Acute type A aortic dissection (Type I, proximal, ascending)
|
|
- Hannah Quinn
- 5 years ago
- Views:
Transcription
1 Acute Type A Aortic Dissection R. Morton Bolman, III, MD Acute type A aortic dissection (Type I, proximal, ascending) is a true surgical emergency. It is estimated that patients suffering this calamity experience approximately a 1% per hour mortality in the first 48 hours and 90% of these patients will be dead by the end of 3 months without surgery. The majority of type A dissections propagate through the aortic arch and the descending and thoracoabdominal aorta. The dissection flap can be associated with malperfusion of virtually any major artery emanating from the aorta by virtue of either static or dynamic obstructive physiology. That said, however, the most common modes of death in type A dissection are the following two: (1) rupture into the pericardial space with acute tamponade or (2) compromise of the coronary circulation with resultant myocardial ischemia. Forty to 50% of cases are accompanied by significant degrees of aortic insufficiency. This is not due necessarily to any inherent abnormality in the aortic valve, but rather to dissection involving the aortic root with diastolic prolapse of one or more commissures causing the insufficiency. The symptoms and syndromes that can accompany type A aortic dissection are numerous and variable. It is of the utmost importance in this setting that the surgeon remains focused on the immediately life-threatening consequences of proximal dissection in planning the approach to the patient. Once the proximal aorta is stabilized, the risk of rupture into the pericardium and of acute compromise of one or both coronary arteries is removed. This allows a more deliberate and systematic approach to any distal malperfusion that may be present. Perioperative Procedure The patient is positioned supine and prepped and draped from the chin to the feet. It is important to include the lower extremities in the operative field in case conduit for bypassing the coronary arteries becomes necessary. Routine transesophageal echocardiography is employed for perioperative management, confirmation of the diagnosis, quantitative evaluation of aortic valve competence, and left ventricular Division of Cardiac Surgery, Brigham and Women s Hospital, Boston, Massachusetts. Address reprint requests to R. Morton Bolman, III, MD, Division of Cardiac Surgery, Brigham and Women s Hospital, 75 Francis Street, Boston, MA rbolman@partners.org function, as well as screening for any other cardiac abnormalities. Incision The approach is via midline sternotomy with the option of extending the incision along the left sternocleidomastoid muscle on the left if necessary (Fig. 1). Cannulation for Bypass The patient can be cannulated for bypass either via the right axillary artery through an incision in the deltopectoral groove on the right (Fig. 2A) or via the femoral artery with the best pulse (Fig. 2B). We prefer to attach a 6-mm woven Dacron graft to either the axillary or the femoral artery, into which is inserted the arterial cannula or connector. Bicaval venous cannulation is preferred, and the superior vena cava is encircled with a tourniquet. A left ventricular vent is inserted through the right superior pulmonary vein and a retrograde cardioplegia catheter is positioned in the coronary sinus. Handheld cannulae should be available for direct administration of cardioplegic solution directly into the coronary ostia in the event that significant aortic insufficiency is present. In this article, we focus our attention on a typical situation in which the aortic tear occurs in the ascending aorta, the situation in 70 to 85% of cases. Conduct of the Operative Procedure With the patient on cardiopulmonary bypass and the left ventricle vented, cooling can be initiated to a depth of 16 to 20 C. Once ventricular fibrillation occurs, it is acceptable to clamp the ascending aorta proximal to the intended level of distal repair to allow assessment and reconstruction of the proximal aorta to begin during the period of systemic cooling. In the presence of the dissected ascending aorta, it is safest to open the aorta, once the clamp is placed, during a period of retrograde administration of cardioplegia. Once the coronary ostia are identified, antegrade induction doses of blood cardioplegia should be administered individually into each coronary ostium. Once the heart is cold and arrested, protection should consist of retrograde cold blood cardioplegia supplemented by intermittent antegrade doses into the coronary ostia. Myocardial protection is challenging and of the utmost importance in these cases (Fig. 3) /09/$-see front matter 2009 Elsevier Inc. All rights reserved. doi: /j.optechstcvs
2 Acute type A aortic dissection 125 Figure 1 The patient is positioned supine and prepped and draped from the chin to the feet. The incision is a midline sternotomy, with the option of extending the incision along the left sternocleidomastoid muscle on the left, if necessary. m muscle. Proximal Aortic Reconstruction The aorta is transected at the level of the sinotubular junction. Careful assessment of the aortic root is now performed. The transesophageal echocardiogram offers the best assessment of aortic root dimension. It is important that this measurement be obtained before arresting the heart and opening the aorta, as evaluation of aortic size is very difficult in the arrested heart. In the situation where the aortic root size is determined to be normal, careful assessment of the valve anatomy and integrity is performed. If the transesophageal echocardiogram demonstrates no aortic insufficiency, and the valve appears anatomical relatively normal, proximal reconstruction is relatively straightforward. Strips of Teflon felt, approximately 1 cm in width and approximating the circumference of the aorta in length, are positioned, one inside and one outside the dissected aorta. These strips of Teflon felt are employed to sandwich the dissected walls of the aorta together. A horizontal mattress suture of 3-0 monofilament suture is used to approximate these strips, taking care to capture all layers of the aorta (Fig. 4). If one or more of the aortic commissures is dissected, leading to prolapse and aortic insufficiency, the commissure(s) can be restored to its appropriate level with a felt-reinforced monofilament suture passed through all walls of the remaining aorta (Fig. 5). The reconstruction as previously described then ensues, creating a proximal aorta to which a woven Dacron graft can be attached. Dissection can extend to the level of the coronary ostia. If the coronary artery remains intact, even in the presence
3 126 R.M. Bolman, III Figure 2 This figure demonstrates the cannulation for bypass. Either the axillary artery (A) or the femoral artery with the strongest pulse (B) can be cannulated. We favor attaching a 6 mm Dacron graft to the artery, and cannulating the graft for bypass, as shown. Bicaval venous cannulation is favored for venous return. A left ventricular vent is positioned via the right superior pulmonary vein (RSPV) and a retrograde cardioplegia cannula is positioned in the coronary sinus. a. artery; IVC inferior vena cava; SVC superior vena cava.
4 Acute type A aortic dissection 127 Figure 3 With the patient on bypass and the left ventricle vented, cooling can begin. When the heart fibrillates, the ascending aorta can be clamped at a level proximal to the intended site of distal reconstruction. This is accomplished during the delivery of retrograde cardioplegia through the coronary sinus. Once the aorta is opened, the cardioplegia is delivered directly into the coronary ostia as demonstrated. a. artery. of dissection extending down to the level of coronary artery, the method of reconstruction described above will usually suffice. If, however, the intima at the coronary ostium is disrupted, it is difficult to preserve such a coronary artery, and other methods of reconstruction will have to be employed. Distal Aortic Reconstruction by the Open Technique When the patient reaches the desired systemic temperature, attention should be directed to the distal aortic reconstruction. There will be an obligate period of at least 1
5 128 R.M. Bolman, III Figure 4 The delaminated proximal aortic layers are reapproximated between strips of Teflon felt using a continuous 3-0 monofilament horizontal mattress suture. a. artery.
6 Acute type A aortic dissection 129 Figure 5 This figure depicts the reconstructed proximal aorta. The dissected layers of the aorta have been reapproximated between layers of Teflon felt. The aortic commissures are resuspended to their normal location in the aortic root with felt-reinforced sutures. hour of rewarming. Efficient conduct of the operation requires that the distal reconstruction be completed, so that rewarming can be initiated during the completion of the proximal reconstruction. The patient is placed in steep Trendelenburg position, and the tourniquet around the superior vena cava cannula is tightened. The surgeon should have selected a woven Dacron graft for reconstruction of the ascending aorta on sizing the proximal aorta at the level of the sinotubular junction. Valve sizers can be helpful in this estimation. Care should be taken to minimize the period of deep hypothermia with circulatory arrest. This can be accomplished by becoming organized for this distal reconstruction before discontinuing cardiopulmonary bypass. When ready, the pump is turned off; the inferior vena cava cannula is clamped, and the tourniquet about the superior vena cava is tightened. Then retrograde cerebral perfusion via the superior vena cava is initiated at the level of the heart lung machine. Central venous pressure should be monitored and should not exceed 25 mm Hg. This usually allows flows of 500 to 800 ml/min. The aortic cross-clamp is removed. The aorta is inspected from within. The aorta is transected at the base of the innominate artery. If, as is usually the case, the dissection extends into the aortic arch and beyond, distal aortic reconstruction will be necessary before attaching the ascending conduit. One-centimeter Teflon felt strips cut in length to approximate the circumference of the distal aorta are placed, one inside and one outside the aorta. These are approximated with a horizontal mattress suture of 3-0 monofilament suture, taking care to capture all aortic layers (Fig. 6). This creates an excellent landing zone for the Dacron graft. The graft is then brought to the field and anastomosed to this reconstructed distal aorta using 2-0 or 3-0 running monofilament suture, again taking care to capture all layers of the reconstructed distal aorta (Fig. 7A). If the patient is cannulated via the right axillary artery, and if flows have been adequate, the retrograde cerebral perfusion can be turned off once the anastomosis has been completed. Antegrade flow is then started at a low rate of 500 ml/min to fill the ascending aorta and cerebral vessels and to remove any air. This is accomplished as a clamp is placed on the graft just proximal to the anasto-
7 130 R.M. Bolman, III Figure 6 When the patient reaches the desired temperature, the period of circulatory arrest is initiated with the patient in steep Trendelenburg position. The aorta is transected at the base of the innominate artery. The delaminated layers of the distal ascending aorta are reapproximated between layers of Teflon felt with a continuous 3-0 monofilament horizontal mattress suture, in a manner analogous to that employed on the proximal ascending aorta. Note that the tourniquet surrounding the superior vena cava is tightened, and the patient is receiving continuous retrograde cerebral perfusion via the superior vena cava cannula during this portion of the procedure.
8 Acute type A aortic dissection 131 Figure 7 (A) The previously-chosen Dacron graft is brought to the field and anastomosed endto-end to the reconstructed distal ascending aorta using 2-0 or 3-0 monofilament suture. (B) Once the distal anastomosis is completed, the ascending aorta and its branches are carefully deaired by a combination of retrograde and antegrade flushing maneuvers. The graft is clamped proximal to the anastomosis, and flow is restored to the patient s head and body via the axillary artery inflow. Systemic rewarming can now be initiated.
9 132 R.M. Bolman, III Figure 8 Distal reperfusion has been initiated through a side arm of the ascending graft. This can also be accomplished by direct cannulation of the ascending graft just proximal to the distal suture line. This method would be employed if the patient had previously placed on bypass with femoral artery cannulation, or if there was some concern regarding the adequacy of perfusion via the right axillary artery. Once the distal suture line has been completed, it is critical that reperfusion be initiated in an antegrade manner.
10 Acute type A aortic dissection 133 Figure 9 This figure depicts the completion of the anatomic repair. The Dacron graft is shown being anastomosed to the reconstructed proximal aorta using a continuous 2-0 or 3-0 monofilament suture.
11 134 R.M. Bolman, III Figure 10 The completed procedure is depicted. The dissected ascending aorta has been removed, the valve resuspended, all air evacuated from the left circulation, and the patient has been decannulated. mosis; full flow is initiated to the head and body of the patient and rewarming is initiated (Fig. 7B). If the patient was cannulated via a femoral artery, it is very important at this time to cannulate the ascending graft, so that perfusion can occur in an antegrade fashion (Fig. 8). If one perfuses retrograde through a femoral artery, blood can easily traverse both true and false channels in the distal aorta. This can serve to pressurize and potentially disrupt the reconstructed distal aortic suture line. Completion of Proximal Reconstruction With the distal aorta repaired, attention can be redirected to the proximal reconstruction. The sinotubular junction, sandwiched between two layers of Teflon felt, can be readily anastomosed to the ascending Dacron graft using a running monofilament suture, and taking care to capture all layers of the reconstructed proximal aorta (Fig. 9). Other Situations Should the valve need to be replaced because of intrinsic valve pathologic problems (eg, bicuspid aortic valve with stenosis, unrepairable commissural dissection, etc.), valve replacement can take place in the usual fashion. It is often helpful to anastomose a short segment of the Dacron conduit to the proximal aorta before inserting the valve. This makes for ready graft-to-graft anastomosis as a completion procedure.
12 Acute type A aortic dissection 135 Aortic Root Intact, Valve Requires Replacement In this instance, there are two options. If the valve (either bicuspid or tricuspid) appears salvageable, a valve-sparing aortic root replacement can be performed. This can be either total root replacement or replacement of only the sinus or sinuses containing the damaged coronary artery ostium. Although the prospect of embarking on a procedure of this magnitude in this setting can be daunting, in actuality, this is one of the more hemostatic methods to reconstruct the aortic root. Dissection Involves Aortic Root, as Well as One or Both Coronary Ostia If the valve is abnormal (calcium deposits, fenestrations, etc), in the interest of preserving time, a composite valve graft can be employed to reconstruct the proximal aorta. With either the valve-sparing root replacement or the composite root replacement, reimplantation of severely dissected coronary arteries is highly unpredictable and fraught with risk. It is often preferable to ligate the proximal coronary artery and to perform a saphenous vein bypass or bypasses in this setting. Completion of Procedure The patient is returned to normal temperature and, following deairing, is separated from cardiopulmonary bypass, and the operation is completed in the usual fashion (Fig. 10). Suggested Reading Danner BC, Natour E, Horst M, et al: Comparison of operative techniques in acute type A aortic dissection performing the distal anastomosis. J Card Surg 22: , 2007 Fann JI, Glower DD, Miller DC, et al: Preservation of aortic valve in type 1 aortic dissection complicated by aortic regurgitation. J Thorac Cardiovasc Surg 102(1):62-73, 1991, discussion Immer FF, Aeschimann R, Englberger L, et al: Resuspension of the aortic valve in acute type A dissection: Long-term results. J Heart Valve Dis 17:94-97, 2008, discussion 97 Lai DT, Miller DC, Mitchell RS, et al: Acute type A aortic dissection complicated by aortic regurgitation: Composite valve graft versus separate valve graft versus conservative valve repair. J Thorac Cardiovasc Surg 126(6): , 2003
Anatomy determines the close vicinity of the sinuses of
Aortic Valve Reimplantation According to the David Type I Technique Matthias Karck, MD, and Axel Haverich, MD Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
More informationMinimal access aortic valve surgery has become one of
Minimal Access Aortic Valve Surgery Through an Upper Hemisternotomy Approach Prem S. Shekar, MD Minimal access aortic valve surgery has become one of the accepted forms of surgical therapy for patients
More informationDisease of the aortic valve is frequently associated with
Stentless Aortic Bioprosthesis for Disease of the Aortic Valve, Root and Ascending Aorta John R. Doty, MD, and Donald B. Doty, MD Disease of the aortic valve is frequently associated with morphologic abnormalities
More informationThe arterial switch operation has been the accepted procedure
The Arterial Switch Procedure: Closed Coronary Artery Transfer Edward L. Bove, MD The arterial switch operation has been the accepted procedure for the repair of transposition of the great arteries (TGA)
More informationAdvances in the Treatment of Acute Type A Dissection: An Integrated Approach
Advances in the Treatment of Acute Type A Dissection: An Integrated Approach Joseph E. Bavaria, MD, Derek R. Brinster, MD, Robert C. Gorman, MD, Y. Joseph Woo, MD, Thomas Gleason, MD, and Alberto Pochettino,
More informationAn anterior aortoventriculoplasty, known as the Konno-
The Konno-Rastan Procedure for Anterior Aortic Annular Enlargement Mark E. Roeser, MD An anterior aortoventriculoplasty, known as the Konno-Rastan procedure, is a useful tool for the cardiac surgeon. Originally,
More informationAORTIC DISSECTIONS Current Management. TOMAS D. MARTIN, MD, LAT Professor, TCV Surgery Director UF Health Aortic Disease Center University of Florida
AORTIC DISSECTIONS Current Management TOMAS D. MARTIN, MD, LAT Professor, TCV Surgery Director UF Health Aortic Disease Center University of Florida DISCLOSURES Terumo Medtronic Cook Edwards Cryolife AORTIC
More informationType II arch hybrid debranching procedure
Safeguards and Pitfalls Type II arch hybrid debranching procedure Prashanth Vallabhajosyula, Wilson Y. Szeto, Nimesh Desai, Caroline Komlo, Joseph E. Bavaria Division of Cardiovascular Surgery, University
More informationSaphenous Vein Autograft Replacement
Saphenous Vein Autograft Replacement of Severe Segmental Coronary Artery Occlusion Operative Technique Rene G. Favaloro, M.D. D irect operation on the coronary artery has been performed in 180 patients
More informationA Study of Prior Cases
A Study of Prior Cases Clinical theme Sub theme Clinical situation/problem Clinical approach Outcome/Lesson Searchable Key word(s) 1 Cannulation Cannulae insertion The surgeon was trying to cannulate for
More informationThe Rastelli procedure has been traditionally used for repair
En-bloc Rotation of the Truncus Arteriosus A Technique for Complete Anatomic Repair of Transposition of the Great Arteries/Ventricular Septal Defect/Left Ventricular Outflow Tract Obstruction or Double
More informationThe radial procedure was developed as an outgrowth
The Radial Procedure for Atrial Fibrillation Takashi Nitta, MD The radial procedure was developed as an outgrowth of an alternative to the maze procedure. The atrial incisions are designed to radiate from
More informationModification in aortic arch replacement surgery
Gao et al. Journal of Cardiothoracic Surgery (2018) 13:21 DOI 10.1186/s13019-017-0689-y LETTER TO THE EDITOR Modification in aortic arch replacement surgery Feng Gao 1,2*, Yongjie Ye 2, Yongheng Zhang
More informationOpen fenestration for complicated acute aortic B dissection
Art of Operative Techniques Open fenestration for complicated acute aortic B dissection Santi Trimarchi 1, Sara Segreti 1, Viviana Grassi 1, Chiara Lomazzi 1, Marta Cova 1, Gabriele Piffaretti 2, Vincenzo
More informationThe management of chronic thromboembolic pulmonary
Technique of Pulmonary Thromboendarterectomy Isabelle Opitz, MD, and Marc de Perrot, MD, MSc, FRCSC Toronto Pulmonary Endarterectomy Program, Toronto General Hospital, Ontario, Canada. Address reprint
More informationPartial anomalous pulmonary venous connection to superior
Cavo-Atrial Anastomosis Technique for Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava The Warden Procedure Robert A. Gustafson, MD Partial anomalous pulmonary venous connection
More informationCoronary Artery from the Wrong Sinus of Valsalva: A Physiologic Repair Strategy
Coronary Artery from the Wrong Sinus of Valsalva: A Physiologic Repair Strategy Tom R. Karl, MS, MD he most commonly reported coronary artery malformation leading to sudden death in children and young
More informationObstructed total anomalous pulmonary venous connection
Total Anomalous Pulmonary Venous Connection Richard A. Jonas, MD Children s National Medical Center, Department of Cardiovascular Surgery, Washington, DC. Address reprint requests to Richard A. Jonas,
More informationSELECTIVE ANTEGRADE TECHNIQUE OF CHOICE
SELECTIVE ANTEGRADE CEREBRAL PERFUSION IS THE TECHNIQUE OF CHOICE MARKO TURINA University of Zurich Zurich, Switzerland What is so special about the operation on the aortic arch? Disease process is usually
More information14 Valvular Stenosis
14 Valvular Stenosis 14-1. Valvular Stenosis unicuspid valve FIGUE 14-1. This photograph shows severe valvular stenosis as it occurs in a newborn. There is a unicuspid, horseshoe-shaped leaflet with a
More informationThe goal of the hybrid approach for hypoplastic left heart
The Hybrid Approach to Hypoplastic Left Heart Syndrome Mark Galantowicz, MD The goal of the hybrid approach for hypoplastic left heart syndrome (HLHS) is to lessen the cumulative impact of staged interventions,
More informationCardiac tumors are unusual and cardiac malignancy, usually
Cardiac Autotransplantation Shanda H. Blackmon, MD,* and Michael J. Reardon, MD Cardiac tumors are unusual and cardiac malignancy, usually sarcoma, is a very small subset of these. The literature on cardiac
More informationIn 1980, Bex and associates 1 first introduced the initial
Technique of Aortic Translocation for the Management of Transposition of the Great Arteries with a Ventricular Septal Defect and Pulmonary Stenosis Victor O. Morell, MD, and Peter D. Wearden, MD, PhD In
More informationEbstein s anomaly is defined by a downward displacement
Repair of Ebstein s Anomaly Sylvain Chauvaud, MD Ebstein s anomaly is a tricuspid valve anomaly associated with poor right ventricular contractility in severe cases. Surgery is indicated in all symptomatic
More informationThe stentless bioprosthesis has many salient features that
Aortic Valve Replacement with the Medtronic Freestyle Xenograft Using the Subcoronary Implantation Technique D. Michael Deeb, MD The stentless bioprosthesis has many salient features that make it an attractive
More informationPulmonary thromboendarterectomy (PTE) is indicated for
Pulmonary Thromboendarterectomy Steven R. Meyer, MD, PhD, and Christopher G.A. McGregor, MB, FRCS, MD (Hons) Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
More informationMechanical Bleeding Complications During Heart Surgery
Mechanical Bleeding Complications During Heart Surgery Arthur C. Beall, Jr., M.D., Kenneth L. Mattox, M.D., Mary Martin, R.N., C.C.P., Bonnie Cromack, C.C.P., and Gary Cornelius, C.C.P. * Potential for
More informationTetralogy of Fallot (TOF) with absent pulmonary valve
Repair of Tetralogy of Fallot with Absent Pulmonary Valve Syndrome Karl F. Welke, MD, and Ross M. Ungerleider, MD, MBA Tetralogy of Fallot (TOF) with absent pulmonary valve syndrome (APVS) occurs in 5%
More informationEbstein s anomaly is a congenital malformation of the right
Cone Reconstruction of the Tricuspid Valve for Ebstein s Anomaly: Anatomic Repair Joseph A. Dearani, MD, Emile Bacha, MD, and José Pedro da Silva, MD Division of Cardiovascular Surgery, Mayo Clinic, Rochester,
More informationFrozen elephant trunk for DeBakey type 1 dissection: the Cleveland Clinic technique
Masters of Cardiothoracic Surgery Frozen elephant trunk for DeBakey type 1 dissection: the Cleveland Clinic technique Eric E. Roselli, Michael Z. Tong, Faisal G. Bakaeen Aorta Center, Department of Thoracic
More informationAtrial fibrillation (AF) is associated with increased morbidity
Ablation of Atrial Fibrillation with Concomitant Surgery Edward G. Soltesz, MD, MPH, and A. Marc Gillinov, MD Atrial fibrillation (AF) is associated with increased morbidity and mortality in coronary artery
More informationOperative Strategy. Operative Technique
Domingo Liotta, M.D.; Christian Cabrol, M.D; Miguel del Rio, M.D; Armando Diluch, M.D; Adriano Malusardi, M.D. Figure 11 Acute dissected aortic root and ascending aorta with valvular regurgitation. -Replacement
More informationSURGICAL INTERVENTION IN AORTOPATHIES ZOHAIR ALHALEES, MD RIYADH, SAUDI ARABIA
SURGICAL INTERVENTION IN AORTOPATHIES ZOHAIR ALHALEES, MD RIYADH, SAUDI ARABIA In patients born with CHD, dilatation of the aorta is a frequent feature at presentation and during follow up after surgical
More informationTotal arch replacement with separated graft technique and selective antegrade cerebral perfusion
Masters of Cardiothoracic Surgery Total arch replacement with separated graft technique and selective antegrade cerebral perfusion Teruhisa Kazui 1,2 1 Hamamatsu University School of Medicine, Hamamatsu,
More informationSurgical management of acute type A aortic dissection: branch-first arch replacement with total aortic repair
Art of Operative Techniques Surgical management of acute type A aortic dissection: branch-first arch replacement with total aortic repair Sean D. Galvin 1, Nisal K. Perera 2, George Matalanis 2 1 Department
More informationTechniques to preserve the native aortic valve during aortic
Valve-Sparing Aortic Root Replacement with the Valsalva Graft Duke Cameron, MD, and Luca Vricella, MD Techniques to preserve the native aortic valve during aortic root replacement have evolved considerably
More informationSun s procedure for complex aortic arch repair: total arch replacement using a tetrafurcate graft with stented elephant trunk implantation
Art of Operative Techniques Sun s procedure for complex aortic arch repair: total arch replacement using a tetrafurcate graft with stented elephant trunk implantation Wei-Guo Ma 1,2, Jun-Ming Zhu 1, Jun
More informationValve-sparing aortic root replacement (VSRR) at the Johns
Valve-Sparing Aortic Root Replacement With the Valsalva Graft Duke Cameron, MD, and Luca Vricella, MD Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, Maryland. Address reprint requests
More informationTo reduce the morbidity and mortality associated with
Cardiac Surgery Aortic Arch Replacement/ Selective Antegrade Perfusion David Spielvogel, MD*, Steven L. Lansman, MD, PhD, and Randall B. Griepp, MD To reduce the morbidity and mortality associated with
More informationValve-sparing versus composite root replacement procedures in patients with Marfan syndrome
Masters of Cardiothoracic Surgery Valve-sparing versus composite root replacement procedures in patients with Marfan syndrome Joseph S. Coselli 1,2,3, Scott A. Weldon 1,4, Ourania Preventza 1,2,3, Kim
More informationAortic Arch/ Thoracoabdominal Aortic Replacement
Aortic Arch/ Thoracoabdominal Aortic Replacement Joseph S. Coselli, M.D. Vice Chair, Department of Surgery Professor, Chief, and Cullen Foundation Endowed Chair Division of Cardiothoracic Surgery Baylor
More informationThe pericardial sac is composed of the outer fibrous pericardium
Pericardiectomy for Constrictive or Recurrent Inflammatory Pericarditis Mauricio A. Villavicencio, MD, Joseph A. Dearani, MD, and Thoralf M. Sundt, III, MD Anatomy and Preoperative Considerations The pericardial
More informationAortic valve repair is an accepted option for aortic valve
Complex Aortic Valve Disease in Children Christopher W. Baird, MD,* and Pedro J. del Nido, MD Aortic valve repair is an accepted option for aortic valve pathologic conditions in children and young adults.
More informationOperation for Type A Aortic Dissection: Introduction of Retrograde Cerebral Perfusion
Operation for Type A Aortic Dissection: Introduction of Retrograde Cerebral Perfusion Masaya Kitamura, MD, Akimasa Hashimoto, MD, Takehide Akimoto, MD, Osamu Tagusari, MD, Shigeyuki Aorni, MD, and Hitoshi
More informationHeart Dissection. 5. Locate the tip of the heart or the apex. Only the left ventricle extends all the way to the apex.
Heart Dissection Page 1 of 6 Background: The heart is a four-chambered, hollow organ composed primarily of cardiac muscle tissue. It is located in the center of the chest in between the lungs. It is the
More informationSurgical Management of Left Ventricular Aneurysms by the Jatene Technique
Surgical Management of Left Ventricular Aneurysms by the Jatene Technique James L. Cox Few significant improvements in left ventricular aneurysm (LVA) surgery occurred from the time of Cooley s report
More informationA Loeys-Dietz Patient with a Trans-Atlantic Odyssey. Repeated Aortic Root Surgery ending with a Huge Left Main Coronary Aneurysm 4
1 2 3 A Loeys-Dietz Patient with a Trans-Atlantic Odyssey Repeated Aortic Root Surgery ending with a Huge Left Main Coronary Aneurysm 4 5 6 7 8 9 Thierry Carrel 1, Florian Schoenhoff 1 and Duke Cameron
More informationHeart transplantation is the gold standard treatment for
Organ Care System for Heart Procurement and Strategies to Reduce Primary Graft Failure After Heart Transplant Masaki Tsukashita, MD, PhD, and Yoshifumi Naka, MD, PhD Primary graft failure is a rare, but
More informationThe modified Konno procedure, or subaortic ventriculoplasty,
Modified Konno Procedure for Left Ventricular Outflow Tract Obstruction David P. Bichell, MD The modified Konno procedure, or subaortic ventriculoplasty, first described by Cooley and Garrett in1986, 1
More informationCT angiography in type I acute aortic dissection complicated with malperfusion - a visual review of obstruciton patterns
CT angiography in type I acute aortic dissection complicated with malperfusion - a visual review of obstruciton patterns Eneva M. St. Ekaterna University Hospital Report objectives 1. Review malperfusion
More informationCurrent Technique of the Arterial Switch Procedure for Transposition of the Great Arteries
Current Technique of the Arterial Switch Procedure for Transposition of the Great Arteries EDWARD L. BOVE, M.D. Section of Thoracic Surgev, C.S. Mott Children's Hospital, The University of Michigan Medical
More informationPrepared Pulmonary venous Orifice
HOW TO DO IT The Surgical Technique of Heterotopic Heart Transplantation D. Novitzky, M.D., F.C.S.(S.A.), D. K. C. Cooper, M.A., M.B., B.S., Ph.D., F.R.C.S., and C. N. Barnard, M.D., M.Med., M.S., Ph.D.,
More informationEchocardiography as a diagnostic and management tool in medical emergencies
Echocardiography as a diagnostic and management tool in medical emergencies Frank van der Heusen MD Department of Anesthesia and perioperative Care UCSF Medical Center Objective of this presentation Indications
More informationAnatomy of the coronary arteries in transposition
Thorax, 1978, 33, 418-424 Anatomy of the coronary arteries in transposition of the great arteries and methods for their transfer in anatomical correction MAGDI H YACOUB AND ROSEMARY RADLEY-SMITH From Harefield
More informationRepair of Complete Atrioventricular Septal Defects Single Patch Technique
Repair of Complete Atrioventricular Septal Defects Single Patch Technique Fred A. Crawford, Jr., MD The first repair of a complete atrioventricular septal defect was performed in 1954 by Lillehei using
More informationThe evolution of the Fontan procedure for single ventricle
Hemi-Fontan Procedure Thomas L. Spray, MD The evolution of the Fontan procedure for single ventricle cardiac malformations has included the development of several surgical modifications that appear to
More informationEbstein s anomaly is characterized by malformation of
Fenestrated Right Ventricular Exclusion (Starnes Procedure) for Severe Neonatal Ebstein s Anomaly Brian L. Reemtsen, MD,* and Vaughn A. Starnes, MD*, Ebstein s anomaly is characterized by malformation
More informationPerfusion for Repair of Aneurysms of the Transverse Aortic Arch
technique This new section is open for technicians to explore the unusual, the difficult, the innovative methods by which perfusion meets the challenge of the hour and produces the ultimate goal - a life
More informationAcute myocardial infarction (MI) due to extension of
Coronary Malperfusion Due to Type A Aortic Dissection: Mechanism and Surgical Management Koji Kawahito, MD, Hideo Adachi, MD, Sei-ichiro Murata, MD, Atsushi Yamaguchi, MD, and Takashi Ino, MD Department
More informationChapter 14. The Cardiovascular System
Chapter 14 The Cardiovascular System Introduction Cardiovascular system - heart, blood and blood vessels Cardiac muscle makes up bulk of heart provides force to pump blood Function - transports blood 2
More informationMinimally invasive valve-sparing aortic root reimplantation
Surgical Technique on Cardiac Surgery Page 1 of 5 Minimally invasive valve-sparing aortic root reimplantation Vishal N. Shah 1,2, Oleg I. Orlov 1,2, Cinthia Orlov 1,2, Serge Sicouri 1, Manabu Takebe 2,
More informationAORTIC DISSECTION. DISSECTING ANEURYSMS OF THE AORTA or CLASSIFICATION
DISSECTING ANEURYSMS OF THE AORTA or AORTIC DISSECTION CLASSIFICATION DeBakey classified aortic dissections into types I, II, and III :- Type I dissection the tear site originates in the ascending aorta,
More informationCannulation of the femoral artery with retrograde
PROXIMAL AORTIC PERFUSION FOR COMPLEX ARCH AND DESCENDING AORTIC DISEASE Stephen Westaby, MS, FRCS Takahiro Katsumata, MD Objective: Cannulation of the femoral artery is used routinely for hypothermic
More informationAcute dissections of the descending thoracic aorta (Debakey
Endovascular Treatment of Acute Descending Thoracic Aortic Dissections Nimesh D. Desai, MD, PhD, and Joseph E. Bavaria, MD Acute dissections of the descending thoracic aorta (Debakey type III or Stanford
More informationHeart Transplant ation Technique
Heart Transplant ation Technique R. Morton Bolman I11 Since its clinical inception in 1967, heart transplantation has benefited thousands of patients with heart failure. The surgical technique has remained
More informationCongenital supravalvar aortic stenosis (SVAS) is the least
Brom Repair for Supravalvar Aortic Stenosis Max B. Mitchell, MD,* and Steven P. Goldberg, MD Congenital supravalvar aortic stenosis (SVAS) is the least common form of left ventricular outflow tract (LVOT)
More informationParasternal Approach for Minimally Invasive Aortic Valve Surgery
Parasternal Approach for Minimally Invasive Aortic Valve Surgery Lawrence H. Cohn Aortic valve replacement for the stenotic or regurgitant aortic valve has been one of the major advances of medical science
More informationCT of Acute Thoracic Aortic Syndromes Stuart S. Sagel, M.D.
CT of Acute Thoracic Aortic Syndromes Stuart S. Sagel, M.D. Thoracic Aortic Aneurysms Atherosclerotic Dissection Penetrating ulcer Mycotic Inflammatory (vasculitis) Traumatic Aortic Imaging Options Catheter
More informationThe need for right ventricular outflow tract reconstruction
Polytetrafluoroethylene Bicuspid Pulmonary Valve Implantation James A. Quintessenza, MD The need for right ventricular outflow tract reconstruction and pulmonary valve replacement is increasing for many
More informationTechniques for repair of complete atrioventricular septal
No Ventricular Septal Defect Patch Atrioventricular Septal Defect Repair Carl L. Backer, MD *, Osama Eltayeb, MD *, Michael C. Mongé, MD *, and John M. Costello, MD For the past 10 years, our center has
More informationTetralogy of Fallot (TOF) with atrioventricular (AV)
Tetralogy of Fallot with Atrioventricular Canal Defect: Two Patch Repair Sitaram M. Emani, MD, and Pedro J. del Nido, MD Tetralogy of Fallot (TOF) with atrioventricular (AV) canal defect is classified
More informationPenetrating wounds of the heart and great vessels
Thorax (1973), 28, 142. Penetrating wounds of the heart and great vessels A report of 30 patients C. E. ANAGNOSTOPOULOS and C. FREDERICK KITTLE Department of Surgery, Section of Thoracic and Cardiovascular
More informationMinimally invasive mitral valve surgery: tips, tricks and technique
Surgical Technique on Cardiac Surgery Page 1 of 6 Minimally invasive mitral valve surgery: tips, tricks and technique Allen Cheng, Amy M. Ramsey Division of Cardiovascular and Thoracic Surgery, Oklahoma
More informationAortic root enlargement is an invaluable surgical technique
Aortic Root Enlargement in the Adult Christopher M. Feindel, MD, CM, FRCS(C) Aortic root enlargement is an invaluable surgical technique with which every cardiac surgeon performing aortic valve replacement
More informationLAB 12-1 HEART DISSECTION GROSS ANATOMY OF THE HEART
LAB 12-1 HEART DISSECTION GROSS ANATOMY OF THE HEART Because mammals are warm-blooded and generally very active animals, they require high metabolic rates. One major requirement of a high metabolism is
More informationPublicado : Interactive CardioVascular Thoracic Surgery 2011;12:650.
Pulmonary embolism due to biological glue after repair of type A aortic dissection Jose Rubio Alvarez,MD, PhD, 1 Juan Sierra Quiroga, MD, PhD, 1 Anxo Martinez de Alegria MD 2, Jose-Manuel Martinez Comendador,
More informationAggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection
Aggressive Resection/Reconstruction of the Aortic Arch in Type A Dissection M. Grabenwoger Dept. of Cardiovascular Surgery Hospital Hietzing Vienna, Austria Disclosure Statement Consultant of Jotec, Hechingen,
More informationCirculatory arrest (CA) is usually necessary for surgical correction of pathologic
Surgical Techniques Mehmet Unal, MD Oguz Yilmaz, MD Ilker Akar, MD Ilker Ince, MD Cemal Aslan, MD Fatih Koc, MD Haluk Kafali, MD Key words: Aneurysm, dissecting/surgery; aortic aneurysm, thoracic/surgery;
More informationMODIFICATION OF THE MAZE PROCEDURE FOR ATRIAL FLUTTER AND ATRIAL FIBRILLATION
MODIFICATION OF THE MAZE PROCEDURE FOR ATRIAL FLUTTER AND ATRIAL FIBRILLATION II. Surgical technique of the maze III procedure The operative technique of the maze III procedure for the treatment of patients
More informationSurgical Procedures and Complications
Radiological Society of North America, RSNA 2013 Refresher Course Program: Vascular Track Surgical Procedures and Complications Learning objectives Outline RC 112 : Key Concepts: Surgical Procedures and
More informationGelweave TM. Thoracic and Thoracoabdominal Graft Geometries. Ante-Flo TM 4 Branch Plexus. Siena Valsalva TM Trifurcate Arch Graft. Coselli.
Gelweave TM Thoracic and Thoracoabdominal Graft Geometries Ante-Flo TM 4 Branch Plexus Siena Valsalva TM Trifurcate Arch Graft Coselli Lupiae Product availability subject to local regulatory approval.
More informationCardiovascular System. Heart Anatomy
Cardiovascular System Heart Anatomy 1 The Heart Location & general description: Atria vs. ventricles Pulmonary vs. systemic circulation Coverings Walls The heart is found in the mediastinum, the medial
More informationIn the frequent catastrophic cascade of events immediately
Operation for Acute and Chronic Aortic Dissection: Recent Outcome With Regard to Neurologic Deficit and Early Death Hazim J. Safi, MD, Charles C. Miller III, PhD, Michael J. Reardon, MD, Dimitrios C. Iliopoulos,
More informationAcute Aortic Regurgitation Secondary to Aortic Dissection
Acute Aortic Regurgitation Secondary to Aortic Dissection Surgical Management Without Valve Replacement Hassan Najafi, M.D., William S. Dye, M.D., Hushang Javid, M.D., James A. Hunter, M.D., Marshall D.
More informationCJ Shuster A&P2 Lab Addenum Beef Heart Dissection 1. Heart Dissection. (taken from Johnson, Weipz and Savage Lab Book)
CJ Shuster A&P2 Lab Addenum Beef Heart Dissection 1 Heart Dissection. (taken from Johnson, Weipz and Savage Lab Book) Introduction When you have finished examining the model, you are ready to begin your
More informationVerbrede mediastinum: Treatment
Verbrede mediastinum: Treatment Klinische les - Cardiale Heelkunde Gabriele Bislenghi ASO Heelkunde UZ Leuven Moderator: prof. B. Meuris Overview Aortic dissection Boerhaave Aortic Dissection Aortic dissection
More informationControversy exists regarding the extent of proximal
Does the Extent of Proximal or Distal Resection Influence Outcome for Type A Dissections? Marc R. Moon, MD, Thoralf M. Sundt III, MD, Michael K. Pasque, MD, Hendrick B. Barner, MD, Charles B. Huddleston,
More informationCardioplegia Circuit Products { ANTEGRADE}
Cardioplegia Circuit Products { ANTEGRADE} Antegrade cannulae are designed to deliver cardioplegia solution to the heart via the coronary ostia in the normal direction of blood flow (antegrade perfusion).
More informationTracheal stenosis in infants and children is typically characterized
Slide Tracheoplasty for Congenital Tracheal Stenosis Peter B. Manning, MD Tracheal stenosis in infants and children is typically characterized by the presence of complete cartilaginous tracheal rings and
More informationUse of pericardial baffle in the management of intractable bleeding in patients undergoing aortic surgery
Use of pericardial baffle in the management of intractable bleeding in patients undergoing aortic surgery Introduction Intractable bleeding can occur in complex aortic surgeries such as redo aortic surgeries,
More informationUniversity of Florida Department of Surgery. CardioThoracic Surgery VA Learning Objectives
University of Florida Department of Surgery CardioThoracic Surgery VA Learning Objectives This service performs coronary revascularization, valve replacement and lung cancer resections. There are 2 faculty
More informationThe Edge-to-Edge Technique f For Barlow's Disease
The Edge-to-Edge Technique f For Barlow's Disease Ottavio Alfieri, Michele De Bonis, Elisabetta Lapenna, Francesco Maisano, Lucia Torracca, Giovanni La Canna. Department of Cardiac Surgery, San Raffaele
More informationClinical Applications of Femoral Vein-to-Artery Cannulation for Mechanical Cardiopulmonary Support and Bypass
Clinical Applications of Femoral Vein-to-Artery Cannulation for Mechanical Cardiopulmonary Support and Bypass Robert L. Berger, M.D., Virender K. Saini, M.D., and Everett L. Dargan, M.D. ABSTRACT Femoral
More informationACTIVITY 9: BLOOD AND HEART BLOOD
ACTIVITY 9: BLOOD AND HEART OBJECTIVES: 1) How to get ready: Read Chapters 21 & 22, McKinley et al., Human Anatomy, 4e. All text references are for this textbook. Read dissection instructions BEFORE YOU
More informationAppendix A.1: Tier 1 Surgical Procedure Terms and Definitions
Appendix A.1: Tier 1 Surgical Procedure Terms and Definitions Tier 1 surgeries AV Canal Atrioventricular Septal Repair, Complete Repair of complete AV canal (AVSD) using one- or two-patch or other technique,
More informationManagement of Fusiform Ascending Aortic Aneurysms
Management of Fusiform Ascending Aortic Aneurysms Stuart Houser, M.D., Jose Mijangos, M.D., Amarenda Sengupta, M.D., Lawrence Zaroff, M.D., Robert Weiner, M.D., and James A. DeWeese, M.D. ABSTRACT Thirteen
More informationMitral valve infective endocarditis (IE) is the most
Mitral Valve Replacement for Infective Endocarditis With Annular Abscess: Annular Reconstruction Gregory J. Bittle, MD, Murtaza Y. Dawood, MD, and James S. Gammie, MD Mitral valve infective endocarditis
More informationTHE CARDIOVASCULAR SYSTEM. Part 1
THE CARDIOVASCULAR SYSTEM Part 1 CARDIOVASCULAR SYSTEM Blood Heart Blood vessels What is the function of this system? What other systems does it affect? CARDIOVASCULAR SYSTEM Functions Transport gases,
More informationI worldwide [ 11. The overall number of transplantations
Expanding Applicability of Transplantation After Multiple Prior Palliative Procedures Alan H. Menkis, MD, F. Neil McKenzie, MD, Richard J. Novick, MD, William J. Kostuk, MD, Peter W. Pflugfelder, MD, Martin
More information