scholarly journals High prevalence of early arch reobstruction after arch repair in patients with anomalous right subclavian artery

2019 ◽  
Vol 57 (1) ◽  
pp. 78-84 ◽  
Author(s):  
Nandhini Ravintharan ◽  
Yves d’Udekem ◽  
Matthew Henry ◽  
Johann Brink ◽  
Igor E Konstantinov ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Subclavian Artery ◽  
Adverse Outcomes ◽  
Bronchial Obstruction ◽  
High Prevalence ◽  
Long Term Follow Up ◽  
Arch Obstruction ◽  
Subclavian Vessel

Abstract OBJECTIVES Having an anomalous right subclavian artery has been quoted to be a risk factor for early and late adverse events. We wanted to determine the rate of adverse outcomes in patients who have undergone arch repair with an associated anomalous right subclavian artery. METHODS The follow-up of 76 patients, with an anomalous right subclavian artery, who underwent arch repair at a single institution for various indications between 1981 and 2017 was reviewed. RESULTS There were 12 patient deaths. Twenty-three patients required an aortic arch reintervention (17 surgeries, 2 of which were indicated for bronchial obstruction). At last follow-up, 8 of 54 surviving patients (15%) had arch reobstruction (peak gradient >25 mmHg or reintervention). Freedom from aortic arch obstruction at 10 and 15 years was 51% [95% confidence interval (CI) 36–65%] and 35% (95% CI 19–51%), respectively. Neither the complete resection of the adjacent ridge nor the detachment and reimplantation of the anomalous subclavian vessel seemed to have an impact on the rate of reobstruction [hazard ratio (HR) 1.6, 95% CI 0.77–3.5; P = 0.2 and HR 0.61, 95% CI 0.083–4.5; P = 0.6, respectively]. CONCLUSIONS Patients with an anomalous right subclavian artery are at risk of arch reobstruction necessitating reintervention but long-term follow-up was unable to demonstrate the mechanism of this obstruction in patients with this anomaly.

Safety Behaviors and Speech Treatment for Adults Who Stutter

2014 ◽  
Vol 57 (4) ◽  
pp. 1308-1313 ◽  
Author(s):  
Fjola Dogg Helgadottir ◽  
Ross G. Menzies ◽  
Mark Onslow ◽  
Ann Packman ◽  
Sue O'Brian
Keyword(s):  
Social Phobia ◽  
Behavior Therapy ◽  
Cognitive Behavior ◽  
Safety Behaviors ◽  
Safety Behavior ◽  
High Prevalence ◽  
Long Term Follow Up ◽  
Adults Who Stutter

Purpose Those with anxiety use safety behaviors when attempting to prevent negative outcomes. There is evidence that these behaviors contribute to the persistence of anxiety disorders. Safety behaviors have been prominent in the cognitive behavior therapy literature during the last decade, particularly with social phobia management. However, nothing is known of safety behavior use by those who stutter. This is surprising given the high prevalence of social phobia in the stuttering population who seek clinical help. Method Clinical psychologists and speech-language pathologists (SLPs) created a list of safety behaviors that might be used by adults during treatment for stuttering. Participants were 160 SLPs who were asked whether they advised adults who stutter to use any of these safety behaviors. Results SLPs commonly recommend safety behaviors during stuttering management. Factor structures were found for the following 5 safety behavior categories: (a) general safety behaviors, (b) practice and rehearsal, (c) general avoidance, (d) choosing safe and easy people, and (e) control-related safety behaviors. Conclusions There is a need to determine the frequency with which adults who receive stuttering treatment follow these clinician recommendations. In addition, there is a need to experimentally determine whether following such recommendations prevents fear extinction at long-term follow-up.

scholarly journals Coarctation repair through left thoracotomy in neonates and infants

2018 ◽  
Vol 22 (4) ◽  
pp. 12
Author(s):  
M. M. Belyaeva ◽  
V. N. Ilyin ◽  
O. Yu. Kornouhov ◽  
Yu. Yu. Kornouhov ◽  
O. I. Kalinina
Keyword(s):  
Aortic Arch ◽  
Conflict Of Interest ◽  
Septal Defect ◽  
Coarctation Repair ◽  
Long Term Follow Up ◽  
End To End ◽  
Neonates And Infants ◽  
Aortic Arch Hypoplasia

<p><strong>Aim.</strong> A growing interest in the use of sternotomy and perfusion for repair of aortic coarctation in neonates and infants has enabled us to retrospectively review our own experience in this practice. Our purpose was to determine the efficacy of coarctation repair with extended end-to-end anastomosis through left thoracotomy focusing on a re-intervention rate and dynamics of transverse aortic arch growth during long-term follow-up. <br /><strong>Methods.</strong> One hundred and twenty-four patients under 3 months old who underwent coarctation repair (between 2008 and 2016) were enrolled in this study. In 43 patients (35%), aorta coarctation was combined with ventricular septal defect, 49 patients (39.5%) had transversal aortic arch hypoplasia (Z-score less than –2). All operations were carried out by using extended “end-to-end” anastomosis technique via thoracotomy. In patients with concomitant ventricular septal defect, PA-banding was performed simultaneously. Overall follow-up was 3.6 (0.3–8.0) years. <br /><strong>Results.</strong> Early mortality was 1.6%. Late survival rate was 93.5%. Recurrent aortic arch obstruction was revealed in 10 (8%) patients, on the average, in 6.5 (3.5–15) months after coarctation repair. Management of re-stenosis with balloon aortoplasty was effective in all cases and had no complications. A statistically significant growth (p&lt;0.001) of the transverse aortic arch was observed in those patients who had hypoplasia of the arch before surgery. <br /><strong>Conclusion.</strong> Repair of coarctation of the aorta by resection and extended “end-to-end” anastomosis via thoracotomy without perfusion has low operative mortality, an excellent survival rate and a reduced rate of balloon re-intervention. Patients with baseline moderate transverse aortic arch hypoplasia demonstrate a growth of the aorta up to normal values in long-term follow-up. Endovascular balloon dilatation of aortic re-coarctation zone during long-term follow-up is an effective and safe procedure. <br />Received 20 June 2018. Revised 5 September 2018. Accepted 12 September 2018.<br /><strong>Funding:</strong> The study did not have sponsorship.<br /><strong>Conflict of interest:</strong> Authors declare no conflict of interest.<br /><strong>Author contributions</strong><br />Conception and study design: V.N. Ilyin<br />Data collection and analysis: M.M. Belyaeva, O.Yu. Kornoukhov, Yu.Yu. Kornoukhov, O.I. Kalinina<br />Drafting the article: M.M. Belyaeva <br />Critical revision of the article: V.N. Ilyin, O.Yu. Kornoukhov<br />Final approval of the version to be published: M.M. Belyaeva, V.N. Ilyin, O.Yu. Kornoukhov, Yu.Yu. Kornoukhov, O.I. Kalinina</p>

Long-term follow-up of subvalvular aortic stenosis in children: a single-centre experience

2021 ◽  
pp. 1-8
Author(s):  
Mehmet G. Ramoğlu ◽  
Selen Karagözlü ◽  
Tayfun Uçar ◽  
Zeynep Eyileten ◽  
Adnan Uysalel ◽  
...  
Keyword(s):  
Aortic Insufficiency ◽  
Adverse Outcomes ◽  
Subaortic Stenosis ◽  
Male Predominance ◽  
Single Centre Experience ◽  
Long Term Follow Up ◽  
Echocardiographic Parameters ◽  
Subvalvular Aortic Stenosis

Abstract Objective: The aim of this study is to evaluate clinical and surgical outcomes of children with subaortic stenosis, to determine the risk factors for surgery and reoperation and to compare isolated subaortic stenosis and those concomitant with CHDs. Methods: The study involved 80 children with subaortic stenosis. The patients were first classified as isolated and CHD group, and the isolated group was further classified as membranous/fibromuscular group. The initial, pre-operative, post-operative and the most recent echocardiographic data, demographic properties and follow-up results of the groups were analysed and compared. The correlation of echocardiographic parameters with surgery and reoperation was evaluated. Results: There was a significant male predominance in all groups. The frequency of the membranous type was higher than the fibromuscular type in the whole and the CHD group. The median time to the first operation was 4.6 years. Thirty-five (43.7%) patients underwent surgery, 5 of 35 (14%) patients required reoperation. The rate of surgery was similar between groups, but reoperation was significantly higher in the isolated group. The gradient was the most important factor for surgery and reoperation in both groups. In the isolated group besides gradient, mitral-aortic separation was the only echocardiographic parameter correlated with surgery and reoperation. Conclusion: Reoperation is higher in isolated subaortic stenosis but similar in membranous and fibromuscular types. Early surgery may be beneficial in preventing aortic insufficiency but does not affect the rate of reoperation. Higher initial gradients are associated with adverse outcomes, recurrence and reoperation.

Reply: Impact of Cardio-Renal Syndrome on adverse outcomes in patients with Fabry disease in a long-term follow-up

2018 ◽  
Vol 258 ◽  
pp. 206
Author(s):  
Albina Nowak ◽  
Martin Siegenthaler ◽  
Mehdi Namdar ◽  
Frank Ruschitzka
Keyword(s):  
Fabry Disease ◽  
Adverse Outcomes ◽  
Long Term Follow Up

scholarly journals Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case–control study

Vascular ◽  
2016 ◽  
Vol 24 (5) ◽  
pp. 523-530 ◽  
Author(s):  
Misato Kobayashi ◽  
Lyubov Chaykovska ◽  
Bernd van der Loo ◽  
Thi Dan Linh Nguyen ◽  
Gilbert Puippe ◽  
...  
Keyword(s):  
Aortic Arch ◽  
False Lumen ◽  
Long Term Results ◽  
Acute Type ◽  
Elephant Trunk ◽  
Long Term Follow Up ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Aim To describe the long-term experience of a simplified frozen elephant trunk technique (sFETT) used in complicated acute type A aortic dissection (AAAD) treatment. Methods and results Between January 2001 and December 2012, 34 patients (mean age 59.9 ± 11.0 years) with complicated AAAD (DeBakey I) underwent an emergency surgery including sFETT. sFETT consisted in gluing the dissected aortic arch wall layers with gelatine-resorcinol adhesive and video-assisted antegrade open arch aortic stent-graft deployment in the arch or proximal descending aorta. In addition to sFETT, the aortic root was addressed with standard techniques. A 30-day mortality was 14.7% (five patients) due to bleeding (1), multiple organ failure (2), and colon ischemia (2). Postoperative morbidity included neurological (2), renal (1) and cardio-pulmonary complications (4), as well as wound infection (1). Mean follow-up was 74.4 ± 45.0 months. Actual survival rates were 73.5% at 1 year, 70.2% at 5 years, and 58.5% at 13 years of follow-up. Six patients died during long-term follow-up from heart failure (1) and unknown reasons (5). Five patients required reoperation for aortic arch (3) or aorto-iliac (2) progression of aneurysm during the mid- and long-term follow-up. The remaining patients showed favorable evolution of the dissected aorta with false lumen occlusion in most cases and stable aortic diameters. Conclusions In AAAD patients, sFETT as used in our series is an easy and safe technique to repair the aortic arch. Long-term results after sFETT showed false lumen occlusion and stable aortic diameter in up to 13 years of follow-up.

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