- Risk factors for mortality after endovascular repair for blunt thoracic aortic injury. [Journal Article]J Vasc Surg 2019JV
- CONCLUSIONS: TEVAR for BTAI is associated with a 7.3% in-hospital mortality in the Vascular Quality Initiative. Treatment of grade 1 injuries has increased significantly in recent years. Factors most strongly associated with mortality include age, male gender, renal impairment, LSCA involvement, and high ISS score. A simple point score model based on these variables robustly predicts in-hospital mortality and may assist in appropriate patient selection and risk stratification.
- Occluded mammary graft post-coronary bypass surgery: do we need to look for the second one? A case report. [Journal Article]Eur Heart J Case Rep 2019; 3(2)EH
- CONCLUSIONS: This patient has an unusual anatomic variant of two LIMAs originating from the LCSA. The proximal rudimentary LIMA was misinterpreted as an occluded arterial graft while the second, well-developed LIMA connected to the LAD had an unusually distal origin and had therefore been overlooked. This anatomical variant should be kept in mind when the internal mammary graft seems to be occluded.
- Anatomic suitability for "off-the-shelf" thoracic single side-branched endograft in patients with type B aortic dissection. [Journal Article]J Vasc Surg 2019JV
- CONCLUSIONS: Although the new TSSB device can allow for a more proximal seal zone and eliminate the need for open aortic arch debranching, only 28% of patients with type B dissection who required zone 2 TEVAR met all the anatomic requirements for this device. Future devices will need to account for the short distance between the left carotid and LSCA to be more broadly applicable.
- Isolation of the left brachiocephalic artery revisited: A 52-year literature review and introduction of a novel anatomic-clinical-prognostic classification. [Review]Ann Pediatr Cardiol 2019 May-Aug; 12(2):117-129AP
- Isolation of the left brachiocephalic artery (ILBA) is an extremely rare anomaly of aortic arch with diverse manifestations in the neurologic system, heart, and left upper arm. This anomaly is defined as the absence of connection of the left brachiocephalic artery (LBA) to aortic arch and connection of LBA to pulmonary artery (PA) through a patent arterial duct (PAD). However, this definition is …
Isolation of the left brachiocephalic artery (ILBA) is an extremely rare anomaly of aortic arch with diverse manifestations in the neurologic system, heart, and left upper arm. This anomaly is defined as the absence of connection of the left brachiocephalic artery (LBA) to aortic arch and connection of LBA to pulmonary artery (PA) through a patent arterial duct (PAD). However, this definition is not inclusive of all cases. Not only are there inconsistencies in the definition and terminology of this aortic arch anomaly but also there is no classification for this anomaly despite its heterogeneous nature in terms of anatomy, clinical presentation and prognosis. We performed a 52-year comprehensive literature review in the period between 1966 and 2018. Our inclusion criteria were any manuscript that included a case report or case series, with confirmed diagnosis of ILBA. All quantitative data were analyzed using descriptive analysis by SPSS version 21 (IBM SPSS Statistics, USA). Results were presented as mean ± standard deviation and median. Based on the presence or absence of connection of LBA to PA and the number of sources of steal from the LBA, we classified ILBA into three types: single-steal type with no connection of LBA to PA and single source of blood flow steal from LBA through the left subclavian artery (LSCA), double-steal type with connection of LBA to PA through PAD and two sources of steal through LSCA and arterial duct (AD), and triple-steal type with bilateral PADs and therefore, three sources of blood flow steal from LBA including the LSCA and the double ADs. Patients with single-steal type have the best prognosis and present latest with symptoms of cerebrovascular insufficiency or left arm claudication. The oldest reported patient was 69 years of age with symptoms of dizziness and near syncope. No death was reported in these patients. Double-steal type is the most common type and is often associated with genetic syndromes and/or extracardiac anomalies. Triple-steal type is the rarest type with the earliest presentation and worst prognosis. The oldest reported patient was 60 days of age. All reported cases had cardiac symptoms, pulmonary overcirculation, pulmonary hypertension, and fatal outcome.
- Efficacy and safety of TEVAR with debranching technique for blunt traumatic aortic injury in patients with severe multiple trauma. [Journal Article]Eur J Trauma Emerg Surg 2019EJ
- CONCLUSIONS: Despite debranching TEVAR taking approximately 60 min longer than simple TEVAR, short-term results indicated it to be acceptable for BTAI in multiple trauma patients to avoid LSCA complications unless we fail to stop bleeding first.
- Five-year outcomes after thoracic endovascular aortic repair of symptomatic type B penetrating aortic ulcer with intramural hematoma in Chinese patients. [Journal Article]J Thorac Dis 2019; 11(1):206-213JT
- CONCLUSIONS: The short- and mid-term results of TEVAR treatment for symptomatic Stanford type B PAU associated with IMH in Chinese patients were encouraging. Long-term follow-up is anticipated.
- Early- and long-term results of thoracic endovascular aortic repair for blunt traumatic thoracic aortic injury: a single-centre experience. [Journal Article]Eur J Cardiothorac Surg 2019EJ
- CONCLUSIONS: This study demonstrates that the endovascular treatment of blunt traumatic thoracic aortic injury is a safe and effective therapeutic method over a long-term follow-up period. LSCA coverage and long stent graft placement might be indications for revascularization to prevent spinal cord injury.
- Pectoral Muscle Atrophy After Axillary Artery Cannulation for Aortic Arch Surgery. [Journal Article]Semin Thorac Cardiovasc Surg 2019 Autumn; 31(3):414-421ST
- To investigate postoperative pectoral atrophy in 141 patients undergoing aortic arch surgery involving bilateral axillary artery cannulations with side grafts. The depth from the skin to the axillary artery surrounding the thoracoacromial artery (zone 1), and the thicknesses of pectoralis major (zone 2) and pectoralis minor (zone 3) were measured by computed tomography before surgery, at 1 and 6 …
To investigate postoperative pectoral atrophy in 141 patients undergoing aortic arch surgery involving bilateral axillary artery cannulations with side grafts. The depth from the skin to the axillary artery surrounding the thoracoacromial artery (zone 1), and the thicknesses of pectoralis major (zone 2) and pectoralis minor (zone 3) were measured by computed tomography before surgery, at 1 and 6 months after surgery, and at the most recent follow-up assessment (PostT2) (mean = 41 months, range 11-75 months). Based on the median value (47.4 mm) of zone 1, the preoperative pectoral thickness was categorized into 2 groups: pectoral thickness >47.4 mm (thick group) and ≤47.4 mm (thin group). Mean changes in the pectoral thickness from baseline were evaluated using the longitudinal mixed-effects model. Forty-three of 110 patients underwent total arch replacements and extra-anatomical bypasses for left subclavian artery anastomoses. In 3 patients, axillary artery grafts became infected. There was no obvious harm associated with muscle wasting. Mean changes from baseline in zones 1, 2, and 3 showed significant declines at PostT2 (-13.40 ± 9.73 mm [P < 0.0001], -7.00 ± 5.23 mm [P < 0.0001], and -7.23 ± 6.42 mm [P < 0.0001], respectively). In the thick group, the progression of pectoral atrophy in zones 1 and 3 was significantly more than that of the thin group (P < 0.0001 for both zones). Postoperative pectoral atrophy progressed rapidly. The preoperative pectoral size might be of no use in the prevention of pectoral atrophy. Further investigation to prevent the pectoral atrophy is needed.
- Fetal Echocardiographic Measures to Improve the Prenatal Diagnosis of Coarctation of the Aorta. [Journal Article]Pediatr Cardiol 2018PC
- The objective of this study is to identify fetal echocardiographic measures that predict postnatal coarctation of the aorta (CoA). A retrospective review of patients from 2013 to 2017 identified 13 cases of prenatal diagnosis of CoA confirmed postnatally and 14 cases of prenatal diagnosis of CoA with normal arches postnatally. There were 30 controls. Measurements were made and indices applied on …
The objective of this study is to identify fetal echocardiographic measures that predict postnatal coarctation of the aorta (CoA). A retrospective review of patients from 2013 to 2017 identified 13 cases of prenatal diagnosis of CoA confirmed postnatally and 14 cases of prenatal diagnosis of CoA with normal arches postnatally. There were 30 controls. Measurements were made and indices applied on all available longitudinal fetal echocardiograms for each patient. Linear mixed effects models were used to examine the between-group differences in the trajectories of the measurements. Significant differences were seen in the true CoA group for the following: smaller distal transverse arch diameter to distance between the left common carotid and left subclavian arteries (DT/LCA-LSCA) index (p = 0.04), smaller distal transverse arch diameter (p = 0.005), and longer brachiocephalic to left common carotid artery (LCA) (p = 0.004) and LCA-left subclavian artery (LSCA) distances (p < 0.0001). Additionally, the LCA/DT index trend appears to differentiate false positives from true coarctations (p < 0.03). The fetal echocardiographic DT/LCA-LSCA index, brachiocephalic-LCA distance and LCA-LSCA distance are significant predictors of postnatal coarctation. The LCA/DT index trend over time may differentiate which of those patients with prenatal concern for coarctation are more likely to develop coarctation postnatally. The use of fetal echocardiographic measures may improve prenatal detection and predication of postnatal coarctation.
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- Frozen elephant trunk with modified en bloc arch reconstruction and left subclavian transposition for chronic type A dissection. [Journal Article]J Thorac Dis 2018; 10(9):5376-5383JT
- CONCLUSIONS: Acceptable early and mid-term outcomes were achieved for patients with chronic type A dissection using en bloc technique with LSCA-LCCA transposition during TAR and FET procedure. This technique may be an alternative approach to chronic type A dissection in selected patients.