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Sample records for 5th aortic arch

  1. 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.

  2. Double aortic arch

    MedlinePlus

    Aortic arch anomaly; Double arch; Congenital heart defect - double aortic arch; Birth defect heart - double aortic arch ... aorta is a single arch that leaves the heart and moves leftward. In double aortic arch, some ...

  3. 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

  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. 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

  6. Giant aortic arch aneurysm complicating Kawasaki's disease

    PubMed Central

    Hakim, Kaouthar; Boussada, Rafik; Chaker, Lilia; Ouarda, Fatma

    2014-01-01

    Kawasaki disease (KD) is a common acute vasculitis in pediatric population that usually involves small- and middle-sized arteries, commonly coronary arteries. Although the incidence and natural course of coronary aneurysms after KD are well documented in studies, related reports on peripheral arterial and aortic aneurysms are scarce. We report the occurrence of a giant aortic aneurysm involving the horizontal part of aortic arch in a 28-month-old boy diagnosed with KD. This complication was managed by steroids therapy in the beginning. Because of mechanical complication and potential risk of rupture, surgery was undertaken. PMID:25298695

  7. 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

  8. 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.

  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.

  10. [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

  11. Thoracic endovascular aortic repair for blunt thoracic aortic injuries in complex aortic arch vessels anatomies.

    PubMed

    Piffaretti, Gabriele; Carrafiello, Gianpaolo; Ierardi, Anna Maria; Mariscalco, Giovanni; Macchi, Edoardo; Castelli, Patrizio; Tozzi, Matteo; Franchin, Marco

    2015-08-01

    The aim of this study is to report the use of thoracic endovascular aortic repair (TEVAR) in blunt thoracic aortic injuries (BTAIs) presenting with complex anatomies of the aortic arch vessels. Two patients were admitted to our hospital for the management of BTAI. Anomalies were as follow: aberrant right subclavian artery (n = 1) and right-sided aortic arch with 5 vessels anatomy variant (n = 1). TEVAR was accomplished using parallel graft with periscope configuration in the patient with the aberrant right subclavian artery. At 12-month follow-up, computed tomography angiographies confirmed the exclusion of the BTAI, the stability of the endograft, the resolution of the pseudoaneurysm, and the patency of the parallel endograft. Aortic arch vessels variants and anomalies are not rare, and should be recognized and studied precisely to plan the most appropriate operative treatment. TEVAR proved to be effective even in complex anatomies.

  12. Adult presentation with vascular ring due to double aortic arch.

    PubMed

    Kafka, Henryk; Uebing, Anselm; Mohiaddin, Raad

    2006-11-01

    This is a case report on the use of cardiovascular magnetic resonance imaging to diagnose vascular ring due to double aortic arch in an adult presenting with an abnormal chest X-ray. The experience in this case and the literature review identify the benefits of using cardiovascular magnetic resonance imaging to clarify complex aortic arch anatomy.

  13. 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

  14. 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.

  15. Conservative management of aortic arch injury following penetrating trauma.

    PubMed

    Mohammed, R K; Cheung, S; Parikh, S P; Asgaria, K

    2015-04-01

    Aortic arch injuries following penetrating trauma are typically lethal events with high mortality rates. Traditionally, the standard of care for patients presenting with penetrating injury and aortic involvement has included surgical intervention. We report the case of a 31-year-old man who was managed non-operatively after sustaining multiple stab wounds to the left chest and presenting with mid aortic arch injury.

  16. 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.

  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. 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

  19. Right Aortic Arch and Coarctation: A Rare Association

    PubMed Central

    Ismat, Fraz A.; Weinberg, Paul M.; Rychik, Jack; Karl, Tom R.; Fogel, Mark A.

    2006-01-01

    Objectives Understand anatomical and clinical correlatives to coarctation in right aortic arch. Background Coarctation of the aorta is rare in patients with a functional right aortic arch. We reviewed a single institutional experience, examining associated diagnoses, diagnostic methodology, and surgical approaches. Methods A retrospective study was performed of our echocardiographic, magnetic resonance imaging, catheterization, and surgical databases from 1988 to 2001. Results Of 240 patients with right aortic arch, 10 (4.1%) had coarctation, constituting 1.9% of all native coarctations (n = 524). Nine (90%) had long-segment hypoplasia. Six (60%) had an aberrant left subclavian artery or retroesophageal diverticulum, 3 (30%) had mirror image branching, and 1 (10%) had a double arch with an atretic left arch. Other congenital heart defects were seen in 6 (60%) comprising 3 with ventricular septal defects, and one each with double-outlet right ventricle, cor triatriatum, and pulmonary valve abnormality. No patients with long-segment hypoplasia had bicuspid aortic valve. Six (60%) had vascular rings, and 5 (50%) had other associated syndromes. Magnetic resonance imaging and/or echocardiography successfully diagnosed all of these patients. Although long-segment right aortic arch coarctation courses behind the trachea posteriorly, only 2 needed an extra-anatomic (jump) graft; the remainders were repaired with patch angioplasty. Conclusion Coarctation with right aortic arch is rare, constituting 4.1% of all patients with right aortic arch, compared with 5–8% of patients with left aortic arch and congenital heart disease. Nearly all had long-segment hypoplasia without bicuspid aortic valve, and half were part of other syndrome complexes. This association can be diagnosed noninvasively and can often be repaired by patch angioplasty. PMID:17330153

  20. Hybrid Endovascular Repair in Aortic Arch Pathologies: A Retrospective Study

    PubMed Central

    Ma, Xiaohui; Guo, Wei; Liu, Xiaoping; Yin, Tai; Jia, Xin; Xiong, Jiang; Zhang, Hongpeng; Wang, Lijun

    2010-01-01

    The aortic arch presents specific challenges to endovascular repair. Hybrid repair is increasingly evolving as an alternative option for selected patients, and promising initial results have been reported. The aim of this study was to introduce our experiences and evaluate mid-term results of supra aortic transpositions for extended endovascular repair of aortic arch pathologies. From December 2002 to January 2008, 25 patients with thoracic aortic aneurysms and dissections involving the aortic arch were treated with hybrid endovascular treatment in our center. Of the 25 cases, 14 were atherosclerotic thoracic aortic aneurysms and 11 were thoracic aortic dissection. The hybrid repair method included total-arch transpositions (15 cases) or hemi-arch transpositions (10 cases), and endovascular procedures. All hybrid endovascular procedures were completed successfully. Three early residual type-I endoleaks and one type-II endoleak were observed. Stroke occurred in three patients (8%) during the in-hospital stage. The perioperative mortality rate was 4%; one patients died post-operatively from catheter related complications. The average follow-up period was 15 ± 5.8 months (range, 1–41 months). The overall crude survival rate at 15 months was 92% (23/25). During follow-up, new late endoleaks and stent-raft related complications were not observed. One case (4%) developed a unilateral lower limb deficit at 17 days and was readmitted to hospital. In conclusion, the results are encouraging for endovascular aortic arch repair in combination with supra-aortic transposition in high risk cases. Aortic endografting offers good mid-term results. Mid-term results of the hybrid approach in elderly patients with aortic arch pathologies are satisfying. PMID:21151464

  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. Surgical repair for aortic dissection accompanying a right-sided aortic arch.

    PubMed

    Obitsu, Yukio; Koizumi, Nobusato; Iwahashi, Toru; Saiki, Naozumi; Shigematsu, Hiroshi

    2010-01-01

    Aortic anomaly in which a right-sided aortic arch associated with Kommerell's diverticulum and aberrant left subclavian artery is rare. The present report describes a patient with type-B aortic dissection accompanying aortic anomalies consisting of right-sided aortic arch and the left common carotid and left subclavian artery arising from Kommerell's diverticulum. As dissecting aortic aneurysm diameter increased rapidly, Single-stage surgical repair of extensive thoracic aorta was performed through median sternotomy and right posterolateral fifth intercostal thoracotomy, yielding favorable results. Our surgical procedures are discussed.

  3. Surgical repair for aortic dissection accompanying a right-sided aortic arch

    PubMed Central

    2010-01-01

    Aortic anomaly in which a right-sided aortic arch associated with Kommerell's diverticulum and aberrant left subclavian artery is rare. The present report describes a patient with type-B aortic dissection accompanying aortic anomalies consisting of right-sided aortic arch and the left common carotid and left subclavian artery arising from Kommerell's diverticulum. As dissecting aortic aneurysm diameter increased rapidly, Single-stage surgical repair of extensive thoracic aorta was performed through median sternotomy and right posterolateral fifth intercostal thoracotomy, yielding favorable results. Our surgical procedures are discussed. PMID:20459743

  4. 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.

  5. Type B Aortic Dissection Repair Using a Thoraflex Hybrid Prosthesis in a Complex Aortic Arch Anatomy

    PubMed Central

    Ghanem, Moussa Abi; Gomez-Sanchez, Mario; Chaufour, Xavier; Marcheix, Bertrand

    2016-01-01

    Thoracic endovascular aortic repair (TEVAR) is recognized as an attractive option to treat complicated Type B aortic dissection. Nevertheless, TEVAR is not always technically possible. We report the case of a 53-year-old male with complicated Type B aortic dissection, in the setting of a complex anomalous aortic arch anatomy with an aneurysmal aberrant right subclavian artery. He was successfully treated by the frozen elephant trunk technique using the Thoraflex hybrid graft.

  6. Management of hypoplastic aortic arch associated with neonatal coarctation.

    PubMed

    Caspi, J; Ilbawi, M N; Muster, A; Roberson, D; Arcilla, R

    1994-12-01

    Controversy still exists as to whether hypoplastic aortic arch frequently associated with neonatal coarctation, should be enlarged at the time of coarctation repair. To determine the indications for and the outcome of repair of hypoplastic aortic arch, pre- and postoperative angiograms/echocardigraphy of 77 cases with isolated (n = 25, Group 1) or complex (n = 52, Group 2) neonatal coarctation operated upon between 1/80 and 12/89 were reviewed. Age was 5-14 days (mean 8 +/- 1.6). Aortic arch/ascending aorta diameter ratio (AR/AA) as a measure of the degree of aortic arch hypoplasia was 0.39-0.64 (0.52 +/- 0.04) in isolated and 0.15-0.47 (0.34 +/- 0.06) in complex coarctation (p < 0.05). Left subclavian flap aortoplasty was used in 72 patients; alone in 25, in combination with pulmonary artery banding in 43 patients, and simultaneously with intracardiac repair in 4 patients. Extensive reconstruction of aortic arch and coarctation with synthetic patch was performed in the remaining 5 patients (AR/AO = 0.16 +/- 0.03) using cardiopulmonary by-pass at the time of intracardiac repair. Operative mortality was 2/76 (2.5%). Follow-up is 6.6 +/- 1.4 years. Recoarctation occurred in 3 patients (4%). AR/AA increased to 0.86 +/- 0.1 in isolated (p < 0.05 vs preoperative) and to 0.7 +/- 0.1 in complex coarctation (p < 0.05 vs preoperative). In the majority of cases, hypoplastic aortic arch associated with coarctation grows satisfactorily following simple repair of coarctation with no significant residual narrowing.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. [Right aortic arch, Kommerell's diverticulum and aberrant left subclavian artery].

    PubMed

    Simón-Yarza, I; Viteri-Ramírez, G; Etxano, J; Roblero, P Slon; Ferreira, M; Alemañ, G Bastarrika

    2011-01-01

    The right aberrant subclavian artery or "arteria lusoria" is the most common anatomical variant of the embryonic development of the aorta and its branches, with a presence in 0.5-2% of the population. Less frequently, a right aortic arch with aberrant left subclavian artery may be present. These anatomical variations should be included in the differential diagnosis of superior mediastinal widening seen on chest radiographs. In this report, we present a right aortic arch with left aberrant subclavian artery dilated at its origin (Kommerell's diverticulum) as a cause of superior mediastinal widening detected incidentally on a chest radiograph.

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. Complex Atheromatosis of the Aortic Arch in Cerebral Infarction

    PubMed Central

    Capmany, Ramón Pujadas; Ibañez, Montserrat Oliveras; Pesquer, Xavier Jané

    2010-01-01

    In many stroke patients it is not possible to establish the etiology of stroke. However, in the last two decades, the use of transesophageal echocardiography in patients with stroke of uncertain etiology reveals atherosclerotic plaques in the aortic arch, which often protrude into the lumen and have mobile components in a high percentage of cases. Several autopsy series and retrospective studies of cases and controls have shown an association between aortic arch atheroma and arterial embolism, which was later confirmed by prospectively designed studies. The association with ischemic stroke was particularly strong when atheromas were located proximal to the ostium of the left subclavian artery, when the plaque was ≥ 4 mm thick and particularly when mobile components are present. In these cases, aspirin might not prevent adequately new arterial ischemic events especially stroke. Here we review the evidence of aortic arch atheroma as an independent risk factor for stroke and arterial embolism, including clinical and pathological data on atherosclerosis of the thoracic aorta as an embolic source. In addition, the impact of complex plaques (≥ 4 mm thick, or with mobile components) on increasing the risk of stroke is also reviewed. In non-randomized retrospective studies anticoagulation was superior to antiplatelet therapy in patients with stroke and aortic arch plaques with mobile components. In a retrospective case-control study, statins significantly reduced the relative risk of new vascular events. However, given the limited data available and its retrospective nature, randomized prospective studies are needed to establish the optimal secondary prevention therapeutic regimens in these high risk patients. PMID:21804777

  14. Surgical treatment for right aortic arch with Kommerell's diverticulum.

    PubMed

    Ishikawa, Noboru; Oi, Masaya; Maruta, Kazuto; Iizuka, Hirofumi; Kawaura, Hiroyuki

    2013-12-01

    Kommerell's diverticulum causes compression of the esophagus between the aberrant origin of the left subclavian artery and ascending aorta, leading to dysphagia or dyspnea. We describe 3 cases of successful surgical treatment of right aortic arch with Kommerell's diverticulum and aberrant origin of the left subclavian artery, using a right anterolateral partial sternotomy. This allows both resection of the Kommerell's diverticulum as well as reconstruction of the aberrant origin of the left subclavian artery anatomically.

  15. 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

  16. [Extended aortic arch replacement through gull-wing approach to Kommerell's diverticulum and aneurysmal right-sided aortic arch with aberrant left subclavian artery].

    PubMed

    Yasuhara, Kiyomitsu; Obayashi, Tamiyuki; Koyano, Tetsuya; Okonogi, Shuichi

    2011-09-01

    The patient was a 76-year-old man. He was referred to our hospital to treat Kommerell's diverticulum and aneurysmal right-sided aortic arch with aberrant left subclavian artery. We performed extended aortic arch replacement using gull-wing approach. He was discharged uneventfully without any complication. Gull-wing approach method has an advantage of wide surgical field and may be useful for extensive thoracic aortic disease.

  17. Atresia of the Aortic Arch in 4-Year-Old Child: A Clinical Case Study

    PubMed Central

    Nigro Stimato, Vittoria; Didier, Dominique; Beghetti, Maurice; Tissot, Cécile

    2015-01-01

    Atresia of the aortic arch is a rare congenital heart defect with a high mortality when associated with other intracardiac defects. Cardiac magnetic resonance (CMR) provides the exact anatomy of the aortic arch and collateral circulation and is useful to diagnose-associated aortic arch anomalies. This report describes the case of a 4-year-old child with atresia of the aortic arch, referred to our institution with the diagnosis of aortic coarctation and bicuspid aortic valve. On clinical exam, the femoral pulses were not palpable and there was a significant differential blood pressure between the upper and lower limbs. The echocardiography showed a severely stenotic bicuspid aortic valve but was limited for the exact description of the aortic arch. CMR showed absence of lumen continuity between the ascending and descending aorta distal to the left subclavian artery, extending over 5 mm, with the presence of a bend in the arch and diverticulum on either side of the zone of discontinuity, suggesting the diagnosis atresia of the aortic arch rather than coarctation or interruption. The patient benefited from a successful surgical commissurotomy of the aortic valve and reconstruction of the aortic arch with a homograft. The post-operative CMR confirmed the good surgical result. This case emphasizes the utility of CMR to provide good anatomical information to establish the exact diagnosis and the operative strategy. PMID:25853109

  18. Aberrant left subclavian artery associated with a Kommerell's diverticulum and a left-sided aortic arch.

    PubMed

    Yu, Pey-Jen; Balsam, Leora B; Mussa, Firas F; DeAnda, Abe

    2012-09-01

    Kommerell's diverticulum is most commonly associated with either an aberrant left subclavian artery from a right-sided aortic arch or an aberrant right subclavian artery from a left-sided aortic arch. We describe an exceedingly rare case of an aberrant left subclavian artery arising from a Kommerell's diverticulum in a patient with a left-sided aortic arch, the "nonaberrant aberrant left subclavian artery."

  19. [Total arch replacement for right aortic arch with Kommerell diverticulum and aberrant left subclavian artery].

    PubMed

    Yoshida, S; Aomi, S; Ozawa, H; Maeda, T; Kawai, A; Nishida, H; Endo, M; Koyanagi, H

    2003-05-01

    A 57-year-old man suspected of having angina pectoris underwent coronary angiography and comprehensive examination, which revealed a right-side aortic arch accompanying Kommerell diverticulum and a aberrant left subclavian artery. Esophagography indicated that the esophagus was compressed on its right posterior side and the computed tomography (CT) revealed that the posterior side of the tracheal was compressed, however, the patient experienced no difficulty in breathing, hoarseness of voice or dysphasia. The size of the aortic diverticulum was less than 5 cm and the patient showed no symptom, however, if it was left untreated, there was a risk of rupture in the future. Also the esophagus and tracheal may develop complications due to prolonged compression. Therefore, we decided that the case required surgical operation. Total arch replacement was performed through mediastinotomy and right posterolateral in the 4th intercostal. The postoperative condition was good, and the patient was discharged without any complications.

  20. Asymptomatic Interrupted Aortic Arch, Severe Tricuspid Regurgitation, and Bicuspid Aortic Valve in a 76-Year-Old Woman

    PubMed Central

    Tajdini, Masih; Sardari, Akram; Forouzannia, Seyed Khalil; Baradaran, Abdolvahab; Hosseini, Seyed Mohammad Reza

    2016-01-01

    Interrupted aortic arch is a rare congenital abnormality with a high infancy mortality rate. The principal finding is loss of luminal continuity between the ascending and descending portions of the aorta. Because of the high mortality rate in infancy, interrupted aortic arch is very rare among adults. In this report, we describe the case of a 76-year-old woman with asymptomatic interrupted aortic arch, severe tricuspid regurgitation, and bicuspid aortic valve. To our knowledge, she is the oldest patient ever reported with this possibly unique combination of pathologic conditions. In addition to reporting her case, we review the relevant medical literature. PMID:27777532

  1. Outcomes of Concomitant Total Aortic Arch Replacement with Coronary Artery Bypass Grafting

    PubMed Central

    Komiya, Tatsuhiko; Tsuneyoshi, Hiroshi; Shimamoto, Takeshi

    2016-01-01

    Objective: Total aortic arch replacement is a highly invasive procedure. Here, we have investigated patient outcomes following total aortic arch replacement with or without coronary artery bypass grafting. Methods: One hundred and eighty-one patients underwent total aortic arch replacement without coronary artery bypass grafting, and 65 underwent with coronary artery bypass grafting. We compared preoperative, operative, and postoperative factors and analyzed survival outcomes. We used univariate and multivariate analyses to determine factors associated with long-term mortality. Results: Cardiopulmonary bypass and surgical times were significantly longer in the concomitant total aortic arch replacement with coronary artery bypass grafting group. Hospital mortality was 3.3% in the total aortic arch replacement group and 7.7% in the concomitant total aortic arch replacement with coronary artery bypass grafting group. Perioperative myocardial infarction was not seen in either group. There were no significant differences in mortality between the groups. Multivariate analysis revealed preoperative age, ischemic heart disease, and estimated glemerular filtration rate (eGFR) as risk factors affecting long-term mortality, whereas concomitant total aortic arch replacement with coronary artery bypass grafting was not a risk factor. Conclusion: Although patients’ backgrounds should be considered, total aortic arch replacement can be concomitantly performed with coronary artery bypass grafting surgery without additional mortality risk. PMID:27237968

  2. [Traumatic injury of the proximal aortic arch after blunt chest trauma;report of a case].

    PubMed

    Kato, Masanori; Sugimura, Yukiharu

    2015-02-01

    We report a rare case of an proximal aortic arch injury caused by blunt chest trauma. A 48-year-old woman was transferred to our hospital because of traffic accident. Computed tomography (CT) showed a small ulcer-like projection (ULP) at the proximal part of the aortic arch. An elective surgery for aortic repair was performed because of significant enlargement of the ULP in the aortic arch revealed by follow-up CT. The patient's postoperative course was uneventful, and she was discharged on the 14th postoperative day.

  3. Alternative surgical approach to treat aortic arch aneurysm after ascending aortic replacement with hybrid prosthesis.

    PubMed

    Zeitani, Jacob; Nardi, Paolo; Bellos, Kyriakos; De Propris, Silvia; Chiariello, Luigi

    2013-10-01

    We present a surgical technique to treat the distal aortic arch in patients who previously underwent ascending aortic replacement using the frozen elephant trunk. After debranching of the epiaortic vessels using a custom-made four-branch graft and systemic cooling, the extracorporeal circulation is interrupted, maintaining antegrade cerebral perfusion through the four-branch prosthesis. Then the "old" Dacron prosthesis, previously implanted for the ascending aortic replacement, is partially incised at its distal end, leaving a margin of prosthesis anastomosed to the native distal aorta, and the E-vita stent-graft is deployed under direct vision. Then the two margins of the "old" Dacron and the new Dacron E-vita prosthesis (Jotec Inc., Hechingen, Germany) are sutured together with one suture line to guarantee sealing and reconstruction of the aorta. This technique presents several advantages: the discrepancy between the graft size and the native aortic diameter is avoided, performing the anastomosis between two prosthetic materials with similar diameters is easier; there is no risk of tears in the diseased native aortic wall and related bleeding; and finally, it is easier to perform the anastomosis at the level of the ascending aorta rather than at the distal arch, especially when the disease of the aorta is extended to the descending segment.

  4. Stress analysis in a layered aortic arch model under pulsatile blood flow

    PubMed Central

    Gao, Feng; Watanabe, Masahiro; Matsuzawa, Teruo

    2006-01-01

    Background Many cardiovascular diseases, such as aortic dissection, frequently occur on the aortic arch and fluid-structure interactions play an important role in the cardiovascular system. Mechanical stress is crucial in the functioning of the cardiovascular system; therefore, stress analysis is a useful tool for understanding vascular pathophysiology. The present study is concerned with the stress distribution in a layered aortic arch model with interaction between pulsatile flow and the wall of the blood vessel. Methods A three-dimensional (3D) layered aortic arch model was constructed based on the aortic wall structure and arch shape. The complex mechanical interaction between pulsatile blood flow and wall dynamics in the aortic arch model was simulated by means of computational loose coupling fluid-structure interaction analyses. Results The results showed the variations of mechanical stress along the outer wall of the arch during the cardiac cycle. Variations of circumferential stress are very similar to variations of pressure. Composite stress in the aortic wall plane is high at the ascending portion of the arch and along the top of the arch, and is higher in the media than in the intima and adventitia across the wall thickness. Conclusion Our analysis indicates that circumferential stress in the aortic wall is directly associated with blood pressure, supporting the clinical importance of blood pressure control. High stress in the aortic wall could be a risk factor in aortic dissections. Our numerical layered aortic model may prove useful for biomechanical analyses and for studying the pathogeneses of aortic dissection. PMID:16630365

  5. 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.

  6. Temporary extra-anatomic brain perfusion followed by total rerouting of the supra-aortic vessels for hybrid repair of a ruptured aortic arch aneurysm.

    PubMed

    Joyeux, Frederic; Canaud, Ludovic; Hireche, Kheira; Berthet, Jean-Philippe; Marty-Ane, Charles; Alric, Pierre

    2011-10-01

    Hybrid repair of ruptured aortic arch repair has been proposed as a valuable approach. However, the presence of an anterior mediastinal hematoma must be carefully detected because of the inherent risk of rupture at sternotomy. We report the case of a patient presenting a ruptured aortic arch aneurysm with anterior rupture who underwent hybrid repair using a temporary extra-anatomic brain perfusion followed by total rerouting of the supra-aortic trunks. We propose this adjunctive technique as a means of allowing a safe endovascular exclusion of aortic arch lesions and avoiding the risk of acute and total aortic rupture in case of anterior rupture of aortic arch aneurysms.

  7. 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

  8. Ortner's syndrome: Cardiovocal syndrome caused by aortic arch pseudoaneurysm.

    PubMed

    Al Kindi, Adil H; Al Kindi, Faiza A; Al Abri, Qasim S; Al Kemyani, Nasser A

    2016-10-01

    72-year-old hypertensive presented with two weeks history of left sided chest pain and hoarseness. Workup demonstrated a pseudoaneurysm in the lesser curvature of the distal aortic arch opposite the origin of the left subclavian artery from a penetrating atherosclerotic ulcer. Following a left carotid-subclavian bypass, endovascular stenting of the aorta was performed excluding the pseudoaneurysm. Patient had excellent angiographic results post-stenting. Follow up at 12 weeks demonstrated complete resolution of his symptoms and good stent position with no endo-leak. Ortner's syndrome describes vocal changes caused by cardiovascular pathology. It should be included in the differential diagnosis of patients with cardiovascular risk factors presenting with hoarseness. This case demonstrates the use of endovascular stents to treat the causative pathology with resolution of symptoms. In expert hands, it represents low risk, minimally invasive therapeutic strategy with excellent early results in patients who are high risk for open procedure. PMID:27688676

  9. Anomalous Origin of the Left Vertebral Artery from the Aortic Arch

    PubMed Central

    Einstein, Evan H.; Song, Linda H.; Villela, Natalia L. A.; Fasani-Feldberg, Gregory B.; Jacobs, Jonathan L.; Kim, Dolly O.; Nathawat, Akshay; Patel, Devika; Bender, Roger B.; Peters, Daniel F.

    2016-01-01

    Anatomic anomalies of the aortic arch have implications for clinical practice if their significance is understood. Our case study involves a cadaveric finding of the left vertebral artery originating directly from the aortic arch. Although this anatomical variation has been documented, the prevalence of this anomaly may be generally underestimated. After noting this anomaly, we analyzed 27 cases and found that four female cadavers had the left vertebral artery originating from the aortic arch rather than the left subclavian artery. With a prevalence rate of 14.8%, it would seem that this anomaly is more significant than previously thought, which could have implications for surgical practice. PMID:27757404

  10. Congenital Anomalies of the Aortic Arch: Evaluation with the Use of Multidetector Computed Tomography

    PubMed Central

    Büyükbayraktar, Fatma Gül; Ölçer, Tülay; Cumhur, Turhan

    2009-01-01

    Congenital anomalies of the aortic arch have clinical importance, as the anomalies may be associated with vascular rings or other congenital cardiovascular diseases. Multidetector computed tomography (MDCT) angiography enables one to display the detailed anatomy of vascular structures and the spatial relationships with adjacent organs; this ability is the greatest advantage of the use of MDCT angiography in comparison to other imaging modalities in the evaluation of the congenital anomalies of the aortic arch. In this review article, we illustrate 16-slice MDCT angiography appearances of congenital anomalies of the aortic arch. PMID:19270864

  11. Hybrid repair of right aortic arch aneurysm with a Kommerell's diverticulum.

    PubMed

    Tanaka, Koyu; Yoshitaka, Hidenori; Chikazawa, Genta; Sakaguchi, Taichi; Totsugawa, Toshinori; Tamura, Kentaro

    2014-07-01

    We describe the case of a 74-year-old man who underwent a hybrid open and endovascular approach for repair of dissecting thoracic aortic aneurysm of a right aortic arch with aberrant left subclavian artery arising from a Kommerell's diverticulum. Total debranching using a tailored quadrifurcated graft and thoracic endovascular aneurysm repair for the transverse aortic lesion were performed. The procedures were successfully accomplished with complete exclusion of the aneurysm. This hybrid procedure for complex aortic arch disease may reduce perioperative complications compared to challenging conventional open approaches.

  12. Two Cases of Thoracic Aortic Aneurysm with Right Aortic Arch: Comparison of Two Operative Strategies for Hybrid Thoracic Endovascular Repair

    PubMed Central

    Onohara, Takeshi; Nakamura, Yoshinobu; Kishimoto, Yuichiro; Harada, Shingo; Fujiwara, Yoshikazu; Saiki, Munehiro

    2014-01-01

    Hybrid TEVAR was performed in 2 patients with right aortic arch accompanied by Kommerell’s diverticulum and aortic aneurysm. In patient 1, total debranch + TEVAR was performed with 1-stage median sternotomy. In patient 2, total arch replacement and insertion of a peripheral elephant trunk were performed first, followed by TEVAR. No endoleaks or aortic events were observed in either case during the observation period, and both patients had good postoperative clinical courses. We report our experience with two such cases that were treated with two different methods of hybrid TEVAR, and discuss the merits and demerits of each treatment method. PMID:25298843

  13. Right aortic arch with aberrant left innominate artery arising from Kommerell's diverticulum*

    PubMed Central

    Faistauer, Ângela; Torres, Felipe Soares; Faccin, Carlo Sasso

    2016-01-01

    We report a case of an uncommon thoracic aorta anomaly-right aortic arch with aberrant left innominate artery arising from Kommerell's diverticulum-that went undiagnosed until adulthood. PMID:27777481

  14. A novel case of L-transposition with a right-dominant double aortic arch.

    PubMed

    Goldberg, David J; Glatz, Jenifer; Weinberg, Paul M; Gillespie, Matthew J

    2009-01-01

    We describe a case of congenitally corrected transposition with a double aortic arch. This unique combination of lesions highlights the importance of a complete anatomic assessment prior to referral for surgery. PMID:19664032

  15. 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.

  16. Blunt Traumatic Aortic Injury of Right Aortic Arch in a Patient with an Aberrant Left Subclavian Artery

    PubMed Central

    Yeo, Daryl Li-Tian; Haider, Sajjad; Zhen, Claire Alexandra Chew

    2015-01-01

    Right-sided aortic arch (RAA) is a rare congenital developmental variant present in about 0.1 percent of the population. This anatomical anomaly is commonly associated with congenital heart disease and complications from compression of mediastinal structures. However, it is unknown if patients are at a higher risk of blunt thoracic aortic injury (BTAI). We report a case of a 20-year-old man admitted to the hospital after being hit by an automobile. Computed tomographic scan revealed an RAA with an aberrant left subclavian artery originating from a Kommerell’s diverticulum. A pseudo-aneurysm was also seen along the aortic arch. A diagnosis of blunt traumatic aortic injury was made. The patient was successfully treated with a 26mm Vascutek hybrid stentgraft using the frozen elephant trunk technique. A literature review of the pathophysiology of BTAI was performed to investigate if patients with right-sided aortic arch are at a higher risk of suffering from BTAI. Results from the review suggest that although theoretically there may be a higher risk of BTAI in RAA patients, the rarity of this condition has prevented large studies to be conducted. Previously reported cases of BTAI in RAA have highlighted the possibility that the aortic isthmus may be anatomically weak and therefore prone to injury. We have explored this possibility by reviewing current literature of the embryological origins of the aortic arch and descending aorta. PMID:25745378

  17. Blunt traumatic aortic injury of right aortic arch in a patient with an aberrant left subclavian artery.

    PubMed

    Yeo, Daryl Li-Tian; Haider, Sajjad; Zhen, Claire Alexandra Chew

    2015-03-01

    Right-sided aortic arch (RAA) is a rare congenital developmental variant present in about 0.1 percent of the population. This anatomical anomaly is commonly associated with congenital heart disease and complications from compression of mediastinal structures. However, it is unknown if patients are at a higher risk of blunt thoracic aortic injury (BTAI). We report a case of a 20-year-old man admitted to the hospital after being hit by an automobile. Computed tomographic scan revealed an RAA with an aberrant left subclavian artery originating from a Kommerell's diverticulum. A pseudo-aneurysm was also seen along the aortic arch. A diagnosis of blunt traumatic aortic injury was made. The patient was successfully treated with a 26mm Vascutek hybrid stentgraft using the frozen elephant trunk technique. A literature review of the pathophysiology of BTAI was performed to investigate if patients with right-sided aortic arch are at a higher risk of suffering from BTAI. Results from the review suggest that although theoretically there may be a higher risk of BTAI in RAA patients, the rarity of this condition has prevented large studies to be conducted. Previously reported cases of BTAI in RAA have highlighted the possibility that the aortic isthmus may be anatomically weak and therefore prone to injury. We have explored this possibility by reviewing current literature of the embryological origins of the aortic arch and descending aorta.

  18. Quantification of the aortic arch morphology in 3D CTA images for endovascular aortic repair (EVAR)

    NASA Astrophysics Data System (ADS)

    Wörz, S.; von Tengg-Kobligk, H.; Henninger, V.; Böckler, D.; Kauczor, H.-U.; Rohr, K.

    2008-03-01

    We introduce a new model-based approach for the segmentation and quantification of the aortic arch morphology in 3D CTA images for endovascular aortic repair (EVAR). The approach is based on a 3D analytic intensity model for thick vessels, which is directly fitted to the image. Based on the fitting results we compute the (local) 3D vessel curvature and torsion as well as the relevant lengths not only along the 3D centerline but particularly along the inner and outer contour. These measurements are important for pre-operative planning in EVAR applications. We have successfully applied our approach using ten 3D CTA images and have compared the results with ground truth obtained by a radiologist. It turned out that our approach yields accurate estimation results. We have also performed a comparison with a commercial vascular analysis software.

  19. Right-sided Aortic Arch with Aberrant Left Subclavian Artery from Kommerell's Diverticulum.

    PubMed

    Mubarak, M Y; Kamarul, A T; Noordini, M D

    2011-09-01

    A previously healthy 52-year-old man had a chest radiograph for medical check-up and found to have a right-sided aortic arch. Computed tomography of the thorax revealed a right-sided aortic arch with aberrant left subclavian artery originated from Kommerell's diverticulum. Barium swallow examination showed compression of the posterior wall of the esophagus. He was asymptomatic and no surgical intervention was performed.

  20. A remnant left aortic arch and a right aortic arch as well as Kommerell's diverticulum with an aberrant left subclavian artery.

    PubMed

    Akita, Masafumi; Urashima, Kyoko

    2011-01-01

    We report the case of a 63-year-old woman who had dysphagia and dyspnea for one year. Enhanced computed tomography revealed that she had an ascending aortic dorsal projection and a right aortic arch as well as Kommerell's diverticulum (KD) with an aberrant left subclavian artery (LSA). Her KD compressed her trachea and esophagus. We cut her aorta just distal to the KD and performed an ascending and total arch replacement through a midsternotomy. The LSA was reconstructed in front of her trachea. Her dysphagia and dyspnea disappeared following the operation and her postoperative course was uneventful.

  1. Abnormal aortic arch morphology in Turner syndrome patients is a risk factor for hypertension.

    PubMed

    De Groote, Katya; Devos, Daniël; Van Herck, Koen; Demulier, Laurent; Buysse, Wesley; De Schepper, Jean; De Wolf, Daniël

    2015-09-01

    Hypertension in Turner syndrome (TS) is a multifactorial, highly prevalent and significant problem that warrants timely diagnosis and rigorous treatment. The objective of this study was to investigate the association between abnormal aortic arch morphology and hypertension in adult TS patients. This was a single centre retrospective study in 74 adult TS patients (age 29.41 ± 8.91 years) who underwent a routine cardiac MRI. Patients were assigned to the hypertensive group (N = 31) if blood pressure exceeded 140/90 mmHg and/or if they were treated with antihypertensive medication. Aortic arch morphology was evaluated on MRI images and initially assigned as normal (N = 54) or abnormal (N = 20), based on the curve of the transverse arch and the distance between the left common carotid-left subclavian artery. We additionally used a new more objective method to describe aortic arch abnormality in TS by determination of the relative position of the highest point of the transverse arch (AoHP). Logistic regression analysis showed that hypertension is significantly and independently associated with age, BMI and abnormal arch morphology, with a larger effect size for the new AoHP method than for the classical method. TS patients with hypertension and abnormal arch morphology more often had dilatation of the ascending aorta. There is a significant association between abnormal arch morphology and hypertension in TS patients, independent of age and BMI, and not related to other structural heart disease. We suggest that aortic arch morphology should be included in the risk stratification for hypertension in TS and propose a new quantitative method to express aortic arch morphology.

  2. Aortic arch thrombectomy in a 2.8 kilogram neonate--a case report and review of the literature.

    PubMed

    Omeje, Ikenna; Ram, Awat; Kostolny, Martin

    2013-02-01

    Aortic arch thrombus is a rare occurrence in neonates. In the few described cases, this has mainly been associated with sepsis or early postnatal interventions, such as insertion of umbilical arterial line. We describe a case of occlusive aortic arch thrombus in a neonate who presented with signs of critical coarctation and successfully underwent surgical thrombectomy on deep hypothermic circulatory arrest. We also present a review of the most recently published cases of aortic arch thrombus in neonates and the treatment options employed.

  3. Goal-directed-perfusion in neonatal aortic arch surgery

    PubMed Central

    Purbojo, Ariawan; Muench, Frank; Juengert, Joerg; Rueffer, André

    2016-01-01

    Reduction of mortality and morbidity in congenital cardiac surgery has always been and remains a major target for the complete team involved. As operative techniques are more and more standardized and refined, surgical risk and associated complication rates have constantly been reduced to an acceptable level but are both still present. Aortic arch surgery in neonates seems to be of particular interest, because perfusion techniques differ widely among institutions and an ideal form of a so called “total body perfusion (TBP)” is somewhat difficult to achieve. Thus concepts of deep hypothermic circulatory arrest (DHCA), regional cerebral perfusion (RCP/with cardioplegic cardiac arrest or on the perfused beating heart) and TBP exist in parallel and all carry an individual risk for organ damage related to perfusion management, chosen core temperature and time on bypass. Patient safety relies more and more on adequate end organ perfusion on cardiopulmonary bypass, especially sensitive organs like the brain, heart, kidney, liver and the gut, whereby on adequate tissue protection, temperature management and oxygen delivery should be visualized and monitored. PMID:27709094

  4. Total surgical aortic arch replacement as a safe strategy to treat complex multisegmental proximal thoracic aortic pathology

    PubMed Central

    Czerny, Martin; König, Tobias; Reineke, David; Sodeck, Gottfried H.; Rieger, Maximilian; Schoenhoff, Florian; Basciani, Reto; Jenni, Hansjörg; Schmidli, Jürg; Carrel, Thierry P.

    2013-01-01

    OBJECTIVE To analyse the results after elective open total aortic arch replacement. METHODS We analysed 39 patients (median age 63 years, median logistic EuroSCORE 18.4) who underwent elective open total arch replacement between 2005 and 2012. RESULTS In-hospital mortality was 5.1% (n = 2) and perioperative neurological injury was 12.8% (n = 5). The indication for surgery was degenerative aneurysmal disease in 59% (n = 23) and late aneurysmal formation following previous surgery of type A aortic dissection in 35.9% (n = 14); 5.1% (n = 2) were due to anastomotical aneurysms after prior ascending repair. Fifty-nine percent (n = 23) of the patients had already undergone previous proximal thoracic aortic surgery. In 30.8% (n = 12) of them, a conventional elephant trunk was added to total arch replacement, in 28.2% (n = 11), root replacement was additionally performed. Median hypothermic circulatory arrest time was 42 min (21–54 min). Selective antegrade cerebral perfusion was used in 95% (n = 37) of patients. Median follow-up was 11 months [interquartile range (IQR) 1–20 months]. There was no late death and no need for reoperation during this period. CONCLUSIONS Open total aortic arch replacement shows very satisfying results. The number of patients undergoing total arch replacement as a redo procedure and as a part of a complex multisegmental aortic pathology is high. Future strategies will have to emphasize neurological protection in extensive simultaneous replacement of the aortic arch and adjacent segments. PMID:23788196

  5. The origin and significance of secondary flows in the aortic arch.

    PubMed

    Black, M M; Hose, D R; Lawford, P V

    1995-01-01

    This paper comprises a study of the secondary flow patterns that can develop in the human aortic arch. Clinical evidence of these secondary flows has been obtained by Kilner et al. using magnetic resonance velocity mapping techniques. Some of their results are presented for comparison in this paper. Four difference parametric models of the aortic arch have been analysed using computational fluid dynamic techniques. Both steady and transient flow conditions have been considered and two different commercially available software packages were used, namely FIDAP and FLOTRAN. A satisfactory comparison of the theoretical analysis with the results, both in vivo and in vitro, obtained by Kilner et al. for their out-of-plane inlet model was found. The theoretical analysis can now be extended to analyse the effect of different configurations and orientations of artificial aortic valves on the resulting aortic arch flow patterns.

  6. Hybrid repair of a Kommerell diverticulum associated with a right aortic arch and a left descending aorta.

    PubMed

    Kawajiri, Hiroyuki; Shimizu, Hideyuki; Yoshitake, Akihiro; Yozu, Ryohei

    2012-12-01

    This report describes the first successful case of a hybrid endovascular approach for management of aneurysmal Kommerell diverticulum arising from the left descending aorta in a right aortic arch. This patient also had dilatation of the ascending aorta and a small aortic arch aneurysm. This three-step procedure consisted of (1) ascending aorta replacement with total debranching using a handmade quarto-branched composite graft; (2) endovascular exclusion of Kommerell diverticulum and the aortic arch aneurysm by covering the whole aortic arch; and (3) coil embolization against the root of the left subclavian artery. The patient had no complications at 16 months after completion.

  7. Preoperative evaluation value of aortic arch lesions by multidetector computed tomography angiography in type A aortic dissection.

    PubMed

    Huang, Fang; Chen, Qiang; Lai, Qing-Quan; Huang, Wen-Han; Wu, Hong; Li, Wei-Cheng

    2016-09-01

    The purpose of this study was to preoperatively evaluate the value of aortic arch lesions by multidetector computed tomography (MDCT) angiography in type A aortic dissection (AD).From January 2013 to December 2015, we enrolled 42 patients with type A AD who underwent MDCT angiography in our hospital. The institutional database of patients was retrospectively reviewed to identify MDCT angiography examinations for type A AD. Surgical corrections were conducted in all patients to confirm diagnostic accuracy.In this study, the diagnostic accuracy of MDCT angiography was 100% in all 42 patients. The intimal tear site locations that were identified in patients included the ascending aorta (n = 25), aortic arch (n = 12), and all other sites (n = 5). Compared with the control group, there were significant differences in the aortic arch anatomy among the cases. Regarding the distance between the left common carotid and left subclavian arteries, compared with the control group, most cases with type A AD had a significant variation.MDCT angiography plays an important role in detecting aortic arch lesions of type A AD, especially in determining the location of the intimal entry site and change of branch blood vessels. Surgeons can formulate an appropriate operating plan, according to the preoperative MDCT diagnosis information. PMID:27684852

  8. Comparison of invasive and non-invasive pressure gradients in aortic arch obstruction

    PubMed Central

    Wisotzkey, Bethany L.; Hornik, Christoph P.; Green, Amanda S.; Barker, Piers C. A.

    2016-01-01

    Background Aortic arch obstruction can be evaluated by catheter peak-to-peak gradient or by Doppler peak instantaneous pressure gradient. Previous studies have shown moderate correlation in discrete coarctation, but few have assessed correlation in patients with more complex aortic reconstruction. Methods We carried out retrospective comparison of cardiac catheterisations and pre- and post-catheterisation echocardiograms in 60 patients with native/recurrent coarctation or aortic reconstruction. Aortic arch obstruction was defined as peak-to-peak gradient ≥25 mmHg in patients with native/recurrent coarctation and ≥10 mmHg in aortic reconstruction. Results Diastolic continuation of flow was not associated with aortic arch obstruction in either group. Doppler peak instantaneous pressure gradient, with and without the expanded Bernoulli equation, weakly correlated with peak-to-peak gradient even in patients with a normal cardiac index (r=0.36, p=0.016, and r=0.49, p=0.001, respectively). Receiver operating characteristic curve analysis identified an area under the curve of 0.61 for patients with all types of obstruction, with a cut-off point of 45 mmHg correctly classifying 64% of patients with arch obstruction (sensitivity 39%, specificity 89%). In patients with aortic arch reconstruction who had a cardiac index ≥3 L/min/m2, a cut-off point of 23 mmHg correctly classified 69% of patients (71% sensitivity, 50% specificity) with an area under the curve of 0.82. Conclusion The non-invasive assessment of aortic obstruction remains challenging. The greatest correlation of Doppler indices was noted in patients with aortic reconstruction and a normal cardiac index. PMID:25602135

  9. Loss of unc45a precipitates arteriovenous shunting in the aortic arches

    PubMed Central

    Anderson, Matthew J.; Pham, Van N.; Vogel, Andreas M.; Weinstein, Brant M.; Roman, Beth L.

    2008-01-01

    Aortic arch malformations are common congenital disorders that are frequently of unknown etiology. To gain insight into the factors that guide branchial aortic arch development, we examined the process by which these vessels assemble in wild type zebrafish embryos and in kurzschlusstr12 (kus tr12) mutants. In wild type embryos, each branchial aortic arch first appears as an island of angioblasts in the lateral pharyngeal mesoderm, then elaborates by angiogenesis to connect to the lateral dorsal aorta and ventral aorta. In kustr12 mutants, angioblast formation and initial sprouting are normal, but aortic arches 5 and 6 fail to form a lumenized connection to the lateral dorsal aorta. Blood enters these blind-ending vessels from the ventral aorta, distending the arteries and precipitating fusion with an adjacent vein. This arteriovenous malformation (AVM), which shunts nearly all blood directly back to the heart, is not genetically programmed, as its formation correlates with blood flow and aortic arch enlargement. By positional cloning, we have identified a nonsense mutation in unc45a in kustr12 mutants. Our results are the first to ascribe a role for Unc45a, a putative myosin chaperone, in vertebrate development, and identify a novel mechanism by which an AVM can form. PMID:18462713

  10. 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.

  11. 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

  12. 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

  13. ``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.

  14. 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.

  15. [Operation for a giant pseudoaneurysm of the aortic arch without artificial circulation].

    PubMed

    Shlomin, V V; Didenko, Iu P; Puzdriak, P D; Drozhzhin, I G; Bondarenko, P B

    2016-01-01

    Presented herein is a variant of surgical management of a patient with a giant false aneurysm of the aortic arch in the posterior mediastinum. Using the technique of temporary bypass or temporary "debranching" made it possible to carry out a reconstructive intervention without the use of an artificial circulation apparatus. This technique also decreases the necessity of using heparin, thus diminishing the risk of blood loss both during the operation and in the postoperative period. The described variant of the operation for a false aneurysm of the aortic arch extends and supplements the surgeon's capabilities of performing interventions on the aortic arch in the absence of a possibility of using an artificial circulation apparatus both in a scheduled and emergency situation. PMID:27626263

  16. Aortic arch surgery with a single centrifugal pump for selective cerebral perfusion and systemic circulation.

    PubMed

    Iwata, Keiji; Shimazaki, Yasuhisa; Sakamoto, Tomohiko; Ueda, Hideki; Nakagawa, Masashi; Yamada, Hideto; Doi, Teruo; Ooue, Takuya

    2010-01-01

    In aortic arch surgery, two pumps are required for systemic perfusion and selective cerebral perfusion (SCP). A new technique with a single centrifugal pump for systemic perfusion and SCP was developed and its efficacy and safety evaluated. This technique was adopted for total arch replacement in 22 consecutive patients with true aneurysms (13) and aortic dissection (nine) from January 2005 to January 2008. Cerebral perfusion lines branched from the main perfusion line. During SCP, right radial arterial pressure was maintained at 50 mm Hg and left common carotid arterial pressure at 60 mm Hg, and the regional cerebral oxygen saturation (rSO(2)) values were maintained at approximately >80% of the baseline value. Two operative deaths (9%) occurred due to pneumonia and hemorrhage in the left lung, respectively. Stroke occurred in one patient (5%). This simple circuit system can thus be easily and safely applied for aortic arch surgery.

  17. Comprehensive three-dimensional analysis of right-sided aortic arch with multiple vascular anomalies

    PubMed Central

    2014-01-01

    Background Right-sided aortic arch is a rare congenital defect usually diagnosed incidentally in adults; it is often asymptomatic unless aneurismal disease develops. In half the cases, an aberrant left subclavian artery arises from a Kommerell’s diverticulum; in these cases, congenital heart anomaly is very rarely present. Case presentation We report a case of incidentally-detected right-sided aortic arch with multiple vascular anomalies including left subclavian artery originating from a Kommerell’s diverticulum, supra-sinus origin of coronary arteries and coronary arteriovenous fistula. Conclusion Through comprehensive 3-dimensional reconstruction of the aortic arch and surrounding structures we defined anatomical relationships, which is useful for follow-up and treatment. PMID:25138741

  18. Right-sided aortic arch with the retroesophageal left subclavian artery as the fourth branch

    PubMed Central

    Chai, Ok Hee; Han, Eui-Hyeog; Kim, Hyoung Tae

    2013-01-01

    We present a rare variation of the right-sided aortic arch with the retroesophageal left subclavian artery as the forth branch found in a cadaver of an 89-year-old Korean woman during a routine dissection. In this case, the first branch that arose from the ascending aorta was the left common carotid artery, which crossed ventral to the trachea in a left cephalic direction, followed by the right common carotid artery and then the right subclavian artery. Distal to these branches the aortic arch ran dorsally, passing between the esophagus and the vertebra. The left subclavian artery arose from the descending portion of the aortic arch, crossing over to the left upper extremity behind the esophagus. This anomaly was not accompanied by congenital heart disease. Accurate information regarding this variation is of great importance to surgeons for its early identification and preservation during interventions and to radiologists for precise interpretation of angiograms. PMID:23869265

  19. 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

  20. 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

  1. Multidetector Computed Tomography for Congenital Anomalies of the Aortic Arch: Vascular Rings.

    PubMed

    García-Guereta, Luis; García-Cerro, Estefanía; Bret-Zurita, Montserrat

    2016-07-01

    The development of multidetector computed tomography has triggered a revolution in the study of the aorta and other large vessels and has replaced angiography in the diagnosis of congenital anomalies of the aortic arch, particularly vascular rings. The major advantage of multidetector computed tomography is that it permits clear 3-dimensional assessment of not only vascular structures, but also airway and esophageal compression. The current update aims to summarize the embryonic development of the aortic arch and the developmental anomalies leading to vascular ring formation and to discuss the current diagnostic and therapeutic role of multidetector computed tomography in this field.

  2. A right-sided aortic arch and aberrant left subclavian artery with proximal segment hypoplasia.

    PubMed

    Margolis, Justin; Bilfinger, Thomas; Labropoulos, Nicos

    2012-03-01

    The right-sided thoracic aortic arch is a rare congenital malformation occurring during embryologic development. A majority of the cases present with two anatomic variations, one of which is an aberrant left subclavian artery (LSA) originating off the distal descending aortic arch. This aberrant LSA courses across and compresses thoracic structures on its way to the left thoracic outlet. While this aberrant vessel causes mostly benign symptoms, patients may first present with rupture of a thoracic aneurysm. This thoracic aneurysm is commonly known as Kommerell's diverticulum. This paper presents a case of an aberrant LSA originating off Kommerell's diverticulum with a proximal long-segment hypoplasia, a very rare anatomic variation.

  3. 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

  4. 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

  5. Primary complete repair of partial double aortic arch and Kommerell diverticulum.

    PubMed

    Kleine, Peter; Balci, Mustafa; Moritz, Anton

    2011-02-01

    Tracheal and esophageal stenosis caused by double aortic arch and Kommerell diverticulum is a rare but important pathologic entity in adult patients. Clinical symptoms are caused by esophageal or tracheal stenosis, or both. The present article describes a surgical method of complete repair with division of the rudimentary left arch, resection of the diverticulum, and transposition of the left subclavian artery. This method was transferred from pediatric patients and led to excellent clinical results in 2 consecutive adult patients compared with the previous technique with division of the left arch alone.

  6. 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

  7. 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

  8. 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

  9. 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

  10. Endovascular stenting for type B dissection involving a right-sided aortic arch

    PubMed Central

    Croccia, Maria Grazia; Levantino, Maurizio; Cioni, Roberto; Bortolotti, Uberto

    2012-01-01

    Endovascular stent-graft repair is emerging as the treatment of choice for complicated type B aortic dissection. In this report we describe a patient who presented with type B aortic dissection involving a right-sided aortic arch (RAA), a rare congenital vascular anomaly. The initial aggressive medical treatment proved unsuccessful due to false aneurysm expansion. Given the greater complexity of conventional surgical repair and the limited experience with this rare malformation, endovascular repair was preferred and successfully performed. We report the first case of endovascular repair of type B dissection involving RAA, confirming that endovascular treatment is technically feasible also when the dissection involves this unusual vascular malformation. PMID:22561295

  11. [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

  12. 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

  13. 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

  14. Incidence of Branching Patterns Variations of the Arch in Aortic Dissection in Chinese Patients

    PubMed Central

    Tapia, G. Pullas; Zhu, Xiaohua; Xu, Jing; Liang, Pan; Su, Gang; Liu, Hai; Liu, Yang; Shu, Liliang; Liu, Shuiqi; Huang, Chen

    2015-01-01

    Abstract Several authors have described anatomic variations of the aortic arch in 13% to 20% of the patients who do not have aortic disease. However, few studies have evaluated these patterns in the thoracic aortic dissection (TAD). In the authors’ knowledge, this is the first survey that specifically investigates the frequency of these variations in a broad, nonselected group of Chinese patients with aortic dissection. Furthermore, it compares this group with a group of patients without aortic disease. The objective of this study was to define the variation frequency of the aortic arch branches pattern using the tomographic studies of 525 Chinese patients with a diagnosis of TAD. The Stanford classification was used to set the site of the initial tear of the dissection. In addition, we performed an epidemiological analysis of the aortic arch anatomic variations in TAD, and its possible implications for surgical or endovascular treatment. The general hypothesis proposal asserted that Chinese patients with dissection of the aorta have a similar incidence of variations of the aortic arch to the patients without aortic disease. A retrospective study of cases and controls was carried out using the tomographic studies (CT) of all patients admitted to the First Affiliated Hospital of Zhengzhou University, located at Henan-China, with a confirmed diagnosis of aortic dissection from January 2012 until December 2014. The group of cases consisted of 525 patients: 374 men and 151 women, with a mean age of 52.27 years (range, 20–89). The average age of the patients with Stanford A and B aortic dissection was 49.46 and 53.67, respectively. The control group consisted of 525 unselected patients without TAD who underwent a CT scan of the chest due to other indications. This group consisted of 286 men and 239 women, with a mean age of 53.60 years (range, 18–89). All the patients with aneurysm or dissection were excluded from the control group. We performed a statistical

  15. A case of balanced type double aortic arch diagnosed incidentally by transthoracic echocardiography in an asymptomatic adult patient.

    PubMed

    Seo, Han Seok; Park, Yong Hyun; Lee, Ju Hyoung; Hur, So Chong; Ko, Yu Jin; Park, So Yeon; Kim, Jun Hwan; Kim, Young Jung; Kim, So Yon; Kwon, Nak Hyun

    2011-09-01

    A 36-year-old male patient with no remarkable medical history was admitted to our hospital for a health check up. On chest radiography, bilateral aortic notches at the level of aortic arch were shown suggesting aortic arch anomaly without any clinical symptoms. Two aortic arches were almost same-in-size on suprasternal view of transthoracic echocardiography. In addition, multidetector computed tomography showed balanced type double aortic arch forming a complete vascular ring which encircled the trachea and esophagus. The trachea was slightly compressed by the vascular ring whereas the esophagus was intact. Nevertheless, the pulmonary function test was normal. The patient was discharged from hospital with instructions for periodic follow-up.

  16. Right Aortic Arch and Kommerell's Diverticulum Repaired without Reconstruction of Aberrant Left Subclavian Artery.

    PubMed

    Osawa, Hiroshi; Shinohara, Daisuke; Orii, Kouan; Hosaka, Shigeru; Fukuda, Shoji; Akashi, Okihiko; Furukawa, Hiroshi

    2013-01-01

    Right aortic arch with Kommerell's diverticulum is a very rare situation. Surgical treatment is recommended for symptomatic patients or asymptomatic patients with a large diverticulum. However planning the strategy of operation is difficult without a 3D imaging. We report a case of a 57-year-old man with right aortic arch, Kommerell's diverticulum, and aberrant left subclavian artery. After a 3D-CT imaging, the patient underwent descending aortic replacement without reconstruction of aberrant left subclavian artery. After operation, there was no signs or symptoms of ischemia of the left arm. If the reconstruction of the aberrant subclavian artery was too difficult, closing its orifice is an acceptable decision. It has been found advantageous because of a decrease blood loss and a shorter cardiopulmonary bypass duration. If an ischemia of the arm is noticed, additional reconstruction will have to be considered. 3D-CT imaging was very useful to have a proper orientation and plan for the operative strategy.

  17. 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.

  18. 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

  19. 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

  20. Endoanchor stenting for the repair of a Type I endoleak in the aortic arch following the endovascular repair of a Kommerrell's diverticulum.

    PubMed

    Menon, Rohan S; Muetterties, Corbin; Moser, George William; Wheatley, Grayson H

    2016-08-01

    As more challenging aortic arch anatomy is being treated using aortic stent-grafts, there is an increased risk for proximal Type I endoleaks at the proximal seal zone or subsequent graft migration. We report a case of an endoanchor-assisted thoracic endovascular aneurysm repair of a patient with an aberrant right subclavian artery (ARSA) and aortic arch aneurysm who developed a proximal Type I endoleak in the aortic arch which was subsequently treated with endoanchors. PMID:27349832

  1. Primary repair of interrupted aortic arch and associated heart lesions in newborns.

    PubMed

    Tláskal, T; Chaloupecky, V; Marek, J; Hŭcín, B; Kostelka, M; Tax, P; Kucera, V; Janousek, J; Skovránek, J; Reich, O

    1997-04-01

    Primary repair of interrupted aortic arch and associated heart lesions was performed in 13 patients aged from 1 to 85 days. The surgery was performed through the midline sternotomy approach in extracorporeal circulation and deep hypothermia. Hypothermic circulatory arrest at 14 to 19 degrees C was used for reconstruction of the aortic arch. In all patients it was possible to perform a direct anastomosis between the ascendent and descendent aorta. At the same time closure of the ventricular septal defect was performed in 11 patients, closure of the atrial septal defect in 4, correction of persistent truncus arteriosus in 3, resection of subaortic stenosis in 2, arterial switch repair of transposition of the great arteries in 1, correction of double outlet right ventricle in 1 and patch closure of aortico-pulmonary window in 1 patient. Three (23.1%) newborns died in the early postoperative period: two from sepsis and one from multiple organ failure. Ten patients (76.9%) were followed up for 1 to 29 months postoperatively. All of them are in very good condition with a nonrestrictive aortic anastomosis. Primary one-stage repair of interrupted aortic arch and associated heart lesions is preferred to the two-stage repair in all newborns with this critical congenital heart disease. PMID:9201119

  2. [Distal Aortic Arch Aneurysm, Acute type B Aortic Dissection, and Acute Bilateral Limb Ischemia Treated by Two-stage Total Arch Replacement;Report of a Case].

    PubMed

    Hashimoto, Kazunori; Itoh, Satoshi; Tajima, Yasushi; Kimura, Naoyuki; Yuri, Kohichi; Matumoto, Harunobu; Adachi, Kohichi; Yamaguchi, Atushi; Adachi, Hideo

    2015-05-01

    A 74-year-old female patient experienced sudden and severe pain in her lower back and both legs. Upon examination, her femoral pulses were weak, and her legs were pale. Computed tomography revealed a 66-mm thoracic aneurysm in the distal arch and type B aortic dissection. Stenosis was present from the terminal aorta to the iliac arteries. The left common iliac artery was occluded at its bifurcation, and both lower limbs were ischemic. We performed bilateral axillary-femoral artery bypass, which improved blood flow to both limbs. The next day, it was apparent that compartment syndrome had developed in the patient's left leg. Rehabilitation therapy was effective for the compartment syndrome, the patient's symptoms resolved, and she was discharged. We later performed two-stage total arch replacement, and the subsequent clinical course has been without incident.

  3. Single Stage Aortic Arch Replacement without Circulatory Arrest

    PubMed Central

    Marenchino, Ricardo G; Domenech, Alberto

    2016-01-01

    A 78-year-old man with a Kommerell diverticulum and aberrant right subclavian artery was admitted for thoracic pain and severe malnutrition due to esophageal compression. We performed an atypical surgical procedure including extra-anatomical debranching and direct aortic repair, trying to avoid deep hypothermic circulatory arrest and shorten the cardiopulmonary bypass time.

  4. Surgical repair of distal arch psendoaneurysm from ruptured penetrating aortic ulcer with the frozen elephant trunk technique.

    PubMed

    Kokotsakis, John; Tassopoulos, Dimitrios; Ttofi, Jacob; Harling, Leanne; Ashrafian, Hutan; Velissarios, Konstantinos; Kratimenos, Theodore; Anagnostou, Stratos; Athanasiou, Thanos

    2014-04-05

    Ruptured Penetrating Ulcer and aortic arch pseudo-aneurysm is a rare condition but one which carries a high risk of rupture. We report the case of a 74-year-old man with aortic arch pseudo-aneurysm, in which a Frozen Elephant Trunk procedure was successfully performed. There were no postoperative complications at 6 months follow-up. The Computed Tomography Angiogram demonstrated thrombus formation in the pseudo-aneurysm lumen, with no endoleak on the stented part of the descending thoracic aorta and complete patency of all branches of aortic arch. This case demonstrates that the Frozen Elephant Trunk technique may be the treatment of choice when treating such complex aortic arch lesions provided there is no absolute contraindication to radical surgical intervention. However, long-term clinical efficacy and safety have yet to be confirmed.

  5. Video-assisted thoracoscopic left lower lobectomy in a patient with lung cancer and a right aortic arch.

    PubMed

    Wada, Hideyuki; Hida, Yasuhiro; Kaga, Kichizo; Hase, Ryunosuke; Ohtaka, Kazuto; Muto, Jun; Reiko, Nakada-Kubota; Hirano, Satoshi; Matsui, Yoshiro

    2012-01-01

    A right aortic arch is a rare congenital anomaly, with a reported incidence of around 0.1%. A patient with a right aortic arch underwent video-assisted thoracic surgery left lower lobectomy and mediastinal lymph node dissection for squamous cell carcinoma. There was no aortic arch or descending aorta in the left thoracic cavity, but the esophagus. There was no anomaly in the location or branching of the pulmonary vessels, the bronchi, and the lobulation of the lungs. The vagus nerve was found at the level of the left pulmonary artery. The arterial ligament was found between the left subclavian artery and the left pulmonary artery. The recurrent laryngeal nerve was recurrent around the left subclavian artery. A Kommerell diverticulum was found at the origin of the left subclavian artery. The patient experienced no complications. We conclude that video-assisted thoracoscopic lobectomy with mediastinal dissection is feasible for treating lung cancer with a right aortic arch.

  6. MR angiography of the anomalous branching of aortic arch and left subclavian artery arising from Kommerell's diverticulum. Case report.

    PubMed

    Silit, E; Mutlu, H; Karaman, B; Basekim, C C

    2004-03-01

    We report the magnetic resonance (MR) angiographic findings of an asymptomatic case with abnormal branching of aortic arch and Kommerell's diverticulum, which to our knowledge has not been described previously.

  7. Transcranial Doppler Sonography for Optimization of Cerebral Perfusion in Aortic Arch Operation.

    PubMed

    Ghazy, Tamer; Darwisch, Ayham; Schmidt, Torsten; Fajfrova, Zuzana; Zickmüller, Claudia; Masshour, Ahmed; Matschke, Klaus; Kappert, Utz

    2016-01-01

    An open operation on the aortic arch is a complex procedure that requires not only surgical expertise but also meticulous management to ensure excellent outcomes. In recent years, the procedure has often been performed with the patient under circulatory arrest, with antegrade cerebral perfusion. With such a strategy, efficient monitoring to ensure adequate cerebral perfusion is essential. Here we describe a case of Stanford type A aortic dissection repair in which transcranial Doppler sonography was used as an excellent monitoring tool to allow visualization of cerebral flow and the online status of perfusion, providing instant feedback to allow changes in strategy to optimize inadequate cerebral perfusion. PMID:26694304

  8. Open thoracic aortic repair for dysphagia in patients with Kommerell's diverticulum and right-sided aortic arch with aberrant left subclavian artery.

    PubMed

    Reece, T Brett; Wallen, Tyler J; Jagasia, Dinesh H; Bavaria, Joseph E; Szeto, Wilson Y

    2010-01-01

    Kommerell's diverticulum of an aberrant left subclavian artery associated with a right-sided aortic arch is a rare congenital aortic anomaly. This communication reports two cases of this congenital anomaly leading to severe dysphagia. Both cases were successfully repaired with a staged open approach rather than an endovascular approach, which would not have addressed the presenting symptom of dysphagia.

  9. 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

  10. 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.

  11. [Right patent ductus arteriosus with an ipsilateral aortic arch: percutaneous closure with amplatzer devices].

    PubMed

    Santiago, Justo; Acuña, Manuel; Arispe, Elizabeth; Camargo, Ronaldo; Neves, Juliana; Arnoni, Daniel; Fontes, Valmir F; Pedra, Carlos A

    2007-03-01

    The association of a right aortic arch with an ipsilateral patent ductus arteriosus is rare, especially when there are no other intracardiac anomalies. We report three female patients aged 26, 35 and 9 years with this combination in whom previous attempts at surgical closure by thoracotomy and sternotomy were unsuccessful and who subsequently underwent successful percutaneous closure of the defects using Amplatzer devices. In two patients, although angiography demonstrated the presence of type-A patent ductus arteriosus, it was not possible to determine the minimum diameter accurately and it was necessary to measure it using a sizing balloon. An Amplatzer duct occluder was used in two patients and an Amplatzer muscular ventricular septal defect occluder, in the other. In all patients, full closure was confirmed in the catheterization laboratory and the patients were discharged on the same day with no complications. Percutaneous closure of a right patent ductus arteriosus associated with a right aortic arch is feasible, safe and effective.

  12. A case report of persistent fifth aortic arch presenting with severe left ventricular dysfunction.

    PubMed

    Nakashima, Kouki; Oka, Norihiko; Hayashi, Hidenori; Shibata, Miyuki; Kitamura, Tadashi; Itatani, Keiichi; Miyaji, Kagami

    2014-01-01

    According to several previous reports on persistent fifth aortic arch (PFAA), the presentation of the patients was usually either very mild when diagnosed by physical examination including upper body systemic hypertension and systolic murmur, or severe with ductal shock in the neonatal period. In our case, the clinical course was unique with relatively mild narrowing at the distal PFAA and an interrupted fourth aortic arch. It can be classified as medium severity based on the timing of presentation to the hospital. In the present case, severe LV dysfunction suggested sustained narrowing at the junction between the PFAA and the descending aorta and insufficient development of collateral arteries.We experienced a case with PFAA with severe LV dysfunction. These findings suggest another differential diagnosis for severe LV dysfunction in infancy.

  13. 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

  14. Endovascular repair of ruptured aberrant left subclavian artery with right aortic arch.

    PubMed

    Motoki, Manabu; Hattori, Koji; Kato, Yasuyuki; Takahashi, Yosuke; Kotani, Shinsuke; Nishimura, Shinsuke; Shibata, Toshihiko

    2013-02-01

    Association of a right-sided aortic arch with an aberrant left subclavian artery is rare. We present a case of successful endovascular repair of a ruptured Kommerell diverticulum associated with a right-sided aortic arch and aberrant left subclavian artery. We treated a 47-year-old woman with a diagnosis of ruptured aberrant left subclavian artery with thoracic endovascular stent-grafts. The descending aorta above Kommerell diverticulum was a reverse-tapered configuration. We managed the rather hostile neck with an extra-large Palmaz stent. A left carotid-to-subclavian bypass with an 8-mm Dacron graft was also performed to restore left arm perfusion and prevent vertebrobasilar insufficiency.

  15. 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.

  16. 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.

  17. 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

  18. Double incomplete aortic arch and Kommerell's Diverticulum as a cause of chronic cough.

    PubMed

    Sierra-Galan, Lilia M; Shveid-Gerson, Daniela; Gomez-Garza, Gilberto; Rey-Rodriguez, Alejandro

    2015-01-01

    Vascular rings which can cause symptoms related the trachea and esophagus compression occur in less than 1% of all cardiovascular malformations. Double incomplete aortic arch with right-sided aorta and aberrant left subclavian artery is the rarest one, and its present in 0.04-0.1% of autopsy series. A case of this malformation with a Kommerell's Diverticulum is presented. This diverticulum has risk of severe complications such as dissection and/or rupture.

  19. 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

  20. A Staged Hybrid Procedure to Manage Complex Cerebral Hypoperfusion in Aortic Arch Aneurysm.

    PubMed

    Hernández Carbonell, Teresa; Haulon, Stephan; Prat, Alain; Martin-Gonzalez, Teresa; Tyrrell, Mark R; Sobocinski, Jonathan

    2015-10-01

    We report the management of a patient who had an open-surgical repair following traumatic avulsion of the supra-aortic trunks (SAT) 30 years prior to presentation with a large arch aneurysm and poor cerebral collaterals. "Simple" thoracic endovascular aneurysm repair (TEVAR) was not an option because it would have excluded the collateral circulation to the carotid and vertebral arteries. We devised a two-stage hybrid procedure to repair this challenging aneurysm.

  1. [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

  2. Late leakage from four-branch prosthetic graft after total aortic arch repair.

    PubMed

    Hiraoka, Arudo; Chikazawa, Genta; Sakaguchi, Taichi; Yoshitaka, Hidenori

    2016-01-01

    We present two cases with late graft leakage of unknown aetiology after open total aortic arch repair (TAR). Case 1: a 73-year-old woman underwent TAR for arch aneurysm with 24-mm four-branch graft. She had a previous history of pacemaker implantation for sick sinus syndrome and warfarin therapy for atrial fibrillation. Follow-up computed tomography (CT) revealed increased low-density area around the graft 4 years after surgery and blood leakage was shown in delayed-phase CT. Thoracic endovascular aortic repair (TEVAR) was performed to cover the haematic leakage, and shrinkage of the lesion was achieved 1 month after TEVAR. Case 2: a 72-year-old man with diabetes mellitus, hypertension and hyperlipidaemia was admitted to our institute for treatment of aortic arch aneurysm. TAR was successfully performed; however, leakage from the prosthetic graft was noticed by expert radiologists in follow-up delayed-phase CT scan 6 years after surgery. The leakage was resolved 1 month after TEVAR. Although the cause of late leakage was not determined, the slowly expanding haematoma proved to be treatable by additional TEVAR.

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

    NASA Astrophysics Data System (ADS)

    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.

  4. 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.

  5. 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.

  6. Biomechanical implications of excessive endograft protrusion into the aortic arch after thoracic endovascular repair.

    PubMed

    Rinaudo, Antonino; Raffa, Giuseppe Maria; Scardulla, Francesco; Pilato, Michele; Scardulla, Cesare; Pasta, Salvatore

    2015-11-01

    Endografts placed in the aorta for thoracic endovascular aortic repair (TEVAR) may determine malappositioning to the lesser curvature of the aortic wall, thus resulting in a devastating complication known as endograft collapse. This premature device failure commonly occurs in young individuals after TEVAR for traumatic aortic injuries as a result of applications outside the physical conditions for which the endograft was designed. In this study, an experimentally-calibrated fluid-structure interaction (FSI) model was developed to assess the hemodynamic and stress/strain distributions acting on the excessive protrusion extension (PE) of endografts deployed in four young patients underwent TEVAR. Endograft infolding was experimentally measured for different hemodynamic scenarios by perfusion testing and then used to numerically calibrate the mechanical behavior of endograft PE. Results evinced that the extent of endograft can severely alter the hemodynamic and structural loads exerted on the endograft PE. Specifically, PE determined a physiological aortic coarctation into the aortic arch characterized by a helical flow in the distal descending aorta. High device displacement and transmural pressure across the stent-graft wall were found for a PE longer than 21 mm. Finally, marked intramural stress and principal strain distributions on the protruded segment of the endograft wall may suggest failure due to material fatigue. These critical parameters may contribute to the endograft collapse observed clinically and can be used to design new devices more suitable for young individuals to be treated with an endoprosthesis for TEVAR of blunt traumatic aortic injuries.

  7. Can the left subclavian artery revascularization during aortic arch surgery be managed using the in situ left internal mammary artery?

    PubMed

    Magagna, Paolo; Cresce, Giovanni Domenico; Auriemma, Stefano; Salvador, Loris

    2016-07-01

    The management of the left subclavian artery (LSA) revascularization during aortic arch surgery is controversial and often challenging, especially during an emergency life-saving procedure. We report on a case of a 64-year old man, admitted to our institution with a Type A acute aortic dissection who underwent a frozen elephant trunk procedure with debranching of the supra-aortic vessels completed with an LSA revascularization using the in situ left internal mammary artery.

  8. One-stage repair of aberrant left brachiocephalic artery and coarctation of the aorta in right aortic arch

    PubMed Central

    Gandolfo, Fabrizio; Albanese, Sonia B.; Secinaro, Aurelio D.M.; Carotti, Adriano

    2013-01-01

    The combination of right aortic arch with aberrant left brachiocephalic artery and aortic coarctation is very rare. Here, we report the case of a 3.1-kg neonate with multiple malformations who received detailed preoperative anatomical definition by chest computed tomography (CT) scan and eventually underwent one-stage repair at the age of 17 days. The surgical technique included left brachiocephalic artery detachment and its end-to-end anastomosis to the branch of a monofurcated pulmonary homograft used to treat the aortic arch coarctation simultaneously. Postoperative control chest CT scan performed 3 months postoperatively revealed optimal repair. Considerations on imaging and surgical technique are reported. PMID:23667064

  9. A Case of Acute Traumatic Aortic Injury of a Right-sided Aortic Arch with Rupture of an Aberrant Left Subclavian Artery

    PubMed Central

    Taif, Sawsan; Al Kalbani, Jokha

    2013-01-01

    Acute traumatic aortic injury is a potentially lethal condition with most patients die at the scene of the accidents. Rapid deceleration due to motor vehicle accidents is the commonest mechanism of injury. These injuries can be successfully repaired in the few patients who survive the initial trauma if proper diagnosis and rapid treatment are provided. The occurrence of acute traumatic aortic injury in patients with congenital abnormality of the aortic arch has been rarely reported; however, it renders the diagnosis and treatment more difficult. In this paper, we describe an extremely rare case of aortic injury in a young patient who had a right sided aortic arch with rupture of an aberrant left subclavian artery. The patient was suspected to have a Kommerell’s diverticulum in the aberrant subclavian artery origin. This injury resulted in an unusually huge pseudoaneurysm involving part of the mediastinum and extending into the neck. Unfortunately; patient succumbed in spite of surgical intervention. PMID:24421931

  10. A case of acute traumatic aortic injury of a right-sided aortic arch with rupture of an aberrant left subclavian artery.

    PubMed

    Taif, Sawsan; Al Kalbani, Jokha

    2013-12-01

    Acute traumatic aortic injury is a potentially lethal condition with most patients die at the scene of the accidents. Rapid deceleration due to motor vehicle accidents is the commonest mechanism of injury. These injuries can be successfully repaired in the few patients who survive the initial trauma if proper diagnosis and rapid treatment are provided. The occurrence of acute traumatic aortic injury in patients with congenital abnormality of the aortic arch has been rarely reported; however, it renders the diagnosis and treatment more difficult. In this paper, we describe an extremely rare case of aortic injury in a young patient who had a right sided aortic arch with rupture of an aberrant left subclavian artery. The patient was suspected to have a Kommerell's diverticulum in the aberrant subclavian artery origin. This injury resulted in an unusually huge pseudoaneurysm involving part of the mediastinum and extending into the neck. Unfortunately; patient succumbed in spite of surgical intervention.

  11. Computational fluid dynamics modeling and analysis of the effect of 3-D distortion of the human aortic arch.

    PubMed

    Mori, Daisuke; Yamaguchi, Takami

    2002-06-01

    An idealized CFD model and a realistic one were used to investigate the effect of the 3-D distortion of the aortic arch on the blood flow and its pathophysiological significance with respect to the pathogenesis of the aortic aneurysm. From the results of the flow simulations, the distortion of the centerline of the pipe was shown to affect significantly the flow structure. A right-handed vortex at the descending arch, and a left-handed one at the end of the arch tended to develop in the realistic model. But the secondary flow did not become a single helix. The top of the arch was the region where complex spatial and temporal WSS distributed. It was also observed that the direction of WSS had a significant circumferential component at the top of the arch.

  12. 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

  13. Hybrid repair of a ruptured right-sided aortic arch with an aberrant left subclavian artery arising from a diverticulum of Kommerell: a case report.

    PubMed

    Mavroudis, Constantine D; Copelan, Alexander; Sokhandon, Farnoosh; Altshuler, Jeffrey

    2014-10-01

    Right-sided aortic arch with an aberrant left subclavian artery is a rare aortic arch anomaly. Although usually asymptomatic, aneurysm formation, dissection, and rupture can occur due to the aberrant vasculature and can be life-threatening. Hybrid, endovascular techniques have been implemented in instances of elective repair of aneurysmal diverticula of Kommerell in similar anatomical settings, but little has been written regarding urgent cases of rupture. We report a case of ruptured right-sided aortic arch with an aberrant left subclavian artery arising from a diverticulum of Kommerell successfully treated with hybrid aortic debranching and thoracic endovascular aortic stenting.

  14. 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.

    PubMed

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

    2009-07-01

    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.

  15. 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.

  16. [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

  17. 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.

  18. Right Aortic Arch and Kommerell's Diverticulum Repaired without Reconstruction of Aberrant Left Subclavian Artery

    PubMed Central

    Shinohara, Daisuke; Orii, Kouan; Hosaka, Shigeru; Fukuda, Shoji; Akashi, Okihiko; Furukawa, Hiroshi

    2013-01-01

    Right aortic arch with Kommerell's diverticulum is a very rare situation. Surgical treatment is recommended for symptomatic patients or asymptomatic patients with a large diverticulum. However planning the strategy of operation is difficult without a 3D imaging. We report a case of a 57-year-old man with right aortic arch, Kommerell's diverticulum, and aberrant left subclavian artery. After a 3D-CT imaging, the patient underwent descending aortic replacement without reconstruction of aberrant left subclavian artery. After operation, there was no signs or symptoms of ischemia of the left arm. If the reconstruction of the aberrant subclavian artery was too difficult, closing its orifice is an acceptable decision. It has been found advantageous because of a decrease blood loss and a shorter cardiopulmonary bypass duration. If an ischemia of the arm is noticed, additional reconstruction will have to be considered. 3D-CT imaging was very useful to have a proper orientation and plan for the operative strategy. PMID:23710412

  19. Multi-Detector Row Computed Tomographic Evaluation of a Rare Type of Complete Vascular Ring: Double Aortic Arch with Atretic Left Arch Distal to the Origin of Left Subclavian Artery

    PubMed Central

    Hung, Ying-Ying; Fu, Yun-Ching; Wei, Hao-Ji; Chen, Clayton Chi-Chang

    2013-01-01

    Double aortic arch with an atretic left arch distal to the origin of left subclavian artery was diagnosed with multi-detector row computed tomography (MDCT) in two children with dysphagia. This rare type of complete vascular ring is clinically important because it may be confused with right aortic arch in mirror imaging. Anatomic details of this rare type of complete vascular ring demonstrated on MDCT facilitated appropriate surgical treatment. PMID:24043984

  20. ALTE and Feeding Intolerance as a Presentation of Double Aortic Arch

    PubMed Central

    Green Golan Mackintosh, Liza; Bynum, Francine

    2016-01-01

    Many children who are admitted to pediatric hospitals with the chief complaint of apparent life-threatening event (ALTE) are, in fact, well appearing by the time the inpatient medical team evaluates the patient. This presents a diagnostic and therapeutic challenge. We describe a case of a six-month-old full-term female presenting with an ALTE and found to have a double aortic arch, a congenital anomaly that usually presents with a more progressive onset of symptoms such as chronic cough, positional stridor, and feeding difficulties. This case highlights the importance of maintaining a broad differential in a patient presenting with findings of tracheoesophageal pathology on clinical exam. PMID:27722004

  1. 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

  2. Repair of right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum.

    PubMed

    Chen, C L

    1990-07-01

    A case of right aortic arch with an aberrant left subclavian artery arising from a Kommerell's diverticulum of the descending thoracic aorta with a left ligamentum arteriosum completing a vascular ring about the trachea and esophagus is presented. A posterolateral left thoracotomy alone is sufficient to provide an excellent exposure for the division of the ligamentum arteriosum and the resection of the Kommerell's diverticulum. Furthermore, the development of a subclavian steal syndrome is prevented by the reimplantation of the divided left subclavian artery into the left common carotid artery through this same incision.

  3. Video assisted thoracoscopic surgery cases with right-sided aortic arch aneurysm and complete vascular ring: Case report

    PubMed Central

    Nezafati, Mohammad Hassan; Nezafati, Pouya

    2014-01-01

    Introduction Right-sided aortic arch with aberrant left subclavian artery and ligamentum arteriosum, after double aortic arch, is the second most common complete vascular ring. It was traditionally treated by open surgical thoracotomy and recently video assisted thoracoscopic surgery (VATS) has been used in some cases. Presentation of case We describe the cases of two infants who presented with gastroesophageal reflux, dyspnea, dysphagia secondary to aneurysmal dilatation of the retroesophageal arch confirmed by imaging data. VATS procedure was performed through a left thoracoscopic approach. Ligamentum arteriosus compressed esophagus was clipped, sectioned and then released the esophagus in one case; also, In the second case, we clipped and sectioned aorta, distal to the origin of aberrant left subclavian artery. Discussion CT angiography and MRI are known to be the most effective available imaging methods for vascular ring detection. Also, there are several surgical approaches to vascular rings such as, thoracotomy and thoracoscopy. There is a large body of evidence confirming the safety, efficacy and convenience of VATS as a therapeutic option for congenital heart disease including right-sided aortic arch and aberrant left subclavian artery. Conclusion VATS is a less invasive and safe strategy for management of right-sided aortic arch with aberrant left subclavian artery and ligamentum arteriosum. PMID:25544489

  4. Endovascular Repair of a Kommerell’s Diverticulum and Aneurysmal Right-sided Aortic Arch: A Case Report

    PubMed Central

    Kannno, Megumu; Ishikawa, Kazunori; Takano, Takashi; Ono, Takano; Morishima, Shigehiro

    2009-01-01

    Right-sided aortic arch with aberrant left subclavian artery is an uncommon anomaly. We describe a case of Kommerell’s diverticulum involving the distal portion of a right-sided aortic arch and the origin of an aberrant left subclavian artery in a 74-year-old man with hoarseness. The patient underwent successful endovascular repair of the aneurysm with use of a Gore TAG thoracic endoprosthesis and coil embolization of the left subclavian artery. Postoperative computed tomography showed complete exclusion of the lesion, without endoleaks. Endovascular repair is feasible and can be effective in such cases. PMID:23555359

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

    PubMed

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

    2015-12-01

    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.

  6. 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

  7. Continuous flow left ventricular assist device implantation concomitant with aortic arch replacement and aortic valve closure in a patient with end-stage heart failure associated with bicuspid aortic valve.

    PubMed

    Akiyama, Masatoshi; Hosoyama, Katsuhiro; Kumagai, Kiichiro; Kawamoto, Shunsuke; Saiki, Yoshikatsu

    2015-12-01

    Left ventricular assist device (LVAD) implantation has become an established treatment for patients with end-stage heart failure as a bridge to cardiac transplantation. During LVAD implantation, some patients require concomitant surgeries, including tricuspid valve repair, aortic valve repair or replacement, and patent foramen ovale closure. However, concomitant aortic surgeries are rare in patients requiring LVAD implantation. We successfully performed total arch replacement with an open distal technique, aortic valve closure, and continuous flow LVAD implantation simultaneously. PMID:25957796

  8. [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

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

    PubMed Central

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

    2014-01-01

    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

  10. Right aortic arch and Kommerell's diverticulum associated with acute aortic dissection and pericardial tamponade

    PubMed Central

    Ebner, Lukas; Huber, Andreas; Christe, Andreas

    2013-01-01

    The right-sided aorta associated with an aberrant left subclavian artery is a rare anomaly of the aortic branches in the upper mediastinum. We present a 62-year-old patient suffering from an acute dissection of the ascending aorta associated with hemopericardium. In this case, there was also aneurysmal dilatation of the origin of the left subclavian artery, known as diverticulum of Kommerell. PMID:23986854

  11. Persistent Aortic Arch Hypoplasia After Coarctation Treatment Is Associated With Late Systemic Hypertension

    PubMed Central

    Quennelle, Sophie; Powell, Andrew J; Geva, Tal; Prakash, Ashwin

    2015-01-01

    Background Mild transverse aortic arch (TAA) hypoplasia is common after coarctation treatment, but is considered benign in the absence of an arm-leg systolic blood pressure (SBP) difference. Hypertension (HTN) is a common long-term morbidity after successful coarctation treatment. We examined whether mild TAA hypoplasia after coarctation treatment is associated with late systemic HTN. Methods and Results We retrospectively reviewed 92 patients (median age, 19.9 years; range, 4.9 to 57.8; 60% male) 14.1±10.3 years after successful coarctation treatment (surgery in 63, stent in 16, and balloon dilation in 13), excluding those with resting right arm-leg blood pressure gradient >20 mm Hg, atypical coarctation, and major associated heart defects. Minimum body-surface area (BSA)-adjusted TAA cross-sectional area (CSA) was calculated from cardiac magnetic resonance (CMR) images. On follow-up, 38 of 92 (41%) patients had systemic HTN using standard criteria. Systemic HTN was independently associated with smaller TAA CSA/BSA (P=0.006; odds ratio [OR], 6.41 per 0.5 cm2/m2 decrease), higher age at CMR (P=0.03; OR, 1.57 per 5-year increase), and in a subset (n=61), higher arm-leg SBP difference during exercise (P=0.05; OR, 1.03 per 1-mm-Hg increase). Lower ratio of TAA diameter/descending aorta diameter was associated with a larger increase in right arm SBP during peak exercise (P=0.006; r2=0.11). Conclusions Persistent mild aortic arch hypoplasia, even in the absence of an arm-leg SBP difference at rest, is associated with late systemic HTN. Further studies should be undertaken to determine whether more-aggressive arch reconstruction at initial repair can reduce the incidence of systemic HTN. PMID:26112642

  12. Two-Stage Hybrid Repair in a Patient with Acute Type A Aortic Dissection Associated with Right Aortic Arch with Aberrant Left Subclavian Artery Originating from a Kommerell Diverticulum

    PubMed Central

    Sakata, Kimimasa; Gyoten, Takayuki; Nagura, Saori; Yamashita, Akio; Fukahara, Kazuaki; Kotoh, Keiju; Yoshimura, Naoki

    2016-01-01

    Right aortic arch with aberrant left subclavian artery and Kommerell diverticulum are rare anomalies. A 42-year-old man was referred with sudden-onset chest pain. Enhanced computed tomography (CT) showed a right aortic arch with early thrombosed acute type A aortic dissection and an aberrant left subclavian artery arising from a Kommerell diverticulum. Medical therapy was instituted; however, follow-up CT revealed an ulcer-like projection. The patient was managed with a two-stage hybrid procedure comprising total arch replacement and endovascular repair and experienced no postoperative complications. Two-stage hybrid repair is a safe and effective surgical option for rare complex aortic anomalies.

  13. Unsteady and three-dimensional simulation of blood flow in the human aortic arch.

    PubMed

    Shahcheraghi, N; Dwyer, H A; Cheer, A Y; Barakat, A I; Rutaganira, T

    2002-08-01

    A three-dimensional and pulsatile blood flow in a human aortic arch and its three major branches has been studied numerically for a peak Reynolds number of 2500 and a frequency (or Womersley) parameter of 10. The simulation geometry was derived from the three-dimensional reconstruction of a series of two-dimensional slices obtained in vivo using CAT scan imaging on a human aorta. The numerical simulations were obtained using a projection method, and a finite-volume formulation of the Navier-Stokes equations was used on a system of overset grids. Our results demonstrate that the primary flow velocity is skewed towards the inner aortic wall in the ascending aorta, but this skewness shifts to the outer wall in the descending thoracic aorta. Within the arch branches, the flow velocities were skewed to the distal walls with flow reversal along the proximal walls. Extensive secondary flow motion was observed in the aorta, and the structure of these secondary flows was influenced considerably by the presence of the branches. Within the aorta, wall shear stresses were highly dynamic, but were generally high along the outer wall in the vicinity of the branches and low along the inner wall, particularly in the descending thoracic aorta. Within the branches, the shear stresses were considerably higher along the distal walls than along the proximal walls. Wall pressure was low along the inner aortic wall and high around the branches and along the outer wall in the ascending thoracic aorta. Comparison of our numerical results with the localization of early atherosclerotic lesions broadly suggests preferential development of these lesions in regions of extrema (either maxima or minima) in wall shear stress and pressure.

  14. 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

  15. [A successful surgical case of a dissecting aortic aneurysm with right-sided aortic arch and right-sided descending aorta].

    PubMed

    Osako, M; Ueda, T; Mori, A; Mitsumaru, A; Yozu, R; Kawada, S

    1996-08-01

    The patient was a 70-year-old female whose aortogram and chest computer tomogram revealed DeBakey type IIIb dissecting aortic aneurysm in association with right-sided aortic arch, right-sided descending aorta and aberrant left subclavian artery arising from the Kommerell's diverticulum. Because she had cachexy with hoarseness and difficulty in swallowing caused by an aneurysm she received hypotensive therapy until recovery of her general condition before elective operation. The aneurysm was 7 cm in diameter and was replaced with vascular graft. Reconstruction of the aberrant left subclavian artery and closure of the false lumen via right thoracotomy were also performed under partial bypass installed between the right common femoral vein and artery using modified PCPS. Postoperative computer tomogram and aortogram showed properly replaced vascular graft and closure of false lumen. Dissecting aortic aneurysm complicated with a right-sided arch is quite rare. Including our case, 12 cases have been reported in the world and 9 cases were in Japan. This is one of the most successful surgical case for DeBakey type IIIb dissecting aortic aneurysm in association with right-sided aortic arch, right-sided descending aorta and aberrant left subclavian artery arising from the Kommerell's diverticulum.

  16. MDCT of right aortic arch with aberrant left subclavian artery associated with kommerell diverticulum and calcified ligamentum arteriosum.

    PubMed

    Kanza, Rene Epunza; Berube, Michel; Michaud, Pierre

    2013-04-28

    We present a case of the right aortic arch with kommerell diverticulum (KD) and aberrant left subclavian artery in a symptomatic 50-year-old patient with a calcification in the presumed attachment site of the ligamentum arteriosum (LA) to the KD. In another 30-year-old male patient, the entire course of a calcified LA was demonstrated using multidetector row computed tomography.

  17. 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.

  18. Cerebral oximetry monitoring during aortic arch aneurysm replacement surgery in Jehovah's Witness patient -A case report-.

    PubMed

    Kim, Seong-Hyop; Yoon, Tae-Gyoon; Kim, Tae-Yop; Kim, Hae-Kyoung; Sung, Woo-Sung

    2010-02-01

    Anesthetic management for aortic arch aneurysm (AAA) surgery employing deep hypothermic circulatory arrest in a Jehovah's Witness (JW) patient is a challenge to anesthesiologist due to its complexity of procedures and their refusal of allogeneic transfusion. Even in the strict application of intraoperative acute normovolemic hemodilution (ANH) and intraopertive cell salvage (ICS) technique, prompt timing of re-administration of salvaged blood is essential for successful operation without allogeneic transfusion or ischemic complication of major organs. Cerebral oximetery (rSO(2)) monitoring using near infrared spectroscopy is a useful modality for detecting cerebral ischemia during the AAA surgery requiring direct interruption of cerebral flow. The present case showed that rSO(2) can be used as a trigger facilitating to find a better timing for the re-administration of salvaged blood acquired during the AAA surgery for JW patient. PMID:20498799

  19. 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

  20. Bovine Aortic Arch and Bilateral Retroesophageal Course of Common Carotid Arteries in a Symptomatic Patient

    PubMed Central

    Bissacco, Daniele; Domanin, Maurizio; Schinco, Giuseppina; Gabrielli, Livio

    2016-01-01

    Anatomical variations of carotid arteries may be related to their development (agenesis, aplasia, hypoplasia) or course (coiling, kinking, tortuosity). Partial or total aberrancies in carotid vessel anatomy rarely occur. We describe the case of a 95-year-old woman presented with sudden onset of confusion and disorientation together with upper limb clonus. Computed tomography (CT)-scan revealed a left frontal brain injury with a not conclusive carotid doppler ultrasound. CT angiography reported a bovine aortic arch with bilateral retroesophageal course of both common carotid arteries and left severe (>70%) internal carotid artery stenosis. The knowledge of anatomical variations of the course of carotid arteries is relevant for possible surgical or endovascular repair or in case of otolaryngology or intubation procedures. PMID:27699162

  1. Bovine Aortic Arch and Bilateral Retroesophageal Course of Common Carotid Arteries in a Symptomatic Patient

    PubMed Central

    Bissacco, Daniele; Domanin, Maurizio; Schinco, Giuseppina; Gabrielli, Livio

    2016-01-01

    Anatomical variations of carotid arteries may be related to their development (agenesis, aplasia, hypoplasia) or course (coiling, kinking, tortuosity). Partial or total aberrancies in carotid vessel anatomy rarely occur. We describe the case of a 95-year-old woman presented with sudden onset of confusion and disorientation together with upper limb clonus. Computed tomography (CT)-scan revealed a left frontal brain injury with a not conclusive carotid doppler ultrasound. CT angiography reported a bovine aortic arch with bilateral retroesophageal course of both common carotid arteries and left severe (>70%) internal carotid artery stenosis. The knowledge of anatomical variations of the course of carotid arteries is relevant for possible surgical or endovascular repair or in case of otolaryngology or intubation procedures.

  2. Transaortic stent grafting of a Kommerell diverticulum arising from a right-sided aortic arch.

    PubMed

    Takahashi, Shinya; Orihashi, Kazumasa; Okada, Kenji; Imai, Katsuhiko; Takasaki, Taiichi; Uchida, Naomichi; Sueda, Taijiro

    2014-05-01

    In this article, we report the case of a 68-year-old woman who presented with shortness of breath. Respiratory function tests showed a slightly obstructive physiology. Computed tomography (CT) results revealed an aberrant left subclavian artery and a Kommerell diverticulum arising from a right-sided aortic arch that was compressing the trachea and the surrounding tissues. A median sternotomy was performed with the patient under circulatory arrest with moderate hypothermia, and a transaortic stent graft was inserted to exclude the Kommerell diverticulum. The aberrant left subclavian artery was ligated and an axillo-axillar bypass was constructed. Postoperative CT showed complete exclusion of the Kommerell diverticulum without an endoleak. The patient's breathing difficulty was resolved, and she was discharged uneventfully. This procedure should be considered as an alternative strategy for exclusion of Kommerell diverticulum.

  3. Minimizing the Risk of Preoperative Brain Injury in Neonates with Aortic Arch Obstruction

    PubMed Central

    Algra, Selma O.; Haas, Felix; Poskitt, Kenneth J.; Groenendaal, Floris; Schouten, Antonius N. J.; Jansen, Nicolaas J. G.; Azakie, Anthony; Gandhi, Sanjiv; Campbell, Andrew; Miller, Steven P.; McQuillen, Patrick S.; de Vries, Linda S.

    2015-01-01

    Objective To determine whether prenatal diagnosis lowers the risk of preoperative brain injury by assessing differences in the incidence of preoperative brain injury across centers. Study design From 2 prospective cohorts of newborns with complex congenital heart disease studied by preoperative cerebral magnetic resonance imaging, one cohort from the University Medical Center Utrecht (UMCU) and a combined cohort from the University of California San Francisco (UCSF) and University of British Columbia (UBC), patients with aortic arch obstruction were selected and their imaging and clinical course reviewed. Results Birth characteristics were comparable between UMCU (n = 33) and UCSF/UBC (n = 54). Patients had a hypoplastic aortic arch with either coarctation/interruption or hypoplastic left heart syndrome. In subjects with prenatal diagnosis, there was a significant difference in the prevalence of white matter injury (WMI) between centers (11 of 22 [50%] at UMCU vs 4 of 30 [13%] at UCSF/UBC; P < .01). Prenatal diagnosis was protective for WMI at UCSF/UBC (13% prenatal diagnoses vs 50% postnatal diagnoses; P < .01), but not at UMCU (50% vs 46%, respectively; P > .99). Differences in clinical practice between prenatally diagnosed subjects at UMCU vs UCSF/UBC included older age at surgery, less time spent in the intensive care unit, greater use of diuretics, less use of total parenteral nutrition (P < .01), and a greater incidence of infections (P = .01). In patients diagnosed postnatally, the prevalence of WMI was similar in the 2 centers (46%at UMCU vs 50% at UCSF/UBC; P > .99). Stroke prevalence was similar in the 2 centers regardless of prenatal diagnosis (prenatal diagnosis: 4.5% at Utrecht vs 6.7% at UCSF/UBC, P = .75; postnatal diagnosis: 9.1% vs 13%, respectively, P > .99). Conclusion Prenatal diagnosis can be protective for WMI, but this protection may be dependent on specific clinical management practices that differ across centers. PMID:25306190

  4. 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.

  5. Successful Surgical Exclusion of Rapidly Expanding Kommerell Diverticulum Following a Total Arch Replacement for an Acute Type A Aortic Dissection

    PubMed Central

    Tanaka, Kuniyoshi; Natsume, Kayoko; Yamamoto, Kiyohito; Hiraiwa, Takane

    2014-01-01

    A 50-year-old man presented with an acute type A aortic dissection with an aberrant right subclavian artery. Emergent total arch replacement with an elephant trunk was performed. Intraoperatively, the origin of the aberrant right subclavian artery could not be resected because it was located too far from the distal arch. After two weeks, the patient became aware of dysphagia. Postoperative computed tomography showed the esophagus was compressed anteriorly by the aneurismal origin of this aberrant vessel (Kommerell diverticulum) with a patent false lumen. Additional replacement of the descending aorta via left thoracotomy was performed immediately to exclude a Kommerell diverticulum. PMID:25298842

  6. Successful surgical exclusion of rapidly expanding kommerell diverticulum following a total arch replacement for an acute type a aortic dissection.

    PubMed

    Tanaka, Keizo; Tanaka, Kuniyoshi; Natsume, Kayoko; Yamamoto, Kiyohito; Hiraiwa, Takane

    2014-01-01

    A 50-year-old man presented with an acute type A aortic dissection with an aberrant right subclavian artery. Emergent total arch replacement with an elephant trunk was performed. Intraoperatively, the origin of the aberrant right subclavian artery could not be resected because it was located too far from the distal arch. After two weeks, the patient became aware of dysphagia. Postoperative computed tomography showed the esophagus was compressed anteriorly by the aneurismal origin of this aberrant vessel (Kommerell diverticulum) with a patent false lumen. Additional replacement of the descending aorta via left thoracotomy was performed immediately to exclude a Kommerell diverticulum.

  7. Bending and pressurisation test of the human aortic arch: experiments, modelling and simulation of a patient-specific case.

    PubMed

    García-Herrera, Claudio M; Celentano, Diego J; Cruchaga, Marcela A

    2013-01-01

    This work presents experiments, modelling and simulation aimed at describing the mechanical behaviour of the human aortic arch during the bending and pressurisation test. The main motivation is to describe the material response of this artery when it is subjected to large quasi-static deformations in three different stages: bending, axial stretching and internal pressurisation. The sample corresponds to a young artery without cardiovascular pathologies. The pressure levels are within the normal and hypertension physiological ranges. The two principal findings of this work are firstly, the material characterisation performed via tensile test measurements that serve to derive the material parameters of a hyperelastic isotropic constitutive model and, secondly, the assessment of these material parameters in the simulation of the bending and pressurisation test. Overall, the reported material characterisation was found to provide a realistic description of the mechanical behaviour of the aortic arch under severe complex loading conditions considered in the bending and pressurisation test.

  8. Repair of Kommerell's diverticulum with aberrant left subclavian artery in an elderly patient with right aortic arch and dysphagia lusoria.

    PubMed

    Panduranga, Prashanth; Al-Delamie, Taha; Ratnam, Laxmi; Al-Mukhaini, Mohammed; Zachariah, Sunny

    2011-11-01

    A 60-year-old femalepresented with progressive dysphagia and was found to have a right-sided aortic arch with external posterior compression of the upper esophagus due to severe compression from a Kommerell's diverticulum with an aberrant left subclavian artery. This patient underwent division of the diverticulum with an aorto-subclavian graft implantation under femoro-femoral bypass and recovered uneventfully. A review of the literature and discussion of the surgical management is presented.

  9. MDCT of right aortic arch with aberrant left subclavian artery associated with kommerell diverticulum and calcified ligamentum arteriosum

    PubMed Central

    Kanza, Rene Epunza; Berube, Michel; Michaud, Pierre

    2013-01-01

    We present a case of the right aortic arch with kommerell diverticulum (KD) and aberrant left subclavian artery in a symptomatic 50-year-old patient with a calcification in the presumed attachment site of the ligamentum arteriosum (LA) to the KD. In another 30-year-old male patient, the entire course of a calcified LA was demonstrated using multidetector row computed tomography. PMID:23671755

  10. 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

  11. Persistent right aortic arch and aberrant left subclavian artery in a white Bengal tiger (Panthera tigris).

    PubMed

    Ketz, C J; Radlinsky, M; Armbrust, L; Carpenter, J W; Isaza, R

    2001-06-01

    A 3-mo-old male white Bengal tiger (Panthera tigris) presented with the chief complaint of regurgitation of solid food since weaning at 2 mo of age. Compared with its littermates, the tiger was in poor body condition and weighed only 10.3 kg when its littermates were estimated at 20-25 kg. Thoracic radiographs showed a megaesophagus cranial to the heart base. A contrast esophagram more clearly outlined the megaesophagus, and fluoroscopy demonstrated normal motility of the caudal esophagus. Endoscopic examination revealed a structure coursing dorsally from right to left over the esophagus and a constrictive band on the left of the esophagus at the heart base. Nonselective angiography confirmed the presence of a persistent right aortic arch, as well as an aberrant left subclavian artery. A left fourth intercostal thoracotomy was performed, and the ligamentum arteriosum was double ligated and divided. The left subclavian artery did not cause significant compromise of the esophagus and was not manipulated at surgery. The tiger recovered well from anesthesia and surgery. Solid food was slowly introduced over a 2-mo period without any regurgitation. The cub gained weight rapidly after surgery.

  12. 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

  13. Persistent right aortic arch and aberrant left subclavian artery in a white Bengal tiger (Panthera tigris).

    PubMed

    Ketz, C J; Radlinsky, M; Armbrust, L; Carpenter, J W; Isaza, R

    2001-06-01

    A 3-mo-old male white Bengal tiger (Panthera tigris) presented with the chief complaint of regurgitation of solid food since weaning at 2 mo of age. Compared with its littermates, the tiger was in poor body condition and weighed only 10.3 kg when its littermates were estimated at 20-25 kg. Thoracic radiographs showed a megaesophagus cranial to the heart base. A contrast esophagram more clearly outlined the megaesophagus, and fluoroscopy demonstrated normal motility of the caudal esophagus. Endoscopic examination revealed a structure coursing dorsally from right to left over the esophagus and a constrictive band on the left of the esophagus at the heart base. Nonselective angiography confirmed the presence of a persistent right aortic arch, as well as an aberrant left subclavian artery. A left fourth intercostal thoracotomy was performed, and the ligamentum arteriosum was double ligated and divided. The left subclavian artery did not cause significant compromise of the esophagus and was not manipulated at surgery. The tiger recovered well from anesthesia and surgery. Solid food was slowly introduced over a 2-mo period without any regurgitation. The cub gained weight rapidly after surgery. PMID:12790433

  14. Congenital subclavian steal syndrome with multiple cerebellar infarctions caused by an atypical circumflex retroesophageal right aortic arch with atretic aberrant left subclavian artery.

    PubMed

    Mamopoulos, Apostolos T; Luther, Bernd

    2014-09-01

    A right-sided aortic arch is a rare anomaly with an incidence of 0.1% worldwide and is usually associated with a mirror image of all supra-aortic branches or an aberrant left subclavian artery. The latter is often associated with a Kommerell diverticulum, although it can rarely be hypoplastic or atretic and lead to congenital subclavian steal. In most patients, the situation is well-tolerated. In this report, we present a case of subclavian steal syndrome with multiple cerebellar infarcts in a patient with an atypical right-sided aortic arch and an atretic aberrant left subclavian artery arising from a left-sided descending thoracic aorta.

  15. 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

  16. 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.

  17. 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

  18. Congenital Cardiac, Aortic Arch, and Vascular Bed Anomalies in PHACE Syndrome (From The International PHACE Syndrome Registry)

    PubMed Central

    Bayer, Michelle L.; Frommelt, Peter C.; Blei, Francine; Breur, Johannes M.P.J.; Cordisco, Maria R.; Frieden, Ilona J.; Goddard, Deborah S.; Holland, Kristen E.; Krol, Alfons L.; Maheshwari, Mohit; Metry, Denise W.; Morel, Kimberly D.; North, Paula E.; Pope, Elena; Shieh, Joseph T.; Southern, James F.; Wargon, Orli; Siegel, Dawn H.; Drolet, Beth A.

    2014-01-01

    PHACE syndrome represents the association of large infantile hemangiomas of the head and neck with brain, cerebrovascular, cardiac, ocular, and ventral/midline defects. Cardiac and cerebrovascular anomalies are the most common extracutaneous features of PHACE, and they also constitute the greatest source of potential morbidity. Congenital heart disease in PHACE is incompletely described, and this study was conducted to better characterize its features. This study of the International PHACE Syndrome Registry represents the largest central review of clinical, radiology, and pathology data for cardiovascular anomalies in PHACE patients to date. 62/150 (41%) subjects had intracardiac, aortic arch, or brachiocephalic vessel anomalies. Aberrant origin of a subclavian artery was the most common cardiovascular anomaly (present in 31/150 (21%) of subjects). Coarctation was the second most common anomaly, identified in 28/150 (19%), and can be missed clinically in PHACE patients because of the frequent association of arch obstruction with aberrant subclavian origin. 23/62 (37%) subjects with cardiovascular anomalies required procedural intervention. A higher percentage of hemangiomas were located on the left side of the head/neck in patients with coarctation (46% vs. 39%); however, hemangioma distribution did not predict the presence of cardiovascular anomalies overall. In conclusion, PHACE is associated with a high risk of congenital heart disease. Cardiac and aortic arch imaging with detailed assessment of arch patency and brachiocephalic origins is essential for any patient suspected of having PHACE. Longitudinal investigation is needed to determine the long-term outcomes of cardiovascular anomalies in PHACE. PMID:24079520

  19. 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.

  20. 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).

  1. Dysphagia lusoria caused by persistent right aortic arch with aberrant left subclavian artery and diverticulum of Kommerell.

    PubMed

    McNally, P R; Rak, K M

    1992-01-01

    It requires a high index of suspicion to make the diagnosis of dysphagia lusoria. Clinically, these adults will present with symptoms of intermittent solid food dysphagia, and a mediastinal abnormality may be seen on chest x-ray. Noninvasive imaging of the chest with either computerized tomography or magnetic resonance scanning are excellent methods for evaluating the mediastinum for solid tumors or vascular anomalies that can cause extrinsic esophageal compression. Dysphagia lusoria caused by a persistence of the right embryologic aortic arch and diverticulum of Kommerell with an aberrant left subclavian artery may be satisfactorily managed by dietary modification when the symptoms are mild.

  2. Resection of Kommerell Diverticulum After the Arterial Switch for TGA With Bilateral PDAs and Right Aortic Arch.

    PubMed

    Ochiai, Yoshie; Joo, Kunihiko; Onzuka, Tatsushi; Nakashima, Atsuhiro; Nagatomo, Yusaku; Watanabe, Mamie; Muneuchi, Jun

    2016-10-01

    We present a very rare case of bilateral ductus arteriosus in transposition of the great arteries with right aortic arch and aberrant retroesophageal left subclavian artery (SCA). Around 1 month after the successful arterial switch operation, the baby showed wheezing and retractive breathing. The computed tomography revealed that trachea and esophagus were sandwiched between the posterior displaced ascending aorta and the origin of the retroesophageal aberrant left SCA, the so-called Kommerell diverticulum (KD). This compression was successfully relieved by resection of the KD and division of the retroesophageal aberrant SCA through right thoracotomy.

  3. Single-Stage Repair of an Unusual Association: Congenital Gerbode Defect, Hypoplastic Aortic Arch, and Partially Anomalous Pulmonary Venous Return in an Infant.

    PubMed

    Flores, Saul; Kimball, Thomas R; Nelson, David P; Morales, David L S

    2016-07-01

    We present the case of a two-month-old male with congenital Gerbode defect, hypoplastic aortic arch, and left-sided partially anomalous pulmonary venous return. The patient underwent single-stage surgical repair, which consisted of aortic arch advancement with resection of the coarctation segment, pulmonary vein repair, and primary closure of the Gerbode defect. The anomalous pulmonary vein posed a particular challenge due to its size and distance from the left atrium, which we approached with a posterior atrial wall trapdoor baffle technique, without mobilizing the affected vein. Postoperatively and at one year follow-up, there was no evidence of residual lesions and there was unobstructed flow pattern across the aortic arch and the affected pulmonary vein.

  4. Origin of the left subclavian artery as the first branch and origin of the right subclavian artery as the fourth branch of the aortic arch with crisscrossing posterior to the common carotid arteries

    PubMed Central

    Zhang, Junlin; Guileyardo, Joseph M.

    2016-01-01

    We describe an aortic arch anomaly consisting of the origin of the left subclavian artery as the fourth branch and the right subclavian artery as the first branch off the aortic arch with crisscrossing of these two arteries anterior to the trachea without clinical consequences. This anomaly, to our knowledge, has not been reported previously. PMID:27695185

  5. Origin of the left subclavian artery as the first branch and origin of the right subclavian artery as the fourth branch of the aortic arch with crisscrossing posterior to the common carotid arteries

    PubMed Central

    Zhang, Junlin; Guileyardo, Joseph M.

    2016-01-01

    We describe an aortic arch anomaly consisting of the origin of the left subclavian artery as the fourth branch and the right subclavian artery as the first branch off the aortic arch with crisscrossing of these two arteries anterior to the trachea without clinical consequences. This anomaly, to our knowledge, has not been reported previously.

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

    PubMed

    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

  7. A right-sided aortic arch with Kommerell's diverticulum of the aberrant left subclavian artery presenting with syncope.

    PubMed

    Yang, Ming-Hsun; Weng, Zen-Chung; Weng, Yu-Guo; Chang, Hsiao-Huang

    2009-05-01

    A right-sided aortic arch with an aneurysm of the aberrant subclavian artery is a rare disease. We report a case of Kommerell's diverticulum of an aberrant left subclavian artery in a patient with a right-sided aortic arch. Fewer than 50 cases have been reported in the literature. A number of operative strategies are described. Right thoracotomy provides good exposure and avoids the morbidity associated with bilateral thoracotomy or sternotomy and thoracotomy. In our patient with symptoms of dysphagia, syncope, and left subclavian steal syndrome, a left thoracotomy was used. The repair was accomplished by division of a left ligamentum arteriosum, obliteration of the Kommerell's aneurysm, and an aorto-subclavian bypass. Postoperative complications included left vocal cord palsy and Horner's syndrome. Hoarseness and left ptosis recovered spontaneously 3 months after surgery, and the patient remained symptom-free at the 1-year follow-up. We believe a left thoracotomy for direct repair of Kommerell's diverticulum is a simple and safe method without the increased morbidity found in other procedures.

  8. 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

  9. 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

  10. 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

  11. [Esophageal perforation during nasogastric tube insertion in a patient with right-sided aortic arch and thoracic aorta. Pathophysiology and surgical implications].

    PubMed

    de Dominicis, F; Rekik, R; Merlusca, G; Deguines, J B; Gamain, J; Berna, P

    2009-08-01

    Esophageal perforation during nasogastric tube insertion is a very unusual occurrence. In this case report, radiologic images revealed a right-sided aortic arch with a right-sided thoracic aorta. This anatomical anomaly probably contributed to the complication and necessitated a modified approach to the surgical repair.

  12. Aortic arch replacement with a beating heart: a simple method using continuous 3-way perfusion.

    PubMed

    Abu-Omar, Y; Ali, J M; Colah, S; Dunning, J J

    2014-01-01

    We describe a simplified 3-way perfusion strategy that could be used in complex aortic procedures, which ensures continuous end-organ perfusion and minimizes the potential risks of cardiac, cerebral and peripheral ischaemic complications.

  13. 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.

  14. Frequency and potential consequences of origin of the left vertebral artery (or the arteria thryoidea ima) directly from the aortic arch

    PubMed Central

    Zhang, Junlin; Guileyardo, Joseph M.

    2016-01-01

    Described herein are findings in a 58-year-old man in whom necropsy disclosed origin of the left vertebral artery (or the arteria thryoidea ima) directly from the aortic arch. No functional consequences resulted. Study of previous publications disclosed the frequency of this anomaly in adults to be approximately 3.5%. Dissection has been reported to be more frequent in the left vertebral artery when it arises directly from the aorta than when it arises from the left subclavian artery.

  15. Hybrid repair of penetrating aortic ulcer associated with right aortic arch and aberrant left innominate artery arising from aneurysmal Kommerell's diverticulum with simultaneous repair of bilateral common iliac artery aneurysms.

    PubMed

    Guo, Yuanyuan; Yang, Bin; Cai, Hongbo; Jin, Hui

    2014-02-01

    We present the first case of a hybrid endovascular approach to a penetrating aortic ulcer on the left descending aorta with a right aortic arch and aberrant left innominate artery arising from an aneurysmal Kommerell's diverticulum. The patient also had bilateral common iliac artery aneurysms. The three-step procedure consisted of a carotid-carotid bypass, followed by endovascular exclusion of the ulcer and the aneurysmal Kommerell's diverticulum, and then completion by covering the iliac aneurysms. The patient had no complications at 18 months after surgery. In such rare configurations, endovascular repair is a safe therapeutic option.

  16. Asymptomatic pseudo-aneurysm of the aortic arch in a patient with aberrant right subclavian artery. A complication of Kommerell's diverticulum?

    PubMed

    Panagiotou, Matthew; Filias, Vasilios; Prokakis, Christos; Koletsis, Efsrtratios

    2008-08-01

    Kommerell's diverticulum is an aortic arch deformity associated with an aberrant subclavian artery. Symptoms related to compression of adjacent structures, dilatation of the aortic diverticulum or accelerated atherosclerosis leading to increased risks of dissection and rupture represent the indications for surgical treatment. Several surgical strategies have been used for the management of this congenital abnormality. We present the case of a 56-year-old male with a pseudo-aneurysm of a left aortic arch adjacent to a Kommerell's diverticulum at the orifice of a left subclavian artery. The patient also presented an aberrant right subclavian artery originating from the posterior wall of the ecstatic take-off of the left subclavian artery. Our surgical strategy was limited to the resection of the aneurysm without any manipulation of the aortic diverticulum and aberrant right subclavian artery, as the wall of both aorta adjacent to the saccular aneurysm and left subclavian artery was normal, the Kommerell's diverticulum was small and the patient was asymptomatic.

  17. In vitro flow investigations in the aortic arch during cardiopulmonary bypass with stereo-PIV.

    PubMed

    Büsen, Martin; Kaufmann, Tim A S; Neidlin, Michael; Steinseifer, Ulrich; Sonntag, Simon J

    2015-07-16

    The cardiopulmonary bypass is related to complications like stroke or hypoxia. The cannula jet is suspected to be one reason for these complications, due to the sandblast effect on the vessel wall. Several in silico and in vitro studies investigated the underlying mechanisms, but the applied experimental flow measurement techniques were not able to address the highly three-dimensional flow character with a satisfying resolution. In this work in vitro flow measurements in a cannulated and a non-cannulated aortic silicone model are presented. Stereo particle image velocimetry measurements in multiple planes were carried out. By assembling the data of the different measurement planes, quasi 3D velocity fields with a resolution of~1.5×1.5×2.5 mm(3) were obtained. The resulting velocity fields have been compared regarding magnitude, streamlines and vorticity. The presented method shows to be a suitable in vitro technique to measure and address the three-dimensional aortic CPB cannula flow with a high temporal and spatial resolution.

  18. 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.

  19. Cardiac-MRI demonstration of the ligamentum arteriosum in a case of right aortic arch with aberrant left subclavian artery.

    PubMed

    Paparo, Francesco; Bacigalupo, Lorenzo; Melani, Enrico; Rollandi, Gian Andrea; Caro, Giovanni De

    2012-05-28

    Right-sided aortic arch with aberrant left subclavian artery (RAA/ALSC) is the second most common mediastinal complete vascular ring. Adult presentation of dysphagia lusoria due to a RAA/ALSC is uncommon with fewer than 25 cases reported in the world literature. The left lateral portion of this vascular ring is not a vessel, but an atretic ductus arteriosus, the ligamentum arteriosum, which has been identified in different cases as the major cause of tracheo-esophageal impingement. Surgical division of the ligamentum arteriosum allows the vessels to assume a less constricting pattern decreasing dysphagic symptoms. Clear visualization of the ligamentum arteriosum by diagnostic imaging has not been obtained in previously reported cases. We demonstrated, using magnetic resonance imaging, the location and the complete course of a left-sided ligamentum arteriosum in a patient with adult-onset dysphagia due to a RAA/ALSC with a small Kommerell's diverticulum, providing, during the same session, a complete assessment of both mediastinal vascular abnormalities and esophageal impingement sites.

  20. Simultaneous individually controlled upper and lower body perfusion for valve-sparing root and total aortic arch replacement: a case study.

    PubMed

    Fernandes, Philip; Mayer, Rick; Adams, Corey; Chu, Michael W A

    2011-12-01

    Optimal perfusion strategies for extensive aortic resection in patients with mega-aortic syndromes include: tailored myocardial preservation, antegrade cerebral perfusion, controlled hypothermia and selective organ perfusion. Typically, the aortic arch resection and elephant trunk procedure are performed under hypothermic circulatory arrest with myocardial and cerebral protection. However, mesenteric and systemic ischemia occur during circulatory arrest and commonly rely upon deep hypothermia alone for metabolic protection. We hypothesized that simultaneously controlled mesenteric and systemic perfusion can attenuate some of the metabolic debt accrued during circulatory arrest, which may help improve perioperative outcomes. The perfusion strategy consisted of delivering a 1 to 3 liter per minute flow at 25 degrees C to the head/upper body via right axillary graft and simultaneous perfusion to the lower body/ mesenteric organs of 1 to 3 liters per minute at 30 degrees C via a right femoral arterial graft. We describe our technique of simultaneous mesenteric, systemic, cerebral and myocardial perfusion, and protection utilized for a young male patient with Marfan's syndrome, while undergoing a valve sparing root replacement, total arch replacement and elephant trunk reconstruction. This perfusion technique allowed us to deliver differential flow rates and temperatures to the upper and lower body (cold head/warm lower body perfusion) to minimize ischemic debt and quickly reverse metabolic derangements. PMID:22416605

  1. Clinical and biochemical outcomes for additive mesenteric and lower body perfusion during hypothermic circulatory arrest for complex total aortic arch replacement surgery.

    PubMed

    Fernandes, P; Cleland, A; Adams, C; Chu, M W A

    2012-11-01

    Surgical repair of transverse aortic arch aneurysms frequently employ hypothermia and antegrade cerebral perfusion as protective strategies during circulatory arrest. However, prolonged mesenteric and lower limb ischemia can lead to significant lactic acidosis and end organ dysfunction, which remains a significant cause of post-operative morbidity and mortality. We report our experience with additive warm mesenteric and lower body perfusion (1-3 L/min, 30°C) in addition to continuous cerebral and myocardial perfusion in 5 patients who underwent total aortic arch replacement with trifurcated head vessel re-implantation and distal elephant trunk reconstruction. Concomitant surgical procedures included re-operations (2), aortic root operations (2), coronary artery bypass (2) and descending thoracic aortic replacement (1). Serum lactate levels demonstrated a rapid decline from a peak 9.9 ± 2.6 post circulatory arrest to 3.4 ± 2.0 in the intensive care unit (ICU). The lowest serum bicarbonate levels were 19.3 ± 3.5 mmol/L, intra-operatively, which normalized to 28.4 ± 2.4 mmol/L on return to the ICU. The lowest pH levels were 7.25 ± 0.10, corrected to 7.43 ± 0.04 on return to the ICU. Mean cardiopulmonary bypass and aortic cross-clamp times were 361 ± 104 and 253 ± 85 minutes, respectively. Mean cerebral and lower body circulatory arrest times were 0 (0) and 50 ± 35 minutes, respectively. The mean time required for systemic rewarming was 95 ± 66 minutes. There were no in-hospital mortalities and no patient experienced any neurological, mesenteric, renal or lower limb ischemic complications. Two patients required mechanical ventilation >24 hours, and one patient returned for reoperation for bleeding. Median intensive care unit and total hospital lengths of stay were 5 and 16 days, respectively. Our results suggest early serum lactate clearance, normalization of acidosis, and metabolic recovery when utilizing a simultaneous cerebral perfusion and warm body

  2. 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

  3. 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

  4. Aortic arch calcification and risk of cardiovascular or all-cause and mortality in dialysis patients: A meta-analysis

    PubMed Central

    Zhang, Ao; Wang, Shiji; Li, Hongxiang; Yang, Juan; Wu, Hui

    2016-01-01

    Studies on aortic arch calcification (AAC) and mortality risk in maintenance dialysis patients have yielded conflicting findings. We conducted this meta-analysis to investigate the association between the presence of AAC and cardiovascular or all-cause and mortality risk in maintenance dialysis patients. Observational studies evaluating baseline AAC and cardiovascular or all-cause mortality risk in maintenance dialysis patients were searched through the PubMed and Embase, CNKI, VIP and Wanfang databases until January 2016. A total of 8 studies with 3,256 dialysis patients were identified. Compared with patients without AAC, the presence of AAC was associated with greater risk of cardiovascular mortality (hazard risk [HR] 2.30; 95% confidence intervals [CI] 1.78–2.97) and all-cause mortality (HR 1.44; 95% CI 1.19–1.75). Subgroup analyses indicated that the pooled HR for cardiovascular and all-cause mortality was 2.31 (95% CI 1.57–3.40) and 1.45 (95% CI 1.08–1.96) for the grade 2/3 AAC. Peritoneal dialysis patients with AAC had greater cardiovascular (HR 3.93 vs. HR 2.10) and all-cause mortality (HR 2.36 vs. HR 1.33) than hemodialysis patients. The AAC appears to be independently associated with excessive cardiovascular and all-cause mortality in maintenance dialysis patients. Regular follow-up AAC might be helpful to stratify mortality risk in dialysis patients. PMID:27748417

  5. Saccular Aneurysms of the Transverse Aortic Arch Based on a Presentation at the 2013 VEITH Symposium, November 19–23, 2013 (New York, NY, USA)

    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

  6. Frequency and potential consequences of origin of the left vertebral artery (or the arteria thryoidea ima) directly from the aortic arch

    PubMed Central

    Zhang, Junlin; Guileyardo, Joseph M.

    2016-01-01

    Described herein are findings in a 58-year-old man in whom necropsy disclosed origin of the left vertebral artery (or the arteria thryoidea ima) directly from the aortic arch. No functional consequences resulted. Study of previous publications disclosed the frequency of this anomaly in adults to be approximately 3.5%. Dissection has been reported to be more frequent in the left vertebral artery when it arises directly from the aorta than when it arises from the left subclavian artery. PMID:27695186

  7. Successful staged repair for a rare type of truncus arteriosus with interruption of the aortic arch and abnormal origin of the left coronary artery.

    PubMed

    Uchita, Shunji; Harada, Yorikazu; Honda, Kentaro; Toguchi, Koji; Nishimura, Yoshiharu; Suenaga, Tomohiro; Takeuchi, Takashi; Suzuki, Hiroyuki; Okamura, Yoshitaka

    2013-01-01

    We report a successful staged repair for a quite rare combination of truncus arteriosus (TA), Van Praagh type A4, and abnormal origin of the left coronary artery (CA). Furthermore, the case was complicated by a variant of the chromosomal anomaly in cat-cry syndrome. The presence of interruption of the aortic arch (IAA) and abnormal CA origin has been previously reported to increase mortality. To decrease the risk of bronchomalacia in infants, bilateral pulmonary artery banding (PAB) was performed as the first stage procedure for adjusting the pulmonary flow. Staged repair is a useful strategy for infants with complex TA. PMID:23714656

  8. Progression of Aortic Arch Calcification Over 1 Year Is an Independent Predictor of Mortality in Incident Peritoneal Dialysis Patients

    PubMed Central

    Lee, Mi Jung; Shin, Dong Ho; Kim, Seung Jun; Oh, Hyung Jung; Yoo, Dong Eun; Ko, Kwang Il; Koo, Hyang Mo; Kim, Chan Ho; Doh, Fa Mee; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae-Hyun; Choi, Kyu Hun; Kang, Shin-Wook

    2012-01-01

    Backgrounds and Aims The presence and progression of vascular calcification have been demonstrated as important risk factors for mortality in dialysis patients. However, since the majority of subjects included in most previous studies were hemodialysis patients, limited information was available in peritoneal dialysis (PD) patients. Therefore, the aim of this study was to investigate the prevalence of aortic arch calcification (AoAC) and prognostic value of AoAC progression in PD patients. Methods We prospectively determined AoAC by chest X-ray at PD start and after 12 months, and evaluated the impact of AoAC progression on mortality in 415 incident PD patients. Results Of 415 patients, 169 patients (40.7%) had AoAC at baseline with a mean of 18.1±11.2%. The presence of baseline AoAC was an independent predictor of all-cause [Hazard ratio (HR): 2.181, 95% confidence interval (CI): 1.336–3.561, P = 0.002] and cardiovascular mortality (HR: 3.582, 95% CI: 1.577–8.132, P = 0.002). Among 363 patients with follow-up chest X-rays at 12 months after PD start, the proportion of patients with AoAC progression was significantly higher in patients with baseline AoAC (64.2 vs. 5.3%, P<0.001). Moreover, all-cause and cardiovascular death rates were significantly higher in the progression groups than in the non-progression group (P<0.001). Multivariate Cox analysis revealed that AoAC progression was an independent predictor for all-cause (HR: 2.625, 95% CI: 1.150–5.991, P = 0.022) and cardiovascular mortality (HR: 4.008, 95% CI: 1.079–14.890, P = 0.038) in patients with AoAC at baseline. Conclusions The presence and progression of AoAC assessed by chest X-ray were independently associated with unfavorable outcomes in incident PD patients. Regular follow-up by chest X-ray could be a simple and useful method to stratify mortality risk in these patients. PMID:23144974

  9. 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

  10. 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.

  11. Relationship between hemodynamics and atherosclerosis in aortic arches of apolipoprotein E-null mice on 129S6/SvEvTac and C57BL/6J genetic backgrounds

    PubMed Central

    Tomita, Hirofumi; Hagaman, John; Friedman, Morton H.; Maeda, Nobuyo

    2011-01-01

    Objective We investigated the relationships between hemodynamics and differential plaque development at the aortic arch of apolipoprotein E (apoE)-null mice on 129S6/SvEvTac (129) and C57BL/6J (B6) genetic backgrounds. Methods Mean flow velocities at the ascending and descending aorta (mVAA and mVDA) were measured by Doppler ultrasound in wild type and apoE-null male mice at 3 and 9 months of age. Following dissection of the aortic arches, anatomical parameters and plaque areas were evaluated. Results Arch plaques were five times bigger in 129-apoE than in B6-apoE mice at 3 months, and twice as large at 9 months. The geometric differences, namely larger vessel diameter in the B6 strain and broader inner curvature of the aortic arch in the 129 strain, were exaggerated in 9-month-old apoE-null mice. Cardiac output and heart rate under anesthesia were significantly higher in the B6 strain than in the 129 strain. The values of mVAA were similar in the two strains, while mVDA was lower in the 129 strain. However, there was a 129-apoE-specific reduction of flow velocities with age, and both mVAA and mVDA were significantly lower in 129-apoE than in B6-apoE mice at 9 months. The mean relative wall shear stress (rWSS) over the aortic arch in 129-apoE and B6-apoE mice were not different, but animals with lower mean rWSS had larger arch plaques within each strain. Conclusions The plaque formation in the arch of apoE-null mice is accompanied by strain-dependent changes in both arch geometry and hemodynamics. While arch plaque sizes negatively correlate with mean rWSS, additional factors are necessary to account for the strain differences in arch plaque development. PMID:22078246

  12. Right-sided aortic arch: surgical treatment of an aneurysm arising from a Kommerell's diverticulum and extending to the descending thoracic aorta with an aberrant left subclavian artery.

    PubMed

    Caus, T; Gaubert, J Y; Monties, J R; Moulin, G; Mouly, A; Cornen, A; Mesana, T

    1994-02-01

    The case of a 44-year-old black man who presented with severe dysphagia, cough and chest pain caused by a 12-cm aneurysm developing from a Kommerell's diverticulum at the origin of an aberrant retro-oesophageal left subclavian artery is reported. The aortic arch and descending thoracic aorta were right sided. Diagnosis was established before operation by computed tomography, magnetic resonance imaging and arteriography. The aneurysm extended a considerable distance down the descending aorta and therefore the risk of postoperative paraplegia was considered to be high. Accordingly selective arteriography was performed to locate the Adamkievicz's artery which arose only 2 cm below the end of the aneurysm. Resection grafting of the aneurysm including the upper third of the descending aorta via right thoractomy was performed. The patient made an uneventful recovery and was discharged 20 days later. This case appears to be the first successful operation for this pathology.

  13. [The surgical correction of the right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum--a rare case from clinical practice].

    PubMed

    Baev, B; Nachev, G; Chirkov, A

    1995-01-01

    Reports on the surgical management of the vascular ring formed by the right aortic arch with aberrant retroesophageal left subclavian artery and left ligamentum arteriosum are relatively few. The authors present a case of a thirty-three-year old woman with cough, dysphonia and stridor without dysphagia. Surgical management which was performed through a bilateral thoracotomy with transversal sternotomy, included division of the ligamentum arteriosum and of the aberrant left subclavian artery and suture of the latter. There was no need to resect the Kommerell's diverticulum, because of lack of any dysphagia despite of the well documented severe compression of the esophagus. The authors experience proved that in difficult cases the bilateral thoracotomy and transversal sternotomy is an useful approach to perform complete surgical repair of this abnormality.

  14. Endovascular exclusion of complex postsurgical aortic arch pseudoaneurysm using vascular plug devices and a review of vascular plugs.

    PubMed

    Verma, Himanshu; Hiremath, Niranjan; Maiya, Shreesha; George, Robbie K; Tripathi, Ramesh K

    2012-12-01

    We report the management of a patient presenting with haemoptysis due to aortobronchial fistula. He had previously undergone emergency exclusion bypass of a ruptured pseudoaneurysm developing post-aortic coarctation repair. Computed tomography scan showed persistent filling of pseudoaneurysm sac from proximal and distal aortic ligature sites tied during previous exclusion bypass surgery. Successful exclusion of aneurysm was achieved by using 3 vascular plug devices (1 Amplatzer plug II and 2 Amender patent ductus arteriosus occluder devices). We also review types of Amplatzer vascular plugs and their use in peripheral vascular interventions.

  15. Congenital stridor and wheezing as harbingers of the del22q11.2 syndrome presenting cardiovascular malformations of right aortic arch, aberrant left subclavian artery, Kommerell's diverticulum, and left ligamentum arteriosum.

    PubMed

    Lee, Meng-Luen; Chen, Ming; Tsao, Lon-Yen; Chiu, Han-Yao; Chiu, Ing-Sh; Yang, Albert D; Tsai, Pei-Ling

    2011-01-01

    A complete vascular ring composed of right aortic arch, aberrant left subclavian artery with Kommerell's diverticulum, and left ligamentum arteriosum was diagnosed by barium esophagography, echocardiography, angiography, and multidetector computed tomography of chest in an 18-day-old male neonate who presented with remarkable inspiratory stridor, expiratory wheezing, postprandial vomiting, and dysphagia since birth, and survived surgical division of the left ligamentum arteriosum, resection of the Kommerell's diverticulum, and reimplanation of the left subclavian artery to the left common carotid artery. Cytogenetic analysis and fluorescence in situ hybridization study of his blood revealed chromosome 22q11.2 deletion, with a karyotype of 46,XY.ish del(22)(q11.2 q11.2). A constellation of right aortic arch, aberrant left subclavian artery with Kommerell's diverticulum, and left ligamentum arteriosum in neonates may cause refractory stridor, wheezing, vomiting, and dysphagia, which can serve as harbingers of the del22q11.2 syndrome.

  16. Is moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion superior to deep hypothermic circulatory arrest in elective aortic arch surgery?

    PubMed

    Poon, Shi Sum; Estrera, Anthony; Oo, Aung; Field, Mark

    2016-09-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether moderate hypothermia circulatory arrest with selective antegrade cerebral perfusion (SACP) is more beneficial than deep hypothermic circulatory arrest in elective aortic arch surgery. Altogether, 1028 papers were found using the reported search, of which 6 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. There were four retrospective observational studies, one prospective randomized controlled trial and one meta-analysis study. There were no local or neuromuscular complications related to axillary arterial cannulation reported. In the elective setting, four studies showed that the in-hospital mortality for moderate hypothermia is consistently low, ranging from 1.0 to 4.3%. In a large series of hemiarch replacement comparing 682 cases of deep hypothermia with 94 cases of moderate hypothermia with SACP, 20 cases (2.8%) of permanent neurological deficit were reported, compared to 3 cases (3.2%) in moderate hypothermia. Three observational studies and a meta-analysis study did not identify an increased risk of postoperative renal failure and dialysis following either deep or moderate hypothermia although a higher incidence of stroke was reported in the meta-analysis study with deep hypothermia (12.7 vs 7.3%). Longer cardiopulmonary bypass time and circulatory arrest time were reported in four studies for deep hypothermia, suggesting an increased time required for systemic cooling and rewarming in that group. Overall, these findings suggested that in elective aortic arch surgery, moderate hypothermia with selective antegrade cerebral perfusion adapted to the duration of circulatory arrest can be performed safely with acceptable mortality and morbidity outcomes. The risk of spinal cord

  17. 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

  18. Modified Arch-First Technique Performed on a Beating Heart for an Arch Aneurysm with Atheromatous Plaques

    PubMed Central

    2013-01-01

    A shaggy aorta with unstable atheromatous plaques has a high risk of neurologic complications in cases of arch aneurysm. We report the use of a modified arch-first technique involving arch replacement for a beating heart after reconstruction of supra-aortic vessels while maintaining normal blood pressure. The procedure was performed in a patient who had an arch aneurysm, complicated by an aberrant right subclavian artery (ARSA) and a shaggy aorta ascending to the aortic arch. This modified arch-first technique is an alternative surgical approach that is used for arch aneurysms involving a shaggy aorta, in order to prevent embolic debris-related complications. PMID:23825510

  19. [Peritoneal dialysis in a patient with right hemiparesis, lupus nephritis, significant insufficiency of arteries of aortic arch and celiac disease: case report].

    PubMed

    Altabas, Karmela; Crne, Natasa; Franjić, Björn Dario; Pavlović, Drasko; Josipović, Josipa

    2012-10-01

    Peritoneal dialysis (PD) is a method of choice in patients in whom there are difficulties concerning creation of AV fistula. A 38-year old female patient came to our hospital because of a need of making an AV fistula. She had end-stage renal insufficiency of unknown origin. She had a right hemiparesis with a contracture of the right fist and epilepsy because of the stroke she suffered in 1993. After doing the diagnostics, we have found that patient had lupus nephritis, occlusion of brachiocephalic trunk, right and left common carotid artery and left subclavian artery. We also diagnosed celiac disease and a significant anemia. It was not possible to form an AV fistula, as it was not possible to do an assisted PD. Because of the right hemiparesis and contracture of the right fist, the possibility of performing PD independently was questionable. Despite the handicap, the patient had strong motivation and she managed to master the technique of PD independently. Even though it was estimated that she had a high risk score for applying anesthesia (ASA IV), the insertion of the peritoneal catheter went without complications. Because of the comorbidity, especially because of the significant stenosis and occlusions of the arteries of aortic arch, the kidney transplantation will not be performed. In the last fifteen months, the patient is performing PD independently, without any infectious complications, she is feeling well and is satisfied with the quality of her life. The consequences of the renal insufficiency are under control, systemic lupus erythematosus is, with a low dose of corticosteroids, in a steady state, malnutrition is corrected, but there is still hypoalbuminemia noted.

  20. 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

  1. 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.

  2. 168. GENERAL VIEW FROM 5TH AVE. VIEW SOUTH, ACROSS 5TH ...

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

    168. GENERAL VIEW FROM 5TH AVE. VIEW SOUTH, ACROSS 5TH AVE., TOWARD BUILDING 506 (ON LEFT) AND BUILDING 435. - Quonset Point Naval Air Station, Roger Williams Way, North Kingstown, Washington County, RI

  3. 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

  4. 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

  5. An unusual constellation of congenital malformations in a single patient including partial anomalous pulmonary venous return, persistent left superior vena cava, aberrant pulmonary fissure, anomalous aortic arch, tracheal diverticulum and annular pancreas.

    PubMed

    Lapa, T; Vedelago, J; Kim, H; Patrick, E

    2014-10-31

    We report a case of a male patient with a constellation of rare congenital anomalies consisting of: partial anomalous pulmonary venous return (PAPVR), persistent left superior vena cava, 'bovine arch' aortic branching, tracheal diverticulum, aberrant lung fissure anatomy and an annular pancreas. He had presented with a history of worsening dyspnoea. To the best of our knowledge, this is the first reported case of a single patient with such a vast constellation of anomalies. The radiological evaluations, epidemiology, embryology and clinical features of the anomalies are discussed. It is important for radiologists to be aware of each of these anomalies as distinct entities; detection of a single anomaly should alert to the possibility that further anatomic aberrancies may be present.

  6. Kids & Family Reading Report™. 5th Edition

    ERIC Educational Resources Information Center

    Scholastic Inc., 2015

    2015-01-01

    This report presents the 5th Edition of Scholastic's biannual study of children's and parents' attitudes and behaviors about reading. The latest research touches on reading aloud to children of all ages, the impact of reading independently for fun at school and at home, the importance of frequent reading, and the books children want most to read.…

  7. Genetics, Pregnancy, and Aortic Degeneration.

    PubMed

    Crawford, Jeffrey D; Hsieh, Cindy M; Schenning, Ryan C; Slater, Matthew S; Landry, Gregory J; Moneta, Gregory L; Mitchell, Erica L

    2016-01-01

    We present a case of familial thoracic aortic aneurysm and dissection (FTAAD) in a pregnant female. FTAAD is an inherited, nonsyndromic aortopathy resulting from several genetic mutations critical to aortic wall integrity have been identified. One such mutation is the myosin heavy chain gene (MYH11) which is responsible for 1-2% of all FTAAD cases. This mutation results in aortic medial degeneration, loss of elastin, and reticulin fiber fragmentation predisposing to TAAD. Aortic disease is more aggressive during pregnancy as a result of increased wall stress from hyperdynamic cardiovascular changes and estrogen-induced aortic media degeneration. Our patient was a 29-year-old G2P1 woman at 26 weeks gestation presenting with abdominal and back pain. Work-up revealed a 6.4-cm ascending aortic aneurysm with a type A dissection extending into all arch vessels, aortic coarctation at the isthmus, and a separate focal type B aortic dissection with visceral involvement. Surgical management included concomitant cesarean section with delivery of a live premature infant, tubal ligation, ascending aortic replacement with reconstruction of the arch vessels, and aortic valve resuspension. The type B dissection was managed medically without complication. This is the first reported case of aortic dissection in a patient with FTAAD/MYH11 mutation and pregnancy. This case highlights that FTAAD and pregnancy cause aortic degeneration via distinct mechanisms and that hyperdynamics of pregnancy increase aortic wall stress. Management of pregnancy associated with aortopathy requires early transfer to a tertiary center, careful investigation to identify familial aortopathy, fetal monitoring, and a multidisciplinary team approach. PMID:26381327

  8. Hybrid Endovascular Repair for an Arch Aneurysm Combined with Aberrant Right Subclavian Artery

    PubMed Central

    Higashiue, Shinichi; Kuroyanagi, Satoshi; Furuya, Onichi; Naito, Shiho; Kojima, Saburo

    2015-01-01

    This report describes a hybrid endovascular approach to a 9.3-cm saccular aneurysm of the left sided aortic arch combined with an aberrant right subclavian artery. The two-step procedure consisted of a bilateral carotid-subclavian bypass, followed by an ascending aorta-bicarotid bypass and completed by an endovascular exclusion of the aneurysm by covering the whole aortic arch and its branches. The patient had no postoperative complications and was discharged 10 postoperative day. Hybrid procedures may be useful in complex aortic arch pathologies and may reduce postoperative complications in comparison with conventional open surgery. PMID:25848437

  9. Neuroprotection during aortic surgery.

    PubMed

    Lindsay, Helen; Srinivas, Coimbatore; Djaiani, George

    2016-09-01

    Neurological injury is a major limitation of aortic surgery, whether it involves spinal cord injury following intervention to the thoracoabdominal aorta, or stroke following surgery on the arch and ascending aorta. Despite an extensive body of literature and various proposals, a completely effective strategy to prevent or treat neurological injury remains elusive. In this article, we summarise the evidence for established and emerging strategies, and review current concepts in pathophysiology and risk assessment as they relate to neurological injury. PMID:27650340

  10. Multi-mode heterodyned 5th-order infrared spectroscopy

    NASA Astrophysics Data System (ADS)

    Leger, Joel D.; Varner, Clyde; Rubtsov, Igor V.

    2016-10-01

    Fifth-order multidimensional infrared spectroscopy with heterodyned detection was carried out in the three-beam dual-frequency configuration. Numerous 5th-order cross peaks were detected for the 4-azidobutyrate-N-hydroxysuccinimide ester compound in solution involving several vibrational modes ranging in frequency from 1045 to 2100 cm-1. Cross peaks involving overtones (2X/Z) and combination bands (XY/Z) among the tags, modes X and Y excited by the first two mid-IR laser pulses, and the reporter, modes Z excited by the third laser pulse, were acquired and the factors affecting the amplitude of 5th-order cross peaks are discussed. The 5th-order cross peaks were detected among modes that are spatially close (a few bonds apart) as well as for modes spatially separated by ca. 12 Å (eight bonds apart). In both cases, the waiting time dependences for the 3rd and 5th order cross peaks were found to be different. In particular, the waiting time at which the cross-peak maximum is reached, the decay time, and the value of a plateau at large waiting times were all differing strongly. The differences are explained by reduced sensitivity of the 5th-order signals to modes coupled weakly to the reporter mode and different relaxation dynamics involving overtone state of the tag. The ability of the 5th-order peaks to single out the modes coupled strongly to the reporter can help identifying specific energy relaxation and transport pathways, which will be useful for understanding energy transport dynamics in molecules. The absorptive 5th-order cross peaks were constructed which report on three-point correlation functions. It is shown that in addition to the triple-frequency correlation functions, a correlation of the frequencies with the mode coupling (anharmonicity) can be naturally measured by the 5th-order spectroscopy. The current limit for detecting 5th-order signals was estimated at the level of 1 × 10-3 in reduced anharmonicity, which is determined by the corresponding two

  11. Hybrid treatment of penetrating aortic ulcer.

    PubMed

    Lara, Juan Antonio Herrero; Martins-Romêo, Daniela de Araújo; Escudero, Carlos Caparrós; Vázquez, Rosa María Lepe; Falcón, María Del Carmen Prieto; Batista, Vinicius Bianchi

    2015-01-01

    Penetrating atherosclerotic aortic ulcer is a rare entity with poor prognosis in the setting of acute aortic syndrome. In the literature, cases like the present one, located in the aortic arch, starting with chest pain and evolving with dysphonia, are even rarer. The present report emphasizes the role played by computed tomography in the diagnosis of penetrating atherosclerotic ulcer as well as in the differentiation of this condition from other acute aortic syndromes. Additionally, the authors describe a new therapeutic approach represented by a hybrid endovascular surgical procedure for treatment of the disease.

  12. Quadricuspid aortic valves.

    PubMed

    Timperley, Jonathan; Milner, Robert; Marshall, Andrew J; Gilbert, Timothy J

    2002-12-01

    Quadricuspid aortic valves (QAV) are a rare but well recognized cause of significant aortic regurgitation. The first case was found reported in 1862. Since then there have been 110 reported cases of QAV and we report 4 more. Previously, these were diagnosed at the time of surgery or postmortem examination. With advances in echocardiography, including harmonic imaging, and also the advent of transesophageal echocardiography, more cases are being diagnosed prior to surgery. We describe four more cases, three diagnosed preoperatively and one at the time of surgery, and then review the previously reported cases. Of the 114 cases reported, 46 had the aortic valve replaced, most commonly in the 5th and 6th decade of life. Hurwitz and Roberts classified quadricuspid valves according to the size of the leaflets. It has previously been believed that QAVs with four equal sized leaflets were less likely to develop significant aortic regurgitation; however, on review of the available cases, this would not appear to be the case. The preoperative diagnosis of QAVs is important as they can be associated with abnormally placed coronary ostium. Of the 114 cases reported, there are 10 reports of abnormally placed ostia. There has been at least one reported case of death occurring because of obstruction of an abnormally placed right coronary ostium by a prosthetic aortic valve.

  13. 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

  14. 5th Latin American pesticide residue workshop (LAPRW 2015)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    This invited editorial proceedings article introduces the 6 research papers published in the special topical collection for the 5th Latin American Pesticide Residue Workshop held in Santiago, Chile, May 10-13, 2015. The meeting was a great success with more than 50 talks, 140 posters, 21 vendors, a...

  15. Are You a Reader? 5th Graders Respond

    ERIC Educational Resources Information Center

    Barone, Diane; Barone, Rebecca

    2016-01-01

    The author tells the story of a 5th-grade teacher who challenges her class to take on self-identities as readers. Students defined seven characteristics of what it means to be a good reader and considered whether those characteristics applied to them: Good readers read for fun, talk about books, usually finish the book they're reading, can relate…

  16. 5th Conference on Aerospace Materials, Processes, and Environmental Technology

    NASA Technical Reports Server (NTRS)

    Cook, M. B. (Editor); Stanley, D. Cross (Editor)

    2003-01-01

    Records are presented from the 5th Conference on Aerospace Materials, Processes, and Environmental Technology. Topics included pollution prevention, inspection methods, advanced materials, aerospace materials and technical standards,materials testing and evaluation, advanced manufacturing,development in metallic processes, synthesis of nanomaterials, composite cryotank processing, environmentally friendly cleaning, and poster sessions.

  17. Working Together for Student Achievement. 5th Biennial Joint Report

    ERIC Educational Resources Information Center

    Washington State Board of Education, 2014

    2014-01-01

    The Washington state Board of Education (SBE) and the Professional Educator Standards Board (PESB) submitted this 5th biennial joint report to the Governor, Legislative Education Committees, and Superintendent of Public Instruction. The report outlines the collaborative work of the Boards, highlights accomplishments, and provides goals and…

  18. Guilt by association: paradigm for detecting a silent killer (thoracic aortic aneurysm)

    PubMed Central

    Elefteriades, John A; Sang, Adam; Kuzmik, Gregory; Hornick, Matthew

    2015-01-01

    Recent studies have confirmed a close association between various medical conditions (intracranial aneurysm, abdominal aortic aneurysm, temporal arteritis, autoimmune disorder, renal cysts), certain aortic anatomic variants (bovine aortic arch, direct origin of left vertebral artery from aortic arch, bicuspid aortic valve), and family history of aneurysm disease with thoracic aortic aneurysm and dissection. This paper reviews these associations. We propose to capitalise on these associations as powerful and expanding opportunities to diagnose the virulent but silent disease of thoracic aortic aneurysm. This can be accomplished by recognition of this ‘guilt by association’ with the other conditions. Thus, patients with associated diseases and anatomic variants should be investigated for silent aortic aneurysms. Such a paradigm holds substantial potential for reducing death from the silent killer represented by thoracic aortic aneurysm disease. PMID:25932333

  19. Modified cuffed anastomosis technique to treat pseudoaneurysms following thoracic endovascular aortic repair

    PubMed Central

    Matsuo, Satoshi; Oda, Katsuhiko; Motoyoshi, Naotaka; Saiki, Yoshikatsu

    2012-01-01

    Pseudoaneurysm after thoracic endovascular aortic repair (TEVAR) is very rare. We report a case of thoracic aortic pseudoaneurysms due to flares at the proximal end of a stent graft after TEVAR for ductal aneurysm. We describe a total aortic arch replacement in this case using a modified cuffed anastomosis technique with an elephant trunk procedure leaving the partial stent graft in situ. PMID:22314008

  20. 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.

  1. [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)

  2. Unexpected death caused by rupture of a dilated aorta in an adult male with aortic coarctation.

    PubMed

    Leth, Peter Mygind; Knudsen, Peter Thiis

    2015-09-01

    Aortic coarctation (AC) is a congenital aortic narrowing. We describe for the first time the findings obtained by unenhanced post mortem computed tomography (PMCT) in a case where the death was caused by cardiac tamponade from a ruptured aneurysmal dilatation of the ascending aorta and the aortic arch without dissection combined with aortic coarctation. The patient, a 46-year-old man, was found dead at home. PMCT showed haemopericardium and dilatation of the ascending aorta and the aortic arch. This appearance led to the mistaken interpretation that the images represented a dissecting aneurysm. The autopsy showed instead a thin-walled and floppy dilatation of the ascending aorta and aortic arch with a coarctation just proximal to the ligamentum arteriosum. A longitudinal tear was found in the posterior aortic wall just above the valves. Blood in the surrounding soft tissue intersected with a large haematoma (1000ml) in the pericardial sac. Cardiac hypertrophy (556g) was observed in the patient, though no other cardiovascular abnormalities were found. Histological analysis showed cystic medial necrosis of the ascending aortic wall. A ruptured aneurysmal dilatation of the ascending aorta and the aortic arch without aortic dissection associated with AC is an uncommon cause of haemopericardium that has only been described a few times before. The case is discussed in relation to other reported cases and in the context of the present understanding of this condition.

  3. Dental arch asymmetry

    PubMed Central

    Al-Zubair, Nabil Muhsen

    2014-01-01

    Objective: This study was conducted to assess the dental arch asymmetry in a Yemeni sample aged (18-25) years. Materials and Methods: The investigation involved clinical examination of 1479 adults; only 253 (129 females, 124 males) out of the total sample were selected to fulfill the criteria for the study sample. Study models were constructed and evaluated to measure mandibular arch dimensions. Three linear distances were utilized on each side on the dental arch: Incisal-canine distance, canine-molar distance and incisal-molar distance, which represent the dental arch segmental measurements. Results: When applying “t-test” at P < 0.05, no significant differences were found between the right and left canine-molar, incisal-canine and incisal-molar distances in both dental arches for both sexes. The greater variation (0.30 mm) was observed between right and left canine-molar distance in the maxillary dental arch in male and the smaller (0.04 mm) in the mandibular dental arch between the right and left canine-molar distance in females. Conclusion: The findings of the present study revealed a symmetrical pattern of dental arches, since the right and left sides showed no statistically significant difference. In general, it can be observed that the measurements related to the central incisors and canines have the widest range of reading and give the impression that the location of central incisor and canines to each other and to other teeth is the strongest factor in determining the dental arch asymmetry. PMID:24966774

  4. [Aortic vascular anomalies and Kommerell's diverticulum, an imagiologic diagnosis].

    PubMed

    Mascarenhas, Vasco; Marques, Hugo; Valentim, Hugo; Guerra, Adalgisa; Afonso, P Diana; Ventura, Carlos; Gaspar, Augusto

    2012-01-01

    Aortic vascular anomalies are complex anatomic entities requiring often complex and problematic surgical approaches. The authors report the clinical case of a Kommerell's diverticulum and right-sided aortic arch. Right-sided aortic arch is an uncommon congenital defect of the aorta and it is rare in the setting of an otherwise normal heart. A right-sided aortic arch was described more than two centuries ago. Several classifications of these anomalies have been proposed on the basis of the arrangement of the arch vessels, relationships with the esophagus, or the presence of congenital heart anomalies. In the adult population, a right-sided aortic arch is often asymptomatic, unless aneurismal disease develops. This usually occurs at the level of the take-off of an aberrant left subclavian artery and is known as a Kommerell's diverticulum. In spite of its rarity, this condition is clinically relevant due to the mortality associated with rupture, morbidity caused by compression of mediastinal structures, and complexity of surgery.

  5. 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...

  6. 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

  7. [Chronic type A aortic dissection associated with Turner syndrome; report of a case].

    PubMed

    Tanaka, Hideyuki; Kozaki, Tomofumi; Kume, Masazumi; Miyamoto, Shinji

    2014-12-01

    Aortic dissection is a critical but rare complication of Turner syndrome. This report describes a case of chronic aortic dissection in a patient with Turner syndrome. A 54-year-old woman, suffering from mild back pain for 1 month, was referred to our hospital with a diagnosis of Stanford type A chronic aortic dissection and a bicuspid aortic valve with moderate regurgitation. Computed tomography revealed aortic dissection, involving all arch branches, extending from the ascending to the abdominal aorta. The true lumen of the brachial artery was nearly obstructed by the thrombosed false lumen. Elective aortic arch repair and aortic valve replacement were successfully performed. The patient was diagnosed with 45, XO Turner syndrome after surgery. Taking aortopathy of Turner syndrome into consideration, surveillance of the residual aorta was performed. No rapidly progressive dilatation of the residual aorta was detected during the 6 years' follow-up.

  8. Unreliability of aortic size index to predict risk of aortic dissection in a patient with Turner syndrome

    PubMed Central

    Nijs, Jan; Gelsomino, Sandro; Lucà, Fabiana; Parise, Orlando; Maessen, Jos G; Meir, Mark La

    2014-01-01

    Aortic size index (ASI) has been proposed as a reliable criterion to predict risk for aortic dissection in Turner syndrome with significant thresholds of 20-25 mm/m2. We report a case of aortic arch dissection in a patient with Turner syndrome who, from the ASI thresholds proposed, was deemed to be at low risk of aortic dissection or rupture and was not eligible for prophylactic surgery. This case report strongly supports careful monitoring and surgical evaluation even when the ASI is < 20 mm/m2 if other significant risk factors are present. PMID:24944765

  9. An unusual constellation of congenital malformations in a single patient including partial anomalous pulmonary venous return, persistent left superior vena cava, aberrant pulmonary fissure, anomalous aortic arch, tracheal diverticulum and annular pancreas

    PubMed Central

    Lapa, T; Vedelago, J; Kim, H; Patrick, E

    2014-01-01

    We report a case of a male patient with a constellation of rare congenital anomalies consisting of: partial anomalous pulmonary venous return (PAPVR), persistent left superior vena cava, ‘bovine arch’ aortic branching, tracheal diverticulum, aberrant lung fissure anatomy and an annular pancreas. He had presented with a history of worsening dyspnoea. To the best of our knowledge, this is the first reported case of a single patient with such a vast constellation of anomalies. The radiological evaluations, epidemiology, embryology and clinical features of the anomalies are discussed. It is important for radiologists to be aware of each of these anomalies as distinct entities; detection of a single anomaly should alert to the possibility that further anatomic aberrancies may be present. PMID:25362184

  10. 167. GENERAL VIEW DOWN 5TH AVE. VIEW TO SOUTHWEST DOWN ...

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

    167. GENERAL VIEW DOWN 5TH AVE. VIEW TO SOUTHWEST DOWN 5TH AVE. SHOWING FROM LEFT TO RIGHT, BUILDING 504, 436, 11, AND 155. - Quonset Point Naval Air Station, Roger Williams Way, North Kingstown, Washington County, RI

  11. Combined surgical and catheter-based treatment of extensive thoracic aortic aneurysm and aortic valve stenosis.

    PubMed

    De Backer, Ole; Lönn, Lars; Søndergaard, Lars

    2015-02-15

    An extensive thoracic aortic aneurysm (TAA) is a potentially life-threatening condition and remains a technical challenge to surgeons. Over the past decade, repair of aortic arch aneurysms has been accomplished using both hybrid (open and endovascular) and totally endovascular techniques. Thoracic endovascular aneurysm repair (TEVAR) has changed and extended management options in thoracic aorta disease, including in those patients deemed unfit or unsuitable for open surgery. Accordingly, transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with symptomatic severe aortic valve stenosis (AS) who are considered at high risk for surgical aortic valve replacement. In this report, we describe the combined surgical and catheter-based treatment of an extensive TAA and AS. To our knowledge, this is the first report of hybrid TAA repair combined with TAVR.

  12. PREFACE: 5th Baltic Conference on Silicate Materials

    NASA Astrophysics Data System (ADS)

    Mezinskis, G.; Bragina, L.; Colombo, P.; Frischat, G. H.; Grabis, J.; Greil, P.; Deja, J.; Kaminskas, R.; Kliava, J.; Medvids, A.; Nowak, I.; Siauciunas, R.; Valancius, Z.; Zalite, I.

    2011-12-01

    Logo This Volume of IOP Conference Series: Materials Science and Engineering presents a selection of the contributions to the 5th Baltic Conference on Silicate Materials (BaltSilica2011) held at Riga Technical University, Riga, Latvia from 23-25 May 2011. The conference was organized by Riga Technical University (Latvia) and Kaunas University of Technology (Lithuania). The series of Baltic conferences on silicate materials was started since 2004: the first conference was held in Riga, Latvia, 2004; the second conference was held in Kaunas, Lithuania 2005; the third was held again in Riga, Latvia, 2007, and the fourth was held in Kaunas, Lithuania 2009. BaltSilica 2011 was attended by around 50 participants from Latvia, Lithuania, Estonia, Germany, Poland, Italy, France, Ukraine and Russia. In comparison with previous silicate materials conferences, the broadening of participating countries is an indication of the interest of scientists, engineers and students to exchange research ideas, latest results, and to find new research topics for cooperation in the fields of silicate, high temperature materials, and inorganic nanomaterials. The scientific programme included 8 invited plenary lectures 23 oral presentations and 25 posters [1]. Scientific themes covered in the conference and in this special issue: Natural and Artificial Stone Materials; Traditional and New Ceramic and Glass-Like Materials; Nanoparticles and Nanomaterials. This volume consists of 23 selected proceeding papers. The Editor of this special issue is grateful to all the contributors to BaltSilica 2011. I am also very grateful to the scientific committee, the local organizing committee, the session chairs, the referees who refereed the submitted articles to this issue, and to students from the Department of Silicate, High Temperature and Inorganic Nanomaterials Technology of the Riga Technical University who ensured the smooth running of the conference. Particular thanks goes to eight plenary

  13. Mechanism of development of aortic transection: a possible new angle.

    PubMed

    Warwick, R; Mediratta, N; Pullan, M; Chalmers, J; Poullis, M

    2013-03-01

    Aortic transection injury is a frequently fatal injury secondary to sudden deceleration. To date magnitude of deceleration is the only factor known to influence the development of an aortic transection injury. We hypothesise that different 3D geometries of the aortic arch in healthy young adult patients as a possible predisposing factor for transection injuries when undergoing sudden deceleration. We extend this to hypothesise that the direction of deceleration may be important as well. In addition we hypothesise that the stage in the cardiac cycle, which determines central aortic blood pressure, when the deceleration occurs as an important factor. We utilise known engineering principles such as Newton's second Law of motion, moment of inertia, law of Laplace, and the theory of superposition to explain our hypothesis. We present limited data to demonstrate the wide variation in aortic arch 3D geometry to explain the possible an individual's variable susceptibility to transection injuries via the principle of moment of inertia. Engineering principles suggest that 3D aortic arch geometry, direction of deceleration and stage in the cardiac cycle, in addition to the magnitude of deceleration are potentially important factors in predisposing certain individuals in a given situation to aortic transaction injuries.

  14. 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

  15. Managing Haemophilia for Life: 5th Haemophilia Global Summit.

    PubMed

    Hermans, Cedric; Dolan, Gerry; Jennings, Ian; Windyga, Jerzy; Lobet, Sébastien; Rodríguez-Merchán, E Carlos; Di Minno, Matteo Nicola Dario; Jiménez-Yuste, Víctor; O'Mahony, Brian

    2015-10-01

    The 5th Haemophilia Global Summit was held in Barcelona, Spain, in September 2014. The programme was designed by an independent Scientific Steering Committee of haemophilia experts and explored issues relevant to the practical management of haemophilia, as well as key opportunities and challenges for care in the future. The topics outlined in this supplement were selected by the Scientific Steering Committee for their relevance to improving haemophilia care globally. In this supplement from the meeting, Gerry Dolan explores pharmacokinetics and dynamics in haemophilia, and Gerry Dolan and Ian Jennings jointly address the role of the laboratory in haemophilia care. The potential benefits of low-dose prophylaxis regimens for people with haemophilia in the developing world are reviewed by Jerzy Windyga, and the question of whether 'Future haemophilia research should be undertaken in the developing world' is debated by Jerzy Windyga and Cedric Hermans. Management strategies for ankle arthropathy are discussed by Sébastien Lobet and E. Carlos Rodríguez-Merchán, and the use of ultrasound for the early detection of haemophilic arthropathy is addressed by Matteo Nicola Dario Di Minno and Víctor Jiménez-Yuste. Finally, the role of patients in the future of haemophilia care is reviewed by Brian O'Mahony. PMID:26350039

  16. Managing Haemophilia for Life: 5th Haemophilia Global Summit.

    PubMed

    Hermans, Cedric; Dolan, Gerry; Jennings, Ian; Windyga, Jerzy; Lobet, Sébastien; Rodríguez-Merchán, E Carlos; Di Minno, Matteo Nicola Dario; Jiménez-Yuste, Víctor; O'Mahony, Brian

    2015-10-01

    The 5th Haemophilia Global Summit was held in Barcelona, Spain, in September 2014. The programme was designed by an independent Scientific Steering Committee of haemophilia experts and explored issues relevant to the practical management of haemophilia, as well as key opportunities and challenges for care in the future. The topics outlined in this supplement were selected by the Scientific Steering Committee for their relevance to improving haemophilia care globally. In this supplement from the meeting, Gerry Dolan explores pharmacokinetics and dynamics in haemophilia, and Gerry Dolan and Ian Jennings jointly address the role of the laboratory in haemophilia care. The potential benefits of low-dose prophylaxis regimens for people with haemophilia in the developing world are reviewed by Jerzy Windyga, and the question of whether 'Future haemophilia research should be undertaken in the developing world' is debated by Jerzy Windyga and Cedric Hermans. Management strategies for ankle arthropathy are discussed by Sébastien Lobet and E. Carlos Rodríguez-Merchán, and the use of ultrasound for the early detection of haemophilic arthropathy is addressed by Matteo Nicola Dario Di Minno and Víctor Jiménez-Yuste. Finally, the role of patients in the future of haemophilia care is reviewed by Brian O'Mahony.

  17. 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

  18. 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

  19. 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

  20. 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

  1. 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

  2. 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

  3. 5th Austrian Hungarian workshop on celestial mechanics

    NASA Astrophysics Data System (ADS)

    Süli, Áron

    2011-06-01

    The 5th Hungarian-Austrian Workshop on Celestial Mechanics took place from 9th until the 10th of April 2010 in Vienna, Austria. The workshop was held in the Institute for Astronomy of Vienna University. From the Eötvös University and from the host institute experts and PhD students gathered together to discuss the challenges and new results of the actual problems of celestial mechanics. The workshop was held in the meeting room at the Sternwarte of the Vienna University located in a magnificent park in the heart of Vienna. Following the themes of the four previous events the focus for this workshop ranged from the Trojan problem, dynamics in binary star systems and exoplanetray systems. We were pleased to acknowledge the support of the host university. The talks were characterized by a large spectrum, which is typical of the workshops on celestial mechanics. Several talks discussed different aspects of the trojan problem, such as the three Trojan Problem, dynamics of trojan-like planets in binary stars, the frequencies of their motion around the triangular lagrangian points, etc. Several speakers focused on the formation of planetary systems and on the field of exoplanetary systems, like exoplanetary systems in higher order mean motion resonances, formation of planets in binary systems, stability of exomoons etc. Some of the presentation used sophisticated mathematical tools in order to understand mean motion resonances, the Sitnikov problem applying the KAM and the Nekhoroshev theorem. The theme of a number of talks was the motion of Solar System bodies: dynamics of the newly discovered moons of Pluto and of near-Earth asteroids. General problems were also addressed, among others chaos in Hamiltonian systems, adaptive Lie-integration method and iterative solution approximation to the generalised Sitnikov problem.

  4. PREFACE: 5th Workshop of Young Researchers in Astronomy & Astrophysics

    NASA Astrophysics Data System (ADS)

    Forgács-Dajka, Emese; Plachy, Emese; Molnár, László

    2010-04-01

    The 5th Workshop of Young Researchers in Astronomy and Astrophysics was held on 2-4 September 2009 at the Eötvös University in Budapest, Hungary. This meeting fits into a conference series which can already be considered a tradition where the younger generation has the opportunity to present their work. The event was also a great opportunity for senior astronomers and physicists to form new connections with the next generation of researchers. The selection of invited speakers concentrated on the researchers currently most active in the field, mostly on a post-doctoral/tenure/fresh faculty position level. A number of senior experts and PhD students were also invited. As the conference focused on people rather than a specific field, various topics from theoretical physics to planetology were covered in three days. The programme was divided into six sections: Physics of the Sun and the Solar System Gravity and high-energy physics Galactic and extragalactic astronomy, cosmology Celestial mechanics and exoplanets Infrared astronomy and young stars Variable stars We had the pleasure of welcoming 10 invited review talks from senior researchers and 42 contributed talks and a poster from the younger generation. Participants also enjoyed the hospitality of the pub Pál at the Pálvölgyi-cave after giving, hearing and disputing countless talks. Brave souls even descended to the unbuilt, adventurous Mátyásvölgyi-cave. Memories of the conference were shadowed though. Péter Csizmadia, one of our participants and three other climbers attempted a first ever ascent to the Ren Zhong Feng peak in Sichuan, China, but they never returned from the mountains. Péter departed to China shortly after the conference, with best wishes from participants and friends. We dedicate this volume to his memory. The organisers thankthe Physics Doctoral School of Eötvös University for its hospitality. The workshop was supported by the Mecenatúra and Polányi Mihály Programmes of the National

  5. 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 ...

  6. 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, ...

  7. Aortic Aneurysm

    MedlinePlus

    ... these occur in the part of the aorta running through the chest Abdominal aortic aneurysms (AAA) - these occur in the part of the aorta running through the abdomen Most aneurysms are found during ...

  8. Assessment of Perfusion toward the Aortic Valve Using the New Dispersion Aortic Cannula during Coronary Artery Bypass Surgery

    PubMed Central

    Grooters, Ronald K.; Thieman, Kent C.; Schneider, Robert F.; Nelson, Mark G.

    2000-01-01

    When there is an echocardiographic diagnosis of severe mobile atherosclerotic plaque in the aortic arch or descending aorta, perfusion toward the aortic arch during cardiopulmonary bypass may create a high risk of embolic neurologic injury. Other perfusion methods, such as cannulation of the femoral or axillary arteries, are not always possible, due to atherosclerosis. The ascending aorta may be an alternative site for perfusion, since it is less frequently diseased. We assessed a new technique of perfusion toward the aortic valve using a new cannula designed for this purpose (Dispersion aortic cannula). Our study included 100 consecutive patients, 72 men and 28 women, with an average age of 68 ± 1.0 years (range, 39–89 years). There were no complications related to insertion of the cannula or perfusion. The ascending aorta could be cross-clamped and side-clamped without perfusion problems. Three deaths occurred; none was related to the cannulation technique. No intra-operative stroke occurred. Two patients suffered neurologic events, one on day 1 and the other on day 6; both had been fully alert after surgery. Perfusion toward the aortic valve appears to be safe and hemodynamically effective. This cannulation technique appears to be an acceptable alternative to present methods. Comparative studies will be needed to determine whether this alternative technique is effective in patients with severe aortic arch disease. PMID:11198309

  9. Combined surgical and endovascular approach to treat a complex aortic coarctation without extracorporeal circulation.

    PubMed

    Carrel, Thierry P; Berdat, Pascal A; Baumgartner, Iris; Dinkel, Hans-Peter; Schmidli, Jürg

    2004-10-01

    Various therapeutic approaches have been proposed to treat complex coarctation of the aorta (eg, recoarctation, which requires repetitive interventions, or coarctation with a hypoplastic aortic arch). Resection followed by end-to-end anastomosis or by graft interposition is technically demanding and exposes the patient to considerable perioperative risks. Cardiopulmonary bypass and deep hypothermic circulatory arrest may be necessary to control the distal aortic arch. The role of stent technology in treating this type of lesion has not yet been defined. We present a 21-year-old woman with a recurrent coarctation of the aorta associated with a hypoplastic aortic arch and a pseudoaneurysm of the proximal descending aorta. She had undergone 4 previous interventions. Treatment consisted of a combined surgical and endovascular approach without cardiopulmonary bypass and included extraanatomic aortic bypass, partial debranching of the supraaortic vessels, and stent-graft insertion to exclude the aneurysm.

  10. 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.

  11. 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.

  12. 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/

  13. 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

  14. 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.

  15. [Acute forearm compartment syndrome after total arch replacement].

    PubMed

    Kigawa, Ikutaro; Miyairi, Takeshi; Tanaka, Satona; Unai, Shinya; Miura, Sumio; Ohno, Takayuki; Fukuda, Sachito; Takamoto, Shinichi

    2011-06-01

    A 61-year-old female presented with shortness of breath and was found to have moderate aortic regurgitation with annulo-aortic ectasia and an aneurysm involving the aortic arch. She underwent Bentall operation and total arch replacement with a branched prosthesis. The patient developed hypesthesia and paresis of the left forearm one day after the surgery. Computed tomography revealed complete occlusion of the left subclavian artery (LSA). An emergency operation was performed 15 hours after the initial operation. A new bypass graft to the axillary artery was placed since the LSA was occluded by the wide arterial dissection. However, her left forearm showed rapid swelling within a few hours. Under the diagnosis of acute compartment syndrome (ACS) of the forearm, emergency decompression fasciotomy was performed. She was discharged with a mild dysfunction of her forearm and hand 40 days after the operation. The rapid progression of ACS was thought to have been associated with not only the severe and prolonged ischemia but also the venous obstruction caused by the ligation of left brachiocephalic vein during the initial operation. Immediate and complete decompression, including the deep compartment of the forearm, was essential to achieve a full functional recovery from ACS.

  16. Determination of the Colour Preferences of 5th Grade Students in Relation to Gender

    ERIC Educational Resources Information Center

    Uysal, Hüseyin

    2016-01-01

    The purpose of this research is to determine the colour preferences of 5th grade students in relation to the concept of gender. The study was conducted with the 19 5th grade students studying at Central District of Bartin Province in 2015 to 2016 academic year. Throughout the research, quantitative research method had been used while survey had…

  17. [Aortic aneurysm].

    PubMed

    Villar, Fernando; Pedro-Botet, Juan; Vila, Ramón; Lahoz, Carlos

    2013-01-01

    Aortic aneurysm is one important cause of death in our country. The prevalence of abdominal aortic aneurism (AAA) is around 5% for men older than 50 years of age. Some factors are associated with increased risk for AAA: age, hypertension, hypercholesterolemia, cardiovascular disease and, in particular, smoking. The medical management of patients with an AAA includes cardiovascular risk treatment, particularly smoking cessation. Most of major societies guidelines recommend ultrasonography screening for AAA in men aged 65 to 75 years who have ever smoked because it leads to decreased AAA-specific mortality. PMID:24238836

  18. Temporary extracorporeal bypass modalities during aortic surgery.

    PubMed

    Bassin, Levi; Bell, David

    2016-09-01

    The key to aortic surgery is protection of the brain, heart, spinal cord, and viscera. For operations involving the aortic arch, the focus is on cerebral protection, while for pathology involving the descending thoracic aorta, the focus is on spinal protection. Optimal cerebral and spinal protection requires an extensive knowledge of the operative steps and an understanding of the cardiopulmonary bypass modalities that are possible. A bloodless field is required when operating on the aorta. As a result, periods of ischemia to the central nervous system and end-organ viscera are often unavoidable. The main techniques to mitigate ischemia include hypothermia and selective perfusion of the ischemic organ in question. This chapter will first briefly review bypass modalities and then describe how they can be used for various aortic scenarios. PMID:27650344

  19. Endovascular repair of thoracic aortic aneurysm

    PubMed Central

    Akin, Ibrahim; Kische, Stephan; Rehders, Tim C.; Nienaber, Christoph A.; Rauchhaus, Mathias

    2010-01-01

    A thoracic aortic aneurysm (TAA) is a potentially life-threatening condition with structural weakness of the aortic wall, which can progress to arterial dilatation and rupture. Today, both an increasing awareness of vascular disease and the access to tomographic imaging facilitate the diagnosis of TAA even in an asymptomatic stage. The risk of rupture for untreated aneurysms beyond a diameter of 5.6 cm ranges from 46% to 74% and the two-year mortality rate is greater than 70%, with most deaths resulting from rupture. Treatment options include surgical and non-surgical repair to prevent aneurysm enlargement and rupture. While most cases of ascending aortic involvement are subject to surgical repair (partially with valve-preserving techniques), aneurysm of the distal arch and descending thoracic aorta are amenable to emerging endovascular techniques as an alternative to classic open repair or to a hybrid approach (combining debranching surgery with stent grafting) in an attempt to improve outcomes. PMID:22419919

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. Transcatheter aortic valve implantation: anesthetic considerations.

    PubMed

    Billings, Frederic T; Kodali, Susheel K; Shanewise, Jack S

    2009-05-01

    Aortic valvular stenosis remains the most common debilitating valvular heart lesion. Despite the benefit of aortic valve (AV) replacement, many high-risk patients cannot tolerate surgery. AV implantation treats aortic stenosis without subjecting patients to sternotomy, cardiopulmonary bypass (CPB), and aorta cross-clamping. This transcatheter procedure is performed via puncture of the left ventricular (LV) apex or percutaneously, via the femoral artery or vein. Patients undergo general anesthesia, intense hemodynamic manipulation, and transesophageal echocardiography (TEE). To elucidate the role of the anesthesiologist in the management of transcatheter AV implantation, we review the literature and provide our experience, focusing on anesthetic care, intraoperative events, TEE, and perioperative complications. Two approaches to the aortic annulus are performed today: transfemoral retrograde and transapical antegrade. Iliac artery size and tortuosity, aortic arch atheroma, and pathology in the area of the (LV) apex help determine the preferred approach in each patient. A general anesthetic is tailored to achieve extubation after procedure completion, whereas IV access and pharmacological support allow for emergent sternotomy and initiation of CPB. Rapid ventricular pacing and cessation of mechanical ventilation interrupts cardiac ejection and minimizes heart translocation during valvuloplasty and prosthesis implantation. Although these maneuvers facilitate exact prosthesis positioning within the native annulus, they promote hypotension and arrhythmia. Vasopressor administration before pacing and cardioversion may restore adequate hemodynamics. TEE determines annulus size, aortic pathology, ventricular function, and mitral regurgitation. TEE and fluoroscopy are used for positioning the introducer catheter within the aortic annulus. The prosthesis, crimped on a valvuloplasty balloon catheter, is implanted by inflation. TEE immediately measures aortic regurgitation and

  5. 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

  6. 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 ...

  7. 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

  8. 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

  9. 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.

  10. 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.

  11. 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

  12. [Reconstructive surgery of aortic arch interruption in adults].

    PubMed

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

    2016-01-01

    Актуальность. Перерыв дуги является редкой врожденной аномалией дуги аорты и требует оперативного лечения, так как при естественном течении сопровождается высокой летальностью. Цель — оценка клинических результатов хирургического лечения перерыва дуги аорты у взрослых. Материал и методы. Оперированы 7 пациентов с коарктацией/перерывом дуги аорты. В 2 (28,6%) наблюдениях выполнена аллопластика дуги аорты, в 4 (57,1%) — протезирование дистальной части дуги и начального отдела нисходящей аорты. В 1 (14,3%) наблюдении произведено супракоронарное протезирование восходящего отдела, дуги и начального отдела нисходящей аорты. Все операции выполняли в условиях умеренной гипотермии (25 °С), циркуляторного арреста с унилатеральной перфузией головного мозга через брахицефальный ствол со скоростью перфузии 8—10 мл/кг/мин и поддержанием давления в артериальной магистрали на уровне 69,6±14,7 мм рт.ст. Результаты. Длительность ИК составила 242±36,1 мин, окклюзии аорты — 110,7±40,4 мин, ЦА — 58,6±17,9 мин. В послеоперационном периоде ни в одном наблюдении не отмечено почечной недостаточности, клинических симптомов сосудистого поражения головного и спинного мозга, кардиальных осложнений. В 1 (14,3%) наблюдении была произведена рестернотомия по поводу кровотечения. По данным контрольной МСКТ, выполненной в послеоперационном периоде, обеспечен достаточный просвет нисходящей аорты в 100% наблюдений. Пиковый градиент на нисходящей аорте после аллопластики составил 29±1,4 мм рт.ст., после протезирования аорты — 10±4,2 мм рт.ст. Послеоперационная и госпитальная 30-дневная летальность отсутствовала. Вывод. Радикальные реконструктивные операции при перерыве дуги аорты у взрослых пациентов являются эффективным хирургическим подходом, обеспечивающим хороший клинический и гемодинамический результат операции.

  13. 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.

  14. 6. 5TH FLOOR, VIEW NORTH OF KETTLE SOAP STORAGE TANKS ...

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

    6. 5TH FLOOR, VIEW NORTH OF KETTLE SOAP STORAGE TANKS (RIGHT) AND WEIGH HOPPERS OVER SITES OF REMOVED AMALGAMATORS (LEFT) - Colgate & Company Jersey City Plant, Building No. B-14, 54-58 Grand Street, Jersey City, Hudson County, NJ

  15. 17. 4th floor roof, view south, 4th and 5th floor ...

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

    17. 4th floor roof, view south, 4th and 5th floor setback to left and atrium structure to right - Sheffield Farms Milk Plant, 1075 Webster Avenue (southwest corner of 166th Street), Bronx, Bronx County, NY

  16. 25. April 5th one month's work. View looking north. Storehouse ...

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

    25. April 5th one month's work. View looking north. Storehouse #1 under construction, storehouse #2 site work in progress toward foreground. - U.S. Navy Fleet Supply Base, Storehouse No. 1, 830 Third Avenue, Brooklyn, Kings County, NY

  17. Arches showing UV flaring activity

    NASA Technical Reports Server (NTRS)

    Fontenla, J. M.

    1988-01-01

    The UVSP data obtained in the previous maximum activity cycle show the frequent appearance of flaring events in the UV. In many cases these flaring events are characterized by at least two footpoints which show compact impulsive non-simultaneous brightenings and a fainter but clearly observed arch developes between the footpoints. These arches and footpoints are observed in line corresponding to different temperatures, as Lyman alpha, N V, and C IV, and when observed above the limb display large Doppler shifts at some stages. The size of the arches can be larger than 20 arcsec.

  18. A huge saccular aortic aneurysm compressing right coronary artery 7 years after aortic valve replacement due to bicuspid aortic valve insufficiency

    PubMed Central

    Park, Sang Min; Jeong, Haemin; Hong, Kyung-Soon; Kim, Christopher

    2016-01-01

    Abstract Background: In a patient underwent aortic valve replacement (AVR) due to bicuspid aortic valve (BAV) insufficiency without marked dilation of ascending aorta, the development of delayed-typed aneurysmal complication of ascending aorta has been often reported because the dilated aorta tends to grow insidiously with age. Case summary: A 58-year-old man who underwent AVR with mechanical valve due to severe aortic regurgitation secondary to BAV 7 years previously presented with exertional chest discomfort for 1 year. An echocardiography showed a well-functioning mechanical aortic valve without any significant abnormal findings. Cardiac multidetector computed tomography (MDCT) revealed a huge saccular aortic root aneurysm (79.7 mm × 72.8 mm in size) compressing the proximal right coronary artery resulting in ∼90% eccentric diffuse luminal narrowing. The patient subsequently underwent open-heart surgery with resection of the ascending aortic aneurysmal sac and consecutive ascending aorta and hemi-arch replacement using a graft. Conclusion: After successful AVR in the patient with BAV insufficiency and mildly dilated ascending aorta, a regular aortic imaging such as cardiac MDCT with aortography would be helpful to monitor the morphology and size of ascending aorta and related complications to guide future management. PMID:27749539

  19. 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.

  20. Chylous Ascites after Abdominal Aortic Aneurysm Repair.

    PubMed

    Ohki, Shinichi; Kurumisawa, Soki; Misawa, Yoshio

    2016-01-01

    A 73-year-old man was transferred for treatment of abdominal aortic aneurysm. He had no history of abdominal surgeries. Grafting between the infra-renal abdominal aorta and the bilateral common iliac arteries was performed. Proximal and distal cross clamps were applied for grafting. He developed chylous ascites on the 5th post-operative day, 2 days after initiation of oral intake. Fortunately, he responded to treatment with total parenteral hyper-alimentation for 10 days, followed by a low-fat diet. There was no recurrence of ascites. PMID:27087873

  1. Split-graft technique in neonatal heart transplant for aortic atresia.

    PubMed

    Gil-Jaurena, Juan-Miguel; González-López, María-Teresa; Pita-Fernández, Ana; Pérez-Caballero, Ramón

    2016-10-01

    We describe a neonate with aortic atresia and hypoplastic aorta, listed for heart transplant after extracorporeal membrane oxygenation resuscitation and ductal stenting. The donor aorta was detached from the graft, after an isolated arch reconstruction prior to the transplant itself in a routine fashion. To the best of our knowledge, this is the first reported case of neonatal arch reconstruction before transplantation performed with grafts from the same donor in a split-way strategy.

  2. Split-graft technique in neonatal heart transplant for aortic atresia.

    PubMed

    Gil-Jaurena, Juan-Miguel; González-López, María-Teresa; Pita-Fernández, Ana; Pérez-Caballero, Ramón

    2016-10-01

    We describe a neonate with aortic atresia and hypoplastic aorta, listed for heart transplant after extracorporeal membrane oxygenation resuscitation and ductal stenting. The donor aorta was detached from the graft, after an isolated arch reconstruction prior to the transplant itself in a routine fashion. To the best of our knowledge, this is the first reported case of neonatal arch reconstruction before transplantation performed with grafts from the same donor in a split-way strategy. PMID:27354464

  3. [Surgical Treatment for Kommerell's Diverticulum with Aortic Dissection;Report of a Case].

    PubMed

    Yanagihara, Takayuki; Fukui, Toshihiro; Takanashi, Shuichiro

    2015-05-01

    A 43-year-old man was referred to our hospital with chest pain. Computed tomography revealed thrombosed type B aortic dissection and distal aortic arch aneurysm with maximum diameter of 56 mm accompanied by an aberrant right subclavian artery (Kommerell's diverticulum). After performing anti-hypertensive treatment, we planned surgical treatment the operation. Graft replacement of distal aortic arch aneurysm was performed through left posterolateral thoracotomy with deep hypothermic circulatory arrest. The aberrant right subclavian artery was reconstructed with an interposed graft. Postoperative course was uneventful and he was discharged on the 9th postoperative day. Kommerell's diverticulum with aortic dissection is a relatively rare condition. Here we describe our surgical strategy with a review of the literature.

  4. Surgical Strategy for Thoracic Aortic Pseudoaneurysm with Sternal Adherence

    PubMed Central

    Ito, Tsutomu; Hayashi, Sachiko; Iida, Yasunori; Misumi, Takahiko; Shimizu, Hideyuki

    2016-01-01

    A thoracic aortic pseudoaneurysm is a life-threatening complication following thoracic aortic surgery. We describe a surgical strategy for this pseudoaneurysm with a high risk for rupture during median sternotomy. The pseudoaneurysm was distended and widely adherent to the posterior sternum. Elective cardiopulmonary bypass and moderate hypothermia were established, and sternotomy was performed without left ventricle distention or brain ischemia. Total arch replacement was successful and the patient was discharged on post operative day (POD) 18. A key surgical strategy was to avoid ventricular fibrillation before sternotomy. Appropriate sternotomy timing and perfusion strategy are crucial for successful treatment.

  5. Management of Aortic Replacement-Induced Chylothorax by Lipiodol Lymphography

    PubMed Central

    Yoshitake, Akihiro; Hachiya, Takashi; Inaba, Yu; Tamura, Kentaro; Yashiro, Hideki; Nakatsuka, Seiji; Shimizu, Hideyuki

    2015-01-01

    Chylothorax is a rare but serious complication of thoracic aortic surgery, leading to malnutrition, respiratory insufficiency, and prolonged hospital stay. In this article, we describe the successful treatment of a case of intractable chylothorax by lipiodol lymphography. The patient was a 39-year-old man who underwent descending aortic replacement for a remaining dissected aneurysm after total arch replacement. Chylothorax developed postoperatively. After complete oral intake cessation, total parenteral nutrition, and plasmatic factor XIII administration, lipiodol lymphography detected the chyle leakage location and subsequently decreased pleural effusion. The patient recovered uneventfully and was discharged on postoperative day 30 without any complications. PMID:26131032

  6. 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

  7. Retrograde Embolization of the Left Vertebral Artery in a Type II Endoleak After Endovascular Treatment of Aortic Thoracic Rupture: Technical Note

    SciTech Connect

    Rabellino, Martin; Garcia Nielsen, L.; Baldi, S.; Zander, T.; Arnaiz, L.; Llorens, R.; Zerolo, I.; Maynar, M.

    2009-01-15

    Endoleak is a frequent complication after endovascular repair of aortic rupture. We describe the case of a female patient with traumatic aortic injury, treated with endograft, who developed a type II endoleak through the left subclavian and vertebral arteries. Both arteries originated independently from the aortic arch, and were managed with coil embolization of each vessel. We also report our experience with treating the left vertebral artery by placing a microcatheter through the right vertebral one.

  8. Type F Congenital Quadricuspid Aortic Valve: A Very Rare Case Diagnosed by 3-dimenional Transoesophageal Echocardiography

    PubMed Central

    Garg, Pankaj; Kamaruddin, Hazlyna; Orme, Rachel; Watt, Victoria

    2014-01-01

    Congenital quadricuspid aortic valve (QAV) is a rare cardiac anomaly. Several different anatomical variations of a quadricuspid aortic valve have been described. Aortic regurgitation is the predominant valvular dysfunction associated with QAV and patients tend to present in their 5th or 6th decade of life. This anomaly is rarely picked up by transthoracic echocardiogram (TTE). A comprehensive transoesophageal echocardiography (TOE) study is more likely to diagnose it. We describe a very rare type of QAV – Type F in a 52-year-old lady who presented with symptoms of shortness of breath and pre-syncope. We include TOE images and intra-operative valve images. PMID:24707324

  9. [Intra-operative Acute Aortic Dissection during Aortic Root Reimplantation and Mitral Valve Reconstruction Surgery in a Patient with Marfan Syndrome;Report of a Case].

    PubMed

    Teramoto, Chikao; Kawaguchi, Osamu; Araki, Yoshimori; Yoshikawa, Masaharu; Uchida, Wataru; Takemura, Gennta; Makino, Naoki

    2016-08-01

    In patients with Marfan syndrome, cardiovascular complication due to aortic dissection represents the primary cause of death. Iatrogenic acute aortic dissection during cardiac surgery is a rare, but serious adverse event. A 51-year-old woman with Marfan syndrome underwent elective aortic surgery and mitral valve reconstruction surgery for the enlarged aortic root and severe mitral regurgitation. We replaced the aortic root and ascending aorta based on reimplantation technique. During subsequent mitral valve reconstruction, we found the heart pushed up from behind. Trans-esophageal echocardiography revealed a dissecting flap in the thoracic descending aorta. There was just weak signal of blood flow in the pseudolumen. We did not add any additional procedures such as an arch replacement. Cardio-pulmonary bypass was successfully discontinued. After protamine sulfate administration and blood transfusion, blood flow in the pseudolumen disappeared. The patient was successfully discharged from the hospital on 33th postoperative day without significant morbidities. PMID:27476568

  10. The 5th edition of the Roma-BZCAT. A short presentation

    NASA Astrophysics Data System (ADS)

    Massaro, E.; Maselli, A.; Leto, C.; Marchegiani, P.; Perri, M.; Giommi, P.; Piranomonte, S.

    2015-05-01

    The 5th edition of the Roma-BZCAT Multifrequency Catalogue of Blazars is available in a printed version and online at the ASDC website (http://www.asdc.asi.it/bzcat); it is also in the NED database. It presents several relevant changes with respect to the past editions which are briefly described in this paper.

  11. Oral Persuasion: A Saleable Work Skill. Occupation Simulation Packet. Grades 5th-6th.

    ERIC Educational Resources Information Center

    Lee, Dennis W.

    This teacher's guide contains simulated work experiences for 5th and 6th grade students using the isolated skill concept - oral persuasion. Teacher instructions include objectives, evaluation, and sequence of activities. The guide contains pre-tests and post-tests with instructions and answer keys. Two pre-skill activities are suggested, such as…

  12. A Longitudinal Study of a 5th Grade Science Curriculum Based on the 5E Model

    ERIC Educational Resources Information Center

    Scott, Timothy P.; Schroeder, Carolyn; Tolson, Homer; Huang, Tse-Yang; Williams, Omah M.

    2014-01-01

    The Center for Mathematics and Science Education at Texas A&M University contracted with Region 4 Education Service Center (ESC) and a large, diverse school district to conduct a longitudinal study from 2005-2009. The state achievement test scores of 5th graders who were taught using a Grade 5 science textbook designed by Region 4 ESC were…

  13. Successfully Promoting 21st Century Online Research Skills: Interventions in 5th-Grade Classrooms

    ERIC Educational Resources Information Center

    Kingsley, Tara L.; Cassady, Jerrell C.; Tancock, Susan M.

    2015-01-01

    This quantitative study was developed to explore the ability to impact elementary student 21st Century online research skills with a planned classroom intervention curriculum. The repeated measures quasi-experimental study randomly assigned all 5th grade classes in a Midwestern, suburban school (n = 418) to a 12-week intervention or control…

  14. A Network Sets Things in Motion: TEDD Celebrates its 5(th) Anniversary.

    PubMed

    2015-01-01

    At the Annual Meeting at ZHAW Waedenswil on 22 October 2015, the TEDD-Network (Tissue Engineering for Drug Development and Substance Testing) celebrated its 5(th) anniversary. Since its foundation, TEDD has become an internationally renowned competence centre and includes currently 91 members from academia and industry. They cover the entire development and value chain. PMID:26671055

  15. The 5th World Environmental Education Congress, 2009: A Research Project

    ERIC Educational Resources Information Center

    Jickling, Bob; Sauve, Lucie; Briere, Laurence; Niblett, Blair; Root, Emily

    2010-01-01

    This paper contextualizes the 5th World Environmental Education Congress, discusses the theoretical underpinnings of the Congress theme "Earth Our Common Home," and relates this theorizing to the research project that was woven through the Congress. We provide a rationale for engaging in this research project, as an invitation for Congress…

  16. 10. Interior view, working house, scale floor (5th level). View ...

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

    10. Interior view, working house, scale floor (5th level). View facing across floor toward no. 2 scale and garner. Tile structure at left center is weighmaster's shack; view facing east. - Saint Anthony Elevator No. 3, 620 Malcom Avenue, Southeast, Minneapolis, Hennepin County, MN

  17. Socially, Developmentally, and Academically Appropriate Prevention Curriculum for 5th Graders

    ERIC Educational Resources Information Center

    Harthun, Mary L.; Dustman, Patricia A.; Reeves, Leslie J.; Marsiglia, Flavio F.; Hecht, Michael L.

    2009-01-01

    This paper reports on a process in which program designers, classroom teachers, and students worked together to adapt the 7th grade "keepin' it REAL" prevention curriculum to a developmentally, socially, and academically appropriate curriculum for 5th graders. A Community-Based Participatory Research methodology (CBPR), combined with a 9-step…

  18. The Effect of Progressive Sentence Development Activities on 5th Graders' Description Skills

    ERIC Educational Resources Information Center

    Hamzadayi, Ergun

    2015-01-01

    The aim of this study was to examine the effect of progressive sentence development activities on 5th graders' description skills. The study was conducted based on the pretest-posttest quasi-experimental model with a control group. A total of 58 students participated in the study; 29 in the control group, and 29 in the experimental group. The…

  19. Vocabulary and Syntactic Knowledge Factors in 5th Grade Students' Reading Comprehension

    ERIC Educational Resources Information Center

    Mokhtari, Kouider; Niederhauser, Dale S.

    2013-01-01

    In this study, we examined 5th grade students' levels of vocabulary knowledge and syntactic awareness relative to their reading comprehension performance. The aim was to explore the contributions of vocabulary and syntactic awareness as potential sources of reading comprehension difficulty for these readers. Overall, we found that both vocabulary…

  20. 9. 5TH FLOOR, INTERIOR DETAIL TO EAST OF SOAP BIN ...

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

    9. 5TH FLOOR, INTERIOR DETAIL TO EAST OF SOAP BIN No. 4: UPPER SCREWS MOVED SOAP CHIPS HORIZONTALLY FROM BIN TO BIN; LOWER LEFT-AND RIGHT-HAND SCREWS MOVED CHIPS TO CHUTE LEADING TO 3RD FLOOR SOAP MILLS - Colgate & Company Jersey City Plant, Building No. B-14, 54-58 Grand Street, Jersey City, Hudson County, NJ

  1. 78 FR 53454 - Filing Dates for the Louisiana Special Elections in the 5th Congressional District

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-29

    ... From the Federal Register Online via the Government Publishing Office FEDERAL ELECTION COMMISSION Filing Dates for the Louisiana Special Elections in the 5th Congressional District AGENCY: Federal Election Commission. ACTION: Notice of filing dates for special election. SUMMARY: Louisiana has...

  2. Urban 5th Graders Conceptions during a Place-Based Inquiry Unit on Watersheds

    ERIC Educational Resources Information Center

    Endreny, Anna Henderson

    2010-01-01

    This study aimed to determine how 33 urban 5th grade students' science conceptions changed during a place-based inquiry unit on watersheds. Research on watershed and place-based education was used as a framework to guide the teaching of the unit as well as the research study. A teacher-researcher designed the curriculum, taught the unit and…

  3. An Investigation of Science and Technology Teachers' Views on the 5th Grade Science Course

    ERIC Educational Resources Information Center

    Dasdemir, Ikramettin

    2014-01-01

    This study was conducted to explore the science and technology teachers' views on the implementation of 5th grade science course. Open-ended questions were used as a data collection tool. The study sample consisted of 28 science and technology teachers working in Erzurum in 2012-2013 education year. The data gathered were analysed via content…

  4. Effects of temperature and modified atmospheres on diapausing 5th instar codling moth metabolism

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Diapausing 5th instars of codling moth, Cydia pomonella, are serious quarantine pests of in-shell walnuts. Previous research indicates that heat treatments in combination with high concentrations of carbon dioxide and low concentrations of oxygen may be effective for controlling this pest in walnuts...

  5. [Effects of atrial natriuretic peptide on aortic baroreceptor activity in rats].

    PubMed

    Ma, X Y; Zhang, W Y; Ho, S Y

    1994-10-01

    Effects of atriopeptin III (AP III) on the aortic baroreceptor activity in rats were studied in the isolated aorta arch-aortic nerve preparation in situ. By perfusing the isolated aortic arch with AP III (2.0 micrograms/ml) in rats, at constant intra-aortic pressure (IAP) of 13.3 kPa, the integral of aortic nerve activity (IANA) was increased by 64 +/- 27% (P < 0.001), the stepwise increases and decreases of IAP were correspondingly accompanied by increase and decrease in IANA, while the saturation pressure (SP) and the operating range (OR) of aortic baroreceptor activity were decreased from 22.5 +/- 0.5 to 21.3 +/- 0.5 kPa (P < 0.05) and 12.1 +/- 0.4 to 10.6 +/- 0.4 (P < 0.05), respectively, and the threshold pressure (TP) did not show any changes. The function curve of aortic baroreceptor was shifted to left and upward, and the peak integral value (PIV) and the peak slope (PS) of the curve were increased from 508 +/- 66 to 730 +/- 52% (P < 0.05), 55.6 +/- 7.5 to 93.2 +/- 6.8%.kPa-1 (P < 0.05), respectively. After washing out of AP III, the IANA returned to the control level. By perfusing the aortic arch with sodium nitroprusside (NP, 1.0 microgram/ml), at constant intra-aortic pressure (IAP) of 13.3 kPa, although the IANA was decreased as compared with the control, there was no statistical significance (P > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Balloon aortic valvuloplasty.

    PubMed

    Wang, A; Harrison, J K; Bashore, T M

    1997-01-01

    Balloon aortic valvuloplasty is a percutaneous, therapeutic option for patients with severe aortic stenosis, yet the effectiveness of this procedure is dependent on the morphology of the stenotic aortic valve and the respective mechanism of dilation. In younger patients with congenital aortic stenosis, acute and intermediate-term results are good. However, in adult patients, in whom degenerative aortic stenosis is the most common cause, the acute clinical and hemodynamic benefits of balloon aortic valvuloplasty are not lasting, as restenosis occurs in most patients within 6 months. Sympatomatic relief for adults undergoing balloon aortic valvuloplasty is only apparent in patients with normal left ventricular function, who generally are also candidates for aortic valve replacement. Furthermore, the long-term survival for adults after balloon aortic valvuloplasty is similar to the natural history of untreated severe aortic stenosis. In this article, the mechanism of balloon aortic valvuloplasty, as well as its clinical and hemodynamic effects, are reviewed in the context of the different morphological types of aortic stenosis. In addition, two large registries of adult patients treated with balloon aortic valvuloplasty provide important information regarding the acute and long-term results of this procedure and are reviewed.

  7. Aortic Annular Enlargement during Aortic Valve Replacement

    PubMed Central

    Dumani, Selman; Likaj, Ermal; Dibra, Laureta; Llazo, Stavri; Refatllari, Ali

    2016-01-01

    In the surgery of aortic valve replacement is always attempted, as much as possible, to implant the larger prosthesis with the mains goals to enhance the potential benefits, to minimise transvalvular gradient, decrease left ventricular size and avoid the phenomenon of patient-prosthesis mismatch. Implantation of an ideal prosthesis often it is not possible, due to a small aortic annulus. A variety of aortic annulus enlargement techniques is reported to avoid patient-prosthesis mismatch. We present the case that has submitted four three times open heart surgery. We used Manouguian technique to enlarge aortic anulus with excellent results during the fourth time of surgery. PMID:27703574

  8. 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

  9. Axillary Artery Cannulation in Acute Aortic Dissection: A Word of Caution.

    PubMed

    Baek, Wan Ki; Kim, Young Sam; Lee, Mina; Yoon, Yong Han; Kim, Joung Taek; Lim, Hyun Kyung

    2016-04-01

    Arterial cannulation into the right axillary artery is a commonly adopted perfusion strategy in the treatment of acute aortic dissection. Here we describe our experience of accidentally cannulating the axillary artery in a case of acute aortic dissection with an aberrant right subclavian artery, which was missed preoperatively because its proximal segment was malperfused by the dissection and thereby not enhanced. The rapid hemodynamics collapse at the start of the bypass was reversed by prompt switching to femoral perfusion. Postoperative follow-up computed tomographic angiography revealed a well-perfused right aberrant subclavian artery. Surgeons should be aware of an aortic arch anomaly whenever performing an axillary artery cannulation. PMID:27000577

  10. Repair of Late Retrograde Type A Aortic Dissection After TEVAR: Causes and Management.

    PubMed

    Mosquera, Victor X; Marini, Milagros; Fraga-Manteiga, Daniel; Gulias, Daniel; Cuenca, Jose J

    2016-03-01

    One of the most feared complications of thoracic endovascular aortic repair (TEVAR) and hybrid arch repair is retrograde type A aortic dissection (RTAD). More than two-thirds of RTAD occurs in the immediate postoperative period and first postoperative month. In presentations beyond that point, progression of the native aortopathy must be considered. We report a late presentation of an RTAD seven months after hybrid repair of an aortic intramural hematoma with an ulcer-like projection, and review the causes and management of this TEVAR complication.

  11. 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

  12. Abdominal Aortic Aneurysms: Treatments

    MedlinePlus

    ... information Membership Directory (SIR login) Interventional Radiology Abdominal Aortic Aneurysms Interventional Radiologists Treat Abdominal Aneurysms Nonsurgically Interventional radiologists ...

  13. Anatomic variation of the 5th extensor tendon compartment and extensor digiti minimi tendon.

    PubMed

    Tanaka, Toshikazu; Moran, Steven L; Zhao, Chunfeng; Zobitz, Mark E; An, Kai-Nan; Amadio, Peter C

    2007-08-01

    Anatomic variation within the 5th extensor compartment may contribute to the development of tenosynovitis and limit the usefulness of the extensor digiti minimi (EDM) for tendon transfer. The purpose of this study was to assess the anatomic variation of the EDM tendon and its surrounding retinaculum, with particular attention to anatomical variation between specimens. Forty-one fresh cadaver hands were dissected. The length of the 5th compartment retinaculum was noted. The incidence of an intercompartmental septum was noted in each specimen as well as the type of tendinous attachments present between the EDM and extensor digitorum communis (EDC) tendons. The presence and length of any accessory retinacular bands distal to the edge of proper extensor retinaculum was also noted. Only one specimen contained a single EDM tendon, while 71% (n = 29) of specimens contained two slips and 23% (n = 9) had three slips; 24% (n = 10) of EDC tendons had no slip to the small finger, while 61% (n = 25) of specimens had a single slip to the small finger. The EDC's contribution to the small finger was found to be an independent tendon in 42% of cases (n = 17), while 34% (n = 14) of specimens were found to have a common EDC slip, which branched to both the ring and small finger. Three EDM tendons divided distal to the extensor retinaculum, while the remaining EDM tendons divided beneath or proximal to the extensor retinaculum. Seventy-three percent (n = 30) of the specimens had an accessory retinacular band surrounding the EDM tendon identified at the base of the 5th metacarpal. Eighty-eight percent (n = 36) of hands had a septum between the EDM slips. The surgeon should be aware of variability within the 5th dorsal compartment in cases of trauma and in cases of tendon transfer. In our series 30 of 41 specimens were noted to contain an accessory dorsal retinacular band surrounding the EDM and 36 specimens were noted to contain a septum within the 5th compartment. The presence of an

  14. Trouble-shooting dual arch impressions II.

    PubMed

    Kaplowitz, G J

    1997-09-01

    Dual arch impression procedures can produce accurate impressions and bite registrations for the fabrication of single crowns. To accomplish this, the dentist must select an appropriately sized and shaped tray, appropriate impression material and a dual arch impression procedure suitable for each case. Dual arch impression procedures can save impression material and chair time.

  15. 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…

  16. Palmar arch reconstruction using dorsal venous arch of foot for revascularisation of multiple digits

    PubMed Central

    Krishnakumar, K. S.; Petkar, Kiran; Lateef, Sameer; Rasalkar, Jyoti; Arun, T. J.; Suresh, V.

    2014-01-01

    A case of trauma causing total loss of superficial and deep palmar arches of hand with ischemia of all the digits was managed using dorsal venous arch of the foot to reconstruct the palmar arch. The ends of the venous arch were anastomosed to radial and ulnar arteries and the tributaries to the arch were coapted to the cut ends of the common digital vessels and princeps pollicis. The surgery yielded gratifying results, successfully revascularising all the digits. PMID:24987216

  17. Thoracic aortic aneurysm with aortic pseudocoarctation involving the left subclavian artery.

    PubMed

    Kitabayashi, Katsukiyo; Sakaki, Masayuki; Araki, Kanta; Shibamoto, Ai; Mizoguchi, Hiroki; Ohtake, Shigeaki

    2013-08-01

    A 39-year-old man with a thoracic aortic aneurysm and pseudocoarctation underwent graft replacement of the distal arch. The left subclavian artery, which rose just after the aneurysm, was also reconstructed at surgery. The aneurysmal wall was extremely thin, and the adventitia and a small amount of medial tissue were found on histologic examination. Thus, surgical treatment was recommended due to risk of rupture. Furthermore, because aneurysms involved the cervical branch, separate reconstruction was also performed. Endovascular intervention is not appropriate for this group of patients because of the complex kinking of the aorta and the extremely thin aneurysmal wall.

  18. Instantaneous frequency measurement by in-fiber 0.5th order fractional differentiation

    NASA Astrophysics Data System (ADS)

    Poveda-Wong, L.; Carrascosa, A.; Cuadrado-Laborde, C.; Cruz, J. L.; Díez, A.; Andrés, M. V.

    2016-07-01

    We experimentally demonstrate the possibility to retrieve the instantaneous frequency profile of a given temporal light pulse by in-fiber fractional order differentiation of 0.5th-order. The signal's temporal instantaneous frequency profile is obtained by simple dividing two temporal intensity profiles, namely the intensities of the input and output pulses of a spectrally-shifted fractional order differentiation. The results are supported by the experimental measurement of the instantaneous frequency profile of a mode-locked laser.

  19. 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

  20. 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

  1. Aortic root surgery in combination with hypothermic circulatory arrest: preserve or replace the aortic valve in the context of postoperative neurological outcome? A case match comparison.

    PubMed

    Khaladj, Nawid; Ismail, Issam; Shrestha, Malakh; Peterss, Sven; Pichlmaier, Maximilian; Kallenbach, Klaus; Haverich, Axel; Hagl, Christian

    2009-08-01

    The objective of this study was to compare the results of elective composite (C) vs. David (D) operations in patients requiring additional aortic arch surgery using hypothermic circulatory arrest (HCA) and selective antegrade cerebral perfusion (SACP), with the focus on postoperative neurological outcome and quality of life (SF-36). Between November 1999 and March 2006, 333 patients underwent aortic root surgery and ascending aortic replacement with HCA and SACP at our institution. Out of these patients, 46 were matched with respect to age, gender, HCA-time and year of surgery. Two patients, one in each group, died during hospital stay (4%), with no late deaths. Follow-up was completed in 95% [64 (6-90) months]. Cardiopulmonary bypass (CPB) time (141 min vs. 168 min, P=0.007) and aortic cross-clamp time (99 min vs. 123 min, P=0.004) were significantly longer in the David-group. The incidence of temporary neurological dysfunction (TND 7%: D n=1, C n=2) was not different between groups, no permanent dysfunction could be detected. Follow-up SF-36 scores were comparable. The combination of aortic arch surgery with more time consuming valve sparing aortic root surgery does not increase the risk for adverse outcome applying comparable periods of HCA and SACP.

  2. 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

  3. 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

  4. Initial Experience of Modified Four-Branched Graft Technique and Antegrade TEVAR in Acute Type A Aortic Dissection

    PubMed Central

    Chou, Hung-Tao; Lo, Jen-Ping; Chua, Chai-Hock; Lu, Ming-Jen

    2015-01-01

    Background: We report the initial experience of modified four-branched graft technique for proximal aorta and arch repair, feasibly combined with antegrade thoracic endovascular aortic repair (TEVAR) to extend distal aortic reconstruction in acute type A aortic dissection. Methods: From 2011 to 2013, 12 consecutive patients with acute type A aortic dissection were indicated for arch surgery and underwent surgical replacement of proximal aorta, arch replacement or debranching procedure, and concomitant TEVAR for distal aortic repair. Results: A good surgical field was obtained in all patients. No major complications developed but two hospital deaths were attributed to end-organs damage preoperatively. Good and fast remodeling of thoracic descending aorta was demonstrated in 11 patients in postoperative CT imaging and no aneurysmal dilatation of visceral aorta had been observed in 10 patients during follow-up periods. Conclusion: Modified four-branched graft technique facilitated proximal aorta and arch repair, and provided excellent neurological outcome and favorable short-term results. Single-stage operation combined with antegrade TEVAR is feasible and effective to extend the repair down to the descending aorta, and thus achieved good remodeling of thoracic descending aorta. PMID:26004115

  5. The use of a new hybrid stentgraft for the repair of extensive thoracic aortic aneurysms with the frozen elephant trunk method – first Polish experiences

    PubMed Central

    Krasoń, Marcin; Hrapkowicz, Tomasz; Przybylski, Roman; Filipiak, Krzysztof; Borowicz, Marcin; Niklewski, Tomasz; Głowacki, Jan; Wolny, Tomasz; Nadziakiewicz, Paweł; Walas, Ryszard; Zembala, Marian

    2014-01-01

    The frozen elephant trunk (FET) technique is a modification of the traditional elephant trunk method, which was introduced by Borst in 1983 in order to treat extensive thoracic aortic aneurysms. The crux of the new method is the different type of aortic prosthesis, consisting of a Dacron part (with or without branches leading to the arterial vessels which exit the aortic arch) and a port for extracorporeal circulation with a self-expanding nitinol stentgraft. This combination enables a complete one-stage treatment of the pathologies within the arch and the proximal segment of the descending aorta; moreover, it facilitates the performance of a two-stage hybrid treatment of extensive thoracic aortic aneurysms involving a significant part of the descending aorta. This article presents the cases of four patients with extensive aortic disease, who were implanted with Thoraflex prostheses (Vascutek, Scotland). PMID:26335241

  6. Surgical approach for the treatment of aortoesophageal fistula combined with dual aortic aneurysms: a case report

    PubMed Central

    2013-01-01

    Aortoesophageal fistula is a rare disease with a high mortality rate. The disease is with high mortality due to aneurysm rupture, and thus successfully managed cases are rarely reported. Here, we report a case of aortoesophageal fistula caused by a huge descending aneurysm and another smaller aneurysm found in the aortic arch. Such case was relatively rare in the cardiovascular field. Due to the limited experience, it was difficult to determine the proper therapeutic strategy. For this case, for the dual aneurysm, we surgically inserted an aortic endovascular stent-graft to exclusive the aneurysm and simultaneously repair the other aortic arch aneurysm. The patient had an uneventful recovery and was discharged after 1 month antibiotics therapy for the palliative treatment of the esophageal fistula. She survived for 8 months at home before dying of massive hematemesis. Here, we present the operative method and our therapeutic experience for this extremely rare case. PMID:24180498

  7. ED 02-1 ACUTE AORTIC SYNDROME.

    PubMed

    Song, Jae-Kwan

    2016-09-01

    ascending or aortic arch repairs. Currently available CT or TEE cannot identify this type of localized intimal tear, with the only imaging characteristic reported to be a localized eccentric bulging or aneurysm. This feature is too subtle to diagnose accurately using conventional imaging modalities, suggesting that surgical exploration be performed in patients with aortic pain and aortic root dilatation who show unexplained aortic regurgitation or pericardial effusion. Further investigations are necessary to evaluate the clinical significance and outcomes of patients with incomplete dissection.Non-invasive imaging modalities such as CT and TEE have contributed to a better understanding of acute aortic syndrome, resulting in inclusion of IMH and atypical dissection as new disease entities. Differences in imaging findings may be due to differences in the hemodynamic status of the false lumen, resulting from the wide spectrum of intimal tears, from a localized or 'micro-intimal tear' to a large tear with flow communication resulting in a 'double channel aorta'. Further investigation is required to determine whether the application of different treatment options following risk stratification based on imaging results is rational and can improve the clinical outcomes of patients with this syndrome. PMID:27643004

  8. Effects of the 5th and 7th Grade Enhanced Versions of the "keepin' it REAL" Substance Use Prevention Curriculum

    ERIC Educational Resources Information Center

    Elek, Elvira; Wagstaff, David A.; Hecht, Michael L.

    2010-01-01

    This study assessed the outcomes of adapting the culturally-grounded, middle school, substance-use prevention intervention, "keepin' it REAL" ("kiR"), to target elementary school students and to address acculturation. At the beginning of 5th grade, 29 schools were randomly assigned to conditions obtained by crossing grade of implementation (5th,…

  9. Measuring Listening Comprehension Skills of 5th Grade School Students with the Help of Web Based System

    ERIC Educational Resources Information Center

    Acat, M. Bahaddin; Demiral, Hilmi; Kaya, Mehmet Fatih

    2016-01-01

    The main purpose of this study is to measure listening comprehension skills of 5th grade school students with the help of web based system. This study was conducted on 5th grade students studying at the primary schools of Eskisehir. The scale used in the process of the study is "Web Based Listening Scale". In the process of the study,…

  10. Aortic stiffness determines diastolic blood flow reversal in the descending thoracic aorta: potential implication for retrograde embolic stroke in hypertension.

    PubMed

    Hashimoto, Junichiro; Ito, Sadayoshi

    2013-09-01

    Aortic stiffening often precedes cardiovascular diseases, including stroke, but the underlying pathophysiological mechanisms remain obscure. We hypothesized that such abnormalities could be attributable to altered central blood flow dynamics. In 296 patients with uncomplicated hypertension, Doppler velocity pulse waveforms were recorded at the proximal descending aorta and carotid artery to calculate the reverse/forward flow ratio and diastolic/systolic flow index, respectively. Tonometric waveforms were recorded on the radial artery to estimate aortic pressure and characteristic impedance (Z0) and to determine carotid-femoral (aortic) and carotid-radial (peripheral) pulse wave velocities. In all subjects, the aortic flow waveform was bidirectional, comprising systolic forward and diastolic reverse flows. The aortic reverse/forward flow ratio (35 ± 10%) was positively associated with parameters of aortic stiffness (including pulse wave velocity, Z0, and aortic/peripheral pulse wave velocity ratio), independent of age, body mass index, aortic diameter, and aortic pressure. The carotid flow waveform was unidirectional and bimodal with systolic and diastolic maximal peaks. There was a positive relationship between the carotid diastolic/systolic flow index (28 ± 9%) and aortic reverse/forward flow ratio, which remained significant after adjustment for aortic stiffness and other related parameters. The Bland-Altman plots showed a close time correspondence between aortic reverse and carotid diastolic flow peaks. In conclusion, aortic stiffness determines the extent of flow reversal from the descending aorta to the aortic arch, which contributes to the diastolic antegrade flow into the carotid artery. This hemodynamic relationship constitutes a potential mechanism linking increased aortic stiffness, altered flow dynamics, and increased stroke risk in hypertension.

  11. A Social Medium: ASM's 5th Cell-Cell Communication in Bacteria Meeting in Review

    PubMed Central

    Federle, Michael J.

    2015-01-01

    The 5th American Society for Microbiology Conference on Cell-Cell Communication in Bacteria (CCCB-5), which convened from 18 to 21 October 2014 in San Antonio, TX, highlighted recent advances in our understanding of microbial intercellular signaling. While the CCCB meetings arose from interests in pheromone signaling and quorum sensing, it was evident at CCCB-5 that the cell-cell communication field is continuing to mature, expanding into new areas and integrating cutting-edge technologies. In this minireview, we recap some of the research discussed at CCCB-5 and the questions that have arisen from it. PMID:25917904

  12. Evaluation of the 5th edition of the TNM classification for gastric cancer: improved prognostic value

    PubMed Central

    Kranenbarg, E Klein; Hermans, J; van Krieken, J H J M; van de Velde, C J H

    2001-01-01

    The main change in the 5th edition (1997) of the TNM classification for gastric cancer compared to the 4th edition (1987) is the use of the number of involved nodes instead of the location of positive nodes. As a result stage grouping is also altered. A second change is the requirement for the examination of at least 15 nodes to justify the N0 status. Patients with fewer examined negative nodes are unclassifiable (Nx). Data were retrieved from a randomized trial database comparing D1 and D2 dissection and 633 curatively operated patients were included. According to the criteria of the 5th edition, 39% of the node-positive patients had another N stage compared to the 4th: 21% had a lower and 18% had a higher stage. 5-year survival rates according to the 4th edition N0, N1 and N2 groups were respectively 72%, 34% and 27%. According to the 5th edition these percentages were for the N0, N1, N2, N3 and Nx groups respectively 75%, 38%, 19%, 8% and 65%. The former 1987 N1 and N2 group were significantly split into three new N 1997 groups (P = 0.006, respectively P< 0.0005). The Cox's regression analysis showed the N 1997 classification to be the most important prognostic variable, with a higher prognostic value than N 1987. In addition, the new TNM stage was also a better prognosticator. The requirement for examining at least 15 nodes, however, could not be fulfilled in 38% of all node-negative patients and we found that a minimum of 5 consecutive negative lymph nodes is a reliable number for staging purposes. We conclude that the 5th edition of the TNM classification provides a better estimation of prognosis, however, examination of at least 15 negative regional lymph nodes is too high a threshold and 5 gives similar prognostic value. © 2001 Cancer Research Campaign http://www.bjcancer.com PMID:11139315

  13. Indoor Air '90: the 5th in a series of international conferences on the indoor environment.

    PubMed

    Walkinshaw, D

    1992-01-01

    The 5th International Conference on Indoor Air Quality and Climate: INDOOR AIR '90 continued a series of international scientific conferences begun in 1978 on a complex, interdisciplinary subject increasingly recognized to be of importance to human comfort, health and productivity, and having important implications for building design and furnishing, office equipment, appliances, cleaning, heating, ventilating, humidifying and air-conditioning. INDOOR AIR '90 constituted a week long program of 542 paper and poster presentations and forum discussions, 100 exhibits, and a public forum. This paper summarizes some of the highlights of this conference and links these to some of the studies reported at earlier INDOOR AIR Conference.

  14. Preface to Special Topic: Selected Papers from the 5th International Conference on Optofluidics.

    PubMed

    Fan, Shih-Kang; Yang, Zhenchuan

    2016-01-01

    The 5th International Conference on Optofluidics (Optofluidics 2015) was held in Taipei, Taiwan, July 26-29, 2015. The aim of this conference was to provide a forum to promote scientific exchange and to foster closer networks and collaborative ties between leading international researchers in optics and micro/nanofluidics across various disciplines. The scope of Optofluidics 2015 was deliberately broad and interdisciplinary, encompassing the latest advances and the most innovative developments in micro/nanoscale science and technology. Topics ranged from fundamental research to its applications in chemistry, physics, biology, materials, and medicine.

  15. 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

  16. Para-aortic lymphocyst.

    PubMed

    Helmkamp, B F; Krebs, H B; Isikoff, M B; Poliakoff, S R; Averette, H E

    1980-10-15

    Although numerous articles regarding the etiology, incidence, complications, and management of pelvic lymphocysts have been published in the American literature since 1958, there has been no mention of para-aortic lymphocyst as a complication of para-aortic node dissection. Two recent cases of symptomatic para-aortic lymphocyst have prompted a review of our para-aortic node dissection technique when this procedure is not combined with a more extensive pelvic lymphadenectomy. Our modification in technique is to use retroperitoneal para-aortic drainage by constant pressure-controlled suction following closure of the posterior parietal peritoneum, and the results in our first 15 patients are presented. There were no complications related to the drainage technique. Abdominal ultrasound and intravenous urography have proved to be excellent diagnostic tools in the initial evaluation and subsequent follow-up of para-aortic lymphocytes.

  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. Antero-lateral partial sternotomy for extensive thoracic aortic aneurysm

    PubMed Central

    Ishikawa, Noboru; Omoto, Tadashi; Ono, Masahiro; Miyauchi, Tadamasa; Oi, Masaya; Maruta, Kazuto; Iizuka, Hirofumi; Kawaura, Hiroyuki

    2013-01-01

    OBJECTIVES Surgical strategies for patients with aortic arch aneurysm extending to the descending aorta remain controversial. The antero-lateral partial sternotomy (ALPS) approach has been developed as a less invasive alternative single-stage strategy for extensive thoracic arch aneurysm (ETAA). METHODS From September 2007 to April 2011, 18 patients underwent elective total arch replacement for ETAA by the ALPS approach (ALPS group). In this approach, a skin incision was made from the bottom of the xiphoid to the anterior axillary line at the third intercostal space with a convex curved line. The thorax was entered through the third intercostal space and a partial lower sternotomy was done. Surgical outcomes were compared with those of 22 patients with ETAA who underwent elective total arch replacement by median sternotomy alone (MS) with regard to the level of distal anastomosis, postoperative complications and mortality. RESULTS In the ALPS group, no hospital mortality occurred and one patient experienced pneumonia. No significant difference between the ALPS and MS groups was seen in operative time (384.1 ± 41.6 min vs 402.3 ± 85.3 min P = 0.423) and cardiopulmonary bypass time (220.8 ± 47.1 min vs 236.9 ± 45.4 min P = 0.286). In contrast, distal anastomosis was at a significantly lower vertebral level in the ALPS than in the MS group (5.5 ± 0.4 vs 4.3 ± 0.9, respectively: P < 0.0001). CONCLUSIONS The ALPS approach provides good surgical exposure for distal aortic arch aneurysms extending to the descending aorta and ensures the accurate reconstruction of the distal anastomosis without major complications. PMID:23243031

  19. Aiming at One-Stage Corrective Surgery for Extended Thoracic Aortic Dilatation

    PubMed Central

    Niinimaki, Eetu; Kajander, Henri; Paavonen, Timo; Sioris, Thanos; Mennander, Ari

    2014-01-01

    Definitive treatment of extended thoracic aortic dilatation is a major surgical challenge. Histopathology of resected thoracic aortic wall may reveal undiagnosed aortitis affecting outcome. We sought to investigate the benefit of thorough histopathology after one-stage corrective surgery for the treatment of extended thoracic aortic dilatation. Five patients underwent one-stage corrective surgery using the hybrid open arch repair by the frozen elephant trunk together with endovascular aortic grafting. A representative sample of the resected aortic arch was procured for histology. T- and B-lymphocytes, plasma cells, macrophages, and immunoglobulin G4 (IgG4) positivity were evaluated by immunohistochemistry. The mean preoperative maximum aortic diameter was 54 mm (range, 41–79 mm). The mean follow-up was 18 months (range, 1–24 months). As confirmed by computed tomography (CT) upon follow-up, complete thrombosis of the false lumen at the level of the frozen elephant trunk was achieved in all patients with dissection. One patient was operated due to atherosclerotic dilatation of the thoracic aorta, and postoperative CT showed successful exclusion of the atherosclerotic dilatation; this 75-year-old man was diagnosed with IgG4-positive aortitis and experienced unexpected blindness after surgery without evidence of emboli or long-term neurological impairment upon repeated brain CT. The hybrid open arch repair by the frozen elephant trunk and simultaneous endovascular repair is a feasible choice for one-stage surgery through sternotomy aiming at definitive treatment of extended thoracic aortic pathology. However, systematic evaluation of inflammation may reveal concealed aortitis affecting postoperative outcome and need for long-term surveillance. PMID:25075162

  20. 5th Bionanotox and Applications International Research Conference, Peabody, Little Rock, Arkansas, USA

    NASA Astrophysics Data System (ADS)

    Sabb, Taneicie; Chowdhury, Parimal

    2011-06-01

    "BioNanoTox and Toxicity: using Technology to Advance Discovery" was this year's theme at the 5th BioNanoTox and Applications International Research Conference held at the Peabody Hotel, Little Rock, Arkansas on November 4-5th, 2010. This year, the international participation in this conference increased to 25 countries spanning the globe. The conference began with opening remarks by Paul Howard, Associate Director of the National Center for Toxicological Research, Food and Drug Administration, Jefferson, Arkansas, United States. Two keynote speakers, Dr. Ananth V. Annapragada and Dr. Merle G. Paule presented lectures on "Toxicity of Novel Nanoparticles for CT imaging" and "The Biology of Neurotoxicity: using Technology to Advance Discovery", respectively. Teachers, students, faculty, and scientists presented oral and poster presentations on fundamental and translational research related to BioNanoTox and related fields of science. Six presentation sessions were held over the two-day conference. There were 31 presentations and 39 posters from disciplines ranging from biology to chemistry, toxicology, nanotechnology, computational sciences, mathematics, engineering, plant science, and biotechnology. Poster presentation awards were presented to three high school students, three high school teachers, and three college students. In addition to poster awards a memorial, travel, and BioNanoTox award were presented. This year's meeting paved the way for a more outstanding meeting for the future.

  1. High energy diode pumped 5th harmonic generation of Nd: YAG laser

    NASA Astrophysics Data System (ADS)

    Yu, Yang; Cheng, Chee Yuen; Chia, Yong Poo; Wong, Wee Hoong; Yong, Saw Soon; Qu, Weijuan; Peng, Xiaoyuan

    2013-03-01

    This paper reports a high power diode pump 5th harmonic generation of Nd: YAG laser system, which could generate up to 300 mW TEM00 mode output with 100 Hz repetition rate at 213 nm. A diode pump module was specially designed for a high efficiency and good beam quality at the fundamental wavelength 1064 nm. An amplifier was set up out of the cavity to boost up the energy level of fundamental wavelength. In order to get high efficiency of the 5th harmonic generation, the cavity of the fundamental wavelength is EOM Q-switched which could generate very high peak power of the fundamental wavelength laser for extra cavity harmonic generations. Finally, 14% conversion efficiency from IR to UV was achieved, which is the highest efficiency in the market to the best of our knowledge right now. 213 nm is a very good substitute wavelength of 193 nm for different UV applications, the system of which is more compact, higher energy, less maintenance and better beam quality than the system of 193 nm.

  2. Flow in an Aortic Coarctation

    NASA Astrophysics Data System (ADS)

    Loma, Luis; Miller, Paul; Hertzberg, Jean

    2009-11-01

    Coarctation of the aorta is a congenital cardiovascular defect that causes a constriction in the descending thoracic aorta. To gain a better understanding of the cause of post-surgical problems, a rigid glass and a compliant in vitro model of the aortic arch and descending aorta with a coarctation were constructed. Near-physiologic compliance was obtained using a silicone elastomer. Stereoscopic PIV was used to obtain 3D velocity maps. Results show a high speed turbulent jet formed at the exit of the coarctation. Flow in the rigid model was significantly different from in the compliant model. In the rigid model, the jet was symmetric, creating a toroidal recirculation area. In the compliant model, the jet was directed towards the medial wall, inducing flow reversal only at the lateral wall. Peak velocities and turbulence intensities were higher in the rigid model, however shear rate values in the compliant model were significantly above both the rigid model and normal in vivo values at the medial wall. In both models the reattachment region fluctuated, creating oscillatory shear.

  3. Revisiting impressions using dual-arch trays.

    PubMed

    Small, Bruce W

    2012-01-01

    Making routine perfect impressions is the goal of any restorative dentist. Using dual-arch trays is an easy, repeatable way to accomplish that goal, as long as each step is done before the next and each step is performed perfectly. This column reviewed several articles that support the metal dual-arch concept and provided some clinical tips that might help restorative dentists. The dual-arch technique does have its limits and is meant for one or two teeth in a quadrant when there are other teeth to occlude with. Also, if the case involves anterior guidance, a full-arch impression maybe advisable.

  4. 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.

  5. EDITORIAL: 'Best article' prize for the 5th anniversary of Environmental Research Letters 'Best article' prize for the 5th anniversary of Environmental Research Letters

    NASA Astrophysics Data System (ADS)

    Kammen, Dan; Wright, Guillaume

    2011-12-01

    To celebrate the 5th anniversary of Environmental Research Letters (ERL) the publishers of the journal, IOP Publishing, have awarded a prize for the five best articles published in ERL since the journal began in 2006. The procedure for deciding the winning articles was as thorough as possible to ensure that the most outstanding articles would win the prize. A shortlist of 25 nominated research articles, five for each year since ERL was launched, which were chosen based on a range of criteria including novelty, scientific impact, readership, broad appeal and wider media coverage, was selected. The ERL Editorial Board then assessed and rated these 25 articles in order to choose a winning article for each year. We would like to announce that the following articles have been awarded ERL's 5th anniversary best article prize: 2006/7 The Bodélé depression: a single spot in the Sahara that provides most of the mineral dust to the Amazon forest Ilan Koren, Yoram J Kaufman, Richard Washington, Martin C Todd, Yinon Rudich, J Vanderlei Martins and Daniel Rosenfeld 2006 Environ. Res. Lett. 1 014005 2008 Causes and impacts of the 2005 Amazon drought Ning Zeng, Jin-Ho Yoon, Jose A Marengo, Ajit Subramaniam, Carlos A Nobre, Annarita Mariotti and J David Neelin 2008 Environ. Res. Lett. 3 014002 2009 How difficult is it to recover from dangerous levels of global warming? J A Lowe, C Huntingford, S C B Raper, C D Jones, S K Liddicoat and L K Gohar 2009 Environ. Res. Lett. 4 014012 2010 Is physical water scarcity a new phenomenon? Global assessment of water shortage over the last two millennia Matti Kummu, Philip J Ward, Hans de Moel and Olli Varis 2010 Environ. Res. Lett. 5 034006 2011 Implications of urban structure on carbon consumption in metropolitan areas Jukka Heinonen and Seppo Junnila 2011 Environ. Res. Lett. 6 014018 Our congratulations go to these authors. In recognition of their outstanding work, we are delighted to offer all of the authors of the winning articles free

  6. Effects of temperature and modified atmospheres on diapausing 5th instar codling moth metabolism.

    PubMed

    Neven, Lisa G; Lehrman, Nathan J; Hansen, Lee D

    2014-05-01

    The oxygen and capacity limitation of thermal tolerance (OCLTT) has been established in aquatic insect larvae, but OCLTT has not been shown to generally apply to terrestrial insects. Previous research indicates that heat treatments in combination with high concentrations of carbon dioxide and low concentrations of oxygen may be effective for controlling diapausing codling moth, a quarantine pest in walnuts, but treatment requires long times and the killing mechanism is unknown. In this study, the effects of temperature and modified atmospheres on metabolism in diapausing 5th instar codling moth (Cydia pomonella) was investigated with multi-channel differential scanning calorimeters, one equipped with an oxygen sensor. O2 consumption and metabolic heat rates in air were measured simultaneously at isothermal temperatures from 5 to 50°C at 5°C intervals. Both rates increased with increasing temperatures from 5 to 40°C. The ratio of metabolic heat rate to O2 consumption rate at temperatures ≤40°C shows that a portion of the metabolic heat is from normal anabolic reactions of metabolism. At 45 and 50°C in air, O2 consumption and metabolic heat rates dropped to near zero. These results indicate that treatment of walnuts in air at >45°C for a short period of time (minutes) is effective in killing diapausing 5th instar codling moth larvae. Continuous heating scans at 0.4°C/min were used to measure metabolic heat rates from 10 to 50°C with air and modified atmospheres with lowered oxygen and high carbon dioxide. A rapid increase was observed in heat rates above 40°C in scans with O2≥11%. Taken together with the isothermal results showing no metabolic heat production or oxygen uptake at 45 and 50°C, these results demonstrate that thermal damage to cell membranes and loss of control of oxidation reactions is the lethal mechanism at high temperature when O2≥11%. The data from scans with O2≤2% and high CO2 show the effects of oxygen limitation as postulated by

  7. Principles of Antegrade Cerebral Perfusion During Arch Reconstruction in Newborns/Infants

    PubMed Central

    Fraser, Charles D.; Andropoulos, Dean B.

    2008-01-01

    Antegrade cerebral perfusion (ACP) is a cardiopulmonary bypass technique that uses special cannulation procedures to perfuse only the brain during neonatal and infant aortic arch reconstruction. It is used in lieu of deep hypothermic circulatory arrest (DHCA), and thus has the theoretical advantage of protecting the brain from hypoxic ischemic injury. Despite this, recent comparative studies have demonstrated no difference in neurodevelopmental outcomes with ACP vs. DHCA for neonatal arch repair. This article presents animal and human data demonstrating that ACP flows less than 30 ml/kg/min are inadequate for many patients, and may be the explanation for lack of outcome difference vs. DHCA. A technique for ACP, its physiologic basis, and a neuromonitoring strategy are presented, and then the results of an outcome study are reviewed demonstrating that with ACP technique at higher flows of 50–80 ml/kg/min guided by neuromonitoring, periventricular leukomalacia (PVL) is eliminated on postoperative brain MRI after neonatal cardiac surgery. PMID:18396227

  8. The hemostatic disturbance in patients with acute aortic dissection

    PubMed Central

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

    2016-01-01

    Abstract 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

  9. 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

  10. Proceedings of the 5th US/German Workshop on Salt Repository Research Design and Operation

    SciTech Connect

    Hansen, Francis D.; Leigh, Christi; Stein, Walter; Bollingerfehr, Wilhelm; Von Berlepsche, Thilo

    2015-01-01

    The 5th US/German Workshop on Salt Repository Research, Design, and Operation was held in Santa Fe New Mexico September 8-10, 2014. The forty seven registered participants were equally divided between the United States (US) and Germany, with one participant from The Netherlands. The agenda for the 2014 workshop was under development immediately upon finishing the 4th Workshop. Ongoing, fundamental topics such as thermomechanical behavior of salt, plugging and sealing, the safety case, and performance assessment continue to advance the basis for disposal of heat-generating nuclear waste in salt formations. The utility of a salt underground research laboratory (URL) remains an intriguing concept engendering discussion of testing protocol. By far the most interest in this years’ workshop pertained to operational safety. Given events at the Waste Isolation Pilot Plant (WIPP), this discussion took on a new sense of relevance and urgency.

  11. Exploratory Factor Analysis of Diagnostic and Statistical Manual, 5th Edition, Criteria for Posttraumatic Stress Disorder.

    PubMed

    McSweeney, Lauren B; Koch, Ellen I; Saules, Karen K; Jefferson, Stephen

    2016-01-01

    One change to the posttraumatic stress disorder (PTSD) nomenclature highlighted in the Diagnostic and Statistical Manual, 5th Edition (DSM-5; American Psychiatric Association, 2013) is the conceptualization of PTSD as a diagnostic category with four distinct symptom clusters. This article presents exploratory factor analysis to test the structural validity of the DSM-5 conceptualization of PTSD via an online survey that included the PTSD Checklist-5. The study utilized a sample of 113 college students from a large Midwestern university and 177 Amazon Mechanical Turk users. Participants were primarily female, Caucasian, single, and heterosexual with an average age of 32 years. Approximately 30% to 35% of participants met diagnostic criteria for PTSD based on two different scoring criteria. Results of the exploratory factor analysis revealed five distinct symptom clusters. The implications for the classification of PTSD are discussed.

  12. Highlights from the 5th Annual Meeting of the Italian Society of Virology.

    PubMed

    Salata, Cristiano; Calistri, Arianna; Palù, Giorgio

    2006-07-01

    The 5th National Congress of the Italian Society of Virology (SIV) was attended by junior- and senior-level virologists to promote interactions and scientific collaborations among the different areas of Virology and allied sciences. The invited and selected lecturers covered the following topics: General Virology and Viral Genetics; Virus-host Interaction and Pathogenesis; Viral Oncogenesis; Viral Immunology and Vaccines; Anti-viral Therapy; Innovative Diagnostics; Viral Biotechnologies and Cell and Gene Therapy. As in the previous editions (Salata and Palù, 2004; Salata et al., 2005), a specific topic was thoroughly covered in a roundtable. This year the elected subject was "HIV: determinants of pathogenicity and clinical implications." The final program and the abstract book can be found at the web site http://www.siv-virologia.it. This report summarizes the lessons learned from the plenary lectures and the selected oral presentations of the 2005 meeting.

  13. Dental health in antique population of Vinkovci - Cibalae in Croatia (3rd-5th century).

    PubMed

    Peko, Dunja; Vodanović, Marin

    2016-08-01

    Roman city Cibalae (Vinkovci) - the birthplace of Roman emperors Valentinian I and Valens was a very well developed urban ares in the late antique what was evidenced by numerous archaeological findings. The aim of this paper is to get insight in dental health of antique population of Cibalae. One hundred individuals with 2041 teeth dated to 3rd - 5th century AD have been analyzed for caries, antemortem tooth loss, periapical diseases and tooth wear. Prevalence of antemortem tooth loss was 4.3% in males, 5.2% in females. Prevalence of caries per tooth was 8.4% in males, 7.0% in females. Compared to other Croatian antique sites, ancient inhabitants of Roman Cibalae had rather good dental health with low caries prevalence and no gender differences. Statistically significant difference was found between males in females in the prevalence of periapical lesions and degree of tooth wear. Periapical lesions were found only in males. PMID:27598951

  14. Recurrent Idiopathic Catatonia: Implications beyond the Diagnostic and Statistical Manual of Mental Disorders 5th Edition.

    PubMed

    Caroff, Stanley N; Hurford, Irene; Bleier, Henry R; Gorton, Gregg E; Campbell, E Cabrina

    2015-08-31

    We describe a case of recurrent, life-threatening, catatonic stupor, without evidence of any associated medical, toxic or mental disorder. This case provides support for the inclusion of a separate category of "unspecified catatonia" in the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) to be used to classify idiopathic cases, which appears to be consistent with Kahlbaum's concept of catatonia as a distinct disease state. But beyond the limited, cross-sectional, syndromal approach adopted in DSM-5, this case more importantly illustrates the prognostic and therapeutic significance of the longitudinal course of illness in differentiating cases of catatonia, which is better defined in the Wernicke-Kleist-Leonhard classification system. The importance of differentiating cases of catatonia is further supported by the efficacy of antipsychotics in treatment of this case, contrary to conventional guidelines.

  15. APTWG: The 5th Asia-Pacific Transport Working Group Meeting

    NASA Astrophysics Data System (ADS)

    Gao, X.; Ghim, Y.-C.; Sun, Y. W.; Gao, Z.; Inagaki, S.; Chen, W.; Zhang, T.; Wang, Z. X.

    2016-03-01

    This conference report gives a summary on the contributed papers and discussions presented at the 5th Asia-Pacific Transport Working Group Meeting held at Dalian, China from 9-12 June 2015. The main goal of the working group is to develop a predictive understanding of the basic mechanisms responsible for particle, momentum and energy transport in magnetically confined plasmas. The topics of the meeting in 2015 were organized under five main headings: (1) turbulence suppression and transport barrier formation, (2) effect of magnetic topology on MHD activity and transport, (3) non-diffusive contribution of momentum and particle transport, (4) non-local transport and turbulence spreading and coupling and (5) energetic particles and instability. The Young Researchers’ Forum which was held at this meeting is also described in this report.

  16. Theoretical studies of Ir5Th and Ir5Ce nanoscale precipitates in Ir

    SciTech Connect

    Morris, James R; Averill, Frank; Cooper, Valentino R

    2014-01-01

    Experimentally, it is known that very small amounts of thorium and/or cerium added to iridium metal form a precipitate, Ir5Th / Ir5Ce, which improves the high temperature mechanical properties of the resulting alloys. We demonstrate that there are low-energy configurations for nano-scale precipitates of these phases in Ir, and that these coherent arrangements may assist in producing improved mechanical properties. One precipitate/matrix orientation gives a particularly low interfacial energy, and a low lattice misfit. Nanolayer precipitates with this orientation are found to be likely to form, with little driving force to coarsen. The predicted morphology of the precipitates and their orientation with the matrix phase provide a potential experiment that could be used to test these predictions.

  17. The endovascular management of recurrent aortic hypoplasia and coarctation in a 15-year-old male.

    PubMed

    Rhodes, Andrew B; O'Donnell, Sean D; Gillespie, David L; Rasmussen, Todd E; Johnson, Chatt A; Fox, Charles J; Burklow, Thomas R; Hagler, David J

    2005-03-01

    A 15-year-old male complained of easy fatigability, leg weakness, and pain on exertion with episodes of syncope while playing baseball. His past medical history was significant for aortic coarctation associated with a congenital bovine hypoplastic aortic arch. A recent arteriogram revealed innominate and left common carotid artery stenosis as well as recurrent coarctation. He had previously undergone three Dacron patch aortoplasties. At the age of 7, he underwent a fourth operation for recurrent coarctation and because of extensive scar tissue in the region of his prior procedures, a left subclavian artery-to-descending aortic bypass was performed. An endovascular repair to deal with the recent recurrence was performed because of prior surgical difficulties. Percutaneous balloon-expandable stents were placed in the aortic coarctation, innominate, and the left common carotid arteries. Postprocedure, ankle brachial indices were >1 and the patient remains asymptomatic after 1 year.

  18. 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

  19. Failure of Marfan anatomic criteria to predict risk of aortic dissection in Turner syndrome: necessity of specific adjusted risk thresholds†

    PubMed Central

    Maureira, Juan-Pablo; Vanhuyse, Fabrice; Lekehal, Malik; Hubert, Thierry; Vigouroux, Charlène; Mattei, Marie-Françoise; Grandmougin, Daniel; Villemot, Jean-Pierre

    2012-01-01

    Patients with Turner syndrome are prompt to develop spontaneous acute aortic dissection following insidious aortic dilatation, with abnormal cardiovascular anatomy and consequently require specific guidelines for regular surveillance since they represent a subset of high-risk young patients. We report a rare and uncommon case of spontaneous acute aortic dissection in a 48-year old female patient with Turner syndrome who was not apparently eligible for a prophylactic surgery. A CT scan showed a Stanford type A aortic dissection and was urgently referred for surgical management. We operated on the patient under deep hypothermia (18°C) and circulatory arrest with a retrograde cerebroplegia as the primary entry tear was located in the arch. The postoperative course was uneventful and the patient was discharged at the eighth postoperative day. Following description of this case, special attention was paid to determine predisposing risk factors for aortic dissection to be specifically adjusted to TS patients. PMID:22286600

  20. Partial aortic root remodeling for root reconstruction in patients with acute type A dissection

    PubMed Central

    Huang, Fuhua; Li, Liangpeng; Qin, Wei; Su, Cunhua; Wang, Liming; Xiao, Liqiong; Chen, Xin

    2016-01-01

    Abstract In the present study, we reported our experience with partial aortic root remodeling for root reconstruction in patients with acute type A dissection, which involves in non-coronary sinus and/or the right coronary sinus with just one trimmed Dacron graft. Between February 2001 and May 2010, we performed partial aortic root remodeling in 40 patients, who underwent emergency surgical intervention. The dissected sinuses were excised leaving a 3-5 mm rim of the aortic wall from the attached aortic valve cusps. A short piece (4-5 cm) of collagen coated woven polyester vascular prosthesis was trimmed with one or two “tongues” to reconstruct the non-coronary sinus and/or the right coronary sinus, but without using separated patches. Additional procedures were including hemi-arch replacement in 11 patients, and total arch replacement plus stent-elephant trunk in 20 patients. The mean follow-up time was 36.4±3.6 months. In-hospital mortality was only 5.0% (2/40); furthermore, 3 (8.6%) patients underwent re-operation of the aortic valve and 2 (5.7%) patients died during follow-up. At the end of follow-up, trivial or no aortic regurgitation was found in 33 patients, but mild aortic regurgitation was found in 2 patients. Our data suggest that the early and mid-term results of partial aortic root remodeling were favorable, and it restored valve durability and function. Thus, the use of technique for root reconstruction in patients with acute type A dissection should be vigorously encouraged.

  1. 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

  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. 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

  4. Peripartum Type A Aortic Dissection Repair Using Frozen Elephant Trunk Technique

    PubMed Central

    Ito, Tsutomu; Inaba, Yu; Hayashi, Sachiko; Misumi, Takahiko; Shimizu, Hideyuki

    2016-01-01

    A 43-year-old woman with abdominal and back pain during childbirth consulted us 1 day postdelivery. Contrast-enhanced computed tomography (CT) revealed partially thrombosed type A aortic dissection with intimal tear in the proximal descending thoracic aorta. Conservative antihypertensive treatment was started. However, her abdominal pain progressively deteriorated. Repeat CT revealed narrowing of the descending aorta true lumen and progressive bowel malperfusion. Total arch replacement was urgently performed using the frozen elephant trunk technique. Postoperative CT showed true lumen widening and symptom disappearance. Follow-up CT demonstrated excellent aortic remodeling.

  5. Stanford type A aortic dissection in a patient with Marfan syndrome during pregnancy: a case report.

    PubMed

    Kim, Won Ho; Bae, Jisue; Choi, Seung Won; Lee, Jong-Hwan; Kim, Chung Su; Cho, Hyun Sung; Lee, Sangmin M

    2016-02-01

    Aortic dissection during pregnancy is a devastating event for both the pregnant woman and the baby. We report a case of acute aortic dissection (Stanford type A) in a pregnant woman with Marfan syndrome at the 29(th) week of gestation. She underwent a cesarean section followed by an ascending aorta and total arch replacement with cardiopulmonary bypass, without a prior sternotomy. The hemodynamic parameters were kept stable during the cesarean section by using inotropes and vasopressors under transesophageal echocardiography monitoring. The newborn survived after endotracheal intubation and management in a neonatal intensive care unit. PMID:26885307

  6. A Case of an Aortic Abscess around the Elephant Trunk

    PubMed Central

    Kawasaki, Muneyasu; Katayanagi, Tomoyuki; Okuma, Shinnosuke; Masuhara, Hiroshi; Shiono, Noritsugu; Watanabe, Yoshinori

    2015-01-01

    A 52-year-old male patient with a history of total arch replacement using the elephant trunk technique for acute aortic dissection 4 years before visited our hospital with the chief complaint of persistent fever. Chest computed tomography (CT) suggested prosthetic vascular graft infection, which was treated surgically after chemotherapy. The first surgery consisted of debridement of an abscess around the vascular graft and in the aorta around the elephant trunk, and thoracic descending aorta replacement and vacuum-assisted closure (VAC) in view of the risk of bleeding from the peripheral region of the elephant trunk. One week later, omental filling was performed as the second step. This is a very rare case of aortic abscess around the elephant trunk that could successfully be managed by graft-conserving treatment. PMID:26226888

  7. Effects of aortic irregularities on blood flow.

    PubMed

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

    2016-04-01

    Anatomic aortic anomalies are seen in many medical conditions and are known to cause disturbances in blood flow. Turner syndrome (TS) is a genetic disorder occurring only in females where cardiovascular anomalies, particularly of the aorta, are frequently encountered. In this study, numerical simulations are applied to investigate the flow characteristics in four TS patient- related aortic arches (a normal geometry, dilatation, coarctation and elongation of the transverse aorta). The Quemada viscosity model was applied to account for the non-Newtonian behavior of blood. The blood is treated as a mixture consisting of water and red blood cells (RBC) where the RBCs are modeled as a convected scalar. The results show clear geometry effects where the flow structures and RBC distribution are significantly different between the aortas. Transitional flow is observed as a jet is formed due to a constriction in the descending aorta for the coarctation case. RBC dilution is found to vary between the aortas, influencing the WSS. Moreover, the local variations in RBC volume fraction may induce large viscosity variations, stressing the importance of accounting for the non-Newtonian effects. PMID:26104133

  8. Assessment of Altered 3D Blood Characteristics in Aortic Disease by Velocity Distribution Analysis

    PubMed Central

    Garcia, Julio; Barker, Alex J; van Ooij, Pim; Schnell, Susanne; Puthumana, Jyothy; Bonow, Robert O; Collins, Jeremy D; Carr, James C; Markl, Michael

    2014-01-01

    Purpose To test the feasibility of velocity distribution analysis for identifying altered 3D flow characteristics in patients with aortic disease based on 4D flow MRI volumetric analysis. Methods Forty patients with aortic (Ao) dilation (mid ascending aortic diameter MAA=40±7 mm, age=56±17 yr, 11 females) underwent cardiovascular MRI. Four groups were retrospectively defined: mild Ao dilation (n=10, MAA<35 mm); moderate Ao dilation (n=10, 3545 mm); Ao dilation+aortic stenosis AS (n=10, MAA>35 mm and peak velocity >2.5m/s). 3D PC-MR angiograms were computed and used to obtain a 3D segmentation of the aorta which was divided into four segments: root, ascending aorta, arch, descending aorta. Radial chart displays were used to visualize multiple parameters representing segmental changes in the 3D velocity distribution associated with aortic disease. Results Changes in the velocity field and geometry between cohorts resulted in distinct hemodynamic patterns for each aortic segment. Disease progression from mild to Ao dilation+AS resulted in significant differences (P<0.05) in flow parameters across cohorts and increased radial chart size for root and ascending aorta segments by 146% and 99%, respectively. Conclusion Volumetric 4D velocity distribution analysis has the potential to identify characteristic changes in regional blood flow patterns in patients with aortic disease. PMID:25252029

  9. Stanford-A acute aortic dissection, inflammation, and metalloproteinases: a review.

    PubMed

    Cifani, Noemi; Proietta, Maria; Tritapepe, Luigi; Di Gioia, Cira; Ferri, Livia; Taurino, Maurizio; Del Porto, Flavia

    2015-01-01

    Acute aortic dissection (AAD) is a life-threatening disease with an incidence of about 2.6-3.6 cases per 100,000/year. Depending on the site of rupture, AAD is classified as Stanford-A when the ascending aortic thoracic tract and/or the arch are involved, and Stanford-B when the descending thoracic aorta and/or aortic abdominal tract are targeted. It was recently shown that inflammatory pathways underlie aortic rupture in both type A and type B Stanford AAD. An immune infiltrate has been found within the middle and outer tunics of dissected aortic specimens. It has also been observed that the recall and activation of macrophages inside the middle tunic are key events in the early phases of AAD. Macrophages are able to release metalloproteinases (MMPs) and pro-inflammatory cytokines which, in turn, give rise to matrix degradation and neoangiogenesis. An imbalance between the production of MMPs and MMP tissue inhibitors is pivotal in the extracellular matrix degradation underlying aortic wall remodelling in dissections occurring both in inherited conditions and in atherosclerosis. Among MMPs, MMP-12 is considered a specific marker of aortic wall disease, whatever the genetic predisposition may be. The aim of this review is, therefore, to take a close look at the immune-inflammatory mechanisms underlying Stanford-A AAD.

  10. Need for Specific Sugar-Sweetened Beverage Lessons for 4th and 5th Graders

    PubMed Central

    Bea, Jennifer W.; Jacobs, Laurel; Waits, Juanita; Hartz, Vern; Martinez, Stephanie H.; Standfast, Rebecca D.; Farrell, Vanessa A.; Bawden, Margine; Whitmer, Evelyn; Misner, Scottie

    2015-01-01

    Objective Consumption of sugar-sweetened beverages (SSB) is linked to obesity. We hypothesized that school-based nutrition education would decrease SSB consumption. Design Self-selected interventional cohort with random selection for pre and post measurements Setting Arizona SNAP-Ed eligible schools Participants Randomly selected (9%) 4th and 5th grade classroom students Intervention The University of Arizona Nutrition Network (UANN) provided general nutrition education training and materials to teachers, to be delivered to their students. The UANN administered behavioral questionnaires to students in both Fall and Spring. Main Outcome Measure(s) Change in SSB consumption Analyses Descriptive statistics were computed for student demographics and beverage consumption on the day prior to testing. Paired t-tests evaluated change in classroom averages. Linear regression assessed potential correlates of SSB consumption. Results Fall mean SSB consumption was 1.1 (±0.2) times; mean milk and water intake were 1.6 (±0.2) and 5.2 (±0.7) times, respectively. Beverage consumption increased (3.2%) in springtime, with increased SSBs (14.4%) accounting for the majority (p=0.006). Change in SSB consumption was negatively associated with baseline SSB and water consumption, but positively associated with baseline milk fat (p≤0.05). Conclusions and Implications The results suggest the need for beverage specific education to encourage children to consume more healthful beverages in warmer weather. PMID:25239840

  11. Emotions, arousal, and frontal alpha rhythm asymmetry during Beethoven's 5th symphony.

    PubMed

    Mikutta, Christian; Altorfer, Andreas; Strik, Werner; Koenig, Thomas

    2012-10-01

    Music is capable of inducing emotional arousal. While previous studies used brief musical excerpts to induce one specific emotion, the current study aimed to identify the physiological correlates of continuous changes in subjective emotional states while listening to a complete music piece. A total of 19 participants listened to the first movement of Ludwig van Beethoven's 5th symphony (duration: ~7.4 min), during which a continuous 76-channel EEG was recorded. In a second session, the subjects evaluated their emotional arousal during the listening. A fast fourier transform was performed and covariance maps of spectral power were computed in association with the subjective arousal ratings. Subjective arousal ratings had good inter-individual correlations. Covariance maps showed a right-frontal suppression of lower alpha-band activity during high arousal. The results indicate that music is a powerful arousal-modulating stimulus. The temporal dynamics of the piece are well suited for sequential analysis, and could be necessary in helping unfold the full emotional power of music.

  12. The 5th Symposium on Post-Transcriptional Regulation of Plant Gene Expression (PTRoPGE)

    SciTech Connect

    Karen S. Browning; Marie Petrocek; Bonnie Bartel

    2006-06-01

    The 5th Symposium on Post-Transcriptional Regulation of Plant Gene Expression (PTRoPGE) will be held June 8-12, 2005 at the University of Texas at Austin. Exciting new and ongoing discoveries show significant regulation of gene expression occurs after transcription. These post-transcriptional control events in plants range from subtle regulation of transcribed genes and phosphorylation, to the processes of gene regulation through small RNAs. This meeting will focus on the regulatory role of RNA, from transcription, through translation and finally degradation. The cross-disciplinary design of this meeting is necessary to encourage interactions between researchers that have a common interest in post-transcriptional gene expression in plants. By bringing together a diverse group of plant molecular biologist and biochemists at all careers stages from across the world, this meeting will bring about more rapid progress in understanding how plant genomes work and how genes are finely regulated by post-transcriptional processes to ultimately regulate cells.

  13. Science teaching efficacy beliefs of 5th and 8th grade science teachers

    NASA Astrophysics Data System (ADS)

    Hanson, Susan Melony

    The purpose of this study was to determine which, if any, variables had a significant relationship to personal science teaching efficacy beliefs and outcome expectancies. The independent variables tested were number of undergraduate science methods courses taken, level of teacher education, number of years as a classroom teacher, number of years as a science teacher, teacher beliefs regarding instructional strategies in science, and teacher beliefs regarding student engagement in the science classroom. Through surveys completed by 5th and 8th grade science teachers, the researcher analyzed data via multiple regressions to determine significance. Results of the data analysis showed the greatest significance was between personal science teaching efficacy beliefs and number of years as a classroom teacher, and teacher beliefs regarding instructional strategies in science and outcome expectancy and student engagement in the science classroom. Implications for current practice include a need for improved teacher education programs for pre-service science teachers, collaboration between universities and public school districts, improved methods for teacher retention in the science classroom, and the use of hands-on and minds-on instruction in the science classroom.

  14. Arching in tapped deposits of hard disks.

    PubMed

    Pugnaloni, Luis A; Valluzzi, Marcos G; Valluzzi, Lucas G

    2006-05-01

    We simulate the tapping of a bed of hard disks in a rectangular box by using a pseudodynamic algorithm. In these simulations, arches are unambiguously defined and we can analyze their properties as a function of the tapping amplitude. We find that an order-disorder transition occurs within a narrow range of tapping amplitudes as has been seen by others. Arches are always present in the system although they exhibit regular shapes in the ordered regime. Interestingly, an increase in the number of arches does not always correspond to a reduction in the packing fraction. This is in contrast with what is found in three-dimensional systems.

  15. 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.

  16. 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

  17. 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

  18. 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.

  19. Identification and validation of genes affecting aortic lesions in mice.

    PubMed

    Yang, Xia; Peterson, Larry; Thieringer, Rolf; Deignan, Joshua L; Wang, Xuping; Zhu, Jun; Wang, Susanna; Zhong, Hua; Stepaniants, Serguei; Beaulaurier, John; Wang, I-Ming; Rosa, Ray; Cumiskey, Anne-Marie; Luo, Jane Ming-Juan; Luo, Qi; Shah, Kashmira; Xiao, Jianying; Nickle, David; Plump, Andrew; Schadt, Eric E; Lusis, Aldons J; Lum, Pek Yee

    2010-07-01

    Atherosclerosis represents the most significant risk factor for coronary artery disease (CAD), the leading cause of death in developed countries. To better understand the pathogenesis of atherosclerosis, we applied a likeli-hood-based model selection method to infer gene-disease causality relationships for the aortic lesion trait in a segregating mouse population demonstrating a spectrum of susceptibility to developing atherosclerotic lesions. We identified 292 genes that tested causal for aortic lesions from liver and adipose tissues of these mice, and we experimentally validated one of these candidate causal genes, complement component 3a receptor 1 (C3ar1), using a knockout mouse model. We also found that genes identified by this method overlapped with genes progressively regulated in the aortic arches of 2 mouse models of atherosclerosis during atherosclerotic lesion development. By comparing our gene set with findings from public human genome-wide association studies (GWAS) of CAD and related traits, we found that 5 genes identified by our study overlapped with published studies in humans in which they were identified as risk factors for multiple atherosclerosis-related pathologies, including myocardial infarction, serum uric acid levels, mean platelet volume, aortic root size, and heart failure. Candidate causal genes were also found to be enriched with CAD risk polymorphisms identified by the Wellcome Trust Case Control Consortium (WTCCC). Our findings therefore validate the ability of causality testing procedures to provide insights into the mechanisms underlying atherosclerosis development.

  20. Transcatheter aortic valve implantation.

    PubMed

    Kapadia, Samir R; Tuzcu, E Murat

    2009-12-01

    Aortic stenosis is the most important valvular heart disease affecting the elderly population. Surgical aortic valve replacement is the mainstay of treatment, although a substantial number of patients are considered high risk for surgery. Many of these patients do not undergo surgery and have poor outcomes from medically treated symptomatic, severe aortic stenosis. Transcatheter aortic valve implantation (TAVI) provides a promising treatment option for some of these patients. Several devices are under investigation. The Edwards Sapien valve (Edwards Lifesciences, Irvine, CA) and the CoreValve (Medtronic, Minneapolis, MN) have the largest human experience to date. Initial data suggest that these devices have an acceptable safety profile and provide excellent hemodynamic relief of aortic stenosis. The Edwards Sapien valve is currently under investigation in the United States in the PARTNER (Placement of Aortic Transcatheter Valve) trial in high-risk surgical or inoperable patients; TAVI is available for clinical use in both Canada and Europe. TAVI is not used in low- or intermediate-risk surgical patients; however, future studies may prove its applicability in these subsets. The major complications of TAVI include access site-related problems and device malpositioning/migration. There are several new-generation prosthetic valves and delivery systems designed to be low profile and repositionable. Technical advances and refinement of the implantation methods may make TAVI even safer and ultimately a better treatment option, not only for patients with high surgical risk but also for those with moderate or low risk.

  1. [Inflammatory abdominal aortic aneurysm].

    PubMed

    Ziaja, K; Sedlak, L; Urbanek, T; Kostyra, J; Ludyga, T

    2000-01-01

    The reported incidence of inflammatory abdominal aortic aneurysm (IAAA) is from 2% to 14% of patients with abdominal aortic aneurysm and the etiology of this disease is still discussed--according to the literature several pathogenic theories have been proposed. From 1992 to 1997 32 patients with IAAA were operated on. The patients were mostly symptomatic--abdominal pain was present in 68.75% cases, back pain in 31.25%, fever in 12.5% and weight loss in 6.25% of the operated patients. In all the patients ultrasound examination was performed, in 4 patients CT and in 3 cases urography. All the patients were operated on and characteristic signs of inflammatory abdominal aortic aneurysm like: thickened aortic wall, perianeurysmal infiltration or retroperitoneal fibrosis with involvement of retroperitoneal structures were found. In all cases surgery was performed using transperitoneal approach; in three cases intraoperatively contiguous abdominal organs were injured, which was connected with their involvement into periaortic inflammation. In 4 cases clamping of the aorta was done at the level of the diaphragmatic hiatus. 3 patients (9.37%) died (one patient with ruptured abdominal aortic aneurysm). Authors present diagnostic procedures and the differences in the surgical tactic, emphasizing the necessity of the surgical therapy in patients with inflammatory abdominal aortic aneurysm.

  2. Are Aortic Stent Grafts Safe in Pregnancy?

    PubMed Central

    Khandanpour, Nader; Mehta, Tapan A.; Adiseshiah, M.; Meyer, Felicity J.

    2015-01-01

    Aortic stent grafts are increasingly used to treat aortic aneurysms and also other aortic pathologies. The safety of aortic stent grafts in pregnancy has never been studied or reported. We report on two cases of aortic stent grafts in pregnant women and discuss the effect of pregnancy on these aortic stent grafts. PMID:26229702

  3. Trouble-shooting dual arch impressions.

    PubMed

    Kaplowitz, G J

    1996-02-01

    Dual arch impression techniques enable the dentist to capture an impression of the prepared tooth, the opposing teeth and the occlusal registration in one procedure. This saves chair time and impression material.

  4. 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...

  5. Thoracic Duct Embolization with Lipiodol for Chylothorax due to Thoracic Endovascular Aortic Repair with Debranching Procedure

    PubMed Central

    Lee, Kwang Hyoung; Jung, Jae Seung; Cho, Sung Bum; Lee, Seung Hun; Kim, Hee Jung; Son, Ho Sung

    2015-01-01

    Chylothorax is a rare postoperative complication of a thoracic surgical procedure. Here, we report a case of chylothorax after thoracic endovascular aortic repair with debranching for the distal arch aneurysm of the aorta. First, the patient was treated by a medical method (nil per os, fat-free diet, and octreotide), but this method failed. The patient strongly refused surgical treatment. Therefore, we tried to occlude the thoracic duct by lymphangiography Lipiodol, and this line of treatment was successful. PMID:25705604

  6. 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.

  7. 5th International conference on Physics and Astrophysics of Quark Gluon Plasma

    NASA Astrophysics Data System (ADS)

    Sinha, Bikash; Alam, Jan-E.; Nayak, Tapan K.

    2006-11-01

    The 5th International Conference on Physics and Astrophysics of Quark Gluon Plasma (ICPAQGP 2005) was held on 8 - 12 February 2005 at the Variable Energy Cyclotron Centre and Saha Institute of Nuclear Physics campus, Kolkata, India. The conference was enriched by the august presence of about 300 participants representing 18 countries across the globe. It had plenary talks and oral presentations, which form a part of these proceedings. Besides invited and contributed talks there were also a large number of poster presentations. The conference was energized by discussions of fresh experimental data from RHIC on strong elliptic flow, jet quenching, single photon spectra etc. Moreover, new theoretical results were brought to the discussion forum during this conference. Colour glass condensates, hydrodynamical flow, jet quenching and sQGP were intensely debated by the participants. The highlight of ICPAQGP 2005 was the presentation of fresh experimental results from the RHIC-IV run. The ICPAQGP series, since its inception in 1988, has placed emphasis on the role of quark matter in the fields of astrophysics and cosmology. The subsequent conferences held in 1993, 1997, 2001 and 2005 had also retained this focus. The conference was preceded by a Fest Colloquium in honour of Professor Bikash Sinha. Professor Sinha, regarded as the pioneer in establishing quark gluon plasma research in India, has successfully encouraged a group of young Indian researchers to devote themselves wholeheartedly to QGP research - both theoretical and experimental. Members of the International Advisory Committee played a pivotal role mainly in the selection of speakers. The contributions of the Organizing Committee in all aspects, from selecting the contributory talks posters down to arranging local hospitality, were much appreciated. We thank the members of both committees for making ICPAQGP 2005 an interesting platform for scientific deliberation. The ICPAQGP 2005 was supported financially by

  8. Freezing Rain Diagnostic Study Over Eastern Canada Using the 5th Generation Canadian Regional Climate Model

    NASA Astrophysics Data System (ADS)

    Bresson, É.; Paquin, D.; Laprise, R.; Theriault, J. M.; de Elía, R.

    2015-12-01

    Northeastern North America is often affected by freezing rain events during the cold season. They can have significant consequences (from road accidents, to severe power outages) despite their intensity and duration. The 1998 Ice Storm over Eastern Canada and Northeastern United States is an example of an extreme event with catastrophic consequences. A total of up to 150 mm of ice accumulated during 10 days were observed in some areas. This natural disaster has highlighted the need to better understand how such phenomena will evolve with future climate scenario. The goal is to investigate the feasibility of using regional climate modeling to diagnose the occurrence of freezing rain events over Quebec (Canada). To address this issue, we used the 5th generation of the Canadian Regional Climate Model (CRCM5), from 1979 to 2014. An empirical method (Bourgouin, 2000) developed to determine the type of winter precipitations was chosen to diagnose freezing rain events. The study focused in the Montreal area and the St. Lawrence River Valley (Quebec, Canada). The sensitivity of the model to horizontal resolution was explored by using three resolutions: 0.44°, 0.22° and 0.11°. In general, freezing rain was diagnosed consistently at all resolutions but the higher one (0.11°) produced more realistic results due to a better representation of the orography. Using the higher resolution, the results showed that the climatology of the freezing rain occurrence in the Montreal area is comparable to available observations. It also suggested that the role of the specific orography of the region with the St. Lawrence River Valley can impact the characteristics of freezing rain events in this area. Overall, this study will contribute to a better preparedness for such events in the future. High resolution regional climate simulations are essential to improve the reproduction of local scale orographically-forced phenomena.

  9. Black sea surface temperature anomaly on 5th August 1998 and the ozone layer thickness

    NASA Astrophysics Data System (ADS)

    Manev, A.; Palazov, K.; Raykov, St.; Ivanov, V.

    2003-04-01

    BLACK SEA SURFACE TEMPERATURE ANOMALY ON 5th AUGUST 1998 AND THE OZONE LAYER THICKNESS A. Manev , K. Palazov , St. Raykov, V. Ivanov Solar Terrestrial Influences Laboratory, Bulgarian Academy of Sciences amanev@abv.bg This paper focuses on the peculiarities of the Black Sea surface temperature anomaly on 05.08.1998. Researching the daily temperature changes in a number of control fields in the course of 8-10 years, we have found hidden correlations and anomalous deviations in the sea surface temperatures on a global scale. Research proves the statistical reliability of the temperature anomaly on the entire Black Sea surface registered on 04.-05.08.1998. In the course of six days around these dates the temperatures are up to 2°C higher than the maximum temperatures in this period in the other seven years. A more detailed analysis of the dynamics of the anomaly required the investigation of five Black Sea surface characteristic zones of 75x75 km. The analysis covers the period 20 days - 10 days before and 10 days after the anomaly. Investigations aimed at interpreting the reasons for the anomalous heating of the surface waters. We have tried to analyze the correlation between sea surface temperature and the global ozone above the Black Sea by using simultaneously data from the two satellite systems NOAA and TOMS. Methods of processing and comparing the data from the two satellite systems are described. The correlation coefficients values for the five characteristic zones are very high and close, which proves that the character of the correlation ozone - sea surface temperature is the same for the entire Black Sea surface. Despite the high correlation coefficient, we have proved that causality between the two phenomena at the time of the anomaly does not exit.

  10. Development of a Three-Dimensional Finite Element Chest Model for the 5(th) Percentile Female.

    PubMed

    Kimpara, Hideyuki; Lee, Jong B; Yang, King H; King, Albert I; Iwamoto, Masami; Watanabe, Isao; Miki, Kazuo

    2005-11-01

    Several three-dimensional (3D) finite element (FE) models of the human body have been developed to elucidate injury mechanisms due to automotive crashes. However, these models are mainly focused on 50(th) percentile male. As a first step towards a better understanding of injury biomechanics in the small female, a 3D FE model of a 5(th) percentile female human chest (FEM-5F) has been developed and validated against experimental data obtained from two sets of frontal impact, one set of lateral impact, two sets of oblique impact and a series of ballistic impacts. Two previous FE models, a small female Total HUman Model for Safety (THUMS-AF05) occupant version 1.0Beta (Kimpara et al. 2002) and the Wayne State University Human Thoracic Model (WSUHTM, Wang 1995 and Shah et al. 2001) were integrated and modified for this model development. The model incorporated not only geometrical gender differences, such as location of the internal organs and structure of the bony skeleton, but also the biomechanical differences of the ribs due to gender. It includes a detailed description of the sternum, ribs, costal cartilage, thoracic spine, skin, superficial muscles, intercostal muscles, heart, lung, diaphragm, major blood vessels and simplified abdominal internal organs and has been validated against a series of six cadaveric experiments on the small female reported by Nahum et al. (1970), Kroell et al. (1974), Viano (1989), Talantikite et al. (1998) and Wilhelm (2003). Results predicted by the model were well-matched to these experimental data for a range of impact speeds and impactor masses. More research is needed in order to increase the accuracy of predicting rib fractures so that the mechanisms responsible for small female injury can be more clearly defined. PMID:17096277

  11. Patterns of Irregular Burials in Western Europe (1st-5th Century A.D.)

    PubMed Central

    Milella, Marco; Mariotti, Valentina; Belcastro, Maria Giovanna; Knüsel, Christopher J.

    2015-01-01

    Background Irregular burials (IB—burials showing features that contrast with the majority of others in their geographic and chronological context) have been the focus of archaeological study because of their relative rarity and enigmatic appearance. Interpretations of IB often refer to supposed fear of the dead or to social processes taking place in time-specific contexts. However, a comprehensive and quantitative analysis of IB for various geographical contexts is still lacking, a fact that hampers any discussion of these burials on a larger scale. Methods Here, we collected a bibliographic dataset of 375 IB from both Britain and Continental Europe, altogether spanning a time period from the 1st to the 5th century AD. Each burial has been coded according to ten dichotomous variables, further analyzed by means of chi-squared tests on absolute frequencies, non-metric multidimensional scaling, and cluster analysis. Results Even acknowledging the limits of this study, and in particular the bias represented by the available literature, our results point to interesting patterns. Geographically, IB show a contrast between Britain and Continental Europe, possibly related to historical processes specific to these regions. Different types of IB (especially prone depositions and depositions with the cephalic extremity displaced) present a series of characteristics and associations between features that permit a more detailed conceptualization of these occurrences from a socio-cultural perspective that aids to elucidate their funerary meaning. Conclusions and Significance Altogether, the present work stresses the variability of IB, and the need to contextualize them in a proper archaeological and historical context. It contributes to the discussion of IB by providing a specific geographic and chronological frame of reference that supports a series of hypotheses about the cultural processes possibly underlying their occurrence. PMID:26115408

  12. Reoperative transapical transcatheter aortic valve replacement for central aortic regurgitation.

    PubMed

    Zhu, Yuanjia; Kapadia, Samir; Krishnaswamy, Amar; Svensson, Lars G; Mick, Stephanie

    2016-09-01

    Paravalvular leak-related aortic regurgitation after transcatheter aortic valve replacement (TAVR) is a common complication and is associated with increased short- and long-term mortality. However, the impact of isolated central aortic regurgitation is unknown. We report a case of transapical (TA) TAVR with postprocedural central aortic regurgitation, who returned after two years with progression of regurgitation. A reoperative valve-in-valve TA-TAVR was performed. PMID:27405799

  13. 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

  14. Free vibrations of spatial Timoshenko arches

    NASA Astrophysics Data System (ADS)

    Caliò, I.; Greco, A.; D'Urso, D.

    2014-09-01

    This paper addresses the evaluation of the exact natural frequencies and vibration modes of structures obtained by assemblage of plane circular arched Timoshenko beams. The exact dynamic stiffness matrix of the single circular arch, in which both the in-plane and out-of-plane motions are taken into account, is derived in an useful dimensionless form by revisiting the mathematical approach already adopted by Howson and Jemah (1999 [18]), for the in plane and the out-of-plan natural frequencies of curved Timoshenko beams. The knowledge of the exact dynamic stiffness matrix of the single arch makes the direct evaluation of the exact global dynamic stiffness matrix of spatial arch structures possible. Furthermore, it allows the exact evaluation of the frequencies and the corresponding vibration modes, for the distributed parameter model, through the application of the Wittrick and Williams algorithm. Consistently with the dimensionless form proposed in the derivation of the equations of motion and the dynamic stiffness matrix, an original and extensive parametric analysis on the in-plane and out-of-plane dynamic behaviour of the single arch, for a wide range of structural and geometrical dimensionless parameters, has been performed. Moreover, some numerical applications, relative to the evaluation of exact frequencies and the corresponding mode shapes in spatial arched structures, are reported. The exact solution has been numerically validated by comparing the results with those obtained by a refined finite element simulation.

  15. 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 ...

  16. Combined interventional and surgical treatment for acute aortic type a dissection.

    PubMed

    Liu, Jin-Cheng; Zhang, Jin-Zhou; Yang, Jian; Zuo, Jian; Zhang, Jin-Bao; Yu, Shi-Qiang; Chen, Tao; Xu, Xue-Zeng; Wei, Xu-Feng; Yi, Dinghua

    2008-01-01

    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. PMID:18389185

  17. 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.

  18. Communicating Science to Impact Learning? A Phenomenological Inquiry into 4th and 5th Graders' Perceptions of Science Information Sources

    ERIC Educational Resources Information Center

    Gelmez Burakgazi, Sevinc; Yildirim, Ali; Weeth Feinstein, Noah

    2016-01-01

    Rooted in science education and science communication studies, this study examines 4th and 5th grade students' perceptions of science information sources (SIS) and their use in communicating science to students. It combines situated learning theory with uses and gratifications theory in a qualitative phenomenological analysis. Data were gathered…

  19. WWW.com: A Brief Intervention to Bolster a 5th Grader's Regrouping Skills in Math

    ERIC Educational Resources Information Center

    Waugh, Matthew; Harrison, Gina L.

    2014-01-01

    This study examined the efficacy of a brief math intervention using cognitive behaviour instruction (CBI) supplemented by a mnemonic cue system for a 5th grade student with math computation and fluency difficulties. Regrouping operations in addition and subtraction were the targeted skills. Curriculum-based measurements were conducted at the end…

  20. Comparing Science Learning among 4th-, 5th-, and 6th-Grade Students: STS versus Textbook-Based Instruction

    ERIC Educational Resources Information Center

    Yager, Robert E.; Choi, AeRan; Yager, Stuart O.; Akcay, Hakan

    2009-01-01

    Fifteen 4th-, 5th-, and 6th-grade teachers from five school districts each taught two sections of science--one with a Science-Technology-Society (STS) approach and the other with a more traditional textbook approach in which basic science concepts were the major organizers. Local, current, and personally relevant issues provided the context and…

  1. Process Evaluation of "Learn Young, Learn Fair": A Stress Management Programme for 5th and 6th Graders

    ERIC Educational Resources Information Center

    Kraag, Gerda; Van Breukelen, Gerard; Lamberts, Petra; Vugts, Odette; Kok, Gerjo; Fekkes, Minne; Abu-Saad, Huda Huijer

    2007-01-01

    This article describes the process evaluation of a stress management program called "Learn Young, Learn Fair" for 5th and 6th graders. Studies, reviews and meta-analyses of prevention programs report that a common limitation in studies is the restricted documentation of process factors that contribute to the success of interventions. Program…

  2. Using Functional Behavior Assessment to Match Task Difficulty for a 5th Grade Student: A Case Study

    ERIC Educational Resources Information Center

    Haydon, Todd

    2012-01-01

    We used an AB design with a control condition to examine the effects of an academic strategy on a student with a learning disability during a 5th grade math class. During baseline the student had high rates of disruptive behavior, low percentages of intervals of on-task behavior, and low percentages of correct responses. An antecedent-based…

  3. Proceedings of the International Conference on Educational Data Mining (EDM) (5th, Chania, Greece, June 19-21, 2012)

    ERIC Educational Resources Information Center

    International Educational Data Mining Society, 2012

    2012-01-01

    The 5th International Conference on Educational Data Mining (EDM 2012) is held in picturesque Chania on the beautiful Crete island in Greece, under the auspices of the International Educational Data Mining Society (IEDMS). The EDM 2012 conference is a leading international forum for high quality research that mines large data sets of educational…

  4. Brief Report: Data on the Stanford-Binet Intelligence Scales (5th Ed.) in Children with Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Coolican, Jamesie; Bryson, Susan E.; Zwaigenbaum, Lonnie

    2008-01-01

    The Fifth Edition of the Stanford-Binet Intelligence Scales (SB5; Roid, G. H. (2003). "Stanford Binet intelligence scales" (5th ed.). Itasca, IL: Riverside Publishing) is relatively new, with minimal published research on general populations and none with special populations. The present study provides information on the cognitive profiles of…

  5. [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

  6. Awake transapical aortic valve implantation.

    PubMed

    Petridis, Francesco Dimitri; Savini, Carlo; Castelli, Andrea; Di Bartolomeo, Roberto

    2012-05-01

    Transapical aortic valve implantation is being employed as a less invasive alternative to open heart surgery in high-risk patients with severe aortic stenosis. Here we report the case of an awake transapical aortic valve implantation in a patient with severe chronic obstructive pulmonary disease.

  7. Storm Peak Laboratory 5th-6th Grade Climate and Weather Program

    NASA Astrophysics Data System (ADS)

    McCubbin, I. B.; Hallar, A. G.

    2008-12-01

    science. At the end of the day each student has a data sheet with measurements recorded from 5 locations of different elevations to take back to the classroom. Following the field trip, SPL scientists and educators visit the school for a follow-up to help children grasp concepts, represent their data set collected in graphical formats, answer questions, and evaluate students" learning. Currently, approximately 250 students annually participate in the SPL 5th and 6th grade climate education program.

  8. FOREWORD: 5th International Workshop on New Computational Methods for Inverse Problems

    NASA Astrophysics Data System (ADS)

    Vourc'h, Eric; Rodet, Thomas

    2015-11-01

    This volume of Journal of Physics: Conference Series is dedicated to the scientific research presented during the 5th International Workshop on New Computational Methods for Inverse Problems, NCMIP 2015 (http://complement.farman.ens-cachan.fr/NCMIP_2015.html). This workshop took place at Ecole Normale Supérieure de Cachan, on May 29, 2015. The prior editions of NCMIP also took place in Cachan, France, firstly within the scope of ValueTools Conference, in May 2011, and secondly at the initiative of Institut Farman, in May 2012, May 2013 and May 2014. The New Computational Methods for Inverse Problems (NCMIP) workshop focused on recent advances in the resolution of inverse problems. Indeed, inverse problems appear in numerous scientific areas such as geophysics, biological and medical imaging, material and structure characterization, electrical, mechanical and civil engineering, and finances. The resolution of inverse problems consists of estimating the parameters of the observed system or structure from data collected by an instrumental sensing or imaging device. Its success firstly requires the collection of relevant observation data. It also requires accurate models describing the physical interactions between the instrumental device and the observed system, as well as the intrinsic properties of the solution itself. Finally, it requires the design of robust, accurate and efficient inversion algorithms. Advanced sensor arrays and imaging devices provide high rate and high volume data; in this context, the efficient resolution of the inverse problem requires the joint development of new models and inversion methods, taking computational and implementation aspects into account. During this one-day workshop, researchers had the opportunity to bring to light and share new techniques and results in the field of inverse problems. The topics of the workshop were: algorithms and computational aspects of inversion, Bayesian estimation, Kernel methods, learning methods

  9. PREFACE: 5th International EEIGM/AMASE/FORGEMAT Conference on Advanced Materials Research

    NASA Astrophysics Data System (ADS)

    Ayadi, Zoubir; Czerwiec, Thierry; Horwat, David; Jamart, Brigitte

    2009-07-01

    This issue of IOP Conference Series: Materials Science and Engineering, contains manuscripts of talks that will be presented at the 5th International EEIGM/AMASE/FORGEMAT Conference on Advanced Materials Research that will be held at the Ecole Européenne d'Ingénieurs en Génie des Matériaux - European School of Materials Science and Engineering (EEIGM) in Nancy on November 4-5 2009. The conference will be organized by the EEIGM. The aim of the conference is to bring together scientists from the six European universities involved in the EEIGM and in the ''Erasmus Mundus'' AMASE Master (Advanced Materials Science and Engineering) programmes and in the Tempus FORGEMAT European project: Nancy-Université - EEIGM/INPL (Nancy, France), Universität des Saarlandes (Saarbrücken, Germany), Universitat Politècnica de Catalunya - ETSEIB (Barcelona, Spain), Luleå Tekniska Universitet (Luleå, Sweden), Universidad Politecnica de Valencia - ETSII (Valencia, Spain) and AGH University of Science and Technology, (Kralow, Poland). This conference is also open to other universities who have strong links with the EEIGM and it will provide a forum for exchange of ideas, cooperation and future directions by means of regular presentations, posters and a round-table discussion. After careful refereeing of all manuscripts, equally shared between the four editors, 26 papers have been selected for publication in this issue. The papers are grouped together into different subject categories: polymers, metallurgy, ceramics, composites and nanocomposites, simulation and characterization. The editors would like to take this opportunity to thank all the participants who submitted their manuscripts during the conference and responded in time to the editors' request at every stage from reviewing to final acceptance. The editors are indebted to all the reviewers for painstakingly reviewing the papers at very short notice. Special thanks are called for the sponsors of the conference including

  10. Health in the 5th 5-years Development Plan of Iran: Main Challenges, General Policies and Strategies.

    PubMed

    Vosoogh Moghaddam, A; Damari, B; Alikhani, S; Salarianzedeh, Mh; Rostamigooran, N; Delavari, A; Larijani, B

    2013-01-01

    Access to the right to the highest attainable level of health is a constitutional right that obliges governments and other players to take step to increase all individuals' chances of obtaining good health. At the least, health and education are two crucial requirements for this as well. Iran's vision 2025 is going to lead the country to a developed state with the highest rank of economic, scientific and technological status in the region. Enjoying health, welfare, food security, social security, equal opportunities, etc, are also considered as part of characteristics of Iranian society in 2025. Although health system of Iran has many achievements in providing health services specially for the poor following the Islamic Revolution of 1979, but the evidences gathered to develop the 5(th) 5-years economical, social and cultural plan (5(th)5YDP:2011-2015), listed a variety of main challenges in stewardship, financing, resources generation and service provision functions of the existing health system. Thus, to overcome the main challenges, about 11% of general policies of 5(th)5YDP are directly address health related issues with emphasizing on healthy human and comprehensive health approach with considering: Integration of policy making, planning, evaluation, supervision and public financing; Developing both quantity and quality of health insurance system and reducing out-of-pocket expenditures for health services to 30% by the end of the 5th plan. The strategies of 5(th)5YDP adopted by the parliament as an Act will change the health system fundamentally through tuning the main drivers; so, its implementation needs brave leaders, capable managers, motivated technical staff and social mobilization. PMID:23865015

  11. Health in the 5th 5-years Development Plan of Iran: Main Challenges, General Policies and Strategies.

    PubMed

    Vosoogh Moghaddam, A; Damari, B; Alikhani, S; Salarianzedeh, Mh; Rostamigooran, N; Delavari, A; Larijani, B

    2013-01-01

    Access to the right to the highest attainable level of health is a constitutional right that obliges governments and other players to take step to increase all individuals' chances of obtaining good health. At the least, health and education are two crucial requirements for this as well. Iran's vision 2025 is going to lead the country to a developed state with the highest rank of economic, scientific and technological status in the region. Enjoying health, welfare, food security, social security, equal opportunities, etc, are also considered as part of characteristics of Iranian society in 2025. Although health system of Iran has many achievements in providing health services specially for the poor following the Islamic Revolution of 1979, but the evidences gathered to develop the 5(th) 5-years economical, social and cultural plan (5(th)5YDP:2011-2015), listed a variety of main challenges in stewardship, financing, resources generation and service provision functions of the existing health system. Thus, to overcome the main challenges, about 11% of general policies of 5(th)5YDP are directly address health related issues with emphasizing on healthy human and comprehensive health approach with considering: Integration of policy making, planning, evaluation, supervision and public financing; Developing both quantity and quality of health insurance system and reducing out-of-pocket expenditures for health services to 30% by the end of the 5th plan. The strategies of 5(th)5YDP adopted by the parliament as an Act will change the health system fundamentally through tuning the main drivers; so, its implementation needs brave leaders, capable managers, motivated technical staff and social mobilization.

  12. Proximal aortic dissection (dissecting aortic aneurysm) in a mature ostrich.

    PubMed

    Ferreras, M C; González, J; Pérez, V; Reyes, L E; Gómez, N; Pérez, C; Corpa, J M; García-Marín, J F

    2001-01-01

    The gross and histopathologic lesions observed in a case of spontaneous proximal aortic dissection (dissecting aortic aneurysm) in a mature ostrich are reported. At necropsy, a dissecting intramural hematoma was seen in the proximal aorta, extended about 12 cm distally from the aortic valves. Histopathologic changes in aortic dissection included fragmentation and disruption of elastic laminae, presence of cystic extracellular spaces, and pooling of ground substance in the tunica media. Hepatic copper levels were measured, and the low concentration found suggested that a copper deficiency together with other risk factors such as the elevation of blood pressure may have been implicated in the development of the aortic dissection seen in this ostrich.

  13. 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.

  14. Aortic outflow cannula tip design and orientation impacts cerebral perfusion during pediatric cardiopulmonary bypass procedures.

    PubMed

    Menon, Prahlad G; Antaki, James F; Undar, Akif; Pekkan, Kerem

    2013-12-01

    Poor perfusion of the aortic arch is a suspected cause for peri- and post-operative neurological complications associated with cardiopulmonary bypass (CPB). High-speed jets from 8 to 10FR pediatric/neonatal cannulae delivering ~1 L/min of blood can accrue sub-lethal hemolytic damage while also subjecting the aorta to non-physiologic flow conditions that compromise cerebral perfusion. Therefore, we emphasize the importance of cannulation strategy and hypothesize engineering better CPB perfusion through a redesigned aortic cannula tip. This study employs computational fluid dynamics to investigate novel diffuser-tipped aortic cannulae for shape sensitivity to cerebral perfusion, in an in silico cross-clamped aortic arch model modeled with fixed outflow resistances. 17 parametrically altered configurations of an 8FR end-hole and several diffuser cone angled tips in combination with jet incidence angles toward or away from the head-neck vessels were studied. Experimental pressure-flow characterizations were also conducted on these cannula tip designs. An 8FR end-hole aortic cannula delivering 1 L/min along the transverse aortic arch was found to give rise to backflow from the brachicephalic artery (BCA), irrespective of angular orientation, for the chosen ascending aortic insertion location. Parametric alteration of the cannula tip to include a diffuser cone angle (tested up to 7°) eliminated BCA backflow for any tested angle of jet incidence. Experiments revealed that a 1 cm long 10° diffuser cone tip demonstrated the best pressure-flow performance improvement in contrast with either an end-hole tip or diffuser cone angles greater than 10°. Performance further improved when the diffuser was preceded by an expanded four-lobe swirl inducer attachment-a novel component. In conclusion, aortic cannula orientation is crucial in determining net head-neck perfusion but precise angulations and insertion-depths are difficult to achieve practically. Altering the cannula tip

  15. Endovascular aortic aneurysm operations.

    PubMed

    Najibi, Sasan; Terramani, Thomas T; Weiss, Victor J; Smith, Robert B; Salam, Atef A; Dodson, Thomas F; Chaikof, Elliot L; Lumsden, Alan B

    2002-02-01

    Options for the treatment of abdominal and thoracic aortic aneurysms are in a state of evolutionary change. The development and continued refinement of the endoluminal approaches has decreased the need for open aortic aneurysm surgery. Endovascular stent graft technology is an area of active research in which both the delivery systems and the endografts are undergoing continued improvement so that patients with what was previously thought to be unfavorable anatomy may be treated by these means. The design and deployment techniques of the currently available endografts, as well as those in clinical trials, are presented. PMID:11822962

  16. 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.

  17. Descending endograft for DeBakey type 1 aortic dissection: pro.

    PubMed

    Berretta, Paolo; Di Eusanio, Marco

    2016-05-01

    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

  18. Right subclavian artery aneurysm in an adolescent with a bicuspid aortic valve.

    PubMed

    Marinho, J; Pires, A; Sousa, G; Castela, E

    2013-01-01

    Bicuspic aortic valve is the most common congenital cardiac anomaly (Fedak et al. 106:900-904, 2002), and it is associated with other structural anomalies of the aorta, such as coarctation, suggesting a common embryologic developmental mechanism (Mergan et al. 104:118-119, 2004). In more than a half of patients, it is associated with progressive dilation and aneurysm formation of the aorta (Warnes 89:965-966, 2003) despite normally functioning bicuspid aortic valves. In this context, aneurysms of the right subclavian artery are extremely rare, and even more so when associated with a right-sided aortic arch that has a left aberrant subclavian artery with a Kommerell diverticulum, as found in the reported case. These aneurysms represent a significant risk for thromboembolism and rupture, and elective surgical management should be advised, even for asymptomatic cases.

  19. Aortic wraps a modification to aortic grafting.

    PubMed

    Gordon, J A

    1989-09-01

    Aortic wrapping has been attempted on occasion when the standard replacement of a diseased lower third of the aorta by a trouser graft is not feasible. Cellophane has been the most common agent employed, but these wraps have met with minimal success and on occasion has even been passed rectally. Kartchner and Lovett have reviewed the techniques and results of the later procedures replacing the cellophane wraps. In most instances a Dacron sheet was utilized. Six cases are reviewed from a solo private practice in which a standard trouser graft replacement was varied by using an alternative form of wrapping.

  20. Vibration of axially loaded circular arches

    SciTech Connect

    Sabir, A.B.; Djoudi, M.S.

    1996-11-01

    The work in the present paper is devoted to the determination of the buckling loads and natural frequencies of axially loaded arch structures. The finite element method is employed using a strain based arch element. The element is based on the conventional Euler curved beam type of strain displacement relationship and satisfies the exact representation of rigid body modes. The sub-space iteration technique is used to determine the eigenvalues and corresponding eigenvectors of the governing transcendental equation. The buckling of a pinned arch subjected to a uniform lateral pressure is first considered. The work is then extended to produce a comprehensive set of results for the vibration of axially loaded arches which are either pinned or fixed at both ends. The first symmetric and anti symmetric modes of vibration are determined and the effect of the axial load on these frequencies is investigated. The practical problem of an arch with a backfill is then considered and the effect of the elastic packing due to this backfill on the natural frequencies is determined.

  1. Automatic aorta segmentation and valve landmark detection in C-arm CT for transcatheter aortic valve implantation.

    PubMed

    Zheng, Yefeng; John, Matthias; Liao, Rui; Nöttling, Alois; Boese, Jan; Kempfert, Jörg; Walther, Thomas; Brockmann, Gernot; Comaniciu, Dorin

    2012-12-01

    Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure to treat severe aortic valve stenosis. As an emerging imaging technique, C-arm computed tomography (CT) plays a more and more important role in TAVI on both pre-operative surgical planning (e.g., providing 3-D valve measurements) and intra-operative guidance (e.g., determining a proper C-arm angulation). Automatic aorta segmentation and aortic valve landmark detection in a C-arm CT volume facilitate the seamless integration of C-arm CT into the TAVI workflow and improve the patient care. In this paper, we present a part-based aorta segmentation approach, which can handle structural variation of the aorta in case that the aortic arch and descending aorta are missing in the volume. The whole aorta model is split into four parts: aortic root, ascending aorta, aortic arch, and descending aorta. Discriminative learning is applied to train a detector for each part separately to exploit the rich domain knowledge embedded in an expert-annotated dataset. Eight important aortic valve landmarks (three hinges, three commissures, and two coronary ostia) are also detected automatically with an efficient hierarchical approach. Our approach is robust under all kinds of variations observed in a real clinical setting, including changes in the field-of-view, contrast agent injection, scan timing, and aortic valve regurgitation. Taking about 1.1 s to process a volume, it is also computationally efficient. Under the guidance of the automatically extracted patient-specific aorta model, the physicians can properly determine the C-arm angulation and deploy the prosthetic valve. Promising outcomes have been achieved in real clinical applications. PMID:22955891

  2. EDITORIAL: 5th International Symposium on Particle Image Velocimetry, PIV'03

    NASA Astrophysics Data System (ADS)

    Sung, Hyung Jin; Kim, Kyung Chun; Lee, Sang Joon

    2004-06-01

    The advent of particle image velocimetry (PIV) in the late 20th century brought about a paradigm change in the technique of flow field measurement, from point measurement to field measurement. This revolution is a result of the recent advances in computers, video cameras, optics and lasers and a deeper understanding of the theory of image processing, and such advances continue by keeping pace with leading-edge technologies such as biotechnology, nanotechnology and so forth. Recently, the PIV technique has been extended in new directions such as stereoscopic PIV, holographic PIV, dynamic PIV, micro PIV and simultaneous PLIF/PIV techniques. This special issue contains research dealing with many of the most recent developments in PIV. The papers were selected from more than 120 papers presented at the 5th International Symposium on Particle Image Velocimetry (PIV'03) held in Busan, Korea, during 22-24 September 2003. Special thanks are due to the invited speakers who have contributed their original work to this special issue, which will enhance the academic reputation of Measurement Science and Technology (MST). Fourteen papers were selected by the Scientific Committee of PIV'03. After the standard refereeing process of MST, nine papers were finally accepted for publication. The selected papers can be categorized into three groups: new PIV algorithms and evaluation methods, three-dimensional velocity field measurement techniques and micro/bio PIV applications. As a new PIV technique, Lecuona et al introduced PIV evaluation algorithms for industrial applications having high shear flow structures. Billy et al used a single-pixel-based cross-correlation method for measuring flow inside a microchannel. Foucaut et al carried out PIV optimization using spectral analysis for the study of turbulent flows. Doh et al applied a 3D PTV method to the wake behind a sphere using three CCD cameras. Hori and Sakakibara developed a high-speed scanning stereoscopic PIV system and

  3. PREFACE: 5th International Workshop on Top Quark Physics (TOP2012)

    NASA Astrophysics Data System (ADS)

    Salamanna, G.; Boisvert, V.; Cerrito, L.; Khan, A.; Moretti, S.; Owen, M.; Schwanenberger, C.

    2013-07-01

    The 5th International Workshop on Top Quark Physics (TOP 2012) took place in Winchester, UK, from the 16-21 September. It gathered students as well as people active in the top quark sector and provided a framework to highlight the newest results and matters related to top quark physics. Discovered in 1995, the top quark is the sixth and heaviest of all quarks, and it is the only one with a lifetime short enough to be observed 'naked'. This makes it an important testing ground in the search for new physics. In fact, the fact of its mass being so much larger than the other quarks, hints at its special role in the Higgs mechanism. For the same reason, in many models of New Physics, new heavy resonances are expected to couple mostly with top quarks. Even if no new particles are observed, the direct correlation between its angular momentum and that of its detectable decay products allows us to probe indirectly New Physics in action when top quarks are created. In this edition of the TOP conference series, for the first time, the agenda was equally balanced between 'traditional' measurements and the now vast number of searches for physics BSM in the top quark sector, thanks mostly to the amount of data collected at the LHC in its Run I. New results were presented by both the Tevatron and the LHC collaborations: improved ttbar and single top cross-section measurements, refined techniques to measure the top quark mass and a large number of results on properties such as spin correlation and W boson polarization in top quark decays were shown. More technical discussions on the experimental issues, both from the detector and the simulation side also took place, drawing together experimentalists and theorists. Reviews of the latest results on ttbar asymmetry both from CDF and D0 and from ATLAS and CMS were shown, and theorists active in the field made some interesting points on this hot topic. Additionally, results on the search for fourth generation fermions and new

  4. PREFACE: 5th DAE-BRNS Workshop on Hadron Physics (Hadron 2011)

    NASA Astrophysics Data System (ADS)

    Jyoti Roy, Bidyut; Chatterjee, A.; Kailas, S.

    2012-07-01

    The 5th DAE-BRNS Workshop on Hadron Physics was held at the Bhabha Atomic Research Centre (BARC), Mumbai from 31 October to 4 November 2011. This workshop series, supported by the Board of Research in Nuclear Sciences, Department of Atomic Energy (BRNS, DAE), Govt. of India, began ten years ago with the first one being held at BARC, Mumbai in October 2002. The second one was held at Puri in 2005, organized jointly by Institute of Physics, Bhubneswar and Saha Institute of Nuclear Physics, Kolkata. The 3rd and 4th ones took place, respectively, at Shantineketan in 2006, organized by Visva Bharati University, and at Aligarh in 2008, organized by Aligarh Muslim University, Aligarh. The aim of the present workshop was to bring together the experts and young researchers in the field of hadron physics (both experiment and theory) and to have in-depth discussions on the current research activities in this field. The format of the workshop was: a series of review lectures by various experts from India and abroad, the presentation of advanced research results by researchers in the field, and a review of major experimental programs being planned and pursued in major laboratories in the field of hadron physics, with the aim of providing a platform for the young participants for interaction with their peers. The upcoming international FAIR facility at GSI is a unique future facility for studies of hadron physics in the charm sector and hyper nuclear physics. The Indian hadron physics community is involved in this mega science project and is working with the PANDA collaboration on the development of detectors, simulation and software tools for the hadron physics programme with antiprotons at FAIR. A one-day discussion session was held at this workshop to discuss India-PANDA activities, the current collaboration status and the work plan. This volume presents the workshop proceedings consisting of lectures and seminars which were delivered during the workshop. We are thankful to

  5. PREFACE: The 5th International Conference on Radiotherapy Gel Dosimetry (DOSGEL 2008)

    NASA Astrophysics Data System (ADS)

    Maris, Thomas G.; Pappas, Evangelos

    2009-07-01

    The International Conference on Radiotherapy Gel Dosimetry (DOSGEL) is held every two years. Its purpose is to bring together basic science and clinical researchers, medical physicists and clinicians from around the world to discuss the state-of-the-art of the gel dosimetry technique and to set the directions and trends for its future improvements. Gel dosimetry can be broadly defined as using a gel that can react to the absorption of ionizing radiation, and that can retain this information which can subsequently be retrieved by an external imaging modality. Examples of radiation-sensitive gels include, but are not limited to, polymer gel dosimeters, Fricke gel dosimeters and others. Imaging modalities that are of general use in this field are (in alphabetical order) magnetic resonance imaging (MRI), optical light computed tomography and x-ray computed tomography. This volume comprises the proceedings of the 5th International Conference on Radiotherapy Gel Dosimetry (DOSGEL 2008). The conference, organised by the University of Crete, Medical Physics Department, took place in Hersonissos, Crete, Greece from 29 September to 3 October 2008. The meeting aimed to continue the series of biannual DOSGEL conferences and focused on the promotion of gel dosimetry techniques by setting the trends for their future improvements. The main scientific session topics of DOSGEL 2008 were the following: Chemistry and fundamental properties of polymer gel dosimeters Gel dosimetry with Optical Computed Tomography Gel dosimetry with Magnetic Resonance Imaging Gel dosimetry with other than Optical CT and MR scan Techniques Other 3D dosimeters Gel dosimetry applications Local Organizing Committee Thomas G Maris (University of Crete, Greece, Chairman DOSGEL 2008) John Damilakis (University of Crete, Greece) Evangelos Pappas (University of Crete, Greece) Antonios Papadakis (University of Crete, Greece) Fotini Zacharopoulou (University of Crete, Greece) John Stratakis (University of Crete

  6. Bicuspid Aortic Cusp Fusion Morphology Alters Aortic 3D Outflow Patterns, Wall Shear Stress and Expression of Aortopathy

    PubMed Central

    Mahadevia, Riti; Barker, Alex J; Schnell, Susanne; Entezari, Pegah; Kansal, Preeti; Fedak, Paul W.M.; Malaisrie, S Chris; McCarthy, Patrick; Collins, Jeremy; Carr, James; Markl, Michael

    2014-01-01

    Background: Aortic 3D blood flow was analyzed to investigate altered ascending aorta (AAo) hemodynamics in bicuspid aortic valve (BAV) patients and its association with differences in cusp fusion patterns (right-left, RL versus right-noncoronary, RN) and expression of aortopathy. Methods and Results: 4D flow MRI measured in vivo 3D blood flow in the aorta of 75 subjects: BAV patients with aortic dilatation stratified by leaflet fusion pattern (n=15 RL-BAV, mid AAo diameter=39.9±4.4mm; n=15 RN-BAV, 39.6±7.2mm); aorta size controls with tricuspid aortic valves (n=30, 41.1±4.4mm); healthy volunteers (n=15, 24.9±3.0mm). Aortopathy type (0-3), systolic flow angle, flow displacement, and regional wall shear stress (WSS) were determined for all subjects. Eccentric outflow jet patterns in BAV patients resulted in elevated regional WSS (p<0.0125) at the right-anterior walls for RL-BAV and right-posterior walls for RN-BAV compared to aorta size controls. Dilatation of the aortic root only (type 1) or involving the entire AAo and arch (type 3) was found in the majority of RN-BAV patients (87%) but was mostly absent for RL-BAV (87% type 2). Differences in aortopathy type between RL-BAV and RN-BAV were associated with altered flow displacement in the proximal and mid AAo for type 1 (42-81% decrease versus type 2) and distal AAo for type 3 (33-39% increase versus type 2). Conclusions: The presence and type of BAV fusion was associated with changes in regional WSS distribution, systolic flow eccentricity, and expression of BAV aortopathy. Hemodynamic markers suggest a physiologic mechanism by which valve morphology phenotype can influence phenotypes of BAV aortopathy. PMID:24345403

  7. South Arch volcanic field9d\

    USGS Publications Warehouse

    Lipman, P.W.; Clague, D.A.; Moore, J.G.; Holcomb, R.T.

    1989-01-01

    Several young lava fields were imaged by GLORIA sidescan sonar along the Hawaiian Arch south of Hawaii. The largest, 35 by 50 km across, includes a central area characterized by high sonar backscatter and composed of several flow lobes radiating from a vent area. Reflection profiling and sea-floor photography indicate that the central lobes are flat sheet flows bounded by pillowed margins; thin surface sediment and thin palagonite rinds on lava surfaces suggest ages of 1-10 ka. Vents are localized along the arch crest near bases of Cretaceous seamounts. Two dredged flows are basanite and alkalic basalt, broadly similar to rejuvenated-stage and some pre-shield alkalic lavas on the Hawaiian Ridge. Arch volcanism represents peripheral leakage of melt from the Hawaiian hot spot over much larger areas than previously recognized. -Authors

  8. Long-Term Results of Open Stent-Grafting Using a Matsui-Kitamura Stent to Treat Thoracic Aortic Aneurysm

    PubMed Central

    Kanno, Megumu; Takano, Takashi; Watanabe, Kouyu; Ueno, Kyohei; Ono, Takashi; Satou, Kouichi

    2014-01-01

    Purpose: We describe a retrospective study of initial and long-term outcomes with an open stent grafting (OSG) with a Matsui-Kitamura stent for treating thoracic aortic aneurysm. Methods: Between August 2005 and September 2013, 50 patients with aortic arch disease extending to the descending aorta underwent OSG. Circulatory arrest with total cardiopulmonary bypass and selective cerebral perfusion were used, and the aorta was transected between the brachiocephalic and left subclavian artery. The stent-graft was inserted, sutured to a transected aortic edge, and anastomosed to a four-branched arch graft. Preoperative, operative, and short- and long-term postoperative data were obtained from the patients’ medical records. Results: The perioperative (within 30 days) mortality rate was 8%. Two patients (4%) had a stroke and 5 patients (10%) had a spinal cord injury resulting in paraplegia or paraparesis (1 patient each) or transient paraplegia (3 patients). Actuarial survival rates at 1, 3, 5, and 7 years postoperatively were 87.8%, 78.3%, 70.7%, and 65.3%, respectively; the rates of freedom from an aortic event were 100%, 89.1%, 82.2%, and 74.7%. There were no complications related to use of the stent-graft. Conclusion: Our OSG method provided durable results in patients treated for thoracic aortic aneurysm, with few adverse events. PMID:24899135

  9. A case of type-2 endoleak from a bronchial artery after endovascular aortic repair for Kommerell diverticulum.

    PubMed

    Amako, Mau; Wada, Hideichi; Matsumura, Hitoshi; Morita, Yuichi; Shimizu, Masayuki; Ohsumi, Masahiro; Sukehiro, Yuta; Minematsu, Noritoshi; Nishimi, Masaru; Tashiro, Tadashi

    2014-11-01

    We describe a case of type-2 bronchial artery endoleak after endovascular aortic repair of Kommerell diverticulum (KD) involving right-sided aortic arch and aberrant left subclavian artery (LSA). A 68-year-old woman underwent an endovascular repair of KD with an aberrant LSA in our hospital. Follow-up computed tomography (CT) at 6 months after the procedure showed an endoleak. Digital subtraction angiography revealed a type-2 endoleak from a bronchial artery, but no type-1 or type-2 endoleak from the aberrant left subclavian artery. We performed coil embolization of the KD and the left subclavian artery. The endoleak disappeared in the postoperative CT.

  10. Summative assessment of 5th year medical students’ clinical reasoning by script concordance test: requirements and challenges

    PubMed Central

    2012-01-01

    Background The Script Concordance Test (SCT) has not been reported in summative assessment of students across the multiple domains of a medical curriculum. We report the steps used to build a test for summative assessment in a medical curriculum. Methods A 51 case, 158-question, multidisciplinary paper was constructed to assess clinical reasoning in 5th-year. 10–16 experts in each of 7 discipline-based reference panels answered questions on-line. A multidisciplinary group considered reference panel data and data from a volunteer group of 6th Years, who sat the same test, to determine the passing score for the 5th Years. Results The mean (SD) scores were 63.6 (7.6) and 68.6 (4.8) for the 6th Year (n = 23, alpha = 0.78) and and 5th Year (n = 132, alpha =0.62) groups (p < 0.05), respectively. The passing score was set at 4 SD from the expert mean. Four students failed. Conclusions The SCT may be a useful method to assess clinical reasoning in medical students in multidisciplinary summative assessments. Substantial investment in training of faculty and students and in the development of questions is required. PMID:22571351

  11. [Minimally invasive cardiac surgery for aortic valve disease].

    PubMed

    Fujimura, Y; Katoh, T; Hamano, K; Gohra, H; Tsuboi, H; Esato, K

    1998-12-01

    Recent surgical advances leading to good operative results have contributed to the trend to useminimally invasive approaches, even in cardiac surgery. Smaller incisions are clearly more cosmetically acceptable to patients. When using a minimally invasive approach, it is most important to maintain surgical quality without jeopardizing patients. A good operative visual field leads to good surgical results. In the parasternal approach, we use a retractor to harvest an internal thoracic artery in coronary artery bypass surgery. Retracting the sternum upward allows for a good surgical view and permits the use of an arch cannula rather than femoral cannulation. When reoperating for aortic valve repair, the j-sternotomy approach requires less adhesiolysis compared with the traditional full sternotomy. No special technique is necessary to perform aortic valve surgery using the j-sternotomy approach. However, meticulous attention must be paid to avoiding left ventricular air embolisms to prevent postoperative stroke or neurocognitive deficits, especially when utilizing a minimally invasive approach. Transesophageal echo is useful not only for monitoring cardiac function but also for monitoring the persence of air in the left ventricle and atrium. This paper compare as the degree of invasion of minimally invasive cardiac surgery and the traditional full sternotomy. No differences were found in the occurrence of systemic inflammatory response syndrome between patients undergoing minimally invasive cardiac surgery and the traditional technique. Therefore it is concluded that minimally invasive surgery for patients with aortic valve disease may become the standard approach in the near future.

  12. 2. STONE ARCH BRIDGE. TIMBERS ON THE UPSTREAM FACE OF ...

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

    2. STONE ARCH BRIDGE. TIMBERS ON THE UPSTREAM FACE OF THE PIER PROTECTED THE STONEWORK FROM DAMAGE FROM ICE FLOWS, BARGES, ETC. - Lockport Historic District, Stone Arch Bridge, Spanning Des Plaines River at Ninth Street, Lockport, Will County, IL

  13. 5. TOP OF ARCH AND VIADUCT. NOTE THAT STONES OF ...

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

    5. TOP OF ARCH AND VIADUCT. NOTE THAT STONES OF ARCH HAVE BEEN DRAFTED FINISH AROUND THE EDGE) AND THE KEYSTONE HAS BEEN ROUGHLY POINTED. - Valley Railroad, Folly Mills Creek Viaduct, Interstate 81, Staunton, Staunton, VA

  14. Isolated bilateral fractures of zygomatic arches: report of a case.

    PubMed

    Ho, V

    1994-12-01

    Isolated unilateral fractures of the zygomatic arch are uncommon. Isolated bilateral fractures of the zygomatic arches are even more rare. Indeed a search of the literature failed to find any previous report of this fracture pattern.

  15. 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

  16. 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

  17. 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

  18. VIEW FROM DOWN STREAM OF ARCH IN ELEVATION. NOTE FINISHED ...

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

    VIEW FROM DOWN STREAM OF ARCH IN ELEVATION. NOTE FINISHED INTERIOR ARCH. SSW BY 205 DEGREES - Chasm Brook Bridge, Spanning Chasm Brook on West Sargent Mountain Carriage Road, Bar Harbor, Hancock County, ME

  19. Arches and contact forces in a granular pile.

    PubMed

    Carlevaro, C M; Pugnaloni, L A

    2012-06-01

    Assemblies of granular particles mechanically stable under their own weight contain arches. These are structural units identified as sets of mutually stable grains. It is generally assumed that these arches shield the weight above them and should bear most of the stress in the system. We test such hypothesis by studying the stress born by in-arch and out-of-arch grains. We show that, indeed, particles in arches withstand larger stresses. In particular, the isotropic stress tends to be larger for in-arch grains whereas the anisotropic component is marginally distinguishable between the two types of particles. The contact force distributions demonstrate that an exponential tail (compatible with the maximization of entropy under no extra constraints) is followed only by the out-of-arch contacts. In-arch contacts seem to be compatible with a Gaussian distribution consistent with a recently introduced approach that takes into account constraints imposed by the local force balance on grains.

  20. 21. AN IMAGE OF THE FIRST LARGE, ELLIPTICAL RING ARCH ...

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

    21. AN IMAGE OF THE FIRST LARGE, ELLIPTICAL RING ARCH ON THE WEST END OF THE BRIDGE. THE PARKWAY PASSES BENEATH A MINOR ARCH BEYOND. - Main Street Bridge, Spanning East Fork Whitewater River, Richmond, Wayne County, IN

  1. 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

  2. GENERAL VIEW OF THE ARCH AS SEEN AT SUNSET FROM ...

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

    GENERAL VIEW OF THE ARCH AS SEEN AT SUNSET FROM THE PARK, LOOKING SOUTHEAST - Jefferson National Expansion Memorial Arch, Mississippi River between Washington & Poplar Streets, Saint Louis, Independent City, MO

  3. 4. GENERAL VIEW OF THE ARCH FROM THE NORTHWEST SHOWING ...

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

    4. GENERAL VIEW OF THE ARCH FROM THE NORTHWEST SHOWING THE PARK GROUND IN THE FOREGROUND - Jefferson National Expansion Memorial Arch, Mississippi River between Washington & Poplar Streets, Saint Louis, Independent City, MO

  4. PREFACE: The 5th International Symposium in Quantum Theory and Symmetries (QTS5)

    NASA Astrophysics Data System (ADS)

    Arratia, O.; Calzada, J. A.; Gómez-Cubillo, F.; Negro, J.; del Olmo, M. A.

    2008-02-01

    This volume of Journal of Physics: Conference Series contains the Proceedings of the 5th International Symposium in Quantum Theory and Symmetries (QTS5), held in Valladolid, Spain, 22-28 July 2007. This is the fifth of a series of conferences previously held in Goslar (Germany) 1999, QTS1; Cracow (Poland) 2001, QTS2; Cincinnati (USA) 2003, QTS3, and Varna (Bulgaria) 2005, QTS4. The QTS5 symposium gathered 181 participants from 39 countries working in different fields on Theoretical Physics. The spirit of the QTS conference series is to join researchers in a wide variety of topics in Theoretical Physics, as a way to make accessible recent results and the new lines of different fields. The QTS5 conference offered the following list of topics: Symmetries in String Theory, Quantum Gravity and related Symmetries in Quantum Field Theories, Conformal and Related Field Theories, Lattice and Noncommutative Theories, Gauge Theories Quantum Computing, Information and Control Foundations of Quantum Theory Quantum Optics, Coherent States, Wigner Functions Dynamical and Integrable Systems Symmetries in Condensed Matter and Statistical Physics Symmetries in Particle Physics, Nuclear, Atomic and Molecular Nonlinear Quantum Mechanics Time Asymmetric Quantum Mechanics SUSY Quantum Mechanics, PT symmetries and pseudo-Hamiltonians Mathematical Methods for Symmetries and Quantum Theories Symmetries in Chemistry Biology and other Sciences Papers accepted for publication in the present issue are based on the contributions from the participants in the QTS5 conference after a peer review process. In addition, a special issue of Journal Physics A: Mathematical and Theoretical contains contributions from plenary speakers, some participants as well as contributions from other authors whose works fit into the topics of the conference. The organization of the conference had the following pattern. In the morning there were five plenary or general sessions for all the participants, which aimed to

  5. PREFACE: The 5th International Symposium in Quantum Theory and Symmetries (QTS5)

    NASA Astrophysics Data System (ADS)

    Arratia, O.; Calzada, J. A.; Gómez-Cubillo, F.; Negro, J.; del Olmo, M. A.

    2008-02-01

    This volume of Journal of Physics: Conference Series contains the Proceedings of the 5th International Symposium in Quantum Theory and Symmetries (QTS5), held in Valladolid, Spain, 22-28 July 2007. This is the fifth of a series of conferences previously held in Goslar (Germany) 1999, QTS1; Cracow (Poland) 2001, QTS2; Cincinnati (USA) 2003, QTS3, and Varna (Bulgaria) 2005, QTS4. The QTS5 symposium gathered 181 participants from 39 countries working in different fields on Theoretical Physics. The spirit of the QTS conference series is to join researchers in a wide variety of topics in Theoretical Physics, as a way to make accessible recent results and the new lines of different fields. The QTS5 conference offered the following list of topics: Symmetries in String Theory, Quantum Gravity and related Symmetries in Quantum Field Theories, Conformal and Related Field Theories, Lattice and Noncommutative Theories, Gauge Theories Quantum Computing, Information and Control Foundations of Quantum Theory Quantum Optics, Coherent States, Wigner Functions Dynamical and Integrable Systems Symmetries in Condensed Matter and Statistical Physics Symmetries in Particle Physics, Nuclear, Atomic and Molecular Nonlinear Quantum Mechanics Time Asymmetric Quantum Mechanics SUSY Quantum Mechanics, PT symmetries and pseudo-Hamiltonians Mathematical Methods for Symmetries and Quantum Theories Symmetries in Chemistry Biology and other Sciences Papers accepted for publication in the present issue are based on the contributions from the participants in the QTS5 conference after a peer review process. In addition, a special issue of Journal Physics A: Mathematical and Theoretical contains contributions from plenary speakers, some participants as well as contributions from other authors whose works fit into the topics of the conference. The organization of the conference had the following pattern. In the morning there were five plenary or general sessions for all the participants, which aimed to

  6. PREFACE: The 5th International Symposium on Quantum Theory and Symmetries (QTS5)

    NASA Astrophysics Data System (ADS)

    Gadella, M.; Izquierdo, J. M.; Kuru, S.; Negro, J.; del Olmo, M. A.

    2008-08-01

    This special issue of Journal of Physics A: Mathematical and Theoretical appears on the occasion of the 5th International Symposium on Quantum Theory and Symmetries (QTS5), held in Valladolid, Spain, from 22-28 July 2007. This is the fith in a series of conferences previously held in Goslar (Germany) 1999, QTS1; Cracow (Poland) 2001, QTS2; Cincinnati (USA) 2003, QTS3; and Varna (Bulgaria) 2005, QTS4. The QTS5 symposium gathered 181 participants from 39 countries working in different fields of theoretical physics. The spirit of the QTS conference series is to join researchers in a wide variety of topics in theoretical physics, as a way of making accessible recent results and the new lines of different fields. This is based on the feeling that it is good for a physicist to have a general overview as well as expertise in his/her own field. There are many other conferences devoted to specific topics, which are of interest to gain deeper insight in many technical aspects and that are quite suitable for discussions due to their small size. However, we believe that general conferences like this are interesting and worth keeping. We like the talks, in both plenary and parallel sessions, which are devoted to specific topics, to be prepared so as to be accessible to any researcher in any branch of theoretical physics. We think that this objective is compatible with rigour and high standards. As is well known, similar methods and techniques can be useful for many problems in different fields. We hope that this has been appreciated during the sessions of the QTS5 conference. The QTS5 conference offered the following list of topics: 1. Symmetries in string theory, quantum gravity and related topics 2. Symmetries in quantum field theories, conformal and related field theories, lattice and noncommutative theories, gauge theories 3.Quantum computing, information and control 4. Foundations of quantum theory 5. Quantum optics, coherent states, Wigner functions 6. Dynamical and

  7. Ascending-to-descending aortic bypass and aortic valve replacement for concomitant severe aortic coarctation and aortic stenosis.

    PubMed

    Chu, Michael W A; Adams, Corey; Torres, Pedro

    2011-04-01

    We present a 33-year-old male with severe, symptomatic aortic coarctation and aortic stenosis assessed on a humanitarian medical mission to a developing country. Contemplating limited time and available resources, we performed a simultaneous single-stage approach with ascending-to-descending aortic bypass with a reinforced gortex graft and concomitant aortic valve replacement through a median sternotomy. The patient had an uneventful postoperative convalescence and was discharged on postoperative day 5. At 1-year follow-up, he was asymptomatic and doing well with good blood pressure control and complete equalization of upper and lower limb blood pressure measurements. Computed tomography and transthoracic echocardiography demonstrated a widely patent ascending-to-descending aortic bypass graft and a normally functioning prosthetic aortic valve, respectively. In developing countries where health care resources are limited, a combined approach with an extra-anatomic, thoracic aortic bypass, and aortic valve replacement resulted in good early and 1-year outcomes. This procedure may represent the most effective surgical option for patients with concomitant aortic coarctation and aortic stenosis.

  8. Aortic wall shear stress in Marfan syndrome.

    PubMed

    Geiger, Julia; Arnold, Raoul; Herzer, Lena; Hirtler, Daniel; Stankovic, Zoran; Russe, Max; Langer, Mathias; Markl, Michael

    2013-10-01

    The aim of this study was to quantify changes in thoracic aortic wall shear stress (WSS) in asymptomatic patients with Marfan syndrome (MFS) compared with healthy controls. WSS in the thoracic aorta was quantified based on time-resolved 3D phase contrast MRI with three-directional velocity encoding (4D flow MRI, temporal resolution ∼44 ms, spatial resolution ∼2.5 mm) in 24 patients with confirmed MFS (age = 18 ± 12 years) and in 12 older healthy volunteers (age = 25 ± 3 years). Diameters of the thoracic aorta normalized to body surface area were similar for both groups. Peak systolic velocity, absolute WSS, time-averaged WSS, circumferential WSS, peak systolic WSS, and WSS eccentricity were calculated in eight analysis planes distributed along the thoracic aorta. Plane-wise comparison revealed significant differences between MFS patients and volunteers in the proximal ascending aorta for peak systolic velocities (1.11 ± 0.23 m/s vs. 1.34 ± 0.18 m/s, P = 0.004) and circumferential WSS (0.14 ± 0.03 N/m(2) vs. 0.11 ± 0.02 N/m(2), P = 0.007). WSS eccentricity was altered in most of the ascending aorta and proximal arch (P = 0.009-0.020). MFS patients demonstrated segmental differences in peak systolic WSS with a significantly higher WSS at the inner curvature in the proximal ascending aorta and at the anterior part in the more distal ascending aorta (P < 0.01). These findings indicate differences in WSS associated with MFS despite similar aortic dimensions compared to controls.

  9. Angiopoietin-2 attenuates angiotensin II-induced aortic aneurysm and atherosclerosis in apolipoprotein E-deficient mice

    PubMed Central

    Yu, Hongyou; Moran, Corey S.; Trollope, Alexandra F.; Woodward, Lynn; Kinobe, Robert; Rush, Catherine M.; Golledge, Jonathan

    2016-01-01

    Angiogenesis and inflammation are implicated in aortic aneurysm and atherosclerosis and regulated by angiopoietin-2 (Angpt2). The effect of Angpt2 administration on experimental aortic aneurysm and atherosclerosis was examined. Six-month-old male apolipoprotein E deficient (ApoE−/−) mice were infused with angiotensin II (AngII) and administered subcutaneous human Fc-protein (control) or recombinant Angpt2 (rAngpt2) over 14 days. Administration of rAngpt2 significantly inhibited AngII-induced aortic dilatation and rupture of the suprarenal aorta (SRA), and development of atherosclerosis within the aortic arch. These effects were blood pressure and plasma lipoprotein independent and associated with Tie2 activation and down-regulation of monocyte chemotactic protein-1 (MCP-1) within the SRA. Plasma concentrations of MCP-1 and interleukin-6 were significantly lower in mice receiving rAngpt2. Immunostaining for the monocyte/macrophage marker MOMA-2 and the angiogenesis marker CD31 within the SRA were less in mice receiving rAngpt2 than controls. The percentage of inflammatory (Ly6Chi) monocytes within the bone marrow was increased while that in peripheral blood was decreased by rAngpt2 administration. In conclusion, administration of rAngpt2 attenuated angiotensin II-induced aortic aneurysm and atherosclerosis in ApoE−/− mice associated with reduced aortic inflammation and angiogenesis. Up-regulation of Angpt2 may have potential therapeutic value in patients with aortic aneurysm and atherosclerosis. PMID:27767064

  10. 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

  11. 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

  12. 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

  13. [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

  14. Teacher and Parent Views on the Instruction of 5th Grade Students by Branch Teachers in the 4+4+4 Education System

    ERIC Educational Resources Information Center

    Yildizhan, Yusuf Hayri

    2015-01-01

    The objective of this study is to examine the teacher and parent views on the instruction of 5th grade students by branch teachers. This study is designed according to the phenomenology design and uses qualitative data. In order to collect data, open-ended questions were asked to 18 teachers and 16 parents of 5th grade students on the subject, and…

  15. 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.

  16. 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

  17. Almanac 2014: aortic valve disease.

    PubMed

    Otto, Catherine M

    2015-06-01

    The past few years have seen major advances in the diagnosis of aortic valve disease and in our understanding of the pathophysiology of disease. In addition, transcatheter aortic valve implantation has transformed our clinical management options. This article summarises new aortic valve disease research published in Heart in 2013 and 2014, within the context of other major studies published in general medical journals, including a discussion of the potential impact of these new research findings on the clinical approach to management of adults with aortic valve disease.

  18. Infrarenal Aortic Occlusion

    PubMed Central

    Traverso, L. W.; Baker, J. D.; Dainko, E. A.; Machleder, H. I.

    1978-01-01

    Twenty-eight patients with total occlusion of the infrarenal aorta have been seen at the UCLA Hospitals in the past 11 years. Claudication was the presenting complaint in all but one patient, with one-third having ischemic rest pain. The average age of these patients was 54 years, and their histories revealed a surprising absence of myocardial infarction, stroke, or diabetes, although 40% had essential hypertension. Heavy tobacco use, however, was characteristic of the entire group. Arteriography proved valuable in identifying and characterizing the vascular abnormalities, but posed problems in technique and interpretation. Significant distal arterial disease was detected radiographically in only 21% of these patients. Operative correction of the aortic occlusion was performed on 26 patients, 18 by aortic bypass grafts and eight by aorto-iliac endarterectomy, with one early postoperative death. Although the thrombus extended to the renal artery origins in 77% of the cases, a well-designed technical approach did not require renal artery occlusion. Using serial creatinine determinations, one case of renal insufficiency was detected which was associated with prolonged postoperative hypotension. Although the extent of distal disease was more severe in those who underwent bypass, symptoms of claudication returned earlier and were more prominent in the endarterectomy group. This recurrence of systems was not favorably altered by sympathectomy performed concomitantly with the initial procedure. Even though this condition seems to pose difficult technical obstacles and has a poor prognosis, infrarenal aortic occlusion can be successfully treated by aortic bypass, with favorable long-term results, if particular attention is paid to elements of the preoperative evaluation and the intraoperative technical requirements peculiar to this relatively uncommon disease entity. ImagesFig. 1.Fig. 2.Fig. 3. PMID:646479

  19. Modal Analysis of Landscape and Double-O Arches

    NASA Astrophysics Data System (ADS)

    Moore, J. R.; Dorsey, A.; Wood, J. R.; Thorne, M. S.; Bilderback, E.

    2014-12-01

    We combine in-situ ambient vibration measurements with 3D numerical modeling to study the resonance characteristics of two prominent arches in Arches National Park, Utah: Landscape Arch and Double-O Arch. We placed broadband seismometers on each arch and recorded up to three hours of ambient seismic data. Identified spectral peaks are interpreted to represent resonant frequencies of the arches, and further studied for their polarization attributes. We developed 3D models of each site using ground-based photogrammetry in order to perform numerical modal analyses. Assigning representative material properties, we are able to match the measured fundamental frequency of each arch, as well as certain higher-order resonant frequencies. Landscape Arch is the longest arch in North America and is remarkably slender, while Double-O Arch is a prominent visitor attraction. Repeat ambient vibration measurements over time will be used to assess changes in resonance characteristics, which in turn provide evidence of internal mechanical change. Our goal is to understand how the arches respond to their environment, and ultimately be able to assess progressive damage of these iconic features.

  20. Validation of the 5th and 95th Percentile Hybrid III Anthropomorphic Test Device Finite Element Model

    NASA Technical Reports Server (NTRS)

    Lawrence, C.; Somers, J. T.; Baldwin, M. A.; Wells, J. A.; Newby, N.; Currie, N. J.

    2014-01-01

    NASA spacecraft design requirements for occupant protection are a combination of the Brinkley criteria and injury metrics extracted from anthropomorphic test devices (ATD's). For the ATD injury metrics, the requirements specify the use of the 5th percentile female Hybrid III and the 95th percentile male Hybrid III. Furthermore, each of these ATD's is required to be fitted with an articulating pelvis and a straight spine. The articulating pelvis is necessary for the ATD to fit into spacecraft seats, while the straight spine is required as injury metrics for vertical accelerations are better defined for this configuration. The requirements require that physical testing be performed with both ATD's to demonstrate compliance. Before compliance testing can be conducted, extensive modeling and simulation are required to determine appropriate test conditions, simulate conditions not feasible for testing, and assess design features to better ensure compliance testing is successful. While finite element (FE) models are currently available for many of the physical ATD's, currently there are no complete models for either the 5th percentile female or the 95th percentile male Hybrid III with a straight spine and articulating pelvis. The purpose of this work is to assess the accuracy of the existing Livermore Software Technology Corporation's FE models of the 5th and 95th percentile ATD's. To perform this assessment, a series of tests will be performed at Wright Patterson Air Force Research Lab using their horizontal impact accelerator sled test facility. The ATD's will be placed in the Orion seat with a modified-advanced-crew-escape-system (MACES) pressure suit and helmet, and driven with loadings similar to what is expected for the actual Orion vehicle during landing, launch abort, and chute deployment. Test data will be compared to analytical predictions and modelling uncertainty factors will be determined for each injury metric. Additionally, the test data will be used to

  1. 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

  2. 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

  3. Factors affecting the output pulse flatness of the linear transformer driver cavity systems with 5th harmonics

    NASA Astrophysics Data System (ADS)

    Alexeenko, V. M.; Mazarakis, M. G.; Kim, A. A.; Kondratiev, S. S.; Sinebryukhov, V. A.; Volkov, S. N.; Cuneo, M. E.; Kiefer, M. L.; Leckby, J. J.; Oliver, B. V.; Maloney, P. D.

    2016-09-01

    We describe the study we have undertaken to evaluate the effect of component tolerances in obtaining a voltage output flat top for a linear transformer driver (LTD) cavity containing 3rd and 5th harmonic bricks [A. A. Kim et al., in Proc. IEEE Pulsed Power and Plasma Science PPPS2013 (San Francisco, California, USA, 2013), pp. 1354-1356.] and for 30 cavity voltage adder. Our goal was to define the necessary component value precision in order to obtain a voltage output flat top with no more than ±0.5 % amplitude variation.

  4. IBA investigations of loose garnets from Pietroasa, Apahida and Cluj-Someşeni treasures (5th century AD)

    NASA Astrophysics Data System (ADS)

    Bugoi, R.; Oanţă-Marghitu, R.; Calligaro, T.

    2016-03-01

    This paper reports the archaeometric investigations of 418 loose garnets from Pietroasa and Cluj-Someşeni treasures and Apahida II and III princely grave inventories (5th century AD). The chemical composition of the gems was determined by external beam micro-PIXE technique at the AGLAE accelerator of C2RMF, Paris, France. Complementary observations made by Optical Microscopy revealed details on the gemstones cutting and polishing and permitted to identify certain mineral inclusions. The compositional results evidenced several types of garnets from the pyralspite series, suggesting distinct provenances for these Early Medieval gems.

  5. A report on 5th congress of Asia Pacific Pediatric Cardiac Society, New Delhi, India, 6-9 March 2014

    PubMed Central

    Gupta, Saurabh K; Saxena, Anita

    2015-01-01

    The 5th Congress of Asia Pacific Pediatric Cardiac Society was held in New Delhi from 6-9 March 2014. This article describes the journey of preparing and hosting one of the largest international events in the specialty of Pediatric Cardiac Care ever held in India. A total of 938 delegates, including 400 from outside India, participated. The scientific program was inclusive keeping in mind the diverse background of delegates from the member nations. Large numbers of research papers were presented, mostly by fellows in training. PMID:25684899

  6. 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.

  7. 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

  8. 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.

  9. Bicuspid aortic valve and aortic coarctation are linked to deletion of the X chromosome short arm in Turner syndrome

    PubMed Central

    Bondy, Carolyn; Bakalov, Vladimir K; Cheng, Clara; Olivieri, Laura; Rosing, Douglas R; Arai, Andrew E

    2013-01-01

    Background Congenital heart disease (CHD) is a cardinal feature of X chromosome monosomy, or Turner syndrome (TS). Haploinsufficiency for gene(s) located on Xp have been implicated in the short stature characteristic of the syndrome, but the chromosomal region related to the CHD phenotype has not been established. Design We used cardiac MRI to diagnose cardiovascular abnormalities in four non-mosaic karyotype groups based on 50-metaphase analyses: 45,X (n=152); 46,X,del(Xp) (n=15); 46,X,del(Xq) (n=4); and 46,X,i(Xq) (n=14) from peripheral blood cells. Results Bicuspid aortic valves (BAV) were found in 52/152 (34%) 45,X study subjects and aortic coarctation (COA) in 19/152 (12.5%). Isolated anomalous pulmonary veins (APV) were detected in 15/152 (10%) for the 45,X study group, and this defect was not correlated with the presence of BAV or COA. BAVs were present in 28.6% of subjects with Xp deletions and COA in 6.7%. APV were not found in subjects with Xp deletions. The most distal break associated with the BAV/COA trait was at cytologic band Xp11.4 and ChrX:41,500 000. One of 14 subjects (7%) with the 46,X,i(Xq) karyotype had a BAV and no cases of COA or APV were found in this group. No cardiovascular defects were found among four patients with Xq deletions. Conclusions The high prevalence of BAV and COA in subjects missing only the X chromosome short arm indicates that haploinsufficiency for Xp genes contributes to abnormal aortic valve and aortic arch development in TS. PMID:23825392

  10. [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

  11. 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.

  12. 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

  13. 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

  14. Balloon aortic valvuloplasty as a bridge to aortic valve surgery for severe aortic stenosis.

    PubMed

    Nwaejike, Nnamdi; Mills, Keith; Stables, Rod; Field, Mark

    2015-03-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, in patients with severe aortic stenosis, can balloon valvuloplasty be used as a bridge to aortic valve replacement? Altogether 463 papers were found using the reported search, of which 11 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that balloon aortic valvuloplasty is recommended as a bridge to aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI) in patients with severe symptomatic aortic stenosis. Institutional practices, local and logistic factors can affect patient selection and management approaches to severe aortic stenosis, but having the facility to offer balloon aortic valvuloplasty (especially in the TAVI era) provides another management option for patients who would otherwise have been considered unacceptably high risk for aortic valve surgery. The increased incidence of balloon aortic valvuloplasty mirrors the increase in the use of TAVI with a sharp increase in activity from 2006. Success rates for bridging from balloon aortic valvuloplasty to definite surgical intervention are in the range 26.3-74%, with AVR or TAVI occurring within 8 weeks to 7 months. Complications from balloon aortic valvuloplasty such as aortic regurgitation (AR) can be managed successfully. Up to 40% of patients selected by balloon aortic valvuloplasty to have TAVI or AVR do not have these procedures within 2 years. While most of these patients are excluded for objective clinical reasons such as terminal disease/malignancy or other persistent contraindication, some patients refuse definitive treatment and others die while on the waiting list. Outcomes in patients bridged to AVR/TAVI are better than in patients treated with balloon aortic valvuloplasty

  15. 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.

  16. New Insights Into Aortic Diseases

    PubMed Central

    Kuivaniemi, Helena; Sakalihasan, Natzi; Lederle, Frank A.; Jones, Gregory T.; Defraigne, Jean-Olivier; Labropoulos, Nicos; Legrand, Victor; Michel, Jean-Baptiste; Nienaber, Christoph; Radermecker, Marc A.; Elefteriades, John A.

    2013-01-01

    The current state of research and treatment on aortic diseases was discussed in the “3rd International Meeting on Aortic Diseases” (IMAD3) held on October 4–6, 2012, in Liège, Belgium. The 3-day meeting covered a wide range of topics related to thoracic aortic aneurysms and dissections, abdominal aortic aneurysms, and valvular diseases. It brought together clinicians and basic scientists and provided an excellent opportunity to discuss future collaborative research projects for genetic, genomics, and biomarker studies, as well as clinical trials. Although great progress has been made in the past few years, there are still a large number of unsolved questions about aortic diseases. Obtaining answers to the key questions will require innovative, interdisciplinary approaches that integrate information from epidemiological, genetic, molecular biology, and bioengineering studies on humans and animal models. It is more evident than ever that multicenter collaborations are needed to accomplish these goals. PMID:26798669

  17. 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

  18. 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.

  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. Valve-in-Valve Replacement Using a Sutureless Aortic Valve

    PubMed Central

    Dohmen, Pascal M.; Lehmkuhl, Lukas; Borger, Michael A.; Misfeld, Martin; Mohr, Friedrich W.

    2016-01-01

    Patient: Female, 61 Final Diagnosis: Tissue degeneration Symptoms: Dyspnea Medication: — Clinical Procedure: Redo valve replacement Specialty: Surgery Objective: Rare disease Background: We present a unique case of a 61-year-old female patient with homograft deterioration after redo surgery for prosthetic valve endocarditis with root abscess. Case Report: The first operation was performed for type A dissection with root, arch, and elephant trunk replacement of the thoracic aorta. The present re-redo surgery was performed as valve-in-valve with a sutureless aortic biopros-thesis. The postoperative course was uneventful and the patient was discharged on day 6. Conclusions: The current case report demonstrates that sutureless bioprostheses are an attractive option for surgical valve-in-valve procedures, which can reduce morbidity and mortality. PMID:27694795