Descending thoracic aneurysm

Rodrigo Barbosa de Souza, Luis Ernesto Farinha-Arcieri, Marcia Helena Braga Catroxo, Ana Maria Cristina Rebelo Pinto da Fonseca Martins, Roberto Carlos Tedesco, Luis Garcia Alonso, Ivan Hong Jun Koh, Lygia V Pereira
AIMS: Cardiovascular manifestations are a major cause of mortality in Marfan syndrome (MFS). Animal models that mimic the syndrome and its clinical variability are instrumental for understanding the genesis and risk factors for cardiovascular disease in MFS. This study used morphological and ultrastructural analysis to the understanding of the development of cardiovascular phenotypes of the the mgΔloxPneo model for MFS. METHODS AND RESULTS: We studied 6-month-old female mice of the 129/Sv background, 6 wild type (WT) and 24 heterozygous animals from the mgΔloxPneo model...
2019: PloS One
Anjith Prakash Rajakumar, Mithun Sundararaaja Ravikumar, Karthik Raman, Arun Singh, Ejaz Ahmed Sheriff, Rajan Sethuratnam
We report a case of a type B aortic dissection with an aneurysm treated by the replacement of the proximal descending thoracic aorta via the reversed elephant trunk technique. A 48-year-old asymptomatic man was diagnosed with a type B aortic dissection, moderate aortic regurgitation, and a good biventricular function in March 2012. Four years later (April 2016), a contrast-enhanced computed tomography examination revealed an aneurysmal dilatation in the patient's descending thoracic aorta with a thrombosis in the proximal part of the false lumen, which warranted surgical repair...
April 2019: Journal of Tehran Heart Center
Donald G Harris, Sydney L Olson, Annalise M Panthofer, Jon S Matsumura, Paul D DiMusto
OBJECTIVE: Thoracic endovascular aortic repair (TEVAR) has expanded access to descending thoracic aortic aneurysm (DTAA) repair particularly for elderly and frail patients. This high-risk population has limited long-term overall survival, such that appropriate patient selection is required to optimize patient benefit and resource utilization. Our objective was to develop and validate a frailty based, procedure specific risk score for patients undergoing elective TEVAR for DTAA. METHODS: Patients undergoing non-emergent TEVAR for DTAA during 2005 - 2016 were identified in the National Surgical Quality Improvement Program database...
November 6, 2019: Annals of Vascular Surgery
Hajime Kinoshita, Mariko Hori, Atsushi Tamura, Kei Kazuno, Hiroshige Sato, Seiichiro Murata
Spontaneous rupture of the thoracic aorta is a rare disease with a poor prognosis without obvious trauma, aortic aneurysm and aortic dissection. We report 2 cases of successful endovascular aortic repair for spontaneous rupture of the thoracic aorta. Case 1:A 79-year-old man was referred to our hospital complaining of general fatigue. He returned home without any obvious abnormalities in blood tests and computed tomography (CT). The patient was aware of dizziness and fluttering in the early morning the next day, and was transported to the hospital by shock vital...
November 2019: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Takahiro Tokuda, Mototsugu Tamaki, Hideki Kitamura, Yutaka Koyama, Koshi Sawada, Yasuhiko Kawaguchi, Kazuya Konakano, Yasuhide Okawa
An 88-year-old man was admitted with general fatigue. Computed tomography (CT) showed a descending aortic aneurysm. The laboratory data indicated severe infection. Despite negative blood cultures, broad-spectrum intravenous antibiotic therapy was started. Though antibiotic therapy was continued for about 2 weeks, the aneurysm extended 20 mm. Thoracic endovascular aortic repair was performed, and antibiotic therapy was continued for 4 weeks after the procedure, followed by oral antibiotics for 1 year. CT showed regression of the aneurysm 15 months after reconstruction...
November 2019: Journal of Surgical Case Reports
Akiko Tanaka, Harleen K Sandhu, Rana O Afifi, Charles C Miller, Amberly Ray, Madiha Hassan, Hazim J Safi, Anthony L Estrera
OBJECTIVE: To review short-term outcomes and long-term survival and durability after open surgical repairs for chronic distal aortic dissections in patients whose anatomy was amenable to thoracic endovascular aortic repair (TEVAR). METHODS: Between February 1991 and August 2017, we repaired chronic distal dissections in 697 patients. Of those patients, we enrolled 427 with anatomy amenable to TEVAR, which included 314 descending thoracic aortic aneurysms (DTAAs) and 105 extent I thoracoabdominal aortic aneurysms (TAAAs)...
October 1, 2019: Journal of Thoracic and Cardiovascular Surgery
Y F Tang, L Han, X L Fan, B Y Zhang, J J Zhang, Q Xue, Z Y Xu
Objective: To examine the results of surgical treatment for endograft infection after thoracic endovascular aortic repair (TEAVR). Methods: Clinical data of 7 patients underwent surgical treatment for endograft infection after TEAVR at Department of Cardiothoracic Surgery, Changhai Hospital, the Navy Medical University between January 2016 and December 2018 were analyzed retrospectively. There were 6 males and 1 female, aging (51.5±16.7) years (range: 25 to 68 years). The origin of the aortic disease was descending aortic aneurysm in 5 cases, and Stanford B aortic dissection in 2 cases...
November 1, 2019: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Dan Rong, Yangyang Ge, Jie Liu, Xiaoping Liu, Wei Guo
BACKGROUND: Aortic dissection is a separation of the aortic wall, caused by blood flowing through a tear in the inner layer of the aorta. Aortic dissection is an infrequent but life-threatening condition. The incidence of aortic dissection is 3 to 6 per 10,000 per year in the Western population, and can be up to 43 per 10,000 per year in the Eastern population. Over 20% of people with an aortic dissection do not reach a hospital alive. After admission, the mortality rates for people with an aortic dissection are between 10% and 20% for those who received endovascular treatment, and between 20% and 30% for those who had open surgery...
October 30, 2019: Cochrane Database of Systematic Reviews
Mohammed Alsheef, Saud Alsaleh, Nahar Alanezi, Nizar Bakhsh, Rana AlDosary, Lina AlSharif, Arshad Mian, Azeem Ahsan, Isamme AlFayyad
Brucellosis is an endemic infection mainly in the Middle East and the Mediterranean region that can involve any system. However, cardiovascular involvement commonly seen as endocarditis is a rare occurrence, but it is one of the main causes of mortality and morbidity. Brucella mycotic aneurysms are extremely rare and carry a higher morbidity and mortality. Here, we present a case of Brucella mycotic aneurysms in the descending aorta complicated by an aortoesophageal fistula in a 52-year-old diabetic man. The diagnosis was made by thoracic CT angiogram showing a saccular aneurysm arising from the descending aorta and two positive cultures of Brucella melitensis ...
2019: Case Reports in Infectious Diseases
Yuya Kise, Yukio Kuniyoshi, Mizuki Ando, Tatuya Maeda, Hitoshi Inafuku, Satoshi Yamashiro
BACKGROUND: In descending thoracic aortic aneurysm (DTAA) or thoracoabdominal aortic aneurysm (TAAA) surgery, though proximal anastomosis using deep hypothermic circulatory arrest (DHCA) is often selected, there are issues surrounding brain and heart protection. In this study, the usefulness of concomitant upper body perfusion via transapical aortic cannulation during deep hypothermic surgery was examined. METHODS: Between October 2014 and May 2019, 5 patients (Crawford extent II chronic dissection, n = 3; extent IV aneurysms, n = 1; DTAA, n = 1) underwent DTAA/TAAA repair under deep hypothermia using transapical aortic perfusion...
October 21, 2019: Journal of Cardiovascular Surgery
Sho Kusadokoro, Daijiro Hori, Ryo Itagaki, Koichi Adachi, Atsushi Yamaguchi
A 64-year-old man with prior history of total arch replacement with frozen elephant trunk was admitted for an enlarging descending thoracic aortic aneurysm. Preoperative computed tomography revealed previously implanted J graft open stent graft, a frozen elephant trunk device approved in Japan, with enlarged dissected aortic aneurysm from distal anastomosis site to the level of the diaphragm. The patient underwent descending aortic replacement. Proximal anastomosis was directly performed at the distal end of the previously implanted J graft open stent graft...
September 25, 2019: Annals of Vascular Diseases
Gabriela Teixeira, Arlindo Matos, Rui de Almeida, Armando C Lobato
Traditional open total zone 0 replacement of the aortic arch is one of the most complex, challenging and demanding operative procedures in cardiovascular surgery, with significant morbidity (30-40%) and mortality (8-20%) associated. Total endovascular zone 0 replacement of the aortic arch with the chimney/sandwich techniques as described by Lobato AC et al in 2011 is a feasible less invasive, less demanding and time-consuming option to hybrid and/or traditional open replacement of the aortic arch, particularly in the urgent/emergent settings...
October 14, 2019: Annals of Vascular Surgery
Yosuke Kuroda, Nobuyoshi Kawaharada
Endovascular therapy has been advanced in recent years. Thoracic endovascular aneurysm repair (TEVAR) has become the standard treatment for descending aortic aneurysm. For endovascular treatment, there are many pitfalls not found in conventional surgery. From now on, it is necessary not only to master open surgery, but also to master endovascular technique for those who aim at getting qualified as specialist in vascular surgery.
September 2019: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Shinichi Suzuki
Good exposure of aortic lesions is very important to perform the surgery for descending thoracic aneurysm (DTA) and thoracoabdominal aortic aneurysm (TAAA). The patient is positioned in the right lateral decubitus position with the shoulders at 90°, and the hips flexed to 45°. A left thoracoabdominal skin incision is made in the 6th intercostal space beginning at the posterior axillary fold, and is extended through the costal cartilage and obliquely across the abdomen. The left chest cavity is exposed through the 6th intercostal space, and the costal arch is divided, then the descending thoracic aorta is exposed...
September 2019: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Masaki Yamamoto, Hironobu Okada, Junko Nakashima, Takashi Anayama
We describe a treatment strategy for an aberrant arterial aneurysm associated with pulmonary sequestration. A 58-year-old man with impending aberrant arterial aneurysm rupture underwent a 2-stage surgery that included an emergency thoracic endovascular aortic repair (TEVAR) of the descending aorta to occlude the origin of the aberrant artery, followed by lobectomy. TEVAR can lead to faster occlusion of the aneurysm and can avoid operative risk of aneurysm rupture during lobectomy. The aberrant artery was broad where it branched off the aorta and had a short neck, rendering primary ligation or stump-forming unsuitable...
October 3, 2019: Interactive Cardiovascular and Thoracic Surgery
Huai-Dong Chen, Fan He, Xi-Ming Qian
RATIONALE: Marfan syndrome (MFS), an autosomal dominant hereditary disease, often results in structural and functional abnormalities of the aortic wall. Because of residual aortic aneurysm or aortic dissection, patients with MFS usually need repeat operations after the first operation. PATIENT CONCERNS: A patient diagnosed with MFS who had undergone 2 surgeries because of abdominal aortic dissection aneurysm and Stanford A type aortic dissection at different times...
October 2019: Medicine (Baltimore)
William C Frankel, Howard K Song, Rita K Milewski, Sherene Shalhub, Norma L Pugh, Kim A Eagle, Mary J Roman, Reed E Pyeritz, Cheryl L Maslen, William J Ravekes, Dianna M Milewicz, Joseph S Coselli, Scott A LeMaire
BACKGROUND: Although patients with various types of heritable aortopathy often require distal aortic repair, data are limited regarding the most extensive operations-open thoracoabdominal aortic aneurysm (TAAA) repairs. The objective of this multicenter registry study was to characterize TAAA repairs in a large cohort of patients with different heritable aortic diseases. METHODS: From the 3,699 patients enrolled at 8 participating centers in the Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC) Registry, we identified 155 open TAAA repairs in 142 unique patients...
September 27, 2019: Annals of Thoracic Surgery
Tilman Leidenberger, Yaron Gordon, Mina Farag, Michael Delles, Augusto Fava Sanches, Matthias A Fink, Klaus Kallenbach, Hans-Ulrich Kauczor, Fabian Rengier
BACKGROUND: Marfan syndrome predisposes to aortic aneurysm, dissection and rupture. We sought to investigate aortic 4D relative pressure maps derived from 4D flow cardiovascular magnetic resonance (CMR) to identify disease characteristic alterations of the intraaortic pressure field in Marfan patients with aortic root dilation compared to age- and sex-matched healthy controls. METHODS: This prospective case-control study included 11 Marfan patients with aortic root dilation (31±5years, 5 female) and 11 age- and sex-matched healthy controls (31±8years, 5 female) undergoing 4D flow CMR of the thoracic aorta...
September 27, 2019: Annals of Thoracic Surgery
Tim Bishop, Derek Clark, Heather Bendyk, Joey Bell, David Jaynes
Background: There is a lack of consensus in the literature regarding phrenic nerve proximity to thoracic structures at the level of the diaphragm. This study was undertaken to provide thoracic surgeons data on phrenic nerve location in order to reduce iatrogenic injury during invasive surgery. Methods: Bilateral thoracic dissection was performed on 43 embalmed human cadavers (25 males; 18 females) and data was obtained from 33 left and 40 right phrenic nerves. The site of phrenic nerve penetration into the diaphragm was identified...
August 2019: Journal of Thoracic Disease
Young Su Kim, Yang Hyun Cho, Kiick Sung, Duk-Kyung Kim, Suryeun Chung, Taek Kyu Park, Wook Sung Kim
BACKGROUND: We investigated long-term outcomes and cardiac function after extra-anatomic bypass surgery for Takayasu arteritis and midaortic syndrome. METHODS: Between 2007 and 2016, 14 patients underwent extra-anatomic bypass for Takayasu arteritis. Median age was 56.6 years. Median systolic pressure gradient in the stenotic lesion was 79 mmHg. Nine patients underwent bypass surgery from the ascending aorta to the infrarenal aorta, 2 from the ascending aorta to the distal descending thoracic aorta, 1 from the ascending aorta to the supraceliac abdominal aorta, 1 from the descending thoracic aorta to the infrarenal abdominal aorta, and 1 from the descending thoracic aorta to the descending thoracic aorta...
September 23, 2019: Annals of Thoracic Surgery
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