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Aortic isthmus

Neal S Gerstein, Lindsay J Jinkins, Liem C Nguyen, Timothy M Maus, Todd S Dettmer, Lev Deriy
Aortic rupture and transection are constituents of the acute aortic syndrome. Injury to the thoracic aorta during motor vehicle crashes is associated with blunt chest trauma and rapid deceleration mechanisms. Type A dissections and/or rupture of the aorta at the level of the aortic isthmus are the more common presentations of aortic injuries associated with motor vehicle crashes. We present the case of atypical echocardiographic findings of a nearly complete circumferential transection of the proximal ascending aorta injury after a motorcycle crash...
October 4, 2016: Echocardiography
Xiaoyan Gu, Yihua He, Ye Zhang, Lin Sun, Ying Zhao, Jiancheng Han, Xiaowei Liu
OBJECTIVE: Global racial variability in human development can lead to differences in size of fetal cardiac structures during gestation. Our objective is to establish normal reference ranges of fetal cardiac dimensions between 20 and 34 weeks from fetal echocardiograms recorded at a single center in China. METHODS: A prospective cross-sectional study was undertaken on single pregnancies with normal fetuses of varying gestational ages (GAs). A total of 4396 normal fetuses were divided into 15 groups from 20 to 34 weeks according to the GA...
September 26, 2016: Journal of Perinatal Medicine
Fumiaki Shikata, Toru Okamura, Takashi Higaki, Masahiro Okura, Ai Kojima, Shunji Uchita, Hironori Izutani
Aortic coarctation rarely occurs after an arterial switch operation for D-transposition of the great arteries with intact ventricular septum. We report the case of a neonate patient in whom aortic coarctation developed 28 days after an uncomplicated arterial switch operation. Preoperatively, the aorta was noted to have an irregular shape, but there was no pressure gradient across the lesion. The patient underwent successful reoperation to correct the coarctation. We hope that our report raises awareness of a rare early complication after arterial switch operation with intact ventricular septum, and the need to carefully monitor the aortic isthmus in patients who have aortic irregularities, even in the absence of a pressure gradient...
August 2016: Texas Heart Institute Journal
D Paladini, B Deloison, A Rossi, G E Chalouhi, C Gandolfo, P Sonigo, S Buratti, A E Millischer, G Tuo, Y Ville, A Pistorio, A Cama, L J Salomon
OBJECTIVE: Vein of Galen aneurysmal malformation (VGAM) is a rare anomaly in which an adequate perinatal management may warrant good neurological outcome. However, most fetal series are too scant to allow reliable statistical assessment of poor prognostic factors. Aim of this paper is to assess, in a two-center series of 49 cases, the prognostic value of several prenatal variables. The primary endpoint of the analysis is to identify possible prenatal indicators of poor outcome, in terms of mortality and cerebral disabilities...
August 12, 2016: Ultrasound in Obstetrics & Gynecology
Ahmet Can Topcu, Ufuk Ciloglu, Ahmet Bolukcu, Sabri Dagsali
Traumatic aortic rupture is rupture of all or part of the aortic wall, mostly resulting from blunt trauma to the chest. The most common site of rupture is the aortic isthmus. Traumatic rupture of the ascending aorta is rare. A 62-year-old man with a family history of ascending aortic aneurysm was referred to our hospital after a motor vehicle accident. He had symptoms of cardiogenic shock. A contrast-enhanced computed tomographic scan revealed rupture of the proximal ascending aorta and an ascending aortic aneurysm with a diameter of 55 mm at the level of the sinuses of Valsalva...
August 2016: Annals of Thoracic Surgery
Christoph Haller, Devin Chetan, Arezou Saedi, Rachel Parker, Glen S Van Arsdell, Christopher A Caldarone, Osami Honjo
BACKGROUND: Aortic arch reconstruction is a challenging technical step in the Norwood operation or the comprehensive stage II operation. This study sought to analyze differences in aortic arch geometry and dimensions in patients undergoing Norwood or hybrid palliation. METHODS: Retrospective data collection included all patients who underwent Norwood or hybrid palliation at the Hospital for Sick Children in Toronto between 2007 and 2014; 139 patients were analyzed...
July 13, 2016: Annals of Thoracic Surgery
Anna Palatnik, William A Grobman, Leeber S Cohen, Jeffrey S Dungan, Nina L Gotteiner
Prenatal diagnosis of tetralogy of Fallot remains less frequent compared to other major congenital heart defects. In this study, we examined how often the 3-vessel and trachea view was abnormal in a large series of prenatally diagnosed cases of tetralogy of Fallot. In addition, we compared its sensitivity to that of the traditional outflow tract views for detection of tetralogy of Fallot. We found that both views were abnormal in all fetuses with tetralogy of Fallot, showing reversed aortic-to-pulmonary valve and aortic arch isthmus-to-ductus arteriosus ratios in the outflow tract and 3-vessel and trachea views, respectively...
August 2016: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Dominique Tynan, Jennifer Alphonse, Amanda Henry, Alec W Welsh
The aortic isthmus (AoI) is a unique fetal watershed with a waveform reflecting its complex haemodynamic physiology. The systolic component represents left and right ventricular systolic ejection, and the diastolic component represents comparative downstream vascular impedance between the brachiocephalic and subdiaphragmatic fetal circulations. Several indices have been devised to quantify different components of the waveform, including the pulsatility index, resistance index, isthmic flow index, and recently the isthmic systolic index...
2016: Fetal Diagnosis and Therapy
Amit Chakraborty, Paul F von Herrmann, Ryan E Embertson, Kevin P Landwehr, Michael A Winkler
A case of a tornado victim with a delayed presentation of injury to the aortic isthmus is discussed. Tornado forces resemble the forces of high energy explosions, and the injuries that can occur as a result of these forces can be bizarre. The patient presented with the unique computed tomography (CT) findings of isolated pseudoaneurysm of the thoracic aorta in the absence of other traumatic injury to the thorax. Equivocal results of the initial CT aortogram (CTA) were confirmed with ECG-synchronized CTA (ECG-CTA), demonstrating the superiority of ECG-CTA as compared to standard CTA...
July 2016: Clinical Imaging
P Gach, A Dabadie, C Sorensen, E Quarello, B Bonello, H Pico, N Hugues, P Petit, G Gorincour
Aortic coarctation is a local narrowing of the aortic lumen, which is located at the level of the isthmus in 95% of patients. Aortic coarctation accounts for 5 to 8% of all congenital heart diseases. It may have an acute presentation in the form of heart failure in the neonate or may be discovered incidentally in adult because of severe treatment-resistant hypertension. Ultrasound may reveal the presence of aortic coarctation during the antenatal period. In this situation, associated abnormalities should be investigated (including karyotype), because they influence prognosis and indicates whether or not the birth should occur in a center with pediatric cardiology expertise...
May 2016: Diagnostic and Interventional Imaging
Olfa Hdiji, Nouha Bouzidi, Mariem Damak, Chokri Mhiri
BACKGROUND: Acute aortic dissection is an extreme emergency that is generally manifested by violent chest pain irradiating to a patient's back and abdomen. Paraplegia due to spinal cord ischemia and infarction as a presenting manifestation of aortic dissection has been found in 2 to 5% of patients. However, painless paraplegia is exceedingly rare and limited to a few case reports in the literature. We describe a new case with this unusual presentation of aortic dissection and here we emphasize that this condition must be considered in all patients with painless paraplegia...
2016: Journal of Medical Case Reports
Xiaowei Liu, Yihua He, Zhiyun Tian, Jack Rychik
Ventricular size discrepancy may be due to a persistent left superior vena cava (PLSVC) in utero. We sought to investigate for differences in cardiac structure measures and hemodynamics between fetuses with isolated PLSVC connected to the coronary sinus (CS) and normal. Fetuses diagnosed with isolated PLSVC in the second and third trimester were enrolled. We defined two groups: group 1, twenty-five fetuses in the second trimester (22-27 W + 6d); group 2, twenty-two fetuses in the third trimester (28-39 W + 6d)...
August 2016: Pediatric Cardiology
Heemoon Lee, Ji-Hyuk Yang, Tae-Gook Jun, Yang Hyun Cho, I-Seok Kang, June Huh, Jinyoung Song
BACKGROUND: Reconstruction of the aortic arch in patients with complex aortic coarctation or interruption continues to be a challenge because of early left main bronchial compression or recoarctation and late Gothic arch formation. We propose a modified arch reconstruction technique augmenting the lesser curvature with an autologous vascular patch, which can relieve tension on the anastomosis without a prosthetic material. METHODS: We retrospectively reviewed 33 patients with coarctation and arch hypoplasia (n = 31) or arch interruption (n = 2) who underwent arch reconstruction with an autologous vascular patch from 2007 to 2012...
June 2016: Annals of Thoracic Surgery
Maude Gagné-Loranger, Éric Dumont, Pierre Voisine, Siamak Mohammadi, Claude Garceau, Brigitte Dion, François Dagenais
OBJECTIVES: Giant cell arteritis (GCA) may affect mid-size and large-size arteries. Although temporal arteritis is a well-characterized clinical entity, GCA of the thoracic aorta remains ill defined. The aim of the study was to evaluate the clinical presentation, surgical and mid-term outcomes in patients operated for GCA of the thoracic aorta. METHODS: A retrospective review of patients operated for GCA of the thoracic aorta was conducted. The diagnosis of GCA was established by the pathology report...
September 2016: European Journal of Cardio-thoracic Surgery
Julie Blanc, Jean-Claude Fouron, Sven-Erik Sonesson, Marie-Josée Raboisson, Ian Huggon, Roxanne Gendron, Annie Berger, Sophie Brisebois
INTRODUCTION: Our objective was to determine the impact of simple transposition of the great arteries (TGA) on fetal left ventricular (LV) and right ventricular (RV) performances and central circulatory dynamics including the aortic isthmus. MATERIAL AND METHODS: Ventricular stroke volumes were calculated as the product of the cross-sectional area of the corresponding semi-lunar valve and the flow velocity integral through these valves. Volume flow in ductus arteriosus (QDA ) was evaluated using the same technique...
June 2016: Acta Obstetricia et Gynecologica Scandinavica
Patricia Garcia-Canadilla, Fatima Crispi, Monica Cruz-Lemini, Brenda Valenzuela-Alcaraz, Paula A Rudenick, Eduard Gratacos, Bart H Bijnens
OBJECTIVE: The aortic isthmus (AoI) blood flow has a characteristic shape with a small end-systolic notch observed during the third trimester of pregnancy. However, what causes the appearance of this notch is not fully understood. We used a lumped model of the fetal circulation to study the possible factors causing the end-systolic notch and the changes of AoI flow through gestation. METHODS: A validation of the model was performed by fitting patient-specific data from two normal fetuses...
February 24, 2016: Fetal Diagnosis and Therapy
Min Suk Choi, Yang Hyun Cho, Wook Sung Kim, Young Tak Lee, Dong Seop Jeong, Pyo Won Park, Kiick Sung
Background Long-term outcomes of open surgical repair with distal aortic perfusion for blunt aortic injury (BAI) remain undefined in this era of preferential thoracic endovascular aortic repair (TEVAR). Methods We retrospectively reviewed data from 31 consecutive patients (23 males; mean age, 46 ± 16 years) who underwent open surgical repair with distal aortic perfusion for acute BAI between 1998 and 2012 at our center and were followed up for 83 ± 47 months. Results In the 31 patients studied, BAI was most commonly secondary to traffic accidents (87%), with median accident-to-surgery time of 1 day...
January 28, 2016: Thoracic and Cardiovascular Surgeon
Neerod Kumar Jha, Magdi Tofeig, Rajappan Arun Kumar, Amin ElTahir, Syed Mohammad Athar, Aref AlHakami, Arshad Khan, Mohammad Daud Khan
BACKGROUND: Patients with functional aortic interruption of the descending thoracic aorta at the isthmus due to severe coarctation in association with atretic lumen are extremely rare in the adult population. The management is challenging and carries high morbidity and mortality. CASE PRESENTATION: We describe successful percutaneous reconstruction using a covered stent in a similar patient who is doing well two-years after intervention. A literature search was done to explore management strategies and their long-term outcomes for better understanding...
2016: Journal of Cardiothoracic Surgery
Timo Weimar, Sydney L Gaynor, Daniela Y Seubert, Ralph J Damiano, Nicolas Doll
The need to perform an additional atriotomy is a major concern that keeps many surgeons from performing an extended left atrial lesion set in patients with atrial fibrillation during procedures such as aortic valve replacement. This does result either in a suboptimal lesion set or even in ignoring the rhythm disorder, leaving the patient exposed to an increased risk of stroke and possible hemodynamic compromises. This report describes a technique how pulmonary vein isolation, an isolation of the posterior left atrial wall and an anterior mitral annular line, which substitutes for the mitral isthmus line in order to prevent perimitral atrial flutter, can be performed during aortic valve replacement without the need for an atriotomy...
February 2016: Annals of Thoracic Surgery
Amy-Lee Gunter, Zahra Keshavarz-Motamed, Rocco Portaro, Lyes Kadem, Hoi Dick Ng
The initial stages of fetal development require that blood oxygenation occur through the placenta rather than the non functioning lungs. As a result the fetal circulatory system develops a temporary shunt between the aorta and pulmonary artery, known as the ductus arteriosis (DA). This study utilizes CFD techniques to analyze the flow behavior in the aortic isthmus neighboring the DA. The geometry used to represent these structures is equivalent to that of a 25 week old fetus. The effect of aortic and pulmonary pressure pulse wave delay is examined for producing flow disturbances in the fetal circulatory system...
August 2015: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
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