Cases reported "Aortic Arch Syndromes"

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1/18. Total aortic replacement for aortitis syndrome: report of a case.

    We report herein the case of a 35-year-old woman who was administered steroid therapy based on a diagnosis of aortitis syndrome. Despite this treatment, the symptoms of cardiac failure gradually progressed, and she was referred to our hospital to undergo surgery. Preoperative evaluations revealed a large aneurysm extending from the ascending aorta to the thoracoabdominal aorta. A two-staged total aortic replacement was carried out and postoperative digital subtraction angiography showed excellent reconstruction of the entire aorta.
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2/18. Extrathoracic repair of branch occlusions of the aortic arch.

    Thirty extrathoracic operations in twenty-six patients with occlusive disease involving the primary branches of the aortic arch were reviewed. Spanning a fourteen year experience, these operations included carotid-subclavian artery bypass, retrograde common carotid artery thrombectomy, carotid-carotid artery bypass, and femoral-axillary artery bypass. Dacron bypass grafts were used primarily for reconstruction, but saphenous vein bypass and endarterectomy were also employed. Indications for operation, the presence of concomitant cardiovascular disease, surgical technics, patient survival, and late patency of the reconstructions were reviewed. One patient died postoperatively (3.85 per cent). All Dacron grafts were patent on late follow-up examinations. Low mortality and excellent late functional results make extrathoracic repair the approach of choice in the management of occlusive disease of the branches of the aortic arch.
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3/18. Aortic root replacement with a freestyle stentless valve for aortitis syndrome with ascending aortic aneurysm and aortic regurgitation.

    A 47-year-old woman who had been diagnosed as having aortitis syndrome underwent aortic root replacement for an ascending aortic aneurysm and aortic regurgitation. Because the patient has been treated with steroids for more than 20 years, a Freestyle stentless valve was used to avoid the risk of valve detachment. There were no complications observed during the postoperative course. Although long-term follow-up will be necessary to observe the valve durability, the Freestyle stentless valve seems to be useful for aortic root replacement in patients at high risk of valve detachment due to aortitis syndrome.
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4/18. Surgical management of tunnel-like subaortic stenosis via ventricular septal defect in a patient with the interrupted aortic arch.

    A 24-day-old male with interrupted aortic arch (type B), ventricular septal defect, and tunnel-like subaortic stenosis underwent a one-stage surgical treatment. The operative procedure comprised reconstruction of the aortic arch, transatrial excision of the subaortic fibromuscular tissue via the ventricular sepatal defect, and patch closure of the defect. The patient tolerated the procedure well and the postoperative echocardiography demonstrated a residual pressure gradient across the left ventricular outflow tract of 20 mmHg. Our result suggests that the transatrial surgical management of subaortic stenosis via the ventricular sepatal defect produces a safe and promising surgical option.
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5/18. Two-stage surgical and endovascular treatment of an aneurysmal aberrant right subclavian (Lusoria) artery.

    We report a case of a 75-year-old male patient with an asymptomatic aneurysm of an aberrant right subclavian artery (ARSA). Timely elective therapy of this entity is indicated due to the high risk of rupture. Because of the patient's reduced physical state, we performed an interdisciplinary endovascular aortic stent-grafting for the exclusion of the ARSA aneurysm. However, the proximal landing zone for the thoracic stent had to be chosen proximal to the origin of the left subclavian artery. Thus, 2 days before the endovascular procedure, a left-sided carotido-subclavian bypass was accomplished. The peri- and postoperative course was uneventful. The technical results in our patient were excellent, no leakage was visible so far.
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6/18. A case of symptomatic aberrant right subclavian artery.

    Aberrant right subclavian artery is one of the aortic arch anomalies which is almost always asymptomatic. A 27-year-old lady, from Asebe Teferi, presented with dysphagia of eight months duration. physical examination revealed no abnormality. barium swallow and post Intravenous-contrast computerized tomography (CT) scan showed aberrant right subclavian artery. She was operated via the approach of left thoracotomy. The aberrant right subclavian was legated, brought anterior to trachea and reimplanted to the left stubclavian artery. She had uneventful postoperative course and discharged symptom free.
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7/18. Homemade endovascular treatment of postoperative aortobronchial fistulas.

    Successful treatments of aortobronchial fistulas were achieved in two cases using a homemade endovascular stent graft. In one, a 75-year-old man was operated on for a distal arch aneurysm 11 years previously. In the other, a 73-year-old woman was operated on for a ruptured type B aortic dissection 2 months previously. In both cases, the chief complaint was repeated hemoptysis, and the communication between the aorta and the airway tract was at the distal anastomotic site in the descending aorta. To minimize risks associated with reoperation, endovascular stent grafting was selected electively. Postoperative courses were uneventful and there were no recurrences of hemoptysis.
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8/18. Operative treatment of nonspecific aortoarteritis (Takayasu's arteritis).

    Operative treatment of nonspecific aortoarteritis remains controversial and little information is available on the results of reconstruction of extracranial cerebral vasculature in this disease. Our experience with 25 patients with histologically proven symptomatic disease treated during a 4-year period is presented. The aortic arch and its branches were involved in 12 patients and 13 had disease affecting the descending aorta and its tributaries. patients with cerebrovascular disease had aneurysms, minor stroke, or intermittent neurologic dysfunction. Descending aortic involvement resulted either in symptomatic or ruptured aneurysm and renovascular hypertension. Operative treatment of cerebrovascular disease comprised aortic arch (three patients), carotid (three patients), or subclavian artery reconstruction (six patients). Descending aortic reconstruction comprised thoracoabdominal (four patients) or infrarenal (five patients) aneurysmorrhaphy, abdominal aortic replacement with bilateral renal artery reconstruction (two patients), and nephrectomy (two patients). One early postoperative death occurred because of stroke. Twenty-four survivors have been observed between 3 and 42 months. No deaths or further neurologic episodes have occurred during this period and three of five hypertensive patients were cured. We conclude that symptomatic aortoarteritis, including cerebrovascular disease, may be treated by standard operative techniques with rewarding results.
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9/18. aortic valve replacement for acute Takayasu's disease.

    A patient with aortic insufficiency secondary to Takayasu's disease who was treated by aortic valve replacement during active aortic inflammation is described. The patient remains well 29 months postoperatively with minor additional treatment. A review of aortic insufficiency in Takayasu's disease is presented.
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10/18. Surgical treatment of Takayasu's disease.

    Thirty-nine patients (mean age: 33 years) with Takayasu's disease were observed over the past 8 years. Among these patients, 33 had surgical intervention with a mean follow-up of 4 years. Lesions of the aortic arch were the most common (29 patients, 69 lesions) and frequently were associated with lesions in another site as well. However, in this group of patients, the infrequent presence of signs of cerebral vascular insufficiency limited the number of suitable surgical candidates to 14 patients. Lesions of the renal arteries were noted in 25 patients (37 lesions) and were associated with coarctation of the thoracoabdominal aorta in 12 patients. In contrast to lesions of the aortic arch, the presence of severe hypertension was a frequent indication for surgery in Takayasu's disease. Twenty-one patients had operation. Twenty of 21 patients were considered cured or improved of hypertension. The one patient who received no benefit was the only operative death of the study. In conclusion, although Takayasu's disease is progressive and the life expectancy is foreshortened, hypertension secondary to aortic and renal artery lesions is a frequent and important indication for aggressive operative treatment.
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