Thoracic dissection

Thoracic aortic aneurysm and dissection are life-threatening complications of Marfan syndrome (MFS). Studies of human and mouse aortic samples from late stage MFS demonstrate increased TGF-β activation/signaling and diffuse matrix changes. However, the role of the aortic smooth muscle cell (SMC) phenotype in early aneurysm formation in MFS has yet to be fully elucidated. As our objective, we investigated whether an altered aortic SMC phenotype plays a role in aneurysm formation in MFS. We describe previously unrecognized concordant findings in the aortas of a murine model of MFS, mgR, during a critical and dynamic phase of early development...

Type A acute aortic dissection has a high rate of mortality. Emergent surgical repair is the gold standard treatment, but some patients cannot tolerate the open surgery. Here, we report an 82-year-old patient with a history of cerebral infarction and cerebral bleeding who presented with a depressed level of consciousness and who was in a state of shock. A computed tomography (CT) scan showed cardiac tamponade associated with retrograde type A aortic dissection(RAAD), with a primary entry tear at a distal site of the left subclavian artery...

Perigraft seromas are uncommon after surgical repair of the thoracic aorta with woven polyester grafts. A 50-year-old woman required redo sternotomy for the treatment of a perigraft seroma 6 months after total arch replacement for acute type A dissection. After removal of a jelly-like mass, a prosthetic graft was covered with fibrin glue, and the bilateral pleurae beside the graft were opened widely for drainage of effusion into the bilateral pleural cavities. Bacterial culture and laboratory and histological examination of the content confirmed the final diagnosis of perigraft seroma...

BACKGROUND: The prognoses of submucosal esophageal squamous cell carcinoma patients vary. Patients with favorable prognoses may receive less invasive or nonsurgical interventions, whereas patients with poor prognoses or advanced esophageal cancer may require aggressive treatments. We sought to identify prognostic factors for patients with submucosal esophageal squamous cell carcinoma, focusing on lymph node metastasis and recurrence. METHODS: We included 137 submucosal esophageal squamous cell carcinoma patients who had undergone transthoracic esophagectomy with systematic extended lymph node dissection...

Objectives To investigate the feasibility and the mid-term outcomes of the chimney-graft technique for the revascularization of supra-aortic branches in patients with thoracic aortic pathologies involving the aortic arch. Methods A retrospective analysis of a prospectively maintained database between January 2010 and July 2016 was performed. Primary endpoints were 30-day and overall mortality. Secondary endpoints were technical success, target vessel patency, stroke/transitory ischemic attack and type I/III endoleak rate...

OBJECTIVE: The study objective was to assess the effect of preoperative thoracic false lumen branches on thoracic aortic enlargement along the stent graft after thoracic endovascular aortic repair for DeBakey IIIb aortic dissection. METHODS: From January 2011 to December 2013, 67 patients who underwent thoracic endovascular aortic repair for DeBakey IIIb aortic dissection were retrospectively investigated. We assessed preoperative thoracic false lumen branches and diameter measurements at the level of the tracheal carina...

OBJECTIVE: The rate of surgical resection of lung cancer in patients on hemodialysis is expected to increase due to the development of hemodialysis, improved diagnosis of lung cancer, and increases in the number and age of patients. However, studies assessing outcomes of lung resection in these patients are limited. In this retrospective case series, we investigated the safety and efficacy of video-assisted thoracic surgery (VATS) for lobectomy or segmentectomy for lung cancer in patients on hemodialysis...

OBJECTIVE: To report our single-center experience of the hybrid procedure for type B aortic dissection (TBAD) with an aberrant right subclavian artery (ARSA) and the early to midterm outcomes in these patients. METHODS: From December 2011 to February 2016, 16 patients (12 males; median age, 51 years; range, 40-66 years) underwent thoracic endovascular aortic repair and extraanatomic bypass hybrid procedure for TBAD with an ARSA in our center. Demographics, coexisting medical conditions, imaging features, operation details, and follow-up outcomes of these patients were collected retrospectively and analyzed...

Aortic dissection (AD) is a lethal, treatable disruption of the aortic vessel wall. It often presents without classic features, mimicking symptoms of other conditions, and diagnosis is often delayed. Established high-risk markers of AD should be sought and indicate advanced aortic imaging with CT, MRI, or TEE. Treatment is immediate surgical evaluation, aggressive symptom relief, and reduction of the force of blood against the aortic wall by control of heart rate, followed by blood pressure.

There is growing evidence of a differential etiological basis for thoracic aortic aneurysms (TAA), with ascending (As) TAAs being genetically mediated and descending (Des) TAAs more strongly related to acquired pathologies. A comprehensive literature review of this hypothesis has not been carried out. We carried out a systematic literature review based on the latest guidelines on TAA endorsed by the American Heart Association. The etiologies were classified as genetic and inherited, the studies were tabulated accordingly, and Hill's epidemiological criteria of causality were applied...

AIM: We investigated the safety of adding Japanese-style extended 3-field lymphadenectomy in patients treated with neoadjuvant chemoradiotherapy (NACRT) for thoracic esophageal squamous cell carcinoma (TESCC). Furthermore, the efficacy of NACRT, as shown by the pathological and metabolic responses were determined. PATIENTS AND METHODS: One hundred consecutive patients with cStage II-IV TESSC were enrolled. We analyzed the adverse events related to NACRT and surgical complications following surgery...

OBJECTIVE: Robotic-assisted thoracoscopic transdiaphragmatic adrenalectomy (RATTA) represents a novel surgical approach for the management of adrenal pathology in patients with a history of extensive transperitoneal or retroperitoneal procedures. METHODS: Here we report the first described case of RATTA in a 56-year-old woman with metastatic renal cell carcinoma to the left adrenal gland and right lung. With the assistance of cardiothoracic surgery, this patient underwent robotic-assisted thoracoscopic pulmonary wedge resection and RATTA...

OBJECTIVES: Our goal was to report our preliminary results in patients with acute complicated Type B aortic dissection without a suitable landing zone for primary thoracic endovascular aortic repair who were treated with the frozen elephant trunk (FET) technique. METHODS: Within a 25-month period, 14 patients with acute complicated Type B aortic dissection underwent surgical repair using the FET technique. The reasons to perform the FET procedure were an ectatic ascending aorta/arch in 6 patients and the lack of an adequate landing zone in 8 patients...

OBJECTIVES: Our goal was to present our 15-year experience (2001-2015) with the frozen elephant trunk (FET) technique. METHODS: A total of 251 patients (82 with aortic aneurysms, 96 with acute aortic dissection type A, 4 with acute type B dissections, 52 with chronic aortic dissection type A, 17 with chronic type B dissection and 67 redo cases) underwent FET implantation with either the custom-made Chavan-Haverich ( n  = 66), the Jotec E-vita ( n  = 31) or the Vascutek Thoraflex hybrid ( n  = 154) prosthesis...

Mutations in FBN1 have been well identified in syndromic aortic dissection (AD) and familial thoracic aortic aneurysms and dissections. However, whether mutations of FBN1 contribute to sporadic non-syndromic AD and the characteristics of mutations remain unknown.Using next-generation-sequencing technology, FBN1 was sequenced in a total of 702 sporadic cases (including 687 of non-syndromic AD and 15 of sporadic Marfan syndrome (MFS) with aortic event, and 527 normal controls). For the sporadic non-syndromic AD cohort, we found 26 variants in 27 patients (18 with missense, 2 frameshift, 1 initiation codon mutation, 3 nonsense, and 3 splice site mutations)...

The main identified function of BCL2 protein is to prevent cell death by apoptosis. Mice knock-out for Bcl2 demonstrate growth retardation, severe polycystic kidney disease (PKD), gray hair and lymphopenia, and die prematurely after birth. Here, we report a 40-year-old male referred to for abdominal and thoracic aortic dissection with associated aortic root aneurysm, PKD, lymphocytopenia with a history of T cell lymphoblastic lymphoma, white hair since the age of 20, and learning difficulties. PKD, which was also detected in the father and sister, was related to an inherited PKD1 mutation...

Neurogenic thoracic outlet syndrome is caused by a neurologic compression of the brachial plexus before it reaches the arm. Three anatomic areas are common locations for such an entrapment because of their congenital and/or acquired tightness: the interscalene triangle, the costoclavicular space, and the retropectoralis minor space. Because the compression level usually remains unknown, the treatment is still controversial and most teams focus on only one potential site. We propose an all-endoscopic technique of complete brachial plexus neurolysis that can be divided into three parts, one for each entrapment area...

Spinal DAVFs have diverse presentations. MRIs reveal spinal cord swelling in only 45-74%. We present an unusual case of a 57 yo male with a craniocervical junction DAVFs in which the edema appeared in the thoracolumbar region skipping the cervical spinal cord. A case report and literature review from a tertiary referral center. In our patient, symptoms progressed over 3 months from low back and radicular pain to weakness, saddle anesthesia, and urinary retention. MRI showed T2 hyperintensity from T3-4 to the conus medullaris (Fig 1 a,b)...

Interleukin-6 (IL-6) overexpression played an important role in the pathogenesis of thoracic aortic dissection (TAD). Our previous study found enhanced autophagy accompanying with contractile proteins α smooth muscle actin (α-SMA) and smooth muscle 22α (SM22α) degradation in TAD aortic vascular smooth muscle cells (VSMCs). Autophagy is an important way for intracellular proteins degradation, while IL-6 has been found as a contributing factor of autophagy in some cancers. These indicated IL-6 might contribute to the occurrence of TAD by promoting autophagy-induced contractile proteins degradation, which has not been investigated...

The geometric characteristics of uniportal video-assisted thoracic surgery (VATS) are known: one small incision without further dissection of the intercostal space with the simultaneous introduction of instruments to the thoracoscope through an ideal circular truncated cone, as wide as a surgeon's fingerbreadth. The perspective of the uniportal VATS approach realizes projective planes that preserves the depth of intraoperative visualization. The instruments, moving along this planes, enable the surgeon to bring the operative fulcrum inside the chest...