Marfan syndrome) underwent 4D-flow CMR. Spatiotemporal pressure maps were computed from the CMR flow fields solving the pressure Poisson equation. The individual components of pressure were separated into time-varying inertial (“transient”), spatially varying inertial (“convective”), and viscous components. Results Relative aortic pressure is primarily caused by transient effects followed by the convective and small viscous contributions (64.5, 13.6, and 0.3 mmHg/m, respectively, in healthy subjects), although regional analysis revealed prevalent convective effects in specific contexts, e.g., Sinus of Valsalva and aortic arch at instants of peak velocity. Patients showed differences in peak transient values and duration, and localized abrupt convective changes explained by abnormalities in aortic geometry, including the presence of an aneurysm, a pseudo-coarctation, the inlet of a dissection, or by complex flow patterns. Conclusion The evaluation of the three components of relative pressure enables the quantification of mechanistic information for understanding and stratifying aortic disease, with potential future implications for guiding therapy. Magn Reson Med 72:1162–1169, 2014. © 2013 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. PMID:24243444

  7. How to Perfuse: Concepts of Cerebral Protection during Arch Replacement

    PubMed Central

    Habertheuer, Andreas; Wiedemann, Dominik; Kocher, Alfred; Laufer, Guenther; Vallabhajosyula, Prashanth

    2015-01-01

    Arch surgery remains undoubtedly among the most technically and strategically challenging endeavors in cardiovascular surgery. Surgical interventions of thoracic aneurysms involving the aortic arch require complete circulatory arrest in deep hypothermia (DHCA) or elaborate cerebral perfusion strategies with varying degrees of hypothermia to achieve satisfactory protection of the brain from ischemic insults, that is, unilateral/bilateral antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP). Despite sophisticated and increasingly individualized surgical approaches for complex aortic pathologies, there remains a lack of consensus regarding the optimal method of cerebral protection and circulatory management during the time of arch exclusion. Many recent studies argue in favor of ACP with various degrees of hypothermic arrest during arch reconstruction and its advantages have been widely demonstrated. In fact ACP with more moderate degrees of hypothermia represents a paradigm shift in the cardiac surgery community and is widely adopted as an emergent strategy; however, many centers continue to report good results using other perfusion strategies. Amidst this important discussion we review currently available surgical strategies of cerebral protection management and compare the results of recent European multicenter and single-center data. PMID:26713319

  8. Consistency of aortic distensibility and pulse wave velocity estimates with respect to the Bramwell-Hill theoretical model: a cardiovascular magnetic resonance study

    PubMed Central

    2011-01-01

    Background Arterial stiffness is considered as an independent predictor of cardiovascular mortality, and is increasingly used in clinical practice. This study aimed at evaluating the consistency of the automated estimation of regional and local aortic stiffness indices from cardiovascular magnetic resonance (CMR) data. Results Forty-six healthy subjects underwent carotid-femoral pulse wave velocity measurements (CF_PWV) by applanation tonometry and CMR with steady-state free-precession and phase contrast acquisitions at the level of the aortic arch. These data were used for the automated evaluation of the aortic arch pulse wave velocity (Arch_PWV), and the ascending aorta distensibility (AA_Distc, AA_Distb), which were estimated from ascending aorta strain (AA_Strain) combined with either carotid or brachial pulse pressure. The local ascending aorta pulse wave velocity AA_PWVc and AA_PWVb were estimated respectively from these carotid and brachial derived distensibility indices according to the Bramwell-Hill theoretical model, and were compared with the Arch_PWV. In addition, a reproducibility analysis of AA_PWV measurement and its comparison with the standard CF_PWV was performed. Characterization according to the Bramwell-Hill equation resulted in good correlations between Arch_PWV and both local distensibility indices AA_Distc (r = 0.71, p < 0.001) and AA_Distb (r = 0.60, p < 0.001); and between Arch_PWV and both theoretical local indices AA_PWVc (r = 0.78, p < 0.001) and AA_PWVb (r = 0.78, p < 0.001). Furthermore, the Arch_PWV was well related to CF_PWV (r = 0.69, p < 0.001) and its estimation was highly reproducible (inter-operator variability: 7.1%). Conclusions The present work confirmed the consistency and robustness of the regional index Arch_PWV and the local indices AA_Distc and AA_Distb according to the theoretical model, as well as to the well established measurement of CF_PWV, demonstrating the relevance of the regional and local CMR indices. PMID

  9. 18. Understructure, view of south arch abutment showing arch ribs, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    18. Understructure, view of south arch abutment showing arch ribs, columns, sway bracing, floor beams, deck cantilever, railing; view to southwest. - Parks Bar Bridge, Spanning Yuba River at State Highway 20, Smartville, Yuba County, CA

  10. 9. DETAIL OF EAST ARCH, FROM ROADWAY, SHOWING ARCH RIB, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    9. DETAIL OF EAST ARCH, FROM ROADWAY, SHOWING ARCH RIB, ARTICULATED HANGER AND GUARDRAIL. VIEW TO SOUTHEAST. - Rock Valley Bridge, Spanning North Timber Creek at Old U.S. Highway 30, Marshalltown, Marshall County, IA

  11. 10. DETAIL OF WEST ARCH, FROM ROADWAY, SHOWING ARCH RIB, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    10. DETAIL OF WEST ARCH, FROM ROADWAY, SHOWING ARCH RIB, HANGERS AND GUARDRAIL. VIEW TO SOUTH. - Rock Valley Bridge, Spanning North Timber Creek at Old U.S. Highway 30, Marshalltown, Marshall County, IA

  12. BRIDGE ABUTMENTS WITH ARCH SEGMENTS ON RIVER BOTTOM. ARCHES COLLAPSED ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    BRIDGE ABUTMENTS WITH ARCH SEGMENTS ON RIVER BOTTOM. ARCHES COLLAPSED AROUND EIGHT YEARS BEFORE THIS DATE. - Whittlesey Road Bridge, Spanning Black River at Whittlesey Road, Lyons Falls, Lewis County, NY

  13. Clarifying the anatomy of the fifth arch artery

    PubMed Central

    Gupta, Saurabh Kumar; Gulati, Gurpreet Singh; Anderson, Robert H

    2016-01-01

    The artery allegedly forming in the fifth pharyngeal arch has increasingly been implicated as responsible for various vascular malformations in patients with congenitally malformed hearts. Observations from studies on developing embryos, however, have failed to provide support to substantiate several of these inferences such that the very existence of the fifth arch artery remains debatable. To the best of our knowledge, in only a solitary human embryo has a vascular channel been found that truly resembled the artery of the fifth arch. Despite the meager evidence to support its existence, the fifth arch artery has been invoked to explain the morphogenesis of double-barreled aorta, some unusual forms of aortopulmonary communications, and abnormalities of the brachiocephalic arteries. In most of these instances, the interpretations have proved fallible when examined in the light of existing knowledge of cardiac development. In our opinion, there are more plausible alternative explanations for the majority of these descriptions. Double-barreled aorta is more likely to result from retention of the recently identified dorsal collateral channels while abnormalities of brachiocephalic arteries are better explained on the basis of extensive remodeling of aortic arches during fetal development. Some examples of aortopulmonary communications, nonetheless, may well represent persistence of the developing artery of the fifth pharyngeal arch. We here present one such case — a patient with tetralogy of Fallot and pulmonary atresia, in whom the fifth arch artery provided a necessary communication between the ascending aorta and the pulmonary arteries. In this light, we discuss the features we consider to be essential before attaching the tag of “fifth arch artery” to a candidate vascular channel. PMID:27011696

  14. A rare cause of recurrent aortic dissection.

    PubMed

    Agrawal, Yashwant; Gupta, Vishal

    2016-07-01

    We report the case of a 19-year-old man with a history of Loeys-Dietz syndrome (LDS), which was diagnosed when he had a Stanford type A aortic dissection. He also had multiple aneurysms including ones in the innominate, right common carotid, and right internal mammary arteries. He had had multiple procedures including Bentall's procedure, repeat sternotomy with complete arch and valve replacement, and coil embolization of internal mammary artery aneurysm in the past. His LDS was characterized by gene mutation for transforming growth factor-β receptor 1. He presented to our facility with sudden onset of back pain, radiating to the right shoulder and chest. He was diagnosed with Stanford type B aortic dissection and underwent thoracic aorta endovascular repair for his aortic dissection. This case represents the broad spectrum of pathology associated with LDS where even with regular surveillance and aggressive medical management the patient developed Stanford B aortic dissection. PMID:27358537

  15. Development, Implementation, and Evaluation of a Structured Reporting Web Tool for Abdominal Aortic Aneurysms

    PubMed Central

    Karim, Sulafa; Fegeler, Christian; Boeckler, Dittmar; H Schwartz, Lawrence; Kauczor, Hans-Ulrich

    2013-01-01

    Background The majority of radiological reports are lacking a standard structure. Even within a specialized area of radiology, each report has its individual structure with regards to details and order, often containing too much of non-relevant information the referring physician is not interested in. For gathering relevant clinical key parameters in an efficient way or to support long-term therapy monitoring, structured reporting might be advantageous. Objective Despite of new technologies in medical information systems, medical reporting is still not dynamic. To improve the quality of communication in radiology reports, a new structured reporting system was developed for abdominal aortic aneurysms (AAA), intended to enhance professional communication by providing the pertinent clinical information in a predefined standard. Methods Actual state analysis was performed within the departments of radiology and vascular surgery by developing a Technology Acceptance Model. The SWOT (strengths, weaknesses, opportunities, and threats) analysis focused on optimization of the radiology reporting of patients with AAA. Definition of clinical parameters was achieved by interviewing experienced clinicians in radiology and vascular surgery. For evaluation, a focus group (4 radiologists) looked at the reports of 16 patients. The usability and reliability of the method was validated in a real-world test environment in the field of radiology. Results A Web-based application for radiological “structured reporting” (SR) was successfully standardized for AAA. Its organization comprises three main categories: characteristics of pathology and adjacent anatomy, measurements, and additional findings. Using different graphical widgets (eg, drop-down menus) in each category facilitate predefined data entries. Measurement parameters shown in a diagram can be defined for clinical monitoring and be adducted for quick adjudications. Figures for optional use to guide and standardize the

  16. [Evaluation after 20 years of a case of Takayasu's disease that presented with aortic regurgitation].

    PubMed

    Pierre, B; Machet, M C; Marchand, M; Alison, D; Casset-Senon, D; Fauchier, L; Charniot, J C; Babuty, D; Cosnay, P

    2005-03-01

    Takayasu's disease is a segmental multifocal affection of medium and large arteries. The diagnosis is based on the association of stenotic and aneurismal lesions of the aorta and its branches secondary to an inflammatory infiltration of the media and adventitia. Cases of aortic regurgitation associated with aneurismal dilatation of the ascending aorta as the presenting features of Takayasu's disease, as in this case, are rare. Histological examination of the aortic wall may help establish the diagnosis by showing signs of aortitis. The other usual arterial lesions are sometimes missing at the initial phase of the disease. A late histological diagnosis may be difficult as the inflammatory lesions tend to be progressively replaced by fibrotic lesions or a banal atheroma. PMID:15816330

  17. In vitro evaluation of aortic insufficiency with a rotary left ventricular assist device.

    PubMed

    Gregory, Shaun D; Stevens, Michael C; Wu, Eric; Fraser, John F; Timms, Daniel

    2013-09-01

    Aortic insufficiency (AI) is usually repaired prior to rotary blood pump (RBP) implantation but can develop during support due, in part, to the sustained RBP-induced high pressure gradient across the aortic valve. Repair of the aortic valve before or during RBP support predisposes these critically ill patients to even higher risks. This study used an in vitro mock circulation loop to identify the severity of AI and/or left heart failure (LHF) that might benefit from valve repair while investigating RBP operating strategies to reduce the hemodynamic influence of AI. Reproduction of AI with RBP-supported LHF reduced device efficiency, particularly in the more severe cases of AI and LHF. The requirement for repair or closure of the aortic valve was demonstrated in all conditions other than those with only mild AI. When a sinusoidal RBP speed pulse was induced, small changes in systemic flow rate and regurgitant volume were observed with all degrees of AI. Variation of the pulse phase delay only resulted in minor changes to systemic flow rate, with a maximum difference of 0.17 L/min. Although the clinical implications of these small changes may be insignificant, changes in systemic flow rate and transvalvular pressure were shown when the sinusoidal RBP speed pulse was applied with no AI. In these cases, transvalvular pressure was reduced by up to 8% through sinusoidal copulsation of the RBP, which may prevent or delay the onset of AI. This in vitro study suggests that surgical intervention is required with moderate or worse AI and that RBP operating strategies should be further explored to delay the onset and reduce the harmful effects of AI. PMID:23901787

  18. Echocardiography as a Predicting Method in Diagnosis, Evaluation and Assessment of Children with Subvalvar Aortic Stenosis

    PubMed Central

    Bejiqi, Ramush; Bejiqi, Hana; Retkoceri, Ragip

    2016-01-01

    BACKGROUND: Obstruction to the left ventricular outflow of the heart may be above the aortic valve (5%), at the valve (74%), or in the subvalvar region (23%). These anomalies represent 3 to 6% of all patients with congenital heart defects (CHD), and it occurs more often in males (male-female ratio of 4:1). AIM: The purpose of this study was to determine the sensitivity and specificity of transthoracic echocardiography in diagnosis of discrete subaortic membrane, to determine convenient time for surgical intervention, and for identifying involvement of the aortic valve by subaortic shelf. MATERIAL AND METHODS: A retrospective review of the medical records and echocardiograms of 18 patients [14 male (77%) and 4 female (23%)] with discrete subaortic membrane, aged 11 month to 12 years, with mean age of 5 years and 3 month, diagnosed at the Pediatric Clinic in Prishtina, during the period September, 1999 and December, 2010 were done. RESULTS: Four patients, in neonatal age were operated from critical coarctation of the aorta and, initial signs of congestive heart failure were presented. 2 of them were operated in Belgrade, Serbia and 2 in Lausanne, Switzerland. CONCLUSION: In all presented patients bicuspid aortic valve was noted, but none of them subaortic membrane was registered. PMID:27275334

  19. Evaluation of platelet count after isolated biological aortic valve replacement with Freedom Solo bioprosthesis†

    PubMed Central

    Miceli, Antonio; Gilmanov, Daniyar; Murzi, Michele; Parri, Maria S.; Cerillo, Alfredo G.; Bevilacqua, Stefano; Farneti, Pier A.; Glauber, Mattia

    2012-01-01

    OBJECTIVE The risk of thrombocytopenia in patients undergoing aortic valve replacement (AVR) with the Freedom Solo (FS) bioprosthesis is controversial. The aim of our study was to evaluate the postoperative evolution of platelet count and function after AVR in patients undergoing isolated biological AVR with FS. METHODS Between May 2005 and June 2010, 322 patients underwent isolated biological AVR. Of these, 116 patients received FS and were compared with 206 patients who received biological valves. Platelet count, mean platelet volume (MPV), and platelet distribution width (PDW) were evaluated at baseline (T0), first (T1), second (T2), and fifth (T3) postoperative days, respectively. RESULTS Overall in-hospital mortality was 1.5% with no difference between the two groups. Thirty-seven (11.5%) patients developed thrombocytopenia. FS implantation was associated with a higher incidence of thrombocytopenia compared with the control group (24.1% vs 4.4%, p < 0.0001). Patients in the FS group showed a lower platelet count than the control group at T1 (99.4 ± 38 × 103 μl−1 vs 122.5 ± 41.6 × 103 μl−1, p < 0.001), T2 (79.7 ± 36.3 × 103 μl−1 vs 122.5 ± 43.3 × 103 μl−1, p < 0.001) and T3 (86.6 ± 57.4 × 103 μl−1 vs 158.4 ± 55.8 × 103 μl−1, p < 0.001). Moreover, the FS group also had a higher MPV (11.6 ± 0.9 fl vs 11 ± 1 fl, p < 0.001) and higher PDW (15.1 ± 2.3 fl vs 13.9 ± 2.1 fl, p < 0.001) at T3. In a multivariable analysis, FS (p < 0.0001), body surface area (p < 0.0001), cardiopulmonary bypass time (p = 0.003), and lower preoperative platelet counts (p = 0.006) were independent predictors of thrombocytopenia. CONCLUSIONS The FS valve might increase the risk of thrombocytopenia and platelet activation, in the absence of adverse clinical events. Prospective randomized studies on platelet function need to confirm our data. PMID:21664141

  20. Guilt by association: a paradigm for detection of silent aortic disease.

    PubMed

    Ziganshin, Bulat A; Elefteriades, John A

    2016-05-01

    Detection of clinically silent thoracic aortic aneurysm (TAA) is challenging due to the lack of symptoms (until aortic rupture or dissection occurs). A large proportion of TAA are identified incidentally while imaging a patient for other reasons. However, recently several clinical "associates" of TAA have been described that can aid in identification of silent TAA. These "associates" include intracranial aneurysm, aortic arch anomalies, abdominal aortic aneurysm (AAA), simple renal cysts (SRC), bicuspid aortic valve, temporal arteritis, a positive family history of aneurysm disease, and a positive thumb-palm sign. In this article we examine these associates of TAA and the data supporting their involvement with asymptomatic TAA. PMID:27386404

  1. Effect of Different Rotational Directions of BJUT-II VAD on Aortic Swirling Flow Characteristics: A Primary Computational Fluid Dynamics Study.

    PubMed

    Zhang, Qi; Gao, Bin; Chang, Yu

    2016-01-01

    BACKGROUND The BJUT-II VAD is a novel left ventricular assist device (LVAD), which is thought to have significant effects on the characteristics of aortic swirling flow. However, the precise mechanism of the rotational direction of BJTU-II VAD in the aortic swirling flow is unclear. MATERIAL AND METHODS A patient-specific aortic geometric model was reconstructed based on the CT data. Three pump's output flow profiles with varied rotational direction, termed "counterclockwise", "flat profile", and "clockwise", were used as the boundary conditions. The helicity density, area-weighted average of helicity density (Ha), localized normalized helicity (LNH), wall shear stress (WSS), and WSS spatial gradient (WSSG) were calculated to evaluate the swirling flow characteristics in the aorta. RESULTS The results demonstrated that the swirling flow characteristics in the aorta and 3 branches are directly affected by the output blood flow of BJUT-II VAD. In the aortic arch, the helicity density, supported by the clockwise case, achieved the highest value. In the 3 branches, the flat profile case achieved the highest helicity density, whereas the maximum WSS and WSSG generated by clockwise case were lower than in other cases. CONCLUSIONS The outflow of the BJUT-II VAD has significant effects on the aortic hemodynamics and swirling flow characteristics. The helical blood profiles can enhance the strength of aortic swirling flow, and reduce the areas of low WSS and WSSG regions. The clockwise case may have a benefit for preventing development of atherosclerosis in the aorta. PMID:27440399

  2. Aortic Aneurysm Statistics

    MedlinePlus

    ... Blood Pressure Salt Cholesterol Million Hearts® WISEWOMAN Aortic Aneurysm Fact Sheet Recommend on Facebook Tweet Share Compartir ... cause of most deaths from aortic aneurysms. Aortic Aneurysm in the United States Aortic aneurysms were the ...

  3. Abdominal Aortic Aneurysm (AAA)

    MedlinePlus

    ... Resources Professions Site Index A-Z Abdominal Aortic Aneurysm (AAA) Abdominal aortic aneurysm (AAA) occurs when atherosclerosis ... aortic aneurysm treated? What is an abdominal aortic aneurysm? The aorta, the largest artery in the body, ...

  4. Dipyridamole thallium scanning in the evaluation of coronary artery disease in elective abdominal aortic surgery

    SciTech Connect

    Strawn, D.J.; Guernsey, J.M. )

    1991-07-01

    Dipyridamole thallium scanning was routinely performed on 68 consecutive patients who presented for elective aortic surgery. All 68 patients were judged by clinical assessment to be at low risk for perioperative cardiac complications. In addition, 42 of 68 patients had a history of myocardial infarction, stable angina, or abnormal echocardiographic findings (group 1). Twenty-six of 68 patients did not have a history of myocardial infarction, angina, or abnormal echocardiographic findings (group 2). In group 1, 34 of 4 patients had positive results on dipyridamole thallium scanning, and 15 of these patients were found to have critical coronary artery disease on subsequent cardiac catheterization; nine underwent immediate coronary artery bypass grafting, and six had their coronary artery disease treated medically and their vascular operations cancelled. The remaining 27 patients in group 1 underwent elective operations, with six (22%) of 27 sustaining postoperative cardiac complications. None of the group 2 patients was found to have critical coronary artery disease. All patients in group 2 underwent aortic operation without cardiac complication. Routine dipyridamole thallium scanning detected a 22% (15 of 68) incidence of critical coronary artery disease overall. There was a 36% (15 of 42) incidence of critical coronary artery disease in group 1 patients vs 0% in group 2 patients (95% confidence interval, 21% to 50%). The authors conclude that the use of dipyridamole thallium scanning in low-risk patients for cardiac screening prior to elective aortic operations is beneficial in selected patients who have a history of myocardial infarction, angina, or abnormal echocardiographic findings, but is not necessary in patients with no history of coronary artery disease.

  5. Quadricuspid Aortic Valve: A Rare Congenital Cause of Aortic Insufficiency

    PubMed Central

    Vasudev, Rahul; Shah, Priyank; Bikkina, Mahesh; Shamoon, Fayez

    2016-01-01

    Quadricuspid aortic valve (QAV) is a rare congenital cardiac anomaly causing aortic regurgitation usually in the fifth to sixth decade of life. Earlier, the diagnosis was mostly during postmortem or intraoperative, but now with the advent of better imaging techniques such as transthoracic echocardiography, transesophageal echocardiography (TEE), and cardiac magnetic resonance imaging, more cases are being diagnosed in asymptomatic patients. We present a case of a 39-year-old male who was found to have QAV, with the help of TEE, while undergoing evaluation for a diastolic murmur. The patient was found to have Type B QAV with moderate aortic regurgitation. We also present a brief review of classification, pathophysiology, and embryological basis of this rare congenital anomaly. The importance of diagnosing QAV lies in the fact that majority of these patients will require surgery for aortic regurgitation and close follow-up so that aortic valve replacement/repair is done before the left ventricular decompensation occurs. PMID:27195176

  6. [Twenty Years' Experience of the Surgical Treatment of Giant Ascending Aortic Aneurysms].

    PubMed

    Charchan, E R; Stepanenko, A B; Gens, A P; Skvorstov, A A; Galeev, N A; Belov, Yu V

    2015-01-01

    Giant ascending aortic aneurysm is one of the worst lesions of the cardiovascular system. Timely surgical treatment provides the only chance to prolong the lives of such patients. Life expectancy without surgery in these patients is minimal; they die from a ruptured aneurysm or decompensation of organs and systems. In this paper, based on two decades' experience of treating patients with giant aneurysms of ascending aorta and aortic arch in B.V. Petrovsky National Research Center of Surgery we have assessed evaluated immediate results of surgery and proposed measures for prevention of possible complications. Out of 53 patients with giant. ascending aortic aneurysms spontaneous rupture after sternotomy or opening of the pericardium occurred in 5 cases. Overall hospital mortality was 1.9%. Our results indicate that with the right tactics surgical repair of giant ascending aortic aneurysms can be performed with a low mortality. Preliminary cardiopulmonary bypass with peripheral cannulation and cooling prior to sternotomy for the possibility of circulatory arrest is a prerequisite of the prevention of fatal massive hemorrhage. PMID:26898093

  7. Hydrodynamic evaluation of aortic cardiopulmonary bypass cannulae using particle image velocimetry.

    PubMed

    McDonald, C I; Bolle, E; Lang, H F; Ribolzi, C; Thomson, B; Tansley, G D; Fraser, J F; Gregory, S D

    2016-01-01

    The high velocity jet from aortic arterial cannulae used during cardiopulmonary bypass potentially causes a "sandblasting" injury to the aorta, increasing the possibility of embolisation of atheromatous plaque. We investigated a range of commonly available dispersion and non-dispersion cannulae, using particle image velocimetry. The maximum velocity of the exit jet was assessed 20 and 40 mm from the cannula tip at flow rates of 3 and 5 L/min. The dispersion cannulae had lower maximum velocities compared to the non-dispersion cannulae. Dispersion cannulae had fan-shaped exit profiles and maximum velocities ranged from 0.63 to 1.52 m/s when measured at 20 mm and 5 L/min. Non-dispersion cannulae had maximum velocities ranging from 1.52 to 3.06 m/s at 20 mm and 5 L/min, with corresponding narrow velocity profiles. This study highlights the importance of understanding the hydrodynamic performance of these cannulae as it may help in selecting the most appropriate cannula to minimize the risk of thromboembolic events or aortic injury. PMID:25987551

  8. [Thoracoabdominal aortic aneurysm].

    PubMed

    Kalder, J; Kotelis, D; Jacobs, M J

    2016-09-01

    Thoracoabdominal aortic aneurysms (TAAA) are rare events with an incidence of 5.9 cases per 100,000 persons per year. In Germany approximately 940 TAAA procedures are performed annually. The cause of TAAA is mostly degenerative but they can also occur on the basis of an aortic dissection or connective tissue disease (e. g. Marfan's syndrome). Patients often have severe comorbidities and suffer from hypertension, coronary heart disease or chronic obstructive pulmonary disease, mostly as a result of smoking. Operative treatment is indicated when the maximum aortic diameter has reached 6 cm (> 5 cm in patients with connective tissue disease) or the aortic diameter rapidly increases (> 5 mm/year). Treatment options are open surgical aortic repair with extracorporeal circulation, endovascular repair with branched/fenestrated endografts and parallel grafts (chimneys) or a combination of open and endovascular procedures (hybrid procedures). Mortality rates after both open and endovascular procedures are approximately 8 % depending on the extent of the repair. Furthermore, there are relevant risks of complications, such as paraplegia (up to 20 %) and the necessity for dialysis. In recent years several approaches to minimize these risks have been proposed. Besides cardiopulmonary risk evaluation, clinical assessment of patients by the physician with respect to the patient-specific anatomy influences the allocation of patients to one treatment option or another. Surgery of TAAA should ideally be performed in high-volume centers in order to achieve better results. PMID:27558261

  9. Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection

    PubMed Central

    Lee, Jae-Hong; Na, Bubse; Hwang, Yoohwa; Kim, Yong Han; Park, In Kyu; Kim, Kyung-Hwan

    2016-01-01

    A 49-year-old male presented with chills and a fever. Five years previously, he underwent ascending aorta and aortic arch replacement using the elephant trunk technique for DeBakey type 1 aortic dissection. The preoperative evaluation found an esophago-paraprosthetic fistula between the prosthetic graft and the esophagus. Multiple-stage surgery was performed with appropriate antibiotic and antifungal management. First, we performed esophageal exclusion and drainage of the perigraft abscess. Second, we removed the previous graft, debrided the abscess, and performed an in situ re-replacement of the ascending aorta, aortic arch, and proximal descending thoracic aorta, with separate replacement of the innominate artery, left common carotid artery, and extra-anatomical bypass of the left subclavian artery. Finally, staged esophageal reconstruction was performed via transthoracic anastomosis. The patient’s postoperative course was unremarkable and the patient has done well without dietary problems or recurrent infections over one and a half years of follow-up. PMID:26889449

  10. Experimental validation of Doppler echocardiographic measurement of volume flow through the stenotic aortic valve.

    PubMed

    Otto, C M; Pearlman, A S; Gardner, C L; Enomoto, D M; Togo, T; Tsuboi, H; Ivey, T D

    1988-08-01

    In aortic stenosis, evaluation of aortic valve area by the continuity equation assumes that the volume of flow through the stenotic valve can be measured accurately in the left ventricular outflow tract. To test the accuracy of Doppler volume-flow measurement proximal to a stenotic valve, we developed an open-chest canine model in which the native leaflets were sutured together to create variable degrees of acute aortic stenosis. Left ventricular and aortic pressures were measured with micromanometer-tipped catheters. Volume flow was controlled and varied by directing systemic venous return through a calibrated roller pump and back to the right atrium. Because transaortic volume flow will not equal roller pump output when there is coexisting aortic insufficiency (present in 67% of studies), transaortic flow was measured by electromagnetic flowmeter with the flow probe placed around the proximal descending thoracic aorta, just beyond the ligated arch vessels. In 12 adult, mongrel dogs (mean weight, 25 kg), the mean transaortic pressure gradient ranged from 2 to 74 mm Hg, and transaortic volume flow ranged from 0.9 to 3.2 l/min. In four dogs, electromagnetic flow that was measured distal to the valve was accurate compared with volume flow determined by timed collection of total aortic flow into a graduated cylinder (n = 24, r = 0.97, electromagnetic flow = 0.87 Direct +0.13 l/min). In eight subsequent dogs, electromagnetic flow was compared with transaortic cardiac output measured by Doppler echocardiography in the left ventricular outflow tract as circular cross-sectional area [pi(D/2)2] x left ventricular outflow tract velocity-time integral x heart rate.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2969311

  11. Dental Arch Wire

    NASA Technical Reports Server (NTRS)

    1979-01-01

    Straightening teeth is an arduous process requiring months, often years, of applying corrective pressure by means of arch wires-better known as brace-which may have to be changed several times in the course of treatment. A new method has been developed by Dr. George Andreasen, orthodontist and dental scientist at the University of Iowa. The key is a new type of arch wire material, called Nitinol, with exceptional elasticity which helps reduce the required number of brace changes. An alloy of nickel and titanium, Nitinol was originally developed for aerospace applications by the Naval Ordnance Laboratory, now the Naval Surface Weapons Laboratory, White Oaks, Maryland. NASA subsequently conducted additional research on the properties of Nitinol and on procedures for processing the metal.

  12. [Dynamic and cinematic evaluation of the function of bioprosthesis in the aortic position: tester of cardiac valves].

    PubMed

    Bustamante, J; Santamaría, J; Infante, O; Flores, P; Juárez, A

    1996-01-01

    Twenty four pericardial valvular prostheses were tested in a valvular tester device. The valves considered were: 12 valves of the model that has being already in clinical use, manufactured in the Instituto Nacional de Cardiología "Ignacio Chávez", (INC II) and 12 valves of a model in an experimental stage, (PRT I.) The inner diameter in the two group considered were: 17, 19 and 21 mm. All the valves were tested in the aortic position in the valvular tester device. Behavior of the valvular prostheses were examined at various rates of pulsation, 60, 77, 105 and 159 per minute, with an ejection volume of 70 and 80 ml (range of flows between 4200 and 12720 ml min1). The pressure of the ventricular and aortic cameras were registered continuously, by external transducers, and in the other hand, the kinetic of the valves and the degree of opening were evaluated for direct view trough an special window. The grade of incompetence was too evaluated and expressed in percent of the stroke volume. The transvalvular pressure gradient was lower in INC II model valves, specially at moderate and high flows, and at same time had a largest functional area. The degree of incompetence was higher in the 19 and 21 mm diameter valvular subgroups than the same subgroups in the PRT I model. In relation to the 17 mm subgroup, significant differences were not find. The use of the valvular tester showed a basic utility in the hydrodynamic evaluation of the news bioprostheses design, and so in the quality control of the valves than has being manufacturing. PMID:8967818

  13. Burmese Arched Harp

    NASA Astrophysics Data System (ADS)

    Williamson, Robert M.

    Our knowledge of the history, construction, and tunings of the Burmese arched harp (saùng gauk) comes from a variety of sources. Conversations with master harpists, together with recordings made of their performances between 1960 and 1980, provide richly detailed examples of the effect of Western music on a non-Western musical tradition. Scholars' essays and conference proceedings complement these first-hand accounts, expanding our understanding of Burmese music and musical instruments.

  14. Greater arch injuries.

    PubMed

    Shivanna, Deepak; Manjunath, Dayanand; Amaravathi, Rajkumar

    2014-12-01

    Dislocations and fracture dislocations of carpal bones are uncommon injuries which invariably poses challenges in the management. Perilunate fracture dislocations are the combination of ligamentous and osseous injury that involve the "greater arc" of the perilunate associated instability. Despite their severity, these injuries often go unrecognized in the emergency department leading to delayed diagnosis and treatment. A Prospective study was done from June 2008 to December 2013 in 15 cases of complex wrist injuries which included of greater arch injuries, perilunate fracture dislocation and one dorsal dislocation of Scaphoid. 10 cases of perilunate fracture dislocation underwent open reduction and internal fixation with Herbert screw and k-wire, 4 cases of greater arch injury underwent closed reduction and kwire fixation and one case of neglected dorsal dislocation underwent proximal row carpectomy. One patient had Sudecks osteodystrophy 1 had Scaphoid nonunion and 6 had median nerve compression. Overall outcome according to Mayo wrist score was 53 % excellent, 33 % good and 14 % fair. Greater arch injuries are difficult to treat because injuries to many ligaments are involved and failure to recognize early leads to persistent pain, disability and early onset of arthritis. Prompt recognition requires CT scan and MRI. Management requires reduction and multiple K-Wiring according to merits of the case. PMID:25414554

  15. The ARCHES Project

    NASA Astrophysics Data System (ADS)

    Motch, C.; Arches Consortium

    2015-09-01

    The Astronomical Resource Cross-matching for High Energy Studies (ARCHES) project is a FP7-Space funded programme started in 2013 and involving the Observatoire Astronomique de Strasbourg including the CDS (France), the Leibniz- Institut für Astrophysik Potsdam (Germany), the University of Leicester (UK), the Universidad de Cantabria (IFCA, Spain) and the Instituto Nacional de Tecnica Aeroespacial (Spain). ARCHES will provide the international astronomical community with well-characterised multi-wavelength data in the form of spectral energy distributions (SEDs) for large samples of objects extracted from the 3XMM X-ray catalogue of serendipitous sources. The project develops new tools implementing fully probabilistic simultaneous cross-correlation of several catalogues and a multi-wavelength finder for clusters of galaxies. SEDs are based on an enhanced version of the 3XMM catalogue and on a careful selection of the most relevant multi-wavelength archival catalogues. In order to ensure the largest audience, SEDs will be distributed to the international community through CDS services and through the Virtual Observatory. These enhanced resources are tested in the framework of several science cases. More information may be found at http://www.arches-fp7.eu/

  16. CT of nontraumatic thoracic aortic emergencies.

    PubMed

    Bhalla, Sanjeev; West, O Clark

    2005-10-01

    Computed tomography (CT), especially multidetector row CT (MDCT), is often the preferred imaging test used for evaluation of nontraumatic thoracic aortic abnormalities. Unenhanced images, usually followed by contrast-enhanced arterial imaging, allow for rapid detailed aortic assessment. Understanding the spectrum of acute thoracic aortic conditions which may present similarly (aortic dissection, aneurysm rupture, penetrating atherosclerotic ulcer, intramural hematoma) will ensure that patients are diagnosed and treated appropriately. Familiarity with imaging protocols and potential mimics will prevent confusion of normal anatomy and variants with aortic disease. PMID:16274000

  17. Aortic Aging in ESRD: Structural, Hemodynamic, and Mortality Implications.

    PubMed

    London, Gérard M; Safar, Michel E; Pannier, Bruno

    2016-06-01

    Aging incurs aortic stiffening and dilation, but these changes are less pronounced in peripheral arteries, resulting in stiffness and geometry gradients influencing progression of the forward and reflected pressure waves. Because premature arterial aging is observed in ESRD, we determined the respective roles of stiffness and aortic geometry gradients in 73 controls and 156 patients on hemodialysis. We measured aortic pulse wave velocity (PWV) and brachial PWV to evaluate the stiffness gradient [(brachial PWV/aortic PWV)(0.5)] and ascending aortic and aortic bifurcation diameters to assess aortic taper (ascending aortic diameter/aortic bifurcation diameter). The global reflection coefficient was estimated from characteristic impedance and vascular resistance. Cox proportional hazard models were used to determine mortality risk. The age-associated increase in aortic PWV was higher in patients (P<0.001). In controls, aortic ascending and bifurcation diameters increased with age, with an unchanged aortic taper. In patients on hemodialysis, age did not associate with increased ascending aortic diameter but did associate with increased aortic bifurcation diameter and decreased aortic taper, both of which also associated with abdominal aortic calcifications and smaller global reflection coefficient (P<0.001). In patients, multivariate models revealed all-cause and cardiovascular mortality associated with age, aortic PWV, and aortic bifurcation diameter with high specificity and sensitivity. Using stiffness gradient, aortic taper, or global reflection coefficient in the model produced similar results. Thus, whereas aortic stiffness is a known independent predictor of mortality, these results indicate the importance of also evaluating the aortic geometry in patients on hemodialysis. PMID:26475595

  18. Ambient resonance of Mesa Arch, Canyonlands National Park, Utah

    NASA Astrophysics Data System (ADS)

    Starr, Alison M.; Moore, Jeffrey R.; Thorne, Michael S.

    2015-08-01

    We analyzed the resonance characteristics of a prominent natural arch in Canyonlands National Park, Mesa Arch, as measured from ambient seismic data. Evaluating spectral and polarization attributes, we distinguished the first four resonant frequencies of the arch, 2.9, 6.0, 6.9, and 8.5 Hz, as well as basic properties of the associated mode shapes. We then affirmed experimental data using 3-D numerical modal analysis, providing estimates of material properties and clarifying vibrational mode shapes. Monitoring resonant frequencies over time, we searched for shifts associated with changing environmental conditions and long-term progressive damage. We measured ~3% direct daily variation in resonant frequency associated with changing rock temperature, thermal stress, and stiffening of the rock matrix. Independent tilt data showed similar diurnal cycles associated with thermoelastic stresses and deformation of the arch. We observed no permanent resonant frequency shifts related to irreversible damage of Mesa Arch during our study period.

  19. The role of aortic compliance in determination of coarctation severity: lumped parameter modeling, in vitro study and clinical evaluation

    PubMed Central

    Keshavarz-Motamed, Zahra; Edelman, Elazer R.; Motamed, Payam K.; Garcia, Julio; Dahdah, Nagib; Kadem, Lyes

    2015-01-01

    Early detection and accurate estimation of the extent of coarctation of the aorta (COA) is critical to long-term outcome. Peak-to-peak trans-coarctation pressure gradient (PKdP) higher than 20 mmHg is an indication for interventional/surgical repair. Patients with COA have reduced proximal and distal aortic compliances. A comprehensive study investigating the effects of variations of proximal COA and systemic compliances on PKdP, and consequently on the COA severity evaluation has never been done. This study evaluates the effect of aortic compliance on diagnostic accuracy of PKdP. Lumped parameter modeling and in vitro experiments were performed for COA severities of 50%, 75% and 90% by area. Modeling and in vitro results were validated against retrospective clinical data of PKdP, measured in fifty-four patients with COA. Modeling and in vitro. PKdP increases with reduced proximal COA compliance (+36%, +38% and +53% for COA severities of 50%, 75% and 90%, respectively; p<0.05), but decreases with reduced systemic compliance (−62%, −41% and −36% for COA severities of 50%, 75% and 90%, respectively; p<0.01). Clinical study. PKdP has a modest correlation with COA severity (R=0.29). The main determinants of PKdP are COA severity, stroke volume index and systemic compliance. Systemic compliance was found to be as influential as COA severity in PKdP determination (R=0.30 vs. R=0.34). In conclusion, PKdP is highly influenced by both stroke volume index and arterial compliance. Low values of PKdP cannot be used to exclude the severe COA presence since COA severity may be masked by reduced systemic compliance and/or low flow conditions. PMID:26596718

  20. Cost-Effectiveness Evaluation of EHR: Simulation of an Abdominal Aortic Aneurysm in the Emergency Department.

    PubMed

    Ben-Assuli, Ofir; Ziv, Amitai; Sagi, Doron; Ironi, Avinoah; Leshno, Moshe

    2016-06-01

    Health care organizations have installed electronic systems to increase efficiency in health care. Empirically assessing the cost-effectiveness of technologies to the health care system is a challenging and complex task. This study examined cost-effectiveness of additional clinical information supplied via an EHR system by simulating a case of abdominal aortic aneurysm devised and acted professionally by the Israel Center of Medical Simulation. We conducted a simulation-based study on physicians who were asked to treat a simulated patient for the prevalent medical scenario of hip and leg pain that actually corresponded to an abdominal aortic aneurysm. Half of the participating physicians from the Department of Emergency Medicine at Tel-Hashomer Hospital - Israel's largest - had access to an EHR system that integrates medical data from multiple health providers (community and hospitals) in addition to the local health record, and half did not. To model medical decision making, the results of the simulation were combined with a Markov Model within a decision tree. Cost-effectiveness was analyzed by comparing the effects of the admission/discharge decision in units of quality adjusted life years (QALYs) to the estimated costs. The results showed that using EHR in the ED increases the QALY of the patient and improves medical decision-making. The expenditure per patient for one QALY unit as a result of using the EHR was $1229, which is very cost-effective according to many accepted threshold values (less than all these values). Thus, using the EHR contributes to making a cost-effective decision in this specific but prevalent case. PMID:27114352

  1. Aortic coarctation, aneurysm, and ventricular dysfunction in an asymptomatic infant.

    PubMed

    García, Ana I; Aguilar, Juan M; García, Enrique

    2016-06-01

    Aortic arch coarctation with post-coarctation aneurysm is rare in infants. We present the case of an asymptomatic 3-month-old infant with severe left ventricular dysfunction in this setting. The patient underwent surgical repair, and the left ventricular ejection fraction improved to recovery the 4th post-operative month. PMID:26980403

  2. Utility of Proximal Stepwise Technique for Acute Aortic Dissection Involving the Aortic Root.

    PubMed

    Inoue, Yosuke; Minatoya, Kenji; Itonaga, Tatsuya; Oda, Tatsuya; Seike, Yoshimasa; Tanaka, Hiroshi; Sasaki, Hiroaki; Kobayashi, Junjiro

    2016-05-01

    Proximal anastomosis is an important operative procedure in type A acute aortic dissection. We report our experience with the proximal stepwise technique, which is widely used during distal anastomosis in total arch replacement, in a series of 53 patients. We treated 53 patients for aortic dissection using this technique in our center. There were no bleeding adverse events during the operations and no early death caused by bleeding. This hemostatic technique was simple to use and demonstrated excellent early and midterm operative results. PMID:27106475

  3. Aortic Dissection Type A in Alpine Skiers

    PubMed Central

    Schachner, Thomas; Fischler, Nikolaus; Dumfarth, Julia; Bonaros, Nikolaos; Krapf, Christoph; Schobersberger, Wolfgang; Grimm, Michael

    2013-01-01

    Patients and Methods. 140 patients with aortic dissection type A were admitted for cardiac surgery. Seventy-seven patients experienced their dissection in the winter season (from November to April). We analyzed cases of ascending aortic dissection associated with alpine skiing. Results. In 17 patients we found skiing-related aortic dissections. Skiers were taller (180 (172–200) cm versus 175 (157–191) cm, P = 0.008) and heavier (90 (68–125) kg versus 80 (45–110) kg, P = 0.002) than nonskiers. An extension of aortic dissection into the aortic arch, the descending thoracic aorta, and the abdominal aorta was found in 91%, 74%, and 69%, respectively, with no significant difference between skiers and nonskiers. Skiers experienced RCA ostium dissection requiring CABG in 17.6% while this was true for 5% of nonskiers (P = 0.086). Hospital mortality of skiers was 6% versus 13% in nonskiers (P = 0.399). The skiers live at an altitude of 170 (0–853) m.a.s.l. and experience their dissection at 1602 (1185–3105; P < 0.001) m.a.s.l. In 82% symptom start was during recreational skiing without any trauma. Conclusion. Skiing associated aortic dissection type A is usually nontraumatic. The persons affected live at low altitudes and practice an outdoor sport at unusual high altitude at cold temperatures. Postoperative outcome is good. PMID:23971024

  4. Heterogeneity in the Segmental Development of the Aortic Tree: Impact on Management of Genetically Triggered Aortic Aneurysms

    PubMed Central

    Sherif, Hisham M.F.

    2014-01-01

    An extensive search of the medical literature examining the development of the thoracic aortic tree reveals that the thoracic aorta does not develop as one unit or in one stage: the oldest part of the thoracic aorta is the descending aorta with the aortic arch being the second oldest, developing under influence from the neural crest cell. Following in chronological order are the proximal ascending aorta and aortic root, which develop from a conotruncal origin. Different areas of the thoracic aorta develop under the influence of different gene sets. These parts develop from different cell lineages: the aortic root (the conotruncus), developing from the mesoderm; the ascending aorta and aortic arch, developing from the neural crest cells; and the descending aorta from the mesoderm. Findings illustrate that the thoracic aorta is not a single entity, in developmental terms. It develops from three or four distinct areas, at different stages of embryonic life, and under different sets of genes and signaling pathways. Genetically triggered thoracic aortic aneurysms are not a monolithic group but rather share a multi-genetic origin. Identification of therapeutic targets should be based on the predilection of certain genes to cause aneurysmal disease in specific aortic segments. PMID:26798739

  5. Double arch mirror study

    NASA Technical Reports Server (NTRS)

    Vukobratovich, D.; Hillman, D.

    1983-01-01

    The development of a method of mounting light weight glass mirrors for astronomical telescopes compatible with the goals of the Shuttle Infrared Telescope Facility (SIRTF) was investigated. A 20 in. diameter double arch lightweight mirror previously fabricated was modified to use a new mount configuration. This mount concept was developed and fabricated. The mounting concept of the double mounting mirror is outlined. The modifications made to the mirror, fabrication of the mirror mount, and room temperature testing of the mirror and mount and the extension of the mirror and mount concept to a full size (40 in. diameter) primary mirror for SIRTF are discussed.

  6. Evaluation of Groundwater Leakage into a Drainage Tunnel in Jinping-I Arch Dam Foundation in Southwestern China: A Case Study

    NASA Astrophysics Data System (ADS)

    Chen, Yi-Feng; Hong, Jia-Min; Zheng, Hua-Kang; Li, Yi; Hu, Ran; Zhou, Chuang-Bing

    2016-03-01

    The Jinping-I double-curvature arch dam, located in the middle reach of Yalong River and with a maximum height of 305 m, is the world's highest dam of this type that has been completed. Since the second stage of reservoir impounding, after which the reservoir water level was gradually raised by about 232 m, a significant amount of leakage was observed from the drainage holes drilled in the lowest drainage tunnel at the left bank abutment at an elevation of 1595 m a.s.l. (above sea level), with an observed maximum pressure of about 0.3 MPa. A number of investigations, including water quality analysis, digital borehole imaging, tunnel geological mapping, and in situ groundwater monitoring, were performed to examine the source of leaking, the groundwater flow paths, and the performance of the grouting curtains. By defining two objective functions using the in situ time series measurements of flow rate and hydraulic head, respectively, a multiobjective inverse modeling procedure was proposed to evaluate the permeability of the foundation rocks that was underestimated in the design stage. This procedure takes advantage of the orthogonal design, finite element forward modeling of the transient groundwater flow, artificial neural network, and non-dominated sorting genetic algorithm, hence significantly reducing the computational cost and improving the reliability of the inversed results. The geological structures that lead to the leakage were identified and the seepage flow behaviors in the dam foundation and the left bank abutment were assessed. Based on the field measurements and the inverse modeling results, the effects of the engineering treatments of the leakage event on the dam safety were analyzed. It has been demonstrated that the seepage control system is effective in lowering the groundwater level and limiting the amount of seepage in the dam foundation, and the leakage event does not pose a threat to the safety of the dam.

  7. 35. ALTERNATE DESIGN USING THROUGH ARCH SPANS, WITH ARCH REPEATED ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    35. ALTERNATE DESIGN USING THROUGH ARCH SPANS, WITH ARCH REPEATED BETWEEN TOWER LEGS, AND ASHLAR MASONRY WALLS AND PYLONS Pen-and-ink drawing by project architect Alfred Eichler, 1934. - Sacramento River Bridge, Spanning Sacramento River at California State Highway 275, Sacramento, Sacramento County, CA

  8. Comparison of arch forms between Korean and North American white populations.

    PubMed

    Kook, Yoon-Ah; Nojima, Kunihiko; Moon, Hong-Beom; McLaughlin, Richard P; Sinclair, Peter M

    2004-12-01

    The purpose of this study was to evaluate morphologic differences in the mandibular arches of Korean and North American white subjects. The subjects were grouped according to arch form (tapered, ovoid, and square) to compare the frequency distribution of the 3 arch forms between the ethnic groups in each Angle classification. The sample included 160 white (60 Class I, 50 Class II, and 50 Class III) and 368 Korean (114 Class I, 119 Class II, and 135 Class III) subjects. The most facial portion of 13 proximal contact areas was digitized from photocopied images of the mandibular dental arches. Clinical bracket points were calculated for each tooth according to mandibular tooth thickness data, and then 4 linear and 2 proportional measurements were taken. Arch width was statistically significantly smaller in the white group than in the Korean group, but arch depth did not differ. In the Korean group, the most frequent arch form was square, whereas in the white group the tapered arch form predominated. When the subjects were regrouped by arch form, the Korean arches had a tendency to be larger and deeper than the white arches within each of the 3 arch form types. PMID:15592215

  9. The ARCHES project

    NASA Astrophysics Data System (ADS)

    Motch, C.; Arches Consortium

    2014-07-01

    ARCHES (Astronomical Resource Cross-matching for High Energy Studies) is a FP7-Space funded project started in 2013 and involving the Observatoire Astronomique de Strasbourg including the CDS (France), the Leibniz-Institut fuer Astrophysik Potsdam (Germany), the University of Leicester (UK), the Universidad de Cantabria (IFCA, Spain) and the Instituto Nacional de Técnica Aeroespacial (Madrid, Spain). ARCHES aims at providing the international astronomical community with well-characterised multi-wavelength data in the form of spectral energy distributions (SEDs) for large sets of objects extracted from the 3XMM catalogue. The project develops new tools implementing fully probabilistic simultaneous cross-correlation of several catalogues. SEDs are based on an enhanced version of the 3XMM catalogue and on a careful selection of the most relevant multi-wavelength archival catalogues. In order to ensure the largest audience, SEDs will be distributed to the international community through CDS services and through the Virtual Observatory. These enhanced resources are currently tested in the framework of several science cases. An integrated cluster finder is developed at Potsdam, AGN science is studied at Leicester and IFCA while populations of Galactic X-ray sources are investigated at Strasbourg and Madrid.

  10. Aortic regurgitation after transcatheter aortic valve replacement.

    PubMed

    Werner, Nikos; Sinning, Jan-Malte

    2014-01-01

    Paravalvular aortic regurgitation (AR) negatively affects prognosis following transcatheter aortic valve replacement (TAVR). As transcatheter heart valves (THV) are anchored using a certain degree of oversizing at the level of the aortic annulus, incomplete stent frame expansion because of heavily annular calcifications, suboptimal placement of the prosthesis, and/or annulus-prosthesis size-mismatch can contribute to paravalvular AR with subsequent increased mortality risk. Echocardiography is essential to differentiate between transvalvular and paravalvular AR and to further elucidate the etiology of AR during the procedure. However, because echocardiographic quantification of AR in TAVR patients remains challenging, especially in the implantation situation, a multimodal approach to the evaluation of AR with use of hemodynamic measurements and imaging modalities is useful to precisely quantify the severity of AR immediately after valve deployment. "Next-generation" THVs are already on the market and first results show that paravalvular AR related to design modifications (eg, paravalvular space-fillers, full repositionability) are rarely seen in these valve types.  PMID:24632758

  11. Deformable Surface Model for the Evaluation of Abdominal Aortic Aneurysms Treated with an Endovascular Sealing System.

    PubMed

    Casciaro, Mariano E; El-Batti, Salma; Chironi, Gilles; Simon, Alain; Mousseaux, Elie; Armentano, Ricardo L; Alsac, Jean-Marc; Craiem, Damian

    2016-05-01

    Rupture of abdominal aortic aneurysms (AAA) is responsible for 1-3% of all deaths among the elderly population in developed countries. A novel endograft proposes an endovascular aneurysm sealing (EVAS) system that isolates the aneurysm wall from blood flow using a polymer-filled endobag that surrounds two balloon-expandable stents. The volume of injected polymer is determined by monitoring the endobag pressure but the final AAA expansion remains unknown. We conceived and developed a fully deformable surface model for the comparison of pre-operative sac lumen size and final endobag size (measured using a follow-up scan) with the volume of injected polymer. Computed tomography images were acquired for eight patients. Aneurysms were manually and automatically segmented twice by the same observer. The injected polymer volume resulted 9% higher than the aneurysm pre-operative lumen size (p < 0.05), and 11% lower than the final follow-up endobag volume (p < 0.01). The automated method required minimal user interaction; it was fast and used a single set of parameters for all subjects. Intra-observer and manual vs. automated variability of measured volumes were 0.35 ± 2.11 and 0.07 ± 3.04 mL, respectively. Deformable surface models were used to quantify AAA size and showed that EVAS system devices tended to expand the sac lumen size. PMID:26350505

  12. [The form of the dental arch according to the Tweed-Merrifield philosophy: individualization and attempt at standardization].

    PubMed

    Amm, E W; Bou-Serhal, J P

    2003-12-01

    A literature review reveals that changes from the initial arch form lead to a proportionate amount of subsequent relapse and that there is great variation among human arch forms. A persistent search for the ideal arch form is still going on. Many authors presented different techniques for its individualization. A new software ("Arch form generator") was developed to create the arch form following the Tweed-Merrifield concepts. The form and dimensions of 169 mandibular arches were evaluated along with Angle classification and facial type as variables. The reliability of the Ricketts pentamorphic arch forms was questioned and a new arch guide was developed as part of a trial for standardization. The Class III cases showed greater width and smaller cuspid depth when compared to the Class I and Class II cases. The hypodivergent cases showed greater width when compared to the hyperdivergent and normodivergent cases. There is no characteristic form for the human dental arch. PMID:15301362

  13. Acute Aortic Syndromes and Thoracic Aortic Aneurysm

    PubMed Central

    Ramanath, Vijay S.; Oh, Jae K.; Sundt, Thoralf M.; Eagle, Kim A.

    2009-01-01

    Acute and chronic aortic diseases have been diagnosed and studied by physicians for centuries. Both the diagnosis and treatment of aortic diseases have been steadily improving over time, largely because of increased physician awareness and improvements in diagnostic modalities. This comprehensive review discusses the pathophysiology and risk factors, classification schemes, epidemiology, clinical presentations, diagnostic modalities, management options, and outcomes of various aortic conditions, including acute aortic dissection (and its variants intramural hematoma and penetrating aortic ulcers) and thoracic aortic aneurysms. Literature searches of the PubMed database were conducted using the following keywords: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies performed within the past 20 years were included in the review; however, most data are from the past 15 years. PMID:19411444

  14. Aortic Valve Disease

    MedlinePlus

    ... Disease Tricuspid Valve Disease Cardiac Rhythm Disturbances Thoracic Aortic Aneurysm Pediatric and Congenital Heart Disease Heart abnormalities that ... Disease Tricuspid Valve Disease Cardiac Rhythm Disturbances Thoracic Aortic Aneurysm Aortic Valve Disease Overview The human heart has ...

  15. Thoracic aortic aneurysm

    MedlinePlus

    Aortic aneurysm - thoracic; Syphilitic aneurysm; Aneurysm - thoracic aortic ... The most common cause of a thoracic aortic aneurysm is hardening of the ... with high cholesterol, long-term high blood pressure, or who ...

  16. Endovascular aortic aneurysm repair with chimney and snorkel grafts: indications, techniques and results.

    PubMed

    Patel, Rakesh P; Katsargyris, Athanasios; Verhoeven, Eric L G; Adam, Donald J; Hardman, John A

    2013-12-01

    The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR. PMID:23674274

  17. Endovascular Aortic Aneurysm Repair with Chimney and Snorkel Grafts: Indications, Techniques and Results

    SciTech Connect

    Patel, Rakesh P.; Katsargyris, Athanasios Verhoeven, Eric L. G.; Adam, Donald J.; Hardman, John A.

    2013-12-15

    The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR.

  18. Current surgical results of acute type A aortic dissection in Japan.

    PubMed

    Okita, Yutaka

    2016-07-01

    Current surgical results of acute type A aortic dissection in Japan are presented. According to the annual survey by the Japanese Association of Thoracic Surgery, 4,444 patients with acute type A aortic dissection underwent surgical procedures and the overall hospital mortality was 9.1% in 2013. The prevalence of aortic root replacement with a valve sparing technique, total arch replacement (TAR), and frozen stent graft are presented and strategies for thrombosed dissection or organ malperfusion syndrome secondary to acute aortic dissection are discussed. PMID:27563550

  19. Current surgical results of acute type A aortic dissection in Japan

    PubMed Central

    2016-01-01

    Current surgical results of acute type A aortic dissection in Japan are presented. According to the annual survey by the Japanese Association of Thoracic Surgery, 4,444 patients with acute type A aortic dissection underwent surgical procedures and the overall hospital mortality was 9.1% in 2013. The prevalence of aortic root replacement with a valve sparing technique, total arch replacement (TAR), and frozen stent graft are presented and strategies for thrombosed dissection or organ malperfusion syndrome secondary to acute aortic dissection are discussed. PMID:27563550

  20. Percutaneous Closure of an Iatrogenic Puncture of the Aortic Arch

    SciTech Connect

    Patel, S.J. Venn, G.E.; Redwood, S.R.

    2003-08-15

    We report on the management of a rare complication of a vascular sheath being placed inadvertently in the aorta rather than in the venous system following thrombolytic therapy administration in a patient presenting with an acute myocardial infarction and complete heart block.

  1. Reoperative Aortic Root Replacement in Patients with Previous Aortic Root or Aortic Valve Procedures

    PubMed Central

    Chong, Byung Kwon; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won; Kim, Joon Bum

    2016-01-01

    Background Generalization of standardized surgical techniques to treat aortic valve (AV) and aortic root diseases has benefited large numbers of patients. As a consequence of the proliferation of patients receiving aortic root surgeries, surgeons are more frequently challenged by reoperative aortic root procedures. The aim of this study was to evaluate the outcomes of redo-aortic root replacement (ARR). Methods We retrospectively reviewed 66 patients (36 male; mean age, 44.5±9.5 years) who underwent redo-ARR following AV or aortic root procedures between April 1995 and June 2015. Results Emergency surgeries comprised 43.9% (n=29). Indications for the redo-ARR were aneurysm (n=12), pseudoaneurysm (n=1), or dissection (n=6) of the residual native aortic sinus in 19 patients (28.8%), native AV dysfunction in 8 patients (12.1%), structural dysfunction of an implanted bioprosthetic AV in 19 patients (28.8%), and infection of previously replaced AV or proximal aortic grafts in 30 patients (45.5%). There were 3 early deaths (4.5%). During follow-up (median, 54.65 months; quartile 1–3, 17.93 to 95.71 months), there were 14 late deaths (21.2%), and 9 valve-related complications including reoperation of the aortic root in 1 patient, infective endocarditis in 3 patients, and hemorrhagic events in 5 patients. Overall survival and event-free survival rates at 5 years were 81.5%±5.1% and 76.4%±5.4%, respectively. Conclusion Despite technical challenges and a high rate of emergency conditions in patients requiring redo-ARR, early and late outcomes were acceptable in these patients. PMID:27525233

  2. Thoracic Malignancies and Pulmonary Nodules in Patients under Evaluation for Transcatheter Aortic Valve Implantation (TAVI): Incidence, Follow Up and Possible Impact on Treatment Decision

    PubMed Central

    Kaleschke, Gerrit; Schülke, Christoph; Görlich, Dennis; Schliemann, Christoph; Kessler, Torsten; Schulze, Arik Bernard; Buerke, Boris; Kuemmel, Andreas; Thrull, Michael; Wiewrodt, Rainer; Baumgartner, Helmut; Berdel, Wolfgang E.; Mohr, Michael

    2016-01-01

    Background Transcatheter aortic valve implantation (TAVI) has become the treatment of choice in patients with severe aortic valve stenosis who are not eligible for operative replacement and an alternative for those with high surgical risk. Due to high age and smoking history in a high proportion of TAVI patients, suspicious findings are frequently observed in pre-procedural chest computer tomography (CCT). Methods CCT scans of 484 consecutive patients undergoing TAVI were evaluated for incidentally discovered solitary pulmonary nodules (SPN). Results In the entire study population, SPN ≥ 5 mm were found in 87 patients (18%). These patients were compared to 150 patients who were incidentally collected from the 397 patients without SPN or with SPN < 5 mm (control group). After a median follow-up of 455 days, lung cancer was diagnosed in only two patients. Neither SPN ≥ 5 mm (p = 0.579) nor SPN > 8 mm (p = 0.328) were significant predictors of overall survival. Conclusions Despite the high prevalence of SPNs in this single center TAVI cohort lung cancer incidence at midterm follow-up seems to be low. Thus, aggressive diagnostic approaches for incidentally discovered SPN during TAVI evaluation should not delay the treatment of aortic stenosis. Unless advanced thoracic malignancy is obvious, the well documented reduction of morbidity and mortality by TAVI outweighs potentially harmful delays regarding further diagnostics. Standard guideline-approved procedure for SPN can be safely performed after TAVI. PMID:27171441

  3. [Perioperative management of endovascular stent graft placement for abdominal aortic aneurysm].

    PubMed

    Yamashita, A; Ishida, K; Aratake, K; Wakamatsu, H; Kawata, R; Kunihiro, M; Sakabe, T

    2000-09-01

    We retrospectively examined the changes in hemodynamics, oxygen index and renal function along with the complications in 25 patients who had undergone endovascular stent graft placement (ESG) surgery for abdominal aortic aneurysm. During stent graft placement, mean arterial pressure decreased to 58 +/- 8 mmHg by increasing the dose of anesthetics and/or using vasodilators. Except for this intended hypotensive period, mean arterial pressure and heart rate were relatively stable and adequately maintained during surgical manipulation. Oxygenation index was well maintained. A patient with a high preoperative creatinine level underwent prophylactic hemodialysis postoperatively. In other patients except one who died in early postoperative period, both BUN and creatinine levels were kept within normal ranges. Four patients died postoperatively and the causes of the death in two patients are related to the surgical procedure; one with multiple emboli possibly due to released atheloma from the aortic wall during procedure, the other with sepsis due to infected stent graft. Although ESG is a well tolerated procedure, embolism is the most serious complication. Careful preoperative evaluation of the ascending arch and descending aortic wall and monitoring with transcranial doppler are necessary. PMID:11025953

  4. When and how to replace the aortic root in type A aortic dissection

    PubMed Central

    Leshnower, Bradley G.

    2016-01-01

    Management of aortic root pathology during repair of acute type A aortic dissection (TAAD) requires a comprehensive evaluation of the patient’s anatomy, demographics, comorbidities and physiologic status at the time of emergent operative intervention. Surgical options include conservative repair of the root (CRR) (with or without replacement of the aortic valve), replacement of the native valve and aortic root using a composite valve-conduit and valve sparing root replacement (VSRR). The primary objective of this review is to provide data for surgeons to aid in their decision-making process regarding management of the aortic root during repair of TAAD. No time or language restrictions were imposed and references of the selected studies were checked for additional relevant citations. Multiple retrospective reviews have demonstrated equivalent operative mortality between aortic root repair and replacement during TAAD. There is a higher incidence of aortic root reintervention with aortic root repair compared to aortic root replacement (ARR). Experienced, high-volume aortic centers have demonstrated the safety of VSRR in young, hemodynamically stable patients presenting with TAAD. In conclusion, aortic root repair can safely be performed in the vast majority of patients with TAAD. Despite the increased surgical complexity, ARR does not increase operative mortality and improves the freedom from root reintervention. VSRR can be performed in highly selected populations of patients with TAAD with durable mid-term valve function. PMID:27563551

  5. When and how to replace the aortic root in type A aortic dissection.

    PubMed

    Leshnower, Bradley G; Chen, Edward P

    2016-07-01

    Management of aortic root pathology during repair of acute type A aortic dissection (TAAD) requires a comprehensive evaluation of the patient's anatomy, demographics, comorbidities and physiologic status at the time of emergent operative intervention. Surgical options include conservative repair of the root (CRR) (with or without replacement of the aortic valve), replacement of the native valve and aortic root using a composite valve-conduit and valve sparing root replacement (VSRR). The primary objective of this review is to provide data for surgeons to aid in their decision-making process regarding management of the aortic root during repair of TAAD. No time or language restrictions were imposed and references of the selected studies were checked for additional relevant citations. Multiple retrospective reviews have demonstrated equivalent operative mortality between aortic root repair and replacement during TAAD. There is a higher incidence of aortic root reintervention with aortic root repair compared to aortic root replacement (ARR). Experienced, high-volume aortic centers have demonstrated the safety of VSRR in young, hemodynamically stable patients presenting with TAAD. In conclusion, aortic root repair can safely be performed in the vast majority of patients with TAAD. Despite the increased surgical complexity, ARR does not increase operative mortality and improves the freedom from root reintervention. VSRR can be performed in highly selected populations of patients with TAAD with durable mid-term valve function. PMID:27563551

  6. Equivalent Imperfections In Arched Structures

    NASA Astrophysics Data System (ADS)

    Dallemule, Marian

    2015-09-01

    There are currently three design methods to verify the in-plane buckling of an arched structure: substitute member method, the method of equivalent imperfection with recommendations for arched bridges, and the equivalent unique global and local initial imperfection method (EUGLI), which uses the critical elastic buckling mode as an imperfection. The latter method is included in the EN 1993-1-1 cl. 5.3.2 (11) since 2002; however, to this day it is neither utilized in the design practice nor is it incorporated in ordinary structural analysis software. The main purpose of this article is to show the application of the proposed methods in a step-by-step manner to the numerical example considered and to compare these design methods for various arched structures. Verification of the in-plane buckling of an arch is explained in detail.

  7. Real-time transesophageal echocardiography facilitates antegrade balloon aortic valvuloplasty

    PubMed Central

    Ito, Kazato; Yano, Kentaro; Tanaka, Chiharu; Nakashoji, Tomohiro; Tonomura, Daisuke; Takehara, Kosuke; Kino, Naoto; Yoshida, Masataka; Kurotobi, Toshiya; Tsuchida, Takao; Fukumoto, Hitoshi

    2016-01-01

    We report two cases of severe aortic stenosis (AS) where antegrade balloon aortic valvuloplasty (BAV) was performed under real-time transesophageal echocardiography (TEE) guidance. Real-time TEE can provide useful information for evaluating the aortic valve response to valvuloplasty during the procedure. It was led with the intentional wire-bias technique in order to compress the severely calcified leaflet, and consequently allowed the balloon to reach the largest possible size and achieve full expansion of the aortic annulus. PMID:27054107

  8. Aortic valve decalcification revisited.

    PubMed

    Marty, A T; Mufti, S; Murabit, I

    1989-11-01

    A 75-year-old woman with a small calcified aortic root, severe aortic stenosis and triple vessel coronary artery disease developed angina at rest. Aortic valve decalcification and quadruple aorto-coronary bypass were done as her aortic root was too small and calcified to do anything else. Postoperative clinical and hemodynamic results have been excellent. Literature review supports application of this therapy in selected patients with trileaflet senescent aortic stenosis. PMID:2614067

  9. Evaluation of aortic and mitral valve regurgitation by radionuclide ventriculography: comparison with the method of Sandler and Dodge

    SciTech Connect

    Kress, P.; Geffers, H.; Stauch, M.; Nechwatal, W.; Sigel, H.; Bitter, F.; Adam, W.E.

    1981-01-01

    The present investigation was undertaken to introduce a quantitative scintigraphic method for evaluation of regurgitation and to compare it with the generally accepted quantitative method of Sandler and Dodge. Radionuclide ventriculography was carried out after injection of 20 mCi 99mtechnetium-labeled red blood cells. Time-activity curves were obtained from the left and right ventricular regions. The ratio of end-diastolic-end-systolic count-rate differences for the left and right ventricles was calculated. The ratio (A) was compared with a hemodynamic ratio determined after the method of Sandler and Dodge with the stroke volume of the left ventricle measured angiographically, and the stroke volume of the right ventricle measured by thermodilution. In 33 patients with aortic and mitral valve regurgitation researchers found a correlation of r . 0.75. Due to a broad range of normal values of the sensitivity of the scintigraphic method is low. The specificity seems to be high, however, since in 64 patients with all types of heart diseases there were no false positive results. Comparing the described scintigraphic method with other modern or generally accepted methods, the principal advantages are noninvasiveness, good practicability, and the fact that important additional information about the functional state of the heart is gained. This is important in follow-up studies in patients with chronic valvular incompetence. It seems that this method will become a valuable supplement to heart catheterization in the diagnosis of valvular heart disease and may partially replace invasive methods for measuring the regurgitation fraction.

  10. Electrocardiographic diagnosis of left ventricular hypertrophy in aortic valve disease: evaluation of ECG criteria by cardiovascular magnetic resonance

    PubMed Central

    Buchner, Stefan; Debl, Kurt; Haimerl, Josef; Djavidani, Behrus; Poschenrieder, Florian; Feuerbach, Stefan; Riegger, Guenter AJ; Luchner, Andreas

    2009-01-01

    Background Left ventricular hypertrophy (LVH) is a hallmark of chronic pressure or volume overload of the left ventricle and is associated with risk of cardiovascular morbidity and mortality. The purpose was to evaluate different electrocardiographic criteria for LVH as determined by cardiovascular magnetic resonance (CMR). Additionally, the effects of concentric and eccentric LVH on depolarization and repolarization were assessed. Methods 120 patients with aortic valve disease and 30 healthy volunteers were analysed. As ECG criteria for LVH, we assessed the Sokolow-Lyon voltage/product, Gubner-Ungerleider voltage, Cornell voltage/product, Perugia-score and Romhilt-Estes score. Results All ECG criteria demonstrated a significant correlation with LV mass and chamber size. The highest predictive values were achieved by the Romhilt-Estes score 4 points with a sensitivity of 86% and specificity of 81%. There was no difference in all ECG criteria between concentric and eccentric LVH. However, the intrinsicoid deflection (V6 37 ± 1.0 ms vs. 43 ± 1.6 ms, p < 0.05) was shorter in concentric LVH than in eccentric LVH and amplitudes of ST-segment (V5 -0.06 ± 0.01 vs. -0.02 ± 0.01) and T-wave (V5 -0.03 ± 0.04 vs. 0.18 ± 0.05) in the anterolateral leads (p < 0.05) were deeper. Conclusion By calibration with CMR, a wide range of predictive values was found for the various ECG criteria for LVH with the most favourable results for the Romhilt-Estes score. As electrocardiographic correlate for concentric LVH as compared with eccentric LVH, a shorter intrinsicoid deflection and a significant ST-segment and T-wave depression in the anterolateral leads was noted. PMID:19486532

  11. Device Conformability and Morphological Assessment After TEVAR for Aortic Type B Dissection: A Single-Centre Experience with a Conformable Thoracic Stent-Graft Design.

    PubMed

    Bischoff, Moritz S; Müller-Eschner, Matthias; Meisenbacher, Katrin; Peters, Andreas S; Böckler, Dittmar

    2015-01-01

    BACKGROUND The aim of this study was to analyze device conformability in TEVAR of acute and chronic (a/c) type B aortic dissections (TBAD) using the Gore Conformable Thoracic Aortic Stent-graft (CTAG). MATERIAL AND METHODS From January 1997 to February 2014, a total of 90 out of 405 patients in our center received TEVAR for TBAD. Since November 2009, 23 patients (16 men; median age: 62 years) were treated with the CTAG. Indications were complicated aTBAD in 15 (65%) and expanding cTBAD in 8 (35%) patients. Primary endpoints were the assessment of device conformability by measuring the distance (D) from the radiopaque gold band marker (GM) at the proximal CTAG end to the inner curvature (IC) of the arch on parasagittal multiplanar reformations of CT angiography, as well as the evaluation of aortic diameter changes following TEVAR. Median follow-up was 13.3 months (range: 2 days to 35 months). RESULTS Primary and secondary success rates were 91.3% (21/23) and 95.6% (22/23), respectively. There was 1 type Ia endoleak, retrograde dissection or primary conversion was not observed. Median GM-IC-D was 0 mm (range: 0 mm to 10 mm). GM-IC-D was associated with zone 2 placement compared to zone 3 (P=0.036). There was no association between GM-IC-D formation and arch type. In aTBAD cases the true lumen significantly increased after TEVAR (P=0.017) and the false lumen underwent shrinkage (P=0.025). In cTBAD patients the false lumen decreased after TEVAR (P=0.036). CONCLUSIONS The CTAG shows favorable conformability and wall apposition in challenging arch pathologies such as TBAD. PMID:26718893

  12. Device Conformability and Morphological Assessment After TEVAR for Aortic Type B Dissection: A Single-Centre Experience with a Conformable Thoracic Stent-Graft Design

    PubMed Central

    Bischoff, Moritz S.; Müller-Eschner, Matthias; Meisenbacher, Katrin; Peters, Andreas S.; Böckler, Dittmar

    2015-01-01

    Background The aim of this study was to analyze device conformability in TEVAR of acute and chronic (a/c) type B aortic dissections (TBAD) using the Gore Conformable Thoracic Aortic Stent-graft (CTAG). Material/Methods From January 1997 to February 2014, a total of 90 out of 405 patients in our center received TEVAR for TBAD. Since November 2009, 23 patients (16 men; median age: 62 years) were treated with the CTAG. Indications were complicated aTBAD in 15 (65%) and expanding cTBAD in 8 (35%) patients. Primary endpoints were the assessment of device conformability by measuring the distance (D) from the radiopaque gold band marker (GM) at the proximal CTAG end to the inner curvature (IC) of the arch on parasagittal multiplanar reformations of CT angiography, as well as the evaluation of aortic diameter changes following TEVAR. Median follow-up was 13.3 months (range: 2 days to 35 months). Results Primary and secondary success rates were 91.3% (21/23) and 95.6% (22/23), respectively. There was 1 type Ia endoleak, retrograde dissection or primary conversion was not observed. Median GM-IC-D was 0 mm (range: 0 mm to 10 mm). GM-IC-D was associated with zone 2 placement compared to zone 3 (P=0.036). There was no association between GM-IC-D formation and arch type. In aTBAD cases the true lumen significantly increased after TEVAR (P=0.017) and the false lumen underwent shrinkage (P=0.025). In cTBAD patients the false lumen decreased after TEVAR (P=0.036). Conclusions The CTAG shows favorable conformability and wall apposition in challenging arch pathologies such as TBAD. PMID:26718893

  13. On-Pump Beating Heart Extraanatomical Ascending-Descending Aortic Bypass Using a Beating Heart Positioner in an Adult with Aortic Coarctation

    PubMed Central

    Gyoten, Takayuki; Nagura, Saori; Yamashita, Akio; Fukahara, Kazuaki; Kotoh, Keiju; Yoshimura, Naoki

    2016-01-01

    The prognosis of uncorrected aortic coarctation is poor due to development of heart failure. We performed an on-pump beating heart extraanatomical ascending-descending aortic bypass using a beating heart positioner in an adult with coarctation complicated by severe left ventricular hypertrophy. A 51-year-old woman was referred with severe hypertension. Computed tomography demonstrated severe distal aortic arch narrowing. Coarctation of the aorta was diagnosed. A posterior pericardial beating heart extraanatomical bypass via median sternotomy was performed from the ascending to descending aorta using a heart positioner. Her postoperative course was uneventful and blood pressure was normal on a low-dose beta-blocker. PMID:27087874

  14. Surgical Management of Necrotizing Mediastinitis With Large Aortic Pseudoaneurysm.

    PubMed

    Chevalier, Andrew T; Khaja, Minhaj S; Yang, Bo

    2016-05-01

    We report a patient with necrotizing mediastinitis complicated by a giant retrosternal mycotic pseudoaneurysm and prosthetic valve endocarditis successfully managed with a redo sternotomy under hypothermic circulatory arrest. The approach then included extensive débridement of the mediastinum, replacement of the ascending aorta and aortic arch with selective antegrade cerebral perfusion, redo aortic valve replacement, and wound closure with omental flap and myocutaneous flap. After a 2-year survival, the patient suffered reinfection from hemodialysis. Our approach is also applicable to more common presentations of mediastinitis. PMID:27106461

  15. [Computer-assisted evaluation of aortic aneurysm morphology for choosing the method of therapy].

    PubMed

    Allenberg, J R; Schumacher, H; Robbie, P

    1998-01-01

    Computer aided surgery planning software for AAA is a industry-standard software development for viewing patient-specific data on a personal computer through a unique approach, which improve visualization, navigation, and decision support capabilities for both open and endovascular surgery. Raw scan data is extracted from CT scans, and rendered into a three-dimensional format. This 3D modeling technology and user interface provides a patient-specific model with a rapid visual access to the full range of information, including accurate 3D assessment of AAA morphology and pathology, interactive multiplanar reconstructions, measurements, and views to assist the surgeon in understanding of complex 3D relationships. It provides an optimal system for patient evaluation and selection for endovascular repair of AAA and in the post-operative evaluation of stent deployment and/or complications, such as endoleaks. PMID:9931591

  16. Ruptured Mycotic Aortic Aneurysm in a Sooty Mangabey (Cercocebus atys)

    PubMed Central

    Sharma, Prachi; Cohen, Joyce K; Lockhart, Shawn R; Hurst, Steven F; Drew, Clifton P

    2011-01-01

    Mycotic aortic aneurysm is a local, irreversible dilatation of the aorta associated with destruction of the vessel wall by infection and is a grave clinical condition associated with high morbidity and mortality in humans. Rupture of aortic aneurysms can be spontaneous, idiopathic, or due to severe trauma, and the condition has been associated with bacterial and, rarely, fungal infections in humans and animals. Here, we describe a case of ruptured spontaneous aortic aneurysm associated with zygomycetic infection in a 21-y-old female sooty mangabey. The animal did not present with any significant clinical signs before being found dead. At necropsy, she was in good body condition, and the thoracic cavity had a large amount of clotted blood filling the left pleural space and surrounding the lung lobes. Near the aortic arch, the descending thoracic aorta was focally perforated (diameter, approximately 0.15 cm), and clotted blood adhered to the tunica adventitia. The aortic intima had multiple, firm, pale-yellow nodules (diameter, 0.25 to 0.5 cm). Histopathologically, these nodules consisted of severe multifocal pyogranulomatous inflammation intermixed with necrosis, fibrin, and broad, infrequently septate, thin-walled fungal hyphae. Immunohistochemistry revealed fungal hyphae characteristic of Mucormycetes (formerly Zygomycetes), and PCR analysis identified the organism as Basidiobolus spp. Dissemination of the fungus beyond the aorta was not noted. Spontaneous aortic aneurysms have been described in nonhuman primates, but this is the first reported case of a ruptured spontaneous aortic aneurysm associated with entomophthoromycetic infection in a sooty mangabey. PMID:22330581

  17. Renal embolism as a primary manifestation of Streptococcus dysgalactiae subspecies equisimilis endocarditis in a patient with chronic aortic dissection.

    PubMed

    Ishimaru, Naoto; Kinami, Saori; Ohnishi, Hisashi; Takagi, Asuka; Kawamoto, Megumi; Doukuni, Ryota; Umezawa, Kanoko; Oozone, Sachiko; Yoshimura, Sho; Sakamoto, Susumu

    2015-06-01

    We report a case of renal embolism as an initial manifestation of Streptococcus dysgalactiae subspecies equisimilis (SDSE) endocarditis in a patient with chronic aortic dissection. A 37-year-old man who underwent total aortic arch replacement owing to aortic dissection, presented with a 3-h history of fever, chills, and acute right-sided flank pain. The endocarditis affected the native aortic valve and was complicated by a renal embolism. Blood culture results were positive for SDSE. Intravenous penicillin resulted in satisfactory clinical and echocardiographic recovery. PMID:26110298

  18. [Aortic intramural hematoma. An atypical pattern equivalent to aortic dissection].

    PubMed

    López-Mínguez, J R; Merchán, A; Arrobas, J; Fernández, G; González-Egüaras, M; García-Andoaín, J M; Alonso, M; Gamero, C; Poblador, M A; Alonso, F

    1995-09-01

    A case is presented of a hypertensive woman who had suffered a stabbing back pain for some three hours, with mild irradiation to precordium and accompanied by vegetative signs. A sinusal rhythm and negative T waves of little depth were seen on the ECG. A transthoracic bidimensional echocardiogram (TTE) showed a normal left ventricle with a somewhat dilated aortic root and the existence of a double echo running parallel to the anterior wall of the aorta but non-ondulating and without a visible intimal flap. Because of suspected aortic dissection an urgent contrasted CAT and a transesophageal echocardiogram were performed. These were informed as an aneurysm of the aortic root with mural thrombus from the ascending to descending aorta, but with no existing intimal flap suggesting dissection. A cardiac catheterization showed a mildly some dilated aortic root without dissection signs and normal left ventricle and coronary arteries. The patient was presented for surgical evaluation but, since no dissection was present, was not considered urgent surgery; she was admitted to the coronary unit and died 48 hours later in a situation of acute pericardial tamponade, documented by TTE, surely due to rupture of the aortic root to pericardial sack. This way of presenting threatened aorta rupture that has been only recently recognized is discussed, as well as some misconceptions which must be avoided. PMID:7569267

  19. Ball motion and sliding friction in an arched outer-race ball bearing

    NASA Technical Reports Server (NTRS)

    Hamrock, B. J.

    1974-01-01

    The motion of the ball and sliding friction in an arched outer-race ball bearing under thrust load is analyzed. Fatigue life evaluations were made. The analysis is applied to a 150-millimeter-bore ball bearing. The results indicated that for high-speed light-load applications the arched bearing has significant improvement in fatigue life over that of a conventional bearing. An arching of 0.254 mm (0.01 in.) was found to be optimal. Also, for an arched bearing a considerable amount of spinning occurs at the outer-race contacts.

  20. Ball motion and sliding friction in an arched outer race ball bearing

    NASA Technical Reports Server (NTRS)

    Hamrock, B. J.

    1973-01-01

    The motion of the ball and sliding friction in an arched outer race ball bearing under thrust loads is determined. Fatigue life evaluations were made. The analysis is applied to a 150 millimeter bore ball bearing. The results indicated that for high speed-light load applications the arched bearing has significant improvement in fatigue life over that of a conventional bearing. An arching of 0.254 mm (0.01 in.) was found to be an optimal. For an arched bearing it was also found that a considerable amount of spinning occurs at the outer race contacts.

  1. Ball motion and sliding friction in an arched outer race ball bearing

    NASA Technical Reports Server (NTRS)

    Hamrock, B. J.

    1974-01-01

    The motion of the ball and sliding friction in an arched outer-race ball bearing under thrust load is determined. Fatigue life evaluations were made. The analysis is applied to a 150 millimeter bore ball bearing. The results indicated that for high speed-light load applications the arched bearing has significant improvement in fatigue life over that of a conventional bearing. An arching of 0.254 mm (0.01 in.) was found to be an optimal. For an arched bearing it was also found that a considerable amount of spinning occurs at the outer race contacts.

  2. A method for early evaluation of a recently introduced technology by deriving a comparative group from existing clinical data: a case study in external support of the Marfan aortic root

    PubMed Central

    Crowe, Sonya; Chan, K M John; Ranasinghe, Aaron; Attia, Rizwan; Lees, Belinda; Utley, Martin; Golesworthy, Tal; Pepper, John

    2012-01-01

    Objective During the early phase of evaluation of a new intervention, data exist for present practice. The authors propose a method of constructing a fair comparator group using these data. In this case study, the authors use the example of external aortic root support, a novel alternative to aortic root replacement. Design A matched comparison group, of similar age, aortic size and aortic valve function to those having the novel intervention, was constructed, by minimization, from among patients having conventional aortic root replacement in other hospitals during the same time frame. Setting Three cardiac surgical units in England. Patients The first 20 patients, aged 16–58 years with aortic root diameters of 40–54 mm, having external support surgery were compared with 20 patients, aged 18–63 years and aortic root diameters of 38–58 mm, who had conventional aortic root replacement, between May 2004 and December 2009. Interventions A pliant external mesh sleeve, customised by computer-aided design, encloses the whole of the ascending aorta. The comparator group had conventional aortic root replacement, 16 valve-sparing and four with composite valved grafts. Main outcome measures Duration of cardiopulmonary bypass (CPB), myocardial ischaemic time, blood loss and transfusion of blood, platelets and clotting factors. Results Comparing total root replacement and customised aortic root support surgery: CPB (median (range)) was 134 (52–316) versus 0 (0–20) min; myocardial ischaemia 114 (41–250) versus 0 (0–0) min; 4 h blood loss was 218 (85–735) versus 50 (25–400) ml; and 9/18 had blood transfusion, 9/18 platelets and 12/18 fresh frozen plasma after root replacement versus 1/20, 0/20 and 0/20, respectively, for the novel surgery. Conclusions Avoidance or large reductions in CPB, myocardial ischaemia and blood product usage were achieved with the novel surgery. These data are of use in decision analysis and health economic evaluation

  3. Aortic valve replacement in rheumatoid aortic incompetence.

    PubMed Central

    Devlin, A B; Goldstraw, P; Caves, P K

    1978-01-01

    Rheumatoid aortic valve disease is uncommon. and there are few reports of valve replacement in this condition. Aortic valve replacement and partial pericardiectomy was performed in a patient with acute rheumatoid aortitis and aortic incompetence. Previous reports suggest that any patient with rheumatoid arthritis who develops cardiac symptoms should be carefully assessed for surgically treatable involvement of the pericardium or heart valves. Images PMID:725829

  4. Effect of Different Rotational Directions of BJUT-II VAD on Aortic Swirling Flow Characteristics: A Primary Computational Fluid Dynamics Study

    PubMed Central

    Zhang, Qi; Gao, Bin; Chang, Yu

    2016-01-01

    Background The BJUT-II VAD is a novel left ventricular assist device (LVAD), which is thought to have significant effects on the characteristics of aortic swirling flow. However, the precise mechanism of the rotational direction of BJTU-II VAD in the aortic swirling flow is unclear. Material/Methods A patient-specific aortic geometric model was reconstructed based on the CT data. Three pump’s output flow profiles with varied rotational direction, termed “counterclockwise”, “flat profile”, and “clockwise”, were used as the boundary conditions. The helicity density, area-weighted average of helicity density (Ha), localized normalized helicity (LNH), wall shear stress (WSS), and WSS spatial gradient (WSSG) were calculated to evaluate the swirling flow characteristics in the aorta. Results The results demonstrated that the swirling flow characteristics in the aorta and 3 branches are directly affected by the output blood flow of BJUT-II VAD. In the aortic arch, the helicity density, supported by the clockwise case, achieved the highest value. In the 3 branches, the flat profile case achieved the highest helicity density, whereas the maximum WSS and WSSG generated by clockwise case were lower than in other cases. Conclusions The outflow of the BJUT-II VAD has significant effects on the aortic hemodynamics and swirling flow characteristics. The helical blood profiles can enhance the strength of aortic swirling flow, and reduce the areas of low WSS and WSSG regions. The clockwise case may have a benefit for preventing development of atherosclerosis in the aorta. PMID:27440399

  5. Intraoperative tracking of aortic valve plane.

    PubMed

    Nguyen, D L H; Garreau, M; Auffret, V; Le Breton, H; Verhoye, J P; Haigron, P

    2013-01-01

    The main objective of this work is to track the aortic valve plane in intra-operative fluoroscopic images in order to optimize and secure Transcatheter Aortic Valve Implantation (TAVI) procedure. This paper is focused on the issue of aortic valve calcifications tracking in fluoroscopic images. We propose a new method based on the Tracking-Learning-Detection approach, applied to the aortic valve calcifications in order to determine the position of the aortic valve plane in intra-operative TAVI images. This main contribution concerns the improvement of object detection by updating the recursive tracker in which all features are tracked jointly. The approach has been evaluated on four patient databases, providing an absolute mean displacement error less than 10 pixels (≈2mm). Its suitability for the TAVI procedure has been analyzed. PMID:24110703

  6. Abdominal aortic aneurysm

    MedlinePlus

    ... to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aorta becomes ... blood pressure Male gender Genetic factors An abdominal aortic aneurysm is most often seen in males over age ...

  7. Aortic aneurysm repair - endovascular

    MedlinePlus

    ... Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... leaking or bleeding. You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. ...

  8. Aortic aneurysm repair - endovascular

    MedlinePlus

    EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... leaking or bleeding. You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. ...

  9. A model for predicting aortic dynamic response to -G sub z impact acceleration.

    NASA Technical Reports Server (NTRS)

    Advani, S. H.; Tarnay, T. J.; Byars, E. F.; Love, J. S.

    1972-01-01

    A steady state dynamic response model for the radial motion of the aorta is developed from in vivo pressure-displacement and nerve stimulation experiments on canines. The model represented by a modified Van der Pol wave motion oscillator closely predicts steady state and perturbed response results. The applicability of the steady state canine aortic model to tailward acting impact forces is studied by means of the perturbed phase plane of the oscillator. The backflow through the aortic arch resulting from a specified acceleration-time profile is computed and an analysis for predicting the forced motion aortic response is presented.

  10. Techniques for preserving vertebral artery perfusion during thoracic aortic stent grafting requiring aortic arch landing.

    PubMed

    Woo, Edward Y; Bavaria, Joseph E; Pochettino, Alberto; Gleason, Thomas G; Woo, Y Joseph; Velazquez, Omaida C; Carpenter, Jeffrey P; Cheung, Albert T; Fairman, Ronald M

    2006-01-01

    Thoracic endografting offers many advantages over open repair. However, delivery of the device can be difficult and may necessitate adjunctive procedures. We describe our techniques for preserving perfusion to the left subclavian artery despite endograft coverage to obtain a proximal seal zone. We reviewed our experience with the Talent thoracic stent graft (Medtronic, Santa Rosa, CA). From 1999 to 2003, 49 patients received this device (29 men, 20 women). Seventeen patients required adjunctive procedures to facilitate proximal graft placement. We performed left subclavian-to-left common carotid artery transposition (6), left common carotid-to-left subclavian artery bypass with ligation proximal to the vertebral artery (7), and left common carotid-to-left subclavian artery bypass with proximal coil embolization (4). Patients who had anatomy unfavorable to transposition or bypass with proximal ligation (large aneurysms or proximal vertebral artery origin) were treated with coil embolization of the proximal left subclavian artery in order to prevent subsequent type II endoleaks. Technical success rate of the carotid subclavian bypass was 100%. Patient follow-up ranged from 3 to 48 months with a mean of 12 months. Six patients had follow-up <6 months owing to recent graft placement. Primary patency was 100%. No neurologic events occurred during the procedure or upon follow-up. One patient had a transient chyle leak that spontaneously resolved in 24 hours. Another patient had a phrenic nerve paresis that resolved after 3 weeks. We believe that it is important to maintain patency of the vertebral artery specifically when a patent right vertebral system and an intact basilar artery is not demonstrated. Furthermore, we describe a novel technique of coil embolization of the proximal left subclavian artery in conjunction with left common carotid-to-left subclavian artery bypass. This circumvents the need for potentially hazardous mediastinal dissection and ligation of the proximal left subclavian artery in cases of large proximal aneurysms or unfavorable vertebral artery anatomy. PMID:17038570

  11. Abdominal Aortic Aneurysms: Treatments

    MedlinePlus

    ... information Membership Directory (SIR login) Interventional Radiology Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists ...

  12. The Algebra of the Arches

    ERIC Educational Resources Information Center

    Buerman, Margaret

    2007-01-01

    Finding real-world examples for middle school algebra classes can be difficult but not impossible. As we strive to accomplish teaching our students how to solve and graph equations, we neglect to teach the big ideas of algebra. One of those big ideas is functions. This article gives three examples of functions that are found in Arches National…

  13. Management of Traumatic Aortic and Splenic Rupture in a Patient With Ascending Aortic Aneurysm.

    PubMed

    Topcu, Ahmet Can; Ciloglu, Ufuk; Bolukcu, Ahmet; Dagsali, Sabri

    2016-08-01

    Traumatic aortic rupture is rupture of all or part of the aortic wall, mostly resulting from blunt trauma to the chest. The most common site of rupture is the aortic isthmus. Traumatic rupture of the ascending aorta is rare. A 62-year-old man with a family history of ascending aortic aneurysm was referred to our hospital after a motor vehicle accident. He had symptoms of cardiogenic shock. A contrast-enhanced computed tomographic scan revealed rupture of the proximal ascending aorta and an ascending aortic aneurysm with a diameter of 55 mm at the level of the sinuses of Valsalva. Transthoracic echocardiography at the bedside revealed severe aortic valvular insufficiency. We performed a successful Bentall procedure. During postoperative recovery, the patient experienced a cerebrovascular accident. Transesophageal echocardiography did not reveal thrombosis of the mechanical prosthesis. The patient's symptoms resolved in time, and he was discharged from the hospital on postoperative day 47 without any sequelae. He has been symptom free during a 6-month follow-up period. We suggest that individuals who have experienced blunt trauma to the chest and have symptoms of traumatic aortic rupture and a known medical history of ascending aortic aneurysm should be evaluated for a rupture at the ascending aorta and the aortic isthmus. PMID:27449463

  14. Update in the management of type B aortic dissection.

    PubMed

    Nauta, Foeke Jh; Trimarchi, Santi; Kamman, Arnoud V; Moll, Frans L; van Herwaarden, Joost A; Patel, Himanshu J; Figueroa, C Alberto; Eagle, Kim A; Froehlich, James B

    2016-06-01

    Stanford type B aortic dissection (TBAD) is a life-threatening aortic disease. The initial management goal is to prevent aortic rupture, propagation of the dissection, and symptoms by reducing the heart rate and blood pressure. Uncomplicated TBAD patients require prompt medical management to prevent aortic dilatation or rupture during subsequent follow-up. Complicated TBAD patients require immediate invasive management to prevent death or injury caused by rupture or malperfusion. Recent developments in diagnosis and management have reduced mortality related to TBAD considerably. In particular, the introduction of thoracic stent-grafts has shifted the management from surgical to endovascular repair, contributing to a fourfold increase in early survival in complicated TBAD. Furthermore, endovascular repair is now considered in some uncomplicated TBAD patients in addition to optimal medical therapy. For more challenging aortic dissection patients with involvement of the aortic arch, hybrid approaches, combining open and endovascular repair, have had promising results. Regardless of the chosen management strategy, strict antihypertensive control should be administered to all TBAD patients in addition to close imaging surveillance. Future developments in stent-graft design, medical therapy, surgical and hybrid techniques, imaging, and genetic screening may improve the outcomes of TBAD patients even further. We present a comprehensive review of the recommended management strategy based on current evidence in the literature. PMID:27067136

  15. Complex Reoperation for Late Complications After Acute Type A Aortic Dissection Surgery

    PubMed Central

    Stöger, Guillermo; Ríos, Matías; Battellini, Roberto; Bracco, Daniel; Kotowicz, Vadim

    2015-01-01

    The correct management of acute Type A dissection continues to be a challenge. The primary goal is to save the patient´s life. However, the decision regarding the surgical approach determines possible later complications. We present the case of a 59-year-old female patient with a past history of emergent surgery for acute Type A dissection treated by supracoronary ascending and aortic valve replacement 19 years previously. Later, in a second endovascular approach, the descending aorta was treated by a thoracic endoprosthesis. During follow-up a dilated aortic root and a Type I endoleak were observed, and complex reoperation was required. We performed a total aortic arch replacement with a 4-branched graft and a complete aortic root replacement using the Cabrol technique for the reinsertion of the coronary arteries. The mechanical aortic normally functioning valve was preserved. The patient was discharged 30 days postoperatively. PMID:27390749

  16. Guilt by association: a paradigm for detection of silent aortic disease

    PubMed Central

    Ziganshin, Bulat A.

    2016-01-01

    Detection of clinically silent thoracic aortic aneurysm (TAA) is challenging due to the lack of symptoms (until aortic rupture or dissection occurs). A large proportion of TAA are identified incidentally while imaging a patient for other reasons. However, recently several clinical “associates” of TAA have been described that can aid in identification of silent TAA. These “associates” include intracranial aneurysm, aortic arch anomalies, abdominal aortic aneurysm (AAA), simple renal cysts (SRC), bicuspid aortic valve, temporal arteritis, a positive family history of aneurysm disease, and a positive thumb-palm sign. In this article we examine these associates of TAA and the data supporting their involvement with asymptomatic TAA. PMID:27386404

  17. Surgical repair for giant ascending aortic aneurysm to superior vena cava fistula with positive syphilitic test.

    PubMed

    Sekine, Yuji; Yamamoto, Shin; Fujikawa, Takuya; Oshima, Susumu; Ono, Makoto; Sasaguri, Shiro

    2015-10-01

    Syphilitic aortitis is usually associated with thoracic aortic saccular aneurysm, aortic regurgitation and coronary ostial stenosis. However, syphilitic aneurysms have rarely been reported today. Here, we report a patient with ascending aortic aneurysm with aorta-superior vena cava (SVC) fistula with positive syphilitic test. A 52-year-old man was admitted to our institution with a giant ascending aortic aneurysm complicated with SVC syndrome. Computed tomography revealed a giant ascending aneurysm 79 mm in diameter. The result of serodiagnostic tests for syphilis had not been judged yet preoperatively. Total arch replacement concomitant with elephant trunk was performed. Intraoperatively, we detected the ascending aorta to SVC fistula. Postoperatively, we suspected the syphilitic aneurysm strongly, because preoperative serodiagnostic test was concluded to be positive. However, histological examination did not show typical syphilitic features. The patient remains asymptomatic 1 year later. Although extremely rarely today, syphilitic aneurysm should be still considered in the differential diagnosis of ascending aortic aneurysm. PMID:24000069

  18. Regional aortic distensibility and its relationship with age and aortic stenosis: a computed tomography study.

    PubMed

    Wong, Dennis T L; Narayan, Om; Leong, Darryl P; Bertaso, Angela G; Maia, Murilo G; Ko, Brian S H; Baillie, Timothy; Seneviratne, Sujith K; Worthley, Matthew I; Meredith, Ian T; Cameron, James D

    2015-06-01

    Aortic distensibility (AD) decreases with age and increased aortic stiffness is independently associated with adverse cardiovascular outcomes. The association of severe aortic stenosis (AS) with AD in different aortic regions has not been evaluated. Elderly subjects with severe AS and a cohort of patients without AS of similar age were studied. Proximal aortic cross-sectional-area changes during the cardiac cycle were determined using retrospective-ECG-gating on 128-detector row computed-tomography. Using oscillometric-brachial-blood-pressure measurements, the AD at the ascending-aorta (AA), proximal-descending-aorta (PDA) and distal-descending-aorta (DDA) was determined. Linear mixed effects modelling was used to determine the association of age and aortic stenosis on regional AD. 102 patients were evaluated: 36 AS patients (70-85 years), 24 AS patients (>85 years) and 42 patients without AS (9 patients <50 years, 20 patients between 51-70 years and 13 patients 70-85 years). When comparing patients 70-85 years, AA distensibility was significantly lower in those with AS compared to those without AS (0.9 ± 0.9 vs. 1.4 ± 1.1, P = 0.03) while there was no difference in the PDA (1.0 ± 1.1 vs. 1.0 ± 1.2, P = 0.26) and DDA (1.1 ± 1.2 vs. 1.2 ± 0.8, P = 0.97). In patients without AS, AD decreased with age in all aortic regions (P < 0.001). The AA in patients <50 years were the most distensible compared to other aortic regions. There is regional variation in aortic distensibility with aging. Patients with aortic stenosis demonstrated regional differences in aortic distensibility with lower distensibility demonstrated in the proximal ascending aorta compared to an age-matched cohort. PMID:25855464

  19. Transcatheter aortic valve implantation

    PubMed Central

    Oliemy, Ahmed

    2014-01-01

    Transcatheter aortic valve implantation was developed to offer a therapeutic solution to patients with severe symptomatic aortic stenosis who are not candidates for conventional aortic valve replacement. The improvement in transcatheter aortic valve implantation outcomes is still of concern in the areas of stroke, vascular injury, heart block, paravalvular regurgitation and valve durability. Concomitantly, the progress, both technical and in terms of material advances of transcatheter valve systems, as well as in patient selection, renders transcatheter aortic valve implantation an increasingly viable treatment for more and more patients with structural heart disease. PMID:25374670

  20. Contributing Mechanisms of Aortic Atheroma in Ischemic Cerebrovascular Disease.

    PubMed

    Kong, Qi; Ma, Xin

    2015-12-01

    In recent years, the correlation between aortic atheroma (AA) and the occurrence and recurrence of ischemic cerebrovascular disease (ICVD) has attracted much attention, but the contributory mechanisms remain controversial. This review analyzes related research on the roles of AA in ICVD, and demonstrates the correlation between the formation and development of AA and abnormal metabolism, inflammation, hemodynamic changes, and other contributory factors. The presence of complex aortic plaque (CAP) in the ascending aorta and aortic arch increases the risk of cerebral embolism and degree of injury, while the association between CAP in the descending aorta and cerebral embolism remains ambiguous. AA also functions as an indicator of atherosclerosis burden as well as hypercoagulability, which may further increase the risk of ICVD. Further study on the relationship of AA to ICVD will improve diagnosis and treatment in clinical practice. PMID:26522269

  1. Combined open proximal and stent-graft distal repair for distal arch aneurysms: an alternative to total debranching.

    PubMed

    Zierer, Andreas; Sanchez, Luis A; Moon, Marc R

    2009-07-01

    We present herein a novel, combined, simultaneous open proximal and stent-graft distal repair for complex distal aortic arch aneurysms involving the descending aorta. In the first surgical step, the transverse arch is opened during selective antegrade cerebral perfusion, and a Dacron graft (DuPont, Wilmington, DE) is positioned down the descending aorta in an elephant trunk-like fashion with its proximal free margin sutured circumferentially to the aorta just distal to the left subclavian or left common carotid artery. With the graft serving as the new proximal landing zone, subsequent endovascular repair is performed antegrade during rewarming through the ascending aorta. PMID:19559261

  2. The Hindfoot Arch: What Role Does the Imager Play?

    PubMed

    Lin, Yu-Ching; Kwon, John Y; Ghorbanhoseini, Mohammad; Wu, Jim S

    2016-09-01

    Flatfoot deformity is a common disorder of the foot and ankle and is caused by loss of the hindfoot arch. Radiologists and clinicians should be familiar with the anatomy and the imaging criteria used to assess injury to the supporting structures. Radiographs and computed tomography are most useful in characterizing the degree of osseous deformity and ultrasonography and magnetic resonance imaging are most useful in the evaluation of the supporting soft tissue structures. Treatment depends on the clinical symptoms and involves restoring the normal biomechanics of the hindfoot arch through strengthening exercises, foot/ankle orthotics, and surgery. PMID:27545430

  3. Numerical Modelling of Soil Arching in a Shallow Backfill Layer

    NASA Astrophysics Data System (ADS)

    Szajna, Waldemar St.

    2015-03-01

    The paper presents the application of the finite element method into the modelling of soil arching. The phenomenon plays fundamental role in soil-shell flexible structures behaviour. To evaluate the influence of arching on a pressure reduction, a plain strain trapdoor under a shallow layer of backfill was simulated. The Coulomb-Mohr plasticity condition and the nonassociated flow rule were used for the soil model. The research examines the impact of the internal friction angle and the influence of the backfill layer thickness on the value of soil arching. The carried out analyses indicate that the reduction of pressures acting on a structure depends on the value of the internal friction angle, which confirms the earlier research. For a shallow backfill layer however, the reduction is only a local phenomenon and can influence only a part of the structure.

  4. Total aortic repair: the new paradigm in the treatment of acute type A aortic dissection.

    PubMed

    Matalanis, George; Perera, Nisal K; Galvin, Sean D

    2016-05-01

    The surgical management of acute type A aortic dissection (ATAAD) is in a period of rapid evolution. Understanding the complex physiology and anatomy of both acute and chronic dissection has been enhanced by the ready availability of state of the art imaging techniques. Technical advances in the intraoperative monitoring of organ perfusion, together with adjuncts to limit organ injury and increasing sophistication in open and endovascular surgery have led to a major reduction in both perioperative morbidity and mortality. In many centers, there has been a transition in mindset and surgical approach away from a purely central aortic operation focusing on the ascending aorta and a 'live to fight another day' philosophy. The current more global perspective recognizes the importance of aortic valve function, malperfusion, false lumen (FL) patency and the potential for future complex aneurysm development. The time is now right to transition into the next phase of sophistication in the management of ATAAD with the aim of achieving not only a safe acute operation, but to either entirely prevent chronic complications or to greatly simplify their management by the creation of an anatomical situation that facilitates future endovascular intervention in place of complex re-do surgery. We present our view on the evolution of surgery for ATAAD leading to our current technique of Branch First Arch replacement and Total Aortic Repair, which not only provides a safe immediate operation, but also offers the hope of a simplified future management if not a total cure for the pathology. PMID:27386409

  5. Including aortic valve morphology in computational fluid dynamics simulations: initial findings and application to aortic coarctation.

    PubMed

    Wendell, David C; Samyn, Margaret M; Cava, Joseph R; Ellwein, Laura M; Krolikowski, Mary M; Gandy, Kimberly L; Pelech, Andrew N; Shadden, Shawn C; LaDisa, John F

    2013-06-01

    Computational fluid dynamics (CFD) simulations quantifying thoracic aortic flow patterns have not included disturbances from the aortic valve (AoV). 80% of patients with aortic coarctation (CoA) have a bicuspid aortic valve (BAV) which may cause adverse flow patterns contributing to morbidity. Our objectives were to develop a method to account for the AoV in CFD simulations, and quantify its impact on local hemodynamics. The method developed facilitates segmentation of the AoV, spatiotemporal interpolation of segments, and anatomic positioning of segments at the CFD model inlet. The AoV was included in CFD model examples of a normal (tricuspid AoV) and a post-surgical CoA patient (BAV). Velocity, turbulent kinetic energy (TKE), time-averaged wall shear stress (TAWSS), and oscillatory shear index (OSI) results were compared to equivalent simulations using a plug inlet profile. The plug inlet greatly underestimated TKE for both examples. TAWSS differences extended throughout the thoracic aorta for the CoA BAV, but were limited to the arch for the normal example. OSI differences existed mainly in the ascending aorta for both cases. The impact of AoV can now be included with CFD simulations to identify regions of deleterious hemodynamics thereby advancing simulations of the thoracic aorta one step closer to reality. PMID:22917990

  6. Total aortic repair: the new paradigm in the treatment of acute type A aortic dissection

    PubMed Central

    Perera, Nisal K.; Galvin, Sean D.

    2016-01-01

    The surgical management of acute type A aortic dissection (ATAAD) is in a period of rapid evolution. Understanding the complex physiology and anatomy of both acute and chronic dissection has been enhanced by the ready availability of state of the art imaging techniques. Technical advances in the intraoperative monitoring of organ perfusion, together with adjuncts to limit organ injury and increasing sophistication in open and endovascular surgery have led to a major reduction in both perioperative morbidity and mortality. In many centers, there has been a transition in mindset and surgical approach away from a purely central aortic operation focusing on the ascending aorta and a ‘live to fight another day’ philosophy. The current more global perspective recognizes the importance of aortic valve function, malperfusion, false lumen (FL) patency and the potential for future complex aneurysm development. The time is now right to transition into the next phase of sophistication in the management of ATAAD with the aim of achieving not only a safe acute operation, but to either entirely prevent chronic complications or to greatly simplify their management by the creation of an anatomical situation that facilitates future endovascular intervention in place of complex re-do surgery. We present our view on the evolution of surgery for ATAAD leading to our current technique of Branch First Arch replacement and Total Aortic Repair, which not only provides a safe immediate operation, but also offers the hope of a simplified future management if not a total cure for the pathology. PMID:27386409

  7. The ARCHES Integrated Cluster Finder

    NASA Astrophysics Data System (ADS)

    Mints, A.; Schwope, A.

    2014-07-01

    We are developing a tool to search for galaxy clusters associated with X-ray sources from the 3XMM catalog within the ARCHES project (Astronomical Resource cross-matching for High-Energy Studies). We make use of the new cross-matching tool developed for ARCHES to select galaxies in different catalogs around X-ray positions and then try to find clusters by searching for overdensities in the multi-color space. Colors are related to redshifts using spectroscopic data for passively evolving galaxies from the BOSS and VIPERS catalogs. So far we are making use of SDSS, UKIDSS, WISE, and CFHTLS photometric catalogs, but the method can easily be expanded to other data as well (e.g. Pan-STARRS and DES). We present test results of our tool performed on reference samples from the XMM/SDSS cluster survey (Takey et al 2012) and the NORAS/REFLEX surveys.

  8. Aortic Valve Sparing in Different Aortic Valve and Aortic Root Conditions.

    PubMed

    David, Tirone E

    2016-08-01

    The development of aortic valve-sparing operations (reimplantation of the aortic valve and remodeling of the aortic root) expanded the surgical armamentarium for treating patients with aortic root dilation caused by a variety of disorders. Young adults with aortic root aneurysms associated with genetic syndromes are ideal candidates for reimplantation of the aortic valve, and the long-term results have been excellent. Incompetent bicuspid aortic valves with dilated aortic annuli are also satisfactorily treated with the same type of operation. Older patients with ascending aortic aneurysm and aortic insufficiency secondary to dilated sinotubular junction and a normal aortic annulus can be treated with remodeling of the aortic root or with reimplantation of the aortic valve. The first procedure is simpler, and both procedures are likely equally effective. As with any heart valve-preserving procedure, patient selection and surgical expertise are keys to successful and durable repairs. PMID:27491910

  9. Endovascular Treatment of Descending Thoracic Aortic Aneurysms with the EndoFit Stent-Graft

    SciTech Connect

    Saratzis, N.; Saratzis, Athanasios Melas, N.; Ginis, G.; Lioupis, A.; Lykopoulos, D.; Lazaridis, J.; Kiskinis, Dimitrios

    2007-04-15

    Objective. To evaluate the mid-term feasibility, efficacy, and durability of descending thoracic aortic aneurysm (DTAA) exclusion using the EndoFit device (LeMaitre Vascular). Methods. Twenty-three (23) men (mean age 66 years) with a DTAA were admitted to our department for endovascular repair (21 were ASA III+ and 2 refused open repair) from January 2003 to July 2005. Results. Complete aneurysm exclusion was feasible in all subjects (100% technical success). The median follow-up was 18 months (range 8-40 months). A single stent-graft was used in 6 cases. The deployment of a second stent-graft was required in the remaining 17 patients. All endografts were attached proximally, beyond the left subclavian artery, leaving the aortic arch branches intact. No procedure-related deaths have occurred. A distal type I endoleak was detected in 2 cases on the 1 month follow-up CT scan, and was repaired with reintervention and deployment of an extension graft. A nonfatal acute myocardial infarction occurred in 1 patient in the sixth postoperative month. Graft migration, graft infection, paraplegia, cerebral or distal embolization, renal impairment or any other major complications were not observed. Conclusion. The treatment of DTAAs using the EndoFit stent-graft is technically feasible. Mid-term results in this series are promising.

  10. New frontiers in aortic therapy: focus on current trials and devices in transcatheter aortic valve replacement.

    PubMed

    Gutsche, Jacob T; Patel, Prakash A; Walsh, Elizabeth K; Sophocles, Aris; Chern, Sy-Yeu S; Jones, David B; Anwaruddin, Saif; Desai, Nimesh D; Weiss, Stuart J; Augoustides, John G T

    2015-04-01

    The first decade of clinical experience with transcatheter aortic valve replacement since 2002 saw the development of 2 main valve systems, namely the Edwards Sapien balloon-expandable valve series and the Medtronic self-expanding CoreValve. These 2 valve platforms now have achieved commercial approval and application worldwide in patients with severe aortic stenosis whose perioperative risk for surgical intervention is high or extreme. In the second decade of transcatheter aortic valve replacement, clinical experience and refinements in valve design have resulted in clinical drift towards lower patient risk cohorts. There are currently 2 major trials, PARTNER II and SURTAVI, that are both evaluating the role of transcatheter aortic valve replacement in intermediate-risk patient cohorts. The results from these landmark trials may usher in a new clinical paradigm for transcatheter aortic valve replacement in its second decade. PMID:25572322

  11. Mathematical and descriptive classification of variations in dental arch shape in an Australian aborigine population.

    PubMed

    McKee, J K; Molnar, S

    1988-01-01

    The ability to describe dental arch shape is necessary for biomechanical studies of occlusion as well as for anthropological studies of human and primate dental variation. A mathematical method of describing and classifying human dental arch shape was used to assess the nature of individual variability. The method involved the calculation of a series of third-degree polynomials which were fitted to coordinate points along the dental arcade. The slopes of the polynomials, evaluated at these coordinate points, provided a multivariate description of shape, independent of arch size. Graphic representations of arch shape could be constructed from the polynomial equations. These mathematical techniques were used in association with multivariate and univariate statistics to explore the types of variability in dental arch shape among a population of Australian aborigines. The results illustrated the ambiguities of conventional subjective classifications. PMID:3256297

  12. Long-term stability of dental arch form in normal occlusion from 13 to 31 years of age.

    PubMed

    Henrikson, J; Persson, M; Thilander, B

    2001-02-01

    Based on observations of longitudinal changes in dental arch dimensions, it has been stated that an individuality of arch form and an integrity of this form exists. However, longitudinal studies evaluating arch form changes have rarely been reported in the literature. The purpose of this investigation was to use a computer-assisted method for the description and analysis of maxillary and mandibular arch form in a sample of normal occlusion subjects, and to evaluate the long-term stability in dental arch form from the age of 13-31 years. The study was carried out on 30 subjects of Scandinavian origin with normal occlusion, recorded at a mean age of 13.6 years and at follow-up at 31.1 years. Arch form analysis was based on a standardized photographic procedure, digitization of morphological landmarks, and a computerized form analysis in which arch form was described using eccentricity values of conics. No specific arch form could be found to represent the sample. Age changes occurred in arch form, although with large individual variations. For the mandible, a significant change to a more rounded arch form with age was found, which in males was accompanied by a significant increase in inter-molar distance and reduction in arch depth. There was also a significant correlation between change in mandibular arch form and increased irregularity of the lower incisors. These findings of lack of stability in arch form in normal occlusion subjects, when passing from adolescence into adulthood, further question the possibility of achieving stability post-orthodontically. PMID:11296510

  13. Clinical Advantages and Limitations of Monolithic Zirconia Restorations Full Arch Implant Supported Reconstruction: Case Series

    PubMed Central

    Carames, Joao; Yu, Yung Cheng Paul; Pérez, Alejandro; Kang, Mary

    2015-01-01

    Purpose. The purpose of this retrospective case series is to evaluate the clinical advantages and limitations of monolithic zirconia restorations for full arch implant supported restorations and report the rate of complications up to 2 years after insertion. Materials and Methods. Fourteen patients received implant placement for monolithic zirconia full arch reconstructions. Four implants were placed in seven arches, eleven arches received six implants, two arches received seven implants, two arches received eight implants, and one arch received nine implants. Results. No implant failures or complications were reported for an implant survival rate of 100% with follow-up ranging from 3 to 24 months. Conclusions. Monolithic zirconia CAD-/CAM-milled framework restorations are a treatment option for full arch restorations over implants, showing a 96% success rate in the present study. Some of the benefits are accuracy, reduced veneering porcelain, and minimal occlusal adjustments. The outcome of the present study showed high success in function, aesthetics, phonetics, and high patient satisfaction. PMID:26124835

  14. Relationship between lumbar changes and modifications in the plantar arch in women with low back pain

    PubMed Central

    Borges, Cláudia dos Santos; Fernandes, Luciane Fernanda Rodrigues Martinho; Bertoncello, Dernival

    2013-01-01

    OBJECTIVE : Evaluate the probable relationship among plantar arch, lumbar curvature, and low back pain. METHODS : Fifteen healthy women were assessed taking in account personal data and anthropometric measurements, photopodoscopic evaluation of the plantar arch, and biophotogrammetric postural analysis of the patient (both using the SAPO software), as well as evaluation of lumbar pain using a Visual Analog Scale (VAS). The average age of the participants was 30.45 (±6.25) years. RESULTS : Of the feet evaluated, there were six individuals with flat feet, five with high arch, and four with normal feet. All reported algic syndrome in the lumbar spine, with the highest VAS values for the volunteers with high arch. Correlation was observed between the plantar arch and the angle of the lumbar spine (r = -0.71, p = 0.004) Conclusion: High arch was correlated with more intense algic syndrome, while there was moderate positive correlation between flat foot and increased lumbar curvature, and between high arch and lumbar correction. Level of Evidence IV. Case Series. PMID:24453656

  15. Biomechanical properties of the Marfan's aortic root and ascending aorta before and after personalised external aortic root support surgery.

    PubMed

    Singh, S D; Xu, X Y; Pepper, J R; Treasure, T; Mohiaddin, R H

    2015-08-01

    Marfan syndrome is an inherited systemic connective tissue disease which may lead to aortic root disease causing dilatation, dissection and rupture of the aorta. The standard treatment is a major operation involving either an artificial valve and aorta or a complex valve repair. More recently, a personalised external aortic root support (PEARS) has been used to strengthen the aorta at an earlier stage of the disease avoiding risk of both rupture and major surgery. The aim of this study was to compare the stress and strain fields of the Marfan aortic root and ascending aorta before and after insertion of PEARS in order to understand its biomechanical implications. Finite element (FE) models were developed using patient-specific aortic geometries reconstructed from pre and post-PEARS magnetic resonance images in three Marfan patients. For the post-PEARS model, two scenarios were investigated-a bilayer model where PEARS and the aortic wall were treated as separate layers, and a single-layer model where PEARS was incorporated into the aortic wall. The wall and PEARS materials were assumed to be isotropic, incompressible and linearly elastic. A static load on the inner wall corresponding to the patients' pulse pressure was applied. Results from our FE models with patient-specific geometries show that peak aortic stresses and displacements before PEARS were located at the sinuses of Valsalva but following PEARS surgery, these peak values were shifted to the aortic arch, particularly at the interface between the supported and unsupported aorta. Further studies are required to assess the statistical significance of these findings and how PEARS compares with the standard treatment. PMID:26054807

  16. Acute aortic syndrome

    PubMed Central

    2016-01-01

    Acute aortic syndrome (AAS) is a term used to describe a constellation of life-threatening aortic diseases that have similar presentation, but appear to have distinct demographic, clinical, pathological and survival characteristics. Many believe that the three major entities that comprise AAS: aortic dissection (AD), intramural hematoma (IMH) and penetrating aortic ulcer (PAU), make up a spectrum of aortic disease in which one entity may evolve into or coexist with another. Much of the confusion in accurately classifying an AAS is that they present with similar symptoms: typically acute onset of severe chest or back pain, and may have similar radiographic features, since the disease entities all involve injury or disruption of the medial layer of the aortic wall. The accurate diagnosis of an AAS is often made at operation. This manuscript will attempt to clarify the similarities and differences between AD, IMH and PAU of the ascending aorta and describe the challenges in distinguishing them from one another. PMID:27386405

  17. Acute aortic syndrome.

    PubMed

    Corvera, Joel S

    2016-05-01

    Acute aortic syndrome (AAS) is a term used to describe a constellation of life-threatening aortic diseases that have similar presentation, but appear to have distinct demographic, clinical, pathological and survival characteristics. Many believe that the three major entities that comprise AAS: aortic dissection (AD), intramural hematoma (IMH) and penetrating aortic ulcer (PAU), make up a spectrum of aortic disease in which one entity may evolve into or coexist with another. Much of the confusion in accurately classifying an AAS is that they present with similar symptoms: typically acute onset of severe chest or back pain, and may have similar radiographic features, since the disease entities all involve injury or disruption of the medial layer of the aortic wall. The accurate diagnosis of an AAS is often made at operation. This manuscript will attempt to clarify the similarities and differences between AD, IMH and PAU of the ascending aorta and describe the challenges in distinguishing them from one another. PMID:27386405

  18. Aortic dissection with the entrance tear in transverse aorta: analysis of 12 autopsy patients.

    PubMed

    Roberts, C S; Roberts, W C

    1990-11-01

    Clinical and autopsy findings are described in 12 patients who had fatal aortic dissection with the entrance tear in the transverse aorta. The 12 patients represent 7% of 182 autopsies of spontaneous aortic dissection studied by us. The ages of the 12 patients at death ranged from 37 to 87 years (mean, 67 years). Eight were men; 8 had a history of systemic hypertension, and 10 had hearts of increased weight. Diagnosis of aortic dissection was made during life in only 4 of the 12 patients. All 12 patients died of rupture of the false channel within 2 weeks of onset of signs or symptoms compatible with dissection. The direction of aortic dissection from the entrance tear was entirely retrograde in 4 patients, entirely anterograde in 4 patients, and in both directions in 4 patients. Hemopericardium occurred in the first group, left hemothorax in the second group, and either in the last group. Of the 8 patients in whom the ascending aorta was involved, the retrograde dissection in each extended to the aortic root, 6 had pulmonary adventitial hemorrhage, and 4 had involvement of the arch arteries by dissection. In the 4 patients with strictly anterograde dissection, none had dissection in the arch arteries. Thus, tear in the transverse aorta causes a dissection that is usually fata, that often dissects retrogradely, and that may mimic dissection from a tear in ascending aorta. Aortic dissection from a tear in transverse aorta requires early operative intervention. PMID:2241339

  19. Turner syndrome strategies to improve care outcomes--cardiac evaluation using new imaging techniques.

    PubMed

    Mazzanti, Laura; Lovato, Luigi; Prandstraller, Daniela; Scarano, Emanuela; Tamburrino, Federica; Montanari, Francesca; Mineo, Gian Gaspero; Perri, Annamaria; Vestrucci, Benedetta; Giardini, Andrea

    2012-05-01

    Turner syndrome (TS) is at high risk for congenital heart diseases (CHD), aortic dilatation (AoDil) and dissection. New imaging techniques such as MRI have revealed the presence of vascular anomalies (VA) undetected at echo. MR angiography has shown a high prevalence of aortic and venous anomalies. The VA often coexist and interact to increase the risk of premature death in adulthood. AoDil and VA have been found also in asymptomatic individuals with no predisposing factors, but the prevalence is still unknown. We evaluated 100 TS subjects (15-35 yrs) with no aortic CHD at echocardiography with transthoracic MRA; 42 of them showed VA and 58 did not. Aortic diameters were indexed on BSA. At the sinuses of Valsalva a higher prevalence of AoDil was found in subjects with VA than without; 57% of them showed AoDil. The presence of VA (elongation of the transverse arch, bovine arch, left superior vena cava, PAPVD etc.) increased their relative risk of AoDil by more than 2 times. Excluding BSA influence, a severe phenotype influenced positively ascending AoDil. New imaging techniques enhance our ability to provide a prognosis for their adult age and in particular before they seek to become pregnant. PMID:22946280

  20. Endovascular repair of thoracic aortic aneurysms.

    PubMed

    Cartes-Zumelzu, F; Lammer, J; Kretschmer, G; Hoelzenbein, T; Grabenwöger, M; Thurnher, S

    2000-03-01

    The standard technique for the treatment of descending thoracic aortic aneurysms is elective open surgical repair with graft interposition. This standard approach, although steadily improving, is associated with high morbidity and substantial mortality rates and implies a major surgical procedure with lateral thoracotomy, use of cardiopulmonary bypass, long operation times and a variety of peri- and postoperative complications. This and the success of the first endoluminal treatment of abdominal aortic aneurysms by Parodi et al. prompted the attention to be thrown on the treatment of descending thoracic aortic aneurysms with endoluminal stent-grafts in many large centres. The aim of this new minimally invasive technique is to exclude the aneurysm from blood flow and in consequence to avoid pressure stress on the aneurysmatic aortic wall, by avoiding a large open operation with significant perioperative morbidity. The potentially beneficial effect of this new treatment approach was evaluated in the course of this study. PMID:10875224

  1. Structural and ultrastructural evaluation of the aortic wall after transplantation of bone marrow-derived cells (BMCs) in a model for atherosclerosis.

    PubMed

    Felix, Alyne Souza; Monteiro, Nemesis; Rocha, Vinícius Novaes; Oliveira, Genilza; Nascimento, Ana Lucia; de Carvalho, Laís; Thole, Alessandra; Carvalho, Jorge

    2015-08-01

    Stem cells are characterized by their ability to differentiate into multiple cell lineages and display the paracrine effect. The aim of this work was to evaluate the effect of therapy with bone marrow-derived cells (BMCs) on glucose, lipid metabolism, and aortic wall remodeling in mice through the administration of a high-fat diet and subsequent BMCs transplantation. C57BL/6 mice were fed a control diet (CO group) or an atherogenic diet (AT group). After 16 weeks, the AT group was divided into 4 subgroups: an AT 14 days group and AT 21 days group that were given an injection of vehicle and sacrificed after 14 and 21 days, respectively, and an AT-BMC 14 days group and AT-BMC 21 days group that were given an injection of BMCs and sacrificed after 14 and 21 days, respectively. The BMCs transplant had reduced blood glucose, triglycerides, and total cholesterol. There was no significant difference in relation to body mass between the transplanted groups and non-transplanted groups, and all were different than CO. There was no significant difference in the glycemic curve among AT 14 days, AT-BMC 14 days, and AT 21 days, and these were different than the CO and the AT-BMC 21 days groups. The increased thickness of the aortic wall was observed in all atherogenic groups, but was significantly smaller in group AT-BMC 21 days compared to AT 14 days and AT 21 days. Vacuoles in the media tunic, delamination and the thinning of the elastic lamellae were observed in AT 14 days and AT 21 days. The smallest number of these was displayed on the AT-BMC 14 days and AT-BMC 21 days. Marking to CD105, CD133, and CD68 were observed in AT 14 days and AT 21 days. These markings were not observed in AT-BMC 14 days or in AT-BMC 21 days. Electron micrographs show the beneficial remodeling in AT-BMC 14 days and AT-BMC 21 days, and the structural organization was similar to the CO group. Vesicles of pinocytosis, projection of smooth muscle cells, and delamination of the internal elastic lamina

  2. Calcification of the aortic wall in hypercalcemic rabbits.

    PubMed

    Rokita, E; Cichocki, T; Divoux, S; Gonsior, B; Höfert, M; Jarczyk, L; Strzałkowski, A

    1992-10-01

    The mineralization process was investigated in the aortic wall of hypercalcemic rabbits. The elevated calcium level in serum was induced by intramuscular injection of vitamin D3. The animals were killed at different times of the experiment (max. 246 d). The freeze-dried tissue homogenates were used for elemental composition studies by means of proton induced X-ray emission (PIXE) and atomic absorption spectroscopy. The structural information was obtained from infrared (IR) and X-ray diffraction (XRD) spectra. Moreover, the ascending part of the aortic arch was separated and used for micro-PIXE (PIXE in combination with proton microprobe) and histochemical examinations. It was found that hypercalcemia (blood serum Ca content elevated by about 20%) induced calcification of the aortic wall. The mineral phase within the aortic wall consisted of Ca-P salts. The Ca/P ratio continuously increased during the experiment and approached 2 after 246 d of the vitamin D3 treatment. The IR and XRD studies made possible the identification of the complex phase composition of the samples. The hydroxyapatite crystals were detected after 196 days, however, in earlier phases of the experiment, amorphous calcium phosphate, dicalcium phosphate dihydrate and octacalcium phosphate were also observed. On the basis of the data obtained, the mechanism of the precipitation and growth of inorganic deposits in the tunica media of the aortic wall was discussed. PMID:1333314

  3. Is Transcatheter Aortic Valve Implantation of Living Tissue-Engineered Valves Feasible? An In Vitro Evaluation Utilizing a Decellularized and Reseeded Biohybrid Valve.

    PubMed

    Koenig, Fabian; Lee, Jang-Sun; Akra, Bassil; Hollweck, Trixi; Wintermantel, Erich; Hagl, Christian; Thierfelder, Nikolaus

    2016-08-01

    Transcatheter aortic valve implantation (TAVI) is a fast-growing, exciting field of invasive therapy. During the last years many innovations significantly improved this technique. However, the prostheses are still associated with drawbacks. The aim of this study was to create cell-seeded biohybrid aortic valves (BAVs) as an ideal implant by combination of assets of biological and artificial materials. Furthermore, the influence of TAVI procedure on tissue-engineered BAV was investigated. BAV (n=6) were designed with decellularized homograft cusps and polyurethane walls. They were seeded with fibroblasts and endothelial cells isolated from saphenous veins. Consecutively, BAV were conditioned under low pulsatile flow (500 mL/min) for 5 days in a specialized bioreactor. After conditioning, TAVI-simulation was performed. The procedure was concluded with re-perfusion of the BAV for 2 days at an increased pulsatile flow (1100 mL/min). Functionality was assessed by video-documentation. Samples were taken after each processing step and evaluated by scanning electron microscopy (SEM), immunohistochemical staining (IHC), and Live/Dead-assays. The designed BAV were fully functioning and displayed physiologic behavior. After cell seeding, static cultivation and first conditioning, confluent cell layers were observed in SEM. Additionally, IHC indicated the presence of endothelial cells and fibroblasts. A significant construction of extracellular matrix was detected after the conditioning phase. However, a large number of lethal cells were observed after crimping by Live/Dead staining. Analysis revealed that the cells while still being present directly after crimping were removed in subsequent perfusion. Extensive regions of damaged cell-layers were detected by SEM-analysis substantiating these findings. Furthermore, increased ICAM expression was detected after re-perfusion as manifestation of inflammatory reaction. The approach to generate biohybrid valves is promising. However

  4. Evaluation of Aortic Stenosis Severity using 4D Flow Jet Shear Layer Detection for the Measurement of Valve Effective Orifice Area

    PubMed Central

    Garcia, Julio; Markl, Michael; Schnell, Susanne; Allen, Bradley; Entezari, Pegah; Mahadevia, Riti; Malaisrie, S Chris; Pibarot, Philippe; Carr, James; Barker, Alex J

    2014-01-01

    Aims The objective of this study was to evaluate the potential of 4D flow MRI to assess valve effective orifice area (EOA) in patients with aortic stenosis as determined by the jet shear layer detection (JSLD) method. Methods and Results An in-vitro stenosis phantom was used for validation and in-vivo imaging was performed in 10 healthy controls and 40 patients with aortic stenosis. EOA was calculated by the JSLD method using standard 2D phase contrast MRI (PC-MRI) and 4D flow MRI measurements (EOAJSLD-2D and EOAJSLD-4D, respectively). As a reference standard, the continuity equation was used to calculate EOA (EOACE) with the 2D PC-MRI velocity field and compared to the EOAJSLD measurements. The in-vitro results exhibited excellent agreement between flow theory (EOA=0.78 cm2) and experimental measurement (EOAJSLD-4D=0.78±0.01 cm2) for peak velocities ranging from 0.9 to 3.7 m/s. In-vivo results showed good correlation and agreement between EOAJSLD-2D and EOACE (r=0.91, p<0.001; bias: −0.01±0.38cm2; agreement limits: 0.75 to −0.77cm2), and between EOAJSLD-4D and EOACE (r=0.95, p<0.001; bias: −0.09±0.26cm2; limits: 0.43 to −0.62cm2). Conclusion This study demonstrates the feasibility of measuring EOAJSLD using 4D flow MRI. The technique allows for optimization of the EOA measurement position by visualizing the 3D vena contracta, and avoids potential sources of EOACE measurement variability. PMID:24865143

  5. Aortic Balloon Valvuloplasty Prior to Orthotopic Liver Transplantation: A Novel Approach to Aortic Stenosis and End-Stage Liver Disease

    PubMed Central

    Coverstone, Edward; Korenblat, Kevin; Crippin, Jeffrey S.; Chapman, William C.; Kates, Andrew M.; Zajarias, Alan

    2014-01-01

    The combination of severe aortic stenosis and end-stage liver disease increases the morbidity and mortality of surgical aortic valve replacement or orthotopic liver transplantation resulting in a prohibitive operative risk. We propose a staged approach of balloon aortic valvuloplasty prior to orthotopic liver transplantation as a bridge to definitive aortic valve replacement. Between 2010 and 2012, four patients with severe aortic stenosis and end-stage liver disease underwent staged balloon aortic valvuloplasty followed by orthotopic liver transplantation. All patients had been deemed to be inappropriate candidates for liver transplantation or aortic valve surgery due to their comorbidity. One patient died of complications from a perivalvular abscess. Three patients went on to successful graft implantation and function and surgical recovery. Two of the three patients proceeded to definitive surgical aortic valve replacement with the remainder currently undergoing evaluation. In this case series, we present a novel approach of balloon aortic valvuloplasty prior to liver transplantation as a potential bridge to definitive treatment of severe aortic stenosis in the end-stage liver patient. PMID:25431682

  6. Sonic hedgehog is required for the assembly and remodeling of branchial arch blood vessels.

    PubMed

    Kolesová, Hana; Roelink, Henk; Grim, Milos

    2008-07-01

    Sonic hedgehog (Shh) is a morphogen involved in many developmental processes. Injection of cells (5E1) that produce a Shh-blocking antibody causes an attenuation of the Shh response, and this causes vascular malformations and impaired remodeling characterized by hemorrhages and protrusions of the anterior cardinal vein and outflow tract, delayed fusion of the dorsal aortae, impaired branching of the internal carotid artery, and delayed remodeling of the aortic arches. Distribution of smooth muscle cells in the vessel wall is unchanged. In 5E1-injected embryos, we also observed impaired assembly of endothelial cells into vascular tubes, particularly in the sixth branchial arch, around the anterior cardinal vein and around the dorsal aorta. In 5E1-treated embryos, increased numbers of macrophage-like cells, apoptotic cells, and a decreased level of proliferation were observed in head mesenchyme. Together, these observations show that Shh signaling is required at multiple stages for proper vessel formation and remodeling. PMID:18570256

  7. Chest radiography in acute aortic syndrome: pearls and pitfalls.

    PubMed

    Chawla, Ashish; Rajendran, Surendran; Yung, Wai Heng; Babu, Suresh Balasubramanian; Peh, Wilfred C

    2016-08-01

    Acute aortic syndrome is a group of life-threatening diseases of the thoracic aorta that usually present to the emergency department. It includes aortic dissection, aortic intramural hematoma, and penetrating aortic ulcer. Rare aortic pathologies of aorto-esophageal fistula and mycotic aneurysm may also be included in this list. All these conditions require urgent treatment with complex clinical care and management. Most patients who present with chest pain are evaluated with a chest radiograph in the emergency department. It is important that maximum diagnostic information is extracted from the chest radiograph as certain signs on the chest radiograph are extremely useful in pointing towards the diagnosis of acute aortic syndrome. PMID:27282377

  8. 22. VIEW OF STEEL ARCH, SHOWING ABUTMENT INTERIOR, DETAIL OF ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    22. VIEW OF STEEL ARCH, SHOWING ABUTMENT INTERIOR, DETAIL OF ARCH BEARINGS WITH HINGED SEATS AND LATERAL BRACING OF ARCHES, LOOKING NORTH - Notre Dame Bridge, Spanning Merrimack River on Bridge Street, Manchester, Hillsborough County, NH

  9. Thoracic endovascular aortic repair for complicated chronic type B aortic dissection in a patient on hemodialysis with recurrent ischemic colitis.

    PubMed

    Miyazaki, Yuko; Furuyama, Tadashi; Matsubara, Yutaka; Yoshiya, Keiji; Yoshiga, Ryosuke; Inoue, Kentaro; Matsuda, Daisuke; Aoyagi, Yukihiko; Kato, Masaaki; Matsumoto, Takuya; Maehara, Yoshihiko

    2016-12-01

    We present a successful case of thoracic endovascular aortic repair (TEVAR) for chronic Stanford type B aortic dissection (B-AD) with recurrent ischemic colitis. The patient was a 56-year-old woman with abdominal pain as the main complaint who had two operations previously: the total arch replacement 8 years ago and the Bentall 7 years ago for acute Stanford type A aortic dissection. Her abdominal pain worsened as her blood pressure became low during her hemodialysis treatment. An enhanced computed tomography scan was performed on the patient and showed chronic B-AD that occurred from the distal anastomotic part of the total arch graft to the bilateral common iliac arteries. The celiac artery and superior mesenteric artery (SMA) arose from the true lumen, and these were compressed by the expanded false lumen. Her complicated chronic B-AD was treated with the Zenith Dissection Endovascular System, and its procedure was performed as her proximal entry tear was covered by a proximal tapered Zenith TX2 stent graft, supplemented by a noncovered aortic stent extending across both renal arteries, the SMA, and the celiac artery. Seven days after this operation, enhanced computed tomography showed that the patient's true lumen was expanded and her blood flow to the true lumen and SMA was improved. On the other hand, her false lumen tended to be thrombosed. Consequently, she was discharged 10 days after the operation without any postoperative complications as she had no abdominal complaints even though she underwent hemodialysis three times per week after the operation. We believe that TEVAR supplemented by a noncovered aortic stent is an effective treatment, even for highly chronic B-AD in dialysis patients. PMID:27090121

  10. Juxtarenal aortic occlusion.

    PubMed Central

    Tapper, S S; Jenkins, J M; Edwards, W H; Mulherin, J L; Martin, R S; Edwards, W H

    1992-01-01

    The authors' experience with 113 aortic occlusions in 103 patients during a 26-year period (1965 to 1991) is reviewed. The authors found three distinct patterns of presentation: group I (n = 26) presented with acute aortic occlusion, group II (n = 66) presented with chronic aortic occlusion, and group III (n = 21) presented with complete occlusion of an aortic graft. Perioperative mortality rates were 31%, 9%, and 4.7% for each respective group and achieved statistical significance when comparing group I with group II (p = 0.009) and group I with group III (p = 0.015). Group I presented with profound metabolic insults due to acute ischemia and fared poorly. Group II presented with chronic claudication and did well long-term. Group III presented with acute ischemia but did well because of established collateral circulation. The treatment and expected outcome of aortic occlusion depends on the cause. PMID:1616381

  11. Conservative Management of Chronic Aortic Dissection with Underlying Aortic Aneurysm

    PubMed Central

    Yusuf Beebeejaun, Mohammad; Malec, Aleksandra; Gupta, Ravi

    2013-01-01

    Aortic dissection is one of the most common aortic emergencies affecting around 2000 Americans each year. It usually presents in the acute state but in a small percentage of patients aortic dissections go unnoticed and these patients survive without any adequate therapy. With recent advances in medical care and diagnostic technologies, aortic dissection can be successfully managed through surgical or medical options, consequently increasing the related survival rate. However, little is known about the optimal long-term management of patients suffering from chronic aortic dissection. The purpose of the present report is to review aortic dissection, namely its pathology and the current diagnostic tools available, and to discuss the management options for chronic aortic dissection. We report a patient in which chronic aortic dissection presented with recurring episodes of vomiting and also discuss the management plan of our patient who had a chronic aortic dissection as well as an underlying aortic aneurysm. PMID:24179638

  12. Aortic Hemiarch Replacement through a J-Shaped Lower Partial Sternotomy

    PubMed Central

    Waterford, Stephen D.; Rastegar, Michelle; Juan, Viviana

    2015-01-01

    Minimally invasive cardiac surgical techniques include the use of partial sternotomy for aortic valve and mitral valve replacement. Partial sternotomy is associated with less pain, better chest and upper-sternal stability, shorter hospital stays, and faster recoveries. However, aortic arch operations are still typically performed through median sternotomies. We describe the case of a 77-year-old woman who underwent elective hemiarch replacement because of an asymptomatic ascending aortic aneurysm. She requested a minimal incision. Our J-shaped partial lower sternotomy adequately exposed the proximal aorta and enabled all cannulations to be performed through the sternotomy. The patient had an uncomplicated postoperative course. We think that a partial sternotomy for ascending aortic and hemiarch replacement can be considered in selected patients for whom the procedure's benefits are important. PMID:26664318

  13. Elevated Aortic Augmentation Index in Children Following Fontan Palliation: Evidence of Stiffer Arteries?

    PubMed

    Bhat, Deepti P; Gupta, Pooja; Aggarwal, Sanjeev

    2015-08-01

    Children born with a functional single ventricle who undergo Fontan palliation are prone to early pump failure. Whether they develop early arterial stiffness with resultant increase in afterload is not well known. We hypothesized that the aortic stiffness is higher in pediatric Fontan patients when compared to healthy controls. A prospective study was conducted at the Children's Hospital of Michigan. Twenty-two Fontan patients (aged 6-21 years) were compared with 22 healthy controls (aged 9-17 years) selected from children referred to our clinic who had normal cardiac anatomy and function on the echocardiogram. Aortic stiffness was assessed noninvasively by measuring the aortic augmentation index (AAI) using applanation tonometry (Sphygmocor, Atcor, IL). AAI was calculated as AP/PP where augmentation pressure (AP) is the increase in aortic systolic blood pressure (BP) and pulse pressure (PP) is the difference between aortic systolic and diastolic BP. Ten patients (45 %) had hypoplastic left ventricle, and 11 (50 %) had undergone aortic arch surgery. The median AAI was significantly higher in Fontan patients when compared to controls (12.5, IQR 4.8, 17.3 vs 0, IQR -6.3, 5.8; p = 0.0003). History of aortic arch surgery and single ventricle morphology did not have a significant impact on AAI. Pediatric patients who undergo Fontan palliation have significantly higher AAI, a marker of aortic stiffness and increased afterload, compared to healthy controls. Larger longitudinal studies are warranted to elucidate the possible contribution of elevated AAI on pump failure in these patients. PMID:25832849

  14. Transesophageal echocardiography: first-line imaging for aortic diseases

    NASA Technical Reports Server (NTRS)

    Yalcin, F.; Thomas, J. D.; Homa, D.; Flachskampf, F. A.

    2000-01-01

    Transesophageal echocardiography (TEE) is now commonly used to evaluate the thoracic aorta, because it is widely available and provides high-resolution images and flow information by Doppler. This article reviews the essential features on TEE of acute and chronic aortic diseases, such as aortic dissection, aneurysm, and atherosclerosis, and discusses its strengths, weaknesses, and indications.

  15. Operative Treatment of Combined Aortic Stenosis and Coronary Artery Disease

    PubMed Central

    Kadric, Nedzad; Kabil, Emir; Mujanovic, Emir; Hadziselimovic, Mehdin; Jahic, Mirza; Rajkovic, Stojan; Osmanovic, Enes; Avdic, Sevleta; Keranovic, Suad; Behrem, Adnan

    2015-01-01

    Introduction: The aortic valve replacement is a standard operating procedure in patients with severe aortic stenosis. Structure of patients undergoing surgery ranges from young population with isolated mitral valvular disease to the elderly population, which is in addition to the underlying disease additionally burdened with comorbidity. One of the most commonly present factors that further complicate the surgery is coronary heart disease that occurs in, almost, one third of patients with aortic stenosis. The aim is to compare the results of surgery for aortic valve replacement with or without coronary artery bypass graft (CABG). Patients and Methods: From August 2008 to January 2013 in our center operated on 120 patients for aortic stenosis. Of this number, 75 were men and 45 women. The average age was 63.37 years (16-78). Isolated aortic valve replacement was performed in 89 patients and in 31 patients underwent aortic valve replacement and coronary bypass surgery. Implanted 89 biological and 31 mechanical valves. Results: Patients with associated aortic stenosis and coronary artery disease were more expressed symptomatic symptoms preoperatively to patients with isolated aortic stenosis who were on average younger age. Intra-hospital morbidity and mortality was more pronounced in the group of patients with concomitant aortic valve replacement and coronary bypass surgery. Morbidity was recorded in 17 patients (14.3%) in both groups, while the mortality rate in both groups was 12 patients (10.1%). Conclusion: Evaluation of preoperative risk factors and comorbidity in patients with aortic stenosis and coronary artery disease contributes to a significant reduction in intraoperative and postoperative complications. Also, early diagnosis of associated coronary artery disease and aortic stenosis contributes to timely decision for surgery thus avoiding subsequent ischaemic changes and myocardial damage. PMID:25870480

  16. Correlation between maxillary central incisor crown morphology and mandibular dental arch form in normal occlusion subjects.

    PubMed

    Paranhos, Luiz Renato; Lima, Carolina Souto; da Silva, Ricardo Henrique Alves; Daruge Júnior, Eduardo; Torres, Fernando Cesar

    2012-01-01

    The aim of this study was to evaluate the correlation between the morphology of the mandibular dental arch and the maxillary central incisor crown. Cast models from 51 Caucasian individuals, older than 15 years, with optimal occlusion, no previous orthodontic treatment, featuring 4 of the 6 keys to normal occlusion by Andrews (the first being mandatory) were observed. The models were digitalized using a 3D scanner, and images of the maxillary central incisor and mandibular dental arch were obtained. These were printed and placed in an album below pre-set models of arches and dental crowns, and distributed to 12 dental surgeons, who were asked to choose which shape was most in accordance with the models and crown presented. The Kappa test was performed to evaluate the concordance among evaluators while the chi-square test was used to verify the association between the dental arch and central incisor morphology, at a 5% significance level. The Kappa test showed moderate agreement among evaluators for both variables of this study, and the chi-square test showed no significant association between tooth shape and mandibular dental arch morphology. It may be concluded that the use of arch morphology as a diagnostic method to determine the shape of the maxillary central incisor is not appropriate. Further research is necessary to assess tooth shape using a stricter scientific basis. PMID:22666773

  17. Sutureless aortic valve replacement

    PubMed Central

    Phan, Kevin

    2015-01-01

    The increasing incidence of aortic stenosis and greater co-morbidities and risk profiles of the contemporary patient population has driven the development of minimally invasive aortic valve surgery and percutaneous transcatheter aortic valve implantation (TAVI) techniques to reduce surgical trauma. Recent technological developments have led to an alternative minimally invasive option which avoids the placement and tying of sutures, known as “sutureless” or rapid deployment aortic valves. Potential advantages for sutureless aortic prostheses include reducing cross-clamp and cardiopulmonary bypass (CPB) duration, facilitating minimally invasive surgery and complex cardiac interventions, whilst maintaining satisfactory hemodynamic outcomes and low paravalvular leak rates. However, given its recent developments, the majority of evidence regarding sutureless aortic valve replacement (SU-AVR) is limited to observational studies and there is a paucity of adequately-powered randomized studies. Recently, the International Valvular Surgery Study Group (IVSSG) has formulated to conduct the Sutureless Projects, set to be the largest international collaborative group to investigate this technology. This keynote lecture will overview the use, the potential advantages, the caveats, and current evidence of sutureless and rapid deployment aortic valve replacement (AVR). PMID:25870807

  18. Abdominal aortic aneurysm.

    PubMed

    Keisler, Brian; Carter, Chuck

    2015-04-15

    Abdominal aortic aneurysm refers to abdominal aortic dilation of 3.0 cm or greater. The main risk factors are age older than 65 years, male sex, and smoking history. Other risk factors include a family history of abdominal aortic aneurysm, coronary artery disease, hypertension, peripheral artery disease, and previous myocardial infarction. Diagnosis may be made by physical examination, an incidental finding on imaging, or ultrasonography. The U.S. Preventive Services Task Force released updated recommendations for abdominal aortic aneurysm screening in 2014. Men 65 to 75 years of age with a history of smoking should undergo one-time screening with ultrasonography based on evidence that screening will improve abdominal aortic aneurysm-related mortality in this population. Men in this age group without a history of smoking may benefit if they have other risk factors (e.g., family history of abdominal aortic aneurysm, other vascular aneurysms, coronary artery disease). There is inconclusive evidence to recommend screening for abdominal aortic aneurysm in women 65 to 75 years of age with a smoking history. Women without a smoking history should not undergo screening because the harms likely outweigh the benefits. Persons who have a stable abdominal aortic aneurysm should undergo regular surveillance or operative intervention depending on aneurysm size. Surgical intervention by open or endovascular repair is the primary option and is typically reserved for aneurysms 5.5 cm in diameter or greater. There are limited options for medical treatment beyond risk factor modification. Ruptured abdominal aortic aneurysm is a medical emergency presenting with hypotension, shooting abdominal or back pain, and a pulsatile abdominal mass. It is associated with high prehospitalization mortality. Emergent surgical intervention is indicated for a rupture but has a high operative mortality rate. PMID:25884861

  19. Giant aortic aneurysm in a child with Takayasu arteritis.

    PubMed

    Halaweish, Ihab; Patel, Himanshu; Si, Ming-Sing

    2016-03-01

    Takayasu arteritis is a chronic, idiopathic, granulomatous vasculitis involving the aorta, its major branches, and occasionally the pulmonary arteries. Although rare in children, it is the third most common vasculitis in the paediatric population. Although aneurysmal disease has been reported in adults with Takayasu arteritis, it is a rare entity in children. We present the case of a 10-year-old boy with a giant ascending and arch aneurysm that necessitated follow-up surgery for a new aneurysm and occlusive disease. This is also the first published case involving endovascular aortic graft placement for the management of vascular sequela of Takayasu arteritis in a child. PMID:26365418

  20. Syphilitic aortic aneurysm with spastic paraparesis: a novel presentation and review of the literature.

    PubMed

    Gugssa, Seid Ali; Johnston, James C

    2012-12-15

    Syphilitic aortic aneurismal erosion into the vertebral column with associated neurological dysfunction is extraordinarily rare, and the very few reported cases typically involve the descending aorta. We describe the novel presentation of a 55 year old man with a syphilitic aneurysm of the ascending aorta and arch causing spinal erosion with spastic paraparesis. Clinicians must remain cognizant that the resurgence of primary and secondary syphilis, exacerbated by the unrelenting HIV-AIDS epidemic, portends an increasing incidence of tertiary manifestations such as aortic aneurysm formation with its myriad complications including compressive myelopathy. PMID:22925534

  1. Aortic valve surgery - open

    MedlinePlus

    ... choose to have your aortic valve surgery at a center that does many of these procedures. ... DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, ... Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: ...

  2. [Acute aortic syndrome].

    PubMed

    Nienaber, Christoph A

    2016-06-01

    Acute aortic syndrome is the common denominator for acute events to the aortic wall and encompasses dissection of the aorta, intramural hematoma, formation of aortic ulcers and trauma to the aorta with an annual incidence of up to 35 cases/100.000 between 65 and 75 years of age. Both, inflammation and/or microtrauma at the level of the aortic media layer, and a genetic disposition are promoting elements of AAS, while the extent and anatomic involvement of the ascending aorta call for either surgical resection/repair in the proximal part of the aorta, or an endovascular solution for pathologies in the distal aorta; in all cases of dissection (regardless of location) reconstruction/realignment has been proven to portend better long-term outcomes (in addition to medical management of blood pressure). PMID:27254622

  3. Abdominal aortic aneurysm

    MedlinePlus

    ... main blood vessel that supplies blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs ... dissection). Symptoms of rupture include: Pain in the abdomen or back. The pain may be severe, sudden, ...

  4. Abdominal aortic aneurysm.

    PubMed

    Setacci, Francesco; Galzerano, Giuseppe; De Donato, Gianmarco; Benevento, Domenico; Guerrieri, Massimiliano W; Ruzzi, Umberto; Borrelli, Maria P; Setacci, Carlo

    2016-02-01

    Endovascular repair of abdominal aortic aneurysms has become a milestone in the treatment of patients with abdominal aortic aneurysm. Technological improvement allows treatment in more and more complex cases. This review summarizes all grafts available on the market. A complete review of most important trial on this topic is provided to the best of our knowledge, and technical tips and tricks for standard cases are also included. PMID:26771730

  5. Collapse displacements for a mechanism of spreading-induced supports in a masonry arch

    NASA Astrophysics Data System (ADS)

    Coccia, Simona; Di Carlo, Fabio; Rinaldi, Zila

    2015-09-01

    Masonry arch systems and vaulted structures constitute a structural typology widely spread in the historical building heritage. Small displacements of the supports, due to different causes, among which subsidence of foundation systems or movements of underlying structures can lead the masonry arch to a condition of collapse because of gradual change in its geometry. This paper presents a tool, based on a kinematic approach, for the computation of the magnitude of the displacements that cause the collapse of circular arches subject to dead loads, and allows the evaluation of the related thrust value. A parametric study has been carried out in order to develop a deeper understanding of the influence of the involved parameters. In addition, analytic formulations of the maximum allowed displacement and the associated thrust are proposed. Finally, a case study related to the behavior of a masonry arch on spreading-induced abutments is undertaken and discussed.

  6. Wall shear stress indicators in abnormal aortic geometries

    NASA Astrophysics Data System (ADS)

    Prahl Wittberg, Lisa; van Wyk, Stevin; Fuchs, Laszlo; Gutmark, Ephraim; Gutmark-Little, Iris

    2015-11-01

    Cardiovascular disease, such as atherosclerosis, occurs at specific locations in the arterial tree. Characterizing flow and forces at these locations is crucial to understanding the genesis of disease. Measures such as time average wall shear stress, oscillatory shear index, relative residence time and temporal wall shear stress gradients have been shown to identify plaque prone regions. The present paper examines these indices in three aortic geometries obtained from patients whose aortas are deformed due to a genetic pathology and compared to one normal geometry. This patient group is known to be prone to aortic dissection and our study aims to identify early indicators that will enable timely intervention. Data obtained from cardiac magnetic resonance imaging is used to reconstruct the aortic arch. The local unsteady flow characteristics are calculated, fully resolving the flow field throughout the entire cardiac cycle. The Quemada model is applied to account for the non-Newtonian properties of blood, an empirical model valid for different red blood cell loading. The impact of the deformed aortic geometries is analyzed to identify flow patterns that could lead to arterial disease at certain locations.

  7. Syphilis as a Cause of Thoracic Aortic Aneurysm.

    PubMed

    Roberts, William C; Barbin, Clay M; Weissenborn, Matthew R; Ko, Jong M; Henry, A Carl

    2015-10-15

    In 2009, we described morphologic findings in 22 patients having resection of an ascending aortic aneurysm in the previous 11 years at the Baylor University Medical Center, and histologic examination of the aneurysmal wall disclosed classic findings of syphilitic aortitis. The major purpose of that extensively illustrated report was to describe the characteristic gross features of the aneurysm such that syphilitic aortitis might be better recognized at operation and appropriate antibiotics administered postoperatively. The aim of the present study was to emphasize that syphilis remains a major cause of ascending aortic aneurysm. From January 1, 2009, to December 31, 2014, we studied additional 23 patients who had resection of an ascending aortic aneurysm that again histologically had classic features of syphilitic aortitis. All 23 patients were found to have syphilitic aortitis grossly and histologically. The aneurysm involved the ascending portion of aorta in all 23, the arch portion in 12, and the descending thoracic portion in 10. In conclusion, syphilis has far from disappeared. It remains a major cause of ascending aortic aneurysm. PMID:26307174

  8. Novel endovascular procedures and new developments in aortic surgery.

    PubMed

    Cheng, S W K

    2016-09-01

    Endovascular repair has evolved to become a viable mainstream treatment for aortic pathology in both acute and elective settings. As technology advanced, traditional anatomical barriers were progressively tackled using new devices and novel procedures, and there are now multiple options available to the vascular surgeon. In the abdominal aorta, advances in endovascular aneurysm repair have been in the treatment of hostile aortic necks using new sealing concepts and ancillary procedures, and in branch preservation using fenestrations and snorkels. Access challenges have been met with a percutaneous approach and low-profile devices, and standard protocols have improved mortality for ruptured aneurysms. In the thoracic aorta, more invasive hybrid procedures have given way gradually to branched endografts. Particular challenges to the anaesthetist include blood pressure control and the prevention of stroke and paraplegia. Current focus in the thoracic aorta is in treating aortic arch pathology and in optimal management of acute and chronic dissections. This review describes the latest trends in the endovascular treatment of aortic diseases and examines the current evidence for different modalities of management. PMID:27566806

  9. Dental arch dimensions in the mixed dentition: a study of Brazilian children from 9 to 12 years of age

    PubMed Central

    LOULY, Fabiane; NOUER, Paulo Roberto Aranha; JANSON, Guilherme; PINZAN, Arnaldo

    2011-01-01

    Objective This study evaluated dental arch dimensional changes of Brazilian children. Material and methods Dental casts were taken from 66 children (29 males; 37 females) with normal occlusion selected among 1,687 students from public and private schools aged 9, 10, 11 and 12 years, according to the following criteria: Class I canine and molar relationships; well-aligned upper and lower dental arches; mixed dentition; good facial symmetry; no previous orthodontic treatment. Dental arch dimensions were taken by one examiner using the Korkhaus’ compass and a digital pachymeter. ANOVA test was applied to compare the arch dimensions at the different ages and the t-test was used to compare the arch dimensions of male and female subjects. Arch forms were compared by means of chi-square tests. Results Only the maxillary anterior segment length showed a statistically significant increase from 10 to 12 years of age. Males had a significantly larger maxillary depth than females at the age range evaluated. The predominant dental arch form found was elliptical. Conclusion In the studied age range, anterior maxillary length increased from 10 to 12 years of age, males had larger maxillary depth than females and the predominant arch form was elliptical. PMID:21552719

  10. Glowing Solar Material Arches Up and Out

    NASA Video Gallery

    An elongated, streaming arch of solar material rose up at the sun’s edge before breaking apart in this animation of imagery captured by NASA’s Solar Dynamics Observatory on April 28, 2016. While so...

  11. Analysis of an arched outer-race ball bearing considering centrifugal forces

    NASA Technical Reports Server (NTRS)

    Hamrock, B. J.; Anderson, W. J.

    1972-01-01

    A Newton-Raphson method of iteration was used in evaluating the radial and axial projection of the distance between the ball center and the outer raceway groove curvature center (V and W). Fatigue life evaluations were made. The similar analysis of a conventional bearing can be directly obtained from the arched bearing analysis by simply letting the amount of arching be zero (g = 0) and not considering equations related to the unloaded half of the outer race. The analysis was applied to a 150-mm angular contact ball bearing. Results for life, contact loads, and angles are shown for a conventional bearing (g = 0) and two arched bearings (g = 0.127 mm (0.005 in.), and 0.254 mm (0.010 in.)). The results indicate that an arched bearing is highly desirable for high speed applications. In particular, for a DN value of 3 million (20,000 rpm) and an applied axial load of 4448 N (1000 lb), an arched bearing shows an improvement in life of 306 percent over that of a conventional bearing. At 4.2 million DN (28,000 rpm), the corresponding improvement is 340 percent. It was also found for low speeds, the arched bearing does not offer the advantages that it does for high speed applications.

  12. Integrated exploration locates Cincinnati arch dolomite breccias

    SciTech Connect

    Tedesco, S.A. )

    1994-11-28

    Dolomite breccias or chimneys are prolific reservoirs found along the Cincinnati arch and adjacent basins from Tennessee to Ontario. An integrated approach using seismic and surface geochemistry, augmented by subsurface geology and magnetics, has led to a dramatic increase in the number of these fields being discovered in the past 10 years. Historically the reservoirs have been found by random drilling. The paper describes the geology of the arch, breccia characteristics, and case histories of discoveries using this integrated approach.

  13. Abdominal aortic feminism.

    PubMed

    Mortimer, Alice Emily

    2014-01-01

    A 79-year-old woman presented to a private medical practice 2 years previously for an elective ultrasound screening scan. This imaging provided the evidence for a diagnosis of an abdominal aortic aneurysm (AAA) to be made. Despite having a number of recognised risk factors for an AAA, her general practitioner at the time did not follow the guidance set out by the private medical professional, that is, to refer the patient to a vascular specialist to be entered into a surveillance programme and surgically evaluated. The patient became symptomatic with her AAA, was admitted to hospital and found to have a tender, symptomatic, 6 cm leaking AAA. She consented for an emergency open AAA repair within a few hours of being admitted to hospital, despite the 50% perioperative mortality risk. The patient spent 4 days in intensive care where she recovered well. She was discharged after a 12 day hospital stay but unfortunately passed away shortly after her discharge from a previously undiagnosed gastric cancer. PMID:25398912

  14. Primary Stenting in Infrarenal Aortic Occlusive Disease

    SciTech Connect

    Nyman, Ulf; Uher, Petr; Lindh, Mats; Lindblad, Bengt; Ivancev, Krasnodar

    2000-03-15

    Purpose: To evaluate the results of primary stenting in aortic occlusive disease.Methods: Thirty patients underwent primary stenting of focal concentric (n = 2) and complex aortic stenoses (n = 19), and aortic or aorto-iliac occlusions (n = 9). Sixteen patients underwent endovascular outflow procedures, three of whom also had distal open surgical reconstructions. Median follow-up was 16 months (range 1-60 months).Results: Guidewire crossing of two aorto-biiliac occlusions failed, resulting in a 93% (28/30) technical success. Major complications included one access hematoma, one myocardial infarction, one death (recurrent thromboembolism) in a patient with widespread malignancy, and one fatal hemorrhage during thrombolysis of distal emboli from a recanalized occluded iliac artery. One patient did not improve his symptoms, resulting in a 1-month clinical success of 83% (25/30). Following restenting the 26 stented survivors changed their clinical limb status to +3 (n = 17) and +2 (n = 9). During follow-up one symptomatic aortic restenosis occurred and was successfully restented.Conclusions: Primary stenting of complex aortic stenoses and short occlusions is an attractive alternative to conventional surgery. Larger studies with longer follow-up and stratification of lesion morphology are warranted to define its role relative to balloon angioplasty. Stenting of aorto-biiliac occlusions is feasible but its role relative to bypass grafting remains to be defined.

  15. Mandibular arch perimeter changes with lip bumper treatment.

    PubMed

    Osborn, W S; Nanda, R S; Currier, G F

    1991-06-01

    The effects of lip bumper treatment on the mandibular arch were observed in 32 patients with late transitional and early permanent dentitions. Dental cast measurements were made for arch perimeter, arch length, and arch width. Cephalometric radiographs were used to determine labial tipping of the incisors and distal movement of the molars. Arch circumference increased in all patients, ranging from 0.7 mm to 8.8 mm, with an average of 4.1 mm. The mean increase in arch length was 1.2 mm and was largely attributed to anterior tipping of the mandibular incisors. Change in arch length was the most predictive variable for the increase in arch circumference. Passive changes in arch width were recorded, with a mean increase of 2.0 mm in the intercanine distance and 2.5 mm in the first premolar distance. Arch width increments contributed to the increase in arch circumference, but the increases in arch width were not found to be predictive of the change in arch circumference. Changes in either arch circumference or arch length were not related to the duration of treatment, age and sex of the patient, or the eruption status of the permanent second molars. PMID:2038972

  16. Transcatheter Aortic Valve Implantation Assisted with Microcatheter: A New Method to Avoid Coronary Artery Obstruction

    PubMed Central

    Chen, Xiang; Chu, Guo-Jun; Wang, Fei-Yu; Zhu, Yu-Feng; Zhang, Ben; Zhao, Xian-Xian; Qin, Yong-Wen; Ge, Jun-Bo

    2015-01-01

    Background: Lack of fluoroscopic landmarks can make valve deployment more difficult in patients with absent aortic valve (AV) calcification. The goal of this article was to evaluate the feasibility and effectiveness of transcatheter implantation of a valved stent into the AV position of a goat, assisted with a microcatheter which provides accurate positioning of coronary artery ostia to help valved stent deployment. Methods: The subjects were 10 healthy goats in this study. A microcatheter was introduced into the distal site of right coronary artery (RCA) through femoral artery sheath. A minimal thoracic surgery approach was used to access the apex of the heart. The apex of the left ventricle was punctured; a delivery catheter equipped with the valved stent was introduced over a stiff guidewire into the aorta arch. We could accurately locate the RCA ostia through the microcatheter placed in the RCA under fluoroscopy. After correct valve position was confirmed, the valved stent was implanted after rapid inflation of the balloon. The immediate outcome of the function of the valved stents was evaluated after implantation. Results: All ten devices were successfully implanted into the AV position of the goats. Immediate observation after the procedure showed that the valved stents were in the desired position after implantation by angiography, echocardiogram. No obstruction of coronary artery ostia occurred, and no moderate to severe aortic regurgitation was observed. Conclusions: When the procedure of transcatheter implantation of a balloon-expandable valved stent into the AV position of goats is assisted with microcatheter positioning coronary artery ostia, the success rate of operation can be increased in those with noncalcified AV. PMID:25758265

  17. Surgical Aortic Valvuloplasty Versus Balloon Aortic Valve Dilatation in Children.

    PubMed

    Donald, Julia S; Konstantinov, Igor E

    2016-09-01

    Balloon aortic valve dilatation (BAD : is assumed to provide the same outcomes as surgical aortic valvuloplasty (SAV). However, the development of precise modern surgical valvuloplasty techniques may result in better long-term durability of the aortic valve repair. This review of the recent literature suggests that current SAV provides a safe and durable repair. Furthermore, primary SAV appears to have greater freedom from reintervention and aortic valve replacement when compared to BAD. PMID:27587493

  18. Pre- and Postoperative Imaging of the Aortic Root.

    PubMed

    Hanneman, Kate; Chan, Frandics P; Mitchell, R Scott; Miller, D Craig; Fleischmann, Dominik

    2016-01-01

    Three-dimensional datasets acquired using computed tomography and magnetic resonance imaging are ideally suited for characterization of the aortic root. These modalities offer different advantages and limitations, which must be weighed according to the clinical context. This article provides an overview of current aortic root imaging, highlighting normal anatomy, pathologic conditions, imaging techniques, measurement thresholds, relevant surgical procedures, postoperative complications and potential imaging pitfalls. Patients with a range of clinical conditions are predisposed to aortic root disease, including Marfan syndrome, bicuspid aortic valve, vascular Ehlers-Danlos syndrome, and Loeys-Dietz syndrome. Various surgical techniques may be used to repair the aortic root, including placement of a composite valve graft, such as the Bentall and Cabrol procedures; placement of an aortic root graft with preservation of the native valve, such as the Yacoub and David techniques; and implantation of a biologic graft, such as a homograft, autograft, or xenograft. Potential imaging pitfalls in the postoperative period include mimickers of pathologic processes such as felt pledgets, graft folds, and nonabsorbable hemostatic agents. Postoperative complications that may be encountered include pseudoaneurysms, infection, and dehiscence. Radiologists should be familiar with normal aortic root anatomy, surgical procedures, and postoperative complications, to accurately interpret pre- and postoperative imaging performed for evaluation of the aortic root. Online supplemental material is available for this article. PMID:26761529

  19. Aortic aneurysm repair - endovascular- discharge

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000236.htm Aortic aneurysm repair - endovascular - discharge To use the sharing features ... enable JavaScript. AAA repair - endovascular - discharge; Repair - aortic aneurysm - endovascular - discharge; EVAR - discharge; Endovascular aneurysm repair - discharge ...

  20. Screening for Abdominal Aortic Aneurysm

    MedlinePlus

    Understanding Task Force Recommendations Screening for Abdominal Aortic Aneurysm The U.S. Preventive Services Task Force (Task Force) ... final recommendation statement on Screening for Abdominal Aortic Aneurysm. This final recommendation statement applies to adults ages ...

  1. Controlled localized buckling responses of orthodontic arch wires.

    PubMed

    Nikolai, R J; Chung, A Y

    1999-09-01

    The orthodontic arch wire is often activated locally, in transverse bending and/or longitudinal torsion, to engage an individual malaligned tooth. Arch wires with substantial flexibilities and elastic ranges in bending are available. Several clinical reports of distal displacements of molars with appliances activated by locally buckling the arch wire have appeared in the recent published literature. This article contains an explanation of buckling or "column" action and the postbuckling response of a wire, and a report of the results of a controlled, in-vitro study of a sample of 256 wire segments subjected to activation-deactivation, buckling-postbuckling-unbuckling cycles. Continuous force-displacement diagrams were obtained from mechanical tests run at oral temperature. Four orthodontics-relevant, mechanical characteristics were quantified from each diagram, and each specimen was subjected to posttest evaluation for inelastic behavior. Although the deformation of the buckled wire is, in fact, bending, the force-displacement diagrams obtained differed substantially from their familiar counterparts generated in transverse bending. Judging from the force magnitudes induced as the deactivation half-cycles commenced as well as the deactivation rates, not all of the 8 wires seem to be clinically suitable for activation initiated by buckling. Magnitudes of springback were substantial from activations as large as 6 mm, and only 2 of the 8 wires exhibited full deactivations less than 80% of their activating displacements. This relatively new mode of arch wire activation that enables delivery to the dentition of mesiodistal pushing forces has substantial potential for clinical application from several biomechanical standpoints. PMID:10474103

  2. In vivo Study of the Accuracy of Dual-arch Impressions

    PubMed Central

    de Lima, Luciana Martinelli Santayana; Borges, Gilberto Antonio; Junior, Luiz Henrique Burnett; Spohr, Ana Maria

    2014-01-01

    Background: This study evaluated in vivo the accuracy of metal (Smart®) and plastic (Triple Tray®) dual-arch trays used with vinyl polysiloxane (Flexitime®), in the putty/wash viscosity, as well as polyether (Impregum Soft®) in the regular viscosity. Materials and Methods: In one patient, an implant-level transfer was screwed on an implant in the mandibular right first molar, serving as a pattern. Ten impressions were made with each tray and impression material. The impressions were poured with Type IV gypsum. The width and height of the pattern and casts were measured in a profile projector (Nikon). The results were submitted to Student’s t-test for one sample (α = 0.05). Results: For the width distance, the plastic dual-arch trays with vinyl polysiloxane (4.513 mm) and with polyether (4.531 mm) were statistically wider than the pattern (4.489 mm). The metal dual-arch tray with vinyl polysiloxane (4.504 mm) and with polyether (4.500 mm) did not differ statistically from the pattern. For the height distance, only the metal dual-arch tray with polyether (2.253 mm) differed statistically from the pattern (2.310 mm). Conclusion: The metal dual-arch tray with vinyl polysiloxane, in the putty/wash viscosities, reproduced casts with less distortion in comparison with the same technique with the plastic dual-arch tray. The plastic or metal dual-arch trays with polyether reproduced cast with greater distortion. How to cite the article: Santayana de Lima LM, Borges GA, Burnett LH Jr, Spohr AM. In vivo study of the accuracy of dual-arch impressions. J Int Oral Health 2014;6(3):50-5. PMID:25083032

  3. Rearfoot posture of Australopithecus sediba and the evolution of the hominin longitudinal arch

    PubMed Central

    Prang, Thomas C.

    2015-01-01

    The longitudinal arch is one of the hallmarks of the human foot but its evolutionary history remains controversial due to the fragmentary nature of the fossil record. In modern humans, the presence of a longitudinal arch is reflected in the angular relationships among the major surfaces of the human talus and calcaneus complex, which is also known as the rearfoot. A complete talus and calcaneus of Australopithecus sediba provide the opportunity to evaluate rearfoot posture in an early hominin for the first time. Here I show that A. sediba is indistinguishable from extant African apes in the angular configuration of its rearfoot, which strongly suggests that it lacked a longitudinal arch. Inferences made from isolated fossils support the hypothesis that Australopithecus afarensis possessed an arched foot. However, tali attributed to temporally younger taxa like Australopithecus africanus and Homo floresiensis are more similar to those of A. sediba. The inferred absence of a longitudinal arch in A. sediba would be biomechanically consistent with prior suggestions of increased midtarsal mobility in this taxon. The morphological patterns in talus and calcaneus angular relationships among fossil hominins suggest that there was diversity in traits associated with the longitudinal arch in the Plio-Pleistocene. PMID:26628197

  4. Gender identification and morphologic classification of tooth, arch and palatal forms in Saudi population

    PubMed Central

    Mohammad, Aljanakh; Koralakunte, Pavankumar Ravi

    2015-01-01

    Aims: To determine various tooth form, arch form, and palatal form with gender identification between males and females of the Saudi population. Materials and Methods: Irreversible hydrocolloid impressions were made of the maxillary teeth of 100 dentate male and female subjects to obtain study casts. A standardized procedure was adopted to photograph the maxillary dental arches and the maxillary central incisors on the study casts taken from each subject. The outline form of tooth, arch, and palatal form were determined using a standardized method. The average of six prosthodontist's evaluation was considered who classified the outline tracings visually. The statistical analysis was performed using Chi-Square and results tabulated. Results: The predominant tooth is combination form in males and ovoid form in females, the predominant arch is ovoid form in males and square form in females and the predominant palatal form are both U and V shaped in males and U-shaped in females. Conclusion: Except for the tooth form there was a significant difference with arch and palatal form among males and females of the population group studied. The determined tooth, arch and palatal forms are useful in selection and arrangement of artificial teeth among Saudi edentulous population group. Generalizing from the study is questionable as the sample size is small. Further studies should be conducted in a larger sample to confirm the study results PMID:26538903

  5. Rearfoot posture of Australopithecus sediba and the evolution of the hominin longitudinal arch.

    PubMed

    Prang, Thomas C

    2015-01-01

    The longitudinal arch is one of the hallmarks of the human foot but its evolutionary history remains controversial due to the fragmentary nature of the fossil record. In modern humans, the presence of a longitudinal arch is reflected in the angular relationships among the major surfaces of the human talus and calcaneus complex, which is also known as the rearfoot. A complete talus and calcaneus of Australopithecus sediba provide the opportunity to evaluate rearfoot posture in an early hominin for the first time. Here I show that A. sediba is indistinguishable from extant African apes in the angular configuration of its rearfoot, which strongly suggests that it lacked a longitudinal arch. Inferences made from isolated fossils support the hypothesis that Australopithecus afarensis possessed an arched foot. However, tali attributed to temporally younger taxa like Australopithecus africanus and Homo floresiensis are more similar to those of A. sediba. The inferred absence of a longitudinal arch in A. sediba would be biomechanically consistent with prior suggestions of increased midtarsal mobility in this taxon. The morphological patterns in talus and calcaneus angular relationships among fossil hominins suggest that there was diversity in traits associated with the longitudinal arch in the Plio-Pleistocene. PMID:26628197

  6. Contemporary Management of Type B Aortic Dissection in the Endovascular Era.

    PubMed

    Bannazadeh, Mohsen; Tadros, Rami O; McKinsey, James; Chander, Rajiv; Marin, Michael L; Faries, Peter L

    2016-04-01

    Aortic dissection (AD) is one of the most common catastrophic pathologies affecting the aorta. Anatomic classification is based on the origin of entry tear and its extension. Type A dissections originate in the ascending aorta, whereas the entry tear in Type B dissections starts distal to the left subclavian artery. The patients with aortic dissection who manifest complications such as rupture, malperfusion, aneurysmal degeneration, and intractable pain are classified as complicated AD. Risk factors for developing aortic dissection include age, male gender, and aortic wall structural abnormalities. The most common presenting symptom of acute aortic dissection is pain. Malperfusion occurs as a result of end-organ ischemia due to involvement of aortic branches from the dissecting process. This can happen in various locations causing mesenteric ischemia (mesenteric vessels), stroke (aortic arch vessels), renal failure (renal arteries), spinal ischemia, and limb ischemia (iliac or subclavian arteries). Aneurysmal degeneration is the most common complication of patients with chronic Type B dissection who are managed with medical therapy. Management of Type B aortic dissection (TBAD) remains controversial. Many groups recommend conservative therapy for newly diagnosed TBAD and reserve surgical management for patients who develop complications such as rupture, malperfusion, aneurysmal dilatation, and refractory pain. The mainstay of medical therapy includes antihypertensive medication to reduced ΔP/ ΔT by lowering blood pressure and heart rate. With the continued success of thoracic endovascular aortic repair (TEVAR), this procedure has been extended to treat TBAD in selected patients. The outcomes of TEVAR are promising, with early mortality rates from 10% to 20%. With promising results from these series, some groups recommend early TEVAR in uncomplicated TBAD to prevent future adverse events. The goals of endovascular treatment of TBAD are to cover the entry tear

  7. Towards real-time cardiovascular magnetic resonance-guided transarterial aortic valve implantation: In vitro evaluation and modification of existing devices

    PubMed Central

    2010-01-01

    Background Cardiovascular magnetic resonance (CMR) is considered an attractive alternative for guiding transarterial aortic valve implantation (TAVI) featuring unlimited scan plane orientation and unsurpassed soft-tissue contrast with simultaneous device visualization. We sought to evaluate the CMR characteristics of both currently commercially available transcatheter heart valves (Edwards SAPIEN™, Medtronic CoreValve®) including their dedicated delivery devices and of a custom-built, CMR-compatible delivery device for the Medtronic CoreValve® prosthesis as an initial step towards real-time CMR-guided TAVI. Methods The devices were systematically examined in phantom models on a 1.5-Tesla scanner using high-resolution T1-weighted 3D FLASH, real-time TrueFISP and flow-sensitive phase-contrast sequences. Images were analyzed for device visualization quality, device-related susceptibility artifacts, and radiofrequency signal shielding. Results CMR revealed major susceptibility artifacts for the two commercial delivery devices caused by considerable metal braiding and precluding in vivo application. The stainless steel-based Edwards SAPIEN™ prosthesis was also regarded not suitable for CMR-guided TAVI due to susceptibility artifacts exceeding the valve's dimensions and hindering an exact placement. In contrast, the nitinol-based Medtronic CoreValve® prosthesis was excellently visualized with delineation even of small details and, thus, regarded suitable for CMR-guided TAVI, particularly since reengineering of its delivery device toward CMR-compatibility resulted in artifact elimination and excellent visualization during catheter movement and valve deployment on real-time TrueFISP imaging. Reliable flow measurements could be performed for both stent-valves after deployment using phase-contrast sequences. Conclusions The present study shows that the Medtronic CoreValve® prosthesis is potentially suited for real-time CMR-guided placement in vivo after suggested

  8. Transcatheter Aortic Valve Implantation.

    PubMed

    Malaisrie, S Chris; Iddriss, Adam; Flaherty, James D; Churyla, Andrei

    2016-05-01

    Severe aortic stenosis (AS) is a life-threatening condition when left untreated. Aortic valve replacement (AVR) is the gold standard treatment for the majority of patients; however, transcatheter aortic valve implantation/replacement (TAVI/TAVR) has emerged as the preferred treatment for high-risk or inoperable patients. The concept of transcatheter heart valves originated in the 1960s and has evolved into the current Edwards Sapien and Medtronic CoreValve platforms available for clinical use. Complications following TAVI, including cerebrovascular events, perivalvular regurgitation, vascular injury, and heart block have decreased with experience and evolving technology, such that ongoing trials studying TAVI in lower risk patients have become tenable. The multidisciplinary team involving the cardiac surgeon and cardiologist plays an essential role in patient selection, procedural conduct, and perioperative care. PMID:27021619

  9. Abdominal Aortic Aneurysms

    PubMed Central

    Fortner, George; Johansen, Kaj

    1984-01-01

    Aneurysms are common in our increasingly elderly population, and are a major threat to life and limb. Until the advent of vascular reconstructive techniques, aneurysm patients were subject to an overwhelming risk of death from exsanguination. The first successful repair of an abdominal aortic aneurysm using an interposed arterial homograft was reported by Dubost in 1952. A milestone in the evolution of vascular surgery, this event and subsequent diagnostic, operative and prosthetic graft refinements have permitted patients with an unruptured abdominal aortic aneurysm to enjoy a better prognosis than patients with almost any other form of major systemic illness. Images PMID:6702193

  10. Overview of current surgical strategies for aortic disease in patients with Marfan syndrome.

    PubMed

    Miyahara, Shunsuke; Okita, Yutaka

    2016-09-01

    Marfan syndrome is a heritable, systemic disorder of the connective tissue with a high penetrance, named after Dr. Antoine Marfan. The most clinically important manifestations of this syndrome are cardiovascular pathologies which cause life-threatening events, such as acute aortic dissections, aortic rupture and regurgitation of the aortic valve or other artrioventricular valves leading to heart failure. These events play important roles in the life expectancy of patients with this disorder, especially prior to the development of effective surgical approaches for proximal ascending aortic disease. To prevent such catastrophic aortic events, a lower threshold has been recommended for prophylactic interventions on the aortic root. After prophylactic root replacement, disease in the aorta beyond the root and distal to the arch remains a cause for concern. Multiple surgeries are required throughout a patient's lifetime that can be problematic due to distal lesions complicated by dissection. Many controversies in surgical strategies remain, such as endovascular repair, to manage such complex cases. This review examines the trends in surgical strategies for the treatment of cardiovascular disease in patients with Marfan syndrome, and current perspectives in this field. PMID:26586198

  11. Endograft Collapse After Endovascular Treatment for Thoracic Aortic Disease

    SciTech Connect

    Bandorski, Dirk Brueck, Martin; Guenther, Hans-Ulrich; Manke, Christoph

    2010-06-15

    Endovascular treatment is an established therapy for thoracic aortic disease. Collapse of the endograft is a potentially fatal complication. We reviewed 16 patients with a thoracic endograft between 2001 and 2006. Medical records of the treated patients were studied. Data collected include age, gender, diagnosis, indication for endoluminal treatment, type of endograft, and time of follow up. All patients (n = 16; mean age, 61 years; range, 21-82 years) underwent computed tomography (CT) for location of the lesion and planning of the intervention. Time of follow-up with CT scan ranged from 1 to 61 months. Indications for endovascular treatment were degenerative aneurysm (n = 7; 44%), aortic dissection (n = 2; 12%), perforated aortic ulcer (n = 4; 25%), and traumatic aortic injury (n = 3; 19%). Three patients suffered from a collapse of the endograft (one patient distal, two patients proximal) between 3 and 8 days after endovascular treatment. These patients were younger (mean age, 37 {+-} 25 years vs. 67 {+-} 16 years; P < 0.05) and showed more oversizing (proximal, 36 {+-} 19.8% vs. 29 {+-} 20.7% [P > 0.05]; distal, 45 {+-} 23.5% vs. 38 {+-} 21.7% [P > 0.05]). Proximal collapse was corrected by placing a bare stent. In conclusion, risk factors for stent-graft collapse are a small lumen of the aorta and a small radius of the aortic arch curvature (young patients), as well as oversizing, which is an important risk factor and is described for different types of endografts and protheses (Gore TAG and Cook Zenith). Dilatation of the collapsed stent-graft is not sufficient. Following therapy implantation of a second stent or surgery is necessary in patients with a proximal endograft collapse. Distal endograft collapse can possibly be treated conservatively under close follow-up.

  12. Descending endograft for DeBakey type 1 aortic dissection: pro

    PubMed Central

    Berretta, Paolo

    2016-01-01

    The surgical management of patients with DeBakey type 1 acute aortic dissection (DBT1-AAD) represents a major challenge for aortic surgeons. It has been demonstrated that the distal false lumen remains patent in about 70% to 80% of patients undergoing DBT1-AAD surgery and that a patent false lumen worsens the prognosis. In order to improve long term outcomes and reduce the frequency of late aneurysm formation and reoperation, a more aggressive primary operation involving total arch replacement (TAR) and concomitant antegrade stenting of the descending thoracic aorta (DTA) with a frozen elephant trunk (FET) has been introduced. Such extensive operations, however, remain controversial due to their increased technical complexity and perceived higher operative mortality and morbidity. This perspective article will overview the rationale behind, and the potential advantages and current evidence for, FET surgery in acute aortic dissection. PMID:27386410

  13. Mechanics of the pulmonary valve in the aortic position.

    PubMed

    Soares, A L F; van Geemen, D; van den Bogaerdt, A J; Oomens, C W J; Bouten, C V C; Baaijens, F P T

    2014-01-01

    Mathematical models can provide valuable information to assess and evaluate the mechanical behavior and remodeling of native tissue. A relevant example when studying collagen remodeling is the Ross procedure because it involves placing the pulmonary autograft in the more demanding aortic valve mechanical environment. The objective of this study was therefore to assess and evaluate the mechanical differences between the aortic valve and pulmonary valve and the remodeling that may occur in the pulmonary valve when placed in the aortic position. The results from biaxial tensile tests of pairs of human aortic and pulmonary valves were compared and used to determine the parameters of a structurally based constitutive model. Finite element analyzes were then performed to simulate the mechanical response of both valves to the aortic diastolic load. Additionally, remodeling laws were applied to assess the remodeling of the pulmonary valve leaflet to the new environment. The pulmonary valve showed to be more extensible and less anisotropic than the aortic valve. When exposed to aortic pressure, the pulmonary leaflet appeared to remodel by increasing its thickness and reorganizing its collagen fibers, rotating them toward the circumferential direction. PMID:24035437

  14. Apicoaortic conduit and cerebral perfusion in mixed aortic valve disease: a computational analysis

    PubMed Central

    Fragomeni, Gionata; Rossi, Michele; Condemi, Francesca; Mazzitelli, Rosario; Serraino, Giuseppe Filiberto; Renzulli, Attilio

    2013-01-01

    OBJECTIVES The revival of the apicoaortic conduit has attracted new interest in this alternative treatment for severe aortic stenosis unsuitable for conventional valve replacement. However, doubts still exist about the perfusion of the epiaortic vessels after apicoaortic conduit implantation, especially when severe aortic stenosis is associated with aortic valve insufficiency. The aim of the study was to evaluate the perfusion of the epiaortic vessels (innominate artery, left carodit artery and left subclavian artery) in cases of mixed aortic valve disease before and after apicoaortic conduit implantation. METHODS Starting from the data of a real patient with severe aortic stenosis and mild aortic insufficiency who underwent apicoaortic conduit implantation, we created a computational model where severe aortic valve stenosis was associated with different grades of aortic insufficiency (mild, medium and moderate). RESULTS A total of six combinations were analysed. In all simulations, the more severe the concomitant aortic insufficiency, the more the flow through the epiaortic vessels was diminished. After apicoaortic conduit implantation, there was an absolute augmentation of the median output in each epiaortic vessel compared with the same combination of mixed aortic valve disease before implantation. Interestingly, retrograde flow from the conduit in the descending aorta was minimal and did not contribute to the improved output of the epiaortic vessels. CONCLUSIONS The computational analysis suggested a protective effect, rather than steal phenomenon, of the apicoaortic conduit towards the cerebral perfusion, even in cases of mixed aortic valve disease. PMID:23962852

  15. Segmental Aortic Stiffening Contributes to Experimental Abdominal Aortic Aneurysm Development

    PubMed Central

    Raaz, Uwe; Zöllner, Alexander M.; Schellinger, Isabel N.; Toh, Ryuji; Nakagami, Futoshi; Brandt, Moritz; Emrich, Fabian C.; Kayama, Yosuke; Eken, Suzanne; Adam, Matti; Maegdefessel, Lars; Hertel, Thomas; Deng, Alicia; Jagger, Ann; Buerke, Michael; Dalman, Ronald L.; Spin, Joshua M.; Kuhl, Ellen; Tsao, Philip S.

    2015-01-01

    Background Stiffening of the aortic wall is a phenomenon consistently observed in age and in abdominal aortic aneurysm (AAA). However, its role in AAA pathophysiology is largely undefined. Methods and Results Using an established murine elastase-induced AAA model, we demonstrate that segmental aortic stiffening (SAS) precedes aneurysm growth. Finite element analysis (FEA) reveals that early stiffening of the aneurysm-prone aortic segment leads to axial (longitudinal) wall stress generated by cyclic (systolic) tethering of adjacent, more compliant wall segments. Interventional stiffening of AAA-adjacent aortic segments (via external application of surgical adhesive) significantly reduces aneurysm growth. These changes correlate with reduced segmental stiffness of the AAA-prone aorta (due to equalized stiffness in adjacent segments), reduced axial wall stress, decreased production of reactive oxygen species (ROS), attenuated elastin breakdown, and decreased expression of inflammatory cytokines and macrophage infiltration, as well as attenuated apoptosis within the aortic wall. Cyclic pressurization of segmentally stiffened aortic segments ex vivo increases the expression of genes related to inflammation and extracellular matrix (ECM) remodeling. Finally, human ultrasound studies reveal that aging, a significant AAA risk factor, is accompanied by segmental infrarenal aortic stiffening. Conclusions The present study introduces the novel concept of segmental aortic stiffening (SAS) as an early pathomechanism generating aortic wall stress and triggering aneurysmal growth, thereby delineating potential underlying molecular mechanisms and therapeutic targets. In addition, monitoring SAS may aid the identification of patients at risk for AAA. PMID:25904646

  16. Bicuspid aortic valve

    MedlinePlus

    ... is unclear, but it is the most common congenital heart disease . It often runs in families. The bicuspid aortic ... A.M. Editorial team. Related MedlinePlus Health Topics Congenital Heart Defects Heart Valve Diseases Browse the Encyclopedia A.D.A.M., Inc. ...

  17. Cauda equina syndrome: an uncommon symptom of aortic diseases

    PubMed Central

    He, Fuliang; Xing, Tong; Yu, Fang; Li, Hongchuan; Fang, Xiutong; Song, Hongxing

    2015-01-01

    Background: In order to help diagnose and deal with the fetal aortic diseases in time, we retrospectively reviewed 8 patients who presented with cauda equina syndrome (CES) but actually suffered from low spinal nerve ischemia due to aortic diseases. Material and Methods: 8 patients were initially diagnosed as CES. 7 patients were confirmed with aortic diseases. 1 patient was confirmed with aortic saddle embolism post emergent laminectomy. Relief of CES symptoms was evaluated during preoperation and follow-up period. Results: 1 patient was diagnosed as aortic dissection and 5 patients as AAA. These 6 patients underwent endovascular aortic repair (EVAR). The CES was relieved in 5-10 d post procedure. The 7th patient was diagnosed with acute abdominal aortic occlusion and then underwent catheter directed thrombolysis with recombinant tissue plasminogen activator (rTPA) for 20 h and CES disappeared. The JOA scores of the 7 patients were recovered from preoperative 15.14±1.21 to 21.00±2.16 within 5-10 d (P<0.01), and evaluated to be 24.12±1.34, 25.88±1.21 and 26.29±1.11 at 3 m-, 6 m- and 12 m-follow-up point, respectively. The 8th patient was initially diagnosed as lumbar spinal stenosis and lumbar disc herniation. The patient underwent emergent vertebral canal decompression and presented with serious CES symptoms. CTA confirmed that the patient had been suffered from aortic saddle embolism (ASE). Conclusion: CES caused by abdominal aortic diseases is a special event with fetal consequences if it is not recognized and treated promptly. Orthopedists and neurosurgeons should pay attentions particularly to this issue to preserve the cauda equina functions to their maximums. PMID:26379869

  18. Evaluation of Potential Modifiers of the Cardiac Phenotype in the 22q11.2 Deletion Syndrome

    PubMed Central

    Goldmuntz, Elizabeth; Driscoll, Deborah A.; Emanuel, Beverly S.; McDonald-McGinn, Donna; Mei, Minghua; Zackai, Elaine; Mitchell, Laura E.

    2010-01-01

    BACKGROUND The phenotype associated with deletion of the 22q11.2 chromosomal region is highly variable, yet little is known about the source of this variability. Cardiovascular anomalies, including tetralogy of Fallot, truncus arteriosus, interrupted aortic arch type B, perimembranous ventricular septal defects, and aortic arch anomalies, occur in approximately 75% of individuals with a 22q11.2 deletion. METHODS Data from 343 subjects enrolled in a study of the 22q11.2 deletion syndrome were used to evaluate potential modifiers of the cardiac phenotype in this disorder. Subjects with and without cardiac malformations, and subjects with and without aortic arch anomalies were compared with respect to sex and race. In addition, in the subset of subjects from whom a DNA sample was available, genotypes for variants of four genes that are involved in the folate-homocysteine metabolic pathway and that have been implicated as risk factors for other birth defects were compared. Five variants in four genes were genotyped by heteroduplex or restriction digest assays. The chi-square or Fisher’s exact test was used to evaluate the association between the cardiac phenotype and each potential modifier. RESULTS The cardiac phenotype observed in individuals with a 22q11.2 deletion was not significantly associated with either sex or race. The genetic variants that were evaluated also did not appear to be associated with the cardiovascular phenotype. CONCLUSIONS Variation in the cardiac phenotype observed between individuals with a 22q11.2 deletion does not appear to be related to sex, race, or five sequence variants in four folate-related genes that are located outside of the 22q11.2 region. PMID:18770859

  19. 18. SOUTHERNMOST ARCH TOP AND BUTTRESS, AT TURNING POINT WHERE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    18. SOUTHERNMOST ARCH TOP AND BUTTRESS, AT TURNING POINT WHERE THE EARTHEN EMBANKMENT MEETS THE CONCRETE ARCH DAM. VIEW TO SOUTHWEST. - Rock Creek Dam, East end of Rock Creek Road, Auburn, Placer County, CA

  20. 20. WEST CONFEDERATE AVENUE BRIDGE SPANNING CODON'S RUN, ARCH DETAIL ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    20. WEST CONFEDERATE AVENUE BRIDGE SPANNING CODON'S RUN, ARCH DETAIL SHOWING BRICK ARCH FOR MAIN SPAN AND STONE VOUSSOIRS. VIEW W. - Gettysburg National Military Park Tour Roads, Gettysburg, Adams County, PA

  1. 8. GENERAL ELEVATION OF BRIDGE AFTER CONCRETE FOR ARCHES HAS ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    8. GENERAL ELEVATION OF BRIDGE AFTER CONCRETE FOR ARCHES HAS BEEN POURED BUT BEFORE FALSEWORK HAS BEEN REMOVED. TAKEN JAN 7, 1928. - Marsh Rainbow Arch Bridge, West Eighth Street North, Newton, Jasper County, IA

  2. 2. LONGITUDINAL VIEW OF THE CONCRETE ARCH (ONEWAY BRIDGE), LOOKING ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    2. LONGITUDINAL VIEW OF THE CONCRETE ARCH (ONE-WAY BRIDGE), LOOKING NORTHEAST. - Washington Water Power Company Post Falls Power Plant, Concrete Arch Bridge, West of intersection of Spokane & Fourth Streets, Post Falls, Kootenai County, ID

  3. View of Highway 140 west of Arch Rock. Note stone ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of Highway 140 west of Arch Rock. Note stone wall at right and formed concrete wall at center. Looking north-northwest - All Year Highway, Between Arch Rock & Yosemite Valley, El Portal, Mariposa County, CA

  4. Aortic valve annuloplasty: new single suture technique.

    PubMed

    Schöllhorn, Joachim; Rylski, Bartosz; Beyersdorf, Friedhelm

    2014-06-01

    Reconstruction strategies for aortic valve insufficiency in the presence of aortic annulus dilatation are usually surgically challenging. We demonstrate a simple, modified Taylor technique of downsizing and stabilization of the aortic annulus using a single internal base suture. Since April 2011, 22 consecutive patients have undergone safe aortic valve annuloplasty. No reoperations for aortic valve insufficiency and no deaths occurred. PMID:24882316

  5. Radionuclide angiographic evaluation of left ventricular performance at rest and during exercise in patients with aortic regurgitation

    SciTech Connect

    Iskandrian, A.S.; Heo, J.

    1986-06-01

    Radionuclide angiographic evaluation of LV performance at rest and during exercise in patients with AR have shown that an abnormal EF response to exercise may be observed in asymptomatic patients with normal resting LV function. The EF response to exercise has been correlated with a number of clinical and exercise measurements; important among these are the slope of the systolic pressure-to-end-systolic volume, end-systolic volume, cardiac index, pulmonary capillary wedge pressure, and wall stress. The changes in the regurgitant fraction, EF, and LV volume have shown considerable individual variability; they have also allowed a better understanding of the circulatory responses during exercise. Radionuclide angiography provides a reliable and reproducible method of measuring the rest LVEF that is important in the timing and the outcome of valve replacement. The value of the EF response to exercise in patient management is not yet clear; it is possible that other radionuclide-derived measurements at rest or during exercise, such as the systolic pressure-to-end-systolic volume relationship, and the end-systolic volume may provide complementary information to that provided by the EF.

  6. Arch coordination does not affect the stability in class III orthognathic surgery patients.

    PubMed

    Hong, Sung Ok; Ryu, Dong-Mok; Lee, Deok-Won; Jung, Jae Hoon

    2013-11-01

    The purpose of this study was to evaluate if the arch coordination manifested by preorthodontics had an effect on the short-term stability after orthognathic surgery by evaluating the B point, menton, overjet, and overbite. The subjects were 10 healthy adult female and male Koreans (mean age, 24.9 years) with insufficient arch coordination and 10 healthy adult female and male Koreans (mean age, 22 years) with sufficient arch coordination. All subjects had sagittal split ramus osteotomy with 1-piece maxillary Le Fort I surgery with/without genioplasty done from the same practitioner at Kyung Hee University Hospital at Gangdong from 2009 to 2011. All arch widths of the maxilla and mandible were measured. Cephalometric tracings of the subjects were made of the presurgical and postsurgical period with a follow-up at 3 months. Relapse was measured according to cephalometric tracing changes using the V-ceph Cephalometric Analysis Software version 5.5(Osstem, Seoul, South Korea). Insufficient arch coordination did not definitively affect the overall treatment outcome. There was significant difference in the horizontal dimensions of the mandible (vertical plane to point B, overjet) in the study group. The study group showed instability in orthodontic factors, whereas skeletal factors were stable. Vertical dimensions (horizontal plane to point B, horizontal plane to menton, overbite) were not statistically significant. PMID:24220471

  7. Recent advances in aortic valve disease: highlights from a bicuspid aortic valve to transcatheter aortic valve replacement.

    PubMed

    Augoustides, John G T; Wolfe, Yanika; Walsh, Elizabeth K; Szeto, Wilson Y

    2009-08-01

    There have been major advances in the management of aortic valve disease. Because bicuspid aortic valve is common and predicts an increased risk of adverse aortic events, these patients merit aortic surveillance and consideration for ascending aortic replacement when its diameter exceeds 4.0 cm. Serial quantitative echocardiographic analysis, as compared with traditional clinical markers, can result in better timing of surgical intervention for aortic regurgitation. Furthermore, echocardiographic analysis of aortic regurgitation can classify the mechanism based on cusp mobility to guide aortic valve repair. In aortic root replacement, aortic valve preservation with reimplantation is a mainstream surgical option in Marfan syndrome to offer freedom from valve-related anticoagulation. Prosthetic aortic root replacement has further alternatives with the introduction of the aortic neosinus design and acceptable clinical outcomes with the porcine xenograft. Because aortic valve prosthesis-patient mismatch (PPM) may adversely affect patient outcome, its perioperative prevention is important. Furthermore, significant functional mitral regurgitation in association with aortic stenosis often resolves after aortic valve replacement. Echocardiographic assessment of the aortic valve must include valve area because the transaortic pressure gradient may be low in severe stenosis. Aortic valve replacement with partial sternotomy is safe and offers a reasonable less invasive alternative. Transcatheter aortic valve replacement, whether transfemoral or transapical, has revolutionized aortic valve replacement; it remains a major theme in the specialty for 2009 and beyond. PMID:19497768

  8. Detection of abdominal aortic graft infection: comparison of CT and In-labeled white blood cell scans

    SciTech Connect

    Mark, A.S.; McCarthy, S.M.; Moss, A.A.; Price, D.

    1985-02-01

    Aortic graft infections are a rare but potentially lethal complication of aortic graft surgery. The diagnosis and assessment of the extent of a graft infection is difficult on clinical grounds. A prospective study compared CT and indium-labeled white blood cell (In-WBC) scans in the diagnosis of aortic graft infection. Five patients with aortic graft infection and three patients without aortic graft infection were studied by both methods. CT correctly detected the retroperitoneal extension of the infection in three patients with groin infection; In-WBC scans diagnosed the extension only in one patient. Both CT and In-WBC were positive in two patients with aortic graft infection but no groin infection. Both studies were negative in the three patients without evidence of aortic graft infection. The study suggests that CT is more sensitive than In-WBC in evaluating the extent of aortic graft infection and should be the imaging method of choice.

  9. 3. View locking east of 591 foot steel arch of ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    3. View locking east of 591 foot steel arch of bridge. Arch consists of Pratt trusses divided into twenty-four, 24 foot, 7 inch panels. It was fabricated by the King Iron Bridge Company of Cleveland whose circular plaque can be seen where the arch meets the roadway. The steel arch was erected by the Berro construction Co. of Chicago. - Detroit Superior High Level Bridge, Cleveland, Cuyahoga County, OH

  10. Left ventricular dysfunction in the fetus: relation to aortic valve anomalies and endocardial fibroelastosis.

    PubMed Central

    Sharland, G K; Chita, S K; Fagg, N L; Anderson, R H; Tynan, M; Cook, A C; Allan, L D

    1991-01-01

    OBJECTIVE--To examine the relation between a characteristic form of left ventricular dysfunction in the fetus and abnormalities of the aortic valve and endocardial fibroelastosis of the left ventricle. DESIGN--A retrospective study to examine the correlation between echocardiographic findings in the fetus and postnatal or necropsy findings. SETTING--Tertiary referral centre for fetal echocardiography. PATIENTS--Thirty fetuses showing a characteristic echocardiographic picture of left ventricular dysfunction. MAIN OUTCOME MEASURES--The relation between the prenatal echocardiographic features and the postnatal and necropsy findings. RESULTS--At presentation the size of the left ventricular cavity was normal or enlarged in all cases. The measurements of the orifice of the aortic root and mitral valve were either normal or small for the gestational age. The echocardiographic diagnosis made at presentation was critical aortic stenosis in all cases. At necropsy or postnatal examination the aortic valve was dysplastic and stenotic in 15 cases and the left ventricle had become hypoplastic in one of these. Aortic atresia was present in seven patients, three of whom had a hypoplastic left ventricle. In six patients the aortic valve was bicuspid although not obstructive. One of these patients had hypoplasia of the aortic arch and one had a hypoplastic left ventricle but in the remaining four patients endocardial fibroelastosis of the left ventricle was the only abnormality found. No follow up information was available in two. Of 26 patients for whom there was postmortem information, 24 had evidence of some degree of endocardial fibroelastosis of the left ventricle. Sequential observations showed that five cases developed into the hypoplastic left heart syndrome. CONCLUSIONS--This type of left ventricular dysfunction in the fetus is the result of an overlap of diseases, including primary left ventricular endocardial fibroelastosis, critical aortic stenosis, and the hypoplastic

  11. MicroRNAs in aortic disease.

    PubMed

    Vavuranakis, Manolis; Kariori, Maria; Vrachatis, Dimitrios; Aznaouridis, Konstantinos; Siasos, Gerasimos; Kokkou, Eleni; Mazaris, Savvas; Moldovan, Carmen; Kalogeras, Konstantinos; Tousoulis, Dimitris; Stefanadis, Christodoulos

    2013-01-01

    MicroRNAs (miRNAs) are non-coding RNAs of ~22 nucleotides which act as down regulators of gene expression in the post-transcription level and/or in the translation level. Several studies have shown that the process of their maturation is rather crucial for the development of cardiovascular system thus their regulation (up-,down-) is implicated with many cardiac pathologies. This is evaluated through their circulating levels which are reliable, stable and the changes in their serum profiles are representative of tissue alterations serum levels. Furthermore, they have been shown to participate in cardiovascular disease pathogenesis including atherosclerosis, coronary artery disease, myocardial infarction, heart failure cardiac arrhythmias and aortic stenosis. In the present review, we will first describe i) the process of miRNAs' maturation ii) their role in the cardiovascular development, iii) their role as biomarkers of cardiac diseases, iv) the cardiac myo-miR families and the v) their role in cardiac remodeling and the development of cardiac diseases. Second we will review the miRNA families that participate in aortic stenosis separated according to its main pathways (imflammation, fibrosis, calcification). Finally, we will describe the miRNAs that participate in the development of aortic aneurysm and aortic dissection according to their serum levels. PMID:23745808

  12. Familial Thoracic Aortic Aneurysm with Dissection Presenting as Flash Pulmonary Edema in a 26-Year-Old Man

    PubMed Central

    Omar, Sabry; Moore, Tyler; Payne, Drew; Momeni, Parastoo; Mulkey, Zachary; Nugent, Kenneth

    2014-01-01

    We are reporting a case of familial thoracic aortic aneurysm and dissection in a 26-year-old man with no significant past medical history and a family history of dissecting aortic aneurysm in his mother at the age of 40. The patient presented with cough, shortness of breath, and chest pain. Chest X-ray showed bilateral pulmonary infiltrates. CT scan of the chest showed a dissection of the ascending aorta. The patient underwent aortic dissection repair and three months later he returned to our hospital with new complaints of back pain. CT angiography showed a new aortic dissection extending from the left carotid artery through the bifurcation and into the iliac arteries. The patient underwent replacement of the aortic root, ascending aorta, total aortic arch, and aortic valve. The patient recovered well postoperatively. Genetic studies of the patient and his children revealed no mutations in ACTA2, TGFBR1, TGFBR2, TGFB2, MYH11, MYLK, SMAD3, or FBN1. This case report focuses on a patient with familial TAAD and discusses the associated genetic loci and available screening methods. It is important to recognize potential cases of familial TAAD and understand the available screening methods since early diagnosis allows appropriate management of risk factors and treatment when necessary. PMID:25104961

  13. The Tidal Radius of the Arches Cluster

    NASA Astrophysics Data System (ADS)

    Hosek, Matthew; Lu, Jessica R.; Anderson, Jay; Ghez, Andrea; Morris, Mark; Clarkson, William

    2015-08-01

    At a projected distance of just ˜26 pc from the center of the Milky Way, the Arches cluster allows us to examine the structure of a young massive cluster in the strong tidal environment of the Galactic center (GC). We use the HST WFC3IR camera to conduct an astrometric and photometric study of the outer region of the Arches cluster (R > 6.25”) in order to measure its radial profile. Using proper motions we separate cluster members from field stars down to F153M = 20 mag (˜2.5 M_sun) over a 120” x 120” field of view, covering an area 144 times larger than previous proper motion studies. This is a significant improvement over photometrically-determined cluster membership, which is complicated by the high degree of differential reddening across the field. Using cluster membership probabilities, a derived extinction map, and extensive completeness simulations, we construct the radial profile of the Arches cluster to a radius of ˜80” (˜3.1 pc assuming a distance of 8 kpc). Evidence of mass segregation out to this radius is observed, and no significant tidal tail structure is apparent. We find that the projected radial extent of the Arches cluster is significantly larger than its expected tidal radius. This result suggests either that the cluster is not as close to the GC as previously thought or that it is inflated beyond its nominal tidal radius.

  14. Seeing the invisible: painless aortic dissection in the emergency setting.

    PubMed

    Ayrik, C; Cece, H; Aslan, O; Karcioglu, O; Yilmaz, E

    2006-03-01

    Acute dissection of the aorta can be one of the most dramatic cardiovascular emergencies. Classically, aortic dissection presents as sudden, severe chest, back, or abdominal pain that is characterised as ripping or tearing in nature. However, a timely diagnosis can be elusive in the event of an atypical presentation. In this report, the authors present two patients with painless aortic dissection who were misdiagnosed during their initial evaluation in the emergency department. PMID:16498148

  15. Seeing the invisible: painless aortic dissection in the emergency setting

    PubMed Central

    Ayrik, C; Cece, H; Aslan, O; Karcioglu, O; Yilmaz, E

    2006-01-01

    Acute dissection of the aorta can be one of the most dramatic cardiovascular emergencies. Classically, aortic dissection presents as sudden, severe chest, back, or abdominal pain that is characterised as ripping or tearing in nature. However, a timely diagnosis can be elusive in the event of an atypical presentation. In this report, the authors present two patients with painless aortic dissection who were misdiagnosed during their initial evaluation in the emergency department. PMID:16498148

  16. First direct aortic retrievable transcatheter aortic valve implantation in humans.

    PubMed

    Chandrasekhar, Jaya; Glover, Chris; Labinaz, Marino; Ruel, Marc

    2014-11-01

    We describe 2 cases in which transcatheter aortic valve implantation was performed with a Portico prosthesis (St Jude Medical, St Paul, MN) through a direct aortic approach. In 1 of the cases, prosthesis retrieval was needed during the procedure and was essential to the successful outcome. This is the first report, to our knowledge, of direct aortic Portico prosthesis implantation, and it highlights the significance of the retrievable nature of this device. PMID:25442452

  17. Minimally invasive valve sparing aortic root replacement (David procedure) is safe

    PubMed Central

    Krueger, Heike; Umminger, Julia; Koigeldiyev, Nurbol; Beckmann, Erik; Haverich, Axel; Martens, Andreas

    2015-01-01

    Objective Even though minimally invasive cardiac surgery may reduce morbidity, this approach is not routinely performed for aortic root replacements. The purpose of this pilot study was to assess the safety and feasibility of valve sparing aortic root replacement via an upper mini-sternotomy up to the 3rd intercostal space. Methods Between April 2011 and March 2014, 26 patients (22 males, age 47.6±13 years) underwent elective minimally invasive aortic valve sparing root replacement (David procedure, group A). Twelve patients underwent additional leaflet repair. Concomitant procedures were: four proximal aortic arch replacements and one coronary artery bypass grafting (CABG) to the proximal right coronary artery (RCA). During the same time period, 14 patients (ten males, age 64.2±9.5 years) underwent elective David procedure via median full sternotomy (group B). Concomitant procedures included six proximal aortic arch replacements. Although the patient cohorts were small, the results of these two groups were compared. Results In group A, there were no intra-operative conversions to full sternotomy. The aortic cross-clamp and cardiopulmonary bypass (CPB) times were 115.6±30.3 and 175.8±41.9 min, respectively. One patient was re-opened (via same access) due to post-operative bleeding. The post-operative ventilation time and hospital stay were 0.5±0.3 and 10.4±6.8 days, respectively. There was no 30-day mortality. The patient questionnaire showed that the convalescence time was approximately two weeks. In group B: the cross-clamp and CPB times were 114.1±19.9 and 163.0±24.5 min, respectively. One patient was re-opened (7.1%) due to post-operative bleeding. The post-operative ventilation time and hospital stay were 0.6±0.7 and 14.2±16.7 days, respectively. There was no 30-day mortality. Conclusions Minimally invasive valve sparing aortic root replacement can be safely performed in selected patients. The results are comparable to those operated via a full

  18. Increased plantar force and impulse in American football players with high arch compared to normal arch

    PubMed Central

    Carson, Daniel W.; Myer, Gregory D.; Hewett, Timothy E.; Heidt, Robert S.; Ford, Kevin R.

    2014-01-01

    Background Risk of overuse injury among athletes is high due in part to repeated loading of the lower extremities. Compared to individuals with normal arch (NA) structure, those with high (HA) or low arch (LA) may be at increased risk of specific overuse injuries, including stress fractures. A high medial longitudinal arch may result in decreased shock absorbing properties due to increased rigidity in foot mechanics. While the effect of arch structure on dynamic function has been examined in straight line walking and running, the relationship between the two during multi-directional movements remains unstudied. Objective The purpose of this study was to determine if differences in plantar loading in football players occur during both walking and pivoting movements. Method Plantar loading was examined in 9 regions of the foot for 26 participants (16 NA, 10 HA). Results High arch athletes demonstrated increased maximum force in the lateral rear foot and medial forefoot, and force time integral in the medial forefoot while walking. HA athletes also demonstrated increased maximum force in the medial rear foot and medial and central forefoot during rapid pivoting. Conclusions The current findings demonstrate that loading patterns differ between football players with high and normal arch structure, which could possibly influence injury risk in this population. PMID:23141809

  19. Comparison of ejection fraction and Goldman risk factor analysis to dipyridamole-thallium 201 studies in the evaluation of cardiac morbidity after aortic aneurysm surgery

    SciTech Connect

    McEnroe, C.S.; O'Donnell, T.F. Jr.; Yeager, A.; Konstam, M.; Mackey, W.C. )

    1990-04-01

    Associated coronary artery disease is the critical factor that influences early and late mortality after abdominal aortic aneurysm surgery. Dipyridamole-thallium 201 scintigraphy, left ventricular ejection fraction, and Goldman risk factor analysis have been suggested as preoperative noninvasive screening methods to detect significant coronary artery disease. In this series of 95 elective abdominal aortic aneurysm repairs dipyridamole-thallium 201 scintigraphy was highly predictive of the absence of perioperative cardiac morbidity (96% specificity, 44/46 normal scans, no cardiac morbidity), whereas ejection fraction (73% specificity, 31/42 normal ejection fraction, no cardiac morbidity) and Goldman risk factor analysis (84% specificity, 44/51 class I, no cardiac morbidity) were less. Furthermore, thallium redistribution on dipyridamole-thallium 201 scintigraphy leading to coronary angiography identified a significant number of patients with occult coronary artery disease who required preoperative coronary revascularization (8%, 8/95) and might have remained undetected on the basis of left ventricular ejection fraction or Goldman risk factor analysis. Finally, fixed thallium deficit, which some investigators have interpreted as a low probability finding for cardiac morbidity, was associated with a higher than expected incidence of cardiac complications. Forty-six percent (7/15) of all postoperative cardiac complications (three myocardial infarctions, three ischemic events, one death) occurred in patients with abdominal aortic aneurysms with fixed deficits. This suggests that patients with fixed deficits on dipyridamole-thallium 201 scintigraphy should be considered for later delayed (4 hours) thallium images or coronary angiography or both.

  20. [Stent Grafting for Aortic Dissection].

    PubMed

    Uchida, Naomichi

    2016-07-01

    The purpose of stent graft for aortic dissection is to terminate antegrade blood flow into the false lumen through primary entry. Early intervention for primary entry makes excellent aortic remodeling and emergent stent grafting for complicated acute type B aortic dissection is supported as a class I. On the other hand stent grafting for chronic aortic dissection is controversial. Early stent grafting is considered with in 6 months after on-set if the diameter of the descending aorta is more than 40 mm. Additional interventions for residual false lumen on the downstream aorta are still required. Stent graft for re-entry, candy-plug technique, and double stenting, other effective re-interventions were reported. Best treatment on the basis of each anatomical and physical characteristics should be selected in each institution. Frozen elephant trunk is alternative procedure for aortic dissection without the need to take account of proximal anatomical limitation and effective for acute type A aortic dissection. PMID:27440026

  1. Study on Optimal Grouting Timing for Controlling Uplift Deformation of a Super High Arch Dam

    NASA Astrophysics Data System (ADS)

    Lin, Peng; Zhu, Xiaoxu; Li, Qingbin; Liu, Hongyuan; Yu, Yongjun

    2016-01-01

    A grouting model is developed for use during the grouting of the complex foundation of a super high arch dam. The purpose as to determine the optimal grouting timing and appropriate grouting pressure involved in controlling the uplift deformation of the dam. The model determines the optimal grouting time as the height of the arch dam increases with the concrete pouring, by checking the tensile stresses in the dam against standard specifications. The appropriate grouting pressures are given on the basis of the actual grouting pressures monitored during the upstream riverbed foundation grouting. An engineering procedure, applying the model, was then proposed and used during foundation grouting under the toe block of the Xiluodu super high-arch dam in south-western China. The quality of the foundation grouting was evaluated against the results from pressurized water permeability tests, acoustic wave velocity tests, elastic modulus tests and panoramic photographing of the rockmass on completion of the foundation grouting. The results indicated that the proposed grouting model can be applied to effectively reduce the uplift deformation and associated cracking risk for super high arch dams, and it can be concluded that the proposed engineering grouting procedure is a valuable tool for improving foundation grouting under the toe blocks of a super high arch dam.

  2. Analysis of arch-like bones: The rodent mandible as a case study.

    PubMed

    Vassallo, Aldo Iván

    2016-07-01

    Bone strength is determined by the mechanical properties of bone material, and the size and shape of the whole bone, i.e., its architecture. The mandible of vertebrates has been traditionally regarded as a beam oriented in relation to main masticatory loads, i.e., the longer dimension of its cross-section being parallel to the load. Rodents follow this pattern but, in addition, their mandible possesses an intriguing arch-like shape that is apparent when seen in the lateral view. Little attention was given to the structural capacity of this trait. The advantage of an arch is that it can withstand a greater load than a horizontal beam. The objective of this study was to model the rodent mandible like an arch to evaluate its structural strength. The bending moment in an arch-like mandible was 15-25% lower with respect to a beam-like mandible. Further, bending varies with mandible "slenderness" and incisor procumbency, a functionally relevant rodent trait. In the rodent Ctenomys talarum (Caviomorpha; Ctenomyidae), bone stress was substantially reduced when the mandible was modeled as an arch-like structure as compared with a beam-like structure, and safety factors were 15-34% higher. The shape of rodents' mandible might confer a functional advantage to high and repeatedly applied loads resulting from a unique feeding mode: gnawing. J. Morphol. 277:879-887, 2016. © 2016 Wiley Periodicals, Inc. PMID:27059294

  3. Aortic dimensions in Turner syndrome.

    PubMed

    Quezada, Emilio; Lapidus, Jodi; Shaughnessy, Robin; Chen, Zunqiu; Silberbach, Michael

    2015-11-01

    In Turner syndrome, linear growth is less than the general population. Consequently, to assess stature in Turner syndrome, condition-specific comparators have been employed. Similar reference curves for cardiac structures in Turner syndrome are currently unavailable. Accurate assessment of the aorta is particularly critical in Turner syndrome because aortic dissection and rupture occur more frequently than in the general population. Furthermore, comparisons to references calculated from the taller general population with the shorter Turner syndrome population can lead to over-estimation of aortic size causing stigmatization, medicalization, and potentially over-treatment. We used echocardiography to measure aortic diameters at eight levels of the thoracic aorta in 481 healthy girls and women with Turner syndrome who ranged in age from two to seventy years. Univariate and multivariate linear regression analyses were performed to assess the influence of karyotype, age, body mass index, bicuspid aortic valve, blood pressure, history of renal disease, thyroid disease, or growth hormone therapy. Because only bicuspid aortic valve was found to independently affect aortic size, subjects with bicuspid aortic valve were excluded from the analysis. Regression equations for aortic diameters were calculated and Z-scores corresponding to 1, 2, and 3 standard deviations from the mean were plotted against body surface area. The information presented here will allow clinicians and other caregivers to calculate aortic Z-scores using a Turner-based reference population. © 2015 Wiley Periodicals, Inc. PMID:26118429

  4. Novel Molecular Imaging Approaches to Abdominal Aortic Aneurysm Risk Stratification.

    PubMed

    Toczek, Jakub; Meadows, Judith L; Sadeghi, Mehran M

    2016-01-01

    Selection of patients for abdominal aortic aneurysm repair is currently based on aneurysm size, growth rate, and symptoms. Molecular imaging of biological processes associated with aneurysm growth and rupture, for example, inflammation and matrix remodeling, could improve patient risk stratification and lead to a reduction in abdominal aortic aneurysm morbidity and mortality. (18)F-fluorodeoxyglucose-positron emission tomography and ultrasmall superparamagnetic particles of iron oxide magnetic resonance imaging are 2 novel approaches to abdominal aortic aneurysm imaging evaluated in clinical trials. A variety of other tracers, including those that target inflammatory cells and proteolytic enzymes (eg, integrin αvβ3 and matrix metalloproteinases), have proven effective in preclinical models of abdominal aortic aneurysm and show great potential for clinical translation. PMID:26763279

  5. Micromanaging abdominal aortic aneurysms.

    PubMed

    Maegdefessel, Lars; Spin, Joshua M; Adam, Matti; Raaz, Uwe; Toh, Ryuji; Nakagami, Futoshi; Tsao, Philip S

    2013-01-01

    The contribution of abdominal aortic aneurysm (AAA) disease to human morbidity and mortality has increased in the aging, industrialized world. In response, extraordinary efforts have been launched to determine the molecular and pathophysiological characteristics of the diseased aorta. This work aims to develop novel diagnostic and therapeutic strategies to limit AAA expansion and, ultimately, rupture. Contributions from multiple research groups have uncovered a complex transcriptional and post-transcriptional regulatory milieu, which is believed to be essential for maintaining aortic vascular homeostasis. Recently, novel small noncoding RNAs, called microRNAs, have been identified as important transcriptional and post-transcriptional inhibitors of gene expression. MicroRNAs are thought to "fine tune" the translational output of their target messenger RNAs (mRNAs) by promoting mRNA degradation or inhibiting translation. With the discovery that microRNAs act as powerful regulators in the context of a wide variety of diseases, it is only logical that microRNAs be thoroughly explored as potential therapeutic entities. This current review summarizes interesting findings regarding the intriguing roles and benefits of microRNA expression modulation during AAA initiation and propagation. These studies utilize disease-relevant murine models, as well as human tissue from patients undergoing surgical aortic aneurysm repair. Furthermore, we critically examine future therapeutic strategies with regard to their clinical and translational feasibility. PMID:23852016

  6. Association of Aortic Compliance and Brachial Endothelial Function with Cerebral Small Vessel Disease in Type 2 Diabetes Mellitus Patients: Assessment with High-Resolution MRI.

    PubMed

    Shan, Yan; Lin, Jiang; Xu, Pengju; Zeng, Mengsu; Lin, Huandong; Yan, Hongmei

    2016-01-01

    Objective. To assess the possible association of aortic compliance and brachial endothelial function with cerebral small vessel disease in type 2 diabetes mellitus (DM2) patients by using 3.0 T high-resolution magnetic resonance imaging. Methods. Sixty-two clinically confirmed DM2 patients (25 women and 37 men; mean age: 56.8 ± 7.5 years) were prospectively enrolled for noninvasive MR examinations of the aorta, brachial artery, and brain. Aortic arch pulse wave velocity (PWV), flow-mediated dilation (FMD) of brachial artery, lacunar brain infarcts, and periventricular and deep white matter hyperintensities (WMHs) were assessed. Pearson and Spearman correlation analysis were performed to analyze the association between PWV and FMD with clinical data and biochemical test results. Univariable logistic regression analyses were used to analyze the association between PWV and FMD with cerebral small vessel disease. Multiple logistic regression analyses were used to find out the independent predictive factors of cerebral small vessel disease. Results. Mean PWV was 6.73 ± 2.00 m/s and FMD was 16.67 ± 9.11%. After adjustment for compounding factors, PWV was found significantly associated with lacunar brain infarcts (OR = 2.00; 95% CI: 1.14-3.2; P < 0.05) and FMD was significantly associated with periventricular WMHs (OR = 0.82; 95% CI: 0.71-0.95; P < 0.05). Conclusions. Quantitative evaluation of aortic compliance and endothelial function by using high-resolution MRI may be potentially useful to stratify DM2 patients with risk of cerebral small vessel disease. PMID:27525261

  7. Association of Aortic Compliance and Brachial Endothelial Function with Cerebral Small Vessel Disease in Type 2 Diabetes Mellitus Patients: Assessment with High-Resolution MRI

    PubMed Central

    Shan, Yan; Zeng, Mengsu; Lin, Huandong; Yan, Hongmei

    2016-01-01

    Objective. To assess the possible association of aortic compliance and brachial endothelial function with cerebral small vessel disease in type 2 diabetes mellitus (DM2) patients by using 3.0 T high-resolution magnetic resonance imaging. Methods. Sixty-two clinically confirmed DM2 patients (25 women and 37 men; mean age: 56.8 ± 7.5 years) were prospectively enrolled for noninvasive MR examinations of the aorta, brachial artery, and brain. Aortic arch pulse wave velocity (PWV), flow-mediated dilation (FMD) of brachial artery, lacunar brain infarcts, and periventricular and deep white matter hyperintensities (WMHs) were assessed. Pearson and Spearman correlation analysis were performed to analyze the association between PWV and FMD with clinical data and biochemical test results. Univariable logistic regression analyses were used to analyze the association between PWV and FMD with cerebral small vessel disease. Multiple logistic regression analyses were used to find out the independent predictive factors of cerebral small vessel disease. Results. Mean PWV was 6.73 ± 2.00 m/s and FMD was 16.67 ± 9.11%. After adjustment for compounding factors, PWV was found significantly associated with lacunar brain infarcts (OR = 2.00; 95% CI: 1.14–3.2; P < 0.05) and FMD was significantly associated with periventricular WMHs (OR = 0.82; 95% CI: 0.71–0.95; P < 0.05). Conclusions. Quantitative evaluation of aortic compliance and endothelial function by using high-resolution MRI may be potentially useful to stratify DM2 patients with risk of cerebral small vessel disease. PMID:27525261

  8. Cytokine amplification and macrophage effector functions in aortic inflammation and abdominal aortic aneurysm formation.

    PubMed

    Ijaz, Talha; Tilton, Ronald G; Brasier, Allan R

    2016-08-01

    On April 29, 2015, Son and colleagues published an article entitled "Granulocyte macrophage colony-stimulating factor (GM-CSF) is required for aortic dissection/intramural haematoma" in Nature Communications. The authors observed that the heterozygous Kruppel-like transcription factor 6 (KLF6) deficiency or absence of myeloid-specific KLF6 led to upregulation of macrophage GM-CSF expression, promoted the development of aortic hematoma/dissection, and stimulated abdominal aortic aneurysm (AAA) formation when the vessel wall was subjected to an inflammatory stimulus. The additional findings of increased adventitial fibrotic deposition, marked infiltration of macrophages, and increased expression of matrix metalloprotease-9 (MMP-9) and IL-6 were blocked with neutralizing GM-CSF antibodies, or recapitulated in normal mice with excess GM-CSF administration. The authors concluded that GM-CSF is a key regulatory molecule in the development of AAA and further suggested that activation of GM-CSF is independent of the transforming growth factor β (TGFβ)-Smad pathway associated with the Marfan aortic pathology. In this perspective, we expand on this mechanism, drawing from previous studies implicating a similar essential role for IL-6 signaling in macrophage activation, Th17 expansion and aortic dissections. We propose a sequential "two-hit" model of vascular inflammation involving initial vascular injury followed by recruitment of Ly6C(hi) macrophages. Aided by fibroblast interactions inflammatory macrophages produce amplification of IL-6 and GM-CSF expression that converge on a common, pathogenic Janus kinase (JAK)-signal transducers and activations of transcription 3 (STAT3) signaling pathway. This pathway stimulates effector functions of macrophages, promotes differentiation of Th17 lymphocytes and enhances matrix metalloproteinase expression, ultimately resulting in deterioration of vascular wall structural integrity. Further research evaluating the impact of

  9. Cytokine amplification and macrophage effector functions in aortic inflammation and abdominal aortic aneurysm formation

    PubMed Central

    Ijaz, Talha; Tilton, Ronald G.

    2016-01-01

    On April 29, 2015, Son and colleagues published an article entitled “Granulocyte macrophage colony-stimulating factor (GM-CSF) is required for aortic dissection/intramural haematoma” in Nature Communications. The authors observed that the heterozygous Kruppel-like transcription factor 6 (KLF6) deficiency or absence of myeloid-specific KLF6 led to upregulation of macrophage GM-CSF expression, promoted the development of aortic hematoma/dissection, and stimulated abdominal aortic aneurysm (AAA) formation when the vessel wall was subjected to an inflammatory stimulus. The additional findings of increased adventitial fibrotic deposition, marked infiltration of macrophages, and increased expression of matrix metalloprotease-9 (MMP-9) and IL-6 were blocked with neutralizing GM-CSF antibodies, or recapitulated in normal mice with excess GM-CSF administration. The authors concluded that GM-CSF is a key regulatory molecule in the development of AAA and further suggested that activation of GM-CSF is independent of the transforming growth factor β (TGFβ)-Smad pathway associated with the Marfan aortic pathology. In this perspective, we expand on this mechanism, drawing from previous studies implicating a similar essential role for IL-6 signaling in macrophage activation, Th17 expansion and aortic dissections. We propose a sequential “two-hit” model of vascular inflammation involving initial vascular injury followed by recruitment of Ly6Chi macrophages. Aided by fibroblast interactions inflammatory macrophages produce amplification of IL-6 and GM-CSF expression that converge on a common, pathogenic Janus kinase (JAK)-signal transducers and activations of transcription 3 (STAT3) signaling pathway. This pathway stimulates effector functions of macrophages, promotes differentiation of Th17 lymphocytes and enhances matrix metalloproteinase expression, ultimately resulting in deterioration of vascular wall structural integrity. Further research evaluating the impact of

  10. An evaluation of the effect of an angiotensin-converting enzyme inhibitor on the growth rate of small abdominal aortic aneurysms: a randomised placebo-controlled trial (AARDVARK).

    PubMed Central

    Kiru, Gaia; Bicknell, Colin; Falaschetti, Emanuela; Powell, Janet; Poulter, Neil

    2016-01-01

    BACKGROUND Although data are inconsistent, angiotensin-converting enzyme inhibitors (ACE-Is) have been associated with a reduced incidence of abdominal aortic aneurysm (AAA) rupture in analysis of administrative databases. OBJECTIVES (1) To investigate whether or not the ACE-I perindopril (Coversyl arginine, Servier) reduces small AAA growth rate and (2) to evaluate blood pressure (BP)-independent effects of perindopril on small AAA growth and to compare the repeatability of measurement of internal and external aneurysm diameters. DESIGN A three-arm, multicentre, single-blind, randomised placebo-controlled trial. SETTING Fourteen hospitals in England. PARTICIPANTS Men or women aged ≥ 55 years with an AAA of 3.0-5.4 cm in diameter by internal or external measurement according to ultrasonography and who met the trial eligibility criteria. INTERVENTIONS Patients were randomised to receive 10 mg of perindopril arginine daily, 5 mg of the calcium channel blocker amlodipine daily or placebo daily. MAIN OUTCOME MEASURES The primary outcome was AAA diameter growth using external measurements in the longitudinal plane, which in-trial studies suggested was the preferred measure. Secondary outcome measures included AAA rupture, AAA repair, modelling of the time taken for the AAA to reach the threshold for intervention (5.5 cm) or referral for surgery, tolerance of study medication (measured by compliance, adverse events and quality of life) and a comparison of the repeatability of measures of internal and external AAA diameter. Patients were followed up every 3-6 months over 2 years. RESULTS In total, 227 patients were recruited and randomised into the three groups, which were generally well matched at baseline. Multilevel modelling was used to determine the maximum likelihood estimates for AAA diameter growth. No significant differences in the estimates of annual growth were apparent [1.68 (standard error 0.02) mm, 1.77 (0.02) mm and 1.81 (0.02) mm in the

  11. Transcatheter aortic valve implantation.

    PubMed

    Nielsen, Hans Henrik Møller

    2012-12-01

    Transcatheter aortic valve implantation (TAVI) was introduced experimentally in 1989, based on a newly developed heart valve prosthesis - the stentvalve. The valve was invented by a Danish cardiologist named Henning Rud Andersen. The new valve was revolutionary. It was foldable and could be inserted via a catheter through an artery in the groin, without the need for heart lung machine. This allowed for a new valve implantation technique, much less invasive than conventional surgical aortic valve replacement (SAVR). Surgical aortic valve replacement is safe and improves symptoms along with survival. However, up to 1/3 of patients with aortic valve stenosis cannot complete the procedure due to frailty. The catheter technique was hoped to provide a new treatment option for these patients. The first human case was in 2002, but more widespread clinical use did not begin until 2006-2010. Today, in 2011, more than 40,000 valves have been implanted worldwide. Initially, because of the experimental character of the procedure, TAVI was reserved for patients who could not undergo SAVR due to high risk. The results in this group of patients were promising. The procedural safety was acceptable, and the patients experienced significant improvements in their symptoms. Three of the papers in this PhD-thesis are based on the outcome of TAVI at Skejby Hospital, in this high-risk population [I, II and IV]. Along with other international publications, they support TAVI as being superior to standard medical treatment, despite a high risk of prosthetic regurgitation. These results only apply to high-risk patients, who cannot undergo SAVR. The main purpose of this PhD study has been to investigate the quality of TAVI compared to SAVR, in order to define the indications for this new procedure. The article attached [V] describes a prospective clinical randomised controlled trial, between TAVI to SAVR in surgically amenable patients over 75 years of age with isolated aortic valve stenosis

  12. Endovascular Repair of Complex Aortic Aneurysms: Intravascular Ultrasound Guidance with an Intracardiac Probe

    SciTech Connect

    Zanchetta, Mario Rigatelli, Gianluca; Pedon, Luigi; Zennaro, Marco; Ronsivalle, Salvatore; Maiolino, Pietro

    2003-09-15

    To assess the accuracy and efficacy of intravascular ultrasound guidance obtained by an intracardiac ultrasound probe during complex aortic endografting. Between November 1999 and July 2002, 19 patients (5 female, 14 male; mean age 73.5 {+-} 2.1 years) underwent endovascular repair of thoracic (n = 10), complex abdominal (n = 6) and concomitant thoraco-abdominal (n = 3) aortic aneurysm. The most suitable size and configuration of the stent-graft were chosen on the basis of preoperative computed tomographic angiography (CTA) or magnetic resonance angiography (MRA). Intraoperative intravascular ultrasound imaging was obtained using a 9 Fr, 9 MHz intracardiac echocardiography (ICE) probe, 110 cm in length, inserted through a 10 Fr precurved long sheath. The endografts were deployed as planned by CTA or MRA. Before stent-graft deployment, the ICE probe allowed us to view the posterior aortic arch and descending thoraco-abdominal aorta without position-related artifacts, and to identify both sites of stent-graft positioning. After stent-graft deployment, the ICE probe allowed us to detect the need for additional modular components to internally reline the aorta in 11 patients, and to discover 2 incomplete graft expansions subsequently treated with adjunctive balloon angioplasty. In 1 patient, the ICE probe supported the decision that the patient was ineligible for the endovascular exclusion procedure. The ICE probe provides accurate information on the anatomy of the posterior aortic arch and thoracic and abdominal aortic aneurysms and a rapid identification of attachment sites and stent-graft pathology, allowing refinement and improvement of the endovascular strategy.

  13. Assessment of the influence of the compliant aortic root on aortic valve mechanics by means of a geometrical model.

    PubMed

    Redaelli, A; Di Martino, E; Gamba, A; Procopio, A M; Fumero, R

    1997-12-01

    In recent years several researchers have suggested that the changes in the geometry and angular dimensions of the aortic root which occur during the cardiac cycle are functional to the optimisation of aortic valve function, both in terms of diminishing leaflet stresses and of fluid-dynamic behaviour. The paper presents an analytical parametric model of the aortic valve which includes the aortic root movement. The indexes used to evaluate the valve behaviour are the circumferential membrane stress and the stress at the free edge of the leaflet, the index of bending strain, the bending of the leaflet at the line attachment in the radial and circumferential directions and the shape of the conduit formed by the leaflets during systole. In order to evaluate the role of geometric changes in valve performance, two control cases were considered, with different reference geometric configuration, where the movement of the aortic root was ignored. The results obtained appear consistent with physiological data, especially with regard to the late diastolic phase and the early ejection phase, and put in evidence the role of the aortic root movement in the improvement of valve behaviour. PMID:9450254

  14. Management of Acute Aortic Syndrome and Chronic Aortic Dissection

    SciTech Connect

    Nordon, Ian M. Hinchliffe, Robert J.; Loftus, Ian M.; Morgan, Robert A.; Thompson, Matt M.

    2011-10-15

    Acute aortic syndrome (AAS) describes several life-threatening aortic pathologies. These include intramural hematoma, penetrating aortic ulcer, and acute aortic dissection (AAD). Advances in both imaging and endovascular treatment have led to an increase in diagnosis and improved management of these often catastrophic pathologies. Patients, who were previously consigned to medical management or high-risk open surgical repair, can now be offered minimally invasive solutions with reduced morbidity and mortality. Information from the International Registry of Acute Aortic Dissection (IRAD) database demonstrates how in selected patients with complicated AAD the 30-day mortality from open surgery is 17% and endovascular stenting is 6%. Despite these improvements in perioperative deaths, the risks of stroke and paraplegia remain with endovascular treatment (combined outcome risk 4%). The pathophysiology of each aspect of AAS is described. The best imaging techniques and the evolving role of endovascular techniques in the definitive management of AAS are discussed incorporating strategies to reduce perioperative morbidity.

  15. A Perspective Review on Numerical Simulations of Hemodynamics in Aortic Dissection

    PubMed Central

    Wan Ab Naim, Wan Naimah; Ganesan, Poo Balan; Hashim, Shahrul Amry

    2014-01-01

    Aortic dissection, characterized by separation of the layers of the aortic wall, poses a significant challenge for clinicians. While type A aortic dissection patients are normally managed using surgical treatment, optimal treatment strategy for type B aortic dissection remains controversial and requires further evaluation. Although aortic diameter measured by CT angiography has been clinically used as a guideline to predict dilation in aortic dissection, hemodynamic parameters (e.g., pressure and wall shear stress), geometrical factors, and composition of the aorta wall are known to substantially affect disease progression. Due to the limitations of cardiac imaging modalities, numerical simulations have been widely used for the prediction of disease progression and therapeutic outcomes, by providing detailed insights into the hemodynamics. This paper presents a comprehensive review of the existing numerical models developed to investigate reasons behind tear initiation and progression, as well as the effectiveness of various treatment strategies, particularly the stent graft treatment. PMID:24672348

  16. [Thoracic Endovascular Aortic Repair Following Axillo-femoral Bypass in a Patient with Stanford B Acute Aortic Dissection Accompanied by Abdominal Visceral Ischemia;Report of a Case].

    PubMed

    Nishimoto, Takayuki; Bonkohara, Yukihiro; Azuma, Takashi; Iijima, Masaki; Higashidate, Masafumi

    2016-09-01

    A 60-year-old woman was transfer-red to the emergency department of our medical center with worsening chest and back pain. Computed tomography revealed Stanford type B aortic dissection. There was a false lumen from the distal arch to the abdominal aorta just above the celiac artery. Although she was at 1st treated conservatively, she abruptly developed acute renal failure and lower limb ischemia because of an enlarged false lumen, and emergency axillo-femoral bypass surgery was performed with an 8 mm tube graft. However, renal failure gradually worsened, which necessitated continuous hemodiafiltration was performed. Thoracic endovascular aortic repair was then performed, and her renal function recovered. PMID:27586321

  17. The chimney-graft technique for preserving supra-aortic branches: a review.

    PubMed

    Moulakakis, Konstantinos G; Mylonas, Spyridon N; Dalainas, Ilias; Sfyroeras, George S; Markatis, Fotis; Kotsis, Thomas; Kakisis, John; Liapis, Christos D

    2013-05-01

    Evolution in the endovascular era has influenced the management of aortic arch pathologies. "Chimney" or "snorkel" graft technique has been used as an alternative in high risk patients unfit for open repair. We reviewed the published literature on the chimney graft technique for preservation of the supra-aortic branches in order to provide an extensive insight of its feasibility and efficacy and investigate its outcomes. 18 reports were identified, with a total of 124 patients and 136 chimney. Primary technical success was achieved in 123/124 patients (99.2%). The perioperative mortality rate was 4.8% and the stroke rate was 4%, while events of spinal cord ischemia were rare. The overall endoleak rate was 18.5%; 13 patients (10.5%) developed a type I endoleak and 10 (8%) patients a type II endoleak. During a median follow-up period of 11.4 months (range, 0.87-20.1 months) all implanted chimney grafts remained patent. From this, we conclude that endovascular aortic arch repair with chimney grafts is associated with a lower mortality rate compared to totally open or hybrid reconstruction. However, the stroke rate remains noteworthy, and requires longterm data to elucidate. PMID:23977603

  18. The chimney-graft technique for preserving supra-aortic branches: a review

    PubMed Central

    Mylonas, Spyridon N.; Dalainas, Ilias; Sfyroeras, George S.; Markatis, Fotis; Kotsis, Thomas; Kakisis, John; Liapis, Christos D.

    2013-01-01

    Evolution in the endovascular era has influenced the management of aortic arch pathologies. “Chimney” or “snorkel” graft technique has been used as an alternative in high risk patients unfit for open repair. We reviewed the published literature on the chimney graft technique for preservation of the supra-aortic branches in order to provide an extensive insight of its feasibility and efficacy and investigate its outcomes. 18 reports were identified, with a total of 124 patients and 136 chimney. Primary technical success was achieved in 123/124 patients (99.2%). The perioperative mortality rate was 4.8% and the stroke rate was 4%, while events of spinal cord ischemia were rare. The overall endoleak rate was 18.5%; 13 patients (10.5%) developed a type I endoleak and 10 (8%) patients a type II endoleak. During a median follow-up period of 11.4 months (range, 0.87-20.1 months) all implanted chimney grafts remained patent. From this, we conclude that endovascular aortic arch repair with chimney grafts is associated with a lower mortality rate compared to totally open or hybrid reconstruction. However, the stroke rate remains noteworthy, and requires longterm data to elucidate. PMID:23977603

  19. Jurassic stratigraphy of the Wiggins Arch, Mississippi

    SciTech Connect

    Rhodes, J.A.; Maxwell, G.B. )

    1993-09-01

    Mobil and Shell jointly explored the Wiggins arch area in southern Mississippi from 1985 to 1991. The effort concentrated on the Jurassic Norphlet and Smackover formations. Two wells were drilled into Paleozoic crystalline rocks and one well into the Pine Hill formation. Two of these wells were located on the southern side of the Wiggins arch and provide significant data for interpreting Jurassic stratigraphy. The Mobil No. 1 U.S.A. well encountered a complete Jurassic section, but with some significantly different facies than those encountered by wells to the north. A granite wash section is the equivalent to the Frisco City formation previously only found 100 mi to the north-northeast. All 300 ft of Smackover is crystalline dolomite. The Norphlet section is entirely granite wash. The Pine Hill anhydrite is unusually thick and interpreted to be equivalent to the Louann Salt. Correlations to other wells on the Wiggins arch, particularly the Conoco No. 1 Higgins, indicate that the Jurassic can be divided into three transgressive events separated by the Norphlet/Pine Hill and Frisco City/Buckner regressive events.

  20. Oblique slip in Laramide foreland arches

    SciTech Connect

    Erslev, E.A.; Selvig, B.; Molzer, P. . Dept. of Earth Resources)

    1993-03-01

    Don Wise was one of the first structural geologists to recognize the complex, four-dimensional (space and time) nature of basement-involved faulting in the Rocky Mountain foreland. His focus on both small scale kinematic indicators and regional tectonic hypotheses has provided a launching point for many Rocky Mountain geologists. The implications of the anastomosing patterns of Laramide foreland arches on models of regional stress and strain have provoked considerable debate. Hypotheses range from those invoking multiple stages of lateral compression from different directions to single-stage models necessitating a component of strike-slip motion in east-west and north-south arches. These hypotheses were tested using slickenline analysis of minor faulting in structures with different orientations. In Wyoming, structures paralleling the dominant northwest structural trend have slickenlines in the NE-SW vertical plane, consistent with shortening and compression in this direction. The east-west Owl Creek and Casper Mountain structures also have NE-SW trending slickenlines, indicating slip oblique to these arches. In Colorado, minor faults in the north-south margin of the northeastern Front Range also indicate oblique slip, with shortening in the NE-SW quadrant. The actual trend of the slickenlines is more easterly, however, suggesting a change of slip trajectory with latitude, not time, possibly in response to identation by the Colorado Plateau.

  1. Variations among the primary maxillary dental arch forms using a polynominal equation model.

    PubMed

    Tsai, Hung-Huey

    2003-01-01

    This study identifies arch symmetry and describes arch form variations in normal primary maxillary dental casts. Sixty-two percent of casts had asymmetrical arches, and 38% had symmetrical arches. Six types of arch form were identified according to the ratio of arch width to length. There were more long types than short types. The rounded and short types tended to have a more-symmetrical arch than did the long type. PMID:12739689

  2. The Foot's Arch and the Energetics of Human Locomotion.

    PubMed

    Stearne, Sarah M; McDonald, Kirsty A; Alderson, Jacqueline A; North, Ian; Oxnard, Charles E; Rubenson, Jonas

    2016-01-01

    The energy-sparing spring theory of the foot's arch has become central to interpretations of the foot's mechanical function and evolution. Using a novel insole technique that restricted compression of the foot's longitudinal arch, this study provides the first direct evidence that arch compression/recoil during locomotion contributes to lowering energy cost. Restricting arch compression near maximally (~80%) during moderate-speed (2.7 ms(-1)) level running increased metabolic cost by + 6.0% (p < 0.001, d = 0.67; unaffected by foot strike technique). A simple model shows that the metabolic energy saved by the arch is largely explained by the passive-elastic work it supplies that would otherwise be done by active muscle. Both experimental and model data confirm that it is the end-range of arch compression that dictates the energy-saving role of the arch. Restricting arch compression had no effect on the cost of walking or incline running (3°), commensurate with the smaller role of passive-elastic mechanics in these gaits. These findings substantiate the elastic energy-saving role of the longitudinal arch during running, and suggest that arch supports used in some footwear and orthotics may increase the cost of running. PMID:26783259

  3. Thoracic aortic aneurysms and pregnancy.

    PubMed

    Coulon, Capucine

    2015-11-01

    Half of acute aortic dissection in women under the age of 40 occurs during pregnancy or peripartum period. Marfan syndrome is the most common syndromic presentation of ascending aortic aneurysm, but other syndromes such as vascular Ehlers-Danlos syndrome, Loeys-Dietz syndrome and Turner syndrome also have ascending aortic aneurysms and the associated cardiovascular risk of aortic dissection and rupture. Management of aortic root aneurysm has been established in recent recommendations, even if levels of evidence are weak. Pregnancy and postpartum period should be followed very closely and determined to be at high risk. Guidelines suggest that women with aortopathy should be counseled against the risk of pregnancy and about the heritable nature of the disease prior to pregnancy. PMID:26454306

  4. Paraplegia caused by aortic coarctation complicated with spinal epidural hemorrhage.

    PubMed

    Tsai, Yi-Da; Hsu, Chin-Wang; Hsu, Chia-Ching; Liao, Wen-I; Chen, Sy-Jou

    2016-03-01

    Aortic coarctation complicated with spinal artery aneurysm rupture is exceptionally rare and can be source of intraspinal hemorrhage with markedly poor prognosis. A 21-year-old man visited the emergency department because of chest and back pain along with immobility of bilateral lower limbs immediately after he woke up in the morning. Complete flaccid paraplegia and hypoesthesia in dermatome below bilateral T3 level and pain over axial region from neck to lumbar region were noted. A computed tomography excluded aortic dissection. Magnetic resonance imaging revealed a fusiform lesion involving the anterior epidural space from C7 to T2 level suspected of epidural hemorrhage, causing compression of spinal cord. He started intravenous corticosteroid but refused operation concerning the surgical benefits. Severe chest pain occurred with newly onset right bundle branch block that developed the other day. Coronary artery angiography revealed myocardial bridge of left anterior descending coronary artery at middle third and coarctation of aorta. He underwent thoracic endovascular aortic repair uneventfully. The patient was hemodynamically stable but with slow improvement in neurologic recovery of lower limbs. Aortic coarcation can cause paralysis by ruptured vascular aneurysms with spinal hemorrhage and chest pain that mimics acute aortic dissection. A history of hypertension at young age and aortic regurgitated murmurs may serve as clues for further diagnostic studies. Cautious and prudent evaluation and cross disciplines cares are essential for diagnosis and successful management of the disease. PMID:26275629

  5. Acute Type A Aortic Dissection Missed as Acute Coronary Syndrome

    PubMed Central

    Ansari-Ramandi, Mohammad Mostafa; Firoozi, Ata

    2016-01-01

    Although the aortic dissection is not common, its outcome is frequently fatal, and many patients with aortic dissection die before referral to the hospital or any diagnostic testing. The symptoms of aortic dissection can be similar to myocardial ischemia. A 66-year-old male was referred to our hospital with suspicion of aortic dissection after echocardiography done for evaluating his high blood pressure. He had symptoms of acute coronary syndrome two years before and had done coronary angiography. On presentation to our hospital he had a high blood pressure. On reviewing his past medical history and examining, in the film of coronary angiography, the dissection flap in ascending aorta was identified. Although type A aortic dissection is a catastrophic condition with high mortality and requires prompt surgical treatment but in some cases it may be misdiagnosed as acute coronary syndrome. Sometimes against its high mortality when left untreated, patients survive and are diagnosed later in life incidentally. So it is of great importance to have great clinical suspicion for aortic dissection in patients referring to the hospital with chest pain and the predisposing factors. PMID:27437290

  6. Cardiovocal Syndrome Secondary to an Aortic Aneurysm

    PubMed Central

    Wang, Hsing-Won; Chen, Mei-Chien; Chao, Pin-Zhir; Lee, Fei-Peng

    2016-01-01

    We reported that a 68-year-old man presented to the ENT outpatient department complaining of hoarseness for more than 10 months. Clinical exam identified left vocal palsy in the paramedian position and atrophic vocal folds were noted. Chest radiography revealed a large bulging contour overlying aorta and left hilar shadow. Aortic aneurysm was proved by CT scanning. Contrast-enhanced chest computed tomography for further evaluation showed a broad-based aortic aneurysm at proximal descending aorta, projecting anterolaterally. Cardiovocal syndrome was proved. The syndrome is a rare clinical presentation. While a patient with unilateral vocal palsy is encountered, one might keep in mind the possibility of cardiovocal syndrome especially in an adult who had a cardiovascular disease. PMID:27088024

  7. Cardiovocal Syndrome Secondary to an Aortic Aneurysm.

    PubMed

    Wang, Hsing-Won; Chen, Mei-Chien; Chao, Pin-Zhir; Lee, Fei-Peng

    2016-01-01

    We reported that a 68-year-old man presented to the ENT outpatient department complaining of hoarseness for more than 10 months. Clinical exam identified left vocal palsy in the paramedian position and atrophic vocal folds were noted. Chest radiography revealed a large bulging contour overlying aorta and left hilar shadow. Aortic aneurysm was proved by CT scanning. Contrast-enhanced chest computed tomography for further evaluation showed a broad-based aortic aneurysm at proximal descending aorta, projecting anterolaterally. Cardiovocal syndrome was proved. The syndrome is a rare clinical presentation. While a patient with unilateral vocal palsy is encountered, one might keep in mind the possibility of cardiovocal syndrome especially in an adult who had a cardiovascular disease. PMID:27088024

  8. Development of Delirium in the Intensive Care Unit in Patients after Endovascular Aortic Repair: A Retrospective Evaluation of the Prevalence and Risk Factors

    PubMed Central

    Kawatani, Yohei; Nakamura, Yoshitsugu; Hayashi, Yujiro; Taneichi, Tetsuyoshi; Ito, Yujiro; Kurobe, Hirotsugu; Suda, Yuji; Hori, Takaki

    2015-01-01

    Delirium is an acute form of nervous system dysfunction often observed in patients in the intensive care unit. Endovascular aortic repair (EVAR) is considered a minimally invasive surgical treatment for abdominal aortic aneurysm. Although the operation method is widely used, there are few investigations of the rate and risk factors of delirium development after the operation. In this study, we retrospectively examined the rate of delirium development in the intensive care unit (ICU) after EVAR, as well as the associated preoperative risk factors and effects on the lengths of ICU and hospital stays. We examined the 81 consecutive patients who underwent elective EVAR between November 2013 and August 2014. The Intensive Care Delirium Screening Checklist was used to diagnose delirium. Twenty patients (24.7%) were diagnosed with delirium in this study. The ICU and hospital length of stays of patients with delirium were 3.3 ± 2.4 days and 14.5 ± 11.9 days, respectively, the latter of which was significantly longer than that of patients without delirium (p = 0.019). Additionally, renal dysfunction, preoperative benzodiazepine use, and intraoperative transfusion were found to be risk factors for the development of delirium after elective EVAR. PMID:26421186

  9. Intraoperative aortic dissection

    PubMed Central

    Singh, Ajmer; Mehta, Yatin

    2015-01-01

    Intraoperative aortic dissection is a rare but fatal complication of open heart surgery. By recognizing the population at risk and by using a gentle operative technique in such patients, the surgeon can usually avoid iatrogenic injury to the aorta. Intraoperative transesophageal echocardiography and epiaortic scanning are invaluable for prompt diagnosis and determination of the extent of the injury. Prevention lies in the strict control of blood pressure during cannulation/decannulation, construction of proximal anastomosis, or in avoiding manipulation of the aorta in high-risk patients. Immediate repair using interposition graft or Dacron patch graft is warranted to reduce the high mortality associated with this complication. PMID:26440240

  10. The Impact of Subject Age, Gender, and Arch Length on Attitudes of Syrian Dentists towards Shortened Dental Arches

    PubMed Central

    Nassani, Mohammad Zakaria; Al-Nahhal, Tammam Ibrahim; Kujan, Omar; Tarakji, Bassel; Kay, Elizabeth Jane

    2015-01-01

    Objective. This study aimed to investigate the impact of subject age, gender, and arch length on dentists' attitudes towards unrestored shortened dental arches. Materials and Methods. 93 Syrian dentists were interviewed and presented with 24 scenarios for male and female subjects of different ages and shortened dental arches of varying length. Participants were asked to indicate on a standardized visual analogue scale how they would value the health of the mouth if the posterior space was left unrestored. Results. A value of 0.0 represented the worst possible health state for a mouth and 1.0 represented the best. The highest mean value (0.73) was assigned to a shortened dental arch with missing second molar teeth in the mouth of a 70-year-old subject. A 35-year-old female subject with an extremely shortened dental arch (all molar and premolar teeth are missing) attracted the lowest mean value (0.26). The statistical analysis indicated a significant decrease in the value placed on unrestored shortened dental arches as the number of remaining teeth decreased (p < 0.008). While subject gender had almost no impact on dentists' attitudes towards shortened dental arches, the scenarios for the older shortened dental arch subjects attracted significantly higher values compared to the scenarios for the younger subjects (p < 0.017). Conclusion. Subject age and arch length affect dentists' attitudes towards shortened dental arches, but subject gender does not. PMID:26265916

  11. CT of acute abdominal aortic disorders.

    PubMed

    Bhalla, Sanjeev; Menias, Christine O; Heiken, Jay P

    2003-11-01

    Aortic aneurysm rupture, aortic dissection, PAU, acute aortic occlusion, traumatic aortic injury, and aortic fistula represent acute abdominal aortic conditions. Because of its speed and proximity to the emergency department, helical CT is the imaging test of choice for these conditions. MR imaging also plays an important role in the imaging of aortic dissection and PAU, particularly when the patient is unable to receive intravenous contrast material. In this era of MDCT, conventional angiography is used as a secondary diagnostic tool to clarify equivocal findings on cross-sectional imaging. Ultrasound is helpful when CT is not readily available and the patient is unable or too unstable to undergo MR imaging. PMID:14661663

  12. A comparison of the effects of rectangular and round arch wires in leveling the curve of Spee.

    PubMed

    AlQabandi, A K; Sadowsky, C; BeGole, E A

    1999-11-01

    A prospective randomized clinical study was designed to evaluate the effects of full continuous arch wires, rectangular in cross section, on the axial inclination of lower incisors. The intention of rectangular arch wires is to counteract the labial crown moment usually produced during leveling the curve of Spee with full arch mechanics. Patients were randomly assigned to 2 groups. Group 1 (N = 12) received round arch wires throughout the leveling stage. Group 2 (N = 16) started with flat 0.016 x 0.022 nickel titanium arch wires progressing to 0.016 x 0.022 stainless steel. The preadjusted 0.018 x 0.025 edgewise appliance was used in all cases. Lateral cephalometric radiographs and mandibular study models were taken before treatment and when the curve of Spee was leveled (or in some cases when the overbite was considered clinically acceptable). In group 1, the lower incisor proclined a mean of 6.75 degrees +/- 4.85 degrees (P <.01) and in group 2 it proclined a mean of 6.10 degrees +/- 3.95 degrees (P <.01). However, no significant difference in proclination was detected between the 2 groups. Statistically significant, but low, correlations were demonstrated between change in lower incisor axial inclination and relief of crowding r = 0.45) and change in mandibular arch depth r = 0.54), which was in turn inversely correlated with change in intercanine width r = -0.45). In both groups, the lower incisors proclined with uncontrolled tipping that can probably be attributed to the intrusive force introduced by the arch wire being labial to the center of resistance of the lower incisors. The ability of the rectangular arch wires to control labial proclination following leveling of the curve of Spee, as used in this study, was not supported. PMID:10547511

  13. [Cross-sectional study of the evolution of the primary dentition: shape of dental arches, overjet and overbite].

    PubMed

    de Castro, Liana Amado; Modesto, Adriana; Vianna, Roberto; Soviero, Vera Lígia Mendes

    2002-01-01

    The aim of this study was to evaluate the characteristics (shape of dental arches, overjet and overbite) of the primary dentition of 6- to 39-month-old children from four nurseries of Rio de Janeiro, Brazil, and to associate them to gender and dentition phase. It was observed that 68.6% of the children presented round upper arch, while 31.4% had triangular upper arch; 92% of the children presented U-shaped lower arch and 8% had square-shaped lower arch. Moderate overjet was observed in 38.3% of the children, and slight overjet, in 30.3%. Severe (26.6%) and negative (25.5%) overbites were the most prevalent modalities of that condition. There was no association between gender and the studied characteristics. There was statistically significant association between the dentition phase and the shape of the arch, overjet and overbite (p < 0.001, chi-square test). It was possible to observe, in the present study, that early signs of malocclusions appeared when first primary molars erupted, as the posterior vertical dimension of occlusion increased. It was, thus, verified that early signs of malocclusions appear as the primary dentition develops. It is very important that the first dental visit occur during the first year of age, since it allows the pediatric dentist to prevent or carry out an early diagnosis of malocclusions in the primary dentition. PMID:12612778

  14. Aortic biomechanics in hypertrophic cardiomyopathy

    PubMed Central

    Badran, Hala Mahfouz; Soltan, Ghada; Faheem, Nagla; Elnoamany, Mohamed Fahmy; Tawfik, Mohamed; Yacoub, Magdi

    2015-01-01

    Background: Ventricular-vascular coupling is an important phenomenon in many cardiovascular diseases. The association between aortic mechanical dysfunction and left ventricular (LV) dysfunction is well characterized in many disease entities, but no data are available on how these changes are related in hypertrophic cardiomyopathy (HCM). Aim of the work: This study examined whether HCM alone is associated with an impaired aortic mechanical function in patients without cardiovascular risk factors and the relation of these changes, if any, to LV deformation and cardiac phenotype. Methods: 141 patients with HCM were recruited and compared to 66 age- and sex-matched healthy subjects as control group. Pulse pressure, aortic strain, stiffness and distensibility were calculated from the aortic diameters measured by M-mode echocardiography and blood pressure obtained by sphygmomanometer. Aortic wall systolic and diastolic velocities were measured using pulsed wave Doppler tissue imaging (DTI). Cardiac assessment included geometric parameters and myocardial deformation (strain and strain rate) and mechanical dyssynchrony. Results: The pulsatile change in the aortic diameter, distensibility and aortic wall systolic velocity (AWS') were significantly decreased and aortic stiffness index was increased in HCM compared to control (P < .001) In HCM AWS' was inversely correlated to age(r = − .32, P < .0001), MWT (r = − .22, P < .008), LVMI (r = − .20, P < .02), E/Ea (r = − .16, P < .03) LVOT gradient (r = − 19, P < .02) and severity of mitral regurg (r = − .18, P < .03) but not to the concealed LV deformation abnormalities or mechanical dyssynchrony. On multivariate analysis, the key determinant of aortic stiffness was LV mass index and LVOT obstruction while the role LV dysfunction in aortic stiffness is not evident in this population. Conclusion: HCM is associated with abnormal aortic mechanical properties. The severity of cardiac

  15. Carotid artery and aortic arch imaging with ECG gating in DSA

    SciTech Connect

    Francis, D.A.; Sheldon, J.J.; Soila, K.; Tobias, J.

    1985-06-01

    New computer software for gated digital subtraction angiography imaging was used to study 57 patients over 3 months. Better mask registration on isolated sets of systolic and diastolic images improved image quality. Detail of vessel outline and lesion was better than that seen on nongated images.

  16. The management of stenotic and obstructive lesions of the aortic arch branches.

    PubMed

    Shumacker, H B; Isch, J H; Jolly, W W; Fitzgerald, E B

    1977-03-01

    The stenotic internal carotid can be managed in a variety of ways and number of tests can be utilized for assessing the collateral blood flow. Except in unusual situations, carotid thromboendarterectomy with or without a patch graft is generally employed. Although some surgeons use no protective shunt at all, or only upon specific indications, intraluminal shunting is utilized extensively. Our preference is to employ the customary Javid shunt technic except in unusual circumstances that suggest that added safety may be assured by shortening to a matter of seconds the period of interruption of carotid flow. In such cases, we believe the temporary axillary-internal carotid intraluminal shunt is of considerable value. Although mediastinal and thoracic procedures and bypass grafts delivering blood from the ascending aorta are not needed nearly as often as they were formerly, they are essential in certain cases. They yield excellent results and carry small risk. Carotid-subclavian grafts have proved quite valuable in restoring pulsatile flow to the subclavian and carotid systems. Our preference, however, because of technical simplicity, is the carotid-axillary bypass procedure. Subclavian-subclavian and axillary-axillary grafts have been employed successfully. When a carotid-axillary bypass is feasible, we would choose this method instead and reserve the others for unusual anatomic-pathologic situations. PMID:848666

  17. Clampless and Sutureless Hybrid Technique for Aortic Arch Debranching on a Porcelain Aorta.

    PubMed

    Poletto, Giorgio L; Musto, Liam; Civilini, Efrem; Giorgetti, PierLuigi

    2016-06-01

    An innovative hybrid approach to the supraaortic vessels in a porcelain aorta and severe fibrotic tissue reaction at the neck is described. The technique is demonstrated in an 80-year-old woman with previous several carotid operations but still experiencing recurrent transient ischemic attacks. Clinical success was achieved at midterm follow-up, demonstrating the efficacy of hybrid treatment for this high-risk patient. Novel prosthetic vascular grafts that can be applied without cross-clamping may also provide a solution to approaching a porcelain aorta and difficult anatomies. PMID:27211961

  18. Intramural hematoma or aortic dissection – a diagnostic and therapeutic problem. A case report

    PubMed Central

    Suder, Bogdan; Wasilewski, Grzegorz; Sadowski, Jerzy; Kapelak, Bogusław

    2015-01-01

    The authors present a case report of a 60-year-old patient with an ascending aortic aneurysm along with the associated diagnostic and therapeutic problems. The choice of therapy in patients with aortic intramural hematoma is difficult and should be based on comprehensive evaluation of the patient's status as well as on the experience of the radiologist and surgeon. PMID:26702280

  19. Unusual Case of Overt Aortic Dissection Mimicking Aortic Intramural Hematoma

    PubMed Central

    Disha, Kushtrim; Kuntze, Thomas; Girdauskas, Evaldas

    2016-01-01

    We report an interesting case in which overt aortic dissection mimicked two episodes of aortic intramural hematoma (IMH) (Stanford A, DeBakey I). This took place over the course of four days and had a major influence on the surgical treatment strategy. The first episode of IMH regressed completely within 15 hours after it was clinically diagnosed and verified using imaging techniques. The recurrence of IMH was detected three days thereafter, resulting in an urgent surgical intervention. Overt aortic dissection with evidence of an intimal tear was diagnosed intraoperatively. PMID:27066437

  20. The Concept of the Arch Window in the Spiral Switch of the Great Arteries.

    PubMed

    Chiu, Ing-Sh; Lee, Meng-Luen; Huang, Shu-Chien; Chang, Chung-I; Chen, Yih-Sharng; Wu, Mei-Hwan; Anderson, Robert H

    2016-08-01

    When the arterial switch operation includes the Lecompte maneuver, the arterial trunks are reconnected in parallel, rather than the spiral fashion observed in the normal heart. Thus, although the ventriculo-arterial connections are hemodynamically corrected, the anatomic arrangement cannot be considered normal. We hypothesized that, if feasible, it would be advantageous to restore a spiral configuration for the arterial trunks. In 58 patients, we reconstructed the arterial trunks such that, postoperatively, the pulmonary channel spirals round the aorta, passing to either the right or the left, and branches posteriorly. We compared the outcomes with those in 95 patients undergoing a standard non-spiraling operation over the same period. Average follow-up was 8.2 ± 4.5 years. The estimated 10-year survival was similar in the cohorts, at 94.7 % for those with spiraling trunks, as compared to 90.4 % for those with parallel outflow tracts. Reoperation-free survival at 10 years was not significantly different (87.6 vs. 90.5 %). Supravalvar pulmonary stenosis, aortic neo-coarctation, or left bronchial stenosis, however, was encountered in one-eighth of those undergoing a standard operation. None of these complications occurred in those patients who, postoperatively, had spiraling outflow tracts (P = 0.002). Reconstruction of spiraling trunks after the arterial switch has, thus far, avoided the complications of supravalvar pulmonary stenosis, neo-aortic kinking, or bronchial stenosis. The spiraling arrangement prevents compression of the pulmonary vessels and bronchial tree by the aorta, since it provides a wide window in the new aortic arch. PMID:27272691

  1. [Combined Open and Endovascular Repair of Multiple Aortic Aneurysms due to Syphilitic Aortitis].

    PubMed

    Shima, Shotaro; Okamura, Kennichi; Morizumi, Sei; Kawata, Mitsuhiro; Suematsu, Yoshihiro

    2015-06-01

    The patient was a 69-year-old man who presented with low-grade fever and appetite loss. Thoracoabdominal computed tomography revealed multiple aneurysms in the distal arch and descending thoracic and infrarenal aortic regions combined with a right common iliac artery aneurysm. After endovascular stent grafting for a right iliac artery aneurysm, he underwent total arch replacement and open stent grafting for the descending thoracic aneurysms. Pathological microscopic examination revealed an inflammatory infiltrate within the adventitia and destruction of the elastic fibers in the media, which are classical features of syphilitic aortitis. Endovascular aneurysm repair is contraindicated in mycotic infected aneurysms. However, endovascular repair is useful for treating mycotic infected aneurysm, if multiple aneurysms have the possibility of rupture and a high risk of surgery. PMID:26066872

  2. Minimally invasive aortic valve surgery.

    PubMed

    Castrovinci, Sebastiano; Emmanuel, Sam; Moscarelli, Marco; Murana, Giacomo; Caccamo, Giuseppa; Bertolino, Emanuela Clara; Nasso, Giuseppe; Speziale, Giuseppe; Fattouch, Khalil

    2016-09-01

    Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has demonstrably proven to be both safe and effective. Over the last few decades, in an attempt to reduce surgical trauma, different minimally invasive approaches for aortic valve replacement have been developed and are now being increasingly utilized. A narrative review of the literature was carried out to describe the surgical techniques for minimally invasive aortic valve surgery and report the results from different experienced centers. Minimally invasive aortic valve replacement is associated with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. Long-term survival appears to be at least comparable to that reported for conventional full sternotomy. Minimally invasive aortic valve surgery, either with a partial upper sternotomy or a right anterior minithoracotomy provides early- and long-term benefits. Given these benefits, it may be considered the standard of care for isolated aortic valve disease. PMID:27582764

  3. Minimally invasive aortic valve surgery

    PubMed Central

    Castrovinci, Sebastiano; Emmanuel, Sam; Moscarelli, Marco; Murana, Giacomo; Caccamo, Giuseppa; Bertolino, Emanuela Clara; Nasso, Giuseppe; Speziale, Giuseppe; Fattouch, Khalil

    2016-01-01

    Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has demonstrably proven to be both safe and effective. Over the last few decades, in an attempt to reduce surgical trauma, different minimally invasive approaches for aortic valve replacement have been developed and are now being increasingly utilized. A narrative review of the literature was carried out to describe the surgical techniques for minimally invasive aortic valve surgery and report the results from different experienced centers. Minimally invasive aortic valve replacement is associated with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. Long-term survival appears to be at least comparable to that reported for conventional full sternotomy. Minimally invasive aortic valve surgery, either with a partial upper sternotomy or a right anterior minithoracotomy provides early- and long-term benefits. Given these benefits, it may be considered the standard of care for isolated aortic valve disease. PMID:27582764

  4. Enhancing 4D PC-MRI in an aortic phantom considering numerical simulations

    NASA Astrophysics Data System (ADS)

    Kratzke, Jonas; Schoch, Nicolai; Weis, Christian; Müller-Eschner, Matthias; Speidel, Stefanie; Farag, Mina; Beller, Carsten J.; Heuveline, Vincent

    2015-03-01

    To date, cardiovascular surgery enables the treatment of a wide range of aortic pathologies. One of the current challenges in this field is given by the detection of high-risk patients for adverse aortic events, who should be treated electively. Reliable diagnostic parameters, which indicate the urge of treatment, have to be determined. Functional imaging by means of 4D phase contrast-magnetic resonance imaging (PC-MRI) enables the time-resolved measurement of blood flow velocity in 3D. Applied to aortic phantoms, three dimensional blood flow properties and their relation to adverse dynamics can be investigated in vitro. Emerging "in silico" methods of numerical simulation can supplement these measurements in computing additional information on crucial parameters. We propose a framework that complements 4D PC-MRI imaging by means of numerical simulation based on the Finite Element Method (FEM). The framework is developed on the basis of a prototypic aortic phantom and validated by 4D PC-MRI measurements of the phantom. Based on physical principles of biomechanics, the derived simulation depicts aortic blood flow properties and characteristics. The framework might help identifying factors that induce aortic pathologies such as aortic dilatation or aortic dissection. Alarming thresholds of parameters such as wall shear stress distribution can be evaluated. The combined techniques of 4D PC-MRI and numerical simulation can be used as complementary tools for risk-stratification of aortic pathology.

  5. Detail of arched windows on north elevation; camera facing southwest. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Detail of arched windows on north elevation; camera facing southwest. - Mare Island Naval Shipyard, Smithery, California Avenue, west side at California Avenue & Eighth Street, Vallejo, Solano County, CA

  6. ARCH TYPE MAGAZINE # 2131. INTERIOR LOOKING TOWARD ENTRY. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    ARCH TYPE MAGAZINE # 2131. INTERIOR LOOKING TOWARD ENTRY. - Naval Magazine Lualualei, Headquarters Branch, Magazine Type, Various roads in northern & eastern portions of installation, Pearl City, Honolulu County, HI

  7. 16. DETAIL OF SMALL ARCHES AT SOUTH END, FROM WEST. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    16. DETAIL OF SMALL ARCHES AT SOUTH END, FROM WEST. - Philadelphia & Reading Railroad, Wissahickon Creek Viaduct, Spanning Wissahickon Creek, north of Ridge Avenue Bridge, Philadelphia, Philadelphia County, PA

  8. 15. DETAIL OF SMALL ARCHES AT SOUTH END, FROM WEST. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    15. DETAIL OF SMALL ARCHES AT SOUTH END, FROM WEST. - Philadelphia & Reading Railroad, Wissahickon Creek Viaduct, Spanning Wissahickon Creek, north of Ridge Avenue Bridge, Philadelphia, Philadelphia County, PA

  9. 4. North elevation, arch CD. View south Ashton Viaduct, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. North elevation, arch C-D. View south - Ashton Viaduct, State Route 116 (Washington Highway) spanning Blackstone River, Blackstone Canal, & Providence & Worcester Railroad, Ashton, Providence County, RI

  10. Mathematical model of a moment-less arch

    PubMed Central

    2016-01-01

    This paper presents a mathematical model for predicting the geometrical shapes of rigid, two-pin, moment-less arches of constant cross section. The advancement of this work lies in the inclusion of arch self-weight and the ability to produce moment-less arch forms for any span/rise ratio, and any ratio of uniformly distributed load per unit span, w, to uniformly distributed arch weight per unit arch length, q. The model is used to derive the shapes of two classical ‘moment-less’ arch forms: parabolic and catenary, prior to demonstrating a general case, not restricted by the unrealistic load assumptions (absence of q, in the case of a parabolic form, or no w, in the case of a catenary arch). Using the same value of span/rise ratio, and w/q>1, the behaviour of the moment-less and parabolic arches under permanent loading, (w+q), is analysed. Results show the former to be developing much lower stresses than its parabolic rival, even when there are relatively small differences in the two geometries; for a medium span/rise ratio of 4 and w/q=2, differences in the parabolic and moment-less arch geometries would, in practical terms, be viewed as insignificant, but the stresses in them are different. PMID:27436970

  11. Normal azygos arch: retrotracheal visualization on frontal chest tomograms.

    PubMed

    Austin, J H; Thorsen, M K

    1981-12-01

    Anteroposterior, linear tomograms of 78 adult subjects in the supine position revealed visualization of pleural reflections off the retrotracheal part of the normal azygos arch in 38 (49%). The course of the arch varied by about 3 cm. Five distinct patterns were found, mainly depending on the course of the inferior margin of the arch. The inferior margin varied from relatively superior retrotracheal positions to intermediate positions appearing to intersect the carina, to relatively inferior and right-sided positions posterior to the proximal right main bronchus. Recognition of these normal variations of the azygos arch should serve to differentiate them from abnormalities in this region. PMID:6976093

  12. 66. CORBELS, BLIND ARCHES & SHIELDS, COMMONS EAST WALL, LOOKING ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    66. CORBELS, BLIND ARCHES & SHIELDS, COMMONS EAST WALL, LOOKING EAST - Smithsonian Institution Building, 1000 Jefferson Drive, between Ninth & Twelfth Streets, Southwest, Washington, District of Columbia, DC

  13. 2. DETAIL VIEW OF MIDDLE ARCH SPAN, LOOKING NORTHWEST. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    2. DETAIL VIEW OF MIDDLE ARCH SPAN, LOOKING NORTHWEST. - Cumberland & Pennsylvania Railroad, Wills Creek Bridge, Spanning Wills Creek 587 feet West of Eckhart Junction, Cumberland, Allegany County, MD

  14. Total Percutaneous Aortic Repair: Midterm Outcomes

    SciTech Connect

    Bent, Clare L. Fotiadis, Nikolas; Renfrew, Ian; Walsh, Michael; Brohi, Karim; Kyriakides, Constantinos; Matson, Matthew

    2009-05-15

    The purpose of this study was to examine the immediate and midterm outcomes of percutaneous endovascular repair of thoracic and abdominal aortic pathology. Between December 2003 and June 2005, 21 patients (mean age: 60.4 {+-} 17.1 years; 15 males, 6 females) underwent endovascular stent-graft insertion for thoracic (n = 13) or abdominal aortic (n = 8) pathology. Preprocedural computed tomographic angiography (CTA) was performed to assess the suitability of aorto-iliac and common femoral artery (CFA) anatomy, including the degree of CFA calcification, for total percutaneous aortic stent-graft repair. Percutaneous access was used for the introduction of 18- to 26-Fr delivery devices. A 'preclose' closure technique using two Perclose suture devices (Perclose A-T; Abbott Vascular) was used in all cases. Data were prospectively collected. Each CFA puncture site was assessed via clinical examination and CTA at 1, 6, and 12 months, followed by annual review thereafter. Minimum follow-up was 36 months. Outcome measures evaluated were rates of technical success, conversion to open surgical repair, complications, and late incidence of arterial stenosis at the site of Perclose suture deployment. A total of 58 Perclose devices were used to close 29 femoral arteriotomies. Outer diameters of stent-graft delivery devices used were 18 Fr (n = 5), 20 Fr (n = 3), 22 Fr (n = 4), 24 Fr (n = 15), and 26 Fr (n = 2). Percutaneous closure was successful in 96.6% (28/29) of arteriotomies. Conversion to surgical repair was required at one access site (3.4%). Mean follow-up was 50 {+-} 8 months. No late complications were observed. By CT criteria, no patient developed a >50% reduction in CFA caliber at the site of Perclose deployment during the study period. In conclusion, percutaneous aortic stent-graft insertion can be safely performed, with a low risk of both immediate and midterm access-related complications.

  15. The Geologic Story of Arches National Park

    USGS Publications Warehouse

    Lohman, Stanley William

    1975-01-01

    According to former Superintendent Bates Wilson (1956), Prof. Lawrence M. Gould, of the University of Michigan, was the first to recognize the geologic and scenic values of the Arches area in eastern Utah and to urge its creation as a national monument. Mrs. Faun McConkie Tanner told me that Professor Gould, who had done a thesis problem in the nearby La Sal Mountains, was first taken through the area by Marv Turnbow, third owner of Wolfe cabin. (See p. 12.) When Professor Gould went into ecstasy over the beautiful scenery, Turnbow replied, 'I didn't know there was anything unusual about it.'

  16. Occlusive Disease of the Vessels of the Aortic Arch—Diagnosis and Management

    PubMed Central

    Johnson, C. Delmar; Zirkle, Thomas J.; Smith, Louis L.

    1968-01-01

    Physicians should be alert to the possibility of occlusion of one or more of the branches of the aortic arch in any patient having neurologic symptoms or complaint of claudication in the upper extremities. The finding of a pulse deficit in the neck or arm and a blood pressure difference of more than 30 mm of mercury between the two arms is pathognomic of this disease. The presence of the occlusive process can be confirmed and its extent determined by angiography. Vascular reconstruction can be expected to restore normal hemodynamics with gratifying relief of symptoms in the majority of cases. PMID:18730091

  17. Concurrence of Aneurysmal Subarachnoid Hemorrhage and Stanford Type A Acute Aortic Dissection.

    PubMed

    Inamasu, Joji; Suzuki, Takeya; Wakako, Akira; Sadato, Akiyo; Hirose, Yuichi

    2016-06-01

    We report a rare case of concurrent aneurysmal subarachnoid hemorrhage (SAH) and acute aortic dissection (AAD). A 38-year-old man visited our hospital complaining of severe headache, and brain computed tomography (CT) revealed the presence of SAH. Thoracic to neck computed tomography angiography (CTA), performed in addition to brain CTA, suggested a tear in the aortic arch, and subsequent CT aortography established the diagnosis of Stanford type A AAD. The AAD in our patient, who reported no episodes of chest or back pain, was detected incidentally by thoracic to neck CTA. The imaging study has rarely been indicated for SAH except that it provides additional anatomical information in patients for whom extracranial-intracranial bypass surgery or endovascular treatment is considered. Nevertheless, our experience may highlight additional diagnostic value of thoracic to neck CTA in SAH patients. PMID:27083068

  18. Imaging of abdominal aortic aneurysms.

    PubMed

    Sparks, Amy R; Johnson, Philip L; Meyer, Mark C

    2002-04-15

    Given the high rate of morbidity and mortality associated with abdominal aortic aneurysms (AAAs), accurate diagnosis and preoperative evaluation are essential for improved patient outcomes. Ultrasonography is the standard method of screening and monitoring AAAs that have not ruptured. In the past, aortography was commonly used for preoperative planning in the repair of AAAs. More recently, computed tomography (CT) has largely replaced older, more invasive methods. Recent advances in CT imaging technology, such as helical CT and CT angiography, offer significant advantages over traditional CT. These methods allow for more rapid scans and can produce three-dimensional images of the AAA and important adjacent vascular structures. Use of endovascular stent grafts has increased recently and is less invasive for the repair of AAAs in selected cases. Aortography and CT angiography can precisely determine the size and surrounding anatomy of the AAA to identify appropriate candidates for the use of endovascular stent grafts. Helical CT and CT angiography represent an exciting future in the preoperative evaluation of AAAs. However, this technology is not the standard of care because of the lack of widespread availability, the cost associated with obtaining new equipment, and the lack of universal protocols necessary for acquisition and reconstruction of these images. PMID:11989632

  19. Thoracic aortic aneurysm: A rare cause of elevated hemidiaphragm

    PubMed Central

    Ejazi, Md Arshad; Alam, Md Mazhar; Shameem, Mohammad; Bhargava, Rakesh; Adil Wafi, CG; Salauddin

    2016-01-01

    Phrenic nerve palsy causing hemidiaphragm paralysis is a very uncommon feature of thoracic aortic aneurysm. In one case, a 30 year male complained of chronic dull aching chest pain, and hoarseness of voice; posteroanterior view chest radiograph revealed large spherical radiopacity on the left upper lung zone with smooth lobulated margin with elevated left hemidiaphragm. On Colour Doppler sonography, lesion was anechoic on gray scale sonography but on Doppler analysis revealed intense internal vascularity within it with characteristic “Ying Yang” sign. The finding favor the vascular origin of the lesion and a diagnosis of an arterial aneurysm was made Contrast-enhanced computed tomography (CT) of the thorax revealed a large well defined spherical lesion of 8 × 10 cm size with smooth well defined margin arising from the aortic arch and attenuation of impending rupture or dissection were lesion on immediate post contrast and delayed scan was similar to that of aorta. Left hemidiaphragm elevation was explained by the gross mass effect of the aneurysm causing right phrenic nerve palsy. PMID:27578939

  20. Thoracic aortic aneurysm: A rare cause of elevated hemidiaphragm.

    PubMed

    Ejazi, Md Arshad; Alam, Md Mazhar; Shameem, Mohammad; Bhargava, Rakesh; Adil Wafi, C G; Salauddin

    2016-01-01

    Phrenic nerve palsy causing hemidiaphragm paralysis is a very uncommon feature of thoracic aortic aneurysm. In one case, a 30 year male complained of chronic dull aching chest pain, and hoarseness of voice; posteroanterior view chest radiograph revealed large spherical radiopacity on the left upper lung zone with smooth lobulated margin with elevated left hemidiaphragm. On Colour Doppler sonography, lesion was anechoic on gray scale sonography but on Doppler analysis revealed intense internal vascularity within it with characteristic "Ying Yang" sign. The finding favor the vascular origin of the lesion and a diagnosis of an arterial aneurysm was made Contrast-enhanced computed tomography (CT) of the thorax revealed a large well defined spherical lesion of 8 × 10 cm size with smooth well defined margin arising from the aortic arch and attenuation of impending rupture or dissection were lesion on immediate post contrast and delayed scan was similar to that of aorta. Left hemidiaphragm elevation was explained by the gross mass effect of the aneurysm causing right phrenic nerve palsy. PMID:27578939