Aorta (Stamford)
December 2021
Complex pathology of the distal arch and proximal descending thoracic aorta is usually approached by stent endografting or in situ graft replacement. Oftentimes, these options are not feasible due to unfavorable anatomy, multiple previous procedures, active infection, or presence of concomitant cardiac disease. Thoracic aortic extra-anatomic bypass, as part of an open surgical strategy, is a useful and often the only curative option left for the treatment in these patients.
View Article and Find Full Text PDFBackground: Despite modern advances in surgical care, triple-valve surgery (TVS) remains a challenge and carries a mortality of 10% to 20%. No validated risk score is available for TVS, and the effect of advanced age is unknown. This study examined our results in the modern era with the aim of identifying perioperative predictors of adverse outcomes.
View Article and Find Full Text PDFObjective: Surgical repair of acute Type A aortic dissection (AADA) is still associated with high in-hospital mortality. We evaluated the impact of perioperative risk factors on early and midterm survival.
Methods: Retrospective (2002-2011) database analysis at a single institution of 132 consecutive AADA patients (88 male, age 59.
Left circumflex coronary artery anomalies are rare causes of cardiac symptoms, especially in the adult population. Herein we describe a case of a 40-year-old man presenting with stable angina who was found to have aneurysmal formation and fistulization of the left circumflex coronary artery to the coronary sinus. Contrast-enhanced multislice computed tomography was very useful in our case for the diagnosis of such anomalies.
View Article and Find Full Text PDFInt J Physiol Pathophysiol Pharmacol
March 2013
Hyperhomocysteinemia is associated with aortic aneurysm, however, the mechanisms are unclear. We hypothesize that the expression level of genes involved in extracellular matrix (ECM) remodeling, oxidative stress, and enzymes involved in homocysteine metabolism pathway in aortic aneurysm and hyperhomocysteinemia are differentially regulated by DNA methylation. We studied the mRNA levels of MTHFR, SAHH, MMP-1, -9, TIMP-1, -4, peroxiredoxin, NOX-2, -3 (NAPDH oxidase subunits), collagen and elastin in normal and aortic aneurysm tissues from humans and aorta tissue from HHcy (Cystathionine beta synthase heterozygote knockout, CBS+/-) mice treated with high methionine diet.
View Article and Find Full Text PDFInteract Cardiovasc Thorac Surg
June 2013
Fistulization between the aorta and the right atrium is a rare complication of ascending aortic dissection. Because of the typical haemodynamic unstability, the diagnosis is often made by bedside or intraoperative transoesophageal echocardiography. The treatment is surgical, but with very high mortality.
View Article and Find Full Text PDFBackground: Thoracic endovascular aneurysm repair (TEVAR) has been a major advance in the treatment of blunt thoracic aortic injury (BTAI), although many patients still undergo open repair. This study was undertaken to evaluate outcomes with open repair and TEVAR for BTAI.
Study Design: A retrospective review of all patients with BTAI at a single Level I trauma center from 2001 through 2009 was performed.
The objective of this study was to compare retrograde with antegrade cerebral protection during acute aortic dissection repair using cerebral oximetry measurements. Fifty consecutive acute ascending aortic dissection repairs were analyzed. Cerebral oximetry data were collected for 41 of 50.
View Article and Find Full Text PDFInflammatory aortic aneurysms (IAAs) are rare and located mainly in the infra-renal abdominal aorta. The ascending aorta has been typically spared from this process. We report on two cases of ascending aortic inflammatory aneurysms and describe the available literature on this rare entity.
View Article and Find Full Text PDFBackground: Porcine bioprosthesis (bioroots) are an attractive surgical strategy for ascending aorta and arch replacement. This study evaluated the perioperative and late outcomes using this strategy for proximal aortic aneurysmal disease.
Methods: Between March 1998 and November 2009, 170 patients (40% women; median age, 70 years) underwent proximal thoracic aortic replacement using the Freestyle (Medtronics Inc, Minneapolis, MN) bioroot, with graft extension in 149 (87.
Background: The diagnosis of thoracic aortic mobile thrombus (TAMT) is rare and is usually made after debilitating embolic events. The optimal treatment strategy is unknown. We report 14 patients with TAMT and aim to better define the role of early (less than 2 weeks) surgical thrombectomy.
View Article and Find Full Text PDFCardiac arrhythmias, instigated by mechanical and electrical remodeling, are associated with activation of extracellular matrix metalloproteinases (MMPs). However, the connection between intracellular MMPs activation and arrhythmogenesis is not well established. Previously, we determined localization of MMP in the mitochondria using confocal microscopy.
View Article and Find Full Text PDFQ fever is a rare systemic infection caused by Coxiella Burnetii. The presentation with endocarditis is insidious, with negative blood cultures, and oftentimes it is not obvious in diagnostic imaging studies until hemodynamic changes or valve destruction is reached. We report a case of Q fever endocarditis involving the tricuspid and aortic valves and a congenital ventricular septal defect.
View Article and Find Full Text PDFWe describe a case of acute cardiac failure in a patient involved in a motor vehicle accident. A diagnosis of acute mitral regurgitation and left atrioventricular disruption was made with transesophageal echocardiography. Successful repair was performed using the mitral valve leaflets to patch the disruption followed by valve replacement.
View Article and Find Full Text PDFInteract Cardiovasc Thorac Surg
August 2008
Type A aortic dissection is a high risk surgical emergency. Its occurrence during pregnancy represents an extremely high risk for death and sequelae for both the mother and the fetus. Surgical treatment in the form of cesarean delivery and aortic repair using hypothermia and circulatory arrest is mandatory in most patients.
View Article and Find Full Text PDFInteract Cardiovasc Thorac Surg
December 2004
A coronary arteriovenous fistula is a rare occurrence. We report a case of a right coronary artery to superior vena cava fistula presenting with myocardial ischemia.
View Article and Find Full Text PDFTex Heart Inst J
November 2006
We report the case of a 69-year-old man who presented with a symptomatic mycotic aneurysm of the aortic arch. Diagnosis was confirmed by positron emission tomography and by blood cultures positive for Salmonella species. A complete resection of the aortic arch process was performed via left thoracotomy using a cryopreserved aortic homograft and normothermic left heart bypass.
View Article and Find Full Text PDFBackground: Coronary artery remodeling implies structural changes in the vessel wall in response to various pathophysiologic conditions. However, the classification of remodeling is unclear. We hypothesized that the adaptive, positive-outward remodeling is a reactive and compensatory response to the stress.
View Article and Find Full Text PDFBackground: Although improved perioperative outcomes with growth potential of the extracardiac pedicled pericardial Fontan (EPPF) operation have been suggested, no advantage has been demonstrated.
Methods: We retrospectively reviewed our institutional experience of 54 consecutive patients undergoing EPPF between June 1996 and August 2003. Clinical and echocardiographic follow-up was obtained yearly with a mean follow-up of 2.