Gianluca Rigatelli, Marco Zuin, Alan Fong, Truyen TTT Tai and Thach Nguyen
. Noticeably, higher WSS within the ascending aorta have been suspected to be involved in aortic aneurysm and dissection. [ 4 , 5 ] The aim of our study is to investigate, by means of computation fluid dynamic analysis (CFD), the presence and potential impact of turbulences induced by ostial LM stenting, not only in the LM but also within the ascending aorta and arch.
Construction of the virtual model
For the computational domain analysis, we reconstructed the ascending aorticarch from the plane of the aortic valve to the left subclavian artery. Both
location of the sympathetic cervico-thoracic ganglia (CTG) and their surroundings (A) and examples of elevated PSMA-ligand uptake, potentially suggesting malignancy in both CTG complexes (B) , in the left CTG (C) and in the right CTG (D) on fused PET/MR T2-weighted images presented with application of different colour maps. AOR = aorticarch; LCM = longus colli muscle; MCG = middle cervical sympathetic ganglion; SA = subclavian artery; SN = spinal nerve; T2-G = 2nd thoracic sympathetic ganglion; T3-G = 3rd thoracic sympathetic ganglion; VA = vertebral artery; VG
Daniela Toma, Simina-Elena Rusu, Cristina Blesneac, Marian Pop and Rodica Togănel
Background: Critical aortic coarctation is defined as the severe narrowing of the isthmic aortic lumen, representing a neonatal cardiac emergency, part of the congenital heart diseases with duct-dependent systemic circulation.
Aim of the study: To assess the correlation between transthoracic echocardiography and computed tomography angiography (CTA) in the measurement of aortic diameters in a group of newborns diagnosed with duct-dependent aortic coarctation and/or associated hypoplastic aortic arch.
Material and method: We performed a retrospective study on neonates diagnosed with duct-dependent aortic coarctation and/or associated hypoplastic aortic arch between January 1, 2015 and March 1, 2017. The studied parameters were diameters of the aorta at the level of the aortic annulus, coronary sinuses, sinotubular junction, ascending aorta, proximal and distal aortic arch, and the aortic isthmus. Measurements were obtained by transthoracic echocardiography and thoracic CTA.
Results: Fifteen newborns diagnosed with duct-dependent aortic coarctation and/or associated hypoplastic aortic arch were included in this study. There was no statistically significant difference between the two imaging methods, the T test highlighting differences only between the measurements of the aortic annulus (p <0.016) and coronary sinuses (p <0.008). The patients included in the study associated other cardiovascular abnormalities: persistent ductus arteriosus (100%), atrial septal defect (100%), aortic arch hypoplasia (80%), bicuspid aortic valve (73.3%).
Conclusions: These methods reveal important information on the anatomy of the cardiovascular malformation and its impact on the clinical and paraclinical status of the patient, being fundamental for establishing an optimal therapeutic approach.
Cristina Blesneac, Carmen Corina Şuteu, Marian Pop and Rodica Togănel
Unilateral pulmonary artery agenesis is a rare congenital anomaly, that may develop in isolation, or in association with other congenital cardiovascular anomalies, such as tetralogy of Fallot, septal defects, right-sided aortic arch, or pulmonary atresia. Left-sided pulmonary artery agenesis is less frequent than the right-sided one. Diagnosis of unilateral pulmonary artery agenesis can be difficult. We report the case of a 15 year-old boy who presented with reduced exercise tolerance, shortness of breath and cyanosis. He was diagnosed with left pulmonary artery agenesis, associated with subaortic-ventricular septal defect, right-sided aortic arch, and severe pulmonary arterial hypertension (PAH), that precluded the surgical repair. Pulmonary vasodilator therapy was initiated in this case. The mortality rate of this rare anomaly is high due to its complications. It is essential to establish an early and correct diagnosis, in order to provide adequate treatment and prevent complications in this disease.
: Marinkovic S, Milisavljevic M, Antunovic V. Arterije mozga i kicmene mozdine: Anatomske i klinicke karakteristike. 1ed. Beograd: Bit inzenjering, 2001:30-9.
5. Bruneau M, Cornelius JF, George B. Anterolateral approach to the V1 segment of the vertebral artery. Neurosurgery. 2006; 58: 215-9.
6. Bhatia K, Ghabriel MN, Henneberg M. Anatomical variations in the branches of the human aorticarch: a recent study of a South Australian population. Folia Morphol. 2005; 64 (3): 217-24.
7. Albayram S, Gailloud P, Wasserman BA. Bilateral
Nerijus Misonis, Darius Palionis, Algirdas Tamošiūnas, Vaidotas Zabulis, Kristina Ryliškienė and Dalius Jatužis
Aim: The aim of the paper is to evaluate the appearance of the new early ischemic lesions in the brain after carotid angioplasty and stenting on diffusion-weighted magnetic resonance imaging, and their relationship with clinical and procedural factors.
Methods: Carotid artery stenting (CAS) procedures performed by a single interventional cardiologist in years November 2006 to January 2013 were evaluated retrospectively. In total, 227 procedures for 211 patients (mean age 69.8 ± 8.5 years) were performed, from which 171 (75.3%) for male and 56 (24.7%) for female patients. Seventy-two (34.1%) patients had symptomatic stenosis of carotid artery. The following protection systems to avoid the distal microembolism were used during the CAS: (1) Filters: FilterWire EZ (Boston Scientific Corporation); Emboshield NAV (Abbott Vascular); SpideRX (EV3); Defender (Medtronic); FiberNet Filter (Invatec-Medtronic); (2) Occlusion MoMa Baloon System (Invatec-Medtronic). Acute ischemic damages of the brain before and after CAS procedure were diagnosed using magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) sequences. Sixty-five (30.8%) patients underwent MRI test. Exact and asymptomatic χ2 criteria were applied for testing the hypothesis of inter-dependency of the symptoms.
Results: Forty-six (70.8%) patients had new ischemic foci in the brain on MRI DWI after CAS procedures. Among those patients, focal damage of the brain was diagnosed in 36 (78.3%) cases; linear damage of the brain - in 9 (19.6%) patients; ipsilateral damage of the brain - in 37 (80.4%) patients; bilateral damage of the brain - in 16 (34.8%) patients, 38 (82.6%) patients were diagnosed with forebrain damage; 4 (8.7%) patients were diagnosed with damage of brainstem; 5 (10.9%) patients were diagnosed with cerebellum damage. Clinical symptoms of brain damage were diagnosed only for 2 (4.3%) patients. Focal damage of the brain was significantly less frequent only for aortic arch type 1, if compared with aortic arch type 2 and 3: 64.3%, 93.3% and 100.0%, respectively (p < 0.05). Focal damage of the brain occurred least in patients (28.6%) with Emboshield NAV protection type, if compared to other types of protection (71.4-100.0%). Linear >10mmbrain damage was less frequent when using FilterWire EZ, Emboshield NAV and SpideRX protection type. Ipsilateral ischemic brain damage also occurred less frequent when using Emboshield NAV protection type; bilateral damage occurred less frequent when using FilterWire EZ, Emboshield NAV and SpideRX protection type. Ischemic forebrain damage was also diagnosed less often in patients for whom protection type FilterWire EZ and Emboshield NAV was applied.
Conclusions: Most frequent findings by MRI after CAS procedures were focal, ipsilateral and forebrain damage (about 80%), but less than 5% patients had clinical symptoms. In the case of aorta arch type 1 focal ischemic damage of the brain was significantly less frequent, then in aortic arch type 2 and 3. The localization and extent of brain damage was associated with the type of protection systems that have been used.
Simina-Elena Rusu, Daniela Toma, Cristina Blesneac, Laura Matei, Claudiu Ghiragosian and Rodica Togănel
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Carter MM, Tarr RW, Mazer MJ, Carroll FE. The "aortic
91.7% respectively during active TAK using MRA or CTA as the golden standard test. Otherwise, detection of TAK by gallium scan was only supported by case reports. The Numano’s angiographic classification of TAK is described in table 1 . This classification was based on the anatomical distribution of vascular involvement. It was first proposed by Ueno et al. in 1967 and was modified by Hata et al. as Numano’s criteria in 1996 [ 18 ].
Numano’s angiographic classification of TAK
Branches from aorticarch