Saccular “Cauliflower” aneurysm of coarctation of aorta: a hybrid management

2020 ◽  
Vol 30 (9) ◽  
pp. 1360-1362
Author(s):  
Neha Bansal ◽  
Thomas J. Forbes ◽  
Sanjeev Aggarwal
Keyword(s):  
Aortic Arch ◽  
Subclavian Artery ◽  
Aortic Rupture ◽  
Bypass Graft ◽  
Hybrid Approach ◽  
Coarctation Of The Aorta ◽  
Coarctation Of Aorta ◽  
Vascular Surgeon ◽  
Mortality And Morbidity ◽  
Increased Risk

AbstractAneurysm formation around the site of coarctation of aortic arch is a well-recognised complication of untreated coarctation and is associated with an increased risk of aortic rupture and mortality. We present a rare case in a teenage girl with the combination of significant aortic arch coarctation, a “cauliflower-like” saccular aneurysm, and stenosis at the origin of the left subclavian artery. She was successfully managed with a hybrid approach, which is a combination of an endovascular surgical repair (a bypass graft placement from left carotid artery to subclavian artery by a vascular surgeon) and a transcatheter covered stent placement across the stenosis and aneurysm. This case highlights the successful role of a hybrid approach in patient’s who present with a combination of coarctation of the aorta and aortic arch aneurysms. This approach avoids the conventional surgical aortoplasty, which carries a higher mortality and morbidity risk in teenage patients.

scholarly journals Endovascular Treatment of Distal Aortic Arch Aneurysm Associated with Coarctation of Aorta in a Jehovah's Witness

2017 ◽  
Vol 44 (6) ◽  
pp. 399-401 ◽  
Author(s):  
Luigi Di Tommaso ◽  
Vito A. Mannacio ◽  
Ettorino Di Tommaso ◽  
Giovanni B. Pinna ◽  
Immacolata Fontana ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Aortic Rupture ◽  
Coarctation Of The Aorta ◽  
Coarctation Of Aorta ◽  
Safe Alternative ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Substantial Risk ◽  
Distal Aortic Arch Aneurysm ◽  
Arch Aneurysm

Late aneurysm formation in the proximal aorta or distal aortic arch is a recognized sequela of untreated stenosis of the aortic isthmus and is associated with substantial risk of aortic rupture. We describe the case of a 44-year-old man with untreated coarctation of the aorta who presented with a prestenotic dissecting thoracic aortic aneurysm. He declined surgery because he was a Jehovah's Witness. Instead, we performed emergency endovascular aortic repair in which 2 stent-grafts were placed in the descending aorta. Our experience suggests that this procedure is a useful and safe alternative to open surgery in patients who have aneurysms associated with coarctation of the aorta.

scholarly journals Study on the views and methods of ultrasonic screening and diagnosis for abnormal aortic arch in infants

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Xinjian He ◽  
Jiaoyang Chen ◽  
Gaoyang Li
Keyword(s):  
Diagnostic Accuracy ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Coarctation Of The Aorta ◽  
Double Aortic Arch ◽  
Aberrant Right Subclavian Artery ◽  
Coincidence Rate ◽  
Aortic Arch Anomalies ◽  
Screening Sensitivity ◽  
Axis View

Abstract Background The purpose of this study was to explore echocardiographic views and methods of aortic arch anomalies in infants, so as to improve the screening sensitivity and diagnostic accuracy. Methods 140 children with abnormal aortic arch diagnosed by ultrasound in Children’s Hospital of Hebei Province from January 2014 to December 2019 were selected for retrospective analysis. All were confirmed by surgery or/and computerized tomography angiography. Series of views for aortic arch (the three-vessel and tracheal view, aortic arch short axis view, left aortic arch long axis view, aortic arch long axis continuous scan views) were performed in all cases on the basis of the routine views of echocardiography. The screening sensitivity and diagnostic coincidence rate of different echocardiographic views for aortic arch anomalies were analyzed. Results Among the 140 infants, right aortic arch were 21 cases (6/21 were accompanied by mirror branch and 15/21 were with aberrant left subclavian artery). Left aortic arch with aberrant right subclavian artery were 2 cases, and double aortic arch with both arches open were 20 cases. Double aortic arch with left arch atresia were 2 cases, and atresia of the proximal aorta with aortic arch dysplasia was 1 case. Coarctation of the aorta were 67 cases, and interruption of aortic arch were 27 cases. All the patients were correctly diagnosed except that 2 infants with interruption of aortic arch were incorrectly diagnosed as coarctation of the aorta, and 1 infant with coarctation of the aorta was misdiagnosed as interruption of aortic arch by echocardiography. The screening sensitivities of four views and four-view combination for abnormal aortic arch were 99.3, 73.6, 87.1, 99.3, and 100%; the diagnostic coincidence rates were 85.7, 27.1,66.4, 95.0%, and 97.9% respectively. On the basis of traditional left aortic long axis view, other three views had their own advantages. The screening sensitivity and diagnostic coincidence rate of four-view combination were significantly improved. Conclusions The three-vessel trachea view is simple and feasible, which is suitable for screening abnormal aortic arch. The combination of four views conduces to improving screening sensitivity and diagnostic accuracy of aortic arch abnormalities.

Diverticulum of Kommerell with Micro Aneurysm, an Aberrant Right Subclavian Artery and Ventricular Septal Defect in a 39 Years Old Female: Case Report

2021 ◽  
Author(s):  
Xiaoming Bian
Keyword(s):  
Ventricular Septal Defect ◽  
Aortic Arch ◽  
Subclavian Artery ◽  
Septal Defect ◽  
Aortic Rupture ◽  
Vascular Ring ◽  
Vascular Lesion ◽  
Aberrant Right Subclavian Artery ◽  
Successful Operation ◽  
Diverticulum Of Kommerell

Diverticulum of Kommerell is a congenital anomaly in the development of the primitive embryonic aortic vasculature resulting in either an aberrant left subclavian artery (ALSA) from a right-sided aortic arch (RSAA) or an aberrant right subclavian artery (ARSA) from a left-sided aortic arch (LSAA). Kommerell’s diverticulum (KD), is extremely rare in the general population having prevalence of 0.7–2.0 %. KD with true aneurysmal dilatation like any vascular lesion of the thoracic aorta weakens the vasculature and increases the risk of aortic rupture. Timely surgical intervention is of paramount importance in most of these cases. Variable clinical presentations in patients with KD are either a result of compression of some mediastinal organs or strangulation by the vascular ring from the aberrant subclavian artery (ASA). We report a case of a 39 years old Chinese female with a rare co-existence of a huge KD with a microaneurysm, an aberrant right subclavian artery (ARSA), and ventricular septal defect (VSD). She underwent a successful operation and all her pre-surgical symptoms disappeared.

scholarly journals Surgical correction of coarctation of the aorta featuring an incomplete circle of Willis

2020 ◽  
Vol 30 (5) ◽  
pp. 794-795
Author(s):  
Aiko Sonobe ◽  
Hideyuki Kato ◽  
Bryan J Mathis ◽  
Yuji Hiramatsu
Keyword(s):  
Subclavian Artery ◽  
Coarctation Of The Aorta ◽  
Circle Of Willis ◽  
Surgical Correction ◽  
Surgical Strategy ◽  
Aberrant Right Subclavian Artery ◽  
Coarctation Of Aorta ◽  
Rare Anomaly ◽  
Cerebral Malperfusion

Abstract Although devastating complications during simple coarctation of aorta repair now occur less frequently, some unique cases still require extra caution. Here, we report a case of coarctation of the aorta with a rare anomaly in the circle of Willis and an aberrant right subclavian artery, which required a thorough surgical strategy that prevented cerebral malperfusion.

P2244Anomalies in women of the aortic arch in Turner syndrome as an important risk factor for premature morbidity and mortality

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Klaskova ◽  
S Kapralova ◽  
J Zapletalova ◽  
Z Tudos ◽  
K Adamova
Keyword(s):  
Risk Factor ◽  
Aortic Arch ◽  
Cell Line ◽  
Turner Syndrome ◽  
Subclavian Artery ◽  
X Chromosome ◽  
Coarctation Of The Aorta ◽  
Aberrant Right Subclavian Artery ◽  
Structural Abnormality ◽  
Study Group

Abstract Introduction Turner syndrome (TS) represents the most common chromosomal disorder in women being, caused by the absence or structural abnormality of X chromosome. Congenital heart defects affect up to 50% of females with TS.Prevalence of coarctation of the aorta in TS has been estimated 7–18% depending on imaging method. Introduction of cardiac magnetic resonance imaging (MRI) into the routine practice markedly increased the detection rate of anomalies of the aortic arch such as elongated transverse aortic arch with abnormal curvature, i.e.kinking, pseudocoarctation or aberrant right subclavian artery. Aims of study was to estimate prevalence of anomalies of the aortic arch in our study group according to the karyotype. Methods and patients Study group consisted of 67 patients with TS at the age 7.3 yrs (range 0.1 - 16.5 yrs.). Complete cardiovascular examination (echocardiography, MRI of the heart and great vessels) and cytogenetic examination were performed in each of our study patient. Results The prevalence of anomalies of the aortic arch was 15% (10 patients). Four of them had elongated transverse aortic, coarctation of the aorta was found in three cases, aberrant right subclavian artery in two patients and one girl had right aortic arch. 45,X cell line was presented in every patient with anomaly of the aortic arch, none of them had structural abnormality of X chromosome. Conclusions Compared with the general population, the prevalence of CoA and the others anomalies of the aortic arch is significantly higher in women with TS, especially with 45,X cell line. As far as CoA is considered to be one of the major risk factor for aortic dissection detailed cardiovascular screening focused on thoracic aorta anomalies seems to be crucial in order to prevent it. Acknowledgement/Funding Supported by Ministry of Health, Czech Republic - MZ VES 2017 (Reg. No. NV17-29111A).

scholarly journals Aortic arch repair for complex coarctation of the aorta with aberrant bilateral subclavian artery

2015 ◽  
Vol 61 (5) ◽  
pp. 1330
Author(s):  
Ryo Itagaki ◽  
Masashi Tanaka ◽  
Ikuo Katayama ◽  
Satoshi Itoh
Keyword(s):  
Aortic Arch ◽  
Subclavian Artery ◽  
Coarctation Of The Aorta ◽  
Aortic Arch Repair

Left cervical aortic arch associated with multiple vascular anomalies

2011 ◽  
Vol 21 (6) ◽  
pp. 700-702
Author(s):  
José Luiz Balthazar Jacob
Keyword(s):  
Aortic Arch ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Coarctation Of The Aorta ◽  
Vascular Anomalies ◽  
Single Patient ◽  
Cardiovascular Abnormalities ◽  
Rare Anomaly ◽  
Transverse Arch ◽  
Brachiocephalic Arteries

AbstractCervical aortic arch is a rare anomaly occasionally associated with other cardiovascular abnormalities. We present a case of tortuous left cervical aortic arch associated with hypoplastic transverse arch, coarctation of the aorta, and right brachiocephalic arteries arising below the coarctation and stenotic origin of the left subclavian artery. These multiple anatomic anomalies, which are associated in our case, have not been described in a single patient previously.

scholarly journals Two-stage repair of the intrathoracic portion of a left subclavian artery aneurysm after previous coronary artery bypass surgery

2021 ◽  
Vol 2 (1) ◽  
pp. 33-38
Author(s):  
Petar Zlatanović ◽  
Marko Dragaš ◽  
Vladimir Cvetić ◽  
Oliver Radmili ◽  
Aleksandra Vujčić ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Arch ◽  
Coronary Artery Bypass ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Aneurysm ◽  
Two Stage ◽  
Subclavian Artery Aneurysm

Introduction: We present a case of a 70-year-old patient who underwent successful two-stage repair of an intrathoracic left subclavian artery aneurysm (SAA) and who had previously undergone CABG. Case presentation: The patient had previously undergone three-vessel coronary artery bypass graft (CABG) repair with the use of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD). Percutaneous coronary intervention (PCI) was performed as a backup option in case of potential intra-operative LIMA-LAD bypass occlusion. Owing to the impossibility of hybrid repair due to a short proximal landing zone and aortic arch anomaly (bovine type), the vascular surgery review board decided to perform two-stage open surgery. Firstly, the patient underwent a left carotid-subclavian (C-S) bypass with the Dacron graft, with the application of the standard supraclavicular approach. After a few days, the second procedure, through the left posterolateral thoracotomy was performed. The left subclavian artery (SA) was ligated distally to the SAA but proximally to the origin of the LIMA. The distal aortic arch at the site of the left SAA was clamped partially and the aneurysm was excised. The defect of the aortic arch was sutured and reinforced with a felt patch. Postoperatively, the patient had a good recovery, without any signs of myocardial injury or any surgery-related issues. Conclusion: Careful planning and two-stage open surgical treatment of the left SAA, first with a left carotid-subclavian bypass, followed by aneurysm exclusion and suture of the outer aortic arch curvature may be a treatment option for patients not amenable to hybrid treatment.

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