Segment Of Aortic Arch Research Articles

Allograft Model of Aortic Arch Segment Grafting to Abdominal Aorta Through End-to-Side Anastomosis in Mice

The mouse aortic transplantation model is a valuable tool for investigating the mechanisms of atherosclerosis regression, but few laboratories can generate it due to the operation difficulty, especially for the style of end-to-side anastomosis, which facilitates syngeneic heterotopic transplanting a plaque-rich aortic arch into the abdominal aorta. Here we provide a modified protocol for generating this allograft model, which is capable of overcoming several critical surgical challenges such as separating a longer abdominal aorta segment, reducing bleeding and thrombosis, optimizing aortotomy, and improving end-to-side anastomosis to guarantee a potent graft. By transplanting plaque-rich aortic arches into the abdominal aorta of wildtype mice, a high operation success rate (over 90%) was noted with aortic clamping time under 60 min, the graft potency was satisfactory evidenced by examinations of micro-CT, ultrasound, and lower limb blood flow measurement, while a significant atherosclerosis regression was observed in the grafts at 1 week after transplantation.Graphical

Risk factors for target vessel endoleaks after physician-modified fenestrated or branched endovascular aortic arch repair: A retrospective study.

Fenestrated or branched endovascular aortic arch repair (fb-arch repair) is an effective option for treating complex aortic arch lesions, including thoracic aortic aneurysms and aortic dissections. However, the relatively high rate of re-intervention due to target vessel (TV)-related endoleaks have raised concerns. This study aimed to determine risk factors for TV-related endoleaks after fb-arch repair. This was a retrospective analysis of all patients undergoing fb-arch repair between 2017 and 2021in nanjing drum tower hospital of China. All the patients underwent computed tomography angiography (CTA) before surgery; at discharge; and at 3 months, 6 months, and yearly post-discharge. All procedures are performed with physician modified grafts. Two experienced vascular surgeons used CTA and vascular angiography data to assess endoleaks. The study endpoints were mortality, aneurysm rupture, and emergence of and re-intervention for TV-related endoleaks. During the follow-up period, 218 patients underwent fb-arch repair. There were seven perioperative deaths and four deaths during follow-up (two myocardial infarctions and two malignancies). There were nine additional patients who were excluded from the study (two strokes, three with abnormal aortic arch anatomy, and four with insufficient clinical data). Among the 198 patients considered (mean age, 59 ± 13.3 years; 85% male), 309 branch arteries were revascularized. A total of 35 TV-related endoleaks were identified in 28 patients during a mean follow-up of 23 ± 14 months (median 23, IQR 26.3): six type Ic, 4 type IIIb, and 20 type IIIc endoleaks. Patients in the endoleak group had greater aortic arch segment diameters (43.1 ± 5.1 vs. 40.3 ± 4.7; P = 0.004) and a greater number of TVs revascularized (2.0 ± 0.8 vs. 1.5 ± 0.8; P = 0.004) than those in the non-endoleak group. However, the morphological classification of the aortic arch did not seem to affect the occurrence of TV endoleaks (13%, 14%, and 15% for type І, II, and III aortic arches, respectively; P = 0.957). Pre-sewing branch stents in the fenestration position reduced the risk of TV endoleaks (5% vs. 14%; P = 0.037). Additionally, in TVs affected by aortic aneurysm or dissection, the risk of endoleaks increased after reconstruction (17% vs. 8%; P = 0.018). The incidence of secondary TV-related endoleaks after fb-arch repair was 14.1%. The data from this study showed that the incidence of secondary target vessel related endoleaks after fb-arch repair is approximately 14.1%. Additionally, patients with a larger aortic arch diameter or more revascularized arteries during surgery were at increased risk TV-related endoleaks. The target vessels originating from the false lumen or aneurysm sac are more prone to endoleaks after reconstruction. Finally, prefabricated branch stents reduced risk of TV-related endoleaks.

Double-Cuff Bidirectional Branch in Endovascular Aortic Repair: A New Way of Increasing the Flexibility of Inner Branch Endografting

Purpose: The purpose of the study was to describe the design and implantation of a branched stent-graft during endovascular aortic repair incorporating double-cuff bidirectional inner branch. Technique: A new double-cuff bidirectional antegrade and retrograde inner branched stent-graft with large diamond-shaped fenestration was designed for incorporation of a splenic artery. The inner cuffs of the branch were accessible using brachial and/or femoral access. The splenic artery was originating from an aortic segment with narrow inner aortic luminal diameter in a patient with extent IV thoracoabdominal aortic aneurysm with bilobed configuration. The retrograde, more distal inner cuff of the branch was extended into the splenic artery using a self-expandable bridging stent-graft from the femoral approach, whereas the antegrade, more proximal inner cuff of the branch was intentionally occluded using an endovascular plug. The recovery was uneventful and a computed tomography angiography 30 days postoperatively showed patency of all the target vessels without signs of endoleaks. Conclusion: This is the first design of a double-cuff bidirectional inner branched stent-graft. The technique can potentially expand the applications of directional branches to patients with more difficult anatomy in the thoracoabdominal or aortic arch segments. Potential indications are patients with target arteries that are not ideally suited for caudally-oriented branches, patients with accessory vessels, or targets with early branch bifurcations. Clinical Impact This report describes the use of a branched endograft with a new double-cuff bidirectional branch that can potentially address many of the limitations of current BEVAR solutions, such as early bifurcations, double arteries with adjacent origins and arteries with less favorable trajectories for the traditional caudally-oriented branches.

Alterations of arterial morphology in patients with aberrant subclavian artery and type B dissection and its association with dissection

ObjectiveThe arterial morphology in patients with aberrant subclavian artery (ASA) and its association with type B aortic dissection are important for treatment and prevention. In the present study, we examined the arterial morphology of ASA patients with type B dissection and evaluated its association with type B dissection in vivo. MethodsPatients with aortic dissection who had undergone computed tomography angiography were screened for the presence of ASA and type B dissection from January 2011 to May 2021. The angles of ascending aorta, aortic arch, and aortic deviation and the diameters of the ascending aorta, aortic arch, ASA ostium, and middle ASA segment were measured on the computed tomography angiography scans of the ASA patients with type B dissection (group 1; n = 16), clinically matched counterparts without type B dissection (group 2; n = 32), and patients with clinically matched type B dissection without ASA (group 3, n = 32). The correlation between ASA morphology and type B dissection was analyzed using variance analysis or the Wallis H test. ResultsCompared with group 2, group 1 had a sharper ascending aortic angle (131.5° ± 13.7° vs 148.1° ± 7.8°; P = .001), a larger aortic deviation angle in plane 2 (28.2° ± 6.0° vs 22.1° ±7.2°; P = .005) and plane 3 (26.4° ±7.3° vs 21.8° ± 6.3°; P = .028). Similarly, group 1 had a greater diameter in the ascending aorta and aortic arch and the ostium and middle of the ASA (38.3 ± 4.1 mm vs 33.6 ± 4.5 mm [P = .001]; 34.0 ± 9.3 mm vs 26.2 ± 2.9 mm [P = .004]; 20.3 ± 9.3 mm vs 14.0 ± 3.2 mm [P = .018]; 10.8 ± 2.3 mm vs 9.0 ± 1.5 mm [P = .002], respectively), without a significant difference in the aortic arch angle. Compared with group 3, group 1 had a sharper ascending aortic angle (131.5° ± 13.7° vs 142.5° ± 11.7°; P = .026) and smaller aortic deviation angle in plane 1 (21.7° ± 6.2° vs 28.9° ± 6.2°; P = .04) and plane 3 (26.4° ± 7.3° vs 21.8° ± 6.3°; P = .007), although with no significant differences in the aortic arch angle, aortic deviation angle in plane 2, and ascending aortic diameter. ConclusionsThe diameters of the ostium and middle segment of the ASA and ascending aorta and the angles of the ascending aorta and aortic deviation are potential risk factors for type B dissection in patients with ASA, which could provide new insights into the mechanism of type B dissection in patients with ASA.

Influence of intrauterine hemodynamics on the C segment of the aortic arch in the fetus

Objective. To assess the correlation between the hemodynamic characteristics of the left ventricle and geometric features of the aortic arch in the fetus.Methods. The study involved 31 fetuses from 29 to 34 weeks of gestation by echocardiography. The scientists assessed the morphogeometric characteristics of the left ventricle andaortic arch. They studied the following parameters: end-diastolic volume ofthe left ventricle (LVEDV), stroke volume of the leftventricle (LVSV), velocity-time integral of the flow through aortic valve (VTI AV), diameter of the aortic valve ring (AV), diameterof the aortic arch segment between brachiocephalic trunk and left carotid artery (dС). Results. The average gestational age was 31,9±1,4weeks (95% CI: 31,4–32,4 weeks). Average body weight 1899±377 g (95% CI: 1762–2038 g). LVEDV = 1,57±0,64 ml (95% CI: 1,3–1,8). LVSV = 1,3±0,45 ml (95% CI: 1,1–1,4 ml). AV 0,4±0,07 cm (95% CI: 0,39–0,44 cm). C segment of the aorticarc is 0,37±0,07 cm (95% CI: 0,035–0,040 cm). There was direct correlation between the variables used to calculate dC (Pearson correlation coefficient: LVEDV = 0,51; p=0,002; LVSV = 0,46; p=0,005; AV = 0,52, p=0,001). The diameter of the C segment of the aortic arch can be calculated using the following equations: dС= 0,76· LVSV +2,8 (95% CI LVSV 0,2–1,3 95% CI for constant2,1–3,6; Fisher’s criterion 7,6 р=0,01). dС= 0,59· LVEDV +2,8 (95% CI LVEDV 0,2–0,98; 95% CI for constant 2,2–3,5; Fisher’s criterion 10 р=0,004). dС= 0,59·AV+1,3 (95% CI AV 0,22–0,95; 95% CI for constant – 0,23–2,9; Fisher’s criterion 10,7;р=0,003).Conclusion. 1)hemodynamic characteristics of the left ventricle allow predicting the sizeof the aortic arch in fetuses from 29 to 34 weeks of gestation; 2)morphogeometric characteristics of the aortic arch are determined by the characteristics of the left ventricular stroke volume, end-diastolicvolume of the leftventricleand the sizeof the fibrous ring of the aortic valve.

Management of Retrograde Dissection Complicating Thoracic Endovascular Aortic Repair

Background: Retrograde type A aortic dissection is a challenging surgical emergency associated with high morbidity and mortality. Objective: The aim of this study was to describe our experience with retrograde type A aortic dissection (RAAD) following thoracic endovascular aortic repair (TEVAR) and its surgical management strategy. Patients and Methods:Our study was conducted between January 2011 and January 2021 at Cairo University Hospitals, and included 100 patients undergoing (TEVAR) to highlight the management of retrograde dissection complicating the procedure. The mean age was 55 ± 9 years and 76% of patients were males. All retrograde dissection patients underwent emergency surgical repair. Results: The in-hospital mortality was 10% of patients who had RAAD and occurred in one patient who suffered from fatal hematemesis postoperatively. The mean cross clamp time was 93±17 minutes and circulatory arrest time was 25±6 minutes. One patient also suffered from acute renal failure requiring hemodialysis during the postoperative hospital stay. Conclusions: Retrograde type A aortic dissection is an uncommon but potentially catastrophic complication of TEVAR. Surgical replacement of ascending aorta and a segment of aortic arch involving the entry tear offers an efficient strategy

Two-Stage Repair of Aortic Arch Hypoplasia Associated with Other Congenital Heart Defects in Newborns and Infants

Background. The optimal tactics of surgical treatment of aortic arch hypoplasia combined with other congenital heart defects remain controversial. In recent years, the leading clinics of the world prefer one-stage repair of such a combination, however, two-stage treatment is still used by cardiac surgeons and remains one of the variants of surgical tactics.
 The aim. To analyze immediate and long-term results of a two-stage repair of aortic arch hypoplasia with other con-genital heart defects in newborns and infants.
 Materials and methods. The study included 138 infants who were selected for a two-stage repair of aortic arch hy-poplasia with other congenital heart defects. There were 79 (57.2%) male and 59 (42.8%) female patients. The mean age of the patients was 1.4 ± 0.7 months, mean body weight was 4.1 ± 2.0 kg. The main method of the defect diagnosis and evaluation of immediate and long-term results was echocardiographic examination. The aortic arch segment was consid-ered hypoplastic if the Z-score deviation was less than –2.0.
 Results. The hospital mortality rate was 5.8% (n = 8). Two patients (1.4%) had delayed sternal closure in the early postoperative period. As a result of severe myocardial failure, two patients underwent extracorporeal membrane oxy-genation (ECMO). According to echocardiography before discharge, the mean pressure gradient at the site of aortic arch repair was 16 ± 6 mmHg. There was one death in the follow-up period. In 16 (11.5%) patients, aortic arch restenosis developed in the postoperative period. In total, 20 re-interventions were performed: 11 endovascular balloon dilatations and 9 surgical re-interventions. In the early postoperative period, aortopexia was performed in two patients (1.4%) due to compression of the left main bronchus.
 Conclusions. Two-stage repair of aortic arch hypoplasia with other congenital heart defects in newborns and infants is effective and safe treatment with good immediate and long-term results. This study shows that this surgical strategy can be effectively used in this complex pathology.

The choice of tactic for surgical treatment of aortic arch hypoplasia with ventricular septal defect in infants

Aim: to determine the optimal tactic for surgical correction of aortic arch hypoplasia and ventricular septal defect (VSD) in infants based on the comparison of immediate and follow-up outcomes of one- and two-stage repair.Materials and methods. Between 2011 to 2019, 138 patients under the age of one year underwent surgical repair of aortic arch hypoplasia with VSD in the leading Ukrainina cardiosurgical institutions – National M. Amosov Institute of Cardiovascular Surgery Affilated to National Academy of Medical Sciences of Ukraine and Center for Pediatric Cardiology and Cardiac Surgery. Patients were divided into two groups: group I involved 66 (47.8 %) patients who underwent one-stage repai of aortic arch hypoplasia and VSD, group II included 72 (52.2 %) patients with two-stage repair, consisting of aortic arch reconstruction and pulmonary banding at the first stage, and correction of VSD at the second stage.Results. The total hospital mortality was 3.6 % (n = 5). In group I, hospital mortality was 3.0 % (n = 2), in group II – 4.2 % (n = 3), but this difference is not statistically significant (P > 0.05). Follow-up was from 1 month to 11 years. Mortality rate over follow-up period was 0 %. Aortic arch restenosis developed in 16 (11.6 %) patients: 6 (9.1 %) patients in group I and 10 (13.9 %) patients in group II. There was no statistically significant difference in restenosis development between two groups. Compression of the trachea and left main bronchus developed in two patients of group II (2.8 %). There were no residual VSDs which would need repeated repair.Conclusions. Both one-stage and two-stage tactic for surgical treatment of aortic arch hypoplasia with VSD in infants is effective and safe showing good immediate and long-term follow-up results. The study indicates that one- stage correction is more acceptable in infants with hypoplasia of segment C or all aortic arch segments. Stage tactic can be used in hypoplasia of segments B and A.

Abstract 13025: Methotrexate Carried in Lipid Core Nanoparticles Prevented the Dilation and Dissection of the Aortic Arch in Mice With Marfan Syndrome by Increasing the Bioavailability of Intracellular Adenosine

Introduction: Mutations in the fibrillin-1 gene result in aneurysms and rupture of the aorta, the main cause of mortality in patients with Marfan syndrome (MFS). Inflammation is associated with dissection and rupture of the aorta. We showed that methotrexate (MTX) carried in lipid core nanoparticles (LDE) had powerful anti-inflammatory effects on atherosclerotic lesions and myocardial infarction. Hypothesis: To investigate whether treatment with LDE-MTX can prevent the development of aortic arch lesions in MFS. Methods: mgΔloxPneo MFS murine model and wild-type mice were allocated in 3 groups of treatment: LDE only; MTX in commercial formulation; LDE-MTX. The treatment occurred weekly at a dose of 1mg/kg ip, between the 3rd and 6th month of life, period in which both dilation and dissection of the aortic arch are observed. After 12 weeks, animals were submitted to analysis of the aortic arch. Results: Compared to LDE and MTX groups, LDE-MTX treatment showed smaller lumen area of ascending and descending aorta and aortic arch segments in MFS mice. LDE-MTX also decreased collagen volume fraction and the amount of aortic dissections, but did not affect the thickness of the vessel wall and the number of elastic fiber ruptures. Protein expression of the inflammatory markers CD68 (macrophages), CD3 (lymphocytes) and tumor necrosis factor alpha, of the apoptotic marker caspase 3 and of type 1 collagen were lower in LDE-MTX group when compared to LDE and MTX. Moreover, treatment with LDE-MTX reduced TGF-β, ERK and SMAD3 protein expression. Of note, CD68 and CD3 protein expression were positively correlated with the lumen area of the aortic arch (r2=0.36; p<0.001), indicating the importance of inflammation for the aortic dilation. The increase in bioavailability of intracellular adenosine was suggested by higher expression of A2a adenosine receptor and lower levels of adenosine deaminase in the aortic arch. Conclusions: Possibly by increasing the bioavailability of intracellular adenosine, LDE-MTX treatment had the ability to reduce the processes of inflammation, apoptosis and fibrosis that are consequent to fibrillin-1 mutation. By these means, LDE-MTX may conceivably prevent the development of the dilation and dissection in the aortic arch, the hallmarks of MFS.

Methotrexate associated with a lipid core nanoparticle prevented the dilation and dissection of the aortic arch in mice with Marfan syndrome

Abstract Introduction Mutations in the fibrillin-1 gene result in dilation, dissection and rupture of the aorta, the main cause of mortality in patients with Marfan syndrome (MFS). Inflammation is associated with greater susceptibility to dissection and rupture of the aorta. Previously, we showed that methotrexate (MTX) carried in lipid core nanoparticles (LDE) had powerful anti-inflammatory and anti-proliferative effects on rheumatoid arthritis and atherosclerotic lesions induced in rabbits and improved myocardial infarction morphological and functional aspects in rats with ligation of left coronary artery. When MTX is associated to LDE, the uptake of the drug by the cells is increased several-fold, which conceivably endows MTX with enhanced action mechanisms and the drug toxicity is diminished. Purpose To investigate whether treatment with LDE-MTX can prevent the development of aortic arch lesions in a murine model of MFS. Methods mgΔloxPneo MFS murine model and wild-type mice were allocated in 3 groups of treatment: LDE only; MTX in commercial formulation; LDE-MTX. The treatment occurred weekly at a dose of 1mg/kg ip, between the 3rd and 6th month of life, period in which both dilation and dissection of the aortic arch are observed. After 12 weeks, the animals were submitted to echocardiography, morphometry and protein expression of the aortic arch. Results Compared to LDE and MTX groups, LDE-MTX treatment showed smaller lumen area of ascending and descending aorta and aortic arch segments in MFS mice. LDE-MTX also decreased the collagen volume fraction and the amount of aortic dissections, but did not affect the thickness of the vessel wall and the number of elastic fiber ruptures. The protein expression of the inflammatory markers CD68 (macrophages), CD3 (lymphocytes) and tumor necrosis factor alpha, of the apoptotic marker caspase 3 and of type 1 collagen were lower in MFS LDE-MTX group when compared to MFS mice treated with LDE and MTX. Moreover, treatment with LDE-MTX reduced TGF-β, ERK and the SMAD3 protein expression. Of note, CD68 and CD3 protein expression was positively correlated with the lumen area of the aortic arch (r2=0.36; p<0.001), indicating the importance of inflammation for the aortic dilation. The increase in bioavailability of intracellular adenosine in MFS animals treated with LDE-MTX was suggested by the higher expression of A2a adenosine receptor and the lower expression of adenosine deaminase in the aortic arch. Conclusion Possibly by increasing the bioavailability of intracellular adenosine, LDE-MTX treatment had the ability to reduce the processes of inflammation, apoptosis and fibrosis that are consequent to fibrillin-1 mutation. By these means, LDE-MTX may conceivably prevent the development of the dilation and dissection in the aortic arch, the hallmarks of MFS, in this animal model. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo)

Correction of the aortic arch hypoplasia in newborn babies, suffering complete form of atrio-ventricular septal defect

Objective. Tactics of treatment and results of the hypoplasia of the aortic arch correction in newborn babies with complete form of atrio-ventricular septal defect were studied.
 Маterials and methods. During period from 2011 tо 2019 yrs in 21 patients correction of hypoplasia of aortic arch and atrio-ventricular septal defect were performed. The investigated group consisted of patients with a two-ventricular physiology. The patients, suffering imbalanced form of atrio-ventricular septal defect and with variants of hypoplasia in left parts of the heart, were excluded from the investigation. There were 9 (42.9%) boys and 12 (57.1%) girls. Average age of the patients have constituted (2.3 ± 1.1) mo (from 0.06 до 7.7 mo). Average body mass of the patients have constituted (3.8 ± 1.0) kg (from 2.0 до 5.9 kg). The aortic arch segment was considered a hypoplastic one if a Z-score (Standard Score - standard estimation) shift have constituted lesser than 2.0.
 Results. Hospital lethality have constituted 14.2%. Three newborn babies died: 2 - after first stage of correction, and 1 - after second stage of correction. All the patients, to whom a one-staged correction was done, have survived. The causes of lethality were not connected with method of the aortic arch reconstruction. While performance of echocardiography before discharge from the hospital the pressure gradient on place of the aortic arch plasty have constituted (13.6 ± 6.8) mm Hg at average. Average follow-up period have constituted (2.6 ± 2.1) yrs (from 2 mo tо 8.1 yr). In late follow-up period lethality was absent. In 2 (9.5%) patients in postoperative period reoperations on aortic arch and mitral valve were performed. Tracheal compression as well as the main bronchi compression, neurological complications in late follow-up period were absent.
 Conclusion. For the patients, suffering complete form of atrio-ventricular septal defect in conjunction with hypoplasia of aortic arch the staged correction constitutes a more favorable option, owing good immediate and late results. A staged approach in the treatment is indicated for newborn babies, suffering hypoplasia of distal aortic arch and competent atrio-venticular valves or with small regurgitation. Оne-stage correction is indicated in hypoplasia of aortic arch, pronounced regurgitation on common atrio-ventricular valve and pronounced heart failure.

Aortic heterogeneity across segments and under high fat/salt/glucose conditions at the single-cell level.

The aorta, with ascending, arch, thoracic and abdominal segments, responds to the heartbeat, senses metabolites and distributes blood to all parts of the body. However, the heterogeneity across aortic segments and how metabolic pathologies change it are not known. Here, a total of 216 612 individual cells from the ascending aorta, aortic arch, and thoracic and abdominal segments of mouse aortas under normal conditions or with high blood glucose levels, high dietary salt, or high fat intake were profiled using single-cell RNA sequencing. We generated a compendium of 10 distinct cell types, mainly endothelial (EC), smooth muscle (SMC), stromal and immune cells. The distributions of the different cells and their intercommunication were influenced by the hemodynamic microenvironment across anatomical segments, and the spatial heterogeneity of ECs and SMCs may contribute to differential vascular dilation and constriction that were measured by wire myography. Importantly, the composition of aortic cells, their gene expression profiles and their regulatory intercellular networks broadly changed in response to high fat/salt/glucose conditions. Notably, the abdominal aorta showed the most dramatic changes in cellular composition, particularly involving ECs, fibroblasts and myeloid cells with cardiovascular risk factor-related regulons and gene expression networks. Our study elucidates the nature and range of aortic cell diversity, with implications for the treatment of metabolic pathologies.

Antiatherosclerotic Properties of Echinodorus grandiflorus (Cham. & Schltdl.) Micheli: From Antioxidant and Lipid-Lowering Effects to an Anti-Inflammatory Role.

Echinodorus grandiflorus is an important medicinal plant species that is native to South America. Despite extensive popular usage as a hypolipidemic drug, its effects as an atheroprotective agent remain unknown. The aim of this study was to evaluate the effects of an ethanol-soluble fraction that was obtained from E. grandiflorus (ESEG) leaves against the development of atherosclerosis in rabbits. Male rabbits received a diet that was supplemented with 1% cholesterol (cholesterol-rich diet [CRD]) for 60 days. After 30 days of the CRD, the animals were divided into five groups (n = 6) and treated with ESEG (10, 30, and 100 mg/kg), simvastatin (2.5 mg/kg), or vehicle once daily for 30 days. The negative control group was fed a cholesterol-free diet and treated orally with vehicle. At the end of 60 days, serum lipids, oxidized low-density lipoprotein, thiobarbituric acid reactive substances, nitrotyrosine, and serum interleukin 1 beta (IL-1β), IL-6, soluble intercellular adhesion molecule-1 (sICAM-1), and soluble vascular cell adhesion molecule-1 (sVCAM-1) levels were determined. Samples from the aortic arch and thoracic segment were also collected to investigate the tissue antioxidant defense system and perform histopathological analysis. Oral ESEG administration significantly reduced serum lipid levels in CRD-fed rabbits. This treatment also modulated the arterial antioxidant defense system by reducing lipid and protein oxidation. Similarly, serum IL-1β, IL-6, sICAM-1, and sVCAM-1 levels significantly decreased, accompanied by a reduction of atherosclerotic lesions in all arterial branches. These findings suggest that ESEG may be a new herbal medicine that can be directly applied for the treatment and prevention of atherosclerotic disease.

Thoracic endovascular repair of a rare case of leaking aortic arch intramural hematoma secondary to Giant cell arteritis

BackgroundTraditionally thoracic aortic aneurysms (TAA) secondary to Giant Cell Arteritis (GCA) were treated with resection and open repair. However no prior studies have reported an aortic intramural hematoma (IMH) as a presentation of GCA or outcome of thoracic endovascular aortic repair (TEVAR) in TAA or IMH secondary to GCA.Case presentationA 59 year old female, nonsmoker, non-hypertensive, non-diabetic with a known history of GCA, temporal arteritis on prednisone presented with shortness of breath & chest pain. Chest CT revealed aortic arch IMH and large left hemothorax. CTA confirmed distal aortic arch focal dilation, a focal intimal irregularity in the distal aortic arch and extensive IMH without any active extravasation or signs of aortitis. Patient underwent an urgent TEVAR without oversizing the aortic landing zones. Post TEVAR aortogram showed exclusion of the site of IMH origin and dilated aortic arch segment by the stent and absence of active extravasation. One month post-TEVAR CTA showed patent stent graft with resolution of IMH and hemothorax. One year after TEVAR, patient remained asymptomatic.ConclusionGCA can present as an IMH secondary to underlying chronic vasculitis. When endovascular repair is considered, great care should be taken not to grossly oversize aortic landing zones.

Clues and techniques of prenatal ultrasonographic diagnosis for fetal aortic arch anomalies

Objective To explore the ultrasonographic features, diagnostic clues and methods of fetal aortic arch anomalies, and to improve the diagnosis rate of prenatal ultrasonography for fetal aortic arch anomalies. Methods Fetuses with aortic arch anomalies diagnosed by prenatal ultrasound were selected as the study objects. The prenatal ultrasonographic features of the three views of the aortic arch were carefully observed. The three views included the followings: the transverse view(the view of three vessels and trachea), the sagittal view (the longitudinal view of the aortic arch), and the coronal view (the coronal view of the descending aorta). The prenatal diagnostic clues and diagnostic techniques of aortic arch anomalies were summarized and analyzed. Results Eighty-one cases with aortic arch anomalies were followed up. Fifteen cases were left-sided aortic arch and left-sided ductus arteriosus with aberrant right subclavian artery, 22 cases with right aortic arch and left-sided ductus arteriosus with aberrant left subclavian artery, 4 cases were mirror right aortic arch and left-sided ductus arteriosus, 2 cases were mirror right aortic arch and right-sided ductus arteriosus, 11 cases were double aortic arch, 23 cases were coarctation of the aorta, and 4 cases were interruption of aortic arch. Among them, 27 cases were complicated with other cardiac and extra-cardiac malformations and 13 cases with chromosomal abnormalities. Prenatal ultrasonographic clues for diagnosis of coarctation of the aorta included the three vessels and trachea view showing small diameter and disproportion to the diameter of the ductus arteriosus. And the longitudinal view of the aortic arch was helpful for showing the position and the extent of coarctation of the aorta. Prenatal ultrasonographic clues for diagnosis of interruption of aortic arch were that the three vessels and trachea view and the longitudinal view of the aortic arch showed the interruption between aortic arch and descending aorta. And the abnormal combination cases of the aortic arch segments also had their corresponding diagnostic clues. These clues included that the three vessels and trachea view showed abnormal position, arrangement and running of the branches of the aortic arch. And the coronal view of the descending aorta also showed abnormal changes in the branches of aortic arch. Conclusions Various types of congenital aortic arch anomalies have characteristic ultrasonography and their corresponding diagnostic clues and methods. The combined use of the three views of the aortic arch is effective in prenatal diagnosis for aortic arch anomalies. Key words: Ultrasonography, prenatal; Aortic arch anomalies; Diagnostic clues

Unusual presentation of interrupted aortic arch: a case report and radiological review

Interrupted aortic arch, arare congenital malformation and there is a loss of luminal continuity between the ascending and descending portions of the aortic arch. Their incidences are of 3 per million live births and manage by surgical treatment. Till now only 12 cases of isolated interrupted aortic arch reported in adults. We notify the computed tomography imaging findings of a 29-year-old femalepatients presented to our hospital. MDCT has advantages of a less scanning time with more spatial resolution and high temporal resolution. Fine anatomic structures can be evaluated by retrospective reconstruction. Within few years MDCT has become a primary diagnostic tool for evaluation of aortic abnormality. Volumetric scanning of chest done in 64 slices MDCT with plain and contrast enhanced (I.Vnon-ionic) contiguous axial images taken from chest and evaluated in appropriate window settings. Result: Multi-detector computed tomography (MDCT) angiography with a 64 slice MDCT were performed. The aortic arch is seen interrupted, approx. 1.8cm long segment of aortic arch just after the origin of subclavian artery is not seen (absent), thick chunk of irregular calcification is seen in the region of termination of aortic arch. Descending thoracic aorta is smaller in caliber measure approx. 1.1 x 1.2 cm in diameter & shows well luminal contrast opacification. Prominent Para vertebral collaterals seen suggesting collateral filling of descending thoracic aorta. No evident contrast filled patent ductus arteriosus seen, a tubular slightly enhancing structure seen in this region.

Mechanisms underlying antiatherosclerotic properties of an enriched fraction obtained from Ilex paraguariensis A. St.-Hil.

BackgroundIlex paraguariensis A. St. Hil. var. paraguariensis (Aquifoliaceae) popularly known as ‘mate’ is an important species native to South America. Despite numerous studies showing significant antioxidant and lipid lowering properties, the antiatherosclerotic mechanisms of this species remain unknown. PurposeTo evaluate the possible antiatherosclerotic effects of a butanolic fraction (n-BFIP) obtained from I. paraguariensis and to investigate the molecular mechanisms involved in this activity. MethodsFirst, n-BFIP was obtained from the hydroalcoholic extract and a detailed phytochemical investigation about its main secondary metabolites was performed. Then, during 8 experimental weeks, rabbits received diet supplemented with 1% cholesterol (CRD). After 4 weeks of CDR, animals were redistributed into five groups (n = 6) and treated (p.o.) with n-BFIP (10, 30 and 100 mg/kg), simvastatin (5 mg/kg), or vehicle (filtered water, 1 ml/kg) once daily for 4 weeks. An additional group was fed with cholesterol-free diet and treated with vehicle. At the end of 8 weeks, serum samples were obtained for the measurement of serum lipids, lipid and protein oxidation and indirect nitric oxide levels. In addition, serum IL-1β, IL-6, sICAM-1, sVCAM-1, and intracellular cGMP levels in rabbit aortic rings were measured. Samples from the aortic arch and thoracic segment were collected for histopathological analysis. ResultsCRD induced oxidative and nitrosative stress and increased serum lipids, IL-1β, IL-6, sICAM-1, and sVCAM-1 levels. In addition, structural changes in the intima layers of different arterial branches were also found. Although it did not change serum lipids, n-BFIP reverted oxidative and nitrosative stress and reduced IL-1β, IL-6, sICAM-1, and sVCAM-1 levels, besides to increasing intracellular levels of cGMP in vitro. In addition, the formation of atherosclerotic plaques was reduced to values close to those of animals fed with cholesterol-free diet. ConclusionsA 4-week n-FBIP treatment reduces the progression of the atherosclerotic disease in New Zealand rabbits. These effects are associated with an attenuation of oxidative and nitrosative stress, affecting IL-1β, IL-6, sICAM-1 and sVCAM-1 levels.

Coarctation Index Predicts Recurrent Aortic Arch Obstruction Following Surgical Repair of Coarctation of the Aorta in Infants

Recurrent aortic arch obstruction (RAAO) remains a major cause of morbidity following surgical neonatal repair of coarctation of the aorta (CoA). Elucidating predictors of RAAO can identify high-risk patients and guide postoperative management. The Coarctation index (CoA-I), defined as the ratio of the diameter of the narrowest aortic arch segment to the diameter of the descending aorta, has been used to help diagnose RAAO in neonates following the Norwood Procedure. We sought to assess the predictive value of the CoA-I on RAAO after CoA repair in infants with biventricular circulation. Clinical, surgical, and echocardiographic data of infants with biventricular circulation following neonatal CoA repair between 2010 and 2014 were evaluated. RAAO was defined using a composite quantitative outcome variable: a blood pressure gradient >20, a peak aortic arch velocity >3.5m/s by echocardiogram, or a catheter-measured peak-to-peak gradient >20 within 2years of surgery. Univariate and multivariate logistic regression analyses were used. Of the 68 subjects included in the analysis, 15 (22%) met criteria for RAAO. In the multivariate model, only CoA-I (OR 35.89, 95% CI 6.08-211.7, p<0.0001) and use of patch material (OR 9.26, 95% CI 1.57-54.66, p=0.014) were associated with increased risk of RAAO. The odds of developing RAAO was higher in patients with a CoA-I less than 0.7 (OR 33.8, 95% CI 5.7-199.5, p<0.001). Postoperative CoA-I may be used to predict RAAO in patients with biventricular circulation after repair of CoA. Patients with a CoA-I less than 0.7 or patch aortoplasty warrant close follow-up.

Effectiveness of Balloon Angioplasty in Children With Recurrent Aortic Coarctation Depends on the Type of Aortic Arch Pathology.

The aim of this study was to evaluate the effectiveness of balloon angioplasty (BAP) for recurrent aortic coarctation (ReCoA) in infants comparing simple and complex type of aortic arch pathology (Norwood I procedure). ReCoA is a known complication after cardiovascular surgery for coarctation of the aortic arch. In a single center case study, we analyzed 20 infants undergoing BAP for ReCoA comparing simple (n = 10) and complex type of aortic arch pathology (n = 10). At catherization diameter of ReCoA stenosis was 3.2 ± 0.7 mm (mean ± SD) with short localized (11/20) or long hypoplastic stenosis (9/20) before and 4.8 ± 1.2 mm after BAP (P < 0.001). Invasive systolic pressure gradient was reduced from 27.5 ± 16.2 mmHg before to 5.1 ± 6.6 mmHg after BAP (P < 0.001), comparable in simple and complex type of ReCoA. At day 1 after catherization noninvasive systolic arterial blood pressure gradient was reduced from 20.2 ± 23.1 to 6.7 ± 9.9 mmHg (P < 0.001), respectively, calculated continuous wave Doppler echo gradient from 36.3 ± 22 to 16.8 ± 9.6 mmHg (P < 0.01). Complications were aortic arch dissection (1/20), discrete aortic arch aneurysm formation (1/20), pericardial effusion (1/20), and peripheral arterial thrombosis (4/20). At a mid-term follow up of 9.5 months (1-40) after BAP, 3 infants needed early surgical reintervention due to secondary ReCoA, all with long hypoplastic aortic arch segments, but simple type of aortic arch pathology. At mid-term follow up, BAP remains an effective catheter intervention for ReCoA for infants with localized ReCoA, but not with long hypoplastic aortic arch segments, even in simple type of aortic arch pathology.

Early Experience of Endovascular Repair of Post-dissection Aneurysms Involving the Thoraco-abdominal Aorta and the Arch

Outcomes are reported in management of post-dissection aneurysms involving the aortic arch and/or thoraco-abdominal segment (TAAA) treated with fenestrated and branched (complex) endografts. This report includes all patients with chronic post-dissection aneurysms >55 mm in diameter, deemed unfit for open surgery, treated using complex endografts between October 2011 and March 2015. When appropriate, staged management strategies including left subclavian artery revascularization, thoracic endografting, dissection flap fenestration or tear enlargement, and other endovascular procedures were performed at least 3 weeks prior to definitive complex endovascular repair. The following outcome data were collected prospectively at discharge, 12 months and annually thereafter: technical success, endoleaks, target vessel patency, false lumen patency, aneurysm diameter, major and minor complications, re-interventions, and mortality. The cohort comprised 23 patients with a median age of 65 years. Staged procedures were performed in 14 patients (61%). Seven patients with dissections involving the arch were treated with inner branched endografts, and 16 TAAA patients were treated with fenestrated or branched endografts. The technical success rate was 71% following arch repair and 100% following TAAA repair. During early follow up, one of the arch group patients died and one in the TAAA group suffered spinal cord ischemia. The median follow up was 12 months (range 3-48), during which time one patient died of causes unrelated to aneurysm or treatment. Two early re-interventions were performed in the arch group to correct access vessel complications and there were a further two late re-interventions in the TAAA group to treat endoleaks. All target vessels (n = 72) remained patent. This experience indicates that complex endovascular repair of post-dissection aneurysms is a viable alternative to open repair in patients deemed unfit for open surgery. There are insufficient data to allow comparison with the outcome of open surgery in anatomically similar, but fit, patients.