Penza's Surgical Maneuver: A Key to Tackle Complex Proximal Descending Thoracic Aortic Infectious or Malignant Issues

Evgeny Rosseykin; Dmitry Chichevatov; Evgeny Sinev; Evgeny Kobzev

doi:10.1055/s-0040-1714059

Penza's Surgical Maneuver: A Key to Tackle Complex Proximal Descending Thoracic Aortic Infectious or Malignant Issues

Aorta ◽

10.1055/s-0040-1714059 ◽

2020 ◽

Vol 08 (03) ◽

pp. 083-090

Author(s):

Evgeny Rosseykin ◽

Dmitry Chichevatov ◽

Evgeny Sinev ◽

Evgeny Kobzev

Keyword(s):

Aortic Arch ◽

Descending Aorta ◽

Off Pump ◽

Aortic Isthmus ◽

Safe Surgery

AbstractWe performed off-pump ascending-to-descending aortic grafting with the debranching of left carotid and subclavian arteries and total aortic arch transection in three patients. We have called this technique “Penza's Surgical Maneuver” and propose it for a safe surgery in cases where the aortic arch, the aortic isthmus, the beginning segment of the descending aorta, the esophagus, and a lung are diseased.

Download Full-text

Abnormal histology of the aortic arch in coarctation of the aorta

Cardiology in the Young ◽

10.1017/s1047951100001852 ◽

1993 ◽

Vol 3 (4) ◽

pp. 412-416 ◽

Cited By ~ 3

Author(s):

Derk W. Wolterbeek ◽

Arie P. Kappetein ◽

Adriana C. Gittenberger–de Groot

Keyword(s):

Neural Crest ◽

Aortic Arch ◽

Aortic Coarctation ◽

Coarctation Of The Aorta ◽

Lower Number ◽

Descending Aorta ◽

Aortic Isthmus ◽

Cardiac Neural Crest ◽

The Media

SummaryWe examined the number of elastic lamellae in the wall of the proximal aortic arch, aortic isthmus and descending aorta in patients with coarctation of the aorta. In the proximal aortic arch, the number of elastic lamellae was significantly lower in patients with coarctation compared to those with normal hearts without aortic anomalies and those with intracardiac defects but without aortic anomalies. The isthmus also showed a significantly lower number of elastic lamellae in the presence of preductal coarctation. In the descending aorta, the number of elastic lamellae was not significantly different between the different groups. There is doubt about the etiology of coarctation. Recent investigations showed that cells from the cardiac neural crest contribute to the formation of the arch arteries and the media of the arch. A developmental error of the neural crest might be responsible for the abnormal mural structures found in patients with aortic coarctation.

Download Full-text

Bioelastic properties of the aorta in children, adolescents and young adults after cardiac transplantation: a cardiovascular magnetic resonance study

European Heart Journal ◽

10.1093/eurheartj/ehab724.0225 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

F Mueller ◽

K Gummel ◽

B Reich ◽

H Latus ◽

C Jux ◽

...

Keyword(s):

Aortic Arch ◽

Thoracic Aorta ◽

Cardiac Transplantation ◽

Ascending Aorta ◽

Control Group ◽

Cross Sectional ◽

Descending Aorta ◽

Aortic Isthmus ◽

Myocardial T1 ◽

Study Population

Abstract Background Long-term complications after cardiac transplantation are common and typically include arterial hypertension and coronary allograft vasculopathy. Few studies also suggested that heart transplant recipients have an increased arterial stiffness. Purpose This prospective study aimed to assess the bioelastic properties of the aorta as well as LV function, morphology and structure in children and young adults after cardiac transplantation. Methods CMR studies from 34 patients (median age: 17.1 years, range: 8–24 years) who underwent cardiac transplantation in childhood were analysed. Aortic anatomy and distensibility were assessed at five locations of the thoracic aorta using steady-state free precession cine sequences. Pulse wave velocity (PWV) of the aortic arch and the descending thoracic aorta was measured from 2-dimensional phase contrast images. Size and function of the left atrium and the ventricles were assessed from a stack of short axis slices. Myocardial T1 times were determined using a standard MOLLI sequence. Results Cross-sectional areas of the ascending aorta and the aortic arch tended to be lower in patients compared to controls (ascending aorta 464.5±172.5 mm2 vs. 515.3±186.3 mm2, aortic arch 342.4±113.3 mm2 vs. 376.9±148.5 mm2) whereas cross-sectional areas of the descending aorta tended to be higher (aortic isthmus 283.7±102.1 mm2 vs. 257.9±89.5 mm2, aorta descendens diaphragmal 218.4±75.8 mm2 vs. 214.2±75.0 mm2) and showed a correlation with systolic blood pressure (r=0.33). PWV was higher in the aortic arch (4.8±2.4 m/s vs. 3.6±0.7 m/s). Aortic distensibility was slightly higher at all measuring points in the study population compared to the control group and showed an increase with rising distance from the heart (ascending aorta 10.5±5.8 10–3 mm Hg-1, aortic isthmus 13.1±7.5 10–3 mm Hg-1, descending aorta 16.6±6.8 10–3 mm Hg-1). Biventricular volumes were slightly reduced in the patient group compared to the control group but this was not statistically significant. Only left ventricular mass messured during the systolic phase was higher in the study population compared to the control group (males 55.1 g/m2 vs. 53.0 g/m2, females 46.2 g/m2 vs. 45.2 g/m2). T1 mapping demonstrated increased T1 times in the heart-transplanted group compared to published data in healthy adults. In particular, T1 times of the lateral and inferior myocardial segments were higher. Conclusion Patients who underwent cardiac transplantation in childhood seem to have a reduced bioelasticity of the thoracic aorta. Increased myocardial T1 times suggesting alterations in myocardial structure. FUNDunding Acknowledgement Type of funding sources: None.

Download Full-text

Off-Pump Extraanatomic Bypass from the Ascending to the Descending Aorta for Re-Operation of Interrupted Aortic Arch in an Adolescent

Journal of Cardiac Surgery ◽

10.1111/j.1540-8191.2008.00798.x ◽

2009 ◽

Vol 24 (5) ◽

pp. 541-543 ◽

Cited By ~ 1

Author(s):

Nora Lang ◽

Ralf Sodian ◽

Edward Malec ◽

Katarzyna Januszewska ◽

Rainer Kozlik-Feldmann ◽

...

Keyword(s):

Aortic Arch ◽

Interrupted Aortic Arch ◽

Extraanatomic Bypass ◽

Descending Aorta ◽

Off Pump

Download Full-text

Off-pump ascending aorta or aortic arch to descending aorta bypass with a pericardial roll for the treatment of critically ill infants with interrupted aortic arch

Cardiology in the Young ◽

10.1017/s1047951120001687 ◽

2020 ◽

Vol 30 (8) ◽

pp. 1095-1102

Author(s):

Didem M. Oztas ◽

Mert Meric ◽

Metin O. Beyaz ◽

Senay Coban ◽

Gizem Sari ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Aortic Arch ◽

Critically Ill ◽

Septal Defect ◽

Single Ventricle ◽

Interrupted Aortic Arch ◽

Ascending Aorta ◽

Descending Aorta ◽

Off Pump ◽

Aorta Bypass

AbstractAim:Standard surgical treatment of the interrupted aortic arch with the use of cardiopulmonary bypass is risky especially in critically ill babies. In this manuscript, we present the results of off-pump pericardial roll bypass for the treatment of aortic interruption.Material and methods:The technique was applied in nine critically ill infants between July 2011 and December 2019. Data were reviewed retrospectively. There were four girls and five boys. The types of the interruption were type B in six cases and type A in three babies. Additional cardiovascular anomalies were ventricular septal defect in all, atrial septal defect or patent foramen ovale in all, single-ventricle pathologies in two and bicuspid aortic valve in three cases. All the patients were in critical situations such as intubated, having symptoms of infection, congestive heart failure or ischaemia and malperfusion leading visceral organ dysfunction.Results:All patients underwent off-pump ascending aorta or aortic arch to descending aorta bypass with a pericardial roll. Post-operative early mortality occurred in one patient with severe mitral regurgitation due to cardio-septic shock. One patient who had single-ventricle pathology underwent bidirectional Glenn and was lost on the post-operative 26th day due to sepsis 2 years after operation. Two patients presented with dilatation of the pericardial tube 18 and 24 months after the operations and one underwent reconstruction of the neo-arch. The remaining patients are asymptomatic, active and within normal limits of body and mental growth.Conclusion:Treatment of interrupted aortic arch with a bypass with an autologous pericardial roll treated with gluteraldehyde without cardiopulmonary bypass seems a safe and reliable technique especially for the treatment of critically ill infants.

Download Full-text

Dilatation of the entire thoracic aorta in patients with bicuspid aortic valve: a magnetic resonance angiography study

VASA ◽

10.1024/0301-1526.34.3.181 ◽

2005 ◽

Vol 34 (3) ◽

pp. 181-185 ◽

Cited By ~ 12

Author(s):

Westhoff-Bleck ◽

Meyer ◽

Lotz ◽

Tutarel ◽

Weiss ◽

...

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Aortic Valve ◽

Pulmonary Artery ◽

Aortic Arch ◽

Thoracic Aorta ◽

Aortic Root ◽

Ascending Aorta ◽

Descending Aorta ◽

Severe Aortic Regurgitation

Background: The presence of a bicuspid aortic valve (BAV) might be associated with a progressive dilatation of the aortic root and ascending aorta. However, involvement of the aortic arch and descending aorta has not yet been elucidated. Patients and methods: Magnetic resonance angiography (MRA) was used to assess the diameter of the ascending aorta, aortic arch, and descending aorta in 28 patients with bicuspid aortic valves (mean age 30 ± 9 years). Results: Patients with BAV, but without significant aortic stenosis or regurgitation (n = 10, mean age 27 ± 8 years, n.s. versus control) were compared with controls (n = 13, mean age 33 ± 10 years). In the BAV-patients, aortic root diameter was 35.1 ± 4.9 mm versus 28.9 ± 4.8 mm in the control group (p < 0.01). The diameter of the ascending aorta was also significantly increased at the level of the pulmonary artery (35.5 ± 5.6 mm versus 27.0 ± 4.8 mm, p < 0.001). BAV-patients with moderate or severe aortic regurgitation (n = 18, mean age 32 ± 9 years, n.s. versus control) had a significant dilatation of the aortic root, ascending aorta at the level of the pulmonary artery (41.7 ± 4.8 mm versus 27.0 ± 4.8 mm in control patients, p < 0.001) and, furthermore, significantly increased diameters of the aortic arch (27.1 ± 5.6 mm versus 21.5 ± 1.8 mm, p < 0.01) and descending aorta (21.8 ± 5.6 mm versus 17.0 ± 5.6 mm, p < 0.01). Conclusions: The whole thoracic aorta is abnormally dilated in patients with BAV, particularly in patients with moderate/severe aortic regurgitation. The maximum dilatation occurs in the ascending aorta at the level of the pulmonary artery. Thus, we suggest evaluation of the entire thoracic aorta in patients with BAV.

Download Full-text

Aneurysm Hybrid Treatment by Simultaneous Replacement of Ascending Aorta and Aortic Arch and Endoluminal Stenting of the Descending Aorta

The Heart Surgery Forum ◽

10.1532/hsf98.20051033 ◽

2006 ◽

Vol 9 (1) ◽

pp. E530-E532

Author(s):

Friedrich-Christian Riess ◽

Hans Krankenberg ◽

Thilo Tübler ◽

Matthias Danne

Keyword(s):

Aortic Arch ◽

Ascending Aorta ◽

Descending Aorta ◽

Hybrid Treatment

Download Full-text

Type B Interrupted Aorta in an Adult Patient

The Heart Surgery Forum ◽

10.1532/hsf98.2013309 ◽

2014 ◽

Vol 17 (2) ◽

pp. 80

Author(s):

Ahmet Ozkara ◽

Mehmet Ezelsoy ◽

Levent Onat ◽

Ilhan Sanisoglu

Keyword(s):

Cardiopulmonary Bypass ◽

Aortic Arch ◽

Collateral Circulation ◽

Neonatal Period ◽

Interrupted Aortic Arch ◽

Complete Loss ◽

Posterolateral Thoracotomy ◽

Type B ◽

Case Presentation ◽

Descending Aorta

Introduction: Interrupted aortic arch is a rare congenital malformation characterized by a complete loss of luminal continuity between the ascending and descending aorta. It is often diagnosed during the neonatal period.Case presentation: We presented a 51-year-old male patient with interrupted aortic arch type B who was treated successfully with posterolateral thoracotomy without using cardiopulmonary bypass.Conclusion: The prognosis for interrupted aortic arch depends on the associated congenital anomalies, but the outcome is usually very poor unless there is surgical treatment. Survival into adulthood depends on the development of collateral circulation.

Download Full-text