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

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: 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

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

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

Cor triatriatum presenting as heart failure with reduced ejection fraction: a case report

Cor triatriatum is a rare congenital cardiac malformation and it usually refers to the left atrium. We report an unusual case of cor triatriatum in a 33 - year old woman presented with congestive heart failure caused by left ventricular systolic dysfunction

Skeletonization of radial and gastroepiploic conduits in coronary artery bypass surgery

The use of a skeletonized internal thoracic artery in coronary artery bypass graft surgery has been shown to confer certain advantages over a traditional pedicled technique, particularly in certain patient groups. Recent reports indicate that radial and gastroepiploic arteries can also be harvested using a skeletonized technique. The aim of this study is to systematically review the available evidence regarding the use of skeletonized radial and gastroepiploic arteries within coronary artery bypass surgery, focusing specifically on it's effect on conduit length and flow, levels of endothelial damage, graft patency and clinical outcome. Four electronic databases were systematically searched for studies reporting the utilisation of the skeletonization technique within coronary revascularisation surgery in humans. Reference lists of all identified studies were checked for any missing publications. There appears to be some evidence that skeletonization may improve angiographic patency, when compared with pedicled vessels in the short to mid-term. We have found no suggestion of increased complication rates or increased operating time. Skeletonization may increase the length of the conduit, and the number of sequential graft sites, but no clear clinical benefits are apparent. Our study suggests that there is not enough high quality or consistent evidence to currently advocate the application of this technique to radial or gastroepiploic conduits ahead of a traditional pedicled technique