A Case of Replacement of the Ascending Aorta, Transverse Aortic Arch, Descending Aorta, and Upper Abdominal Aorta Using the "Elephant Trunk" Operation.

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.

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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

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506 Uneventful pseudoaneurysm of the ascending aorta with sternal erosion in pregnancy

European Heart Journal Supplements ◽

10.1093/eurheartj/suaa210 ◽

2020 ◽

Vol 22 (Supplement_N) ◽

pp. N142-N145

Author(s):

Alice Benedetti ◽

Alvise Del Monte ◽

Maurizio Rubino ◽

Daniela Mancuso

Keyword(s):

Aortic Valve ◽

Aortic Arch ◽

Left Ventricular ◽

Ascending Aorta ◽

Aortic Arch Aneurysm ◽

Elective Cesarean Section ◽

Elephant Trunk ◽

Severe Aortic Regurgitation ◽

Intimal Flap ◽

Arch Aneurysm

Abstract A 36-year-old woman at 31 weeks’ gestation presented with exertional dyspnoea and palpitations. She had a history of bicuspid aortic valve treated with surgical aortic valvotomy for severe stenosis, followed by ascending aorta replacement for type A acute aortic dissection and Bentall operation with a mechanical valve for severe aortic regurgitation. Eight years after the last surgery, magnetic resonance angiography showed aortic arch aneurysm (49 mm) with a small intimal flap. Thereafter, the patient was lost to follow-up until the current admission. She was hemodynamically stable on presentation and physical examination was unremarkable apart from a mechanical second heart sound. The electrocardiogram showed sinus rhythm with left bundle branch block (Panel A). Transthoracic echocardiography revealed severe left ventricular dilation (EDV 90 ml/m2) with mild dysfunction (EF 50%), normal prosthetic aortic valve function, and aortic arch dilation (50 mm) (Panel B and C). After a multidisciplinary evaluation, elective cesarean section was performed at 34 weeks’ gestation. A post-delivery aortic computed tomography angiography revealed aortic arch aneurysm (52 mm) with intimal flap and two pseudoaneurysms of the anterior aortic wall causing sternal erosion (Panel D, E, F and G). Subsequently, the patient underwent ascending aorta and aortic arch replacement by Frozen Elephant Trunk technique with a 24 x130 mm prosthesis between the aortic root and the descending aorta. The postoperative course was uneventful, and the patient was discharged to a cardiac rehabilitation centre.

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Structural Features in Tunica Media of the Aorta in Lamb

Bulletin of University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca Veterinary Medicine ◽

10.15835/buasvmcn-vm:12624 ◽

2017 ◽

Vol 74 (1) ◽

pp. 111

Author(s):

Dalma CSIBI ◽

Adrian Florin GAL ◽

Cristian RATIU ◽

Viorel MICLAUS

Keyword(s):

Aortic Arch ◽

Outer Part ◽

Structural Features ◽

Ascending Aorta ◽

Tissue Samples ◽

Descending Aorta ◽

Tunica Media ◽

Classic Pattern ◽

The Media ◽

Thoracic And Abdominal

In blood vessels situated just after the heart, an irregular blood flow occurs due to some specific structural elements of the tunica media. The current paper describes the histological aspects of some post-cardiac arterial sections in lamb. The tissue samples were collected from five 30 days old male lambs (ÈšurcanÄƒ breed). Histological specimens from different regions of the aorta were harvested (i.e., the ascending aorta, aortic arch, thoracic and abdominal regions of the descending aorta). From the specified regions, small pieces (cca. 0.5 cm) were fixed in neutral 10% buffered formalin. The tissues were subsequently embedded in paraffin wax, sectioned at 5 Î¼m, and stained with Goldnerâ€™s trichrome and Verhoeff methods. Tissue analysis was performed using an Olympus system for image acquisition and analysis. Histological appearance of the assessed segments of the aorta in lamb is unusual. Major changes occur in tunica media of the aorta. In the ascending aorta, aortic arch and thoracic regions of the aorta, the histological outline is somewhat the same. The internal region of the media possesses the typical lamellar arrangement. Concerning the outer part of tunica media, the smooth muscle has a tendency to form bundles of various sizes. The muscle islands are not present in the media of abdominal region of the aorta, which exhibits the classic pattern of elastic arteries.

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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.

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Primary replacement of the aortic valve, ascending aorta, aortic arch and descending aorta in a patient with Marfan syndrome and dissecting aneurysm.

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.17.127 ◽

1987 ◽

Vol 17 (2) ◽

pp. 127-129 ◽

Cited By ~ 1

Author(s):

J. Tanaka

Keyword(s):

Aortic Valve ◽

Aortic Arch ◽

Marfan Syndrome ◽

Dissecting Aneurysm ◽

Ascending Aorta ◽

Descending Aorta

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ARCH Replacement in Acute Aortic Dissection Type a in Normothermia

Revista de Chimie ◽

10.37358/rc.20.3.7998 ◽

2001 ◽

Vol 71 (3) ◽

pp. 282-286

Author(s):

Ovidiu Stiru ◽

Roxana Carmen Geana ◽

Adrian Tulin ◽

Raluca Gabriela Ioan ◽

Victor Pavel ◽

...

Keyword(s):

Aortic Dissection ◽

Ct Scan ◽

Aortic Arch ◽

Acute Aortic Dissection ◽

Circulatory Arrest ◽

Type A ◽

Ascending Aorta ◽

Descending Aorta ◽

The Right ◽

Aortic Dissection Type A

The purpose of this case presentation is to present a simplified surgical technique when in a patient with acute aortic dissection type A (AAD), aortic arch, and ascending aorta is completely replaced without circulatory arrest. A 67-year old male was presented in our institution with severe chest and back pain at 12 h after the onset of the symptoms. Imaging studies by 3D contrast-enhanced thoracic computed tomography (CT-scan) and transesophageal echocardiography (TEE) revealed ascending aortic dissection towards the aortic arch, which was extending in the proximal descending aorta. We practiced emergency median sternotomy and established cardiopulmonary bypass (CBP) between the right atrium and the right femoral artery with successive cross-clamping of the ascending and descending aorta below the origin of the left subclavian artery (LSA). In normothermic condition without circulatory arrest and with antegrade cerebral perfusion, we replaced the ascending aorta and aortic arch with a four branched Dacron graft. Patient evolution was uneventful, and he was discharged, after fourteen days from the hospital. At a one-year follow-up, 3D CT-scan showed no residual dissection with a well-circulated lumen of the supra-aortic arteries. Using the described surgical approach, CPB was not interrupted, the brain was protected, and hypothermia was no used. This approach made these surgical procedures shorter, and known complications of hypothermia and circulatory arrest are avoided.Acute aortic dissection aortic type A, total arch replacement, normothermia

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