An unusual approach for ascending aorta graft infection: pectoral muscle flap-wrapping via intercostal space

2016 ◽  
Vol 24 (3) ◽  
pp. 599-600
Author(s):  
Muhammet Akyüz
Keyword(s):  
Graft Infection ◽  
Muscle Flap ◽  
Pectoral Muscle ◽  
Ascending Aorta ◽  
Intercostal Space

Sternotomy Sparing Thoratec Heartmate 3 Implantation via Bilateral Minithoracotomy

2018 ◽  
Vol 13 (1) ◽  
pp. 74-76 ◽  
Author(s):  
Julia Riebandt ◽  
Dominik Wiedemann ◽  
Guenther Laufer ◽  
Daniel Zimpfer
Keyword(s):  
Left Ventricular ◽  
Ascending Aorta ◽  
Intercostal Space ◽  
Implantation Technique ◽  
Thromboembolic Complications ◽  
Short Term ◽  
Short Term Mortality ◽  
Transplant Candidates ◽  
The Right ◽  
Outflow Graft

A novel sternotomy sparing implantation technique for the Thoratec HeartMate 3 is described. Cannulation of the left ventricular apex is performed via a minithoracotomy in the left fourth or fifth intercostal space. The outflow graft is advanced through the pericardium to a second minithoracotomy in the right second intercostal space and then anastomosed to the ascending aorta. This approach was performed in three patients so far with no need for conversion. We did not observe any perioperative adverse events, such as bleeding or thromboembolic complications, as well as no short-term mortality. This technique is especially appealing in multimorbid and frail patients, future transplant candidates, and patients with impaired right ventricular function.

The deep pectoral muscle flap in the cat: its vascular supply and potential use

2000 ◽  
Vol 13 (03) ◽  
pp. 141-145 ◽  
Author(s):  
J. Gardner ◽  
R. Allnutt ◽  
R. A. S. White ◽  
S. J. Baines
Keyword(s):  
Internal Thoracic Artery ◽  
Vascular Anatomy ◽  
Muscle Flap ◽  
Pectoral Muscle ◽  
Vascular Supply ◽  
Vascular Pattern ◽  
Lateral Thoracic Artery ◽  
Type V ◽  
Flap Perfusion ◽  
Potential Use

SummaryThe vascular anatomy of the deep pectoral muscle in the cat was defined by contrast radiography of twelve deep pectoral muscles from six feline cadavers. The deep pectoral, muscle in the cat was found to have a type V vascular pattern with a dominant pedicle based on the lateral thoracic artery, with a contribution from the external thoracic artery, and secondary segmental pedicles arising from the internal thoracic artery, with numerous anastomoses between these two vascular fields. Following division of the sternal origin and elevation of the muscle flap, perfusion of the entire muscle from the dominant pedicle was identified. Transposition of the muscle flap within a wide arc of rotation was possible to include the chest wall, sternum, axilla and medial forelimb. This study demonstrates the potential suitability of the deep pectoral muscle flap for use in reconstructive surgery.The feline deep pectoral muscle has a type V vascular pattern, with a dominant pedicle based on the lateral thoracic artery, with a contribution from the external thoracic artery, and secondary segmental pedicles arising from the internal thoracic artery A clinically useful flap, supplied by the dominant pedicle, may be developed by incising the sternal origin of the muscle.

Transaortic Endoclamp for Mitral Valve Operation through Right Minithoracotomy in 369 Patients

2010 ◽  
Vol 5 (6) ◽  
pp. 394-399 ◽  
Author(s):  
Donald D. Glower ◽  
Bhargavi Desai
Keyword(s):  
Mitral Valve ◽  
Ascending Aorta ◽  
Intercostal Space ◽  
Safe Alternative ◽  
Aortic Clamping ◽  
Mitral Valve Operation ◽  
Group A ◽  
Aortic Cannula ◽  
Group B ◽  
Valve Operation

Objective The effects and benefits of a transaortic endoclamp for mitral valve operation through right minithoracotomy have not been established. Methods The records were examined in 671 patients undergoing mitral valve operation using aortic cannulation through a 6-cm right minithoracotomy in the fourth intercostal space. The ascending aorta was cannulated with a 24-Fr cannula through a 12-mm port in the first intercostal space. The experience from 1998 to 2006 with aortic endoclamping (group A, N = 436) was compared with the experience from 2006 to 2009 with external aortic clamping (group B, N = 235). Aortic endoclamping was achieved with a 30 mL endoclamp introduced through the aortic cannula into the ascending aorta to provide aortic endoclamping, anterograde cardioplegia, and root venting. Percutaneous femoral venous cannulation was used. Results Group A and group B had similar demographics. Endoclamp availability (group A) resulted in significantly less fibrillatory arrest (no clamping) in 67 of 436 (15%) versus 104 of 235 (44%) patients in group B (P = 0.001). In patients with aortic clamping, endoclamp (group A) versus external clamp (group B) was not a determinant of clamp time or pump time. Hospital and late outcomes were not different between groups. No patient complications could be attributed to the endoclamp. Conclusions Aortic endoclamping requires no more clamp or pump time than external clamping and can provide a more bloodless field than ventricular fibrillation without obstructing hardware. Aortic endoclamping is a safe alternative for mitral surgery through right minithoracotomy.

scholarly journals Pseudoaneurysm of Ascending Aorta with Sternal Erosion after Double Valve Replacement—A Case Report

2019 ◽  
Vol 04 (02) ◽  
pp. 092-094
Author(s):  
Ravi Kumar Kathi ◽  
Amaresh Rao Malempati ◽  
Goutham Kollapalli ◽  
Chaitra Krishna Batt ◽  
Sayyad Sohail Tarekh
Keyword(s):  
Rare Complication ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Muscle Flap ◽  
Ascending Aorta ◽  
Hypothermic Circulatory Arrest ◽  
Chronic Hypertension ◽  
Pulsatile Mass ◽  
Fatal Hemorrhage ◽  
Femorofemoral Bypass

AbstractPseudoaneurysm of ascending aorta is a rare complication after aortic surgery. Predisposing factors can be infection, chronic hypertension, connective tissue disorders, or dissection. Chest pain, sternal erosion, dysphagia, or stridor can be the modes of presentation. It can also present as a pulsatile mass. Redo sternotomy in a case of pseudoaneurysm of aorta can cause fatal hemorrhage or air embolism. In such a scenario, femorofemoral bypass and hypothermic circulatory arrest help to simplify the approach to the pseudoaneurysm. The authors present a case of a 23-year-old female with pseudoaneurysm of the ascending aorta causing sternal erosion. Ascending aortic repair was done using Dacron patch with femorofemoral bypass and hypothermic circulatory arrest. Sternum was repaired using pectoralis major muscle flap.

Salvage of infected vascular graft via ‘perivascular venous banding’ technique coupled with rectus abdominis myocutaneous muscle flap transposition

Vascular ◽  
2012 ◽  
Vol 21 (1) ◽  
pp. 17-22 ◽  
Author(s):  
F De Santis ◽  
C M Chaves Brait ◽  
G Caravelli ◽  
S Pompei ◽  
V Di Cintio
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Muscle Flap ◽  
Rectus Abdominis ◽  
Banding Technique ◽  
Vascular Graft Infection ◽  
Muscle Flaps ◽  
Crossover Bypass ◽  
Muscle Flap Transposition

This is the case of a severe Pseudomonas aeruginosa biological vascular graft infection, completely involving the perianastomotic tract of a femoro — femoral crossover bypass and resulting in repeated bleeding from the offended vessel wall. After the failure of a sartorious rotational muscle flap transposition into the infected groin wound, this ‘high-grade’ vascular graft infection was finally treated successfully by wrapping a great saphenous vein patch reinforcement circumferentially around the damaged biological vascular conduit and filling the infected wound with a rectus abdominis myocutaneous muscle flap transposition. The aim of this report is to illustrate this novel, to our knowledge, ‘perivascular venous banding’ technique and to evaluate the prospective of future testing of this surgical procedure. Starting from this singular case, we will also review the role of the rotational muscle flaps in the conservative management of major vascular graft infections.

Pectoral Muscle Flap With V-Y Skin Paddle for Covering Sternal Defects

2012 ◽  
Vol 94 (5) ◽  
pp. e131-e133 ◽  
Author(s):  
Martin Molitor ◽  
Martin Šimek ◽  
Vladimír Lonský ◽  
Martin Kaláb ◽  
Jiří Veselý ◽  
...  
Keyword(s):  
Muscle Flap ◽  
Pectoral Muscle ◽  
Skin Paddle

scholarly journals Management of Vascular Graft Infection

2020 ◽  
Vol 1 (3) ◽  
Author(s):  
Harry Ward ◽  
Dominic Howard
Keyword(s):  
Case Report ◽  
Key Management ◽  
Vascular Graft ◽  
Graft Infection ◽  
Muscle Flap ◽  
Diagnostic Process ◽  
Vascular Graft Infection ◽  
Diagnosis And Management ◽  
Surgical Options ◽  
Level 1

This case report focuses on the risk factors, diagnosis, and management of vascular graft infections. A complex and intriguing case is presented and the latest evidence on aetiology and management of this challenging condition are summarised. The contention regarding the diagnostic criteria for graft infection is addressed, and how different imaging modalities and genetic or systemic biomarkers could aid this diagnostic process. Key management challenges are also discussed. Firstly, the difficulties of penetration and efficacy of antimicrobials and the issues surrounding biofilm formation. Secondly, the different surgical options such as graft preservation with partial excision or muscle flap coverage, or excision and revascularisation. Further, the type of explant and the latest innovations in the field of biological grafts are considered. Overall, this case report brings to the fore the lack of structured guidelines and level 1 evidence for the diagnosis and management of vascular graft infection, and calls for a more structured, unified, multi-disciplinary approach.

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