VASCULAR RING- LEFT AORTIC ARCH WITH RIGHT DESCENDING THORACIC AORTA AND RIGHT LIGAMENTUM ARTERIOSUM

Spontaneous rupture of the aorta - a violation of the integrity of the aortic wall which is not caused by an aneurysm, trauma, dissection or disintegrating tumor process, and is an acute life-threatening condition. According to some authors, the main cause of spontaneous rupture of the aorta is a penetrating atherosclerotic ulcer of the aorta, which is an ulceration of aortic atherosclerotic plaque leading to penetration of the internal elastic plate in media. We present a case of successful hybrid surgical treatment of patient with spontaneous rupture of the descending thoracic aorta with the formation of para-aortic hematoma and left-sided hemothorax. The patient underwent a hybrid operation - aortic arch and descending thoracic aorta prosthetic repair, subclavian bypass with left subclavian artery ligation, left-sided thoracotomy, and pleural cavity sanitation. No intraoperative complications were observed, the patient was taken off the ventilator on day 2. The control computed tomography performed on day 10, revealed correct and stable stent graft position with no signs of continued bleeding, endoleak. The patient was discharged in satisfactory condition on day 14. Due to the high hospital mortality of open surgery on the thoracic aorta in case of penetrating atherosclerotic ulcers, as well as the predominance of elderly patients with severe comorbidities that contraindicate open surgery using cardiopulmonary bypass, endovascular and hybrid technologies, which are minimally invasive and traumatic, come to the fore. Endovascular prosthetic repair in case of penetrating atherosclerotic ulcer of aortic arch and descending thoracic aorta is an effective and safe procedure in patients at high risk, showing encouraging long-term results.

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Use of Contrast-Enhanced MR Angiography (CE-MRA) for the Diagnosis of a Vascular Ring Anomaly in a Dog

Case Reports in Veterinary Medicine ◽

10.1155/2012/316530 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Silke Hecht ◽

April M. Durant ◽

William H. Adams ◽

Gordon A. Conklin

Keyword(s):

Magnetic Resonance ◽

Aortic Arch ◽

Vascular Ring ◽

Ligamentum Arteriosum ◽

University Of Tennessee ◽

Contrast Enhanced ◽

Dry Food ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Band Crossing

A 4-month-old female mixed breed dog was presented to the University of Tennessee College of Veterinary Medicine with a history of regurgitation and cachexia. Thoracic radiographs revealed focal megaesophagus cranial to the heart base. Magnetic resonance imaging (MRI) was performed. True fast imaging with steady-state precession (TrueFISP), fast low angle shot (FLASH), and short tau inversion recovery (STIR) sequences were acquired prior to contrast medium administration. Contrast-enhanced magnetic resonance angiography (CE-MRA) demonstrated focal megaesophagus and position of the aortic arch to the right of the esophagus. A small ductus diverticulum and an indistinct linear soft tissue band crossing the esophagus were also noted. Surgical exploration confirmed MR diagnosis of a persistent right aortic arch (PRAA) with left ligamentum arteriosum. The dog improved following surgery but was unable to be transitioned to dry food. To our knowledge this is the first report describing the use of CE-MRA for preoperative diagnosis and guided surgical treatment of a vascular ring anomaly in a dog.

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Intraoperative video showing the sequence of the operation highlighting the removal of the stent and infected material and further reconstruction of the aortic arch, proximal descending thoracic aorta and supra-aortic trunks using a Thoraflex PlexusTM (Terumo Aortic, Vascutek) with cardiopulmonary bypass, moderate hypothermic circulatory arrest and antegrade cerebral perfusion.

ASVIDE ◽

10.21037/asvide.2021.367 ◽

2021 ◽

Vol 8 ◽

pp. 367-367

Author(s):

Ana Lopez-Marco ◽

Saleem Jahangeer ◽

Benjamin Adams ◽

Aung Ye Oo

Keyword(s):

Cardiopulmonary Bypass ◽

Aortic Arch ◽

Thoracic Aorta ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Descending Thoracic Aorta ◽

Infected Material ◽

Antegrade Cerebral Perfusion

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Video-Assisted Thoracoscopic Division of Vascular Rings in Pediatric Patients

The American Surgeon ◽

10.1177/000313480507100403 ◽

2005 ◽

Vol 71 (4) ◽

pp. 289-291 ◽

Cited By ~ 8

Author(s):

Curt S. Koontz ◽

Amina Bhatia ◽

Joe Forbess ◽

Mark L. Wulkan

Keyword(s):

Aortic Arch ◽

Pediatric Patients ◽

Vascular Ring ◽

Operating Time ◽

Surgical Techniques ◽

Retrospective Chart Review ◽

Ligamentum Arteriosum ◽

Vascular Rings ◽

Computed Tomographic ◽

Video Assisted

Vascular rings are usually repaired via left thoracotomy. We report our series of pediatric patients with vascular rings that were repaired thoracoscopically. From February 2002 to September 2004, 13 patients underwent video-assisted thoracoscopic surgical techniques (VATS) division of their vascular ring. Chest magnetic resonance arterography (MRA) and/or computed tomographic arteriography (CTA) were used to evaluate the vascular ring in most patients. Patients were chosen for VATS repair based on surgeon's choice and type of vascular ring. Data are expressed as mean ± SD. The Children's Healthcare of Atlanta Institutional Review Board approved this retrospective chart review. Age and weight was 1.5 ± 1.8 years (range: 4 months–17 years) and 16.0 ± 12.5 kg (range: 6.0–22.1 kg), respectively (n = 13). Associated diseases included congenital heart disease (n = 2). Symptoms included respiratory complaints (n = 6), dysphagia (n = 2), dysphagia and shortness of breath (n = 1), pneumonia (n = 2), tracheal deviation (n = 1), and one patient was asymptomatic. Vascular ring types included double aortic arch (n = 4) and right aortic arch with an aberrant left subclavian artery and a left ligamentum arteriosum (n = 9). Operating time was 70 ± 20 minutes (range: 46–122 minutes). One patient had to be opened because of a large arch. Length of stay was 1.9 ± 0.9 days (range: 1–3 days). There were no complications, and all patients improved clinically at follow-up. Thoracoscopic repair of certain types of vascular rings seems to be safe and effective in children. More patients, however, need to be studied.

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Typical Asthmatic Presentation of Congenital Vascular Ring Can Masquerade a General Physician

Case Reports in Vascular Medicine ◽

10.1155/2013/934790 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4

Author(s):

Naveen Swami ◽

Georgey Koshy ◽

Maan Jamal ◽

Thair S. Abdulla ◽

Abdulaziz Alkhulaifi

Keyword(s):

Aortic Arch ◽

Vascular Ring ◽

Chest Ct ◽

General Physician ◽

Ligamentum Arteriosum ◽

Tracheal Compression ◽

X Ray ◽

Chest X Ray

A 24-year-old woman was referred to pulmonologist with worsening breathlessness and wheeze. During childhood, she was diagnosed with asthma and subsequent exacerbations were treated with bronchodilators for many years. The chest X-ray and a spirometry testing raised a doubt of extrinsic tracheal compression and a subsequent enhanced chest CT (computerized tomogram) scan confirmed a right-sided aortic arch and a vascular ring anomaly compressing the trachea. Standard surgical division of ligamentum arteriosum was able to relieve the trachea and so the symptoms.

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