Since 2000 Dorros et al. reported the first case of type A aortic dissection (TAAD) treated with an endovascular repair, surgeons explored a novel treatment option for TAAD gradually. The application of endovascular repair for TAAD highlights some points below which should pay attention to because of the special anatomic location and morphological characteristics of ascending aorta: (1) customized treatment strategy based on the characteristics of patients; (2) pre-operation evaluation; (3) selection of the stent and delivery system; (4) selection of the access sites; (5) preservation of the coronary artery flow, aortic valve function and perfusion of the branch vessels; (6) accurate location of stent-graft; (7) mid-term and long-term follow-up. In a word, it's helpful to avoid misunderstanding in treatment and improve the safety of operation by grasping the indication and the technical points and making the customized treatment strategy based on the characteristics of patients.
Aneurysm, Dissecting ; surgery ; Aorta ; pathology ; surgery ; Aortic Aneurysm ; surgery ; Blood Vessel Prosthesis Implantation ; Endovascular Procedures ; Humans ; Stents

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

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

Aortic lesions involving branch vessels have always been a great challenge for vascular surgeons. Endovascular repair are growing to take place of traditional open repair for less invasion and lower complication rates. Despite rapid developments in endovascular instruments have been achieved in the last decade, and endovascular techniques such as fenestration stents have been applied in the treatment of aortic lesions involving branch vessels. However, endovascular repairing aortic lesions involving branch vessels remains being restricted by rigorous indication selection as well as requirements of advanced experiences and sophisticated skills. Recently, several studies about treating aortic lesion involving branch vessels with multi-layer bare stents have been reported, the primary results were encouraging and brought new visions for the management of such disease. More approving clinical evidences about the safety and efficacy of multi-layer stents are anticipated.
Aorta ; pathology ; surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; Endovascular Procedures ; Humans ; Prosthesis Design ; Stents

OBJECTIVE: To investigate the effect of bilateral superior cervical sympathetic ganglion occlusion (SCG) on aortic dissection and its possible mechanism. METHODS: Forty-five SD rats were randomly divided into three groups with 15 in each:blank control group, sham operation group and SCG group. β-aminopropione (666 mg·kg·d) was given by subcutaneous injection for 4 weeks to establish the aortic dissection model. Rats in SCG group were given SCG before the injection of β-aminopropione. Blood pressure and heart rate of the rats were monitored using noninvasive tail artery blood pressure measuring instrument; sympathetic activity was monitored using drug block method; the structure of aortic wall was observed using HE staining; collagen fibers in aortic wall was observed using Sirius red staining; protein expression of Apelin was detected by immunohistochemistry; and the protein expression of matrix metalloproteinase (MMP)-2, 9 was detected by Western blotting. RESULTS: During the experiment, the body mass of the sham operation group and SCG group was smaller than that of the blank control group (all <0.05), and the body mass of the SCG group was larger than that of the sham operation group (all <0.05). The heart rate and sympathetic activity of the sham operation group were higher than those of the blank control group (all <0.05), while the SCG group were lower (all <0.05). Compared with the blank control group, the aortic wall in the sham operation group was thickening, while that in the SCG group was improved. A large number of collagen-1 in the aortic wall of the blank control group was stained brown by Sirius red, which was lighter in SCG group, and the staining in the sham operation group was the lightest. Compared with the blank control group, the expression of Apelin, MMP-2 and MMP-9 protein in the sham operation group increased (all <0.05), while those in the SCG group decreased (all <0.05). CONCLUSIONS SCG can effectively reduce the incidence and mortality of aortic dissection in rats, which may be related to the inhibition of sympathetic activity and the decrease of collagen-1, Apelin, MMP-2 and MMP-9 expression.
Aneurysm, Dissecting ; pathology ; surgery ; Animals ; Aorta ; pathology ; Collagen Type I ; Ganglia, Sympathetic ; Random Allocation ; Rats ; Rats, Sprague-Dawley

We report a case of ruptured mycotic aneurysm involving innominate artery requiring an urgent surgical treatment. A 62-yr-old woman presented with fever and dyspnea. Previously, she was diagnosed with colon cancer and received right hemicolectomy and one cycle of adjuvant chemotherapy. On echocardiogram, pericardial effusion was noted and emergency pericardiocentesis was performed. CT scan revealed aortic aneurysm involving ascending aorta and innominate artery, and thrombi surrounding those structures. Patch repair of the defect in the ascending aorta and ringed Goretex graft to bypass the innominate and ascending aorta were performed. We believe that this is the first case of ruptured mycotic aneurysm involving innominate artery.
Aneurysm, Infected/*surgery ; Aorta/pathology ; Aortic Aneurysm/surgery ; Brachiocephalic Trunk/pathology ; Colonic Neoplasms/drug therapy/surgery ; Female ; Human ; Middle Aged ; Tomography, X-Ray Computed ; Transplants

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

Aorta ; pathology ; surgery ; Aortopulmonary Septal Defect ; therapy ; Balloon Occlusion ; methods ; Catheterization, Swan-Ganz ; methods ; Child ; Female ; Humans ; Pulmonary Artery ; pathology ; surgery ; Treatment Outcome

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*

Chimney technique is an assistive technology of endovascular aortic repair, which is used to reconstruct the vital branch vessel invaded by aortic pathology. In chimney technique, most of the commercial aortic stent-graft can be used, and covered branch stent-graft is recommended to decrease the risk of type I a endoleak. The suggested oversizing for aortic stent-graft and branch stent-graft is 15% and 5% respectively, and the length of overlapping between stent-grafts should be more than 2 cm. Type I a endoleak is the main concentration, appropriated oversizing and overlapping are important precautions theoretically. Anticoagulation therapy post-operation is crucial in preventing restenosis of the chimney stent-graft.
Aorta ; pathology ; surgery ; Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation ; Endoleak ; prevention & control ; Endovascular Procedures ; Humans ; Prosthesis Design ; Stents