We describe the finding of unsuspected aortic coarctation, discovered by catheterisation at 4 months, in a neonate first daignosed on the fourth day of life as having tetralogy of Fallot with pulmonary atresia and major aorto-to-pulmonary collateral arteries. This previously unreported combination contravenes the established theory of patterns of flow ...

The treatment of coarctation of aorta with an additional cardiac lesion in adults remains a difficult surgical challenge. We present here an alternative, two-stage, hybrid approach that combined stent repair of aortic coarctation followed by coronary artery bypass operation in an adult with critical coronary lesions and a poor ventricle. ...

Pulmonary artery coarctation is a rare congenital anomaly characterized by single or multiple stenoses of the pulmonary arteries and their branches. There are only a few reports describing the radiological film of this entity. In this paper we report the case of a 68 year-old woman who presented with dyspnea. ...

We report a patient with stenosis of the native ascending aorta after palliation of hypoplastic left heart syndrome and aortic atresia. We describe the approach to diagnosis, temporary support with extracorporeal membrane oxygenation, and successful surgical reintervention. Stenosis of the native ascending aorta is an important, potentially reversible cause of ...

We report on a rare association of severe migraine headaches associated with coarctation of aorta that completely resolved following dilation of the constricted aorta. A 6-year-old girl presented with severe pounding headaches accompanied with recurrent vomiting, associated with photophobia and phonophobia. She experienced frequent awakenings with severe headaches and vomiting. ...

OBJECTIVE: Devices that reduce technical difficulty and anastigmatic time when repairing large vessels such as the thoracic aorta would be beneficial. The aim of this study was to determine if titanium vascular closure staples (3 mm) could be safely and quickly applied in the repair of large vessels such as ...

OBJECTIVE: To evaluate gastric tonometer monitoring for splanchnic hypoperfusion in infants during surgical intervention for aortic coarctation, especially within aortic cross-clamp periods. DESIGN: A prospective study. SETTING: Cardiovascular intensive care unit in a university hospital. PARTICIPANTS: Fourteen infant patients after elective, uncomplicated repair of coarctation of the aorta. INTERVENTIONS: After ...

The present study was performed to investigate the effects of the development of atherosclerosis on foot-to-foot pulse-wave velocity (PWV) from the ascending aorta to different positions along the aorta in Kurosawa and Kusanagi-Hypercholesterolemic (KHC) rabbits aged 10-12 and 22-24 months old, in relation to the percentage fractional lesioned area (PFLA) ...

The middle aortic syndrome, with diffuse narrowing of the thoracic and abdominal aorta, was present in 10 of 18 patients with Williams' syndrome (55%). There were 3 thoracic coarctations, and 2 abdominal coarctations, with gradients greater than 20 mmHg across the zone of narrowing. Seven patients had mild renal arterial ...

OBJECTIVE: The value of CT angiography and three-dimensional (3D) reconstructions was investigated in the postoperative care after surgical repair of aortic coarctation and compared with conventional angiography. SUBJECTS AND METHODS: Twenty-five patients referred because of suspicion of stenosis in the area of former coarctation were prospectively studied with CT angiography ...

BACKGROUND: Aortic fenestration is rarely required for patients with acute or chronic aortic dissection. To better define its role and the indications for its use and to evaluate its success at relieving organ or limb malperfusion, we reviewed our experience with direct fenestration of the aorta. METHODS: A retrospective analysis ...

Assessment of recurrent coarctation after the Norwood procedure by routine measures is complicated by the unusual physiology caused by the presence of a modified Blalock-Tausig shunt with distal aortic arch obstruction. We present a new index that uses 2-dimensional measurement of the reconstructed aortic arch, which is highly sensitive and ...

We report a modified technique for repair of aortopulmonary window in which a native pulmonary artery flap is created and the aortopulmonary window is completely divided. The pulmonary artery flap is used to reconstruct the ascending aorta, and the defect in the pulmonary trunk is closed with an autologous pericardial ...

Structural cardiac defects such as peripheral pulmonary stenosis are well-described in Alagille syndrome (AS), which is transmitted in an autosomal dominant inheritance. The genetic defect, with incomplete penetrance and variable expression, is localized to the short arm of chromosome 20. Abdominal coarctation is an uncommon congenital anomaly, with a spectrum ...

BACKGROUND: Bypass grafting for repeat operation or complex forms of descending aortic disease is an alternative approach to decrease potential complications of anatomic repair. METHODS: Between December 1985 and February 1998, 17 patients (13 men, 4 women; mean age, 47.6 +/- 18.5 years) underwent ascending aorta-to-descending aorta bypass through a ...

An unusual case of subclavian-aortic steal syndrome in a pediatric patient with hypoplastic aortic arch with coarctation of the aorta of unusual location is described. Aortography showed hypoplasia of the arcus aorta and severe coarctation proximal to the left subclavian artery associated with an aneurysm formation on the isthmus and ...

BACKGROUND: The presence of ascending aortic atheroma is a known risk for systemic emboli or early saphenous vein graft failure if unrecognized at the time of cardiopulmonary bypass. METHODS: This study prospectively compared intraoperative omniplane transesophageal echocardiography (TEE) and epiaortic ultrasound (EAU) images in 22 patients (6 women, 16 men, ...

A 57-year-old man with a high-grade aortic stenosis and aortic coarctation was treated with concomitant valve replacement and insertion of a conduit from the ascending aorta to the retrocardiac descending aorta via the left pleura. Because heart failure has been reported shortly after cardiopulmonary bypass using this technique, the conduit ...

A 29-year-old gravid female presented at 22 weeks gestation with an acute Type I aortic dissection and coarctation of the aorta. She underwent emergent repair of her aortic dissection using cardiopulmonary bypass and hypothermia. At 25 weeks gestation, she underwent repair of her coarctation of the aorta. The patient had ...

We reoperated for diffuse supravalvular aortic stenosis using a modified technique of patch plasty described by Brom. A 36-year-old woman admitted to our hospital with a peak systolic pressure gradient of 92 mmHg across the ascending aorta had previously undergone Doty's operation at another hospital. Aortography showed an ascending aorta ...

Sternotomy in a patient with an aneurysm in the ascending aorta adherent to the sternum after cardiac surgery can result in fatal hemorrhage or brain damage unless the distal ascending aorta can be identified and secured immediately. A left anterolateral thoracotomy was used in three patients with adherent aneurysms. The ...

Transarterial left ventricular assist devices (LVADs), such as the Hemopump, IABP, and PUCA-pump, are meant to be introduced into the body via the femoral or axillary artery without major surgery. For certain applications, introduction is performed directly into the aorta via an open thorax procedure. A prototype of a vascular ...

A new technique for primary repair of tetralogy of Fallot with absent pulmonary valve syndrome is suggested. In addition to the standard intracardiac portion of tetralogy of Fallot repair, this approach includes translocation of the pulmonary artery anterior to the aorta, shortening of the ascending aorta, and shortening and plication ...

To determine the capacity of the left ventricle to expand after biventricular repair of left ventricular (LV) outflow tract obstruction, we studied pre- and postoperative echocardiographic variables from 14 infants (< 2 months old) who underwent successful repair of isolated aortic coarctation. We show that in this lesion, LV volume ...

The spatial organization of the microcirculation in gills of Mugil Cephalus, was examined by scanning electron microscopic analysis of corrosion cast prepared by intravascular injection of methyl methacrylate. The afferent branchial artery originates from the ventral aorta and gives rise to afferent filamental artery. From the medio-lateral wall of the ...

PURPOSE: Apoptosis is a physiologic mechanism of cell death that regulates mass and architecture in many tissues. Apoptosis has been described as a feature in human vascular atherosclerosis and large vessel structural integrity. We examined the extent of vascular smooth muscle cell (VSMC) apoptosis in aneurysmal, occlusive, and normal human ...

An easy aortic cannulation technique in minimally invasive pediatric cardiac surgery is described. We have developed a dilator which fits an aortic perfusion cannula. The aortic cannula over the dilator with a hole for passage of a guide wire is inserted into the ascending aorta by the Seldinger technique. Using ...

A patient with an unknown thoracic aortic coarctation underwent angiography for calf claudication. Percutaneous angioplasty and stenting of an external iliac artery (EIA) stenosis produced flow reversal in the EIA, mimicking occlusion on the angiogram. This aberrant situation resulted from a haemodynamic disbalance between the iliac flow and a dominant ...

BACKGROUND: Cross-clamping of the descending thoracic aorta (XC) induces an increase in cardiac output (CO). The intention of this study was to evaluate the high CO during XC by the use of clinically available methods (thermodilution and pulsed Doppler ultrasound) compared to transit-time ultrasound flowmetry of the ascending aorta as ...

Development of a mycotic aneurysm or pseudoaneurysm after subacute bacterial endarteritis is uncommon. Nonetheless, patients with coarctation of the aorta are more likely to develop this complication. We describe a case of a large pseudoaneurysm discovered in a child with a previously undiagnosed aorta coarctation. Successful repair was performed with ...

Regular follow-up is required in patients with previous intervention for coarctation of the aorta to detect recoarctation or aneurysm formation. In this study we describe the findings encountered on routine follow-up exams and we compare the use of contrast-enhanced 3D MR angiography (CE MRA) with fast spin-echo MRI (FSE) to ...

We report a case of congenital absence of the cervical and petrous part of the left internal carotid artery, the middle and proximal part of the basilar artery, and the V4 segment of the left vertebral artery associated with a left persistent trigeminal artery and a coarctation of the aorta. ...

We present a modification of the Norwood stage 1 operation, where the neo-aorta was reconstructed without using graft material. After extensive mobilization of the descending aorta the ductus arteriosus was excised and an end-to-end anastomosis was created between the main pulmonary artery and the distal ductal-aortic junction. The proximal ascending ...

To clarify whether acute medial necrosis of the aorta induces aneurysms and intimal thickening at a later stage, we first attempted to induce acute aortic medial necrosis in 47 normal rabbits by the administration of Russell's viper venom intraperitoneally and of angiotensin II intravenously as used in a previous study ...

The pathogeneses of atherosclerosis in the thoracic aorta is heterogeneous and still incompletely elucidated. Protruding aortic plaques (PAP), reliable markers of atherosclerosis development and extension, could be easily identified by transesophageal echocardiography (TEE). A close relation between atherosclerosis development in the thoracic aorta, stroke and peripheral emboli were established. The ...

It is generally believed that balloon angioplasty of diffuse, long-segment aortic coarctation is not effective. In this report, we describe two neonates with diffuse, long-segment coarctation in association with complex congenital heart defects in whom we were successful in effectively treating coarctation with transumbilical artery balloon angioplasty. Based on this ...

It is presented the case of acute type II aortic dissection in a patient with aneurysmal ascending aorta, hypoplastic arch and isthmic coarctation. One single step replacement of the ascending aorta, arch and the isthmus was performed by ensuring simultaneous optimal perfusion above and below the coarctation through the femoral ...

We report a case of aortic aneurysm at the site of subclavian flap angioplasty repair for coarctation of the aorta. The dilatation involved the lateral wall of the proximal descending aorta that had been constructed by the flap. Five other similar cases have been reported in the literature. Diligent long-term ...

Abdominal aortic coarctation is found in only 2% of aortic coarctation and is usually manifested by renovascular hypertension. Splanchnic arterial occlusive lesions occur in 22% of these patients and are exceptionally symptomatic. We present a case report of a young patient with abdominal aortic coarctation causing hypertension and visceral angina. ...

Resection of an aneurysm of the distal ascending aorta was performed under hypothermic circulatory arrest and retrograde cerebral perfusion though a right anterior thoracotomy. Seven years before, the patient had undergone orthotopic cardiac transplantation and had required pectoral muscle plasty to heal an infectious mediastinitis. This new approach avoided a ...

Recoarctation is a serious complication of the surgical repair of coarctation of the aorta. A combined technique using end-to-end anastomosis and subclavian flap angioplasty has shown good results. However, this technique is not entirely free from longitudinal traction in cases of extended hypoplasia of the aortic isthmus. To obviate these ...

OBJECTIVES: We propose a new strategy using coarctation repair together with a polidioxanone absorbable pulmonary artery banding to limit operative risk and to spare infants with aortic coarctation subsequent operations. BACKGROUND: The alternative for the surgical management of aortic coarctation associated with ventricular septal defect (VSD) is single-stage repair versus ...

Extensive aneurysmal disease of the aorta presents considerable challenges to the cardiovascular surgeon and is generally treated with a staged approach. The elephant trunk principle, in which the downstream end of the primarily inserted graft is allowed to float freely in the downstream aorta, serves this approach. This principle greatly ...

Acute cardiac failure during descending thoracic aorta operations, although rare, may have catastrophic consequences. Under these circumstances, the use of partial veno arterial bypass is advantageous, allowing an assisted perfusion of both proximal and distal circulation districts. Traditionally, the ascending aorta or the aortic arch are the preferred sites of ...

We report a 44-year-old woman with atypical aortic coarctation accompanied by cerebral artery disease. She was hospitalized for vertigo. An extra-anatomic bypass between the ascending aorta and abdominal aorta was performed using partial cardiopulmonary bypass under moderate hypothermia to reduce the after load of the left ventricle and maintain cerebral ...

A case of esophageal cancer infiltrating the left bronchus pars membranacea and the aneurysmal aortic wall was resected en bloc with the bronchial and aortic wall. Descending aorta was substituted by means of a Dacron prosthesis fitted with expandable devices at both ends, allowing a very significant reduction of the ...

BACKGROUND: In patients with Marfan syndrome (MFS), brachial pulse pressure (PP) has been recognized as a risk factor for aortic dilatation, leading to aortic dissection, the main cause of premature death. However, the relationships between aortic PP, aortic stiffness, and aortic root dilation have not been investigated. Our main objective ...

A 3-year-old patient is described with an unusual form of co-arctation due to hypoplasia of the transverse arch and fibromuscular dysplasia involving a long segment of the thoracic aorta. Surgical repair required resection of the aorta from the distal transverse arch to the mid-descending thoracic aorta, and replacement with a ...

OBJECTIVES: to determine whether clamping proximally or distally on the infrarenal aorta during abdominal aortic aneurysm (AAA) repair increases the overall embolic potential. MATERIALS AND METHODS: a sheath was placed in the mid-infrarenal aorta of 16 dogs. In eight animals a cross-clamp was placed at the aortic trifurcation, and in ...

BACKGROUND: Coarctation occurring within the aortic arch is rare and may present difficulties during surgical repair. We describe the operative technique and outcome in 6 patients with this unusual anomaly. METHODS: Five patients had antegrade perfusion with circulatory arrest. Three patients with presubclavian narrowing (one presenting with type B dissection) ...