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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. PMID:22287557

  2. Double aortic arch

    MedlinePlus

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

  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. Persistent Fifth Aortic Arch with Coarctation

    PubMed Central

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

    2016-01-01

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

  5. 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

  6. Hydatid cyst involving the aortic arch.

    PubMed

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

    2007-03-01

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

  7. Techniques for aortic arch endovascular repair.

    PubMed

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

    2016-06-01

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

  8. 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

  9. Hybrid treatment of aortic arch disease

    PubMed Central

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

    2014-01-01

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

  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. 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

  12. Mycotic aneurysm of the aortic arch.

    PubMed

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

    2000-01-01

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

  13. Saccular Aneurysms of the Transverse Aortic Arch

    PubMed Central

    Preventza, Ourania; Coselli, Joseph S.

    2015-01-01

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

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

    PubMed

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

    2012-01-01

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

  15. Blood flow characteristics in the aortic arch

    NASA Astrophysics Data System (ADS)

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

    2012-11-01

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

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

    PubMed Central

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

    2013-01-01

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

  17. Minimally Invasive Techniques for Total Aortic Arch Reconstruction

    PubMed Central

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

    2016-01-01

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

  18. Minimally Invasive Techniques for Total Aortic Arch Reconstruction.

    PubMed

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

    2016-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

    Coselli, J S; Green, S Y

    2015-08-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2016-01-01

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

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

    SciTech Connect

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

    2013-08-01

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

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

    PubMed

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

    2013-05-01

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

  5. Persistent right aortic arch in a yearling horse.

    PubMed Central

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

    1998-01-01

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

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

    PubMed

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

    2016-10-01

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

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

    PubMed Central

    Soulis, JV; Dimitrakopoulou, M; Giannoglou, GD

    2014-01-01

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

  8. 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

  9. 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

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

    PubMed Central

    Alford, Patrick W.; Taber, Larry A.

    2009-01-01

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

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

    SciTech Connect

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

    1982-01-01

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

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

    SciTech Connect

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

    2005-06-15

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

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

    PubMed

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

    2012-11-01

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

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

    PubMed

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

    2001-03-01

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

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

    PubMed

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

    2006-04-01

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

  16. 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.

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

    PubMed

    Janevski, B

    1983-01-01

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

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2015-06-01

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

  20. 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

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

    PubMed

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

    2013-09-01

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

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

    PubMed Central

    2012-01-01

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

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

    PubMed

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

    2016-06-01

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

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

    PubMed Central

    2013-01-01

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

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

    PubMed

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

    2012-11-01

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

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

    PubMed Central

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

    1982-01-01

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

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

    PubMed

    Oz, Kursad; Erek, Ersin; Yildirim, Aydin

    2016-06-01

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

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

    PubMed

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

    2009-10-01

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

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

    PubMed

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

    2014-05-01

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

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

    PubMed

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

    2012-07-01

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

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

    PubMed

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

    2016-08-01

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

  12. 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

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

    PubMed

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

    2016-07-01

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

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

    PubMed Central

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

    2015-01-01

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

  15. 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

  16. ``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.

  17. 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

  18. 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

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

    PubMed

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

    2013-01-01

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

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

    PubMed Central

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

    2015-01-01

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

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

    PubMed

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

    2014-01-01

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

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

    PubMed

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

    2009-05-01

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

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

    PubMed

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

    2016-07-01

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

  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. 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

  6. 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

  7. 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

  8. 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

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

    PubMed Central

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

    2015-01-01

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

  10. 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

  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. 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

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

    PubMed

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

    1988-05-01

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

  14. 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

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2016-07-01

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

  17. 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

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

    PubMed Central

    2014-01-01

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

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

    PubMed

    Lioupis, Christos; Abraham, Cherrie Z

    2011-09-01

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

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

    PubMed

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

    2016-07-01

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

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

    PubMed

    García-Herrera, Claudio M; Celentano, Diego J

    2013-11-01

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

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

    PubMed

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

    2011-01-01

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

  3. 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

  4. 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

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

    PubMed Central

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

    2013-01-01

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

  6. 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

  7. 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.

  8. [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

  9. 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

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

    PubMed

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

    2008-09-01

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

  11. 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.

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

    PubMed

    Genovese, Katia; Humphrey, Jay D

    2015-04-01

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

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

    PubMed

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

    2016-06-01

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

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

    PubMed Central

    Tong, Elizabeth; Hagspiel, Klaus D

    2015-01-01

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

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

    PubMed

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

    2001-02-01

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

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

    PubMed Central

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

    2012-01-01

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

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

    PubMed

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

    2011-12-01

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2015-07-01

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

  4. 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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2011-08-01

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

  7. [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

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

    PubMed

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

    2014-05-01

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

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

    PubMed

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

    2011-10-01

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

  10. 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

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

    PubMed

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

    2005-01-01

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

  12. 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.

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

    PubMed

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

    2016-01-01

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

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

    PubMed

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

    2016-06-01

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

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

    PubMed

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

    2015-10-01

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

  16. 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

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

    PubMed

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

    2007-02-01

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

  18. 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.

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

    PubMed

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

    2015-03-01

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

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

    PubMed

    Quintana, Eduard; Pochettino, Alberto

    2015-07-01

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

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

    PubMed

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

    2016-03-01

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

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

    PubMed

    Erdoğan, Serkan; Kılınç, Mehmet

    2014-06-01

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

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

    PubMed Central

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

    2016-01-01

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

  4. 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

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

    PubMed

    Karasaki, Takahiro; Tanaka, Makoto

    2015-01-01

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

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

    PubMed Central

    Karasaki, Takahiro; Tanaka, Makoto

    2015-01-01

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

  7. 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

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

    PubMed

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

    2015-05-01

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

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

    PubMed Central

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

    2014-01-01

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

  10. 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

  11. 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.

  12. 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

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

    PubMed

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

    2015-10-27

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

  14. 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.

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

    PubMed

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

    2013-05-01

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

  16. 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

  17. 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

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

    PubMed

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

    2008-03-01

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

  19. 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

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

    PubMed Central

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

    2014-01-01

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

  1. 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.

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

    PubMed

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

    2004-11-01

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

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

    PubMed Central

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

    2014-01-01

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

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

    PubMed

    Cirillo, Marco

    2016-04-01

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

  5. 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.

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

    PubMed Central

    Kamali, Younes; Tadjalli, Mina

    2015-01-01

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

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

    PubMed

    Kamali, Younes; Tadjalli, Mina

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  9. 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

  10. 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

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

    PubMed

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

    2016-02-01

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

  12. 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

  13. Aortic arch syndrome

    MedlinePlus

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

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

    PubMed

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

    2010-01-01

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

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

    PubMed

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

    2014-09-01

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

  16. 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

  17. 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

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

    PubMed

    Preventza, Ourania; Coselli, Joseph S

    2015-04-01

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

  19. Syphilitic aortic aneurysm presenting with upper airway obstruction.

    PubMed

    Waikittipong, Somchai

    2012-10-01

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

  20. 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

  1. 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

  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. High arch

    MedlinePlus

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

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

    NASA Astrophysics Data System (ADS)

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

    2013-11-01

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

  5. High arch

    MedlinePlus

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

  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. BOOK REVIEW: ENVIRONMENTAL ENGINEERING, 5TH EDITION

    EPA Science Inventory

    Book Review of Environmental Engineering, 5th Edition (Joseph A. Salvato, Nelson L. Nemerow, Franklin J. Agardy (Editors), John Wiley and Sons, Inc. Hoboken, New Jersey. 2003.). Author wrote review per the request of the Editor-in-Chief of the Journal of Environmental Quality.

  8. Aortic angiography

    MedlinePlus

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

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

    PubMed

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

    2015-01-01

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

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

    PubMed

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

    2013-12-01

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

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

    PubMed Central

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

    2013-01-01

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

  12. Multifrequency Catalogue of Blazars - 5th Edition

    NASA Astrophysics Data System (ADS)

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

    2014-12-01

    The 5th Edition of the Multifrequency Catalogue of Blazars is one of the most complete lists of Active Galactic Nuclei whose emission properties are recognised as typical of blazars. It includes the list of sources and an essential compilation of multifrequency data from radio to gamma rays. The source list for the entire sky is also available online at the ASDC web site (http://www.asdc.asi.it/bzcat/) where it is frequently updated to add new blazars and to improve the database.

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

    PubMed

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

    2016-03-01

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

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

    PubMed

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

    2016-06-01

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

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

    PubMed

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

    2016-05-01

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

  16. Aortic insufficiency

    MedlinePlus

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

  17. Aortic Aneurysm

    MedlinePlus

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

  18. Aortic Aneurysm

    MedlinePlus

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

  19. Aortic insufficiency

    MedlinePlus

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

  20. Aneurysms: thoracic aortic aneurysms.

    PubMed

    Chun, Kevin C; Lee, Eugene S

    2015-04-01

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

  1. 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.

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

    PubMed

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

    2016-06-01

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

  3. Type A aortic dissection with cold agglutinin disease.

    PubMed

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

    2011-08-01

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

  4. [Surgical aspects of acute aortic dissection].

    PubMed

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

    1992-12-01

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

  5. 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…

  6. 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.

  7. 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...

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

    PubMed

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

    2016-06-01

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

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

    PubMed Central

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

    2014-01-01

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

  10. 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...

  11. 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

  12. Aortic Disease Presentation and Outcome Associated with ACTA2 mutations

    PubMed Central

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

    2015-01-01

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

  13. 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

  14. 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

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

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

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

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

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

    PubMed Central

    2011-01-01

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

  2. 5th Annual Global College of Neuroprotection and Neuroregeneration.

    PubMed

    Sharma, Hari Shanker

    2008-06-01

    The 5th Global College of Neuroprotection and Neuroregeneration (GCNN) was held in the historic charming capital city of Bucharest, Romania in JW Marriott Grand Hotel on 3-6 March, 2008. The meeting was a unique blend of basic researchers and clinicians across the Globe presenting their recent findings in neuroprotection and neuroregeneration in a beautiful exotic ambience. More than 300 students and researchers attended the congress and participated in deliberations. Over 60 representatives from various pharmaceutical industries from all over the world supported this event. This meeting was held for the first time as a joint venture with GCNN and the Society for study on Neuroproetction and Neuroplasticity (SSNN), and was a grand success both scientifically and socially. Thus, these joint meetings of the two societies (GCNN and SSNN) will continue in future in different European cities for the coming 5 years. PMID:18505353

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

    PubMed

    Ziganshin, Bulat A; Elefteriades, John A

    2016-05-01

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

  4. 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 ...

  5. 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, ...

  6. 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

  7. 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

  8. 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.

  9. 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

  10. 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.

  11. Greater arch injuries.

    PubMed

    Shivanna, Deepak; Manjunath, Dayanand; Amaravathi, Rajkumar

    2014-12-01

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

  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. Teaching 5th grade science for aesthetic understanding

    NASA Astrophysics Data System (ADS)

    Girod, Mark A.

    Many scientists speak with great zeal about the role of aesthetics and beauty in their science and inquiry. Few systematic efforts have been made to teach science in ways that appeal directly to aesthetics and this research is designed to do just that. Drawing from the aesthetic theory of Dewey, I describe an analytic lens called learning for aesthetic understanding that finds power in the degree to which our perceptions of the world are transformed, our interests and enthusiasm piqued, and our actions changed as we seek further experiences in the world. This learning theory is contrasted against two other current and popular theories of science learning, that of learning for conceptual understanding via conceptual change theory and learning for a language-oriented or discourse-based understanding. After a lengthy articulation of the pedagogical strategies used to teach for aesthetic understanding the research is described in which comparisons are drawn between students in two 5th grade classrooms---one taught for the goal of conceptual understanding and the other taught for the goal of aesthetic understanding. Results of this comparison show that more students in the treatment classroom had aesthetic experiences with science ideas and came to an aesthetic understanding when studying weather, erosion, and structure of matter than students in the control group. Also statistically significant effects are shown on measures of interest, affect, and efficacy for students in the treatment class. On measures of conceptual understanding it appears that treatment class students learned more and forgot less over time than control class students. The effect of the treatment does not generally depend on gender, ethnicity, or prior achievement except in students' identity beliefs about themselves as science learners. In this case, a significant interaction for treatment class females on science identity beliefs did occur. A discussion of these results as well as elaboration and

  14. Overlay improvement by ASML HOWA 5th alignment strategy

    NASA Astrophysics Data System (ADS)

    Wang, Raf; Chiang, CY; Hsu, Wilson; Yang, Richer; Shih, Todd; Chen, Jackie; Chiu, Jonathan; Lin, Wythe

    2009-12-01

    Overlay control is more challenging when DRAM volume production continues to shrink its critical dimention (CD) to 70nm and beyond. Effected by process, the overlay behavior at wafer edge is quite different from wafer center. The big contribution to worse overlay at wafer edge which causes yield loss is misalignment. The analysis in wafer edge suggests that high order uncorrectable overlay residuals are often observed by certain process impact. Therefore, the basic linear model used for alignment correction is not sufficient and it is necessary to introduce an advanced alignment correction model for wafer edge overlay improvement. In this study, we demonstrated the achievement of moderating the poor overlay at wafer edge area by using a high order wafer alignment strategy. The mechanism is to use non-linear correction methods of high order models ( up to 5th order), with support by the function High Order Wafer Alignment (known as HOWA) in scanner. Instead of linear model for the 6 overlay parameters which come from average result, HOWA alignment strategy can do high order fitting through the wafer to get more accurate overlay parameters which represent the local wafer grid distortion better. As a result, the overlay improvement for wafer edge is achieved. Since alignment is a wafer dependent correction, with HOWA the wafer to wafer overlay variation can be improved dynamically as well. In addition, the effects of different mark quantity and sampling distribution from HOWA are also introduced in this paper. The results of this study indicate that HOWA can reduce uncorrectable overlay residual by 30~40% and improve wafer-to-wafer overlay variation significantly. We conclude that HOWA is a noteworthy strategy for overlay improvement. Moreover, optimized alignment mark numbers and distribution layout are also key factors to make HOWA successful.

  15. 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

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

    PubMed

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

    2016-05-01

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

  17. Aortic Dissection Type A in Alpine Skiers

    PubMed Central

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

    2013-01-01

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

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

    PubMed Central

    Sherif, Hisham M.F.

    2014-01-01

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

  19. 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.

  20. 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

  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. 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.

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

    PubMed

    Hashimoto, Junichiro; Ito, Sadayoshi

    2015-07-01

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

  4. The utility of a 5th nap in multiple sleep latency test

    PubMed Central

    Lykouras, Dimosthenis; Rees, Kate

    2016-01-01

    Background This is the first study that aimed to look specifically at the utility of the 5th nap in the multiple sleep latency test (MSLT), a test used to assist in the diagnosis of narcolepsy. Methods Data was retrospectively collected from the Sleep Disorders Centre of a Tertiary Hospital on patients that had a 5th nap during their MSLT from the 08th November 2011 to 12th November 2014. Results Fifty-three patients had a 5th nap performed out of 378 MSLT studies. In 16% of cases a diagnosis of narcolepsy was given directly due to the inclusion of the 5th nap on the MSLT. Here a 5th nap allowed diagnostic criteria of mean sleep latency <8 minutes and >2 SOREMPS to be met. In 53% of cases the mean sleep latency increased due to 5th nap inclusion; the mean sleep latency of the first four naps was 5.6 vs. 6.7 after inclusion of the 5th nap. Conclusions The 5th nap is not often performed within the MSLT studies. Our study shows that only a few patients may benefit from a 5th nap opportunity which also led to increase of the mean sleep latency at the expense of extra time, cost, labour and increased patient anxiety. PMID:26904269

  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. Thoracic aortic aneurysm

    MedlinePlus

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

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

    PubMed

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

    2013-12-01

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

  9. 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

  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

    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

  12. 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

  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. 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.

  15. Aortic valve decalcification revisited.

    PubMed

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

    1989-11-01

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

  16. Chylous Ascites after Abdominal Aortic Aneurysm Repair

    PubMed Central

    Ohki, Shinichi; Kurumisawa, Soki

    2015-01-01

    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

  17. 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

  18. On-Pump Beating Heart Extraanatomical Ascending-Descending Aortic Bypass Using a Beating Heart Positioner in an Adult with Aortic Coarctation

    PubMed Central

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

    2016-01-01

    The prognosis of uncorrected aortic coarctation is poor due to development of heart failure. We performed an on-pump beating heart extraanatomical ascending-descending aortic bypass using a beating heart positioner in an adult with coarctation complicated by severe left ventricular hypertrophy. A 51-year-old woman was referred with severe hypertension. Computed tomography demonstrated severe distal aortic arch narrowing. Coarctation of the aorta was diagnosed. A posterior pericardial beating heart extraanatomical bypass via median sternotomy was performed from the ascending to descending aorta using a heart positioner. Her postoperative course was uneventful and blood pressure was normal on a low-dose beta-blocker. PMID:27087874

  19. Surgical Management of Necrotizing Mediastinitis With Large Aortic Pseudoaneurysm.

    PubMed

    Chevalier, Andrew T; Khaja, Minhaj S; Yang, Bo

    2016-05-01

    We report a patient with necrotizing mediastinitis complicated by a giant retrosternal mycotic pseudoaneurysm and prosthetic valve endocarditis successfully managed with a redo sternotomy under hypothermic circulatory arrest. The approach then included extensive débridement of the mediastinum, replacement of the ascending aorta and aortic arch with selective antegrade cerebral perfusion, redo aortic valve replacement, and wound closure with omental flap and myocutaneous flap. After a 2-year survival, the patient suffered reinfection from hemodialysis. Our approach is also applicable to more common presentations of mediastinitis. PMID:27106461

  20. Work Values of 5th, 8th, and 11th Grade Students

    ERIC Educational Resources Information Center

    Hales, Loyde W.; Fenner, Bradford

    1972-01-01

    Self Realization, Job Security, Money, and Altruism were found to be the most important work values, with 5th and 8th grade students differing from 11th grade students on Altruism and Self Realization. (Author)

  1. 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

  2. 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

  3. 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

  4. Ruptured Mycotic Aortic Aneurysm in a Sooty Mangabey (Cercocebus atys)

    PubMed Central

    Sharma, Prachi; Cohen, Joyce K; Lockhart, Shawn R; Hurst, Steven F; Drew, Clifton P

    2011-01-01

    Mycotic aortic aneurysm is a local, irreversible dilatation of the aorta associated with destruction of the vessel wall by infection and is a grave clinical condition associated with high morbidity and mortality in humans. Rupture of aortic aneurysms can be spontaneous, idiopathic, or due to severe trauma, and the condition has been associated with bacterial and, rarely, fungal infections in humans and animals. Here, we describe a case of ruptured spontaneous aortic aneurysm associated with zygomycetic infection in a 21-y-old female sooty mangabey. The animal did not present with any significant clinical signs before being found dead. At necropsy, she was in good body condition, and the thoracic cavity had a large amount of clotted blood filling the left pleural space and surrounding the lung lobes. Near the aortic arch, the descending thoracic aorta was focally perforated (diameter, approximately 0.15 cm), and clotted blood adhered to the tunica adventitia. The aortic intima had multiple, firm, pale-yellow nodules (diameter, 0.25 to 0.5 cm). Histopathologically, these nodules consisted of severe multifocal pyogranulomatous inflammation intermixed with necrosis, fibrin, and broad, infrequently septate, thin-walled fungal hyphae. Immunohistochemistry revealed fungal hyphae characteristic of Mucormycetes (formerly Zygomycetes), and PCR analysis identified the organism as Basidiobolus spp. Dissemination of the fungus beyond the aorta was not noted. Spontaneous aortic aneurysms have been described in nonhuman primates, but this is the first reported case of a ruptured spontaneous aortic aneurysm associated with entomophthoromycetic infection in a sooty mangabey. PMID:22330581

  5. 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

  6. Aortic valve replacement in rheumatoid aortic incompetence.

    PubMed Central

    Devlin, A B; Goldstraw, P; Caves, P K

    1978-01-01

    Rheumatoid aortic valve disease is uncommon. and there are few reports of valve replacement in this condition. Aortic valve replacement and partial pericardiectomy was performed in a patient with acute rheumatoid aortitis and aortic incompetence. Previous reports suggest that any patient with rheumatoid arthritis who develops cardiac symptoms should be carefully assessed for surgically treatable involvement of the pericardium or heart valves. Images PMID:725829

  7. 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

  8. 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

  9. Abdominal aortic aneurysm

    MedlinePlus

    ... to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs when an area of the aorta becomes ... blood pressure Male gender Genetic factors An abdominal aortic aneurysm is most often seen in males over age ...

  10. Aortic aneurysm repair - endovascular

    MedlinePlus

    ... Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... leaking or bleeding. You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. ...

  11. Aortic aneurysm repair - endovascular

    MedlinePlus

    EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... leaking or bleeding. You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. ...

  12. A model for predicting aortic dynamic response to -G sub z impact acceleration.

    NASA Technical Reports Server (NTRS)

    Advani, S. H.; Tarnay, T. J.; Byars, E. F.; Love, J. S.

    1972-01-01

    A steady state dynamic response model for the radial motion of the aorta is developed from in vivo pressure-displacement and nerve stimulation experiments on canines. The model represented by a modified Van der Pol wave motion oscillator closely predicts steady state and perturbed response results. The applicability of the steady state canine aortic model to tailward acting impact forces is studied by means of the perturbed phase plane of the oscillator. The backflow through the aortic arch resulting from a specified acceleration-time profile is computed and an analysis for predicting the forced motion aortic response is presented.

  13. Techniques for preserving vertebral artery perfusion during thoracic aortic stent grafting requiring aortic arch landing.

    PubMed

    Woo, Edward Y; Bavaria, Joseph E; Pochettino, Alberto; Gleason, Thomas G; Woo, Y Joseph; Velazquez, Omaida C; Carpenter, Jeffrey P; Cheung, Albert T; Fairman, Ronald M

    2006-01-01

    Thoracic endografting offers many advantages over open repair. However, delivery of the device can be difficult and may necessitate adjunctive procedures. We describe our techniques for preserving perfusion to the left subclavian artery despite endograft coverage to obtain a proximal seal zone. We reviewed our experience with the Talent thoracic stent graft (Medtronic, Santa Rosa, CA). From 1999 to 2003, 49 patients received this device (29 men, 20 women). Seventeen patients required adjunctive procedures to facilitate proximal graft placement. We performed left subclavian-to-left common carotid artery transposition (6), left common carotid-to-left subclavian artery bypass with ligation proximal to the vertebral artery (7), and left common carotid-to-left subclavian artery bypass with proximal coil embolization (4). Patients who had anatomy unfavorable to transposition or bypass with proximal ligation (large aneurysms or proximal vertebral artery origin) were treated with coil embolization of the proximal left subclavian artery in order to prevent subsequent type II endoleaks. Technical success rate of the carotid subclavian bypass was 100%. Patient follow-up ranged from 3 to 48 months with a mean of 12 months. Six patients had follow-up <6 months owing to recent graft placement. Primary patency was 100%. No neurologic events occurred during the procedure or upon follow-up. One patient had a transient chyle leak that spontaneously resolved in 24 hours. Another patient had a phrenic nerve paresis that resolved after 3 weeks. We believe that it is important to maintain patency of the vertebral artery specifically when a patent right vertebral system and an intact basilar artery is not demonstrated. Furthermore, we describe a novel technique of coil embolization of the proximal left subclavian artery in conjunction with left common carotid-to-left subclavian artery bypass. This circumvents the need for potentially hazardous mediastinal dissection and ligation of the proximal left subclavian artery in cases of large proximal aneurysms or unfavorable vertebral artery anatomy. PMID:17038570

  14. Abdominal Aortic Aneurysms: Treatments

    MedlinePlus

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

  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. Update in the management of type B aortic dissection.

    PubMed

    Nauta, Foeke Jh; Trimarchi, Santi; Kamman, Arnoud V; Moll, Frans L; van Herwaarden, Joost A; Patel, Himanshu J; Figueroa, C Alberto; Eagle, Kim A; Froehlich, James B

    2016-06-01

    Stanford type B aortic dissection (TBAD) is a life-threatening aortic disease. The initial management goal is to prevent aortic rupture, propagation of the dissection, and symptoms by reducing the heart rate and blood pressure. Uncomplicated TBAD patients require prompt medical management to prevent aortic dilatation or rupture during subsequent follow-up. Complicated TBAD patients require immediate invasive management to prevent death or injury caused by rupture or malperfusion. Recent developments in diagnosis and management have reduced mortality related to TBAD considerably. In particular, the introduction of thoracic stent-grafts has shifted the management from surgical to endovascular repair, contributing to a fourfold increase in early survival in complicated TBAD. Furthermore, endovascular repair is now considered in some uncomplicated TBAD patients in addition to optimal medical therapy. For more challenging aortic dissection patients with involvement of the aortic arch, hybrid approaches, combining open and endovascular repair, have had promising results. Regardless of the chosen management strategy, strict antihypertensive control should be administered to all TBAD patients in addition to close imaging surveillance. Future developments in stent-graft design, medical therapy, surgical and hybrid techniques, imaging, and genetic screening may improve the outcomes of TBAD patients even further. We present a comprehensive review of the recommended management strategy based on current evidence in the literature. PMID:27067136

  17. 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

  18. 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

  19. Surgical repair for giant ascending aortic aneurysm to superior vena cava fistula with positive syphilitic test.

    PubMed

    Sekine, Yuji; Yamamoto, Shin; Fujikawa, Takuya; Oshima, Susumu; Ono, Makoto; Sasaguri, Shiro

    2015-10-01

    Syphilitic aortitis is usually associated with thoracic aortic saccular aneurysm, aortic regurgitation and coronary ostial stenosis. However, syphilitic aneurysms have rarely been reported today. Here, we report a patient with ascending aortic aneurysm with aorta-superior vena cava (SVC) fistula with positive syphilitic test. A 52-year-old man was admitted to our institution with a giant ascending aortic aneurysm complicated with SVC syndrome. Computed tomography revealed a giant ascending aneurysm 79 mm in diameter. The result of serodiagnostic tests for syphilis had not been judged yet preoperatively. Total arch replacement concomitant with elephant trunk was performed. Intraoperatively, we detected the ascending aorta to SVC fistula. Postoperatively, we suspected the syphilitic aneurysm strongly, because preoperative serodiagnostic test was concluded to be positive. However, histological examination did not show typical syphilitic features. The patient remains asymptomatic 1 year later. Although extremely rarely today, syphilitic aneurysm should be still considered in the differential diagnosis of ascending aortic aneurysm. PMID:24000069

  20. Transcatheter aortic valve implantation

    PubMed Central

    Oliemy, Ahmed

    2014-01-01

    Transcatheter aortic valve implantation was developed to offer a therapeutic solution to patients with severe symptomatic aortic stenosis who are not candidates for conventional aortic valve replacement. The improvement in transcatheter aortic valve implantation outcomes is still of concern in the areas of stroke, vascular injury, heart block, paravalvular regurgitation and valve durability. Concomitantly, the progress, both technical and in terms of material advances of transcatheter valve systems, as well as in patient selection, renders transcatheter aortic valve implantation an increasingly viable treatment for more and more patients with structural heart disease. PMID:25374670

  1. Contributing Mechanisms of Aortic Atheroma in Ischemic Cerebrovascular Disease.

    PubMed

    Kong, Qi; Ma, Xin

    2015-12-01

    In recent years, the correlation between aortic atheroma (AA) and the occurrence and recurrence of ischemic cerebrovascular disease (ICVD) has attracted much attention, but the contributory mechanisms remain controversial. This review analyzes related research on the roles of AA in ICVD, and demonstrates the correlation between the formation and development of AA and abnormal metabolism, inflammation, hemodynamic changes, and other contributory factors. The presence of complex aortic plaque (CAP) in the ascending aorta and aortic arch increases the risk of cerebral embolism and degree of injury, while the association between CAP in the descending aorta and cerebral embolism remains ambiguous. AA also functions as an indicator of atherosclerosis burden as well as hypercoagulability, which may further increase the risk of ICVD. Further study on the relationship of AA to ICVD will improve diagnosis and treatment in clinical practice. PMID:26522269

  2. Combined open proximal and stent-graft distal repair for distal arch aneurysms: an alternative to total debranching.

    PubMed

    Zierer, Andreas; Sanchez, Luis A; Moon, Marc R

    2009-07-01

    We present herein a novel, combined, simultaneous open proximal and stent-graft distal repair for complex distal aortic arch aneurysms involving the descending aorta. In the first surgical step, the transverse arch is opened during selective antegrade cerebral perfusion, and a Dacron graft (DuPont, Wilmington, DE) is positioned down the descending aorta in an elephant trunk-like fashion with its proximal free margin sutured circumferentially to the aorta just distal to the left subclavian or left common carotid artery. With the graft serving as the new proximal landing zone, subsequent endovascular repair is performed antegrade during rewarming through the ascending aorta. PMID:19559261

  3. Total aortic repair: the new paradigm in the treatment of acute type A aortic dissection.

    PubMed

    Matalanis, George; Perera, Nisal K; Galvin, Sean D

    2016-05-01

    The surgical management of acute type A aortic dissection (ATAAD) is in a period of rapid evolution. Understanding the complex physiology and anatomy of both acute and chronic dissection has been enhanced by the ready availability of state of the art imaging techniques. Technical advances in the intraoperative monitoring of organ perfusion, together with adjuncts to limit organ injury and increasing sophistication in open and endovascular surgery have led to a major reduction in both perioperative morbidity and mortality. In many centers, there has been a transition in mindset and surgical approach away from a purely central aortic operation focusing on the ascending aorta and a 'live to fight another day' philosophy. The current more global perspective recognizes the importance of aortic valve function, malperfusion, false lumen (FL) patency and the potential for future complex aneurysm development. The time is now right to transition into the next phase of sophistication in the management of ATAAD with the aim of achieving not only a safe acute operation, but to either entirely prevent chronic complications or to greatly simplify their management by the creation of an anatomical situation that facilitates future endovascular intervention in place of complex re-do surgery. We present our view on the evolution of surgery for ATAAD leading to our current technique of Branch First Arch replacement and Total Aortic Repair, which not only provides a safe immediate operation, but also offers the hope of a simplified future management if not a total cure for the pathology. PMID:27386409

  4. 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

  5. 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

  6. The ARCHES Integrated Cluster Finder

    NASA Astrophysics Data System (ADS)

    Mints, A.; Schwope, A.

    2014-07-01

    We are developing a tool to search for galaxy clusters associated with X-ray sources from the 3XMM catalog within the ARCHES project (Astronomical Resource cross-matching for High-Energy Studies). We make use of the new cross-matching tool developed for ARCHES to select galaxies in different catalogs around X-ray positions and then try to find clusters by searching for overdensities in the multi-color space. Colors are related to redshifts using spectroscopic data for passively evolving galaxies from the BOSS and VIPERS catalogs. So far we are making use of SDSS, UKIDSS, WISE, and CFHTLS photometric catalogs, but the method can easily be expanded to other data as well (e.g. Pan-STARRS and DES). We present test results of our tool performed on reference samples from the XMM/SDSS cluster survey (Takey et al 2012) and the NORAS/REFLEX surveys.

  7. Reflecting on the 5th World Environmental Education Congress, Montreal, 2009

    ERIC Educational Resources Information Center

    Jickling, Bob

    2010-01-01

    This article traces the development of the World Environmental Congress movement and its establishment as an important international forum. Reflecting on the 5th Congress, it notes the particular contribution of the Congress theme, "Our Common Home". Finally, it considers environmental education's place alongside other parallel transformative…

  8. 75 FR 63478 - 5th Annual PHEMCE Stakeholders Workshop and BARDA Industry Day

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-15

    ...The Department of Health and Human Services (HHS) is pleased to announce the upcoming 5th Annual Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) Stakeholders Workshop and BARDA Industry Day to be held January 10-12, 2011 at the Walter E. Washington Convention Center in Washington, DC. This annual PHEMCE event will bring together private- and public-sector stakeholders......

  9. 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

  10. 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…

  11. 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…

  12. 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

  13. 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…

  14. 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…

  15. 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...

  16. 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.

  17. 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…

  18. 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…

  19. 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…

  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. How Arizona Compares: Real Numbers and Hot Topics. Policy Choices. 5th Edition

    ERIC Educational Resources Information Center

    Morrison Institute for Public Policy, 2005

    2005-01-01

    Morrison Institute for Public Policy is pleased to present "How Arizona Compares: Real Numbers and Hot Topics," the 5th edition of Arizona "Policy Choices." The Arizona "Policy Choices" volumes seek to do more than report. They are designed to assist decision making, stimulate debate, and serve as references. Arizona "Policy Choices" volumes have…

  2. 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…

  3. 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…

  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. Aortic Valve Sparing in Different Aortic Valve and Aortic Root Conditions.

    PubMed

    David, Tirone E

    2016-08-01

    The development of aortic valve-sparing operations (reimplantation of the aortic valve and remodeling of the aortic root) expanded the surgical armamentarium for treating patients with aortic root dilation caused by a variety of disorders. Young adults with aortic root aneurysms associated with genetic syndromes are ideal candidates for reimplantation of the aortic valve, and the long-term results have been excellent. Incompetent bicuspid aortic valves with dilated aortic annuli are also satisfactorily treated with the same type of operation. Older patients with ascending aortic aneurysm and aortic insufficiency secondary to dilated sinotubular junction and a normal aortic annulus can be treated with remodeling of the aortic root or with reimplantation of the aortic valve. The first procedure is simpler, and both procedures are likely equally effective. As with any heart valve-preserving procedure, patient selection and surgical expertise are keys to successful and durable repairs. PMID:27491910

  6. Biomechanical properties of the Marfan's aortic root and ascending aorta before and after personalised external aortic root support surgery.

    PubMed

    Singh, S D; Xu, X Y; Pepper, J R; Treasure, T; Mohiaddin, R H

    2015-08-01

    Marfan syndrome is an inherited systemic connective tissue disease which may lead to aortic root disease causing dilatation, dissection and rupture of the aorta. The standard treatment is a major operation involving either an artificial valve and aorta or a complex valve repair. More recently, a personalised external aortic root support (PEARS) has been used to strengthen the aorta at an earlier stage of the disease avoiding risk of both rupture and major surgery. The aim of this study was to compare the stress and strain fields of the Marfan aortic root and ascending aorta before and after insertion of PEARS in order to understand its biomechanical implications. Finite element (FE) models were developed using patient-specific aortic geometries reconstructed from pre and post-PEARS magnetic resonance images in three Marfan patients. For the post-PEARS model, two scenarios were investigated-a bilayer model where PEARS and the aortic wall were treated as separate layers, and a single-layer model where PEARS was incorporated into the aortic wall. The wall and PEARS materials were assumed to be isotropic, incompressible and linearly elastic. A static load on the inner wall corresponding to the patients' pulse pressure was applied. Results from our FE models with patient-specific geometries show that peak aortic stresses and displacements before PEARS were located at the sinuses of Valsalva but following PEARS surgery, these peak values were shifted to the aortic arch, particularly at the interface between the supported and unsupported aorta. Further studies are required to assess the statistical significance of these findings and how PEARS compares with the standard treatment. PMID:26054807

  7. 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

  8. 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

  9. Aortic dissection with the entrance tear in transverse aorta: analysis of 12 autopsy patients.

    PubMed

    Roberts, C S; Roberts, W C

    1990-11-01

    Clinical and autopsy findings are described in 12 patients who had fatal aortic dissection with the entrance tear in the transverse aorta. The 12 patients represent 7% of 182 autopsies of spontaneous aortic dissection studied by us. The ages of the 12 patients at death ranged from 37 to 87 years (mean, 67 years). Eight were men; 8 had a history of systemic hypertension, and 10 had hearts of increased weight. Diagnosis of aortic dissection was made during life in only 4 of the 12 patients. All 12 patients died of rupture of the false channel within 2 weeks of onset of signs or symptoms compatible with dissection. The direction of aortic dissection from the entrance tear was entirely retrograde in 4 patients, entirely anterograde in 4 patients, and in both directions in 4 patients. Hemopericardium occurred in the first group, left hemothorax in the second group, and either in the last group. Of the 8 patients in whom the ascending aorta was involved, the retrograde dissection in each extended to the aortic root, 6 had pulmonary adventitial hemorrhage, and 4 had involvement of the arch arteries by dissection. In the 4 patients with strictly anterograde dissection, none had dissection in the arch arteries. Thus, tear in the transverse aorta causes a dissection that is usually fata, that often dissects retrogradely, and that may mimic dissection from a tear in ascending aorta. Aortic dissection from a tear in transverse aorta requires early operative intervention. PMID:2241339

  10. VizieR Online Data Catalog: The Roma BZCAT - 5th edition (Massaro+, 2015)

    NASA Astrophysics Data System (ADS)

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

    2016-02-01

    In the 5th Edition we use similar denomination of blazars adopted in the previous editions. Each blazar is identified by a code, with 5BZ for all blazars, a fourth letter that specifies the type (B, G, Q or U), followed by the truncated equatorial coordinates (J2000). We introduced the edition number before the letters BZ to avoid possible confusion due to the fact that several sources changed their old names because of the new adopted classification. The codes are defined in the "Note (G1)" below. The 5th edition contains 1151 BZB sources, 92 of which are reported as candidates because we could not find their optical spectra in the literature, 1909 BZQ sources, 274 BZG sources and 227 BZU objects (1 data file).

  11. An 8 x 10 to the 5th bit bubble memory cell for spacecraft applications

    NASA Technical Reports Server (NTRS)

    Becker, F. J.; Murray, G. W.; Bohning, O. D.; Stermer, R. L.

    1980-01-01

    A multiple chip magnetic bubble memory cell design developed for NASA embodies the low power, low weight, environmental tolerance and reliability necessary for successful operation in spacecraft launch and mission environments. Packaging of multiple chips in a common magnetic bias, drive coil assembly reduces weight and volume overhead per chip and also reduces the number of coil drive components required. This 8 x 10 to the 5th bit cell is conduction cooled and provides a metal and ceramic sealed hermetic chip environment.

  12. 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.

  13. Proceedings of the 5th International Symposium on Blue Laser and Light Emitting Diodes (ISBLLED-2004)

    NASA Astrophysics Data System (ADS)

    Suh, Eun-Kyung; Yoon, Euijoon; Lee, Hyung Jae

    2004-09-01

    The 5th International Symposium on Blue Laser and Light Emitting Diodes (ISBLLED-2004) was held in Gyeongju, Korea, 15-19 March 2004. The purpose of the symposium was to provide a forum for scientists and engineers to discuss recent progress and future trends in the rapidly advancing wide band gap semiconductor science and technologies and their applications in blue laser and light emitting diodes.

  14. Calcification of the aortic wall in hypercalcemic rabbits.

    PubMed

    Rokita, E; Cichocki, T; Divoux, S; Gonsior, B; Höfert, M; Jarczyk, L; Strzałkowski, A

    1992-10-01

    The mineralization process was investigated in the aortic wall of hypercalcemic rabbits. The elevated calcium level in serum was induced by intramuscular injection of vitamin D3. The animals were killed at different times of the experiment (max. 246 d). The freeze-dried tissue homogenates were used for elemental composition studies by means of proton induced X-ray emission (PIXE) and atomic absorption spectroscopy. The structural information was obtained from infrared (IR) and X-ray diffraction (XRD) spectra. Moreover, the ascending part of the aortic arch was separated and used for micro-PIXE (PIXE in combination with proton microprobe) and histochemical examinations. It was found that hypercalcemia (blood serum Ca content elevated by about 20%) induced calcification of the aortic wall. The mineral phase within the aortic wall consisted of Ca-P salts. The Ca/P ratio continuously increased during the experiment and approached 2 after 246 d of the vitamin D3 treatment. The IR and XRD studies made possible the identification of the complex phase composition of the samples. The hydroxyapatite crystals were detected after 196 days, however, in earlier phases of the experiment, amorphous calcium phosphate, dicalcium phosphate dihydrate and octacalcium phosphate were also observed. On the basis of the data obtained, the mechanism of the precipitation and growth of inorganic deposits in the tunica media of the aortic wall was discussed. PMID:1333314

  15. 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.

  16. Sonic hedgehog is required for the assembly and remodeling of branchial arch blood vessels.

    PubMed

    Kolesová, Hana; Roelink, Henk; Grim, Milos

    2008-07-01

    Sonic hedgehog (Shh) is a morphogen involved in many developmental processes. Injection of cells (5E1) that produce a Shh-blocking antibody causes an attenuation of the Shh response, and this causes vascular malformations and impaired remodeling characterized by hemorrhages and protrusions of the anterior cardinal vein and outflow tract, delayed fusion of the dorsal aortae, impaired branching of the internal carotid artery, and delayed remodeling of the aortic arches. Distribution of smooth muscle cells in the vessel wall is unchanged. In 5E1-injected embryos, we also observed impaired assembly of endothelial cells into vascular tubes, particularly in the sixth branchial arch, around the anterior cardinal vein and around the dorsal aorta. In 5E1-treated embryos, increased numbers of macrophage-like cells, apoptotic cells, and a decreased level of proliferation were observed in head mesenchyme. Together, these observations show that Shh signaling is required at multiple stages for proper vessel formation and remodeling. PMID:18570256

  17. 22. VIEW OF STEEL ARCH, SHOWING ABUTMENT INTERIOR, DETAIL OF ...

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

    22. VIEW OF STEEL ARCH, SHOWING ABUTMENT INTERIOR, DETAIL OF ARCH BEARINGS WITH HINGED SEATS AND LATERAL BRACING OF ARCHES, LOOKING NORTH - Notre Dame Bridge, Spanning Merrimack River on Bridge Street, Manchester, Hillsborough County, NH

  18. Thoracic endovascular aortic repair for complicated chronic type B aortic dissection in a patient on hemodialysis with recurrent ischemic colitis.

    PubMed

    Miyazaki, Yuko; Furuyama, Tadashi; Matsubara, Yutaka; Yoshiya, Keiji; Yoshiga, Ryosuke; Inoue, Kentaro; Matsuda, Daisuke; Aoyagi, Yukihiko; Kato, Masaaki; Matsumoto, Takuya; Maehara, Yoshihiko

    2016-12-01

    We present a successful case of thoracic endovascular aortic repair (TEVAR) for chronic Stanford type B aortic dissection (B-AD) with recurrent ischemic colitis. The patient was a 56-year-old woman with abdominal pain as the main complaint who had two operations previously: the total arch replacement 8 years ago and the Bentall 7 years ago for acute Stanford type A aortic dissection. Her abdominal pain worsened as her blood pressure became low during her hemodialysis treatment. An enhanced computed tomography scan was performed on the patient and showed chronic B-AD that occurred from the distal anastomotic part of the total arch graft to the bilateral common iliac arteries. The celiac artery and superior mesenteric artery (SMA) arose from the true lumen, and these were compressed by the expanded false lumen. Her complicated chronic B-AD was treated with the Zenith Dissection Endovascular System, and its procedure was performed as her proximal entry tear was covered by a proximal tapered Zenith TX2 stent graft, supplemented by a noncovered aortic stent extending across both renal arteries, the SMA, and the celiac artery. Seven days after this operation, enhanced computed tomography showed that the patient's true lumen was expanded and her blood flow to the true lumen and SMA was improved. On the other hand, her false lumen tended to be thrombosed. Consequently, she was discharged 10 days after the operation without any postoperative complications as she had no abdominal complaints even though she underwent hemodialysis three times per week after the operation. We believe that TEVAR supplemented by a noncovered aortic stent is an effective treatment, even for highly chronic B-AD in dialysis patients. PMID:27090121

  19. 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

  20. 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,…

  1. 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,…

  2. The Effects of Reading from the Screen on the Reading Motivation Levels of Elementary 5th Graders

    ERIC Educational Resources Information Center

    Aydemir, Zeynep; Ozturk, Ergun

    2012-01-01

    This study aims to explore the effects of reading from the screen on elementary 5th grade students' reading motivation levels. It used the randomized control-group pretest-posttest model, which is a true experimental design. The study group consisted of 60 students, 30 experimental and 30 control, who were attending the 5th grade of a public…

  3. Juxtarenal aortic occlusion.

    PubMed Central

    Tapper, S S; Jenkins, J M; Edwards, W H; Mulherin, J L; Martin, R S; Edwards, W H

    1992-01-01

    The authors' experience with 113 aortic occlusions in 103 patients during a 26-year period (1965 to 1991) is reviewed. The authors found three distinct patterns of presentation: group I (n = 26) presented with acute aortic occlusion, group II (n = 66) presented with chronic aortic occlusion, and group III (n = 21) presented with complete occlusion of an aortic graft. Perioperative mortality rates were 31%, 9%, and 4.7% for each respective group and achieved statistical significance when comparing group I with group II (p = 0.009) and group I with group III (p = 0.015). Group I presented with profound metabolic insults due to acute ischemia and fared poorly. Group II presented with chronic claudication and did well long-term. Group III presented with acute ischemia but did well because of established collateral circulation. The treatment and expected outcome of aortic occlusion depends on the cause. PMID:1616381

  4. 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

  5. Aortic Hemiarch Replacement through a J-Shaped Lower Partial Sternotomy

    PubMed Central

    Waterford, Stephen D.; Rastegar, Michelle; Juan, Viviana

    2015-01-01

    Minimally invasive cardiac surgical techniques include the use of partial sternotomy for aortic valve and mitral valve replacement. Partial sternotomy is associated with less pain, better chest and upper-sternal stability, shorter hospital stays, and faster recoveries. However, aortic arch operations are still typically performed through median sternotomies. We describe the case of a 77-year-old woman who underwent elective hemiarch replacement because of an asymptomatic ascending aortic aneurysm. She requested a minimal incision. Our J-shaped partial lower sternotomy adequately exposed the proximal aorta and enabled all cannulations to be performed through the sternotomy. The patient had an uncomplicated postoperative course. We think that a partial sternotomy for ascending aortic and hemiarch replacement can be considered in selected patients for whom the procedure's benefits are important. PMID:26664318

  6. Morphogenesis of the human palma arch using three-dimensional geometric modeling.

    PubMed

    Durand, Sebastien; Marin, Frederic; Oberlin, Christophe; Ho Ba Tho, Marie-Christine

    2011-10-01

    The hand goes through complex morphological modifications during embryogenesis. The goal of this study was to use geometric modeling to study the morphometric modifications of the palmar arch. Five embryos were used for the study (sizes: 15, 17, 23, 30, and 44 mm). After digitalization of histologic sections (Sony DXC-930P 3CCD camera, Leica Qwin) and segmentation of the metacarpal cartilaginous matrices (Winsurf 4.3 software), geometric modeling and calculations were performed using MSC.Patran 2005r2 software. Correlations (r > 0.99) were found between embryo size and metacarpal volume, metacarpal surface, and the surface of the modeled palmar arch. The growth of the palmar arch is nonhomothetic. Significant reduction (P = 0.05) in the divergence of the 2nd, 3rd, 4th, and 5th metacarpals was observed. Deepening of the palmar arch is correlated with embryo size and age (r > 0.99). Geometric modeling allows 3D rendering of histologic sections and thus quantitative description of the morphogenesis. The results of this study support the hypothesis that opposition of the thumb in correlation with deepening of the palmar arch appears early in embryological development. It constitutes a specific morphological characteristic that appears very early in the human phylum. The fact that the human thumb is naturally in opposition in the resting position is a consequence of this morphogenesis. The thumb's resting position has received little attention in clinical settings and should be considered as the reference position for biomechanical analysis of the thumb column. PMID:21538563

  7. Elevated Aortic Augmentation Index in Children Following Fontan Palliation: Evidence of Stiffer Arteries?

    PubMed

    Bhat, Deepti P; Gupta, Pooja; Aggarwal, Sanjeev

    2015-08-01

    Children born with a functional single ventricle who undergo Fontan palliation are prone to early pump failure. Whether they develop early arterial stiffness with resultant increase in afterload is not well known. We hypothesized that the aortic stiffness is higher in pediatric Fontan patients when compared to healthy controls. A prospective study was conducted at the Children's Hospital of Michigan. Twenty-two Fontan patients (aged 6-21 years) were compared with 22 healthy controls (aged 9-17 years) selected from children referred to our clinic who had normal cardiac anatomy and function on the echocardiogram. Aortic stiffness was assessed noninvasively by measuring the aortic augmentation index (AAI) using applanation tonometry (Sphygmocor, Atcor, IL). AAI was calculated as AP/PP where augmentation pressure (AP) is the increase in aortic systolic blood pressure (BP) and pulse pressure (PP) is the difference between aortic systolic and diastolic BP. Ten patients (45 %) had hypoplastic left ventricle, and 11 (50 %) had undergone aortic arch surgery. The median AAI was significantly higher in Fontan patients when compared to controls (12.5, IQR 4.8, 17.3 vs 0, IQR -6.3, 5.8; p = 0.0003). History of aortic arch surgery and single ventricle morphology did not have a significant impact on AAI. Pediatric patients who undergo Fontan palliation have significantly higher AAI, a marker of aortic stiffness and increased afterload, compared to healthy controls. Larger longitudinal studies are warranted to elucidate the possible contribution of elevated AAI on pump failure in these patients. PMID:25832849

  8. 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. PMID:27076863

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

    PubMed Central

    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. PMID:27076863

  10. 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

  11. 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

  12. 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

  13. 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

  14. Giant aortic aneurysm in a child with Takayasu arteritis.

    PubMed

    Halaweish, Ihab; Patel, Himanshu; Si, Ming-Sing

    2016-03-01

    Takayasu arteritis is a chronic, idiopathic, granulomatous vasculitis involving the aorta, its major branches, and occasionally the pulmonary arteries. Although rare in children, it is the third most common vasculitis in the paediatric population. Although aneurysmal disease has been reported in adults with Takayasu arteritis, it is a rare entity in children. We present the case of a 10-year-old boy with a giant ascending and arch aneurysm that necessitated follow-up surgery for a new aneurysm and occlusive disease. This is also the first published case involving endovascular aortic graft placement for the management of vascular sequela of Takayasu arteritis in a child. PMID:26365418

  15. Syphilitic aortic aneurysm with spastic paraparesis: a novel presentation and review of the literature.

    PubMed

    Gugssa, Seid Ali; Johnston, James C

    2012-12-15

    Syphilitic aortic aneurismal erosion into the vertebral column with associated neurological dysfunction is extraordinarily rare, and the very few reported cases typically involve the descending aorta. We describe the novel presentation of a 55 year old man with a syphilitic aneurysm of the ascending aorta and arch causing spinal erosion with spastic paraparesis. Clinicians must remain cognizant that the resurgence of primary and secondary syphilis, exacerbated by the unrelenting HIV-AIDS epidemic, portends an increasing incidence of tertiary manifestations such as aortic aneurysm formation with its myriad complications including compressive myelopathy. PMID:22925534

  16. 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.

  17. Aortic valve surgery - open

    MedlinePlus

    ... choose to have your aortic valve surgery at a center that does many of these procedures. ... DA, Harken AH. Acquired heart disease: valvular. In: Townsend CM, ... Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: ...

  18. [Acute aortic syndrome].

    PubMed

    Nienaber, Christoph A

    2016-06-01

    Acute aortic syndrome is the common denominator for acute events to the aortic wall and encompasses dissection of the aorta, intramural hematoma, formation of aortic ulcers and trauma to the aorta with an annual incidence of up to 35 cases/100.000 between 65 and 75 years of age. Both, inflammation and/or microtrauma at the level of the aortic media layer, and a genetic disposition are promoting elements of AAS, while the extent and anatomic involvement of the ascending aorta call for either surgical resection/repair in the proximal part of the aorta, or an endovascular solution for pathologies in the distal aorta; in all cases of dissection (regardless of location) reconstruction/realignment has been proven to portend better long-term outcomes (in addition to medical management of blood pressure). PMID:27254622

  19. Abdominal aortic aneurysm

    MedlinePlus

    ... main blood vessel that supplies blood to the abdomen, pelvis, and legs. An abdominal aortic aneurysm occurs ... dissection). Symptoms of rupture include: Pain in the abdomen or back. The pain may be severe, sudden, ...

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

    PubMed

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

    2016-06-01

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

  1. 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

  2. Abdominal aortic aneurysm.

    PubMed

    Setacci, Francesco; Galzerano, Giuseppe; De Donato, Gianmarco; Benevento, Domenico; Guerrieri, Massimiliano W; Ruzzi, Umberto; Borrelli, Maria P; Setacci, Carlo

    2016-02-01

    Endovascular repair of abdominal aortic aneurysms has become a milestone in the treatment of patients with abdominal aortic aneurysm. Technological improvement allows treatment in more and more complex cases. This review summarizes all grafts available on the market. A complete review of most important trial on this topic is provided to the best of our knowledge, and technical tips and tricks for standard cases are also included. PMID:26771730

  3. 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.

  4. Syphilis as a Cause of Thoracic Aortic Aneurysm.

    PubMed

    Roberts, William C; Barbin, Clay M; Weissenborn, Matthew R; Ko, Jong M; Henry, A Carl

    2015-10-15

    In 2009, we described morphologic findings in 22 patients having resection of an ascending aortic aneurysm in the previous 11 years at the Baylor University Medical Center, and histologic examination of the aneurysmal wall disclosed classic findings of syphilitic aortitis. The major purpose of that extensively illustrated report was to describe the characteristic gross features of the aneurysm such that syphilitic aortitis might be better recognized at operation and appropriate antibiotics administered postoperatively. The aim of the present study was to emphasize that syphilis remains a major cause of ascending aortic aneurysm. From January 1, 2009, to December 31, 2014, we studied additional 23 patients who had resection of an ascending aortic aneurysm that again histologically had classic features of syphilitic aortitis. All 23 patients were found to have syphilitic aortitis grossly and histologically. The aneurysm involved the ascending portion of aorta in all 23, the arch portion in 12, and the descending thoracic portion in 10. In conclusion, syphilis has far from disappeared. It remains a major cause of ascending aortic aneurysm. PMID:26307174

  5. 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

  6. 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...

  7. 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

  8. 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

  9. 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.

  10. 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. PMID:26669983

  11. Genomics into Healthcare: The 5th Pan Arab Human Genetics Conference and 2013 Golden Helix Symposium

    PubMed Central

    Fortina, Paolo; AlKhaja, Najib; Al Ali, Mahmoud Taleb; Hamzeh, Abdul Rezzak; Nair, Pratibha; Innocenti, Federico; Patrinos, George P.; Kricka, Larry J.

    2014-01-01

    The joint 5th Pan Arab Human Genetics conference and 2013 Golden Helix Symposium, “Genomics into Healthcare” was coorganized by the Center for Arab Genomic Studies (http://www.cags.org.ae) in collaboration with the Golden Helix Foundation (http://www.goldenhelix.org) in Dubai, United Arab Emirates from 17 to 19 November, 2013. The meeting was attended by over 900 participants, doctors and biomedical students from over 50 countries and was organized into a series of nine themed sessions that covered cancer genomics and epigenetics, genomic and epigenetic studies, genomics of blood and metabolic disorders, cytogenetic diagnosis and molecular profiling, next-generation sequencing, consanguinity and hereditary diseases, clinical genomics, clinical applications of pharmacogenomics, and genomics in public health. PMID:24526565

  12. 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

  13. 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.

  14. 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.

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

    PubMed Central

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

    2015-01-01

    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. PMID:26243853

  16. Mandibular arch perimeter changes with lip bumper treatment.

    PubMed

    Osborn, W S; Nanda, R S; Currier, G F

    1991-06-01

    The effects of lip bumper treatment on the mandibular arch were observed in 32 patients with late transitional and early permanent dentitions. Dental cast measurements were made for arch perimeter, arch length, and arch width. Cephalometric radiographs were used to determine labial tipping of the incisors and distal movement of the molars. Arch circumference increased in all patients, ranging from 0.7 mm to 8.8 mm, with an average of 4.1 mm. The mean increase in arch length was 1.2 mm and was largely attributed to anterior tipping of the mandibular incisors. Change in arch length was the most predictive variable for the increase in arch circumference. Passive changes in arch width were recorded, with a mean increase of 2.0 mm in the intercanine distance and 2.5 mm in the first premolar distance. Arch width increments contributed to the increase in arch circumference, but the increases in arch width were not found to be predictive of the change in arch circumference. Changes in either arch circumference or arch length were not related to the duration of treatment, age and sex of the patient, or the eruption status of the permanent second molars. PMID:2038972

  17. Surgical Aortic Valvuloplasty Versus Balloon Aortic Valve Dilatation in Children.

    PubMed

    Donald, Julia S; Konstantinov, Igor E

    2016-09-01

    Balloon aortic valve dilatation (BAD : is assumed to provide the same outcomes as surgical aortic valvuloplasty (SAV). However, the development of precise modern surgical valvuloplasty techniques may result in better long-term durability of the aortic valve repair. This review of the recent literature suggests that current SAV provides a safe and durable repair. Furthermore, primary SAV appears to have greater freedom from reintervention and aortic valve replacement when compared to BAD. PMID:27587493

  18. Aortic regurgitation after transcatheter aortic valve replacement.

    PubMed

    Werner, Nikos; Sinning, Jan-Malte

    2014-01-01

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

  19. Aortic aneurysm repair - endovascular- discharge

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000236.htm Aortic aneurysm repair - endovascular - discharge To use the sharing features ... enable JavaScript. AAA repair - endovascular - discharge; Repair - aortic aneurysm - endovascular - discharge; EVAR - discharge; Endovascular aneurysm repair - discharge ...

  20. Screening for Abdominal Aortic Aneurysm

    MedlinePlus

    Understanding Task Force Recommendations Screening for Abdominal Aortic Aneurysm The U.S. Preventive Services Task Force (Task Force) ... final recommendation statement on Screening for Abdominal Aortic Aneurysm. This final recommendation statement applies to adults ages ...

  1. 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.

  2. [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

  3. Contemporary Management of Type B Aortic Dissection in the Endovascular Era.

    PubMed

    Bannazadeh, Mohsen; Tadros, Rami O; McKinsey, James; Chander, Rajiv; Marin, Michael L; Faries, Peter L

    2016-04-01

    Aortic dissection (AD) is one of the most common catastrophic pathologies affecting the aorta. Anatomic classification is based on the origin of entry tear and its extension. Type A dissections originate in the ascending aorta, whereas the entry tear in Type B dissections starts distal to the left subclavian artery. The patients with aortic dissection who manifest complications such as rupture, malperfusion, aneurysmal degeneration, and intractable pain are classified as complicated AD. Risk factors for developing aortic dissection include age, male gender, and aortic wall structural abnormalities. The most common presenting symptom of acute aortic dissection is pain. Malperfusion occurs as a result of end-organ ischemia due to involvement of aortic branches from the dissecting process. This can happen in various locations causing mesenteric ischemia (mesenteric vessels), stroke (aortic arch vessels), renal failure (renal arteries), spinal ischemia, and limb ischemia (iliac or subclavian arteries). Aneurysmal degeneration is the most common complication of patients with chronic Type B dissection who are managed with medical therapy. Management of Type B aortic dissection (TBAD) remains controversial. Many groups recommend conservative therapy for newly diagnosed TBAD and reserve surgical management for patients who develop complications such as rupture, malperfusion, aneurysmal dilatation, and refractory pain. The mainstay of medical therapy includes antihypertensive medication to reduced ΔP/ ΔT by lowering blood pressure and heart rate. With the continued success of thoracic endovascular aortic repair (TEVAR), this procedure has been extended to treat TBAD in selected patients. The outcomes of TEVAR are promising, with early mortality rates from 10% to 20%. With promising results from these series, some groups recommend early TEVAR in uncomplicated TBAD to prevent future adverse events. The goals of endovascular treatment of TBAD are to cover the entry tear

  4. Transcatheter Aortic Valve Implantation.

    PubMed

    Malaisrie, S Chris; Iddriss, Adam; Flaherty, James D; Churyla, Andrei

    2016-05-01

    Severe aortic stenosis (AS) is a life-threatening condition when left untreated. Aortic valve replacement (AVR) is the gold standard treatment for the majority of patients; however, transcatheter aortic valve implantation/replacement (TAVI/TAVR) has emerged as the preferred treatment for high-risk or inoperable patients. The concept of transcatheter heart valves originated in the 1960s and has evolved into the current Edwards Sapien and Medtronic CoreValve platforms available for clinical use. Complications following TAVI, including cerebrovascular events, perivalvular regurgitation, vascular injury, and heart block have decreased with experience and evolving technology, such that ongoing trials studying TAVI in lower risk patients have become tenable. The multidisciplinary team involving the cardiac surgeon and cardiologist plays an essential role in patient selection, procedural conduct, and perioperative care. PMID:27021619

  5. Abdominal Aortic Aneurysms

    PubMed Central

    Fortner, George; Johansen, Kaj

    1984-01-01

    Aneurysms are common in our increasingly elderly population, and are a major threat to life and limb. Until the advent of vascular reconstructive techniques, aneurysm patients were subject to an overwhelming risk of death from exsanguination. The first successful repair of an abdominal aortic aneurysm using an interposed arterial homograft was reported by Dubost in 1952. A milestone in the evolution of vascular surgery, this event and subsequent diagnostic, operative and prosthetic graft refinements have permitted patients with an unruptured abdominal aortic aneurysm to enjoy a better prognosis than patients with almost any other form of major systemic illness. Images PMID:6702193

  6. Overview of current surgical strategies for aortic disease in patients with Marfan syndrome.

    PubMed

    Miyahara, Shunsuke; Okita, Yutaka

    2016-09-01

    Marfan syndrome is a heritable, systemic disorder of the connective tissue with a high penetrance, named after Dr. Antoine Marfan. The most clinically important manifestations of this syndrome are cardiovascular pathologies which cause life-threatening events, such as acute aortic dissections, aortic rupture and regurgitation of the aortic valve or other artrioventricular valves leading to heart failure. These events play important roles in the life expectancy of patients with this disorder, especially prior to the development of effective surgical approaches for proximal ascending aortic disease. To prevent such catastrophic aortic events, a lower threshold has been recommended for prophylactic interventions on the aortic root. After prophylactic root replacement, disease in the aorta beyond the root and distal to the arch remains a cause for concern. Multiple surgeries are required throughout a patient's lifetime that can be problematic due to distal lesions complicated by dissection. Many controversies in surgical strategies remain, such as endovascular repair, to manage such complex cases. This review examines the trends in surgical strategies for the treatment of cardiovascular disease in patients with Marfan syndrome, and current perspectives in this field. PMID:26586198

  7. 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.

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

    PubMed Central

    Berretta, Paolo

    2016-01-01

    The surgical management of patients with DeBakey type 1 acute aortic dissection (DBT1-AAD) represents a major challenge for aortic surgeons. It has been demonstrated that the distal false lumen remains patent in about 70% to 80% of patients undergoing DBT1-AAD surgery and that a patent false lumen worsens the prognosis. In order to improve long term outcomes and reduce the frequency of late aneurysm formation and reoperation, a more aggressive primary operation involving total arch replacement (TAR) and concomitant antegrade stenting of the descending thoracic aorta (DTA) with a frozen elephant trunk (FET) has been introduced. Such extensive operations, however, remain controversial due to their increased technical complexity and perceived higher operative mortality and morbidity. This perspective article will overview the rationale behind, and the potential advantages and current evidence for, FET surgery in acute aortic dissection. PMID:27386410

  9. 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.

  10. Numerical Fluid Dynamics Symposium, 5th, Tokyo, Japan, Dec. 19-21, 1991, Proceedings

    NASA Astrophysics Data System (ADS)

    1991-07-01

    Various papers on numerical fluid dynamics are presented. Individual topics discussed include: numerical analysis (NA) of shock structure problems, CFD development and a future high-speed computer, simulating vortex motion by 3D method, application of CFD to turbomachine design, numerical simulation (NS) of converging shock waves, NS of unsteady 3D shock wave phenomenon, 5th-order accurate compact upwind scheme, development of a multidimensional upwind scheme, fortified solution algorithm, large-eddy simulation of a bound jet, construction of collision model of diatomic molecules, VSL analysis of nonequilibrium flows around a hypersonic body, NA of chemically nonequilibrium flow, topological transition of flow past some axisymmetric bodies, modeling of scalar transport in free turbulence, a contribution to general application of the vortex method. Also addressed are: vortex simulation of artificial control of mixing layers, 3D motion of vortex filaments, Navier-Stokes simulation of 2D mixing layer, active control of vortex shedding frequency by a jet, direct NS of homogeneous turbulent sheer flow, NA of fuel spray jet by Eulerian method, NS of ignition using a premixed pulsed jet, NS of a scram jet combustor flow, numerical simulation of supersonic flow CO chemical laser, adaptive grid generation using optimal control theory, NS of characteristics of the Stalker tube, imcompressible flow solver using velocity vector and a new variable, unsteady analysis of helicopter rotor.

  11. 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

  12. Segmental Aortic Stiffening Contributes to Experimental Abdominal Aortic Aneurysm Development

    PubMed Central

    Raaz, Uwe; Zöllner, Alexander M.; Schellinger, Isabel N.; Toh, Ryuji; Nakagami, Futoshi; Brandt, Moritz; Emrich, Fabian C.; Kayama, Yosuke; Eken, Suzanne; Adam, Matti; Maegdefessel, Lars; Hertel, Thomas; Deng, Alicia; Jagger, Ann; Buerke, Michael; Dalman, Ronald L.; Spin, Joshua M.; Kuhl, Ellen; Tsao, Philip S.

    2015-01-01

    Background Stiffening of the aortic wall is a phenomenon consistently observed in age and in abdominal aortic aneurysm (AAA). However, its role in AAA pathophysiology is largely undefined. Methods and Results Using an established murine elastase-induced AAA model, we demonstrate that segmental aortic stiffening (SAS) precedes aneurysm growth. Finite element analysis (FEA) reveals that early stiffening of the aneurysm-prone aortic segment leads to axial (longitudinal) wall stress generated by cyclic (systolic) tethering of adjacent, more compliant wall segments. Interventional stiffening of AAA-adjacent aortic segments (via external application of surgical adhesive) significantly reduces aneurysm growth. These changes correlate with reduced segmental stiffness of the AAA-prone aorta (due to equalized stiffness in adjacent segments), reduced axial wall stress, decreased production of reactive oxygen species (ROS), attenuated elastin breakdown, and decreased expression of inflammatory cytokines and macrophage infiltration, as well as attenuated apoptosis within the aortic wall. Cyclic pressurization of segmentally stiffened aortic segments ex vivo increases the expression of genes related to inflammation and extracellular matrix (ECM) remodeling. Finally, human ultrasound studies reveal that aging, a significant AAA risk factor, is accompanied by segmental infrarenal aortic stiffening. Conclusions The present study introduces the novel concept of segmental aortic stiffening (SAS) as an early pathomechanism generating aortic wall stress and triggering aneurysmal growth, thereby delineating potential underlying molecular mechanisms and therapeutic targets. In addition, monitoring SAS may aid the identification of patients at risk for AAA. PMID:25904646

  13. Bicuspid aortic valve

    MedlinePlus

    ... is unclear, but it is the most common congenital heart disease . It often runs in families. The bicuspid aortic ... A.M. Editorial team. Related MedlinePlus Health Topics Congenital Heart Defects Heart Valve Diseases Browse the Encyclopedia A.D.A.M., Inc. ...

  14. 18. SOUTHERNMOST ARCH TOP AND BUTTRESS, AT TURNING POINT WHERE ...

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

    18. SOUTHERNMOST ARCH TOP AND BUTTRESS, AT TURNING POINT WHERE THE EARTHEN EMBANKMENT MEETS THE CONCRETE ARCH DAM. VIEW TO SOUTHWEST. - Rock Creek Dam, East end of Rock Creek Road, Auburn, Placer County, CA

  15. 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

  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 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

  19. Aortic valve annuloplasty: new single suture technique.

    PubMed

    Schöllhorn, Joachim; Rylski, Bartosz; Beyersdorf, Friedhelm

    2014-06-01

    Reconstruction strategies for aortic valve insufficiency in the presence of aortic annulus dilatation are usually surgically challenging. We demonstrate a simple, modified Taylor technique of downsizing and stabilization of the aortic annulus using a single internal base suture. Since April 2011, 22 consecutive patients have undergone safe aortic valve annuloplasty. No reoperations for aortic valve insufficiency and no deaths occurred. PMID:24882316

  20. 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

  1. 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.

  2. 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.

  3. 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

  4. 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

  5. Recent advances in aortic valve disease: highlights from a bicuspid aortic valve to transcatheter aortic valve replacement.

    PubMed

    Augoustides, John G T; Wolfe, Yanika; Walsh, Elizabeth K; Szeto, Wilson Y

    2009-08-01

    There have been major advances in the management of aortic valve disease. Because bicuspid aortic valve is common and predicts an increased risk of adverse aortic events, these patients merit aortic surveillance and consideration for ascending aortic replacement when its diameter exceeds 4.0 cm. Serial quantitative echocardiographic analysis, as compared with traditional clinical markers, can result in better timing of surgical intervention for aortic regurgitation. Furthermore, echocardiographic analysis of aortic regurgitation can classify the mechanism based on cusp mobility to guide aortic valve repair. In aortic root replacement, aortic valve preservation with reimplantation is a mainstream surgical option in Marfan syndrome to offer freedom from valve-related anticoagulation. Prosthetic aortic root replacement has further alternatives with the introduction of the aortic neosinus design and acceptable clinical outcomes with the porcine xenograft. Because aortic valve prosthesis-patient mismatch (PPM) may adversely affect patient outcome, its perioperative prevention is important. Furthermore, significant functional mitral regurgitation in association with aortic stenosis often resolves after aortic valve replacement. Echocardiographic assessment of the aortic valve must include valve area because the transaortic pressure gradient may be low in severe stenosis. Aortic valve replacement with partial sternotomy is safe and offers a reasonable less invasive alternative. Transcatheter aortic valve replacement, whether transfemoral or transapical, has revolutionized aortic valve replacement; it remains a major theme in the specialty for 2009 and beyond. PMID:19497768

  6. 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

  7. Left ventricular dysfunction in the fetus: relation to aortic valve anomalies and endocardial fibroelastosis.

    PubMed Central

    Sharland, G K; Chita, S K; Fagg, N L; Anderson, R H; Tynan, M; Cook, A C; Allan, L D

    1991-01-01

    OBJECTIVE--To examine the relation between a characteristic form of left ventricular dysfunction in the fetus and abnormalities of the aortic valve and endocardial fibroelastosis of the left ventricle. DESIGN--A retrospective study to examine the correlation between echocardiographic findings in the fetus and postnatal or necropsy findings. SETTING--Tertiary referral centre for fetal echocardiography. PATIENTS--Thirty fetuses showing a characteristic echocardiographic picture of left ventricular dysfunction. MAIN OUTCOME MEASURES--The relation between the prenatal echocardiographic features and the postnatal and necropsy findings. RESULTS--At presentation the size of the left ventricular cavity was normal or enlarged in all cases. The measurements of the orifice of the aortic root and mitral valve were either normal or small for the gestational age. The echocardiographic diagnosis made at presentation was critical aortic stenosis in all cases. At necropsy or postnatal examination the aortic valve was dysplastic and stenotic in 15 cases and the left ventricle had become hypoplastic in one of these. Aortic atresia was present in seven patients, three of whom had a hypoplastic left ventricle. In six patients the aortic valve was bicuspid although not obstructive. One of these patients had hypoplasia of the aortic arch and one had a hypoplastic left ventricle but in the remaining four patients endocardial fibroelastosis of the left ventricle was the only abnormality found. No follow up information was available in two. Of 26 patients for whom there was postmortem information, 24 had evidence of some degree of endocardial fibroelastosis of the left ventricle. Sequential observations showed that five cases developed into the hypoplastic left heart syndrome. CONCLUSIONS--This type of left ventricular dysfunction in the fetus is the result of an overlap of diseases, including primary left ventricular endocardial fibroelastosis, critical aortic stenosis, and the hypoplastic

  8. 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

  9. The Tidal Radius of the Arches Cluster

    NASA Astrophysics Data System (ADS)

    Hosek, Matthew; Lu, Jessica R.; Anderson, Jay; Ghez, Andrea; Morris, Mark; Clarkson, William

    2015-08-01

    At a projected distance of just ˜26 pc from the center of the Milky Way, the Arches cluster allows us to examine the structure of a young massive cluster in the strong tidal environment of the Galactic center (GC). We use the HST WFC3IR camera to conduct an astrometric and photometric study of the outer region of the Arches cluster (R > 6.25”) in order to measure its radial profile. Using proper motions we separate cluster members from field stars down to F153M = 20 mag (˜2.5 M_sun) over a 120” x 120” field of view, covering an area 144 times larger than previous proper motion studies. This is a significant improvement over photometrically-determined cluster membership, which is complicated by the high degree of differential reddening across the field. Using cluster membership probabilities, a derived extinction map, and extensive completeness simulations, we construct the radial profile of the Arches cluster to a radius of ˜80” (˜3.1 pc assuming a distance of 8 kpc). Evidence of mass segregation out to this radius is observed, and no significant tidal tail structure is apparent. We find that the projected radial extent of the Arches cluster is significantly larger than its expected tidal radius. This result suggests either that the cluster is not as close to the GC as previously thought or that it is inflated beyond its nominal tidal radius.

  10. 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

  11. 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…

  12. 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…

  13. 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…

  14. 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…

  15. 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…

  16. From Cooks to Carpenters: Measuring - A Saleable Work Skill. Occupation Simulation Packet. Grades 5th-6th.

    ERIC Educational Resources Information Center

    Kennedy, Helena

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

  17. 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…

  18. Minimally invasive valve sparing aortic root replacement (David procedure) is safe

    PubMed Central

    Krueger, Heike; Umminger, Julia; Koigeldiyev, Nurbol; Beckmann, Erik; Haverich, Axel; Martens, Andreas

    2015-01-01

    Objective Even though minimally invasive cardiac surgery may reduce morbidity, this approach is not routinely performed for aortic root replacements. The purpose of this pilot study was to assess the safety and feasibility of valve sparing aortic root replacement via an upper mini-sternotomy up to the 3rd intercostal space. Methods Between April 2011 and March 2014, 26 patients (22 males, age 47.6±13 years) underwent elective minimally invasive aortic valve sparing root replacement (David procedure, group A). Twelve patients underwent additional leaflet repair. Concomitant procedures were: four proximal aortic arch replacements and one coronary artery bypass grafting (CABG) to the proximal right coronary artery (RCA). During the same time period, 14 patients (ten males, age 64.2±9.5 years) underwent elective David procedure via median full sternotomy (group B). Concomitant procedures included six proximal aortic arch replacements. Although the patient cohorts were small, the results of these two groups were compared. Results In group A, there were no intra-operative conversions to full sternotomy. The aortic cross-clamp and cardiopulmonary bypass (CPB) times were 115.6±30.3 and 175.8±41.9 min, respectively. One patient was re-opened (via same access) due to post-operative bleeding. The post-operative ventilation time and hospital stay were 0.5±0.3 and 10.4±6.8 days, respectively. There was no 30-day mortality. The patient questionnaire showed that the convalescence time was approximately two weeks. In group B: the cross-clamp and CPB times were 114.1±19.9 and 163.0±24.5 min, respectively. One patient was re-opened (7.1%) due to post-operative bleeding. The post-operative ventilation time and hospital stay were 0.6±0.7 and 14.2±16.7 days, respectively. There was no 30-day mortality. Conclusions Minimally invasive valve sparing aortic root replacement can be safely performed in selected patients. The results are comparable to those operated via a full

  19. Increased plantar force and impulse in American football players with high arch compared to normal arch

    PubMed Central

    Carson, Daniel W.; Myer, Gregory D.; Hewett, Timothy E.; Heidt, Robert S.; Ford, Kevin R.

    2014-01-01

    Background Risk of overuse injury among athletes is high due in part to repeated loading of the lower extremities. Compared to individuals with normal arch (NA) structure, those with high (HA) or low arch (LA) may be at increased risk of specific overuse injuries, including stress fractures. A high medial longitudinal arch may result in decreased shock absorbing properties due to increased rigidity in foot mechanics. While the effect of arch structure on dynamic function has been examined in straight line walking and running, the relationship between the two during multi-directional movements remains unstudied. Objective The purpose of this study was to determine if differences in plantar loading in football players occur during both walking and pivoting movements. Method Plantar loading was examined in 9 regions of the foot for 26 participants (16 NA, 10 HA). Results High arch athletes demonstrated increased maximum force in the lateral rear foot and medial forefoot, and force time integral in the medial forefoot while walking. HA athletes also demonstrated increased maximum force in the medial rear foot and medial and central forefoot during rapid pivoting. Conclusions The current findings demonstrate that loading patterns differ between football players with high and normal arch structure, which could possibly influence injury risk in this population. PMID:23141809

  20. 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

  1. [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

  2. 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

  3. 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

  4. News from the "5th International Meeting on Inflammatory Bowel Diseases" CAPRI 2010.

    PubMed

    Latella, Giovanni; Fiocchi, Claudio; Caprili, Renzo

    2010-12-01

    At the "5th International Meeting on Inflammatory Bowel Diseases selected topics of inflammatory bowel disease (IBD), including the environment, genetics, the gut flora, the cell response and immunomodulation were discussed in order to better understand specific clinical and therapeutic aspects. The incidence of IBD continues to rise, both in low and in high-incidence areas. It is believed that factors associated with 'Westernization' may be conditioning the expression of these disorders. The increased incidence of IBD among migrants from low-incidence to high-incidence areas within the same generation suggests a strong environmental influence. The development of genome-wide association scanning (GWAS) technologies has lead to the discovery of more than 100 IBD loci. Some, as the Th 17 pathway genes, are shared between Crohn's disease (CD) and ulcerative colitis (UC), while other are IBD subtype-specific (autophagy genes, epithelial barrier genes). Disease-specific therapies targeting these pathways should be developed. Epigenetic regulation of the inflammatory response also appears to play an important role in the pathogenesis of IBD. The importance of gut flora in intestinal homeostasis and inflammation was reinforced, the concepts of eubiosis and dysbiosis were introduced, and some strategies for reverting dysbiosis to a homeostatic state of eubiosis were proposed. The current status of studies on the human gut microbiota metagenome, metaprotome, and metabolome was also presented. The cell response in inflammation, including endoplasmic reticulum (ER) stress responses, autophagy and inflammasome-dependent events were related to IBD pathogenesis. It was suggested that inflammation-associated ER stress responses may be a common trait in the pathogenesis of various chronic immune and metabolic diseases. How innate and adaptive immunity signaling events can perpetuate chronic inflammation was discussed extensively. Signal transduction pathways provide intracellular

  5. 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.

  6. 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

  7. Micromanaging abdominal aortic aneurysms.

    PubMed

    Maegdefessel, Lars; Spin, Joshua M; Adam, Matti; Raaz, Uwe; Toh, Ryuji; Nakagami, Futoshi; Tsao, Philip S

    2013-01-01

    The contribution of abdominal aortic aneurysm (AAA) disease to human morbidity and mortality has increased in the aging, industrialized world. In response, extraordinary efforts have been launched to determine the molecular and pathophysiological characteristics of the diseased aorta. This work aims to develop novel diagnostic and therapeutic strategies to limit AAA expansion and, ultimately, rupture. Contributions from multiple research groups have uncovered a complex transcriptional and post-transcriptional regulatory milieu, which is believed to be essential for maintaining aortic vascular homeostasis. Recently, novel small noncoding RNAs, called microRNAs, have been identified as important transcriptional and post-transcriptional inhibitors of gene expression. MicroRNAs are thought to "fine tune" the translational output of their target messenger RNAs (mRNAs) by promoting mRNA degradation or inhibiting translation. With the discovery that microRNAs act as powerful regulators in the context of a wide variety of diseases, it is only logical that microRNAs be thoroughly explored as potential therapeutic entities. This current review summarizes interesting findings regarding the intriguing roles and benefits of microRNA expression modulation during AAA initiation and propagation. These studies utilize disease-relevant murine models, as well as human tissue from patients undergoing surgical aortic aneurysm repair. Furthermore, we critically examine future therapeutic strategies with regard to their clinical and translational feasibility. PMID:23852016

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

    PubMed Central

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

    2015-01-01

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

  9. 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

  10. 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

  11. 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

  12. 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

  13. The 5th Conference on Asian Trends in Prostate Cancer Hormone Therapy.

    PubMed

    Akaza, Hideyuki; Moore, Malcolm A; Chang, Shu-Jen; Cheng, Christopher; Choi, Han Yong; Esuvaranathan, Kesavan; Hinotsu, Shiro; Hong, Sung-Joon; Kim, Choung-Soo; Kim, Wun-Jae; Murai, Masaru; Naito, Seiji; Soebadi, Doddy; Song, Jae-Mann; Umbas, Rainy; Usami, Michiyuki; Xia, Shujie; Yang, Chi-Rei

    2007-01-01

    The Conference on Asian Trends in Prostate Cancer Hormone Therapy is an annual forum for Asian urologists now in its 5th year. The 2006 conference, held in Bali, Indonesia, was attended by 27 leading urologic oncologists from China, Indonesia, Japan, Korea, Singapore, and Taiwan and featured a packed program of presentations and discussions on a wide range of topics such as relationships among clinicians and the newly opened Asia Regional Office for Cancer Control of the International Union Against Cancer (UICC), detection rates of prostate cancer by biopsy in each of the 6 Asian countries, and favored treatment modalities for hormone-refractory prostate cancer (HRPC) in each country. The first session of the conference kicked off with a keynote lecture entitled "Activities of the UICC ARO". UICC's new office will be the nerve center for its activities in the Asia region. Along with the Asian Pacific Organization for Cancer Prevention (APOCP), UICC aims to shift the focus of attention to cancer control. As such APOCP's long-running publication the APJCP is to be re-launched as the Asian Pacific Journal of Cancer Control. Although UICC is primarily concerned with cancer, several risk factors for cancer are common also to other non-communicable diseases such as diabetes and heart disease, and an important strategy is to implement measures to control these various pathologic conditions as a whole. Apart from contributing to an Asian prostate cancer registry the UICC-ARO will provide training courses, working groups, and assistance in collecting and processing data. The keynote lecture was followed by a roundtable discussion on possible ways in which clinicians from each Asian country can work with UICC. A number of suggestions were put forth including better registration, epidemiology research, possible implementation of UICC prostate cancer guidelines, early detection and screening, and roles of diet and phytotherapy. The underlying reasons for the large but

  14. 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

  15. 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

  16. 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.

  17. 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

  18. 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.

  19. [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

  20. The chimney-graft technique for preserving supra-aortic branches: a review.

    PubMed

    Moulakakis, Konstantinos G; Mylonas, Spyridon N; Dalainas, Ilias; Sfyroeras, George S; Markatis, Fotis; Kotsis, Thomas; Kakisis, John; Liapis, Christos D

    2013-05-01

    Evolution in the endovascular era has influenced the management of aortic arch pathologies. "Chimney" or "snorkel" graft technique has been used as an alternative in high risk patients unfit for open repair. We reviewed the published literature on the chimney graft technique for preservation of the supra-aortic branches in order to provide an extensive insight of its feasibility and efficacy and investigate its outcomes. 18 reports were identified, with a total of 124 patients and 136 chimney. Primary technical success was achieved in 123/124 patients (99.2%). The perioperative mortality rate was 4.8% and the stroke rate was 4%, while events of spinal cord ischemia were rare. The overall endoleak rate was 18.5%; 13 patients (10.5%) developed a type I endoleak and 10 (8%) patients a type II endoleak. During a median follow-up period of 11.4 months (range, 0.87-20.1 months) all implanted chimney grafts remained patent. From this, we conclude that endovascular aortic arch repair with chimney grafts is associated with a lower mortality rate compared to totally open or hybrid reconstruction. However, the stroke rate remains noteworthy, and requires longterm data to elucidate. PMID:23977603

  1. The chimney-graft technique for preserving supra-aortic branches: a review

    PubMed Central

    Mylonas, Spyridon N.; Dalainas, Ilias; Sfyroeras, George S.; Markatis, Fotis; Kotsis, Thomas; Kakisis, John; Liapis, Christos D.

    2013-01-01

    Evolution in the endovascular era has influenced the management of aortic arch pathologies. “Chimney” or “snorkel” graft technique has been used as an alternative in high risk patients unfit for open repair. We reviewed the published literature on the chimney graft technique for preservation of the supra-aortic branches in order to provide an extensive insight of its feasibility and efficacy and investigate its outcomes. 18 reports were identified, with a total of 124 patients and 136 chimney. Primary technical success was achieved in 123/124 patients (99.2%). The perioperative mortality rate was 4.8% and the stroke rate was 4%, while events of spinal cord ischemia were rare. The overall endoleak rate was 18.5%; 13 patients (10.5%) developed a type I endoleak and 10 (8%) patients a type II endoleak. During a median follow-up period of 11.4 months (range, 0.87-20.1 months) all implanted chimney grafts remained patent. From this, we conclude that endovascular aortic arch repair with chimney grafts is associated with a lower mortality rate compared to totally open or hybrid reconstruction. However, the stroke rate remains noteworthy, and requires longterm data to elucidate. PMID:23977603

  2. 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.

  3. 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.

  4. Socioeconomic assessment of the proposed inactivation of the 5th Fighter Interceptor Squadron Minot Air Force Base, North Dakota

    SciTech Connect

    Kerley, C.R.; Sage, P.L.; Fichera, J.P.; Lufkin, P.; Stadelman, D.

    1988-12-01

    This assessment examines the potential socioeconomic impacts of inactivating the 5th Fighter Interceptor Squadron (FIS) at Minot Air Force Base (AFB), North Dakota. The study focuses on employment, population, and income impacts and estimates their effects on housing, community services, utilities, transportation, recreation and tourism, and public finance. This assessment is intended primarily for the use of Air Force and community planners concerned with the local consequences of the inactivation. 10 refs., 46 tabs.

  5. Variations among the primary maxillary dental arch forms using a polynominal equation model.

    PubMed

    Tsai, Hung-Huey

    2003-01-01

    This study identifies arch symmetry and describes arch form variations in normal primary maxillary dental casts. Sixty-two percent of casts had asymmetrical arches, and 38% had symmetrical arches. Six types of arch form were identified according to the ratio of arch width to length. There were more long types than short types. The rounded and short types tended to have a more-symmetrical arch than did the long type. PMID:12739689

  6. 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

  7. 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

  8. The Foot's Arch and the Energetics of Human Locomotion.

    PubMed

    Stearne, Sarah M; McDonald, Kirsty A; Alderson, Jacqueline A; North, Ian; Oxnard, Charles E; Rubenson, Jonas

    2016-01-01

    The energy-sparing spring theory of the foot's arch has become central to interpretations of the foot's mechanical function and evolution. Using a novel insole technique that restricted compression of the foot's longitudinal arch, this study provides the first direct evidence that arch compression/recoil during locomotion contributes to lowering energy cost. Restricting arch compression near maximally (~80%) during moderate-speed (2.7 ms(-1)) level running increased metabolic cost by + 6.0% (p < 0.001, d = 0.67; unaffected by foot strike technique). A simple model shows that the metabolic energy saved by the arch is largely explained by the passive-elastic work it supplies that would otherwise be done by active muscle. Both experimental and model data confirm that it is the end-range of arch compression that dictates the energy-saving role of the arch. Restricting arch compression had no effect on the cost of walking or incline running (3°), commensurate with the smaller role of passive-elastic mechanics in these gaits. These findings substantiate the elastic energy-saving role of the longitudinal arch during running, and suggest that arch supports used in some footwear and orthotics may increase the cost of running. PMID:26783259

  9. 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

  10. Emotional and Behavioral Disorders in 1.5th Generation, 2nd Generation Immigrant Children, and Foreign Adoptees.

    PubMed

    Tan, Tony Xing

    2016-10-01

    Existing theories (e.g., acculturative stress theory) cannot adequately explain why mental disorders in immigrants are less prevalent than in non-immigrants. In this paper, the culture-gene co-evolutionary theory of mental disorders was utilized to generate a novel hypothesis that connection to heritage culture reduces the risk for mental disorders in immigrant children. Four groups of children aged 2-17 years were identified from the 2007 United States National Survey of Children's Health: 1.5th generation immigrant children (n = 1378), 2nd generation immigrant children (n = 4194), foreign adoptees (n = 270), and non-immigrant children (n = 54,877). The 1.5th generation immigrant children's connection to their heritage culture is stronger than or similar to the 2nd generation immigrants, while the foreign adoptees have little connection to their birth culture. Controlling for age, sex, family type and SES, the odds for having ADD/ADHD, Conduct Disorder, Anxiety Disorder, and Depression diagnosis were the lowest for the 1.5th generation immigrant children, followed by the 2nd generation immigrant children and the foreign adoptees. The foreign adoptees and non-adopted children were similar in the odds of having these disorders. Connection to heritage culture might be the underlying mechanism that explained recent immigrants' lower rates of mental disorders. PMID:26972324

  11. 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

  12. 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

  13. 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

  14. 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

  15. Intraoperative aortic dissection

    PubMed Central

    Singh, Ajmer; Mehta, Yatin

    2015-01-01

    Intraoperative aortic dissection is a rare but fatal complication of open heart surgery. By recognizing the population at risk and by using a gentle operative technique in such patients, the surgeon can usually avoid iatrogenic injury to the aorta. Intraoperative transesophageal echocardiography and epiaortic scanning are invaluable for prompt diagnosis and determination of the extent of the injury. Prevention lies in the strict control of blood pressure during cannulation/decannulation, construction of proximal anastomosis, or in avoiding manipulation of the aorta in high-risk patients. Immediate repair using interposition graft or Dacron patch graft is warranted to reduce the high mortality associated with this complication. PMID:26440240

  16. The Impact of Subject Age, Gender, and Arch Length on Attitudes of Syrian Dentists towards Shortened Dental Arches

    PubMed Central

    Nassani, Mohammad Zakaria; Al-Nahhal, Tammam Ibrahim; Kujan, Omar; Tarakji, Bassel; Kay, Elizabeth Jane

    2015-01-01

    Objective. This study aimed to investigate the impact of subject age, gender, and arch length on dentists' attitudes towards unrestored shortened dental arches. Materials and Methods. 93 Syrian dentists were interviewed and presented with 24 scenarios for male and female subjects of different ages and shortened dental arches of varying length. Participants were asked to indicate on a standardized visual analogue scale how they would value the health of the mouth if the posterior space was left unrestored. Results. A value of 0.0 represented the worst possible health state for a mouth and 1.0 represented the best. The highest mean value (0.73) was assigned to a shortened dental arch with missing second molar teeth in the mouth of a 70-year-old subject. A 35-year-old female subject with an extremely shortened dental arch (all molar and premolar teeth are missing) attracted the lowest mean value (0.26). The statistical analysis indicated a significant decrease in the value placed on unrestored shortened dental arches as the number of remaining teeth decreased (p < 0.008). While subject gender had almost no impact on dentists' attitudes towards shortened dental arches, the scenarios for the older shortened dental arch subjects attracted significantly higher values compared to the scenarios for the younger subjects (p < 0.017). Conclusion. Subject age and arch length affect dentists' attitudes towards shortened dental arches, but subject gender does not. PMID:26265916

  17. CT of acute abdominal aortic disorders.

    PubMed

    Bhalla, Sanjeev; Menias, Christine O; Heiken, Jay P

    2003-11-01

    Aortic aneurysm rupture, aortic dissection, PAU, acute aortic occlusion, traumatic aortic injury, and aortic fistula represent acute abdominal aortic conditions. Because of its speed and proximity to the emergency department, helical CT is the imaging test of choice for these conditions. MR imaging also plays an important role in the imaging of aortic dissection and PAU, particularly when the patient is unable to receive intravenous contrast material. In this era of MDCT, conventional angiography is used as a secondary diagnostic tool to clarify equivocal findings on cross-sectional imaging. Ultrasound is helpful when CT is not readily available and the patient is unable or too unstable to undergo MR imaging. PMID:14661663

  18. Aortic biomechanics in hypertrophic cardiomyopathy

    PubMed Central

    Badran, Hala Mahfouz; Soltan, Ghada; Faheem, Nagla; Elnoamany, Mohamed Fahmy; Tawfik, Mohamed; Yacoub, Magdi

    2015-01-01

    Background: Ventricular-vascular coupling is an important phenomenon in many cardiovascular diseases. The association between aortic mechanical dysfunction and left ventricular (LV) dysfunction is well characterized in many disease entities, but no data are available on how these changes are related in hypertrophic cardiomyopathy (HCM). Aim of the work: This study examined whether HCM alone is associated with an impaired aortic mechanical function in patients without cardiovascular risk factors and the relation of these changes, if any, to LV deformation and cardiac phenotype. Methods: 141 patients with HCM were recruited and compared to 66 age- and sex-matched healthy subjects as control group. Pulse pressure, aortic strain, stiffness and distensibility were calculated from the aortic diameters measured by M-mode echocardiography and blood pressure obtained by sphygmomanometer. Aortic wall systolic and diastolic velocities were measured using pulsed wave Doppler tissue imaging (DTI). Cardiac assessment included geometric parameters and myocardial deformation (strain and strain rate) and mechanical dyssynchrony. Results: The pulsatile change in the aortic diameter, distensibility and aortic wall systolic velocity (AWS') were significantly decreased and aortic stiffness index was increased in HCM compared to control (P < .001) In HCM AWS' was inversely correlated to age(r = − .32, P < .0001), MWT (r = − .22, P < .008), LVMI (r = − .20, P < .02), E/Ea (r = − .16, P < .03) LVOT gradient (r = − 19, P < .02) and severity of mitral regurg (r = − .18, P < .03) but not to the concealed LV deformation abnormalities or mechanical dyssynchrony. On multivariate analysis, the key determinant of aortic stiffness was LV mass index and LVOT obstruction while the role LV dysfunction in aortic stiffness is not evident in this population. Conclusion: HCM is associated with abnormal aortic mechanical properties. The severity of cardiac

  19. Carotid artery and aortic arch imaging with ECG gating in DSA

    SciTech Connect

    Francis, D.A.; Sheldon, J.J.; Soila, K.; Tobias, J.

    1985-06-01

    New computer software for gated digital subtraction angiography imaging was used to study 57 patients over 3 months. Better mask registration on isolated sets of systolic and diastolic images improved image quality. Detail of vessel outline and lesion was better than that seen on nongated images.

  20. The management of stenotic and obstructive lesions of the aortic arch branches.

    PubMed

    Shumacker, H B; Isch, J H; Jolly, W W; Fitzgerald, E B

    1977-03-01

    The stenotic internal carotid can be managed in a variety of ways and number of tests can be utilized for assessing the collateral blood flow. Except in unusual situations, carotid thromboendarterectomy with or without a patch graft is generally employed. Although some surgeons use no protective shunt at all, or only upon specific indications, intraluminal shunting is utilized extensively. Our preference is to employ the customary Javid shunt technic except in unusual circumstances that suggest that added safety may be assured by shortening to a matter of seconds the period of interruption of carotid flow. In such cases, we believe the temporary axillary-internal carotid intraluminal shunt is of considerable value. Although mediastinal and thoracic procedures and bypass grafts delivering blood from the ascending aorta are not needed nearly as often as they were formerly, they are essential in certain cases. They yield excellent results and carry small risk. Carotid-subclavian grafts have proved quite valuable in restoring pulsatile flow to the subclavian and carotid systems. Our preference, however, because of technical simplicity, is the carotid-axillary bypass procedure. Subclavian-subclavian and axillary-axillary grafts have been employed successfully. When a carotid-axillary bypass is feasible, we would choose this method instead and reserve the others for unusual anatomic-pathologic situations. PMID:848666

  1. Clampless and Sutureless Hybrid Technique for Aortic Arch Debranching on a Porcelain Aorta.

    PubMed

    Poletto, Giorgio L; Musto, Liam; Civilini, Efrem; Giorgetti, PierLuigi

    2016-06-01

    An innovative hybrid approach to the supraaortic vessels in a porcelain aorta and severe fibrotic tissue reaction at the neck is described. The technique is demonstrated in an 80-year-old woman with previous several carotid operations but still experiencing recurrent transient ischemic attacks. Clinical success was achieved at midterm follow-up, demonstrating the efficacy of hybrid treatment for this high-risk patient. Novel prosthetic vascular grafts that can be applied without cross-clamping may also provide a solution to approaching a porcelain aorta and difficult anatomies. PMID:27211961

  2. Unusual Case of Overt Aortic Dissection Mimicking Aortic Intramural Hematoma

    PubMed Central

    Disha, Kushtrim; Kuntze, Thomas; Girdauskas, Evaldas

    2016-01-01

    We report an interesting case in which overt aortic dissection mimicked two episodes of aortic intramural hematoma (IMH) (Stanford A, DeBakey I). This took place over the course of four days and had a major influence on the surgical treatment strategy. The first episode of IMH regressed completely within 15 hours after it was clinically diagnosed and verified using imaging techniques. The recurrence of IMH was detected three days thereafter, resulting in an urgent surgical intervention. Overt aortic dissection with evidence of an intimal tear was diagnosed intraoperatively. PMID:27066437

  3. 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…

  4. The Concept of the Arch Window in the Spiral Switch of the Great Arteries.

    PubMed

    Chiu, Ing-Sh; Lee, Meng-Luen; Huang, Shu-Chien; Chang, Chung-I; Chen, Yih-Sharng; Wu, Mei-Hwan; Anderson, Robert H

    2016-08-01

    When the arterial switch operation includes the Lecompte maneuver, the arterial trunks are reconnected in parallel, rather than the spiral fashion observed in the normal heart. Thus, although the ventriculo-arterial connections are hemodynamically corrected, the anatomic arrangement cannot be considered normal. We hypothesized that, if feasible, it would be advantageous to restore a spiral configuration for the arterial trunks. In 58 patients, we reconstructed the arterial trunks such that, postoperatively, the pulmonary channel spirals round the aorta, passing to either the right or the left, and branches posteriorly. We compared the outcomes with those in 95 patients undergoing a standard non-spiraling operation over the same period. Average follow-up was 8.2 ± 4.5 years. The estimated 10-year survival was similar in the cohorts, at 94.7 % for those with spiraling trunks, as compared to 90.4 % for those with parallel outflow tracts. Reoperation-free survival at 10 years was not significantly different (87.6 vs. 90.5 %). Supravalvar pulmonary stenosis, aortic neo-coarctation, or left bronchial stenosis, however, was encountered in one-eighth of those undergoing a standard operation. None of these complications occurred in those patients who, postoperatively, had spiraling outflow tracts (P = 0.002). Reconstruction of spiraling trunks after the arterial switch has, thus far, avoided the complications of supravalvar pulmonary stenosis, neo-aortic kinking, or bronchial stenosis. The spiraling arrangement prevents compression of the pulmonary vessels and bronchial tree by the aorta, since it provides a wide window in the new aortic arch. PMID:27272691

  5. [Combined Open and Endovascular Repair of Multiple Aortic Aneurysms due to Syphilitic Aortitis].

    PubMed

    Shima, Shotaro; Okamura, Kennichi; Morizumi, Sei; Kawata, Mitsuhiro; Suematsu, Yoshihiro

    2015-06-01

    The patient was a 69-year-old man who presented with low-grade fever and appetite loss. Thoracoabdominal computed tomography revealed multiple aneurysms in the distal arch and descending thoracic and infrarenal aortic regions combined with a right common iliac artery aneurysm. After endovascular stent grafting for a right iliac artery aneurysm, he underwent total arch replacement and open stent grafting for the descending thoracic aneurysms. Pathological microscopic examination revealed an inflammatory infiltrate within the adventitia and destruction of the elastic fibers in the media, which are classical features of syphilitic aortitis. Endovascular aneurysm repair is contraindicated in mycotic infected aneurysms. However, endovascular repair is useful for treating mycotic infected aneurysm, if multiple aneurysms have the possibility of rupture and a high risk of surgery. PMID:26066872

  6. Minimally invasive aortic valve surgery.

    PubMed

    Castrovinci, Sebastiano; Emmanuel, Sam; Moscarelli, Marco; Murana, Giacomo; Caccamo, Giuseppa; Bertolino, Emanuela Clara; Nasso, Giuseppe; Speziale, Giuseppe; Fattouch, Khalil

    2016-09-01

    Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has demonstrably proven to be both safe and effective. Over the last few decades, in an attempt to reduce surgical trauma, different minimally invasive approaches for aortic valve replacement have been developed and are now being increasingly utilized. A narrative review of the literature was carried out to describe the surgical techniques for minimally invasive aortic valve surgery and report the results from different experienced centers. Minimally invasive aortic valve replacement is associated with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. Long-term survival appears to be at least comparable to that reported for conventional full sternotomy. Minimally invasive aortic valve surgery, either with a partial upper sternotomy or a right anterior minithoracotomy provides early- and long-term benefits. Given these benefits, it may be considered the standard of care for isolated aortic valve disease. PMID:27582764

  7. Minimally invasive aortic valve surgery

    PubMed Central

    Castrovinci, Sebastiano; Emmanuel, Sam; Moscarelli, Marco; Murana, Giacomo; Caccamo, Giuseppa; Bertolino, Emanuela Clara; Nasso, Giuseppe; Speziale, Giuseppe; Fattouch, Khalil

    2016-01-01

    Aortic valve disease is a prevalent disorder that affects approximately 2% of the general adult population. Surgical aortic valve replacement is the gold standard treatment for symptomatic patients. This treatment has demonstrably proven to be both safe and effective. Over the last few decades, in an attempt to reduce surgical trauma, different minimally invasive approaches for aortic valve replacement have been developed and are now being increasingly utilized. A narrative review of the literature was carried out to describe the surgical techniques for minimally invasive aortic valve surgery and report the results from different experienced centers. Minimally invasive aortic valve replacement is associated with low perioperative morbidity, mortality and a low conversion rate to full sternotomy. Long-term survival appears to be at least comparable to that reported for conventional full sternotomy. Minimally invasive aortic valve surgery, either with a partial upper sternotomy or a right anterior minithoracotomy provides early- and long-term benefits. Given these benefits, it may be considered the standard of care for isolated aortic valve disease. PMID:27582764

  8. Detail of arched windows on north elevation; camera facing southwest. ...

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

    Detail of arched windows on north elevation; camera facing southwest. - Mare Island Naval Shipyard, Smithery, California Avenue, west side at California Avenue & Eighth Street, Vallejo, Solano County, CA

  9. ARCH TYPE MAGAZINE # 2131. INTERIOR LOOKING TOWARD ENTRY. ...

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

    ARCH TYPE MAGAZINE # 2131. INTERIOR LOOKING TOWARD ENTRY. - Naval Magazine Lualualei, Headquarters Branch, Magazine Type, Various roads in northern & eastern portions of installation, Pearl City, Honolulu County, HI

  10. 16. DETAIL OF SMALL ARCHES AT SOUTH END, FROM WEST. ...

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

    16. DETAIL OF SMALL ARCHES AT SOUTH END, FROM WEST. - Philadelphia & Reading Railroad, Wissahickon Creek Viaduct, Spanning Wissahickon Creek, north of Ridge Avenue Bridge, Philadelphia, Philadelphia County, PA

  11. 15. DETAIL OF SMALL ARCHES AT SOUTH END, FROM WEST. ...

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

    15. DETAIL OF SMALL ARCHES AT SOUTH END, FROM WEST. - Philadelphia & Reading Railroad, Wissahickon Creek Viaduct, Spanning Wissahickon Creek, north of Ridge Avenue Bridge, Philadelphia, Philadelphia County, PA

  12. 4. North elevation, arch CD. View south Ashton Viaduct, ...

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

    4. North elevation, arch C-D. View south - Ashton Viaduct, State Route 116 (Washington Highway) spanning Blackstone River, Blackstone Canal, & Providence & Worcester Railroad, Ashton, Providence County, RI

  13. Mathematical model of a moment-less arch

    PubMed Central

    2016-01-01

    This paper presents a mathematical model for predicting the geometrical shapes of rigid, two-pin, moment-less arches of constant cross section. The advancement of this work lies in the inclusion of arch self-weight and the ability to produce moment-less arch forms for any span/rise ratio, and any ratio of uniformly distributed load per unit span, w, to uniformly distributed arch weight per unit arch length, q. The model is used to derive the shapes of two classical ‘moment-less’ arch forms: parabolic and catenary, prior to demonstrating a general case, not restricted by the unrealistic load assumptions (absence of q, in the case of a parabolic form, or no w, in the case of a catenary arch). Using the same value of span/rise ratio, and w/q>1, the behaviour of the moment-less and parabolic arches under permanent loading, (w+q), is analysed. Results show the former to be developing much lower stresses than its parabolic rival, even when there are relatively small differences in the two geometries; for a medium span/rise ratio of 4 and w/q=2, differences in the parabolic and moment-less arch geometries would, in practical terms, be viewed as insignificant, but the stresses in them are different. PMID:27436970

  14. Normal azygos arch: retrotracheal visualization on frontal chest tomograms.

    PubMed

    Austin, J H; Thorsen, M K

    1981-12-01

    Anteroposterior, linear tomograms of 78 adult subjects in the supine position revealed visualization of pleural reflections off the retrotracheal part of the normal azygos arch in 38 (49%). The course of the arch varied by about 3 cm. Five distinct patterns were found, mainly depending on the course of the inferior margin of the arch. The inferior margin varied from relatively superior retrotracheal positions to intermediate positions appearing to intersect the carina, to relatively inferior and right-sided positions posterior to the proximal right main bronchus. Recognition of these normal variations of the azygos arch should serve to differentiate them from abnormalities in this region. PMID:6976093

  15. 66. CORBELS, BLIND ARCHES & SHIELDS, COMMONS EAST WALL, LOOKING ...

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

    66. CORBELS, BLIND ARCHES & SHIELDS, COMMONS EAST WALL, LOOKING EAST - Smithsonian Institution Building, 1000 Jefferson Drive, between Ninth & Twelfth Streets, Southwest, Washington, District of Columbia, DC

  16. 2. DETAIL VIEW OF MIDDLE ARCH SPAN, LOOKING NORTHWEST. ...

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

    2. DETAIL VIEW OF MIDDLE ARCH SPAN, LOOKING NORTHWEST. - Cumberland & Pennsylvania Railroad, Wills Creek Bridge, Spanning Wills Creek 587 feet West of Eckhart Junction, Cumberland, Allegany County, MD

  17. The Geologic Story of Arches National Park

    USGS Publications Warehouse

    Lohman, Stanley William

    1975-01-01

    According to former Superintendent Bates Wilson (1956), Prof. Lawrence M. Gould, of the University of Michigan, was the first to recognize the geologic and scenic values of the Arches area in eastern Utah and to urge its creation as a national monument. Mrs. Faun McConkie Tanner told me that Professor Gould, who had done a thesis problem in the nearby La Sal Mountains, was first taken through the area by Marv Turnbow, third owner of Wolfe cabin. (See p. 12.) When Professor Gould went into ecstasy over the beautiful scenery, Turnbow replied, 'I didn't know there was anything unusual about it.'

  18. Occlusive Disease of the Vessels of the Aortic Arch—Diagnosis and Management

    PubMed Central

    Johnson, C. Delmar; Zirkle, Thomas J.; Smith, Louis L.

    1968-01-01

    Physicians should be alert to the possibility of occlusion of one or more of the branches of the aortic arch in any patient having neurologic symptoms or complaint of claudication in the upper extremities. The finding of a pulse deficit in the neck or arm and a blood pressure difference of more than 30 mm of mercury between the two arms is pathognomic of this disease. The presence of the occlusive process can be confirmed and its extent determined by angiography. Vascular reconstruction can be expected to restore normal hemodynamics with gratifying relief of symptoms in the majority of cases. PMID:18730091

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

    PubMed Central

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

    2015-01-01

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

  20. 5-Step Methodology for Evaluation and Adaptation of Print Patient Health Information to Meet the <5th Grade Readability Criterion

    PubMed Central

    Hill-Briggs, Felicia; Schumann, Kristina P.; Dike, Ogechi

    2012-01-01

    Background In the setting of declining U.S. literacy, new policies include use of clear communication and low literacy accessibility practices with all patients. Reliable methods for adapting health information to meet such criteria remain a pressing need. Objectives To report method validation (Study 1) and method replication (Study 2) procedures and outcomes for a 5-step method for evaluating and adapting print health information to meet the current low literacy criterion of <5th grade readability. Materials Sets of 18 and 11 publicly-disseminated patient education documents developed by a university-affiliated medical center. Measures Three low-literacy criteria were strategically targeted for efficient, systematic evaluation and text modification to meet a <5th grade reading level: sentence length <15 words, writing in active voice, and use of common words with multisyllabic words (>2–3 syllables) minimized or avoided. Inter-rater reliability for the document evaluations was determined. Results Training in the methodology resulted in inter-rater reliability of 0.99–1.00 in Study 1 and 0.98–1.00 in Study 2. Original documents met none of the targeted low literacy criteria. In Study 1, following low-literacy adaptation, mean reading grade level decreased from 10.4±1.8 to 3.8±0.6 (p<0.0001), with consistent achievement of criteria for words per sentence, passive voice, and syllables per word. Study 2 demonstrated similar achievement of all target criteria, with a resulting decrease in mean reading grade level from 11.0±1.8 to 4.6±0.3 (p < 0.0001). Conclusions The 5-step methodology proved teachable and efficient. Targeting a limited set of modifiable criteria was effective and reliable in achieving <5th grade readability. PMID:22354210

  1. 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

  2. Concurrence of Aneurysmal Subarachnoid Hemorrhage and Stanford Type A Acute Aortic Dissection.

    PubMed

    Inamasu, Joji; Suzuki, Takeya; Wakako, Akira; Sadato, Akiyo; Hirose, Yuichi

    2016-06-01

    We report a rare case of concurrent aneurysmal subarachnoid hemorrhage (SAH) and acute aortic dissection (AAD). A 38-year-old man visited our hospital complaining of severe headache, and brain computed tomography (CT) revealed the presence of SAH. Thoracic to neck computed tomography angiography (CTA), performed in addition to brain CTA, suggested a tear in the aortic arch, and subsequent CT aortography established the diagnosis of Stanford type A AAD. The AAD in our patient, who reported no episodes of chest or back pain, was detected incidentally by thoracic to neck CTA. The imaging study has rarely been indicated for SAH except that it provides additional anatomical information in patients for whom extracranial-intracranial bypass surgery or endovascular treatment is considered. Nevertheless, our experience may highlight additional diagnostic value of thoracic to neck CTA in SAH patients. PMID:27083068

  3. Thoracic aortic aneurysm: A rare cause of elevated hemidiaphragm

    PubMed Central

    Ejazi, Md Arshad; Alam, Md Mazhar; Shameem, Mohammad; Bhargava, Rakesh; Adil Wafi, CG; Salauddin

    2016-01-01

    Phrenic nerve palsy causing hemidiaphragm paralysis is a very uncommon feature of thoracic aortic aneurysm. In one case, a 30 year male complained of chronic dull aching chest pain, and hoarseness of voice; posteroanterior view chest radiograph revealed large spherical radiopacity on the left upper lung zone with smooth lobulated margin with elevated left hemidiaphragm. On Colour Doppler sonography, lesion was anechoic on gray scale sonography but on Doppler analysis revealed intense internal vascularity within it with characteristic “Ying Yang” sign. The finding favor the vascular origin of the lesion and a diagnosis of an arterial aneurysm was made Contrast-enhanced computed tomography (CT) of the thorax revealed a large well defined spherical lesion of 8 × 10 cm size with smooth well defined margin arising from the aortic arch and attenuation of impending rupture or dissection were lesion on immediate post contrast and delayed scan was similar to that of aorta. Left hemidiaphragm elevation was explained by the gross mass effect of the aneurysm causing right phrenic nerve palsy. PMID:27578939

  4. Thoracic aortic aneurysm: A rare cause of elevated hemidiaphragm.

    PubMed

    Ejazi, Md Arshad; Alam, Md Mazhar; Shameem, Mohammad; Bhargava, Rakesh; Adil Wafi, C G; Salauddin

    2016-01-01

    Phrenic nerve palsy causing hemidiaphragm paralysis is a very uncommon feature of thoracic aortic aneurysm. In one case, a 30 year male complained of chronic dull aching chest pain, and hoarseness of voice; posteroanterior view chest radiograph revealed large spherical radiopacity on the left upper lung zone with smooth lobulated margin with elevated left hemidiaphragm. On Colour Doppler sonography, lesion was anechoic on gray scale sonography but on Doppler analysis revealed intense internal vascularity within it with characteristic "Ying Yang" sign. The finding favor the vascular origin of the lesion and a diagnosis of an arterial aneurysm was made Contrast-enhanced computed tomography (CT) of the thorax revealed a large well defined spherical lesion of 8 × 10 cm size with smooth well defined margin arising from the aortic arch and attenuation of impending rupture or dissection were lesion on immediate post contrast and delayed scan was similar to that of aorta. Left hemidiaphragm elevation was explained by the gross mass effect of the aneurysm causing right phrenic nerve palsy. PMID:27578939

  5. [Debranch Thoracic Endovascular Aortic Therapy for Extending Aneurysms].

    PubMed

    Miyamoto, Shinji

    2016-07-01

    To apply endovascular aortic repair for arch or thoracoabdominal pathology, it is essential to reconstruct the branches originating in the treatment area. In cases that a stentgraft has to reach ascending aorta we perform "in situ fenestration with squid capture technique".During the procedure cerebral circulation is maintained by percutaneous cardiopulmonary bypass. After deploying the stentgraft we stab it by a needle while squeezed by snare wire and stick a covered stentgraft eventually. Unlike chimney technique which also can be applied for zone 0 thoracic endovascular aortic therapy( TEVAR),this method has no risk of gutter leak. For now there are no fenestrated nor branched grafts in Japan so that we should perform hybrid TEVAR for throacoabdominal aneurysms if patients' conditions cannot allow graft replacement. In such a case we make bypasses between the common iliac artery( or left leg of bifurcated graft) and visceral arteries using a quadrated graft. All anastomosis can be done in a retroperitoneal single plane. TEVAR shouldn't be performed simultaneously with bypass because unstable hemodynamic increase risk of paraplegia. We have never experienced paraplegia among 50 cases except for 1 case in which TEVAR had to be done urgently under critical hypotension. PMID:27440024

  6. 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

  7. 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.

  8. Limitation of imaging in identifying iatrogenic aortic coarctation following thoracic endovascular aortic repair.

    PubMed

    Thakkar, Rajiv N; Thomaier, Lauren; Qazi, Umair; Verde, Franco; Malas, Mahmoud B

    2015-04-01

    A 21-year-old male suffered blunt trauma from a motor vehicle accident causing thoracic aorta tear. The smallest available stent graft was deployed. Definitive repair was later performed using a 22 × 22 × 116 mm Talent Thoracic Stent Graft. The postoperative course was uneventful. Seventeen months later, he presented with dizziness, chest pain, acute renal failure, malignant hypertension, and troponin elevation. Computed tomography (CT) angiogram and transesophageal echocardiogram did not reveal any dissection, stent stenosis or collapse. Cardiac catheterization showed normal coronary arteries but a 117 mm Hg gradient across the stent graft. Iatrogenic coarctation of the aorta was confirmed with a second measurement during arch angiogram. A Palmaz stent was deployed over the distal end of the previous stent graft with complete resolution of symptoms and gradual normalization of kidney function. This case report demonstrates a need for wider availability and selecting appropriate stent graft in treating traumatic aortic injuries in young patients. It is the first case report of the inability of current imaging modalities in confirming stent collapse. Pressure gradient is a useful tool in confirming stent collapse when clinical scenario does not match CT findings. PMID:25637574

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

    PubMed Central

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

    2016-01-01

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

  10. Standardizing Foot-Type Classification Using Arch Index Values

    PubMed Central

    Weil, Rich; de Boer, Emily

    2012-01-01

    ABSTRACT Purpose: The lack of a reliable classification standard for foot type makes drawing conclusions from existing research and clinical decisions difficult, since different foot types may move and respond to treatment differently. The purpose of this study was to determine interrater agreement for foot-type classification based on photo-box-derived arch index values. Method: For this correlational study with two raters, a sample of 11 healthy volunteers with normal to obese body mass indices was recruited from both a community weight-loss programme and a programme in physical therapy. Arch index was calculated using AutoCAD software from footprint photographs obtained via mirrored photo-box. Classification as high-arched, normal, or low-arched foot type was based on arch index values. Reliability of the arch index was determined with intra-class correlations; agreement on foot-type classification was determined using quadratic weighted kappa (κw). Results: Average arch index was 0.215 for one tester and 0.219 for the second tester, with an overall range of 0.017 to 0.370. Both testers classified 6 feet as low-arched, 9 feet as normal, and 7 feet as high-arched. Interrater reliability for the arch index was ICC=0.90; interrater agreement for foot-type classification was κw=0.923. Conclusions: Classification of foot type based on arch index values derived from plantar footprint photographs obtained via mirrored photo-box showed excellent reliability in people with varying BMI. Foot-type classification may help clinicians and researchers subdivide sample populations to better differentiate mobility, gait, or treatment effects among foot types. PMID:23729964

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

    PubMed Central

    Vora, Sambhav; Pandey, Vinisha

    2015-01-01

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

  12. Aortic dissection--an update.

    PubMed

    Mukherjee, Debabrata; Eagle, Kim A

    2005-06-01

    Acute aortic dissection is a medical emergency with high morbidity and mortality requiring emergent diagnosis and therapy. Rapid advances in noninvasive imaging technology have facilitated the early diagnosis of this condition and should be considered in the differential diagnosis of any patient with chest, back, or abdominal pain. Emergent surgery is the treatment for patients with type A dissection while optimal medical therapy is appropriate in patients with uncomplicated type B dissection. Adequate beta-blockade is the cornerstone of medical therapy. Patients who survive acute aortic dissection need long-term medical therapy with beta-blockers and statins and appropriate serial imaging follow-up. Future advances in this field include biomarkers in the early diagnosis of acute aortic dissection and presymptomatic diagnosis with genetic screening. Overall patients with aortic dissection are at high risk for an adverse outcome and need to be managed aggressively in hospital and long term with frequent follow-up. PMID:15973249

  13. [Clinical study on the surgical cases of the ruptured thoracic aortic aneurysm].

    PubMed

    Ayabe, T; Nakamura, K; Yano, M; Onitsuka, T

    2003-07-01

    The prognosis of the ruptured thoracic aortic aneurysm is poor. Even if the surgical treatment was performed, the clinical outcome does not sufficiently satisfy us. Between January 1978 to July 1999, 171 cases of thoracic aortic surgery were operated in our department, in which 12 patients were with the ruptured thoracic aortic aneurysm without acute dissection. The aneurysm was located in ascending aorta (2), aortic arch (6), descending aorta (3), and thoracoabdominal aorta (1). The aneurysm was ruptured into thorax (4), pericardium (2), mediastinum (3), lung (2), and esophagus (1). The operative procedure was artificial vascular graft replacement (9), patch closure (2), and aneurysmal interposition (1) [bypass with ascending aorta to abdominal aorta)]. The operations were performed during hypothermic circulatory arrest with antegrade selective cerebral perfusion (6), under total (1) or partial complete extracorporeal circulation (5). The hospital death was 33% (4/12). The causes of death were cerebral complication (2), sepsis (1), and multiple organ failure (1). The 12 patients were divided into 2 groups: group A; 8 cases with alive; group D; 4 cases with hospital death. We compared and analyzed the perioperative factors of these 2 groups. On intraoperative factors, operation time (minute) demonstrated a significant difference (498 +/- 129 in group A v.s. 851 +/- 227 in group D, p < 0.05). No significant difference was observed between the groups on extracorporeal circulation time, aortic clumping time, selective cerebral perfusion time, systemic circulatory arrest time, intraoperative blood loss, and blood transfusion. The postoperative major complication was revealed in 6 cases (50%, 6/12), cerebral infarction (3), sepsis (2), and hoarsness (1). In conclusions, to make an effort to shorten an operative time as possible, and to prevent the postoperative neurological dysfunction under selective cerebral perfusion, those efforts should contribute to a good

  14. Evolution of surgical therapy for Stanford acute type A aortic dissection

    PubMed Central

    Chiu, Peter

    2016-01-01

    Acute type A aortic dissection (AcA-AoD) is a surgical emergency associated with very high morbidity and mortality. Unfortunately, the early outcome of emergency surgical repair has not improved substantially over the last 20 years. Many of the same debates occur repeatedly regarding operative extent and optimal conduct of the operation. The question remains: are patients suffering from too large an operation or too small? The pendulum favoring routine aortic valve resuspension, when feasible, has swung towards frequent aortic root replacement. This already aggressive approach is now being challenged with the even more extensive valve-sparing aortic root replacement (V-SARR) in selected patients. Distally, open replacement of most of the transverse arch is best in most patients. The need for late aortic re-intervention has not been shown to be affected by more extensive distal operative procedures, but the contemporary enthusiasm for a distal frozen elephant trunk (FET) only seems to build. It must be remembered that the first and foremost goal of the operation is to have an operative survivor; additional measures to reduce late morbidity are secondary aspirations. With increasing experience, true contraindications to emergency surgical operation have dwindled, but patients with advanced age, multiple comorbidities, and major neurological deficits do not fare well. The endovascular revolution, moreover, has spawned innovative options for modern practice, including ascending stent graft and adaptations of the old flap fenestration technique. Despite the increasingly complex operations and ever expanding therapies, this life-threatening disease remains a stubborn challenge for all cardiovascular surgeons. Development of specialized thoracic aortic teams and regionalization of care for patients with AcA-AoD offers the most promise to improve overall results. PMID:27563541

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

    PubMed

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

    1988-08-01

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

  16. Evolution of surgical therapy for Stanford acute type A aortic dissection.

    PubMed

    Chiu, Peter; Miller, D Craig

    2016-07-01

    Acute type A aortic dissection (AcA-AoD) is a surgical emergency associated with very high morbidity and mortality. Unfortunately, the early outcome of emergency surgical repair has not improved substantially over the last 20 years. Many of the same debates occur repeatedly regarding operative extent and optimal conduct of the operation. The question remains: are patients suffering from too large an operation or too small? The pendulum favoring routine aortic valve resuspension, when feasible, has swung towards frequent aortic root replacement. This already aggressive approach is now being challenged with the even more extensive valve-sparing aortic root replacement (V-SARR) in selected patients. Distally, open replacement of most of the transverse arch is best in most patients. The need for late aortic re-intervention has not been shown to be affected by more extensive distal operative procedures, but the contemporary enthusiasm for a distal frozen elephant trunk (FET) only seems to build. It must be remembered that the first and foremost goal of the operation is to have an operative survivor; additional measures to reduce late morbidity are secondary aspirations. With increasing experience, true contraindications to emergency surgical operation have dwindled, but patients with advanced age, multiple comorbidities, and major neurological deficits do not fare well. The endovascular revolution, moreover, has spawned innovative options for modern practice, including ascending stent graft and adaptations of the old flap fenestration technique. Despite the increasingly complex operations and ever expanding therapies, this life-threatening disease remains a stubborn challenge for all cardiovascular surgeons. Development of specialized thoracic aortic teams and regionalization of care for patients with AcA-AoD offers the most promise to improve overall results. PMID:27563541

  17. Relationships between retinal arteriole anatomy and aortic geometry and function and peripheral resistance in hypertensives.

    PubMed

    Rosenbaum, David; Kachenoura, Nadjia; Koch, Edouard; Paques, Michel; Cluzel, Philippe; Redheuil, Alban; Girerd, Xavier

    2016-07-01

    Microvascular remodeling and large artery stiffness are key determinants of cardiovascular hemodynamics and can now be studied with new non-invasive methods. Our objective was to study the relationships between retinal arteriole anatomy and aortic geometry and function and peripheral resistance (total peripheral resistance (TPR)) in hypertensives. In 80 subjects (age 52±13 years; 53% males; including 23 normotensives and 57 hypertensives, among which 29 were uncontrolled hypertensives), we used: (1) the new non-invasive RTX1 adaptive optics (AO) camera (Imagine Eyes, Orsay, France) to measure the wall-to-lumen ratio (WLR) on retinal microvasculature; (2) cardiovascular magnetic resonance (CMR) imaging to assess aortic stiffness, geometry and cardiac output; and (3) the validated SphymoCor Xcel device to measure central blood pressure (BP) and carotido-femoral pulse wave velocity (Cf-PWV). TPR was calculated as the central mean BP/cardiac output ratio. WLR and TPR were significantly higher and aortic distensibility was significantly lower in hypertensives. Aortic dilation and arch elongation were found in uncontrolled hypertensives. In the univariate analysis, WLR was positively correlated with central BP (P<0.001), TPR (P<0.001) and Cf-PWV (P<0.05), and it was negatively correlated with aortic distensibility (P=0.003); however, it was not correlated with age or cardiovascular risk factors. The multivariate analysis indicated that WLR was associated with TPR (P=0.002) independent of age, BMI, gender, antihypertensive treatments, aortic diameter and central SBP. As expected, age was the major correlate of ascending aorta distensibility and Cf-PWV. New non-invasive vascular imaging methods are complementary for the detection of the deleterious effects of aging or high BP on large and small arteries. AO examination could represent a useful tool for the study and follow-up of microvasculature anatomical changes. PMID:27009576

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

    PubMed

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

    2015-01-01

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

  19. Angiotensin II-superoxide-NFκB signaling and aortic baroreceptor dysfunction in chronic heart failure

    PubMed Central

    Zhang, Dongze; Muelleman, Robert L.; Li, Yu-Long

    2015-01-01

    Chronic heart failure (CHF) affects approximately 5.7 million people in the United States. Increasing evidence from both clinical and experimental studies indicates that the sensitivity of arterial baroreflex is blunted in the CHF state, which is a predictive risk factor for sudden cardiac death. Normally, the arterial baroreflex regulates blood pressure and heart rate through sensing mechanical alteration of arterial vascular walls by baroreceptor terminals in the aortic arch and carotid sinus. There are aortic baroreceptor neurons in the nodose ganglion (NG), which serve as the main afferent component of the arterial baroreflex. Functional changes of baroreceptor neurons are involved in the arterial baroreflex dysfunction in CHF. In the CHF state, circulating angiotensin II (Ang II) and local Ang II concentration in the NG are elevated, and AT1R mRNA and protein are overexpressed in the NG. Additionally, Ang II-superoxide-NFκB signaling pathway regulates the neuronal excitability of aortic baroreceptors through influencing the expression and activation of Nav channels in aortic baroreceptors, and subsequently causes the impairment of the arterial baroreflex in CHF. These new findings provide a basis for potential pharmacological interventions for the improvement of the arterial baroreflex sensitivity in the CHF state. This review summarizes the mechanisms responsible for the arterial baroreflex dysfunction in CHF. PMID:26528122

  20. 3. PORTAL VIEW OF THE CONCRETE ARCH (ONEWAY BRIDGE) THAT ...

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

    3. PORTAL VIEW OF THE CONCRETE ARCH (ONE-WAY BRIDGE) THAT PROVIDES ACCESS TO THE MIDDLE CHANNEL DAM AND POWER PLANT, LOOKING WEST. - Washington Water Power Company Post Falls Power Plant, Concrete Arch Bridge, West of intersection of Spokane & Fourth Streets, Post Falls, Kootenai County, ID

  1. 1. CONTEXTUAL VIEW, LOOKING DOWNSTREAM (NORTHERLY) OF THE CONCRETE ARCH ...

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

    1. CONTEXTUAL VIEW, LOOKING DOWNSTREAM (NORTHERLY) OF THE CONCRETE ARCH ('ONE-WAY BRIDGE') THAT PROVIDES PRIVATE (WWP) ACCESS TO THE MIDDLE CHANNEL OF THE POST FALLS POWER PLANT. - Washington Water Power Company Post Falls Power Plant, Concrete Arch Bridge, West of intersection of Spokane & Fourth Streets, Post Falls, Kootenai County, ID

  2. 4. PORTAL VIEW OF THE CONCRETE ARCH (ONEWAY BRIDGE) THAT ...

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

    4. PORTAL VIEW OF THE CONCRETE ARCH (ONE-WAY BRIDGE) THAT EXITS THE MIDDLE CHANNEL ISLAND AND POST FALLS POWER PLANT, LOOKING EAST. - Washington Water Power Company Post Falls Power Plant, Concrete Arch Bridge, West of intersection of Spokane & Fourth Streets, Post Falls, Kootenai County, ID

  3. VIEW TO THE SOUTHEAST. SPANDREL ARCHES OF THE KELLER BRIDGE ...

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

    VIEW TO THE SOUTHEAST. SPANDREL ARCHES OF THE KELLER BRIDGE ARE SEEN ON THE LEFT; THE SUPERSTRUCTURE OF THE TENNESSEE RIVER RISES ABOVE THE KELLER AND OBSCURES ITS ARCHES. - Keller Memorial Bridge, Spanning Tennessee River at U.S. Highway 31, Decatur, Morgan County, AL

  4. Elemental composition of background soils from Arches National Park, Utah

    SciTech Connect

    Gladney, E.S.; Ferenbaugh, R.W.; Belnap, J.

    1993-05-01

    Background elemental data on soil composition at Arches National Park are reported. The enrichment factor analysis of the soil data from Arches National Park provides some interpretation of the current elemental status of soils at the park. These data provide a basis for determining changes in elemental enrichment status in the future.

  5. 4. ATTLEBORO VIADUCT SHOWING MILL STREET ARCH AT LEFT, ATTLEBORO ...

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

    4. ATTLEBORO VIADUCT SHOWING MILL STREET ARCH AT LEFT, ATTLEBORO STATION AT LEFT CENTER AND SOUTH MAIN STREET ARCH AT RIGHT. ATTLEBORO, BRISTOL CO., MA. Sec. 4116, MP 197.16. - Northeast Railroad Corridor, Amtrak Route between RI/MA State Line & South Station, Boston, Suffolk County, MA

  6. 15. Arched, concrete bridge along elevated rightofway of Shaker Rapid ...

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

    15. Arched, concrete bridge along elevated right-of-way of Shaker Rapid Transit through the east side of city of Cleveland, labelled: 'View Toward West Along Northerly Side Arches at E. 90th St. and Westerly.' 1914. - Shaker Heights Rapid Transit Line, Cleveland, Cuyahoga County, OH

  7. 6. Southwest facing view of the Romanesque Arches. Horizontal line ...

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

    6. Southwest facing view of the Romanesque Arches. Horizontal line above the arches marks the 1923 raising of the dam. Flashboards cap the dam. - Glens Falls Dam, 100' to 450' West of U.S. Route 9 Bridge Spanning Hudson River, Glens Falls, Warren County, NY

  8. 20. VIEW OF STEEL ARCH, SHOWING UNDERSIDE OF BRIDGE DECK ...

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

    20. VIEW OF STEEL ARCH, SHOWING UNDERSIDE OF BRIDGE DECK AT EAST END, TYPICAL FLOOR BEAM DETAILS AND IRVING DECKING, X-BRACING AND PENETRATION OF ARCH LOWER CHORD THROUGH DECK, LOOKING NORTHWEST. GAS LINE IS CARRIED ON FLOOR BEAM OUTRIGGERS. NEW BRIDGE IS AT LEFT - Notre Dame Bridge, Spanning Merrimack River on Bridge Street, Manchester, Hillsborough County, NH

  9. 10. COPY OF OBLIQUE PHOTOGRAPH SHOWING ARCH HANGAR AT RIGHT, ...

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

    10. COPY OF OBLIQUE PHOTOGRAPH SHOWING ARCH HANGAR AT RIGHT, BUILDING 8200 (OBSERVATION TOWER) AT LEFT, AND B-52 AIRCRAFT PARKED ALONG APRON IN BACKGROUND, DATED OCTOBER 1967, PHOTOGRAPH FROM BASE MASTER PLAN LOCATED AT AIR FORCE BASE CONVERSION AGENCY, LORING AIR FORCE BASE, MAINE. - Loring Air Force Base, Arch Hangar, East of Arizona Road near southern end of runway, Limestone, Aroostook County, ME

  10. 12. AN IMAGE OF THE ARCH ENTRADOS LOOKING SOUTH FROM ...

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

    12. AN IMAGE OF THE ARCH ENTRADOS LOOKING SOUTH FROM THE NORTH SIDE OF U.S. 40. THIS DETAIL CLEARLY SHOWS THE FOUR LONGITUDINAL ARCH CASTINGS AND THE GHOSTS OF THE BOARDS USED AS FORMS. - Vandalia Railroad Bridge, Spanning U.S. Route 40, Indianapolis, Marion County, IN

  11. ELEVATION VIEW OF THE REX T. BARBER BRIDGE ARCH CONSTRUCTION, ...

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

    ELEVATION VIEW OF THE REX T. BARBER BRIDGE ARCH CONSTRUCTION, VIEW OF NORTH ARCH FOLLOWING REMOVAL OF TRAVELING FORMWORK, VIEW TO EAST. - Rex T. Barber Veterans Memorial Bridge, Spanning Crooked River Gorge, Dalles-California Highway (US 97), Terrebonne, Deschutes County, OR

  12. PERSPECTIVE VIEW OF THE REX T. BARBER BRIDGE ARCH CONSTRUCTION, ...

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

    PERSPECTIVE VIEW OF THE REX T. BARBER BRIDGE ARCH CONSTRUCTION, VIEW OF SOUTH TRAVELING FORMWORK AND NORTH ARCH PRIOR TO CLOSURE POUR. - Rex T. Barber Veterans Memorial Bridge, Spanning Crooked River Gorge, Dalles-California Highway (US 97), Terrebonne, Deschutes County, OR

  13. Origin of arches in the northwestern Gulf of Mexico basin

    SciTech Connect

    Laubach, S.E.; Jackson, M.L.W. )

    1990-07-01

    The San Marcos and Sabine arches are prominent north- to northwest-trending basement uplifts in the northwestern Gulf of Mexico basin that may be late Mesozoic to Cenozoic foreland or intraplate folds rather than domes over plutons or buoyant basement blocks. These arches are subparallel to and contemporaneous with orogenic episodes in the northwest-trending fold-thrust belt of Mexico. Arch movement was also contemporaneous with rapid convergence between the North American and Pacific plates. Arch development in the gulf as a result of tectonic compression is plausible in view of increasing recognition of wide zones of foreland and intraplate deformation in continents. Current tectonic models of the development of the gulf inaccurately predict gradual, decelerating subsidence when these arches were most active.

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

    NASA Astrophysics Data System (ADS)

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

    2015-08-01

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

  15. Determining shapes and dimensions of dental arches for the use of straight-wire arches in lingual technique

    PubMed Central

    Kairalla, Silvana Allegrini; Scuzzo, Giuseppe; Triviño, Tarcila; Velasco, Leandro; Lombardo, Luca; Paranhos, Luiz Renato

    2014-01-01

    INTRODUCTION: This study aims to determine the shape and dimension of dental arches from a lingual perspective, and determine shape and size of a straight archwire used for lingual Orthodontics. METHODS: The study sample comprised 70 Caucasian Brazilian individuals with normal occlusion and at least four of Andrew's six keys. Maxillary and mandibular dental casts were digitized (3D) and the images were analyzed by Delcam Power SHAPET 2010 software. Landmarks on the lingual surface of teeth were selected and 14 measurements were calculated to determine the shape and size of dental arches. RESULTS: Shapiro-Wilk test determined small arch shape by means of 25th percentile (P25%) - an average percentile for the medium arch; and a large one determined by means of 75th percentile (P75%). T-test revealed differences between males and females in the size of 12 dental arches. CONCLUSION: The straight-wire arch shape used in the lingual straight wire technique is a parabolic-shaped arch, slightly flattened on its anterior portion. Due to similarity among dental arch sizes shown by males and females, a more simplified diagram chart was designed. PMID:25715725

  16. Coronary Flow Impacts Aortic Leaflet Mechanics and Aortic Sinus Hemodynamics

    PubMed Central

    Moore, Brandon L.; Dasi, Lakshmi Prasad

    2016-01-01

    Mechanical stresses on aortic valve leaflets are well-known mediators for initiating processes leading to calcific aortic valve disease. Given that non-coronary leaflets calcify first, it may be hypothesized that coronary flow originating from the ostia significantly influences aortic leaflet mechanics and sinus hemodynamics. High resolution time-resolved particle image velocimetry (PIV) measurements were conducted to map the spatiotemporal characteristics of aortic sinus blood flow and leaflet motion with and without physiological coronary flow in a well-controlled in vitro setup. The in vitro setup consists of a porcine aortic valve mounted in a physiological aorta sinus chamber with dynamically controlled coronary resistance to emulate physiological coronary flow. Results were analyzed using qualitative streak plots illustrating the spatiotemporal complexity of blood flow patterns, and quantitative velocity vector and shear stress contour plots to show differences in the mechanical environments between the coronary and non-coronary sinuses. It is shown that the presence of coronary flow pulls the classical sinus vorticity deeper into the sinus and increases flow velocity near the leaflet base. This creates a beneficial increase in shear stress and washout near the leaflet that is not seen in the non-coronary sinus. Further, leaflet opens approximately 10% farther into the sinus with coronary flow case indicating superior valve opening area. The presence of coronary flow significantly improves leaflet mechanics and sinus hemodynamics in a manner that would reduce low wall shear stress conditions while improving washout at the base of the leaflet. PMID:25636598

  17. [Aortic intramural hematoma. An atypical pattern equivalent to aortic dissection].

    PubMed

    López-Mínguez, J R; Merchán, A; Arrobas, J; Fernández, G; González-Egüaras, M; García-Andoaín, J M; Alonso, M; Gamero, C; Poblador, M A; Alonso, F

    1995-09-01

    A case is presented of a hypertensive woman who had suffered a stabbing back pain for some three hours, with mild irradiation to precordium and accompanied by vegetative signs. A sinusal rhythm and negative T waves of little depth were seen on the ECG. A transthoracic bidimensional echocardiogram (TTE) showed a normal left ventricle with a somewhat dilated aortic root and the existence of a double echo running parallel to the anterior wall of the aorta but non-ondulating and without a visible intimal flap. Because of suspected aortic dissection an urgent contrasted CAT and a transesophageal echocardiogram were performed. These were informed as an aneurysm of the aortic root with mural thrombus from the ascending to descending aorta, but with no existing intimal flap suggesting dissection. A cardiac catheterization showed a mildly some dilated aortic root without dissection signs and normal left ventricle and coronary arteries. The patient was presented for surgical evaluation but, since no dissection was present, was not considered urgent surgery; she was admitted to the coronary unit and died 48 hours later in a situation of acute pericardial tamponade, documented by TTE, surely due to rupture of the aortic root to pericardial sack. This way of presenting threatened aorta rupture that has been only recently recognized is discussed, as well as some misconceptions which must be avoided. PMID:7569267

  18. PREFACE: 5th International Conference on Materials and Applications for Sensors and Transducers (IC-MAST2015)

    NASA Astrophysics Data System (ADS)

    Hristoforou, E.; Vlachos, D. S.; Giouroudi, I.; Kar-Narayan, S.; Potirakis, S.

    2016-03-01

    The 5th International Conference on Materials and Applications for Sensors and Transducers, Mykonos island, Greece, hosted about 110 oral and poster papers and more than 90 participants. IC-MAS, as an international annual conference which tries to meet the needs for various types of sensors, particularly those which may be manufactured by low cost methods (i.e. hybrid sensors, smart specialization devices, particular applications not necessarily requiring integrated micro-nano technologies), covering all types of materials and physical effects, appears to be a necessity. IC-MAST has been established as a high quality international conference by: I. Gathering together multinational researchers from all over the world, working in different materials for sensors and transducers and technical applications of sensors, but also in some cases in the management of the data coming from sensors and transducers. The careful selection of the conference place (like Aegean Sea, Budapest, Prague, Bilbao, Mykonos etc) allows for enjoying the local hospitality and sightseeing. II. Emphasizing in hybrid sensors and smart specialization devices produced by inexpensive methods, without excluding of course micro-nano technology, from all kinds of solid state, liquid and gaseous materials, as well as in particular transducer applications (design and development, as well as use of sensing data) III. Innovatively implementing the Virtual Paper Concept, allowing for large impact of research works presented in the conference by authors who either have no time or no funding support for visiting a conference; this year more than 12 virtual papers are presented in the 5th IC MAST, following a standardized procedure via the our robust and reliable Conference Site (www.icmast.net!) > IV. Allowing for lengthy technical and managerial discussions in terms of sensor, material and instrumentation development; furthermore, the different research groups gathered together are offered the particular

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

    PubMed Central

    2011-01-01

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

  20. Abdominal aortic aneurysm repair - open - discharge

    MedlinePlus

    AAA - open - discharge; Repair - aortic aneurysm - open - discharge ... You had open aortic aneurysm surgery to repair an aneurysm (a widened part) in your aorta, the large artery that carries blood to your ...

  1. Primary School 5th and 8th Graders' Understanding and Mental Models about the Shape of the World and Gravity

    ERIC Educational Resources Information Center

    Öztürk, Ayse; Doganay, Ahmet

    2013-01-01

    This study investigated primary school 5th and 8th graders' understanding and mental models related to the shape of the world and gravity, and how these models reflected the fact and what kind of a change there is from 5th to 8th graders. This research is based on a cross-sectional design. The study was conducted in a low socioeconomic level…

  2. Ministernotomy approach for surgery of the aortic root and ascending aorta.

    PubMed

    Perrotta, Sossio; Lentini, Salvatore

    2009-11-01

    Different minimally invasive approaches have been proposed for cardiac surgery. Between those, the ministernotomy finds wide consensus for the treatment of the aortic disease, being both the upper reversed T and the upper J the mostly used type of incisions. The authors review the literature on the use of ministernotomy in the treatment of the ascending aorta and arch pathology. The scientific literature was reviewed by searching Medline, the Cochrane Library and the CINAHL database. A total of 1411 papers were found in Medline, 186 in the Cochrane database and 514 in CINAHL database; 50 papers were used to write the article; of which seven represent the most significant papers on the subject. The authors, journal, date and country of publication, patients group studied, relevant outcomes, and the results of these papers are tabulated. The ministernotomy is gaining consensus among surgeons. The indication to surgery, initially restricted only to selected elective patients, is now extended to more complex surgeries, including both the aortic root and aortic arch, redo-operations and, in minor cases, to emergency patients. Furthermore, the use of ministernotomy in redo aortic surgery with patent left internal mammary artery (LIMA) to left anterior descending (LAD) artery is a promising alternative. However, the use of this technique is still limited to few institutions and there are still a limited number of studies comparing this approach to full sternotomy in a prospective, randomized fashion. Even with those limitations, from the review of the literature, it seems that ministernotomy approach for aortic root and ascending aorta surgery is a feasible alternative, showing some advantages compared to full sternotomy. Those advantages include: reduced postoperative bleeding and pain, lower risk of mediastinitis, better aesthetic results, and faster respiratory function recovery. This is true not only for first time surgery, but also, and especially, for redo cases

  3. Macracanthorhynchus hirudinaceus Eggs in Canine Coprolite from the Sasanian Era in Iran (4(th)/5(th) Century CE).

    PubMed

    Mowlavi, Gholamreza; Makki, Mahsasadat; Heidari, Zahra; Rezaeian, Mostafa; Mohebali, Mehdi; Araujo, Adauto; Boenke, Nicole; Aali, Abolfazl; Stollner, Thomas; Mobedi, Iraj

    2015-01-01

    Present paper is the second publication introducing the paleoparasitological findings from animal coprolites obtained from archeological site of Chehrabad salt mine in northwestern Iran. The current archeological site is located in northwest of Iran, dated to the Sassanian Era (4(th)/5(th) century CE). In the summer 2012 the carnivore coprolite was obtained within the layers in the mine and were thoroughly analyzed for parasites using TSP rehydration technique. Eggs of 0 were successfully retrieved from the examined coprolite and were confidently identified based on reliable references. Identifying of M. hirudinaceus eggs in paleofeces with clear appearance as demonstrated herein, is much due to appropriate preservation condition has been existed in the salt mine .The present finding could be regarded as the oldest acanthocephalan infection in Iran. PMID:26246822

  4. Macracanthorhynchus hirudinaceus Eggs in Canine Coprolite from the Sasanian Era in Iran (4th/5th Century CE)

    PubMed Central

    MOWLAVI, Gholamreza; MAKKI, Mahsasadat; HEIDARI, Zahra; REZAEIAN, Mostafa; MOHEBALI, Mehdi; ARAUJO, Adauto; BOENKE, Nicole; AALI, Abolfazl; STOLLNER, Thomas; MOBEDI, Iraj

    2015-01-01

    Present paper is the second publication introducing the paleoparasitological findings from animal coprolites obtained from archeological site of Chehrabad salt mine in northwestern Iran. The current archeological site is located in northwest of Iran, dated to the Sassanian Era (4th/5th century CE). In the summer 2012 the carnivore coprolite was obtained within the layers in the mine and were thoroughly analyzed for parasites using TSP rehydration technique. Eggs of 0 were successfully retrieved from the examined coprolite and were confidently identified based on reliable references. Identifying of M. hirudinaceus eggs in paleofeces with clear appearance as demonstrated herein, is much due to appropriate preservation condition has been existed in the salt mine .The present finding could be regarded as the oldest acanthocephalan infection in Iran. PMID:26246822

  5. Aortic or Mitral Valve Replacement With the Biocor and Biocor Supra

    ClinicalTrials.gov

    2016-03-09

    Aortic Valve Insufficiency; Aortic Valve Regurgitation; Aortic Valve Stenosis; Aortic Valve Incompetence; Mitral Valve Insufficiency; Mitral Valve Regurgitation; Mitral Valve Stenosis; Mitral Valve Incompetence

  6. Current aortic endografts for the treatment of abdominal aortic aneurysms.

    PubMed

    Colvard, Benjamin; Georg, Yannick; Chakfe, Nabil; Swanstrom, Lee

    2016-05-01

    Endovascular Aneurysm Repair is a widely adopted method of treatment for patients with abdominal aortic aneurysms. The minimally invasive approach offered with EVAR has become popular not only among physicians and patients, but in the medical device industry as well. Over the past 25 years the global market for aortic endografts has increased rapidly, resulting in a wide range of devices from various companies. Currently, there are seven endografts approved by the FDA for the treatment of abdominal aortic aneurysms. These devices offer a wide range of designs intended to increase inclusion criteria while decreasing technical complications such as endoleak and migration. Despite advances in device design, secondary interventions and follow-up requirements remain a significant issue. New devices are currently being studied in the U.S. and abroad and may significantly reduce complications and secondary interventions. PMID:26959727

  7. Abdominal aortic feminism.

    PubMed

    Mortimer, Alice Emily

    2014-01-01

    A 79-year-old woman presented to a private medical practice 2 years previously for an elective ultrasound screening scan. This imaging provided the evidence for a diagnosis of an abdominal aortic aneurysm (AAA) to be made. Despite having a number of recognised risk factors for an AAA, her general practitioner at the time did not follow the guidance set out by the private medical professional, that is, to refer the patient to a vascular specialist to be entered into a surveillance programme and surgically evaluated. The patient became symptomatic with her AAA, was admitted to hospital and found to have a tender, symptomatic, 6 cm leaking AAA. She consented for an emergency open AAA repair within a few hours of being admitted to hospital, despite the 50% perioperative mortality risk. The patient spent 4 days in intensive care where she recovered well. She was discharged after a 12 day hospital stay but unfortunately passed away shortly after her discharge from a previously undiagnosed gastric cancer. PMID:25398912

  8. Surgical Repair of Retrograde Type A Aortic Dissection after Thoracic Endovascular Aortic Repair

    PubMed Central

    Kim, Chang-Young; Kim, Yeon Soo; Ryoo, Ji Yoon

    2014-01-01

    It is expected that the stent graft will become an alternative method for treating aortic diseases or reducing the extent of surgery; therefore, thoracic endovascular aortic repair has widened its indications. However, it can have rare but serious complications such as paraplegia and retrograde type A aortic dissection. Here, we report a surgical repair of retrograde type A aortic dissection that was performed after thoracic endovascular aortic repair. PMID:24570865

  9. Open aortic surgery after thoracic endovascular aortic repair.

    PubMed

    Coselli, Joseph S; Spiliotopoulos, Konstantinos; Preventza, Ourania; de la Cruz, Kim I; Amarasekara, Hiruni; Green, Susan Y

    2016-08-01

    In the last decade, thoracic endovascular aortic aneurysm repair (TEVAR) has emerged as an appealing alternative to the traditional open aortic aneurysm repair. This is largely due to generally improved early outcomes associated with TEVAR, including lower perioperative mortality and morbidity. However, it is relatively common for patients who undergo TEVAR to need a secondary intervention. In select circumstances, these secondary interventions are performed as an open procedure. Although it is difficult to assess the rate of open repairs after TEVAR, the rates in large series of TEVAR cases (>300) have ranged from 0.4 to 7.9 %. Major complications of TEVAR that typically necessitates open distal aortic repair (i.e., repair of the descending thoracic or thoracoabdominal aorta) include endoleak (especially type I), aortic fistula, endograft infection, device collapse or migration, and continued expansion of the aneurysm sac. Conversion to open repair of the distal aorta may be either elective (as for many endoleaks) or emergent (as for rupture, retrograde complicated dissection, malperfusion, and endograft infection). In addition, in select patients (e.g., those with a chronic aortic dissection), unrepaired sections of the aorta may progressively dilate, resulting in the need for multiple distal aortic repairs. Open repairs after TEVAR can be broadly classified as full extraction, partial extraction, or full salvage of the stent-graft. Although full and partial stent-graft extraction imply failure of TEVAR, such failure is generally absent in cases where the stent-graft can be fully salvaged. We review the literature regarding open repair after TEVAR and highlight operative strategies. PMID:27314956

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

    PubMed Central

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

    2016-01-01

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

  11. First Branchial Arch Fistula: A Rarity and a Surgical Challenge

    PubMed Central

    Rajkumar, J.S.; Anirudh, J.R.; Akbar, S.; Joshi, Niraj

    2016-01-01

    Although 2nd Branchial arch fistulae (from incomplete closure of Cervical sinus of His) are well known, 1st arch fistulae are much rarer (<10%) and are usually not tackled comprehensively. We present a case of a rare first branchial arch fistula of the type II Arnot classification, which presented with two external openings of more than 20 years duration. Patient had a successful resection of all the concerned fistulous tract. Review of literature and the surgical challenges of the procedure are presented herewith.

  12. Aortic regurgitation caused by rupture of the abnormal fibrous band between the aortic valve and aortic wall.

    PubMed

    Minami, Hiroya; Asada, Tatsuro; Gan, Kunio; Yamada, Akitoshi; Sato, Masanobu

    2011-07-01

    This report documents the sudden onset of aortic regurgitation (AR) by an exceptional cause. A 68-year-old woman suddenly experienced general fatigue, and AR was diagnosed. One year later, we performed aortic valve replacement. At surgery, three aortic cusps with a larger noncoronary cusp had prolapsed along with a free-floating fibrous band that had previously anchored the cusp to the aortic wall. Its rupture had induced the sudden onset of AR. There was no sign of infectious endocarditis. We performed successful aortic valve replacement. PMID:21751110

  13. Endovascular stent graft repair for thoracic aortic aneurysms: the history and the present in Japan.

    PubMed

    Kawaguchi, Satoshi; Shimizu, Hideyuki; Yoshitake, Akihiro; Shimazaki, Taro; Iwahashi, Toru; Ogino, Hitoshi; Ishimaru, Shin; Shigematsu, Hiroshi; Yozu, Ryohei

    2013-01-01

    Stent-grafts for endovascular repair of thoracic aortic aneurysms have been commercially available for more than ten years in the West, whereas, in Japan, a manufactured stent-graft was not approved for the use until March 2008. Nevertheless, endovascular thoracic intervention began to be performed in Japan in the early 1990s, with homemade devices used in most cases. Many researchers have continued to develop their homemade devices. We have participated in joint design and assessment efforts with a stent-graft manufacturer, focusing primarily on fenestrated stent-grafts used in repairs at the distal arch, a site especially prone to aneurysm. In March 2008, TAG (W.L. Gore & Associates, Inc., Flagstaff, Arizona, USA) was approved as a stent graft for the thoracic area first in Japan, which was major turning point in treatment for thoracic aortic aneurysms. Subsequently, TALENT (Medtronic, Inc., Minneapolis, Minnesota, USA) was approved in May 2009, and TX2 (COOK MEDICAL Inc., Bloomington, Indiana, USA) in March 2011. Valiant as an improved version of TALENT was approved in November 2011, and TX2 Proform as an improved version of TX2 began to be supplied in October 2012. These stent grafts are excellent devices that showed good results in Western countries, and marked effectiveness can be expected by making the most of the characteristics of each device. A clinical trial in Japan on Najuta (tentative name) (Kawasumi Labo., Inc., Tokyo, Japan) as a line-up of fenestrated stent grafts that can be applied to distal arch aneurysms showing a high incidence, and allow maintenance of blood flow to the arch vessel was initiated. This trial was completed, and Najuta has just been approved in January of 2013 in Japan, and further development is expected. In the U.S., great efforts have recently been made to develop and manufacture excellent stent grafts for thoracic aneurysms, and rapid progress has been achieved. In particular, in the area of the aortic arch, in which we

  14. [MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT].

    PubMed

    Tabata, Minoru

    2016-03-01

    Minimally invasive aortic valve replacement (MIAVR) is defined as aortic valve replacement avoiding full sternotomy. Common approaches include a partial sternotomy right thoracotomy, and a parasternal approach. MIAVR has been shown to have advantages over conventional AVR such as shorter length of stay and smaller amount of blood transfusion and better cosmesis. However, it is also known to have disadvantages such as longer cardiopulmonary bypass and aortic cross-clamp times and potential complications related to peripheral cannulation. Appropriate patient selection is very important. Since the procedure is more complex than conventional AVR, more intensive teamwork in the operating room is essential. Additionally, a team approach during postoperative management is critical to maximize the benefits of MIAVR. PMID:27295772

  15. BIOMECHANICS OF ABDOMINAL AORTIC ANEURYSM

    PubMed Central

    Vorp, David A.

    2009-01-01

    Abdominal aortic aneurysm (AAA) is a condition whereby the terminal aorta permanently dilates to dangerous proportions, risking rupture. The biomechanics of AAA has been studied with great interest since aneurysm rupture is a mechanical failure of the degenerated aortic wall and is a significant cause of death in developed countries. In this review article, the importance of considering the biomechanics of AAA is discussed, and then the history and the state-of-the-art of this field is reviewed - including investigations into the biomechanical behavior of AAA tissues, modeling AAA wall stress and factors which influence it, and the potential clinical utility of these estimates in predicting AAA rupture. PMID:17254589

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

    PubMed

    Zhang, Qi; Gao, Bin; Chang, Yu

    2016-01-01

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

  17. Aneurysms of the ascending aorta and arch: the role of imaging in diagnosis and surgical management.

    PubMed

    Bonnichsen, Crystal R; Sundt, Thoralf M; Anavekar, Nandan S; Foley, Thomas A; Morris, Michael F; Martinez, Matthew W; Williamson, Eric E; Glockner, James F; Araoz, Philip A

    2011-01-01

    Thoracic aortic aneurysms tend to be asymptomatic and were previously often diagnosed only after a complication such as dissection or rupture occurred. Better imaging techniques and an increase in the use of cross-sectional imaging has led to an increase in the diagnosis of aortic aneurysms, which has allowed for elective treatment prior to the development of a complication. The location, size and etiology of an aneurysm all impact the clinical outcomes and these factors are used to determine the appropriate timing of surgical replacement. Surgeons often rely on the information obtained from preoperative imaging to determine when to intervene and what type of procedure will be necessary, making it important for the radiologist to understand these issues in order to provide the necessary information. Postoperative imaging after surgical replacement of the aorta is also important, as there are some common findings that occur in this patient population that can impact how they are treated. The purpose of this article is to review the etiology and associated findings of aneurysms of the ascending aorta and arch, with a focus on how computed tomography angiography and magnetic resonance angiography findings are used to determine the appropriate timing for elective replacement and the type of surgical procedure, as well as the role of follow-up imaging. This will include a review of the most commonly performed types of surgical procedures, to provide an understanding of how the findings of preoperative imaging studies impact what the surgeon does in the operating room, as well as the expected findings of postoperative imaging studies. PMID:21166528

  18. CT of nontraumatic thoracic aortic emergencies.

    PubMed

    Bhalla, Sanjeev; West, O Clark

    2005-10-01

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

  19. 19. SECOND FLOOR, CITY COMMISSION CHAMBERS, DETAIL OF ARCH WITH ...

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

    19. SECOND FLOOR, CITY COMMISSION CHAMBERS, DETAIL OF ARCH WITH MURAL ON RIGHT OF BENCH, SHOWING PIONEERS AND ATLANTIC CITY SEAL - City Hall, Atlantic & Tennessee Avenues, Atlantic City, Atlantic County, NJ

  20. Detail of arched window and eaves molding on west elevation; ...

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

    Detail of arched window and eaves molding on west elevation; camera facing east. - Mare Island Naval Shipyard, Old Administrative Offices, Eighth Street, north side between Railroad Avenue & Walnut Avenue, Vallejo, Solano County, CA