Aorta, Thoracic ; pathology ; surgery ; Blood Vessel Prosthesis Implantation ; Female ; Humans ; Middle Aged

OBJECTIVESTo quantify the changes of the spatial relations between the vertebral body and the thoracic aorta in main right thoracic adolescent idiopathic scoliosis (AIS) following anterior and posterior instrumentation and fusion.

METHODSTwenty-nine patients with main right thoracic AIS were divided into 2 groups. Group A included 13 females and 1 male with an average age of 14.3 years old and average main thoracic Cobb angle of 44.9 degrees, these patients underwent mini-incision thoracic anterior spinal fusion. Group B included 12 females and 3 males with an average age of 14.2 years old and average main thoracic Cobb angle of 46.4 degrees, all of them were treated with posterior spinal fusion. Patients underwent CT scanning from T5 to T12 Pre-and post-operatively. Five parameters pertaining to the spatial relations between the vertebral body and the thoracic aorta including the angle for safety screw placement (gamma), the angle of the aorta relative to the vertebral body (beta), vertebral rotation angle (gamma), distance from the aorta to the closest point of the vertebral body cortex (a) and distance from the posterior wall of the aorta to the anterior edge of the left rib head (b) were analyzed and were correlated with the curve correction.

RESULTSIn Group A, the alpha angle and 3 angle increased while gamma decreased after curve correction, and significant difference were found at T8 and T9 levels (P < 0.05); the a value decreased and b value increased after curve correction and reached significant difference at T9 (P < 0.05). No significant change of these parameters was found in Group B post-operatively. In Group A, the increment of alpha angle, beta angle and b value show great correlation with the decrement of gamma angle (P < 0.01). At the periapical the increment of alpha angle, beta angle and b value show great correlation with decrement of apical vertebral translation, while decrement of a value show great correlation with increment of kyphosis from T5 to T12 (P < 0.01).

CONCLUSIONSUnder anterior instrumentation and correction, the aorta moved anteromedially toward vertebral body on CT scanning. The factors contributing to the aorta shifting included releasing of aorta from vertebrae, vertebral derotation and curve correction.

Adolescent ; Aorta, Thoracic ; pathology ; Bone Screws ; Child ; Female ; Humans ; Male ; Scoliosis ; pathology ; surgery ; Spinal Fusion ; instrumentation ; methods ; Thoracic Vertebrae ; pathology ; surgery

Aortoesophageal fistula is a rare and lethal disorder that may result from primary diseases of aorta or esophagus, aortic bypass graft, ingestion of foreign body, trauma, surgical procedure or instrumentation. Tuberculous fistula is extremely rare. We present a 27-yr-old female patient with aortoesophageal fistula associated with tuberculous mediastinitis. The patient experienced massive hematemesis and esophagoscopy revealed a small mucosal defect with exudate-coated blood vessel like Dieulafoy 's lesion on about 25 cm from the incisor teeth. Despite two sessions of endoscopic hemostatic procedures, active massive hemorrhage recurred and was controlled effectively with a prompt insertion of Sengstaken-Blakemore tube. The patient underwent open thoracotomy, which revealed aortoesophageal fistula. Numerous white-yellowish, millet seed-like tubercles were scattered in pleural and abdominal cavity. Division of fistular tract and esophageal resection with Ivor-Lewis anastomosis were performed. Histopathologic study confirmed tuberculous pleuritis and peritonitis. The patient died of postoperative pulmonary complication.
Adult ; *Aorta, Thoracic/pathology/surgery ; Aortic Diseases/*etiology/pathology/surgery ; Esophageal Fistula/*etiology/pathology/surgery ; *Esophagus/pathology/surgery ; Fatal Outcome ; Female ; Hematemesis/etiology/pathology/surgery ; Humans ; Mediastinitis/pathology ; Tuberculosis, Miliary/*complications

In quadrupeds, the three-dimensional orientation of the heart with respect to the thorax is fundamentally different from that in humans. In this study, we assessed the best surgical approach to the tricuspid valve in sheep. Firstly, different surgical access sites to the tricuspid valve were tested in sheep cadavers, the anatomy was analyzed, and the optimal surgical approach to the tricuspid valve was determined. Secondly - along with cardiopulmonary bypass and cardioplegic arrest -the chosen approach was tested in six adult sheep in vivo. Anatomical analyses revealed that a left thoracotomy provided optimal access to the aorta and left heart. However, visualization of the right heart was significantly impaired. In contrast, a right thoracotomy provided good access to the right heart, but the ascending aorta was difficult to approach. Therefore, in the in vivo studies, arterial cannulation was performed through a carotid (n = 4) or femoral (n = 2) artery. In conclusion, a right-sided thoracotomy allows good visualization of all components of the tricuspid valve complex in sheep, but not of the ascending aorta. Consequently, peripheral vessels are preferred for arterial cannulation. This work may stimulate the investigation of pathomechanisms and/or novel treatment options for tricuspid valve pathologies.
Adult ; Aorta ; Arteries ; Cadaver ; Cardiopulmonary Bypass ; Catheterization ; Heart ; Humans ; Models, Animal ; Pathology ; Sheep* ; Thoracic Surgery ; Thoracotomy* ; Thorax ; Tricuspid Valve*

OBJECTIVE: To explore the safety and efficacy of "chimney graft" technique during thoracic endovascular aneurysm repair (TEVAR) in aortic arch lesions. METHODS: Th e methods, results and the incidence of complications in 25 patients, who received "chimney stent" therapy for aortic arch disease, were reviewed and analyzed. RESULTS: From August, 2010 to August, 2014, 25 aortic arch lesions were treated by TEVAR with "chimney stent", 18 patients were male and 7 were female. The average age was 38-78(65±5.8) years old. Five patients received "chimney stents" for left common carotid artery, while 20 patients received "chimney stent" for left subclavian artery. Three cases showed small amount of Type I leak under immediate postoperative angiography without treatment. The leak was disappeared 1month later. Two patients appeared left upper limb weakness and one of them showed dizzinesss simultaneously. Both of them recovered gradually in follow-up process. Th ere was no limb ischemia or necrosis. Th e locations of aortic and "chimney stent" were stable without any migration and leak complications. CONCLUSION "Chimney graft" technique is a safe and effective treatment for aortic arch lesions due to lack of proximal anchoring zone. The follow up results in a short-term is satisfied.
Adult ; Aged ; Angiography ; Aorta, Thoracic ; pathology ; surgery ; Aortic Aneurysm ; surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; Carotid Artery, Common ; pathology ; surgery ; Endovascular Procedures ; Female ; Humans ; Male ; Middle Aged ; Prosthesis Design ; Stents ; Transplants ; Treatment Outcome

OBJECTIVETo evaluate the effect of extensive aortic diseases (EAD) after hybrid repair with supra-arch branches or visceral arterial debranching and endovascular repair.

METHODSA total of 24 EAD patients (19 male and 5 female) underwent hybrid repair in Department of Vascular Surgery, Zhongshan Hospital, Fudan University between March 2005 and April 2015. The clinical data was analyzed retrospectively. The mean age was (49±12) years (from 29 to 69 years). The high-risk candidates for open surgery were enrolled in the study. The patients, including 14 cases with thoracic aortic aneurysms and 10 cases with aortic dissection, were treated by one or two stages. Post-operative follow-up with CT angiography was performed at 3, 6 and 12 months and then annually thereafter.

RESULTSA total of 74 branches, including 63 with visceral arteries and 11 with supra-arch arteries, were recanalized. Nine patients were treated in two-stage hybrid procedure and fifteen were repaired by one stage. The perioperative mortality was 12.5% (3/24), whereas the aneurysm-related mortality was 8.3% (2/24). The 30-day patency of the grafts was 95.9% (71/74). There was no endoleak, paralysis, and intestinal ischemia at 30 days post-hybrid procedures. Four cases (16.6%) suffered acute renal dysfunction. During the follow-up (3 to 123 months), there were two deaths and one endoleak (type Ia and III) which emerged at 4 months post-procedure. The 1-year and 3-year survival rates were 81.7% and 73.5%, respectively.

CONCLUSIONSHybrid treatment is safe and effective for complex EAD patients in the midterm follow-up. It is especially suitable for the high-risk patients with comorbidities, re-intervention, or little tolerance to open surgery repair.

Adult ; Aged ; Aneurysm, Dissecting ; surgery ; Angiography ; Aorta ; pathology ; surgery ; Aortic Aneurysm, Thoracic ; surgery ; Aortic Diseases ; surgery ; Blood Vessel Prosthesis Implantation ; Endoleak ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Survival Rate ; Tomography, X-Ray Computed ; Treatment Outcome

The purpose of our study was to create a novel rat aorta stent implantation model. Stainless steel bare metal stents (BMS) or paclitaxel-eluting stents (PES) were implanted in male Sprague-Dawley rats (BW 400 +/- 20 g). Two and four weeks after stent implantation, the aorta were collected, fixed with 2% glutaraldehyde, and cut into two segments. One segment was used for scanning electron microscopy analysis to evaluate re-endothelialization, and the other segment was used to calculate the neointimal area. At 2 weeks after stenting, the appearance of neointimal hyperplasia was less in the PES group than in the BMS group. At 4 weeks after stenting, no significant difference in neointimal hyperplasia was observed between two groups. On the other hand, the PES group showed more thrombus formation and less re-endothelialization compared to the BMS group. This study demonstrated the ability of a novel rat model of aorta stenting via a common carotid artery to measure the efficacy and safety of commercially available drug-eluting stents.
Angioplasty/*methods ; Animals ; Aorta, Thoracic/*surgery/ultrastructure ; Coronary Artery Disease/*surgery ; *Drug-Eluting Stents ; Histocytochemistry ; Male ; Microscopy, Electron, Scanning ; Models, Animal ; Neointima/pathology ; Paclitaxel/*administration & dosage ; Rats ; Rats, Sprague-Dawley

Although unilateral antegrade selective cerebral perfusion (UASCP) is considered a safe cerebral protection strategy during aortic surgery, an optimum temperature remains to be defined. This study compared outcomes in patients undergoing UASCP at either <24degrees C or > or =24degrees C. Between 2000 and 2007, 104 consecutive patients underwent aortic surgery using UASCP. Patients were divided into two groups according to systemic temperature: group A comprised 64 patients undergoing deep hypothermia (<24degrees C); and group B comprised 40 patients undergoing moderate hypothermia (> or =24degrees C). Both groups were similar in terms of the extent of aortic replacement and mean UASCP time. The total cardiopulmonary bypass time and aortic cross clamp time were longer in group A. Both groups were similar in terms of 30-day mortality rate (9.4% group A, 10.0% group B), and in terms of temporary (6.7% group A, 7.7% group B) and permanent (11.3% group A, 2.6% group B) neurological deficits. Multivariate analysis showed preoperative shock status was a risk factor for in-hospital mortality, and a preoperative history of a cerebral incident was a risk factor for permanent neurological deficit. UASCP under moderate hypothermia is a relatively safe and effective cerebral protective strategy during aortic surgery.
Aged ; Aorta, Thoracic/surgery ; Aortic Diseases/mortality/pathology/*surgery ; Body Temperature ; Cardiopulmonary Bypass/methods ; *Cerebrovascular Circulation ; Female ; Hospital Mortality ; Humans ; *Hypothermia, Induced ; Magnetic Resonance Angiography ; Male ; Middle Aged ; Reperfusion/methods ; Risk Factors ; Shock/complications ; Stroke/complications ; Treatment Outcome

OBJECTIVETo summarize the experience of endovascular repairing aortic arch disease hybrid with supra-arch debranching procedures.

METHODSIt was a retrospective study. From January 2002 to December 2014, 42 high risk patients with aortic arch disease were treated by supra-arch debranching hybrid with subsequent endovascular repair in the First Affiliated Hospital of Sun Yat-sen University. There were 39 male and 3 female patients with a mean age of (53±13) years (ranging from 34 to 80 years). Of the 42 patients, 7 were thoracic aortic aneurysm, 20 were Stanford type B aortic dissection and 15 were Stanford type A aortic dissection. After the supra-aortic debranching technique, simultaneous (n=16) or staged (n=26, mean interval (7±3) days) endovascular repair were performed. Fisher exact test was used to compare the in-hospital mortality of ascending aorta based debranching and non-ascending aorta based debranching.

RESULTSTechnical success rate was 81.0% (34/42). The overall 30-day complication rate was 31.0% (13/42), including 3 cerebral stroke (7.1%), 8 endoleak (19.0%, including 6 type I endoleak and 2 type II endoleak), 1 circulatory failure, 1 aorto-tracheal fistula. The 30-day mortality was 9.5% (4/42), 2 died of cerebral stroke, 1 died of circulatory failure, 1 died of aorto-tracheal fistula. The in-hospital mortality of ascending aorta based debranching group was obviously higher than that of the non-ascending aorta based debranching group (4/16 vs. 0, P=0.02). The median time of follow-up was 64.8 (2 to 156.9) months. CT scanning was performed at 1, 3 months after surgery and annually thereafter. The overall survival rate was 76.6%. During the follow-up period, there was 4 deaths, and 2 of them were aortic artery related (5.3%). There were 4 de novo complications during the follow-up period, 1 stroke attributed to bypass occlusion was cured by medical treatment, 2 pseudoaneurysm was successfully treated with open surgery, 1 stent-graft induced new distal entry tear was successfully treated with a tapered stent-graft, there was no new endoleak during follow up period, 3 type I endoleak disappeared spontaneously, and 1 type II endoleak disappeared after secondary intervention.

CONCLUSIONSEndovascular repair of aortic arch disease hybrid with supra-arch debranching procedure is low invasive with favorable long-term outcomes. It is suitable for high risk patients of poor general condition with little tolerance to aortic arch replacement. The in-hospital mortality is higher in the ascending aorta based debranching group than in the non-ascending aorta based debranching group. Stroke is a critical fatal complication and should be attached attention.

Adult ; Aged ; Aged, 80 and over ; Aneurysm, Dissecting ; surgery ; Aorta ; pathology ; surgery ; Aortic Aneurysm, Thoracic ; surgery ; Aortic Diseases ; surgery ; Blood Vessel Prosthesis Implantation ; Endoleak ; complications ; Endovascular Procedures ; Female ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Stroke ; complications ; Survival Rate ; Tomography, X-Ray Computed