Arch Wall Research Articles

Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case-control study.

To describe the long-term experience of a simplified frozen elephant trunk technique (sFETT) used in complicated acute type A aortic dissection (AAAD) treatment. Between January 2001 and December 2012, 34 patients (mean age 59.9 ± 11.0 years) with complicated AAAD (DeBakey I) underwent an emergency surgery including sFETT. sFETT consisted in gluing the dissected aortic arch wall layers with gelatine-resorcinol adhesive and video-assisted antegrade open arch aortic stent-graft deployment in the arch or proximal descending aorta. In addition to sFETT, the aortic root was addressed with standard techniques. A 30-day mortality was 14.7% (five patients) due to bleeding (1), multiple organ failure (2), and colon ischemia (2). Postoperative morbidity included neurological (2), renal (1) and cardio-pulmonary complications (4), as well as wound infection (1). Mean follow-up was 74.4 ± 45.0 months. Actual survival rates were 73.5% at 1 year, 70.2% at 5 years, and 58.5% at 13 years of follow-up. Six patients died during long-term follow-up from heart failure (1) and unknown reasons (5). Five patients required reoperation for aortic arch (3) or aorto-iliac (2) progression of aneurysm during the mid- and long-term follow-up. The remaining patients showed favorable evolution of the dissected aorta with false lumen occlusion in most cases and stable aortic diameters. In AAAD patients, sFETT as used in our series is an easy and safe technique to repair the aortic arch. Long-term results after sFETT showed false lumen occlusion and stable aortic diameter in up to 13 years of follow-up.

Clinical observation on the improved reductive surgery for the treatment of zygomatic complex fractures

Objective To observe the clinical effect of improved reductive surgery for zygomatic complex fracture. Methods Thirty-two patients with zygomatic complex fractures were given zygomatic arch and lateral orbital wall fracture CT 3D reconstruction before operation to display position of fracture. The skin incision was made along the lower eyelid margin and extended about 15 mm outward canthus. Then the periosteotomy was done and the periosteum was separated to the back of zygomatic arch. The fracture was fixed with micro titanium nail plate to restore the normal anatomical position of zygomatic arch and to reset orbital margin completely. Results Two weeks after the operation, the soft tissue swelling of the orbital region faded. The deformity was completely corrected, and the opening movement of mouth was improved obviously compared with that before the operation. Three months after the surgery, the zygomatic appearance was symmetrical in 32 cases, with no obvious differences in appearance. Mouth opening degree was higher than 40 mm.The two eyeballs were symmetrical. Conclusion The improved subciliary approach combined with micro titanium nail and plate for zygomatic complex fracture has good effect. Key words: Fractures, traumatic; Zygomatic complex; Reductive surgery, modified; Incision

Hemodynamic Differences Between Central ECMO and Peripheral ECMO: A Primary CFD Study.

BackgroundVeno-arterial extracorporeal membrane oxygenation (VAECMO), including central ECMO (cECMO) and peripheral ECMO (pECMO), is widely used in cardiopulmonary surgery. The outcomes and complications of both types of ECMO are quite different from each other. The hemodynamic differences among them are hypothesized as a key factor. Hence, a numerical study was conducted to test this hypothesis.Material/MethodsIdeal cardiovascular models with pECMO and cECMO were established. The aortic pressure and flow rate were chosen as boundary conditions. The flow pattern, blood flow distributions, flow junction, harmonic index (HI) of blood flow, wall shear stress (WSS), and the oscillatory shear index (OSI) were calculated to evaluate the hemodynamic states.ResultspECMO could achieve better upper limb and brain perfusion (0.05458 vs. 0.05062 kg/s), and worse lower limb perfusion (0.03067 vs. 0.03401 kg/s). There exist low WSS (<0.4 pa) regions at the inner and posterior wall of the aorta, and high WSS (>2 pa) region at the access of the femoral artery. These regions also have relatively high OSI value (reaching 0.45). In contrast, for cECMO, there exist high WSS at the posterior wall of the aortic arch.ConclusionsThe hemodynamic performances of various types of ECMO are different from each other, which maybe the key reasons for the differences in the outcomes and complications. Therefore, for pEMCO, the lower-extremity ischemia is a complication that must be considered. The type, support level, and duration of ECMO should also be carefully regulated according to the patients’ condition, as they are the important factors related to vascular complications.

Bacterial emphysematous prostatic abscess – A case report

s / Urological Science 26 (2015) 301e310 310 Materials and Methods: An 82 years old female patient presented to the Emergency Department with feeling unwell, pyrexia, gross hematuria, nausea and abdominal pain. She gave a history of type 2 Diabetes mellitus with regular follow-up in our hospital. A large right renal mass was detected near 4 years ago. However, she and family refused operation since then due to old age. On examination she looked weakness. A mass was palpable in the right upper quadrant and lumbar region. Liver and spleen were not palpable. There were no signs of peritonitis. Her pulse rate was 121/minute, BP 189/104 and temp 39.3 degree. She had blood tests in the Emergency Department which revealed the following: Hb 15.6 g/dL, WBC 11,400 and platelets 202,000. Electrolytes were as follows: Na 136 mmol/ litre, K 3.3 mmol/litre, BUN: 12, creatinine: 0.8, blood sugar: 213. Chest X ray showed 1) Mild coarse and crowding lung markings, some infiltration in bilateral lungs; but no focal active lung lesion. 2) Borderline cardiomegaly and mild tortuosity of aorta with some calcified atheroma plaques of aortic arch wall.. The patient had ultrasound scanwhich showed mass in the right kidney. Computerised tomography (CT) scan image of abdomen showed anterior upper pole tumor 9.5 x 12 x9.0 cm in size with heterogeneous enhancement and area of necrosis. Extension to perirenal fat and renal sinus fat but not Gerota fascia. Positron emission tomography (PET) revealed: 1. F-18 FDG avid lesion in the left thyroid, malignancy should be considered. 2. Right paraaortic lymph node metastases should be considered. She underwent right-side radical nephrectomy after full staging procedures and appropriate investigations. NDP32: BACTERIAL EMPHYSEMATOUS PROSTATIC ABSCESS e A CASE REPORT Chih-Cheng Lu, Wen-Chou Fan. Division of Urology, Department of Surgery, Chi Mei Medical Center, Liouying, Tainan, Taiwan Purpose: We present a case of emphysematous prostatic infection complicated with multiple organs abscess by Klebsiella pneumoniae. Materials and Methods: A 47 year-old male patient suffered from uncontrolled diabetes. Four days before admission, he had fever and general weakness. He visited our emergent department after empirical treatment at local clinic. After admission, intensive care was given due to diabetic ketoacidosis and septic shock. Although multiple drains for liver and lung, spiking fever persisted. Sequential CT showed air and abscess in the prostate region. Urgent transurethral prostate incision was done to drain the abscess. Afterwards, the general condition became stable. He was discharged with oral antibiotics and antidiabetic drugs. After one year followup, the patient kept uneventful condition with tight diabetic control. Conclusion: Emphysematous prostatic abscess is an unusual acute disease with high morbidity and mortality. The predisposing factors include diabetes mellitus, hepatic cirrhosis, and intravesical obstruction. CT provides a good tool for immediate diagnosis. Treatment of prostatic abscess includes parenteral antibiotics and abscess drainage. Transperineal needle aspiration, transrectal needle aspiration, open perineal incision, and transurethral resection or unroofing are available routes for drainage.

Abstract T MP117: Rosuvastatin May Have Long-Term Clinical Benefits by Causing Plaque Regression and Improving Aortic Stiffness in Ischemic Stroke Patients

Background: Complicated aortic arch plaque (CAP) is important in recurrent ischemic stroke (IS) and prognosis. Keying on the reduced occurrence of IS observed in the large-cohort JUPITER Study, the current investigation assessed clinical benefits and pathophysiology of statin therapy. Methods: Of 112 consecutive acute cerebral embolism patients, 97 gave informed consent for our retrospective survey and were analyzed. All had transesophageal echocardiography (TEE) to assess presence or absence of CAP, defined as aortic wall thickness &gt;4mm or plaque ulceration. Also assessed were aortic stiffness parameter β (Aoβ) and aortic arch wall motion velocity (WMV) evaluated by tissue Doppler imaging. Patients received appropriate conventional antithrombotic therapy as clinically indicated, and in addition we recommended that all patients with CAP receive 5 mg rosuvastatin/day. Patients were divided into 3 groups: those with CAP taking rosuvastatin (Group A, n=26, 68±7 years), those with CAP not taking rosuvastatin (Group B, n=13, 71±9 years), and those without CAP (Group C; n=58, 62±12 years). Follow-up TEE was performed at 6 months in Group A. In these 3 groups recurrent stroke and death were defined as major adverse cerebrovascular events (MACE). Results: Study duration was 710±405 days. CAP was detected in 39 patients (40%), and MACE occurred in 15 (15%). Kaplan-Meier analysis demonstrated that Group B had significantly higher MACE compare to other 2 groups (long-rank test; X2=6.553, p&lt;0.05), while Group A did not differ from Group C despite being significantly older (p&lt;0.05). Group A patients with a follow-up TEE at 6 months showed significant improvement in CAP diameter, Aoβ and peak WMV during the diastolic phase of contraction (5.8±2.0 vs. 4.9±1.9 mm, p&lt;0.01; 19.5±14.6 vs. 12.9±6.5, p&lt;0.05; 1.5±0.4 vs. 1.7±0.4 cm/s, p&lt;0.01, respectively). In addition, CAP were morphologically improved in 15 patients, unchanged in 8, and worsened in 3. Conclusions: Rosuvastatin therapy causes plaque regression and improved aortic arch stiffness in IS patients with CAP, and may also have long-term clinical benefits.

Abstract 20144: Aortic Arch Plaque Deteriorates With Advancing Chronic Kidney Disease Stage

Introduction: The patients with chronic kidney disease (CKD) are likely to suffer from cardiovascular diseases as well as end stage renal disease. CKD plays a role in development of atherothrombotic stroke. In the present study, we investigated the impact of advancing CKD stage on aortic arch plaque and carotid atherosclerosis which are important causes of atherothrombotic stroke. Methods: We enrolled 368 subjects (255 males, 66 ± 12 years) who underwent transesophageal echocardiography and carotid ultrasonography, and measured estimated glomerular filtration rate (eGFR). We defined arch plaque as wall thickness ≥4 mm and the presence of ulceration or mobile plaque in aortic arch. The common carotid artery maximum intima-media thickness (IMT-C max) and carotid artery plaque score was used as parameters of carotid atherosclerosis. Results: There were 31 patients with the history of atherothrombotic stroke. The eGFR correlated with IMT-C max, carotid plaque score and arch wall thickness. IMT-C max, carotid plaque score and arch wall thickness were increased with advancing CKD stage. An increase in IMT-C max was observed even in stage 2 and 3 while carotid plaque was frequently observed in stage 3b or higher. An increase in arch plaque was observed in stage 3a or higher. The patients with atherothrombotic stroke had significantly lower eGFR than those without. The prevalence of atherothrombotic stroke was increased in stage 3b or higher. Conclusions: Aortic arch plaque and carotid plaque deteriorated with advancing chronic kidney disease stage. Aortic arch plaque and carotid plaque were observed even in early stages of CKD.

Occlutech Device to Salvage Aortic Rupture

A 78-year-old patient presented 2 months after surgical repair of a thoracic aortic aneurysm with back pain and hemoptysis. Computed tomography (CT) angiography (Fig 1) revealed a thoracic pseudoaneurysm (stars) and active hemorrhage (arrow) from the inferior wall of the aortic arch between the ascending (A) and descending (D) thoracic aorta. A nonfenestrated thoracic endograft was contraindicated because it would cover the origins of the left common and subclavian arteries. Using a left brachial artery approach, the defect was crossed (Fig 2a, arrow), and an Occlutech device (Occlutech International AB, Helsingborg, Sweden), a double disk made of nitinol mesh with an internal polyethylene patch, was deployed (Fig 2b, arrow).

Imaging Artifacts During Transesophageal Echocardiography

Imaging Artifacts During Transesophageal Echocardiography

Support technology for mine roadways in extreme weakly cemented strata and its application

For the engineering geology conditions of bad mine roadway roof and floor lithology in extremely weak cemented strata, the best section shape of the roadway is determined from the study of tunnel surrounding rock displacement, plastic zone and stress distribution in rectangular, circle arch and arch wall sections, respectively. Based on the mining depth and thickness of the coal seam, roadway support technology solutions with different buried depth and thickness of coal seam are proposed. Support schemes are amended and optimized in time through monitoring data of the deformation of roadway, roof separation, I-beam bracket, bolt and anchor cable force to ensure the long-term stability and security of the roadway surrounding rock and support structure. The monitoring results show that mine roadway support schemes for different buried depth and section can be adapted to the characteristics of ground pressure and deformation of the surrounding rock in different depth well, effectively control the roadway surrounding rock deformation and the floor heave and guarantee the safety of construction and basic stability of surrounding rock and support structure.

Assessment of Aortic Arch Stiffness Using Pulse‐Wave Tissue Doppler Imaging: A Transesophageal Echocardiographic Comparison Study of Acute Ischemic Stroke Patients and Stroke‐Free Patients

Elevated aortic stiffness determined by transesophageal echocardiography (TEE), and presence of complicated aortic plaque provide prognostic information about cerebrovascular disease risk. Recently, pulse-wave tissue Doppler imaging (PW-TDI) has offered a new technique for assessing aortic wall stiffness. The following aortic long-axis view TEE measurements were carried out in 103 consecutive acute ischemic stroke patients and 72 controls (stroke-free patients requiring TEE for conditions such as atrial fibrillation and valvular heart disease): (a) PW-TDI motion velocities measured as expansion peak velocity during systole (Vs) and contraction peak velocity during diastole (Vd); (b) aortic arch stiffness parameter β (Aoβ), defined as β=ln (systolic blood pressure/diastolic blood pressure)/([Dmax-Dmin]/Dmin), where ln is the natural logarithm, Dmax is maximum aortic lumen diameter, and Dmin is minimum aortic lumen diameter. The PW-TDI of Vs and Vd was compared with conventional vessel parameters brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI, calculated from blood pressure and PWV). Comparing acute ischemic stroke patients versus controls, Vs and Vd were significantly decreased (3.3±1.6 vs. 3.9±2.0cm/sec, P<0.05; 1.7±0.6 vs. 2.1±0.8cm/sec, P<0.01, respectively), and Aoβ and aortic arch intima-media thickness (AoIMT) were significantly increased (15.3±12.5 vs. 11.6±6.5, P<0.05; 3.2±2.5 vs. 2.4±2.1mm, P<0.05; respectively). Furthermore, Vs and Vd were significantly negatively correlated with age, Aoβ, AoIMT, CAVI, and baPWV in all cases. The use of aortic arch wall PW-TDI for Vs and Vd evaluation constitutes an easily and readily assessed parameter for evaluating aortic arch stiffness.

Flow patterns and preferred sites of atherosclerotic lesions in the human aorta – I. Aortic arch

To elucidate the role of fluid mechanical factors in the localized genesis and development of atherosclerotic lesions in man. Flow patterns and preferred sites of atherosclerotic lesions in the human aortic arch were studied in detail using isolated transparent aortic trees prepared from humans postmortem and by means of flow visualization of tracer polystyrene microspheres, using cinemicrographic techniques. Under the condition of steady flow that simulated mid-systole, the flow in the aortic arch consisted of three major components; (i) a straight flow to the brachio-cephalic artery located close to the right dorsal wall of the ascending aorta; (ii) a quasi-parallel undisturbed flow located close to the common median plane of the aortic arch and its side branches, and (iii) a clockwise slow, spiral secondary flow located dominantly near the left ventral wall of the aortic arch. Thus, looking down the aorta from its origin, the flow in the aortic arch appeared as a single helical flow revolving in a clockwise direction. Atherosclerotic lesions were found mainly in regions of low wall shear stress such as the proximal lip of the orifice of each side branch where a slow recirculation flow formed, and the left ventral wall of the aortic arch where a slow spiral secondary flow formed.

The use of robotic endovascular catheters in the facilitation of transcatheter aortic valve implantation

The use of transcatheter aortic valve implantation (TAVI) is rapidly increasing with advances in technology and improved clinical outcomes. Adoption of robotic catheter technologies could have a role in TAVI, in different stages of the procedure, to improve endovascular tool manipulation and potentially reduce the risk of cerebral embolization. The aim was to determine whether there are advantages in using a robotic catheter for TAVI in the initial stages of the procedure; aortic arch navigation and valve crossing. A silicone in vitro model of the aorta and stenotic aortic valve was developed. Fifteen operators performed the fluoroscopy-guided simulation using manual and robotic techniques. Performance metrics-time and vessel wall contact (wall-hits) were compared (Wilcoxon's signed-rank test). Overall, the time taken for robotic arch navigation was increased (3.09 min interquartile range (1.24-6.29) vs 1.21 min (0.15-4.42); P = 0.03). Contact with the aortic arch wall, however, significantly decreased using the robotic catheter: wall-hits 1 (0-5) vs 6 (2-22), P < 0.01. For valve crossing, there was no significant increase in time and wall-hits when using the robotic technology. Use of robotic catheter technology is feasible in the initial stages of TAVI. Although it takes longer, robotic navigation reduces contact with the aortic arch wall, potentially reducing the embolic risk during endovascular manipulation. Using a robotic catheter is possible without increasing the number of wall-hits during valve crossing. This may provide a stable platform for wire positioning in the ventricle. With improvements in technology, perhaps allowing valve deployment, the stability and accuracy of the robotic arm may further improve performance.

An unusal case of coarctation associated with hypoplasia of the aortic arch and tissue paper aortic wall thickness: a difficult surgical problem

Background Coarctation of the aorta is frequently associated with aortic arch hypoplasia. This combination is more frequent in neonates, often with severe symptoms and in critical condition. We report an isolated case of aortic arch hypoplasia with tissue paper aortic wall and subclavian artery aneurysm in a young adult that was repaired successfully.

Gene expression in the vascular wall of the aortic arch in spontaneously hypertensive hyperlipidemic model rats using DNA microarray analysis

AimsIn recent years, there has been an increase in patients with arteriosclerosis and the risk of lifestyle-related diseases. However, the pathogenesis and medication of atherosclerosis have not been elucidated. We developed a rat model of lifestyle-related diseases by feeding a high-fat diet and 30% sucrose solution (HFDS) to spontaneously hypertensive hyperlipidemic rats (SHHR) and reported that this model is a useful model of early atherosclerosis. In order to elucidate the pathogenesis of early atherosclerosis, we searched for atherosclerosis-related genes by microarray analysis using the aortic arch rat model of lifestyle-related diseases. Main methodsFour-month-old male Sprague–Dawley rats and SHHR were each divided into two normal diet (ND) groups and two HFDS groups. After a four-month treatment, the expression of mRNA in the aortic arch was detected using the oligo DNA microarray one-color method and quantified using real-time PCR. Key findingsIn this study, we detected 39 genes in microarray analysis. Esm1, Retnlb Mkks, and Grem2 showed particularly marked changes in gene expression in the SHHR-HFDS group. Compared with the SD-ND group, the SHHR-HFDS group had an increase in Mkks gene expression of about 26-fold and an approximately 22-fold increase in the expression of Grem2. Similarly, the expression of Esm1 increased by about 12-fold and that of Retnlg by about 10-fold as shown by quantitative real-time PCR. SignificanceThis study suggested that these four genes might be important in early atherosclerosis development.

Mise en Plate: The scenographic imagination and the contemporary restaurant

In ‘ Mise en Plate : The Scenographic Imagination and the Contemporary Restaurant’, Josh Abrams examines changes in restaurant design and the plating of food as a scenography that engages an audience in the active production of the meal as event, at a human scale tied to a sense of self. Looking at changes over the past thirty years, the essay articulates the increasing role of design in producing the restaurant experience. With a specific focus on the innovations of chef Ferran Adrià at elBulli in Rosas, Spain and chef Grant Achatz at Chicago's Alinea and Next, the article suggests that these changes seek to bring a focus to the relation between the scenographic presentation and the gustatory experience, which traces and references a history of design in culinary innovation dating back at least two hundred years. Abrams proposes that throughout the twentieth century, high-end restaurants and haute cuisine were largely dominated by a limited scenographic imagination; similar, perhaps, to the realist proscenium arch and fourth wall of commercial theatre, restaurants were limited to an interrelated formalisation of codes of both preparation and reception under the writings of Auguste Escoffier and the prevalence of a ‘French’ mode of presentation that became globally predominant under the influence of Michelin's star system. The essay suggests that while particular formalities changed in the 1960s and 70s with the shift towards individual plating in la nouvelle cuisine , the work of chefs like Adrià, Achatz and Noma's René Redzepi in the 1990s and early twenty-first century would seek to reimagine the high-end dining experience as one not about the formality of starched white linens and tuxedoed waiters, but in which the focus on design challenges the diner to co-produce with chefs and front-of-house staff an active dramaturgy in the creation of the event.

Abstract TP216: Cardio-Ankle Vascular Index (CAVI) Is A Novel Parameter To Predict Aortic Arch Plaque Causing Atherothrombotic Stroke

Aortic arch plaque is an important cause of atherothrombotic stroke. The cardio-ankle vascular index (CAVI) has been reported as a novel parameter for aortic stiffness, and high CAVI implies progression of carotid and coronary arteriosclerosis. However, it remains to be determined whether CAVI is associated with arch plaques. We performed CAVI and transesophageal echocardiography in 290 subjects (197 males, 65 ± 12 years), including 29 patients with the history of atherothrombotic stroke. We defined arch plaque as wall thickness ≥ 4 mm and the presence of ulceration or mobile plaque in aortic arch. CAVI showed a good correlation with age, systolic blood pressure, fibrinogen, von Willebrand factor, carotid plaque score and arch wall thickness. CAVI was higher in subjects with following risk factors than in those without; hypertension, diabetes mellitus, and dyslipidemia. CAVI was higher in subjects with ulceration or mobile plaques than in those without. CAVI was higher in subjects with atherothrombotic stroke than in those without (10.5 vs. 8.6, P&lt;0.001). The subjects with CAVI ≥ 9 had higher risk for atherothrombotic stroke compared with those with CAVI &lt; 9 in univariate logistic regression analysis (odds ratio 5.07, 95% confidence interval 2.16-11.91). Multivariate logistic regression analysis revealed that CAVI was an independent risk factor for atherothrombotic stroke. In conclusion, CAVI is a novel parameter predicting aortic arch plaques, which cause atherothrombotic stroke.

Aortic arch reconstruction with reversed subclavian flap technique and patch augmentation for IAA: Use of pericardium patch increases rate of aortic arch stenosis

Purpose: To determine the results of a novel technique for interrupted aortic arch (IAA) repair in regard to survival and freedom from reintervention. With the spatulated subclavian artery a reversed flap is created to form the wall of the posterior aortic arch. Either a patch from autologous pericardium or homograft tissues are used to complete the continuity. Methods: We analyzed medical records of patients undergoing IAA repair using this technique. Results: Between April 2000 and July 2012, 27 patients have undergone IAA repair using the subclavian flap technique. Of these, 2 had an aortopulmonary window, 3 a common arterial trunk, and 3 a transposition of the great arteries. In patients with type B interruption (74%) the left subclavian artery (n = 17) or the right arteria lusoria (n = 3) were used. In type A interruption (26%) only the left subclavian artery was used as flap. Arch repair was completed using fixated autologous pericardium (41%) or a homograft patch (59%). Mean follow-up time was 4.1 ± 2.3 years. No patient was lost at late follow-up. In the early period from 2000 – 2005 (5 pts.) there was one early and one late death. Since 2006 no deaths occurred. Aortic arch stenosis requiring reintervention developed in 8 patients (30%). Four of them could be treated with balloon dilatation, four underwent surgical treatment. The rate of aortic arch stenosis was much lower in patients treated with a homograft patch versus those with a pericardial material (13% versus 55%, p = 0.038). Conclusions: The subclavian flap technique is a promising alternative to either direct anastomosis or prosthesis interposition. As a large part of the arch circumference entails use of patch material, its choice is crucial. Preliminary results raise concern about the use of autologous pericardial patch material.

Two‐ and Three‐Dimensional Transthoracic Echocardiography in the Assessment of Aortic Arch Vasum Vasi to Pulmonary Artery Fistula

We report an elderly patient presenting with a stroke and also hemolytic anemia secondary to mitral and tricuspid valve repair 3 years earlier, in whom two-dimensional transesophageal echocardiography (2DTEE) suspected a fistula into the pulmonary artery (APAF) from the posterior wall of the aortic arch. For further assessment, two-dimensional transthoracic echocardiography (2DTTE) and live/real time three-dimensional transthoracic echocardiography (3DTTE) were performed. 2DTTE showed findings similar to 2DTEE. Color Doppler guided continuous-wave Doppler showed continuous flow throughout the cardiac cycle with systolic preponderance across the fistula with a small peak pressure gradient of 22 mmHg. Sequential systematic cropping of the 3D datasets obtained from 3DTTE confirmed that the flow signals originated from the posterior wall of the aortic arch and not the lumen. Thus, 3DTTE served to increase the confidence level that the fistula most likely originated from a vasum vasi in the wall of the aortic arch. To our knowledge, this type of fistula has not been reported previously. Fistulas from the aortic lumen to the pulmonary artery are also rare and so far only 24 cases have been reported in the literature. These are also reviewed by us.

Past and present for the future in Magyarlóna - a history of a Transylvanian village research

The church of Magyarlóna (Kalotaszeg) has close stylistic connections with one in Szászfenes. Important medieval frescos have been found on the southern section of the wall of the chancel arch. In the 18th century, the church’s interior was entirely transformed to suit the new age and the world of the Reformation. The joiner and painter Lőrinc Umling first worked there in 1750, where he constructed the crown-shaped pulpit canopy. In 1752, the master craftsman created the painted ceiling (one hundred and twenty panels) of the church. In 1768, Umling, together with his sons, painted the church pews. This Transylvanian church and its values are not current in the thoughts of the Hungarian history of art. To appreciate the inner values and consider the painted woodwork as a unique chapter of our architecture, it is necessary to look more deeply into this Hungarian settlement and the origins of the local culture.

Experimental cardiovascular and lung research Impact of geometric changes in a dilated aorta with a bicuspid aortic valve on blood flow disturbances – a numerical modeling study

Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation that occurs in adults. Bicuspid aortic valve is strongly associated with vascular complications, such as aortic root dilatation, thoracic aortic aneurysms, and aortic dissection. This study attempted to examine the hemodynamic effect of two surgical geometry correction procedures using computer and physical modeling. The estimated changes in basic hemodynamic parameters and the possibility of reducing the risk of aortopathy and valve dysfunction can improve long-term outcomes of BAV patients. The blood flowing through the BAV generates an asymmetric, eccentric, helical flow with a significant secondary flow and increased turbulence area. Asymmetric aortic wall deformation, and the increase and redistribution of stress, may constitute the primary reasons behind endothelial damage and aortic dissection in BAV patients. The surgical correction of the dissipated aortic geometry, in contrast to the separation of the common cusp of the BAV, significantly improves the hemodynamic conditions in the ascending aorta, reduces wall stress, and eliminates the critical point of stagnation on the outer wall of the aorta. In vitro modeling methods allow for a patient-specific evaluation of hemodynamic parameters. Two parameters may be particularly helpful in evaluating the degree of aortic dilatation and the risk of aortopathy in BAV patients: the Dean number and the angle between the direction of the main stream flowing out of the valve during the mid-ejection phase and the surface of the outer wall of the aortic arch.