Asymptomatic pseudoaneurysm of the ascending aorta diagnosed due to accompanying infection of a right atrial embolus

Though the incidence of aneurysms involving the aortic root and/or ascending aorta is common, the combination of aortic root aneurysm and the right atrial clot is extremely rare. No such case is reported in literature till date. This case report presents a 52-year gentleman who came to our emergency department with complaints of breathlessness, abdominal distention, pedal swelling, and decreased urine output with extremely poor general condition. After hemodynamic stabilization and preoperative optimization and workup, he was managed with Bentall procedure with right atrial clot removal. The immediate postoperative course was normal except for deranged liver function tests. The patient was discharged on postoperative day ten.

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ANEURYSM OF THE ASCENDING AORTA SIMULATING RIGHT ATRIAL DILATATION

American Journal of Roentgenology ◽

10.2214/ajr.107.2.400 ◽

1969 ◽

Vol 107 (2) ◽

pp. 400-403 ◽

Cited By ~ 3

Author(s):

STEVEN H. CORNELL

Keyword(s):

Ascending Aorta ◽

Right Atrial

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Slow conduction zone as an early electrical remodeling change in patients with atrial fibrillation

European Heart Journal ◽

10.1093/ehjci/ehaa946.0539 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H Kishima ◽

T Mine ◽

E Fukuhara ◽

M Ishihara

Keyword(s):

Atrial Fibrillation ◽

Low Voltage ◽

Ascending Aorta ◽

Right Atrial ◽

Electrical Remodeling ◽

Atrial Pacing ◽

Descending Aorta ◽

Contact Areas ◽

Slow Conduction ◽

Conduction Zone

Abstract Background The slow conduction zone (SCZ) in the left atrium (LA) detected using 3-D mapping and high-resolution imaging system has attracted attention as an arrhythmia substrate of atrial fibrillation (AF). However, the occurrence mechanism of SCZ remains unclear. Purpose This aim of this study is to clarify whether SCZ is related to the low voltage zone (LVZ) or the LA anatomical contact areas with other organs such as aorta or thoracic spine in patients with AF. Methods We studied 36 patients (21 males, 68±10 years, 14 paroxysmal AF; PAF, 17 persistent AF; PeAF, 5 long-standing persistent AF; LS-PeAF) who received catheter ablation for AF. High-density LA mapping during sinus rhythm or right atrial pacing after pulmonary vein isolation were constructed by acquiring more than 2000 endocardial points in each patient. Isochronal activation maps were created at 5-ms interval setting, and the SCZ was identified on the activation map by finding a site with isochronal crowding of ≥3 isochrones, which are calculated as ≤27 cm/s (figure). The LVZ was defined as the following; mild (<1.5 mV), moderate (<1.0 mV), and severe LA-LVZ (<0.5 mV). The LA contact areas (CoAs; ascending aorta-anterior LA, descending aorta-posterior LA, and vertebrae-posterior LA) were assessed using computed tomography. Results The SCZ was distributed linearly (figure), and observed in 35 of 36 patients (97.2%). The SCZ was often found in the anterior (89%), roof (64%), and septal wall (47%) of LA, and longest in patients with LS-PeAF (PAF: 56±34 mm, PeAF; 79±41 mm, LS-PeAF; 107±34mm, P=0.0351). The prevalence rate of SCZ (97.2%) was higher than LVZ (figure, mild LA-LVZ; 91.7%, moderate LA-LVZ: 66.7%, severe LA-LVZ; 25%). The 55.8% of SCZ overlapped with mild LA-LVZ, 37.6% of SCZ with moderate LA-LVZ, and 19.1% of SCZ with severe LA-LVZ. The LA CoAs were found in all patients. A total of 72 CoAs (average surface area, 7.0±4.0 cm2) were identified. A CoA was found in each of the three representative regions, ascending aorta-anterior LA (4.1±2.0 cm2, 36 of 36 patients, 100%), descending aorta-posterior LA (2.3±1.2 cm2, 12 of 36 patients, 33%), and vertebrae-posterior LA (3.4±2.1 cm2, 24 of 36 patients, 67%). However, only 22% of SCZ matched with the LA anatomical contact areas. Conclusion The slow conduction zone reflects LA electrical remodeling and may be a precursor finding of the low voltage zone, not LA contact areas in patients with atrial fibrillation. Funding Acknowledgement Type of funding source: None

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Aortic Dissection Type a after Right Atrial Cryoablation during Port Access Mitral Valve Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182744646 ◽

2012 ◽

Vol 7 (5) ◽

pp. 376-378

Author(s):

Tatjana Fleck ◽

Martin Dworschak ◽

Wilfried Wisser

Keyword(s):

Multiorgan Failure ◽

Mitral Valve Surgery ◽

Minimal Invasive ◽

Ascending Aorta ◽

Maze Procedure ◽

Right Atrial ◽

Tricuspid Valve Repair ◽

Port Access ◽

Right Atrial Appendage ◽

The Right

The case of a 63-year-old woman who underwent minimal invasive mitral and tricuspid valve repair and a concomitant CryoMaze is described. During creation of the last lesion of the right-sided maze procedure, dissection of the ascending aorta occurred that necessitated emergency sternotomy, replacement of the ascending aorta, and aortocoronary bypass grafting to the right coronary artery (RCA) because of detachment of the RCA from the aortic annulus. Repair of this complication was successful; nevertheless, the patient died 5 days after the operation because of multiorgan failure. The cause of this complication can only be speculated, but a relation to the CyroMaze is obvious. Because of the restricted incision with impaired vision especially in the area of the right atrial appendage, the cryoprobe could have come into contact with the orifice of the RCA during the last lesion, with subsequent detachment of the RCA from the aorta, which could subsequently have caused dissection.

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Elevated cardiac pressure inhibits renin release after arterial hypotension in conscious dogs

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1984.247.6.r953 ◽

1984 ◽

Vol 247 (6) ◽

pp. R953-R959 ◽

Cited By ~ 1

Author(s):

M. E. Lee ◽

T. N. Thrasher ◽

D. J. Ramsay

Keyword(s):

Left Atrial ◽

Dose Range ◽

Plasma Renin ◽

Ascending Aorta ◽

Atrial Pressure ◽

Left Atrial Pressure ◽

Renin Release ◽

Right Atrial ◽

Apparent Paradox ◽

Systemic Hypotension

The relative roles of cardiopulmonary, sinoaortic, and renal baroreceptors in the regulation of plasma renin activity (PRA) were evaluated in dogs with chronically implanted cuffs around the ascending aorta proximal to the brachiocephalic artery, the abdominal aorta just proximal to both renal arteries, or both. Inflation of either cuff was adjusted to cause a reduction of distal arterial pressure and hence renal perfusion pressure (RPP) of 0, 5, 10, 20, or 30% of control for 1 h. Reduction of RPP by inflation of the suprarenal cuff (n = 4) led to a significant (P less than 0.05) increase in PRA throughout the dose range examined. However, constriction of the ascending aorta (n = 7) to cause identical reductions in RPP failed to increase PRA. The apparent paradox in these results may be explained by differential effects of the two maneuvers on left atrial pressure. Left atrial pressure increased dose dependently during inflation of the ascending aortic cuff but did not change during inflation of the suprarenal cuff. To determine if elevated right atrial pressure (RAP) would inhibit renin release after systemic hypotension, another group of dogs (n = 4) was prepared with cuffs around the pulmonary artery. Inflation of the pulmonary cuff to cause similar systemic hypotension led to significant (P less than 0.05) increases in PRA and RAP. Therefore we conclude that powerful inhibitory signals, arising from the left heart, can inhibit renin release in response to systemic hypotension.

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Cardiovascular afferent signals and drinking in response to hypotension in dogs

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.1999.277.3.r795 ◽

1999 ◽

Vol 277 (3) ◽

pp. R795-R801 ◽

Cited By ~ 3

Author(s):

Terry N. Thrasher ◽

Craig R. Keenan ◽

David J. Ramsay

Keyword(s):

Pulmonary Artery ◽

Water Intake ◽

Left Atrial ◽

Inferior Vena ◽

Vena Cava ◽

Ascending Aorta ◽

Right Atrial ◽

Arterial Hypotension ◽

Atrial Receptors ◽

Stimulation Of

Arterial hypotension stimulates increases in plasma arginine vasopressin (AVP), plasma renin activity (PRA), and water intake in conscious dogs. We have previously reported that increasing left atrial but not right atrial pressure completely blocks the increase in plasma AVP and PRA induced by hypotension. The goal of the present study was to examine the effect of increasing right or left atrial pressure on water intake induced by arterial hypotension. Dogs were prepared with occluding cuffs on the thoracic inferior vena cava, the pulmonary artery, and the ascending aorta. We reduced mean arterial pressure (MAP) 25% below control by either inferior vena cava constriction (IVCC), pulmonary artery constriction (PAC), or ascending aorta constriction (AAC) and measured water intake over a 2-h period. Cumulative water intake during IVCC ( n = 6) and PAC ( n = 6) was 7.8 ± 2.0 and 6.7 ± 2.6 ml/kg, respectively. There was no difference between either the latency or the volume consumed between the two treatments. In contrast, none of the dogs drank during hypotension induced by AAC ( n = 5). Because the degree of arterial baroreceptor unloading was the same in each treatment by design, we conclude that stimulation of left atrial receptors inhibits drinking in response to arterial hypotension but that stimulation of right atrial receptors has no effect on the response in dogs.

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Luetic Aneurysm of Ascending Aorta with Aorta-to-Right Atrial Fistula

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239700500317 ◽

1997 ◽

Vol 5 (3) ◽

pp. 186-187

Author(s):

Shrivastava Shipra ◽

Shrivastava Sandeep ◽

Soman Rema Krishna Manohar

Keyword(s):

Pulmonary Arterial Hypertension ◽

Aortic Valve ◽

Ascending Aorta ◽

Patch Repair ◽

Right Atrial ◽

Fistulous Opening ◽

Direct Closure ◽

Severe Aortic Regurgitation ◽

Pulmonary Arterial ◽

The Right

We report a case of luetic saccular aneurysm of the ascending aorta eroding into the right atrium causing an aorta-to-right atrial fistula. The patient had severe aortic regurgitation, pulmonary arterial hypertension, and congestive cardiac failure. Patch repair of the aneurysm from the aortic side, direct closure of the fistulous opening from the right atrial side, and aortic valve replacement were performed. The patient recovered fully. This case is reported because of its extreme rarity and good surgical result.

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Successful Rescue from Cardiac Arrest in a Patient with Postinfarction Left Ventricular Blow-Out Rupture: "Extra-Pericardial Aortic Cannulation" for Establishment Total Cardiopulmonary Bypass

The Heart Surgery Forum ◽

10.1532/hsf98.2014351 ◽

2014 ◽

Vol 17 (4) ◽

pp. 217

Author(s):

Suguru Ohira ◽

Hitoshi Yaku ◽

Shunsuke Nakajima ◽

Akihiko Takahashi

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Bypass ◽

Artery Bypass ◽

Median Sternotomy ◽

Venous Drainage ◽

Left Ventricular ◽

Ascending Aorta ◽

Right Atrial ◽

Aortic Cannulation ◽

The Right

We report a quick and simple technique to establish cardiopulmonary bypass (CPB) in a left ventricular (LV) blow-out rupture. A 74-year-old woman with a diagnosis of acute myocardial infarction suddenly collapsed and lost consciousness. A venous-arterial extracorporeal membrane oxygenation (ECMO) device was inserted by femoral cannulation. Emergent median sternotomy was performed. The pericardium was not opened first, and the thymus was divided to expose the ascending aorta just above the pericardial reflection. After placing two purse-string sutures on the distal ascending aorta, a 7-mm aortic cannula (Terumo, Tokyo, Japan) was inserted. The pericardium was then incised. A large volume of blood was expelled from the pericardial space, and CPB was initiated with suction drainage. A two-stage venous drainage cannula was then inserted from the right atrial appendage without hemodynamic collapse. After cardiac arrest, closure of ruptured LV wall and concomitant coronary artery bypass grafting were performed. The patient was weaned from CPB with an intra-aortic balloon pump (IABP) and the previously inserted venous-arterial ECMO. Extra-pericardial aortic cannulation is an effective and reproducible method to prepare for CPB in emergent cases of LV rupture.

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