Frozen Elephant Trunk: A technique which can be offered in complex pathology to fix the whole aorta in one setting

We report a case of treating complex aortic pathology with the use of the Frozen Elephant Trunk technique in a patient with chronic type B aortic dissecting aneurysm associated with arch and ascending aorta dilatation, proximal aortic disease and coronary disease. The case was further complicated due to the involvement of the abdominal vessels and preexisting femoral to femoral crossover bypass. In addition the patient had a tracheostomy for laryngeal cancer

Acute Aortic Syndromes: Newer Developments

Acute aortic syndrome is a modern term that describes the acute presentation of patients with characteristic “aortic” pain caused by one of the life-threatening thoracic aortic conditions including aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer.

Acute Aortic Syndromes: Surgical, Endovascular or Medical Treatment?

The term acute aortic syndrome (AAS) embraces a heterogeneous group of patients with a similar clinical profile of acute presentation and characteristic “aortic pain”. Acute aortic syndrome encompasses classic aortic dissection, less common variants such as intramural hematoma, penetrating aortic ulcer, and iatrogenic or traumatic transsection of the aorta. In some patients, AAS may also be caused by symptomatic degenerative aortic aneurysm. Eventually, any one of AAS may progress to frank aortic rupture that will be contained or not. These acute aortic pathologies appear separately, may precede one another and/or just coexist. AAS is the most frequently fatal condition in the spectrum of patients with chest pain. These patients are characterised by ‘‘aortic pain’’ and a long-lasting history of severe hypertension... (excerpt

Thoracoabdominal aneurysm repair using a four-branched thoracoabdominal graft: a case series

Revascularization of the visceral arteries during thoracoabdominal aneurysm repair is usually performed sequentially by an anastomosis between a prosthetic graft and an aortic patch. There are immediate operative risks such as bleeding and distortion. In the longer term, aneurysm, pseudo-aneurysm and rupture may occur. These require reoperation and are associated with significant morbidity and mortality

Surgery for Hypertrophic Obstructive Cardiomyopathy

Surgical treatment of hypertrophic obstructive cardiomyopathy (HOCM) comprises septal myectomy which though has been limited to patients with refractory symptoms and high resting gradients. Results of surgical intervention are well documented with dramatic reduction in left ventricular outflow tract gradient and resultant relief of symptoms in about 95% of patients. Transcoronary ablation of septal hypertrophy with alcohol is a newer percutaneous technique, designed to ablate hypertrophied cardiac septal muscle through localized infarction, but its efficacy compared with that of surgical myectomy is uncertain. In the present article we briefly review the technique of septal myectomy and compare it with septal ablation, concluding that the standard septal myectomy still remains the preferred and proven therapy. &nbsp

Acute Aortic Syndromes: Surgical, Endovascular or Medical Treatment

The term acute aortic syndrome (AAS) refers to a heterogeneous group of conditions that cause a common set of signs and symptoms, the foremost of which is aortic pain. Various pathological entities may give rise to this syndrome, but the topic has come to focus on penetrating aortic ulcer and intramural hematoma and their relation to aortic dissection. Penetrating aortic ulcer is a focal atherosclerotic plaque that corrodes a variable depth through the intima into the media. Intramural hematoma is a blood collection within the aortic wall not freely communicating with the aortic lumen, with restricted flow. It may represent a subcategory of aortic dissection that manifests different behavior by virtue of limited flow in the false lumen. The initial management of all patients with AAS involves pain relief and aggressive blood pressure control. Subsequent surgical, endovascular or medical treatment depends on the type of AAS and associated procedural risk. An overview of AAS conditions, their pathophysiology and management is herein attempted

Surgery for Hypertrophic Obstructive Cardiomyopathy

Hypertrophic obstructive cardiomyopathy (HOCM) is an inherited disorder with variable expressivity, resulting in asymmetric septal hypertrophy and left ventricular outflow tract obstruction (LVOTO). Symptoms are similar to those of aortic stenosis and are due to LV diastolic dysfunction and myocardial ischemia in the absence of epicardial coronary narrowing. Goals of treatment include symptomatic control, resolution of hemodynamic abnormalities and their sequelae, reduction of sudden cardiac death risk and screening of family members. Left ventricular outflow tract obstruction at rest is a predictor of severe symptoms, heart failure, and death. The majority of patients are managed medically, predominantly with b-blockers and calcium channel blockade.Disopyramide, a negative inotrope, can be used in cases with persistently high resting gradients. To prevent sudden cardiac death, implantable cardioverterdefibrillators are used aggressively

Right Ventricular Outflow Tract Obstruction in a Middle Aged Man with Right-Sided Aortic Arch

Congenital diseases causing an obstruction of the right ventricular outflow tract are difficult to precisely diagnose, especially in elderly patients. We report a case of a 49-year-old man who presented to our hospital with longstanding shortness of breath on exertion. He was finally diagnosed as right ventricular outflow tract obstruction and referred for surgical correction. The patient had a history of descending aorta dissection which was treated by thoracic stent grafting. By that time right-sided aortic arch was diagnosed. The coexistence of right ventricular outflow tract obstraction and right sided aortic arch in the same patient is very rare, to the best of our knowledge

Right Ventricular Outflow Tract Obstruction Caused by Double-Chambered Right Ventricle Presenting in Adulthood

Congenital heart diseases that cause obstruction of the right ventricular outflow tract are often difficult to diagnose. We report the case of a 49-year-old man who presented with long-standing shortness of breath on exertion. Imaging revealed right ventricular outflow tract obstruction caused by a double-chambered right ventricle, and he was referred for surgical correction. This case emphasizes both the detailed perioperative evaluation that is needed when diagnosing adults who present with manifestations of congenital heart disease and a method of successful surgical correction that resulted in symptom resolution

Transcatheter Aortic Valve Implantation in Severe Left Ventricular Dysfunction: A Viable Option in a Patient With Low-Flow, Low-Gradient Critical Aortic Stenosis

Images are provided from a successful procedure of transcatheter aortic valve implantation (TAVI) in an elderly patient with symptomatic low-flow, low-gradient critical aortic stenosis, and associated severe left ventricular dysfunction, who had a very high-risk for surgery