Objective/BackgroundThe purpose of this report is to demonstrate a novel endovascular technique for gaining and producing the maximal landing zone for a thoracic stent graft in a patient with a chronic type B aortic dissection.MethodsThe patient was a 64 year old man with chronic type B aortic dissection. He had developed acute type B aortic dissection and undergone descending thoracic replacement (Zone 2–Th10) 12 years earlier. During follow-up, he developed an anastomotic false aneurysm distally. In the initial operation, the distal anastomosis was performed with fenestration of the dissecting membrane. Computed tomography showed a pseudoaneurysm of 54 mm that was positioned 9 cm proximal to the coeliac artery. The landing zone was < 20 mm in the fenestrated area. At surgery, the true and false lumens were each cannulated from the femoral artery, and a pull through form was made just above the fenestrated flap. After the wire exchange, a 4 mm cutting balloon was positioned on the bottom of the flap, and the flap was gently sawed about 3.5 cm.ResultsAfter stent graft placement no endoleak was observed. The patient was discharged without any complications.ConclusionThis technique was effective in producing a sufficient landing zone for endovascular aortic repair in a patient with an anastomotic pseudoaneurysm of chronic type B aortic dissection.
Objectives
To elucidate the impact of regulation of tricuspid regurgitation (TR) using tricuspid annuloplasty on postoperative changes in right ventricular (RV) systolic and diastolic functions.
Methods
We enrolled 69 patients who underwent aortic or mitral valve surgery between July 2016 to March 2018 without recurrence. Patients with concomitant coronary artery bypass grafting or a history of previous cardiovascular surgery were excluded, remaining 45 patients enrolled. Patients were divided into two groups according to concomitant tricuspid annuloplasty (T: n = 12 vs non‐T: n = 33). RV global longitudinal strain (RVGLS), RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), and early tricuspid inflow velocity/early diastolic tricuspid annular velocity ratio (tricuspid E/e') were assessed as functional indices at preoperative, postoperative and 1‐year follow‐up periods.
Results
RVFAC deteriorated postoperatively but recovered at follow‐up in group T, whereas that in group non‐T showed gradual deterioration overtime. RVGLS and TAPSE showed similar temporary deterioration and recovery between groups. Tricuspid E in group T increased postoperatively and showed significant difference, which was kept until follow‐up period. Tricuspid e' decreased postoperatively, and recovered slightly in both groups. As a result, postoperative RV diastolic function (tricuspid E/e') showed significant difference between groups. This difference was maintained until follow‐up.
Conclusions
RV systolic function deteriorated postoperatively, but there was a tendency to improve at follow‐up regardless of tricuspid annuloplasty. RV diastolic function may potentially be impaired when TR was regulated by tricuspid annuloplasty.
Simultaneous thoracic and abdominal aneurysms comprise approximately
10–20% of all cases of aortic aneurysms. Whether simultaneous or
staged therapy can be used to treat multilevel aortic aneurysms remains
controversial. Herein, we report the case of a 79-year-old woman with
both huge abdominal and saccular thoracic aortic aneurysms who was
referred to our hospital. Multiple stenotic lesions were observed in the
major cerebral arteries; moreover, triple-vessel disease was observed on
the coronary angiogram. Although this case required immediate primary
surgery, cardiopulmonary bypass was difficult due to multiple stenoses
in the cerebral arteries. We performed simultaneous surgery with total
debranching thoracic endovascular aortic repair, endovascular aortic
repair, and off-pump coronary artery grafting. Total debranching
thoracic endovascular aortic repair is useful for avoiding neurological
complications in cases where cardiopulmonary bypass is difficult.
Furthermore, it helps devise an intraoperative cervical branch
reconstruction method.
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