Rescue of a truncus brachiocephalicus-stentgraft prosthesis after dislocation in the descending aorta via left thoracotomy

An 83-year-old male with a history of three prior sternotomies, including coronary artery bypass surgery (CABG), presented with unstable angina. Cardiac catheterization showed left main and triple-vessel disease. The saphenous vein graft (SVG) to the right coronary artery was diseased but patent, and the SVG to the left anterior descending artery (LAD) was occluded. Preoperative evaluation showed a heavily calcified ascending aorta and minimum disease on the descending aorta. He successfully underwent a left thoracotomy 2-vessel off-pump CABG using the descending aorta for the proximal anastomosis. The left thoracotomy approach is a useful alternative to avoid complications associated with resternotomy, especially in patients with a hostile chest, although visualization of the target vessels may be limited.

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Left Thoracotomy HeartWare Implantation With Outflow Graft Anastomosis to the Descending Aorta

ASAIO Journal ◽

10.1097/mat.0b013e3182a708d1 ◽

2013 ◽

Vol 59 (6) ◽

pp. 664-667 ◽

Cited By ~ 20

Author(s):

Ramanan Umakanthan ◽

Nicholas A. Haglund ◽

John M. Stulak ◽

Lyle D. Joyce ◽

Rashid Ahmad ◽

...

Keyword(s):

Descending Aorta ◽

Left Thoracotomy ◽

Outflow Graft

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Transapical cannulation for surgical repair of chronic type B aortic dissection

10.22541/au.163889884.43608042/v1 ◽

2021 ◽

Author(s):

Shinsuke Kotani ◽

Minoru Tabata

Keyword(s):

Aortic Dissection ◽

Circulatory Arrest ◽

Cerebrovascular Event ◽

Type B ◽

Type B Aortic Dissection ◽

Chronic Type ◽

Descending Aorta ◽

Left Thoracotomy ◽

Cerebrovascular Complications ◽

Bloodless Field

Open surgery for chronic type B aortic dissection has been shown to have considerable risks of cerebrovascular complications. Because retrograde perfusion is a potential cause of intraoperative cerebrovascular events, we report our transapical cannulation strategy for descending aorta replacement in chronic type B aortic dissection repair with circulatory arrest. This technique provides an easy and quick establishment of cardiopulmonary bypass by way of a left thoracotomy, and prevention of cerebrovascular event. Transapical cannula can be also used as a vent to ensure a bloodless field during proximal anastomosis and to prevent extension of left ventricle during rewarming. Transapical cannulation is a useful option in open repair of the descending aorta for chronic type B aortic dissection by way of left thoracotomy.

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Descending Aorta Finger Clamping to Control Intra-Abdominal Bleeding Due to Rupture of Anterior Superior Pancreaticoduodenal Artery Aneurysm

Surgical Case Reports ◽

10.31487/j.scr.2020.05.03 ◽

2020 ◽

pp. 1-4

Author(s):

Nobuyuki Takemura ◽

Fuminori Mihara ◽

Hayato Ono ◽

Hitomi Wake ◽

Kaito Yano ◽

...

Keyword(s):

Blood Pressure ◽

Artery Aneurysm ◽

Pancreaticoduodenal Artery ◽

Descending Aorta ◽

Left Thoracotomy ◽

Emergency Situations ◽

Abdominal Bleeding ◽

Severe Hypotension ◽

General Surgeons ◽

Pancreaticoduodenal Artery Aneurysm

Background: Open aortic cross-clamping via a resuscitative left thoracotomy is effective in maintaining adequate blood pressure in patients with abdominal bleeding until achieving hemostasis. However, the procedure to encircle the descending aorta to secure cross-clamping is technically demanding for general surgeons, especially in emergency situations. Case Presentation: We report a case of rupture of the anterior superior pancreaticoduodenal artery aneurysm associated with median arcuate ligament syndrome, which required surgical hemostasis. Because of severe hypotension after laparotomy, open aortic cross-clamping with a left thoracotomy was performed by general surgeons. However, the aortic clamps repeatedly slipped off because the clamping was conducted without encircling the aorta. Then, we attempted finger clamping of the descending aorta, and the blood pressure was quite effectively stabilized. Conclusion: Descending aorta finger clamping via a resuscitative left thoracotomy is easy and feasible and might be an effective procedure to maintain adequate blood pressure for general surgeons.

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Chasing the umbrella: delayed migration of ductal occluder device into the aorta

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492318799932 ◽

2018 ◽

Vol 27 (3) ◽

pp. 217-220

Author(s):

Vijayakumar Raju ◽

Aayush Poddar ◽

Sai Gopalakrishnan ◽

Kalyanasundaram Muthuswamy

Keyword(s):

Patent Ductus Arteriosus ◽

Transcatheter Closure ◽

Ductus Arteriosus ◽

Uneventful Recovery ◽

Surgical Removal ◽

Descending Aorta ◽

Left Thoracotomy ◽

Occluder Device ◽

Patent Ductus

Delayed migration of a ductal occluder device into the aorta after transcatheter closure of a patent ductus arteriosus is extremely rare. We present a case of delayed migration of a ductal occluder into the descending aorta 4 months after its deployment in an 11-year-old girl. Successful surgical removal of the device from the descending aorta and triple-ligation of the ductus arteriosus was performed via a left thoracotomy. The patient made an uneventful recovery.

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How to Do It: Proximal Elephant Trunk Insertion Technique for Preventing Stroke during Replacement of the Descending Aorta through a Left Thoracotomy

The Heart Surgery Forum ◽

10.1532/hsf98.20111024 ◽

2011 ◽

Vol 14 (5) ◽

pp. 328

Author(s):

Hiroshi Kubota ◽

Hidehito Endo ◽

Hiroshi Tsuchiya ◽

Akihiro Yoshimoto ◽

Yu Takahashi ◽

...

Keyword(s):

Open Surgery ◽

Neurologic Complications ◽

Proximal Anastomosis ◽

Aortic Diseases ◽

Insertion Technique ◽

Elephant Trunk ◽

Thoracoabdominal Aorta ◽

Descending Aorta ◽

Left Thoracotomy ◽

Atherosclerotic Lesions

To reduce the risk of stroke during open surgery for the treatment of descending thoracic or thoracoabdominal aortic diseases, we attempted to insert a proximal elephant trunk to stabilize the atherosclerosis at the site of the proximal anastomosis. Although the patients had dense atherosclerotic lesions, they recovered well without neurologic complications. This technique is simple and may be effective for preventing stroke when replacing the descending thoracic or thoracoabdominal aorta through a left thoracotomy.

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Classic Dissection of Thoracic Aorta Complicated by Ascending Aortic Intramural Hematoma: Promt Diagnosis and Successful Endovascular Repair

Case Reports in Medicine ◽

10.1155/2012/257893 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5

Author(s):

Gediminas Rackauskas ◽

Mindaugas Mataciunas ◽

Nerijus Misonis ◽

Diana Zakarkaite ◽

Marijus Gutauskas ◽

...

Keyword(s):

Thoracic Aorta ◽

Bypass Graft ◽

Previous History ◽

Intramural Hematoma ◽

Proximal Part ◽

Middle Part ◽

Interventional Treatment ◽

Descending Aorta ◽

Truncus Brachiocephalicus ◽

The Right

We reported a case of 68-year-old man, with a previous history of hypertension. Patient was admitted to our institution for evaluation of a severe, constant, tearing anterior chest pain radiated to the neck with suspicion of acute aortic dissection. A multidetector computed tomography scan of thorax and abdomen demonstrated a dissection starting from the middle part of aortic arch and extending downward to the descending aorta till the middle part of the thoracic aorta. The dissection was classified as Stanford A, De Bakey I. Surgical treatment of patient was started with bypass graft from the right common carotid artery to the left common carotid with subsequent revascularization of left subclavian artery. Lower parts of above-mentioned arteries were ligated. At the second stage an emergent prosthetic stent-graft was placed distally from the truncus brachiocephalicus up to the proximal part of the descending aorta. We reported a case report to present diagnostic and possible interventional treatment for patient with acute aortic type A dissection.

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