Complications of Extra-Anatomic Aortic Bypass for Complex Coarctation and Aortic Arch Hypoplasia
|
|
- Diana Bates
- 6 years ago
- Views:
Transcription
1 Complications of Extra-Anatomic Aortic Bypass for Complex Coarctation and Aortic Arch Hypoplasia Johann Brink, MD, Melissa G.Y. Lee, BMedSc, Igor E. Konstantinov, MD, PhD, Michael M.H. Cheung, MD, T.H. Goh, MD, Martin Bennett, BAppSc, Christian P. Brizard, MD, and Yves d Udekem, MD, PhD Departments of Cardiac Surgery, and Cardiology, The Royal Children s Hospital, Department of Pediatrics, University of Melbourne and the Murdoch Childrens Research Institute, Melbourne; and Department of Cardiology, Monash Medical Centre, Clayton, Victoria, Australia Background. We have adopted the extra-anatomic bypass graft as the procedure of choice for the treatment of coarctation and aortic arch hypoplasia in the adult-sized patient. However, we have experienced prolonged chest drainage and have decided to investigate this complication and the morbidity related to this procedure. Methods. Between 1996 and 2010, 15 extra-anatomic bypass grafts of the aorta were performed in 14 patients. Their hospital records and follow-up data were retrospectively reviewed and compared with those of 14 consecutive patients operated with other conventional techniques over the same time period. Results. There was no hospital mortality. After the extra-anatomic bypass procedure, patients had longer hospital stay because of prolonged pleural effusions. Four patients developed complications related to persistent effusions leading to reinterventions, which led to mediastinitis in 2 instances. At last follow-up, 2 of 14 patients with extra-anatomic bypass remained hypertensive, while 8 of the 14 patients who underwent other types of repair had arch obstruction, were hypertensive, or both. Conclusions. In the adult-sized patient extra-anatomic bypass of the aortic arch relieves arch obstruction more effectively than conventional techniques. However, this technique is fraught with complications related to prolonged effusion drainage that may lead to mediastinitis and reintervention. Its indication should be weighted carefully. (Ann Thorac Surg 2013;95:676 81) 2013 by The Society of Thoracic Surgeons Coarctation repair should be performed in early infancy because the patients are at higher risk of developing hypertension later in life if they are older at the time of repair [1 6]. At times, this procedure has to be carried out in adolescents and adults when they present with a late diagnosis or when they are diagnosed with residual obstruction related to either the operated site or to a segment of unoperated hypoplastic arch. It has been advocated that the most practical and effective technique of coarctation repair for these indications in adultsized patients is an extra-anatomic bypass graft interposed between the side of the ascending aorta and the descending aorta in the posterior mediastinum because it relieves any arch obstruction more effectively than conventional techniques [7 9]. The resection of the abnormal aortic segment and end-to-end anastomosis can only be performed with difficulty in adults because the tissues cannot be adequately mobilized. Graft patching of the restricted area through a thoracotomy is favored by some but requires extensive dissection, posing a risk of damage to the left recurrent laryngeal and phrenic nerves if cardiopulmonary bypass is required [10]. Graft patching of the arch through a sternotomy requires Accepted for publication Sept 4, Address correspondence to Dr d Udekem, Department of Cardiac Surgery, The Royal Children s Hospital, Flemington Rd, Parkville, Melbourne, Victoria 3052, Australia; yves.dudekem@rch.org.au. extensive dissection, circulatory arrest, or a strategy of regional perfusion, and poses risk to the left recurrent laryngeal nerve. We have adopted the extra-anatomic bypass graft through sternotomy approach in recent years. We have faced complications related to prolonged chest drainage and decided to investigate the morbidity related to this procedure. Patients and Methods The design of the study was approved by the Royal Children s Hospital Research Ethics Committee and the need for individual consent was waived because of the retrospective nature of the project. All patients who had undergone an extraanatomic bypass of the aortic arch through a sternotomy in the Royal Children s Hospital were identified in the hospital database. All their hospital records were reviewed and their follow-up was obtained from the hospital database and requested from their referring cardiologists. Between 1996 and 2010, 15 extra-anatomic bypass grafts of the aorta were performed in 14 patients. Patient characteristics are summarized in Table 1. Surgical Technique Procedures were performed through a median sternotomy with cardiopulmonary bypass and systemic cooling to 34 C. The heart was retracted to expose the posterior pericardium. The procedure was performed on the beat by The Society of Thoracic Surgeons /$36.00 Published by Elsevier Inc
2 Ann Thorac Surg BRINK ET AL 2013;95: EXTRA-ANATOMIC BYPASS PROCEDURE 677 Table 1. Patient Characteristics Characteristic Extra-Anatomic Conventional Gender (M:F) 11 (79%):3 (21%) 12 (86%):2 (14%) Age at current arch operation (years) Associated cardiac anomalies Bicuspid aortic valve 5 (36%) 5 (36%) VSD 3 (21%) 5 (36%) Supravalvular aortic stenosis 2 (14%) 1 (7%) Parachute mitral valve 2 (14%) 0 (0%) Truncus arteriosus 0 (0%) 2 (14%) Pulmonary stenosis 1 (7%) 1 (7%) Subaortic membrane 1 (7%) 0 (0%) Supra mitral valve ring 1 (7%) 0 (0%) Double AA vascular ring 1 (7%) 0 (0%) Ebstein anomaly 0 (0%) 1 (7%) Hypoplastic left heart syndrome 0 (0%) 1 (7%) Previous non-arch cardiac operation 4 (29%) 6 (43%) Previous arch intervention 9 (64%) 14 (100%) Balloon dilatation 3 (33%) 3 (21%) Sternotomy 3 (33%) 5 (36%) End-to-side anastomosis 1 0 Patch repair 1 2 Graft interposition 1 3 Thoracotomy 2 (23%) 5 (36%) End-to-end anastomosis 1 2 Subclavian flap aortoplasty 1 3 Others 1 (11%) 1 (7%) Indication for current arch surgery Native coarctation 2 (14%) 1 (7%) Native coarctation hypoplastic arch 3 (22%) 0 (0%) Recoarctation hypoplastic arch 9 (64%) 12 (86%) Aneurysm 0 (0%) 1 (7%) Mean resting pre-op BP (mm Hg) / /76 15 AA aortic arch; BP blood pressure; VSD ventricular septal defect. ing heart in 10 instances. The heart was arrested in 3 patients because of the need for concomitant procedures and in 2 patients following the surgeon s discretion. The distal descending thoracic aorta was exposed through a vertical incision in the posterior pericardium. A sideclamp was applied to the descending aorta and the distal end-to-side anastomosis was performed between the graft and a longitudinal incision of the aorta. In 3 patients the femoral artery pressure was continuously monitored at the time of clamping to ensure that distal perfusion was maintained during cross-clamping. The grafts used in the initial 14 procedures were Intergard woven collagen coated polyester (Intervascular; Datascope, La Ciotat Cedex, France) in 12 patients, and Gore-Tex (Vascular Graft; W.L. Gore & Associates Inc, Flagstaff, AZ) in 2 patients. The diameters of the vascular grafts used were 16 mm (1), 18 mm (1), 20 mm (10), and 22 mm (2). The side-clamp was removed and the graft was clamped. In 12 patients the graft was passed on the right side of the heart. The pericardial reflection between the right inferior pulmonary vein and the inferior vena cava was largely opened. The graft was then aligned along the diaphragmatic surface of the right ventricle, passed posterior to the inferior vena cava and brought on the lateral side of the right atrium to reach the ascending aorta. The graft was slightly beveled and the end-to-side proximal anastomosis to the ascending aorta was performed with side-bite clamping (Fig 1). In 2 patients the graft was passed on the left side of the heart, anterior to the left lung hilum and anastomosed to the left side of the ascending aorta. In the patient who required a second extra-anatomic bypass graft, Intergard was the material used but with a larger diameter of 22 mm instead of 18 mm; the graft was passed onto the right side of the heart. The chest was closed with a minimum of 2 chest drains. All patients had mediastinal drains; in addition, 4 patients had 1 pleural cavity drained and 1 patient both pleural cavities. Antiplatelet therapy with Aspirin (Aspro Clear, Bayer, Gaillard, France) was initiated on the first postoperative day.
3 678 BRINK ET AL Ann Thorac Surg EXTRA-ANATOMIC BYPASS PROCEDURE 2013;95: Student t test was used to analyze patients resting blood pressure before and after the extra-anatomic bypass operation and other techniques of arch repair, and a non-paired Student t test to compare early outcomes between the 2 arch procedure groups. A p value of less than 0.05 was considered evidence of statistical significance. Data were expressed as mean standard deviation or median (interquartile range). Fig 1. Extra-anatomic aortic bypass graft procedure. Comparative Analysis With Early Postoperative Outcomes After Conventional Techniques In order to compare outcomes after extra-anatomic aortic bypass with those after other techniques of arch repair, our database was searched for patients of similar age (above 12 years) undergoing an arch operation during the study period (1996 to 2010). A total of 14 patients were identified. Definitions Resting hypertension for children and adolescents was defined as a systolic or diastolic blood pressure greater than the 95th percentile for age and height and prehypertension between the 90th and 95th percentile or if blood pressure was greater than 120/80 mm Hg [11]. In adults, resting hypertension was defined as a systolic blood pressure greater than 140 mm Hg or a diastolic blood pressure greater than 90 mm Hg [12]. Reobstruction of the arch was defined as a peak gradient greater than 25 mm Hg across the repair site on echocardiography, or an upper limb to lower limb blood pressure gradient greater than 20 mm Hg. Statistical Analysis All data were exported to and analyzed using STATA version 10.1 (Stat Corp, College Station, TX). A paired Results Fifteen extra-anatomic bypass procedures were performed in 14 patients. All but 1 patient were hypertensive preoperatively. Four patients underwent the following concomitant procedures: aortic valve repair (1); aortic valve repair and ventricular septal defect closure (1); right ventricle to pulmonary artery conduit replacement (1); and redo repair of supravalvular aortic valve obstruction (1) (Table 2). Five patients underwent cardioplegic arrest. Mean cardiopulmonary bypass and cross-clamp time were and minutes, respectively. There was no hospital mortality. The median intensive care unit stay was 1 day (1 1) and all patients were discharged home after a median hospital stay of 9 days (7 13). The drains had to be kept in situ for more than a week in 8 patients (Table 3). Over a median of 6 days (5 9), the mean drainage output was 6 2 ml/kg per day. Triglyceride content was tested in the pleural effusion of 4 patients and was found to be below 0.5 mmol/l in all cases. Four patients required readmission after discharge. Two patients developed recurrent effusion and mediastinitis that required surgical intervention. The first of the patients with mediastinitis had all drains removed on day 4 and was discharged on the postoperative day 10. He subsequently developed Staphylococcus aureus sepsis and a false aneurysm. On postoperative day 62 the graft was removed and a homograft patch aortoplasty of the descending aorta was performed. The patient developed a recurrent false aneurysm 2 years later and required another extra-anatomic aortic bypass procedure as well as an aorta reconstruction with a homograft. Four years after the second extra-anatomic bypass, this same patient developed recurrent graft sepsis and a false aneurysm that required septic graft removal and right subclavianto-iliac arteries bypass graft. The second of these patients with mediastinitis developed a graft kink and required a graft interposition procedure 14 years after the initial extra-anatomic aortic bypass repair, which was performed at the age of 12 years. This patient had his drains removed on day 5 and developed postoperative Staphylococcus aureus mediastinitis requiring drainage. Another 2 patients required readmission, one 10 days and one 13 days after their initial hospital discharge for drainage of pleural and pericardial effusions. The mean follow-up was months. The mean age at follow-up was 18 4 years. One patient died in a motorbike accident 5 years after the extra-anatomic aortic bypass. At last follow-up 3 months prior to the
4 Ann Thorac Surg BRINK ET AL 2013;95: EXTRA-ANATOMIC BYPASS PROCEDURE 679 Table 2. Surgical Technique and Late Outcomes Variable Extra-Anatomic Conventional Surgical arch technique Sternotomy 14 (100%) 6 (43%) Extra-anatomic aortic bypass 14 0 Arch patch with homograft 0 2 Arch patch with Dacron graft 0 1 Extended end-to-end anastomosis 0 2 Gore-Tex graft interposition 0 1 Thoracotomy 0 (0%) 8 (57%) Gore-Tex graft interposition 0 5 End-to-end anastomosis 0 2 Arch patch with Dacron graft 0 1 Concomitant surgery 4 (29%) 3 (21%) AV repair AV repair VSD closure RV-PA conduit replacement Redo repair of supra-av obstruction VSD closure Revision of PA reconstruction Ross procedure RV-PA conduit Number of patients with follow-up 14 (100%) 13 (93%) Mean follow-up time (months) Mean age at follow-up (years) Arch reobstruction at follow-up Not applicable 6 (46%) Resting hypertension at last follow-up 2 (14%) 5 (38%) Mean resting BP at follow-up (mm Hg) / /65 15 AV aortic valve; BP blood pressure; PA pulmonary artery; RV right ventricle; VSD ventricular septal defect. accident, the patient was normotensive on both resting and 24-hour ambulatory blood pressure. The mean resting systolic blood pressure decreased from mm Hg to mm Hg (p 0.006) postoperatively. Two patients remained hypertensive at last follow-up (Table 2). Comparison With Conventional Techniques of Arch Repair All patients were hypertensive prior to surgery. Hospital stay was shorter for these 14 patients undergoing an intervention different to an extra-anatomic aortic bypass (mean length of stay 7 1vs12 11 days; p 0.07). Their drains were kept for shorter lengths of time (4 2vs7 3 days; p 0.003) and their drains output was less (2 1 vs 6 2 ml/kg/day; p 0.001) (Table 3). No patients were Table 3. Postoperative Pericardial Drainage Features and Clinical Impact readmitted for drainage of residual or reaccumulated effusions. Follow-up was available in 13 patients (93%) (Table 2). The mean follow-up was months and mean age at follow-up was 16 3 years of age. Six patients (46%) had reobstruction on echocardiography (2 were operated using a Gore-Tex graft interposition by thoracotomy, 2 end-to-end anastomosis by thoracotomy, 1 patch enlargement of the arch with homograft patch through sternotomy, and 1 extended end-to-end anastomosis through sternotomy). The 2 patients who had an end-toend anastomosis by thoracotomy remained hypertensive. An additional 3 patients were found to be hypertensive at last follow-up. All of them had undergone a Gore-Tex graft interposition (2 through thoracotomy, 1 through sternotomy). The mean resting systolic blood pressure decreased from mm Hg to mm Hg (p 0.008) postoperatively. Variable Total drainage (ml) Total drainage (ml/kg/day) Drains in situ (days) Hospital stay (days) Extra-Anatomic Bypass Procedures (n 15) Conventional Procedures p Value 2,547 1, Comment Historical data from the early nineties demonstrated that hypertension may be lethal when it develops in young adults late after coarctation repair and in adults newly diagnosed with coarctation of the aorta. In the largest and longest study to date from the Mayo clinic, mortality as high as 28% was recorded in the three decades following arch repair [1]. This mortality was attributed to complications related to residual hypertension such as precocious coronary artery disease and from rupture of ab-
5 680 BRINK ET AL Ann Thorac Surg EXTRA-ANATOMIC BYPASS PROCEDURE 2013;95: dominal aortic and cerebral aneurysms. These data, long disregarded as historical, are regaining interest with increasing evidence that the incidence of late hypertension is higher than expected in these patients [13, 14]. All mechanisms leading to late hypertension after coarctation repair have not yet been fully elucidated, but it has been clearly demonstrated that residual obstruction [2, 15] and later age at repair are obvious contributing factors [1 6]. A large proportion of babies born with coarctation also have hypoplasia of the transverse aortic arch. It has become clear that the impact of this hypoplasia has been overlooked in previous decades and an increasing population of these young adults are now presenting with hypertension, often refractory to medical treatment [2]. It is yet unclear whether the relief of any arch obstruction will be sufficient to protect these patients from suffering from late hypertension [2, 16]. Nonetheless, the urgency of treating rapidly and effectively any arch obstruction has formed the rationale for a preferential choice of procedure that will give the best chance of immediate relief. While recurrent stenosis at the site of the previous anastomosis is best dealt with an interventional catheterization procedure, a number of these patients will present with complex hypoplastic lesions of the arch not accessible to balloon dilatation and stenting. Accordingly, surgery remains the favored option. Beyond infancy, end-to-end anastomosis, conventionally used in babies born with coarctation repair, can only be achieved with considerable difficulty because the aortic tissues have lost their elasticity. The long-term results of bypass grafting and patching of the arch have not been yet reported in this specific population of patients reaching an adult size. Extra-anatomic bypass of the arch through a sternotomy has been identified as the best approach in these patients because of its simplicity and its capacity to adequately relieve any obstruction without compromising the left phrenic and the left recurrent laryngeal nerve [7, 9]. Potential difficulties during reoperation in this population of patients with a high incidence of bicuspid aortic valves have not deterred the teams advocating this approach. Following the experience of stenting of adult coarctation, it has been advocated that the loss of elasticity of a segment of aortic arch may lead to hypertension, and it is yet unclear whether the interposition of a long segment of a rigid tubular graft will spare patients from late hypertension [17]. At this stage of our experience, we can conclude that extra-anatomic bypass of the arch has been more effective in relieving the arch obstruction than other techniques we have used over the same time period. Eight of the 14 patients operated with conventional techniques developed residual obstruction, hypertension, or both. Only 2 of the 14 patients undergoing an extra-anatomic bypass remained hypertensive. However, we are concerned by the morbidity associated with this procedure. In our institution, these patients had prolonged hospital stays because of ongoing chest drain losses. They also required repeated hospital admissions due to fluid recollection with subsequent surgical intervention. There is no doubt in our minds that overlooking these chest drain losses were responsible for the dramatic morbidity observed in the 2 young patients suffering early graft infection. The use of extra-anatomic bypass in our center was associated with an increased morbidity compared with the various more conventional techniques of arch repair used over the same time period, and we believe that the encountered prolonged effusions may have been related to the intrapericardial implantation of a long segment of Dacron graft. Vascular surgeons have long been aware of prolonged effusion drainage and perigraft collections after aortic bypass grafting of the abdominal aorta. Graft hemorrhage may occur due to poor anastomotic quality, device failure or rupture, and trans-graft hemorrhage. Because of the serosanguinous nature of the effusions and the time frame of their appearance, we believe that the prolonged effusions suffered by our patients were related to transudation of plasma through the grafts. Graft impermeability depends on the porosity and quality of graft healing. It has already been postulated that poor tissue growth in the mediastinum and the initial expansion and early dilatation observed in woven vascular Dacron [18] grafts may contribute to transgraft hemorrhage [19]. Preliminary reports with a third-generation Dacron graft seem to give promising results [20]. It is comprised of a triple layer composed of standard woven Dacron fused to a polytetrafluoroethylene outer layer by a self-sealing elastomeric membrane, making this graft highly impermeable but also slightly stiffer. This graft might be a possible alternative to prevent excessive early transgraft hemorrhage. We believe that surgeons who adopt this technique of extra-anatomic bypass should be aware of the potential for prolonged postoperative drainage of mediastinal and pleural effusions. We hope that prolonged and adequate drainage of these effusions will prevent the development of the complications that we observed in our patients. Our limited experience with the conventional techniques does not allow us to ascertain the best alternatives for this technique and their relative indications. Because of our high rate of residual obstruction, we tend to believe that any hypoplasia of the arch should be operated through a sternotomy. We believe that graft patching of the arch should be considered in these instances as an alternative to extra-anatomic bypass. The decision of the technique used should take into consideration the urgency of relieving the hypertension and the difficulty of an intervention on the native arch. This decision may need to be customized to the individual patient. In conclusion, in the adult-sized patient extra-anatomic bypass of the aortic arch relieves arch obstruction more effectively than conventional techniques. However, this technique is fraught with complications related to prolonged effusion drainage that may lead to mediastinitis and reintervention. Its indication should be weighted carefully.
6 Ann Thorac Surg BRINK ET AL 2013;95: EXTRA-ANATOMIC BYPASS PROCEDURE 681 Dr Yves d Udekem is a Career Development Fellow of The National Heart Foundation of Australia (CR 10M 5339). This research project was supported by the Victorian Government s Operational Infrastructure Support Program. References 1. Cohen M, Fuster V, Steele PM, Driscoll D, McGoon DC. Coarctation of the aorta. Long-term follow-up and prediction of outcome after surgical correction. Circulation 1989; 80: Hager A, Kanz S, Kaemmerer H, Schreiber C, Hess J. Coarctation Long-term Assessment (COALA): significance of arterial hypertension in a cohort of 404 patients up to 27 years after surgical repair of isolated coarctation of the aorta, even in the absence of restenosis and prosthetic material. J Thorac Cardiovasc Surg 2007;134: Seirafi PA, Warner KG, Geggel RL, Payne DD, Cleveland RJ. Repair of coarctation of the aorta during infancy minimizes the risk of late hypertension. Ann Thorac Surg 1998;66: Presbitero P, Demarie D, Villani M, et al. Long term results (15-30 years) of surgical repair of aortic coarctation. Br Heart J 1987;57: Clarkson PM, Nicholson MR, Barratt-Boyes BG, Neutze JM, Whitlock RM. Results after repair of coarctation of the aorta beyond infancy: a 10 to 28 year follow-up with particular reference to late systemic hypertension. Am J Cardiol 1983; 51: Maron BJ, Humphries JO, Rowe RD, Mellits ED. Prognosis of surgically corrected coarctation of the aorta. A 20-year postoperative appraisal. Circulation 1973;47: McKellar SH, Schaff HV, Dearani JA, et al. Intermediateterm results of ascending-descending posterior pericardial bypass of complex aortic coarctation. J Thorac Cardiovasc Surg 2007;133: Levy Praschker BG, Mordant P, Barreda E, Gandjbakhch I, Pavie A. Long-term results of ascending aorta-abdominal aorta extra-anatomic bypass for recoarctation in adults with 27-year follow-up. Eur J Cardiothorac Surg 2008;34: Berdat PA, Göber V, Carrel T. Extra-anatomic aortic bypass for complex (re-) coarctation and hypoplastic aortic arch in adolescents and adults. Interact Cardiovasc Thorac Surg 2003;2: Sakopoulos AG, Hahn TL, Turrentine M, Brown JW. Recurrent aortic coarctation: is surgical repair still the gold standard? J Thorac Cardiovasc Surg 1998;116: National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004;114(2 Suppl 4th Report): Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003;289: O Sullivan JJ, Derrick G, Darnell R. Prevalence of hypertension in children after early repair of coarctation of the aorta: a cohort study using casual and 24 hour blood pressure measurement. Heart 2002;88: de Divitiis M, Pilla C, Kattenhorn M, et al. Ambulatory blood pressure, left ventricular mass, and conduit artery function late after successful repair of coarctation of the aorta. J Am Coll Cardiol 2003;41: Guenthard J, Zumsteg U, Wyler F. Arm-leg pressure gradients on late follow-up after coarctation repair. Possible causes and implications. Eur Heart J 1996;17: Hauser M, Kuehn A, Wilson N. Abnormal responses for blood pressure in children and adults with surgically corrected aortic coarctation. Cardiol Young 2000;10: Eicken A, Pensl U, Sebening W, et al. The fate of systemic blood pressure in patients after effectively stented coarctation. Eur Heart J 2006;27: Etz CD, Homann T, Silovitz D, et al. Vascular graft replacement of the ascending and descending aorta: do Dacron grafts grow? Ann Thorac Surg 2007;84: Shiiya N, Kunihara T, Matsuzaki K, Sugiki T. Spontaneous perigraft hematoma suggesting transgraft hemorrhage seven years after thoracic aortic replacement with a Dacron graft. Eur J Cardiothorac Surg 2006;30: De Paulis R, Scaffa R, Maselli D, Salica A, Bellisario A, Weltert L. A third generation of ascending aorta Dacron graft: preliminary experience. Ann Thorac Surg 2008;85:
Are more extensive procedures warranted at the time of aortic arch reoperation?
European Journal of Cardio-Thoracic Surgery 52 (2017) 1132 1138 doi:10.1093/ejcts/ezx166 Advance Access publication 1 June 2017 ORIGINAL ARTICLE Cite this article as: Wong JS, Lee MG, Brink J, Konstantinov
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 informationThe application of autologous pulmonary artery in surgical correction of complicated aortic arch anomaly
Original Article The application of autologous pulmonary artery in surgical correction of complicated aortic arch anomaly Shusheng Wen, Jianzheng Cen, Jimei Chen, Gang Xu, Biaochuan He, Yun Teng, Jian
More informationAORTIC COARCTATION. Synonyms: - Coarctation of the aorta
AORTIC COARCTATION Synonyms: - Coarctation of the aorta Definition: Aortic coarctation is a congenital narrowing of the aorta, usually located after the left subclavian artery, near the ductus or the ligamentum
More informationPosterior Pericardial Ascending-to-Descending Aortic Bypass. An Alternative Surgical Approach for Complex Coarctation of the Aorta
Posterior Pericardial Ascending-to-Descending Aortic Bypass An Alternative Surgical Approach for Complex Coarctation of the Aorta Heidi M. Connolly, MD; Hartzell V. Schaff, MD; Uzi Izhar, MD; Joseph A.
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 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 informationSURGICAL TREATMENT AND OUTCOME OF CONGENITAL HEART DISEASE
SURGICAL TREATMENT AND OUTCOME OF CONGENITAL HEART DISEASE Mr. W. Brawn Birmingham Children s Hospital. Aims of surgery The aim of surgery in congenital heart disease is to correct or palliate the heart
More informationDebate in Management of native COA; Balloon Versus Surgery
Debate in Management of native COA; Balloon Versus Surgery Dr. Amira Esmat, El Tantawy, MD Professor of Pediatrics Consultant Pediatric Cardiac Interventionist Faculty of Medicine Cairo University 23/2/2017
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 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 informationHypertension in Repaired Coarctation: When to Intervene and how to treat?
Hypertension in Repaired Coarctation: When to Intervene and how to treat? A.Eicken Klinik für Kinderkardiologie und angeborene Herzfehler, Deutsches Herzzentrum München, Technische Universität München
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 informationLong-term results of a strategy of aortic valve repair in the paediatric population: Should we avoid cusp extension?
Long-term results of a strategy of aortic valve repair in the paediatric population: Should we avoid cusp extension? Y d Udekem, J Siddiqui, C Seaman, I Konstantinov, J Galati, M Cheung, C Brizard Royal
More informationThe Chest X-ray for Cardiologists
Mayo Clinic & British Cardiovascular Society at the Royal College of Physicians, London : 21-23-October 2013 Cases-Controversies-Updates 2013 The Chest X-ray for Cardiologists Michael Rubens Royal Brompton
More informationCoarctation of the Aorta
Interventional Management of Coarctation of the Aorta Lee Benson MD Professor Pediatrics (Cardiology) Director, Cardiac Diagnostic & Interventional Unit The Hospital for Sick Children Toronto, Canada Outline
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 informationHOW SHOULD WE FOLLOW PATIENTS AFTER AORTIC ARCH INTERVENTIONS?
HOW SHOULD WE FOLLOW PATIENTS AFTER AORTIC ARCH INTERVENTIONS? International Symposium on 3D Imaging for Interventional Catheterization in CHD (3DI3 Conference) Martin Bocks, M.D. Pediatric Interventional
More informationCoarctation of the aorta leads to hypertensive cardiovascular sequelae such as
Surgery for Congenital Heart Disease Intermediate-term results of ascending descending posterior pericardial bypass of complex aortic coarctation Stephen H. McKellar, MD, a,b Hartzell V. Schaff, MD, b
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 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 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 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 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 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 informationAbsorbable pulmonary artery banding: a strategy for reducing reoperations
European Journal of Cardio-Thoracic Surgery 51 (2017) 735 739 doi:10.1093/ejcts/ezw409 ORIGINAL ARTICLE Cite this article as: Daley M, Brizard CP, Konstantinov IE, Brink J, Jones B, d Udekem Y. Absorbable
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 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 informationCoarctation of the aorta has specific diagnostic and
Benefits Surgical Repair Coarctation the Aorta in Patients Older Than 50 Years Matthias Bauer, MD, Vladimir V. Alexi-Meskishvili, MD, PhD, Ulrike Bauer, MD, Diab Alfaouri, MD, Peter E. Lange, MD, PhD,
More informationOur Experiences With Adult Type Aortic Coarctation
ISPUB.COM The Internet Journal of Thoracic and Cardiovascular Surgery Volume 7 Number 2 Our Experiences With Adult Type Aortic Coarctation E Duran, S Canbaz, M Acipayam, O Gur, O Karaca Citation E Duran,
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 informationTranscatheter Therapy for Coarctation of the Aorta: The Results of Our Efforts
Transcatheter Therapy for Coarctation of the Aorta: The Results of Our Efforts David Nykanen MD The Heart Center at Arnold Palmer Hospital for Children, Orlando, Florida SOLACI 2017 Buenos Aires, Argentina
More informationSelection of a Surgical Treatment Approach for Aortic Coarctation in Adolescents and Adults
Ann Thorac Cardiovasc Surg 2018; 24: 97 102 Online February 16, 2018 doi: 10.5761/atcs.oa.17-00167 Original Article Selection of a Surgical Treatment Approach for Aortic Coarctation in Adolescents and
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 informationSurgical Treatment of Aortic Arch Hypoplasia
Surgical Treatment of Aortic Arch Hypoplasia In the early 1990s, 25% of patients could face mortality related to complica-tions of hypertensive disease Early operations and better surgical techniques should
More informationCoarctation of the aorta is a congenital narrowing of the
Operative Risk Factors and Durability of Repair of Coarctation of the Aorta in the Neonate Walter H. Merrill, MD, Steven J. Hoff, MD, James R. Stewart, MD, Charles C. Elkins, MD, Thomas P. Graham, [r,
More informationLEFT VENTRICULAR OUTFLOW OBSTRUCTION WITH A VSD: OPTIONS FOR SURGICAL MANAGEMENT
LEFT VENTRICULAR OUTFLOW OBSTRUCTION WITH A VSD: OPTIONS FOR SURGICAL MANAGEMENT 10-13 March 2017 Ritz Carlton, Riyadh, Saudi Arabia Zohair AlHalees, MD Consultant, Cardiac Surgery Heart Centre LEFT VENTRICULAR
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 informationSurgical Management of TOF in Adults. Dr Flora Tsang Associate Consultant Department of Cardiothoracic Surgery Queen Mary Hospital
Surgical Management of TOF in Adults Dr Flora Tsang Associate Consultant Department of Cardiothoracic Surgery Queen Mary Hospital Tetralogy of Fallot (TOF) in Adults Most common cyanotic congenital heart
More informationThe first report of the Society of Thoracic Surgeons
REPORT The Society of Thoracic Surgeons National Congenital Heart Surgery Database Report: Analysis of the First Harvest (1994 1997) Constantine Mavroudis, MD, Melanie Gevitz, BA, W. Steves Ring, MD, Charles
More informationBicuspid aortic root spared during ascending aorta surgery: an update of long-term results
Short Communication Bicuspid aortic root spared during ascending aorta surgery: an update of long-term results Marco Russo, Guglielmo Saitto, Paolo Nardi, Fabio Bertoldo, Carlo Bassano, Antonio Scafuri,
More informationHow to Assess and Treat Obstructive Lesions
How to Assess and Treat Obstructive Lesions Erwin Oechslin, MD, FESC, FRCPC, Director, Congenital Cardiac Centre for Adults Peter Munk Cardiac Centre University Health Network/Toronto General Hospital
More informationAcute type A aortic dissection (Type I, proximal, ascending)
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
More informationCongenital Heart Defects
Normal Heart Congenital Heart Defects 1. Patent Ductus Arteriosus The ductus arteriosus connects the main pulmonary artery to the aorta. In utero, it allows the blood leaving the right ventricle to bypass
More informationCardiac surgery Closure of defect of artrioventicular septum using dual prosthesis patches
CARDIOLOGY / CARDIOTHORACIC SURGERY PROCEDURES PROCEDURE A ( RM 4401 - RM 4800 ) 1 General procedures Replacement of aortic valve (including valvuloplasty) 2 General procedures Replacement of mitral valve
More informationAbsent Pulmonary Valve Syndrome
Absent Pulmonary Valve Syndrome Fact sheet on Absent Pulmonary Valve Syndrome In this condition, which has some similarities to Fallot's Tetralogy, there is a VSD with narrowing at the pulmonary valve.
More informationSurgical Treatment for Double Outlet Right Ventricle. Masakazu Nakao Consultant, Paediatric Cardiothoracic Surgery
for Double Outlet Right Ventricle Masakazu Nakao Consultant, Paediatric Cardiothoracic Surgery 1 History Intraventricular tunnel (Kawashima) First repair of Taussig-Bing anomaly (Kirklin) Taussig-Bing
More informationReconstruction of right ventricular outflow with a valved homograft conduit
Thorax (1974), 29, 617. Reconstruction of right ventricular outflow with a valved homograft conduit D. J. WHEATLEY, S. PRUSTY, and D. N. ROSS Department of Surgery, National Heart Hospital, London WI Wheadey,
More informationABERRANT RIGHT SUBCLAVIAN ARTERY AND CALCIFIED ANEURYSM OF. Jose Rubio-Alvarez, Juan Sierra-Quiroga, Belen Adrio Nazar and Javier Garcia Carro.
ABERRANT RIGHT SUBCLAVIAN ARTERY AND CALCIFIED ANEURYSM OF KOMMERELL S DIVERTICULUM : AN ALTERNATIVE APPROACH. Jose Rubio-Alvarez, Juan Sierra-Quiroga, Belen Adrio Nazar and Javier Garcia Carro. Department
More informationPost-Op Aorta: Differentiating Normal Post-Op vs. Complications. Linda C. Chu, MD Assistant Professor of Radiology Johns Hopkins University
Post-Op Aorta: Differentiating Normal Post-Op vs. Complications Linda C. Chu, MD Assistant Professor of Radiology Johns Hopkins University No disclosures Disclosures Goals and Objectives To review CT technique
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 informationAntegrade Thoracic Stent Grafting during Repair of Acute Debakey I Dissection: Promotes Distal Aortic Remodeling and Reduces Late Open Re-operation
Antegrade Thoracic Stent Grafting during Repair of Acute Debakey I Dissection: Promotes Distal Aortic Remodeling and Reduces Late Open Re-operation Vallabhajosyula, P: Szeto, W; Desai, N; Pulsipher, A;
More informationEXTRA-ANATOMIC AORTIC BYPASS VIA STERNOTOMY FOR COMPLEX AORTIC ARCH STENOSIS IN CHILDREN
EXTRA-ANATOMIC AORTIC BYPASS VIA STERNOTOMY FOR COMPLEX AORTIC ARCH STENOSIS IN CHILDREN Kirk R. Kanter, MD Eldad Erez, MD Willis H. Williams, MD Vincent K. H. Tam, MD Objective: Recurrent aortic narrowing
More informationHybrid Repair of a Complex Thoracoabdominal Aortic Aneurysm
Hybrid Repair of a Complex Thoracoabdominal Aortic Aneurysm Virendra I. Patel MD MPH Assistant Professor of Surgery Massachusetts General Hospital Division of Vascular and Endovascular Surgery Disclosure
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 informationCommon Defects With Expected Adult Survival:
Common Defects With Expected Adult Survival: Bicuspid aortic valve :Acyanotic Mitral valve prolapse Coarctation of aorta Pulmonary valve stenosis Atrial septal defect Patent ductus arteriosus (V.S.D.)
More informationManagement of Difficult Aortic Root, Old and New solutions
Management of Difficult Aortic Root, Old and New solutions Hani K. Najm MD, Msc, FRCSC,, FACC, FESC Chairman, Pediatric and Congenital Heart Surgery Cleveland Clinic Conflict of Interest None Difficult
More informationKinsing Ko, Thom de Kroon, Najim Kaoui, Bart van Putte, Nabil Saouti. St. Antonius Hospital, Nieuwegein, The Netherlands
Minimal Invasive Mitral Valve Surgery After Previous Sternotomy Without Aortic Clamping: Short- and Long Term Results of a Single Surgeon Single Institution Kinsing Ko, Thom de Kroon, Najim Kaoui, Bart
More informationIntroduction. Study Design. Background. Operative Procedure-I
Risk Factors for Mortality After the Norwood Procedure Using Right Ventricle to Pulmonary Artery Shunt Ann Thorac Surg 2009;87:178 86 86 Addressor: R1 胡祐寧 2009/3/4 AM7:30 SICU 討論室 Introduction Hypoplastic
More informationThe pulmonary valve is the most common heart valve
Biologic versus Mechanical Valve Replacement of the Pulmonary Valve After Multiple Reconstructions of the RVOT Tract S. Adil Husain, MD, and John Brown, MD Indiana University School of Medicine, Department
More informationCardiac Catheterization Cases Primary Cardiac Diagnoses Facility 12 month period from to PRIMARY DIAGNOSES (one per patient)
PRIMARY DIAGNOSES (one per patient) Septal Defects ASD (Atrial Septal Defect) PFO (Patent Foramen Ovale) ASD, Secundum ASD, Sinus venosus ASD, Coronary sinus ASD, Common atrium (single atrium) VSD (Ventricular
More informationI have nothing to disclose.
I have nothing to disclose. New approaches in tricuspid valve repair Christian Schreiber ..more than a simple displacement.., the valvar orifice is formed within the ventricular cavity.. Ebstein Historical
More informationCirculatory system. Lecture #2
Circulatory system Lecture #2 The essential components of the human cardiovascular system: Heart Blood Blood vessels Arteries - blood vessels that conduct arterial blood from heart ventricle to organs
More informationHeart and Lungs. LUNG Coronal section demonstrates relationship of pulmonary parenchyma to heart and chest wall.
Heart and Lungs Normal Sonographic Anatomy THORAX Axial and coronal sections demonstrate integrity of thorax, fetal breathing movements, and overall size and shape. LUNG Coronal section demonstrates relationship
More informationSingle stage repair for aortic root aneurysm in a patient with coexisting coarctation incorporating the Cabrol technique: a case report
Iqbal et al. Journal of Cardiothoracic Surgery (2018) 13:75 https://doi.org/10.1186/s13019-018-0761-2 CASE REPORT Single stage repair for aortic root aneurysm in a patient with coexisting coarctation incorporating
More informationS plex of parachute mitral valve, supravalvar ring of the. Shone s Anomaly: Operative Results and Late Outcome
Shone s Anomaly: Operative Results and Late Outcome Steven F. Bolling, MD, Mark D. Iannettoni, MD, Macdonald Dick 11, MD, Amnon Rosenthal, MD, and Edward L. Bove, MD Sections of Thoracic Surgery and Pediatric
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 informationAortic coarctation: a benign lesion?
Aortic coarctation: a benign lesion? A surgeon s path out of stubborness From hypoplastic arches to molecular biology Y. d'udekem The Royal Children s Hospital, Melbourne, Australia Coarctation of the
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 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 informationThe surgical experience of the last decade has allowed us to evaluate. Aortic arch reconstruction with pulmonary autograft patch aortoplasty EDITORIAL
Roussin et al Aortic arch reconstruction with pulmonary autograft patch aortoplasty Régine Roussin, MD a Emre Belli, MD a,b François Lacour-Gayet, MD a Francois Godart, MD c Christian Rey, MD c Jacqueline
More informationAdult Echocardiography Examination Content Outline
Adult Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 2 3 4 5 Anatomy and Physiology Pathology Clinical Care and Safety Measurement Techniques, Maneuvers,
More informationS. Bruce Greenberg, MD FNASCI and President, NASCI Professor of Radiology and Pediatrics University of Arkansas for Medical Sciences
S. Bruce Greenberg, MD FNASCI and President, NASCI Professor of Radiology and Pediatrics University of Arkansas for Medical Sciences No financial disclosures Aorta Congenital aortic stenosis/insufficiency
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acute coronary syndrome(s), anticoagulant therapy in, 706, 707 antiplatelet therapy in, 702 ß-blockers in, 703 cardiac biomarkers in,
More informationAssessing Cardiac Anatomy With Digital Subtraction Angiography
485 JACC Vol. 5, No. I Assessing Cardiac Anatomy With Digital Subtraction Angiography DOUGLAS S., MD, FACC Cleveland, Ohio The use of intravenous digital subtraction angiography in the assessment of patients
More informationConduit Reconstruction of Right Ventricular Outflow Tract
Conduit Reconstruction of Right Ventricular Outflow Tract Experience with 17 Patients E. Ross Kyger, 111, M.D., Luigi Chiariello, M.D., Grady L. Hallman, M.D., and Denton A. Cooley, M.D. ABSTRACT Evaluation
More informationSurgical Management Of TAPVR. Daniel A. Velez, M.D. Congenital Cardiac Surgeon Phoenix Children s Hospital
Surgical Management Of TAPVR Daniel A. Velez, M.D. Congenital Cardiac Surgeon Phoenix Children s Hospital No Disclosures Goals Review the embryology and anatomy Review Surgical Strategies for repair Discuss
More information(Ann Thorac Surg 2008;85:845 53)
I Made Adi Parmana The utility of intraoperative TEE has become increasingly more evident as anesthesiologists, cardiologists, and surgeons continue to appreciate its potential application as an invaluable
More informationCORONARY ARTERY BYPASS GRAFTING (CABG) (Part 1) Mark Shikhman, MD, Ph.D., CSA Andrea Scott, CST
CORONARY ARTERY BYPASS GRAFTING (CABG) (Part 1) Mark Shikhman, MD, Ph.D., CSA Andrea Scott, CST I have constructed this lecture based on publications by leading cardiothoracic American surgeons: Timothy
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 informationConversion of Atriopulmonary to Cavopulmonary Anastomosis in Management of Late Arrhythmias and Atrial Thrombosis
Conversion of Atriopulmonary to Cavopulmonary Anastomosis in Management of Late Arrhythmias and Atrial Thrombosis Jane M. Kao, MD, Juan c. Alejos, MD, Peter W. Grant, MD, Roberta G. Williams, MD, Kevin
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 informationCONGENITAL HEART DISEASE (CHD)
CONGENITAL HEART DISEASE (CHD) DEFINITION It is the result of a structural or functional abnormality of the cardiovascular system at birth GENERAL FEATURES OF CHD Structural defects due to specific disturbance
More informationAortic Coarctation Imaging and Management in Adults. Michael D. Hope, MD
Aortic Coarctation Imaging and Management in Adults Michael D. Hope, MD 1 Background 2 Imaging - Morphology 3 Imaging - Hemodynamics 4 Associations and Complications Campbell M. British Heart Journal 1970
More informationThe Ross Procedure: Outcomes at 20 Years
The Ross Procedure: Outcomes at 20 Years Tirone David Carolyn David Anna Woo Cedric Manlhiot University of Toronto Conflict of Interest None The Ross Procedure 1990 to 2004 212 patients: 66% 34% Mean age:
More informationEACTS Adult Cardiac Database
EACTS Adult Cardiac Database Quality Improvement Programme List of changes to Version 2.0, 13 th Dec 2018, compared to version 1.0, 1 st May 2014. INTRODUCTORY NOTES This document s purpose is to list
More informationCase Report International Journal of Basic and Clinical Studies (IJBCS) 2013;1(1): Elbey MA et al.
Treatment of Interrupted Aorta in Adult Patients; a Challenge Both in Surgery and Transcatheter Intervention Mehmet Ali Elbey MD 1, Ahmet Caliskan MD 2, Ferhat Isık MD 1, Faruk Ertas MD 1, Mehmet Serdar
More informationCMS Limitations Guide - Radiology Services
CMS Limitations Guide - Radiology Services Starting October 1, 2015, CMS will update their existing medical necessity limitations on tests and procedures to correspond to ICD-10 codes. This limitations
More informationCASE REPORT. Mycotic Aneurysm of Ascending Aorta Due to Sarcina Lutea. G. A. Lopez, M.D., and A. R. C. Dobell, M.D.
CASE REPORT Mycotic Aneurysm of Ascending Aorta Due to Sarcina Lutea G. A. Lopez, M.D., and A. R. C. Dobell, M.D. ABSTRACT A patient developed a mycotic aneurysm of the aortic suture line after aortic
More informationCONGENITAL HEART DEFECTS IN ADULTS
CONGENITAL HEART DEFECTS IN ADULTS THE ROLE OF CATHETER INTERVENTIONS Mario Carminati CONGENITAL HEART DEFECTS IN ADULTS CHD in natural history CHD with post-surgical sequelae PULMONARY VALVE STENOSIS
More informationLarge veins of the thorax Brachiocephalic veins
Large veins of the thorax Brachiocephalic veins Right brachiocephalic vein: formed at the root of the neck by the union of the right subclavian & the right internal jugular veins. Left brachiocephalic
More informationROLE OF CONTRAST ENHANCED MR ANGIOGRAPHY IN AORTIC COARCTATION
ROLE OF CONTRAST ENHANCED MR ANGIOGRAPHY IN AORTIC COARCTATION By Adel El Badrawy, Ahmed Abdel Razek, Nermin Soliman, Hala El Marsafawy *, Sameh Amer** From Radiodiagnosis, Pediatric Cardiology* & Cardiothoracic
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 informationManagement of Ascending Aortic
Management of Ascending Aortic Aneurysm Complicating Coarctation of the Aorta Ramanathan Sampath, M.D., William N. O'Connor, M.D., Jacqueline A. Noonan, M.D., and Edward P. Todd, M.D., Ph.D. ABSTRACT Four
More informationHypoplasia of the aortic root1 The problem of aortic valve replacement
Hypoplasia of the aortic root1 The problem of aortic valve replacement ROWAN NICKS, T. CARTMILL, and L. BERNSTEIN Department of Cardio-thoracic Surgery and the Hallstrom Institute of Cardiology, the Royal
More informationManagement of Acute Aortic Syndromes. M. Grabenwoger, MD Dept. of Cardiovascular Surgery Hospital Hietzing, Vienna, Austria
Management of Acute Aortic Syndromes M. Grabenwoger, MD Dept. of Cardiovascular Surgery Hospital Hietzing, Vienna, Austria I have nothing to disclose. Acute Aortic Syndromes Acute Aortic Dissection Type
More informationOutcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease
Outcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease TIRONE E. DAVID, MD ; SEMIN THORAC CARDIOVASC SURG 19:116-120c 2007 ELSEVIER INC. PRESENTED BY INTERN 許士盟 Mitral valve
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 informationLecture 2: Clinical anatomy of thoracic cage and cavity II
Lecture 2: Clinical anatomy of thoracic cage and cavity II Dr. Rehan Asad At the end of this session, the student should be able to: Identify and discuss clinical anatomy of mediastinum such as its deflection,
More informationAdult Congenital Heart Disease: What All Echocardiographers Should Know Sharon L. Roble, MD, FACC Echo Hawaii 2016
1 Adult Congenital Heart Disease: What All Echocardiographers Should Know Sharon L. Roble, MD, FACC Echo Hawaii 2016 DISCLOSURES I have no disclosures relevant to today s talk 2 Why should all echocardiographers
More information