Hybrid repair of aortic arch aneurysm

Aneurysms of the transverse aortic arch requiring surgery most often affects elderly patients with multiple co-morbidities and represents a significant challenge to both patient and surgeon. The hybrid approach developed in recent years (debranching followed by endovascular repair) may improve the morbidity and mortality of the population risk. We present the case report of a 72-year-old man with aortic arch aneurysm arising at the origin of the left subclavian artery involving whole caudal segment of an aortic arch with concomitant single vessel coronary disease. The hybrid procedure was carried out in two stages, first (open surgical approach) performing an extra-anatomic bypass – debranching combining with concomitant coronary artery bypass procedure without heart–lung machine and following day deploying the aortic endograft. Postoperative period was uneventful. On the 15th day after hybrid procedure, the patient was discharged in a stabilized condition for ambulatory care. This approach may be an alternative to standard open procedures in high-risk patients with promising midterm results.     

One-stage coronary bypass and abdominal aortic aneurysm repair

A group of 29 patients with simultaneous coronary disease and abdominal aortic aneurysm were treated two protocols: Group I, 16 patients had coronary bypass surgery and then abdominal aortic aneurysm repair at a later date. This required two hospitalizations and two separate surgeries. Group II, 11 patients, underwent coronary bypass surgery and repair of abdominal aortic aneurysm (AAA) in one sitting. Group III, 2 patients, had PTCA prior to AAA repair. There were 3.1 bypass grafts implanted (Group I), vs 2.9 (Groups II) (ns). All abdominal aneurysms were infrarenal and 22 patients had straight tube graft replacement (76%), and seven bifurcated grafts. Two patients with angina also had symptomatic AAA. Period of hospitalization, morbidity, mortality, time of total recovery, hospital costs, and apprehension of patients were analyzed. There was one death in Group I. In this group, the total recovery time was 4.8 months vs 2.4 months for Group II. Hospitalization time was 16.2 days in Group I vs 8.2 days in Group II. The hospital costs were significantly higher in Group I with an average of $58,950 vs $46,553 in Group II. No deaths occurred in Group II. It is recommended that if a patient with severe coronary disease requiring surgery also presents with an AAA of more than 5 cm, he/she should have both conditions operated on in one session rather than staggering the procedures. It saves time, cost, anxiety, and is well tolerated.Presented at the 38th Annual World Congress, International College of Angiology, Köln, Germany, June 1996.     

A dissecting aortic aneurysm involving a right-sided aortic arch

A 51-year-old woman suddenly developed severe pain in the chest and back, also dyspnea. On admission, she was in a state of preshock. Plain X-ray indicated the lack of the left aortic arch and poor pneumatization in the whole right lung. The thoracic fluid was transparent with yellowish tinge and was contaminated with neither any bacterium nor tubercle bacillus. The response to the Rivalta's reaction was negative. The possibility of pleurisy was, therefore, denied. The ECG and blood biochemical data on the second day suggested the possibility of myocardial ischemia. Plain chest X-ray on the fourth day revealed an increased right pulmonary pneumatization and an enlarged mediastinal shadow toward the aortic arch. Upper pulmonary CT showed a mass on the right side. Enhanced CT disclosed a dissepiment in the center, which was high medially and somewhat low laterally. It was diagnosed as a false lumen due to the lateral displacement of the right aortic arch. Hepatic CT disclosed the tapering of the abdominal aorta from right to left in the prevertebral region. These findings indicated that the aorta descended from the right aortic arch along the right side of the spine and crossed the spine dextrosinistrally at the hepatic level. In addition, dissociant aneurysm was observed in the right aortic arch. Echocardiography showed no evidence of dissociant aneurysm at the aortic base. Chest X-ray, CT and echocardiography showed the dissociation of the aorta from the aortic arch to the abdominal aorta. Thus the diagnosis of De Bakey type III was established. Clinically, DIC and multiorgan disorders were manifested but after medical treatments, the clinical course was uneventful.(ABSTRACT TRUNCATED AT 250 WORDS)     

Dissecting aortic aneurysm involving a right-sided aortic arch.

In this case, the first reported instance of aortic dissection involving a right-sided arch, an anomalous fourth arch vessel, the left subclavian artery, arose from a congenital aortic diverticulum. This report emphasizes the need for precise anatomic definition with aortography to permit appropriate therapy when congenital anomalies of the aortic arch are complicated by dissecting hematoma.     

Relapsing polychondritis with aortic arch aneurysm and aortic arch syndrome

Summary A case of relapsing polychondritis with aortic arch aneurysm and aortic arch syndrome is described. The pattern of vascular involvement supports the inclusion of relapsing polychondritis within the spectrum of systemic vasculitides.     

Ruptured right aortic arch aneurysm

A case of a ruptured right aortic arch aneurysm in a 74-year-old woman presenting with shock is reported. The diagnostic and operative findings are presented. We discuss the surgical approach and review the literature.     

Late aneurysm of the distal aortic arch after repair of aortic interruption. A case report

Aneurysm formation after aortic coarctation repair is not a rare complication of post-coarctation of aorta repair. We describe the case of a 43-year-old woman who had undergone repair of an isolated interruption of the aortic arch 30 years earlier, who came to our hospital with progressive chest pain, cough and dyspnea. A giant aortic aneurysm was revealed in the distal aortic arch by CT study. The patient underwent aneurysmectomy with total aortic arch replacement using a Dacron graft through redo median sternotomy. An embryologic explanation of this patient's anomaly and the previous surgical procedure are discussed for defining this rare clinical condition.     

Surgical therapy of a dissecting aortic aneurysm involving a right-sided aortic arch

Dissecting aortic aneurysm involving a right-sided aortic arch is apparently quite rare. A patient with this unusual entity is described. By performing an extraanatomic bypass, the aneurysm was excluded between stainless steel staples. The patient was discharged from the hospital 21 days postoperatively. Although the reasons for the extreme rarity of this entity are not clear, precise anatomic definition is required for successful surgical therapy.     

Left cervical aortic arch associated with aortic aneurysm

An aortic arch extending into the neck is a rare congenital anaomaly. Left-sided cervical aortic arch was thought to be much less common than right-sided, but they are now almost equal in incidence in the published reports. This paper describes a case of left-sided cervical aortic arch in an adult, with a previously undescribed association, aneurysm of the descending thoracic aorta. Cervical aortic arch must be considered in the differential diagnosis of pulsatile cervical swellings. The embryological development of the aortic arch is discussed. This is still controversial and it is not possible to be sure of the embryological explanation of this congenital anomaly of the aortic arch from a study of the adult anatomy.     

Repair of a false aneurysm of the aortic arch

A 66-year-old man having previously undergone repair of aneurysms of the ascending, transverse and infrarenal aorta, presented with a large false aneurysm of the aortic arch. Successful repair of the aneurysm was achieved under a state of profound hypothermia and circulatory arrest. The patient remains well and free from aortic aneurysmal disease two years after surgery.     

新生儿主动脉弓中断一期手术治疗

目的:回顾总结新生儿主动脉弓中断一期手术治疗经验,探讨新生儿主动脉弓中断的最佳手术时机及手术方式。方法:自2012年10月至2017年10月,我中心共收治新生儿主动脉弓中断26例。男性19例,女性7例;手术年龄3～28 d,平均(17.3±1.6)d;体质量2.6～4.4 kg,平均(3.3±0.1)kg。解剖学分型:A型20例,B型6例。全部病例合并动脉导管未闭,合并主肺动脉间隔缺损1例,合并室间隔缺损25例,其中17例同时合并房间隔缺损。手术均采用正中切口,体外循环采用升主动脉及肺动脉干双插管灌注,先矫治心内畸形,体温降至20～25℃后选择性脑灌注。重建主动脉弓采用扩大端侧吻合17例,扩大端侧吻合+牛心包补片加宽前壁9例。结果:全组术中体外循环转流102～150 min,平均(127.5±15.8)min,主动脉阻断47～75 min,平均(62.3±9.5) min,选择性脑灌注时间20～46 min,平均(32.54±9.4)min。术后死亡2例,病死率7.7%。1例死于术后严重低心排综合征、脑出血,1例死于毛细血管渗漏综合征、肾衰竭。余患儿手术成功,痊愈出院。术后失访2例,随访22例,中位随访时间28个月(9～60个月)。无远期死亡,主动脉弓再狭窄1例,予以行经皮介入球囊扩张。结论:主动脉弓中断一旦诊断明确,应于新生儿期内施行手术。选择性脑灌注下一期矫治主动脉弓中断及其合并畸形手术效果满意。     

Surgical repair of a distal arch aneurysm with a stent-graft

This study evaluates the effectiveness and potential complications of stent-grafting for the treatment of distal arch aneurysms using profound hypothermia and circulatory arrest with retrograde cerebral perfusion. Between December 1998 and December 2001, 9 consecutive patients with a distal arch aneurysm (6 men and 3 women, mean age 71 years) underwent surgical repair using a stent-graft. Profound hypothermic circulatory arrest and retrograde cerebral perfusion were performed in all patients. Endovascular leakage was screened postoperatively using three-dimensional computerized tomography. The mean follow-up period was 27.4 months. Thirty day mortality was 0%. One patient died 3 months after stent-grafting due to proximal leakage into her aneurysm. The mean postoperative extubation period was 2.1 days. No patients suffered cerebral infarction or paraplegia. Although preliminary outcomes using this technique were good, endovascular leakage is a concern. We suggest that, if major proximal leakage is recognized postoperatively, re-intervention should be performed as soon as possible. Endovascular stent-grafting appears to be a good alternative treatment for distal arch aneurysms, although longer follow-up is necessary to more comprehensively evaluate this procedure.     

Left cervical aortic arch associated with aortic aneurysm.

An aortic arch extending into the neck is a rare congenital anaomaly. Left-sided cervical aortic arch was thought to be much less common than right-sided, but they are now almost equal in incidence in the published reports. This paper describes a case of left-sided cervical aortic arch in an adult, with a previously undescribed association, aneurysm of the descending thoracic aorta. Cervical aortic arch must be considered in the differential diagnosis of pulsatile cervical swellings. The embryological development of the aortic arch is discussed. This is still controversial and it is not possible to be sure of the embryological explanation of this congenital anomaly of the aortic arch from a study of the adult anatomy.     

One-stage repair of cardiac and arch anomalies without circulatory arrest

Between 1999 and 2002, 23 patients underwent single-stage complete repair of cardiac anomalies and aortic arch obstruction, without circulatory arrest. Median age was 1.2 years. Intracardiac defects included ventricular septal defect in 9, double-outlet right ventricle in 6, d-transposition of the great arteries and ventricular septal defect in 2, subaortic obstruction in 3, and atrial septal defect in 3. Fourteen patients had coarctation of the aorta, 6 had coarctation with hypoplastic aortic arch, and 3 had interrupted aortic arch. Simple techniques were employed such as cannulation of the ascending aorta near the innominate artery and maintaining cerebral and myocardial perfusion. After correction of arch obstruction, intracardiac repair was undertaken. The mean cardiopulmonary bypass time was 169 min, aortic crossclamp time was 51 min, and arch repair took 16 min. There was no operative mortality or neurological deficit. In follow-up of 1-43 months, no patient had residual coarctation. This simplified technique avoids additional procedures, reduces ischemic time, and prevents problems related to circulatory arrest.     

Endovascular repair of a tuberculous aortic false aneurysm

INTRODUCTION: Aortic aneurysms are a well known but rare complication of tuberculosis. Their major complication is aneurysmal rupture, unforeseeable and lethal. EXEGESIS: Chest pain and hemoptoic expectoration revealed a false aneurysm of the aortic isthmus in a 48-year-old man. Endovascular repair with a stent graft was urgently undertaken. Tuberculosis was diagnosed 6 weeks thereafter by the growth of gastric juice cultures and medically treated. Most tuberculous aortic aneurysms are false aneurysms, caused by an adjacent tuberculous focus eroding the aortic wall. They present with pain, bleeding or as para-aortic masses. CONCLUSION: Tuberculous false aneurysms of the aorta necessitate an early intervention before they rupture. Surgical treatment remains the preferred option but endovascular repair with a stent graft is a therapeutic alternative, to be considered in high-risk surgical patients.