Extend aortic repair for acute type A aortic dissection with rupture and malperfusion complicated with Ehlers-Danlos syndrome

Background Ehlers-Danlos syndrome (EDS) is a disorder in the metabolism of fibrillary collagen. Its vascular type (vEDS) frequently develops arterial rupture and aortic dissection. Case presentation The patient was a 54-year-old gentleman who suffered from cardiac tamponade, malperfusion of the left carotid artery and the right lower extremity due to acute type A aortic dissection. Rupture of the aortic root and a huge entry located from the transverse arch to the proximal descending aorta were found. There were no significant deformities at aortic valve, so we tried extended repairs of valve sparing root replacement (VSRR) and total arch replacement (TAR) with frozen elephant trunk (FET) and were successfully performed. He was finally diagnosed as vascular Ehlers-Danlos syndrome (vEDS) by genetic examination. Conclusion Emergency extensive repairs of VSRR and TAR with FET for critical AAAD with rupture and malperfusion was successfully performed for a vEDS patient.

Hybrid Surgical Repair for Recurrent Coarctation of the Transvers Arch: Case Report

The incidence of postoperative recurrent coarctation of the aorta ranges from 5% to 50%, and largely depends on the age at initial repair. Due to the increased fibrosity and rigidity of the aorta in older age, stent placement is preferred instead of balloon angioplasty, resulting in an almost complete relief of the gradient in >95% of the patients. In patients with transverse arch hypoplasia, transcatheter intervention with further surgical intervention may be needed, and the use of stenting was shown to be effective in the treatment of patients with hypoplastic isthmus, arch or tubular coarctation. In this case of a late re-coarctation, we preferred to apply a hybrid technique for treatment. The first step of the treatment was debranching of the brachiocephalic and left common carotid arteries with upper mini median sternotomy. On the following day, the patient underwent a successful stent placement to the transvers arch.

Characteristics of the Paediatric Foot Arches According to Body Mass Among Primary School Students in Wrocław, Poland

Introduction:The purpose of the study conducted within the framework of the, “Let’s Get the Kids Moving” project was to determine the association between longitudinal and transverse children’s foot arch and their body mass, gender, and age.Materials and method:T he pro-health initiative “Let’s Get the Kids Moving” was created by researchers of the Medical University and the Run for Health Foundation. A total of 655 children (51.5% boys) aged 7 - 10 years from primary schools in southwestern Poland participated in the study. The mean age of the examined pupils was 8.7± 0 .8 years. In all children, we assessed anthropometric measurements (body mass and height) and longitudinal and transverse arch of the foot under a load of their weight. A two-dimensional (2D) foot scanner (Sensor Medica, Italy) was used to examine the plantar part of the pupils’ foot.Results:The obtained data from 655 pupils revealed that excessive body mass predisposed to lower longitudinal and transverse arching. The foot shape was not differentiated by children's gender and age in the youngest age group.Conclusions:Screening of school-aged children's footprints allows for early detection of abnormalities in the shape of the pupil’s feet. This enables the implementation of further early diagnosis for the detection of functional or structural flatfoot in children.

Total anomalous pulmonary venous connection mimicking hypoplastic left heart syndrome

A newborn with supracardiac total anomalous pulmonary venous connection vein presented the small left ventricle with z score of −7.5, retrograde blood supply in the transverse arch, and the dutcus-dependent systemic circulation. The patient underwent the repair of the anomalous pulmonary vein and bilateral pulmonary arterial banding soon after the birth and then transcatheter pulmonary arterial debanding at the age of 10 months because of an appropriate growth of the left ventricle.

The impact of functional excess of footwear on the foot shape of 7-year-old girls and boys

Background Properly fitted shoes can support the development of growing feet and prevent problems and pathologies, not only in childhood, but also in adulthood. This points to the need to conduct research on the impact of shoe fitting on the structure of the foot in order to raise awareness and importance of this problem, to enable proper decisions regarding the purchase and use of shoes. The aim of this study was to analyze indoor footwear fit and its impact on foot structure in 7-year-old schoolchildren. Methods The CQ-ST podoscope and the Clevermess device were used for measurements. The analysis was carried out using the Mann Whitney U test, Wilcoxon signed-rank test, Chi-square test, regression analysis. Results About 40% of girls and boys had shoes that were incorrectly fitted in length, while as many as 74% of girls and 66% of boys wore shoes that were incorrectly fitted in width. Regression analysis demonstrated a statistically significant influence of the footwear length on longitudinal arch of the right and left foot and the transverse arch of the right foot. In boys, the length of the shoes shows associations with the right and left hallux valgus angle. Conclusion A significant percentage of the studied 7-year-olds, regardless of gender, wears inappropriately fitted shoes. In both sexes, the length of the footwear influenced the longitudinal arch of the right and left foot and the transverse arch of the right foot. Due to the deformity of the first metatarsophalangeal joint, the boys with hallux valgus require footwear which is wider and therefore their shoes need to be bigger in size.

Effect of 5-day dry immersion on the human foot morphology evaluated by computer plantography and soft tissues stiffness measuring

Abstract16 participants have been subjected to Dry Immersion model (DI) for 5 days. DI reproduces the space flight factors such as lack of support, mechanical and axial unloading, physical inactivity, elimination of vertical vascular gradient. Long-term bed rest is also associated with similar factors, so the results of the study may be useful for clinical medicine. Computer plantography and measuring the stiffness of the soft tissues of the foot and superficial muscles of the shin (mm. tibialis anterior and peroneus longus) were performed twice before DI exposure, on the 2nd and 4th days of DI exposure, as well as on the 2nd day of the recovery period. DI exposure effects the parameters under study in two ways: by raising the longitudinal arch and by flattening the transverse arch, which is accompanied by a decrease in the soft tissues stiffness of the foot and superficial muscles of the shin. The work reveals the phenomenon of compensating the longitudinal arch state by changing the characteristics that reflect the transverse arch state. The results of the study for the first time demonstrate the correlation of the foot morphological characteristics with a decrease in stiffness of mm. peroneus longus and tibialis anterior.

Biomechanical characteristics of the metatarsal part of the foot in swimmers in walking

Objective: to investigate the characteristics of the distribution of pressure under the foot during walking in swimmers of various ages and experience.Materials and methods. The study involved swimmers aged 11.4 ± 1.9 years, of both sexes, with at least 4 years of training experience (n = 23) and masters of sports in swimming, 19.3 ± 1.5 years old with 12.2 ± 1.3 years of experience (n = 23). The study used a podometric footscan® platform from RSscan company. Kinematic and dynamic parameters of pressure under the foot during natural walking were recorded. The focus was on the indicators of contact with the support in the zones of the metatarsal part of the foot. The peak pressure value in each metatarsal zone and the time to reach it were taken into account.Results. In the course of the study, the order in which the maximum pressure under the metatarsal zones manifests was understood, which appeared in a sequence: fifth, fourth, first, third and second metatarsal zones. It was found that in young athletes the transverse arch of the foot during walking undergoes a relatively greater load than in older athletes. Moreover, relatively high values were noted in the zones of the second and third metatarsals in both age groups.Conclusions: the swimmer’s foot experiences a significant professional transformation associated with specific sports activities, which dictates the need to introduce certain preventive and corrective measures into sports training.

DYNAMICS OF CHANGES IN SELECTED PARAMETERS OF FOOT ARCHING IN CHILDREN BETWEEN 5 AND 9 YEARS OLD

The foot is an important element of the locomotor apparatus and performs a number of functions in our body. Abnormalities in its shape can affect everyday functioning. Therefore, it is worth paying attention to the proper development of the feet in children. The aim of the study was to assess the dynamics of changes in selected parameters of foot development in younger children of school age. The study involved 70 children. The observations were conducted twice in the same children, aged 5 and 9 years. Their feet were examined using a podoscope. Clarke's method was used to assess the longitudinal arch of the feet, and the Wejsflog length-width index for assessing the transverse arch. In addition, parameters such as the length and width of the foot, the position of the big toe, the little toe and the back of the heel were analysed. Longer and wider feet were characteristic of boys. As the children became older, the longitudinal arch of the feet fell, while only girls showed a slight improvement in the lateral arch of the foot. There was a high rate of flat feet. The children examined, who were aged 5 and 9 years, had a correctly positioned toe and heel, while there was varus of the little toe. The length-width dimensions of the feet changed significantly over time. Girls and boys differed significantly in the values of the Clarke's angle defining the longitudinal arch of the feet, while no significant differences in the lateral arch of the feet were noted. With age, there was no change in the position of the toe, toe and heel.