The angiosome model was first pioneered by Jan Taylor in 1987 by his influential anatomical works in the plastic reconstructive surgery field. The concept depicts the human body into three-dimensional blocks of tissue, fed by specific arterial and venous irrigation sources, the "angiosomes". Adjacent angiosomes are linked by a vast ...

Thromboendarterectomy remains a high-risk procedure. The use of circulatory arrest as a technique to allow pulmonary artery visualization is associated with cerebral and organ damage secondary to the ischaemic insult. Application of techniques learned from thoracic aortic stenting and minimal invasive valvular surgery may mean that circulatory arrest becomes an ...

Percutaneous intervention is becoming an increasingly recognised modality for the management of prosthetic paravalvar leaks (PVLs) with particular utility in severely symptomatic non-surgical candidates. To date, application of this intervention has predominantly involved closure of mitral valve PVLs. Consequently, current literature on its application to aortic PVLs is limited. This ...

This study sought to determine the most reproducible multidetector computed tomography (MDCT) measurements of the aortic annulus and to determine methods to improve the applicability of these measurements for transcatheter aortic valve implantation. The reproducibility and applicability of MDCT annular measurements to guide transcatheter aortic valve implantation remain unclear. Annular ...

Abstract  The left coronary artery arising from the pulmonary artery (ALCAPA) is a rare congenital anomaly. It causes high mortality if untreated in childhood. Only 10% to 15% of patients reach adulthood. We report a successful repair of ALCAPA in an adult with a rolled-conduit-extended-reimplantation technique. The procedure is easily ...

INTRODUCTION: Intracranial flow diverting devices are increasingly used to treat cerebral aneurysms. A reliable, non-invasive follow-up modality would be desirable. Our aim was to compare intra-arterial digital subtraction angiography (ia DSA) to angiographic computed tomography with intravenous contrast agent application (iv ACT) in the visualisation of flow diverting devices and ...

We report the use of a remotely steerable catheter to treat kinked renal bridging stents 8 months after branched endovascular repair of a type III thoracoabdominal aortic aneurysm. Conventional techniques using single, coaxial, and manually steerable sheaths proved too unstable to provide the support required to pass a wire against ...

A 42-year-old man was referred to our hospital for an electrophysiologic study because of recurrent episodes of palpitation. On coronary angiogram, an anomalous atresia of the coronary sinus (CS) ostium was discovered. The ablation catheter was inserted from the right femoral artery to the accessory pathway (AP) of posterior paraseptal ...

The positive early experiences with TAVI however, revealed that vascular access remains a hindrance to broader application and success of the procedure. This article will review the most common vascular routes used to deliver transcatheter aortic valves, and describe a new technique via the right axillary/subclavian artery approach.

Resveratrol is a polyphenolic compound found in red wine that is believed to be responsible for its beneficial cardiovascular effects. Extensive research in the past several decades has identified multiple mechanisms by which resveratrol modifies the cardiovascular risk factors that lead to coronary artery disease, yet translation to the clinical ...

BACKGROUND AND IMPORTANCE:: Fusiform intracranial aneurysms (FIA) are challenging to treat by surgical and endovascular means due to their complex morphology and configurations. Various surgical techniques including clip reconstruction, wrapping with or without clip enforcement, and trapping with or without bypass have been extensively described. The objective of this study ...

Rapid and striking development in both the techniques and devices make it possible to treat most of cerebral aneurysms endovascularly. Stent has become one of the most important tools in treating difficult aneurysms not feasible for simple coiling. The physical features, the dimensions, and the functional characteristics of the stents ...

This article describes a rare case of pulmonary sequestration presenting in infancy with mixed systemic and pulmonary venous drainage. This case illustrates the clinical application of the high temporal resolution three-dimensional "keyhole" magnetic resonance angiography technique in the neonatal age group to achieve a diagnosis noninvasively. Further insight into the ...

The distal balloon anchoring technique involves inflation of a balloon distal to or at a target lesion to facilitate equipment delivery. We report various applications of this technique to facilitate complex coronary and peripheral arterial interventions.

Covered stents or stent grafts are exciting new products with multiple applications for patients with vascular disease, including hemodialysis access-related complications. Although most of the current uses of stent grafts in these settings are "off-label" (ie, not approved by the US Food and Drug Administration) several studies are currently underway ...

A 78-year-old woman presented with increasing dyspnea on walking, occasional chest pain, and a single episode of presyncope. An echocardiogram showed a calcified aortic valve with severe aortic stenosis. A computed tomography scan showed a functionally bicuspid aortic valve and moderate calcification of the leaflets. An incidental fine linear membrane ...

BACKGROUND: Intraoperative fluorescence angiography with indocyanine green (ICG) as a tracer has recently been introduced as a novel technique for neurosurgery. We evaluated the feasibility and efficacy of near-infrared (NIR) indocyanine green (ICG) videoangiography for patients undergoing carotid endarterectomy (CEA). METHODS: Sixty patients (7 females, 53 males; mean age, 71.8 years) ...

Members of the growth factor family of neurotrophins [NTs; e.g. brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT3)] and their high-affinity receptors (tropomyosin-related kinase; Trk) and low-affinity receptors p75 neurotrophin receptor (p75NTR) have been localized to pulmonary artery (PA) in humans. However, their role is unclear. Based on previous findings of NTs ...

Real-time three-dimensional transesophageal echocardiography (RT-3D-TEE) represents a unique perioperative cardiovascular imaging tool which, without any need for off-line reconstruction, has been shown to be highly valuable for evaluating mitral valve and other intracardiac structures. It is highly probable that, in the near future, RT-3D-TEE will have a positive effect on ...

: Spinal dural arteriovenous fistulae (dAVFs), are lesions involving an aberrant connection between a radicular feeding artery and the venous system of the spinal cord at the dural sleeve of the nerve root. When rare dAVFs are occult on digitally subtracted catheter-based angiography, they present a diagnostic and therapeutic challenge. ...

Objectives: We have developed a method using transthoracic echocardiography in establishing optimal visualization of the aortic root, to reduce the amount of contrast medium used in each patient. Background: During transcatheter aortic valve implantation, it is necessary to obtain an optimal fluoroscopic projection for deployment of the valve showing the ...

aortic valve stenosis is the most common valvular heart disease in the Western world. The most common cause of aortic valve stenosis in adults is calcification of a normal trileaflet or congenital bicuspid valve. Calcific aortic valve stenosis is an active disease process characterized by mechanical stress, endothelial damage, lipid ...

The optimal surgical management of patients presenting with an aortic coarctation together with other cardiovascular disorders is unclear. In this study, we report the case of an adult male with an aortic coarctation associated with a bicuspid aortic valve and an ascending aortic aneurysm. The patient underwent single-stage repair involving ...

Aortic valve stenosis (AVS) is associated with significant cardiovascular morbidity and mortality. To date, no therapeutic modality has been shown to be effective in retarding AVS progression. We evaluated the effect of angiotensin-converting enzyme inhibition with ramipril on disease progression in a recently developed rabbit model of AVS. The effects ...

The transport of particles in surrogate and actual arterial geometries has been investigated synergistically by experimentation and numerical simulation. The motivating application for this work is orbital atherectomy which spawns a particle cloud in the process of debulking plaque from arterial walls. Paired simulations and experiments were performed to prove ...

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa is a rare complication of infective endocarditis of the aortic valve eventually resulting in coronary artery compression, stroke or rupture into the left atrium, aorta or pericardial space. A prompt diagnosis by either transthoracic or transesophageal echocardiography is mandatory to address the patient to ...

BACKGROUND:: Recently, the non-invasive technique of microscope integrated intraoperative near infrared indocyanine green angiography [ICGA] was developed, allowing assessment of the cerebral vasculature in the operative field after intravenous injection of a fluorescent dye. OBJECTIVE:: To prospectively compare the value of ICGA derived information during cerebral aneurysm surgery with data ...

In bicuspid aortic valve (BAV) disease, the role of genetic and hemodynamic factors influencing ascending aortic pathology is controversial. To test the effect of BAV geometry on ascending aortic flow, a finite element analysis was undertaken. A surface model of aortic root and ascending aorta was obtained from magnetic resonance ...

This case report illustrates our experience with transapical minimally invasive aortic valve implantation in a patient with an extended aneurysm of the thoracoabdominal aorta, who had previously undergone a replacement of the ascending aorta with concomitant aortic valve reconstruction (David procedure). Endovascular stent grafting of the descending aorta was also ...

Bicuspid aortic valve (BAV) is associated with ascending aortopathy predisposing to aneurysmal dilatation and dissection, even after successful aortic valve replacement (AVR). There is, however, scant evidence on which to make recommendations for prophylactic replacement of the ascending aorta at the time of AVR. The medical records of patients who ...

An 80-year old nun with severe calcific aortic stenosis and a bicuspid aortic valve was referred for transcatheter aortic valve implantation. She was declined for conventional surgery on the basis of poor left ventricular function, frailty, and a logistic EuroSCORE of 29.66. A 29-mm Medtronic-Corevalve bioprosthesis was implanted by transfemoral ...

The management of patients with degeneration of surgical bioprosthetic valve replacement remains a challenge because of the higher risk of re-do aortic valve replacement. We present a case series of five patients with degenerated aortic bioprostheses treated with transfemoral transcatheter aortic valve implantation (TAVI). From December 2009 to May 2010, ...

the aim of this study was to evaluate the long-term results of transcatheter balloon aortic valvuloplasty, the preferred treatment for congenital aortic stenosis (AS). aortic valve function and reintervention late after this procedure are not well characterized. from 1985 to 2008, 563 patients underwent balloon dilation for congenital AS. After ...

It is almost unknown which demographic factors or medications affect the progression of aortic stenosis (AS) in Japanese patients with mild AS. We identified a total of 194 patients with native tricuspid valvular AS, defined as a continuous-wave Doppler determined peak aortic valve jet velocity of ≥2.0 m/s, in whom echo ...

A role of coagulation in the pathogenesis of aortic stenosis (AS) is unknown. The aim of this study was to investigate the fibrin (Fn) presence and its determinants in calcified stenotic aortic valve leaflets. Twenty-one patients with dominant AS and 17 well-matched patients with dominant aortic insufficiency (AI) undergoing aortic ...

We report an unusual case of a 78-year-old man readmitted to our Cardiac Surgery Division due to a severe regurgitation of the stentless bioprosthesis Freedom Solo implanted, strictly following the manufacturer's recommendations, approximately six months before for aortic stenosis of native valve. Although different possible etiologies may be determined for ...

A 56-year-old patient admitted to hospital for the suspicion of an acute coronary syndrome underwent coronary angiography without detection of significant lesions. Seven days later the echocardiography showed acute severe aortic valve insufficiency. Intraoperatively we found a perforated leaflet probably due to lesion during transcatheter procedure.

This study assessed the rate of periprocedural embolic ischemic brain injury during transapical aortic valve replacement in 25 consecutive patients. Transcatheter aortic valve implantation is rapidly being established as a new therapeutic approach for aortic valve stenosis. Although initial clinical results are promising, it is unknown whether mobilization and embolization ...

This is a case of a 65-year-old male with history of double mechanical valve implantation (aortic and mitral) who presented with symptoms of severe volume overload either related to cardiac disease or underlying cirrhosis. The precise etiology could not be determined by clinical examination and noninvasive diagnostic tests. A cardiac ...

We describe initial human experience with a novel cerebral embolic protection device. Cerebral emboli are the major cause of procedural stroke during percutaneous aortic valve interventions. With right radial artery access, the embolic protection device is advanced into the aortic arch. Once deployed a porous membrane shields the brachiocephalic trunk ...

Transcatheter aortic valve implantation (TAVI) has been an important breakthrough in the treatment of patients with symptomatic, severe aortic stenosis and contraindications for surgical aortic valve replacement. Accurate aortic root measurements and evaluation of spatial relationships with the coronary ostia are crucial in pre-operative TAVI assessment. In addition, characterisation of ...

BACKGROUND: Conventional aortic valve replacement can be technically challenging in patients with porcelain aorta and is associated with a high rate of stroke and mortality. Porcelain aorta is even sometimes seen as contraindication for surgery. Minimally invasive off-pump transapical aortic valve implantation may be an optimal strategy to treat elderly ...

BACKGROUND: Main pulmonary artery (MPA) dilation is reported to occur in association with pulmonary valve (PV) abnormalities and in genetic diseases of connective tissue. AIM: To determine whether MPA dilation occurs with bicuspid aortic valve (BAV) in the absence of PV abnormality. METHODS: MPA and aortic dimensions were investigated in ...

Transcatheter aortic valve implantation has been shown to be an effective treatment for severe aortic stenosis in high-risk surgical patients. Many of these patients have significant coexisting coronary artery disease. We report the first case of combined off-pump transapical aortic valve implantation and minimally invasive direct coronary artery bypass via ...

OBJECTIVE: The purpose of this review is to show the range of abnormality involving the aortic valve and ascending thoracic aorta using 64- and 128-MDCT with 2D and 3D CT angiography. CONCLUSION: Ascending aorta abnormality can be complicated by secondary involvement or associated disease involving the aortic valve, coronary arteries, ...

There is growing consensus that the ascending aorta should be replaced at the time of aortic valve replacement for bicuspid aortic valve even if it is only moderately dilated; the natural history of nonreplaced sinuses of Valsalva is less clear. We identified patients without defined connective tissue disorder undergoing primary ...

The aim of this study was to determine the feasibility and durability of truly stentless aortic valve replacement using autologous pericardium sutured directly onto the aortic wall. Eleven patients (mean age, 55.9 years) requiring aortic valve replacement were recruited. A circular piece of pericardium about 8 cm in diameter was ...

Aortic valve endocarditis with perivalvular abscess formation remains a demanding condition and the results of the surgery are not optimal. Abscess localized in the aortic basis area can weaken the aortic wall, leading to further deterioration and rupture. The presented case allows us to recommend a maximal aggressive approach in ...

We evaluated the long-term outcome of aortic valve after arterial switch operation (ASO). A retrospective review of 324 hospital survivors after ASO was performed. Echocardiographic findings and incidence and progression of aortic regurgitation (AR) were investigated. Endpoints of the study were the first documented occurrence of moderate or severe AR ...

As populations in Western civilizations are aging, the prevalence of degenerative aortic valve stenosis is increasing. CT imaging provides information on aortic valve pathology in many ways: In nonenhanced scans, aortic valve calcification can be quantified accurately, which helps to understand the pathogenesis and progression of aortic sclerosis and stenosis. ...