Arcus Aorta Research Articles

A rare spatial relation of the great arteries in patients with transposition of the great arteries: Posterior aorta and its effect on outcomes

Background: This study aimed to evaluate patients diagnosed with posterior transposition of the great arteries (TGA) in detail. Methods: This retrospective study included 192 patients (155 males, 37 females; mean age: 0.4±0.9 month; range, 0.1 to 6 month) with TGA who were followed between August 1, 2016, and August 1, 2022. Patients with ventriculoarterial discordance, normal vessel relationship, and mitral-aortic continuity were considered posterior TGA. Demographic features, clinical findings, echocardiographic data, and surgical results of each patient were recorded. Results: Posterior TGA was present in 11 (5.7%) of the patients. The median age of patients with posterior TGA at the time of surgery was two months (interquartile range [IQR], 1-3 months), and their median body weight was 6.2 kg (IQR, 5-7.2 kg). The median oxygen saturation of the patients was 85% (IQR, 80-90%). A ventricular septal defect was present in all patients on echocardiography. There was also nonrestrictive atrial septal defect and patent ductus arteriosus in four patients, and one patient had arcus aorta hypoplasia. A coronary anomaly was determined in eight of the patients during surgery. These were 1LRCA2Cx in three cases, 1LRCx in three cases, 1R2LCx in one case, and 1L2RCx in one case. Arterial switch operation and ventricular septal defect closure was performed in 10 patients initially and in one patient after a pulmonary banding operation. The median cardiopulmonary bypass time was 190 min (IQR, 170-210 min). The Lecompte maneuver was not performed in any of the patients. The median stay in the intensive care unit and the hospital was 7 days (IQR, 5-10 days) and 16 days (IQR, 14-18 days), respectively. Two patients died in the early postoperative period. Conclusion: In patients with suspected congenital heart disease, a segmental echocardiographic evaluation should be performed, and it should be kept in mind that the aorta may be located posteriorly as a rare spatial relationship in patients with TGA.

Vertebrobasilar system variations; Analysis with multi-detector CT angiography

Objective: The vertebrobasilar system provides vascular nutrition to the posterior part of the brain, medulla spinalis, medulla oblongata, and cerebellum. Anatomical variations in these vascular structures increase the incidence of thrombus and aneurysms in patients. This study examines the presence of anatomical anomalies in the vertebrobasilar system. Material and Methods: Retrospective CT angiogram images of 93 adult cases over 18 years of age who were examined for any reason in KSU, Training and Research Hospital Radiology Unit. Results: Vertebral artery hypoplasia was observed in 15% of the cases. Left dominance was observed in 64.2% of the cases, right dominance in 28.6%, and co-dominance in 7.2%. Vertebral artery duplication was not observed. Vertebral artery fenestration was observed in 2.1% of cases. Vertebral artery of flexible origin was detected in 7.5%. In 57% of cases with a variable origin, the vertebral artery originated as the second branch of the subclavian artery. The right vertebral artery originating from the brachiocephalic artery was seen in 14.2%, the left vertebral artery originating from the arcus aorta was seen in 14.2%, and the left aberrant vertebral artery was seen in 14.2%. Fenestration of the basilar artery was observed in 2.1%, and hypoplasia of the basilar artery in 1.1%. Fetal type PCA variation was observed in 35.4% of cases, bilateral fetal PCA in 3.2%, right fetal PCA in 17.2%, and left fetal PCA in 15%. PCA duplication was observed in 3.2%, SCA duplication in 16.1%, unpaired single SCA in 2.1%, and SCA fenestration in 1.1%. An unpaired single AICA was observed in 15%, duplication of AICA in 2.1%, hypoplastic AICA in 6.4%, and AICA originating from SCA in 1.1%. An unpaired single PICA was observed in 12.9%, hypoplastic PICA in 2.1%, basilar artery originating PICA in 9.6%, AICA originating PICA in 4.3%, and PICA duplication in 1.1%. Conclusion: This study provides a detailed analysis of anatomical variations in the vertebrobasilar system using multi-detector CT angiography. The findings highlight the prevalence and diversity of these variations, such as vertebral artery hypoplasia, dominance patterns, fenestrations, and origin variations. These variations have significant clinical implications, particularly in the context of interventional and surgical procedures, as well as in the diagnosis and management of cerebrovascular diseases. Recognizing and understanding these anatomical differences can aid clinicians in planning more effective treatment strategies, potentially reducing the risk of complications associated with thrombus and aneurysm formation. Further research with larger and more diverse populations is recommended to validate these findings and to explore the impact of these variations on clinical outcomes. Ultimately, this study contributes to the existing body of knowledge and underscores the importance of personalized approaches in the management of vertebrobasilar system anomalies.

Aortic dissection in a renal transplant patient presenting with gastroenteritis: case report

Acute aortic dissection (AD) is a true cardiovascular emergency whose diagnosis and treatment process is very difficult for the patient and the physician, with a mortality rate of 50% in some cases if not intervened within the first 48 hours. AD is classified according to the anatomical region of the aorta affected. Class 1 De Bakey dissection involves the ascending aorta, arcus aorta and descending aorta. Class 2 De Bakey is limited to the ascending aorta, while class 3 De Bakey starts from the descending aorta. According to the Stanford classification, dissection type is divided into A and B. The most common complaints at presentation are predatory chest pain in Type A dissection and low back pain or abdominal pain in Type B dissection.

A RARE CASE OF TYPE A AORTIC DISSECTION PRESENTING AS ACUTE STROKE: A DIAGNOSTIC CHALLENGE

Abstract A 60–year–old woman presented to the emergency department with acute left hemiplegia, not chest pains. Past medical history was significant for family history of aortic aneurysm, arterial hypertension. At brain–CT was reported hypodensity areas in posterior arm of the right internal capsule and in right tempero–polar lobe, confirmed on brain–MRI, and compatible with acute ischemic injury. Echocolor–dopper of epiaortic vessels documentated ulcerated plaque into the right common carotid artery (CCA). Selective catheterization found focal dissection obstructing the flow, treated with self–expanding stent. On echocardiography evalutation for suspiction of TAAD: dilatation of ascending aorta with flap oscillation, severe arotic regurgitation, pericardial effusion (Fig. 1). CT–Angiography was performed with evidence of type A dissection extending superiorly to the right CCA and inferiorly to the iliac bifurcation. For coma state, the patient was mechanically ventilated, and seriate CTs showed new ischemic lesions and hemorrhagic infarction of previous. Because of contraindication for cardiac surgery due neurological state, the patient was referred at medical therapy as bridge to hybrid aortic arc substitution at resolution of intracranial hemorrhages. In the next days there was progressive improvement neurological status with restoration of sensory and autonomic breathing with hemodynamic stability. Aortic dissection (AD) is defined as a disruption of the medial layer leading to the formation of two lumens separated by an intimomedial flap. AD is a critical diagnosis to make due to life–threatening outcomes and its non–specific presentation as in the case of our patient where the management of AD was delayed due to an unusual initial clinical presentation. Multimodality imaging approach has been fundamental for correct diagnosis and risk stratification. A limited number of studies have reported cases with stroke as the first symptom with concomitant TAAD. Concomitant intracerebral hemorrhage and TAAD is a very rare presentation and the optimal timing of surgery in these patients is unknown. In our opinion, patients who presents acute stroke should be carefully evaluated using multimodal imaging to exclude TAAD before administering reperfusion therapy. In addition, performing CAS before surgery for TAAD is challenging but might be a valid treatment option to maintain good brain perfusion and improve prognosis, but further investigations are needed.

Morphological investigation of arcus aortae and branches in badger (Meles meles)

The branches originating from the arcus aortae formed by the aortae after exiting the heart differ between animals. In this study, it was aimed to examine the morphology of the arcus aortae in the badger (Meles meles). Two adult badgers, which died as a result of a traffic accident at different times and were brought to the Anatomy laboratory, were used as material. Thorax was dissected and the heart and aortae were exposed. It was observed the heart was located between 3rd-7th costae and was connected to the diaphragma with the ligamentum sternophericardiacum. It was determined that truncus brachiocephalicus and arteria subclavia sinistra was originated from the arcus aortae at the level of 4th costa. It was determined that the first branch of truncus brachiocephalicus was arteria carotis communis sinistra and then divided into arteria subclavia dextra and arteria carotis communis dextra, respectively. It was seen that arteria vertebralis, truncus costocervicalis, arteria cervicalis superficialis and arteria thoracica interna originated from arteria subclavia sinistra. Branches of arteria subclavia dextra were found to be similar to arteria subclavia sinistra. It was determined that the branches originating from the arcus aortae were similar to those in cats and dogs. It is thought that this study will contribute to the anatomical knowledge of the endangered badger, which is under protection.

Ascending Aortic Aneurysm Surgery with Bovine Aortic Arch

The most common presentation in aortic arch anatomy and therefore normal evaluation is the form in which the left common carotid artery is isolated from the arcus aorta. A variant of the aortic arch, where the left common carotid artery arises from the brachiocephalic artery or from a common root with the brachiocephalic artery, is called the bovine aortic arch. Awareness of aortic arch variants in daily practice is very important for interventional clinicians. In our article, it is aimed to emphasize the literature review and surgical importance of this variant by means of different aneurysm operations performed in our clinic.

Direct transcatheter aortic valve implantation (TAVI) decreases silent cerebral infarction when compared to routine balloon valvuloplasty.

Silent cerebral infarctions (SCI), as determined by neuron-specific enolase (NSE) elevations, may develop after the transcatheter aortic valve implantation (TAVI) procedure. Our aim in this study was to compare the SCI rates between patients who underwent routine pre-dilatation balloon aortic valvuloplasty (pre-BAV) and patients who underwent direct TAVI without pre-BAV. A total of 139 consecutive patients who underwent TAVI in a single center using the self-expandable Evolut-R valve (Medtronic, Minneapolis, Minnesota, USA) were included in the study. The first 70 patients were included in the pre-BAV group, and the last 69 patients were included in the direct TAVI group. SCI was detected by serum NSE measurements performed at baseline and 12h after the TAVI. New NSE elevations > 12 ng/mL after the procedure were counted as SCI. In addition, SCI was scanned by MRI (magnetic resonance imaging) in eligible patients. TAVI procedure was successful in all of the study population. Post-dilatation rates were higher in the direct TAVI group. Post-TAVI NSE positivity (SCI) was higher in the routine pre-BAV group (55(78.6%) vs. 43(62.3%) patients, p = 0.036) and NSE levels were also higher in this group (26.8 ± 15.0 vs. 20.5 ± 14.8 ng/ml, p = 0.015). SCI with MRI was found to be significantly higher in the pre-BAV group than direct TAVI group (39(55.1%) vs. 31(44.9%) patients). The presence of atrial fibrillation and diabetes mellitus (DM), total cusp calcification volume, calcification at arcus aorta, routine pre-BAV and failure at first try of the prosthetic valve implantation were significantly higher in SCI (+) group. In the multivariate analysis, presence of DM, total cusp calcification volume, calcification at arcus aorta, routine pre-BAV and failure at first try of the prosthetic valve implantation were significantly associated with new SCI development. Direct TAVI procedure without pre-dilation seems to be an effective method and avoidance of pre-dilation decreases the risk of SCI development in patients undergoing TAVI with a self-expandable valve.

Multidetector computed tomography evaluation of origin, V2 segment variations and morphology of vertebral artery.

The current study aimed to determine the origin of vertebral artery (VA) on both sides and the levels of entry into respective foramen transversarium (FT), to evaluate possible effects of sex on the entry levels, and to investigate the frequency of VA dominance and VA hypoplasia based on the VA V2 segment. For this study, archived images of patients undergoing multidetector computed tomography (MDCT) examination of the chest and headneck for various reasons at Gaziantep University Medical Faculty Hospital were reviewed retrospectively. Three-dimensional reconstructions were performed for a total of 644 VA images from 322 patients using Horos software, and VA origin, the level of entry to FT and transverse diameters of both VA and FT were measured at the point of entry. It was found that, among males, the VA originated from the truncus brachiocephalicus on the right side in only 1 patient and from the aortic arch in 2 patients on the left side. Left VA emerging from the aortic arch was observed in 2 females. The right VA was found to enter the FT at C3 in 1 male, at C4 in 6 patients (5 males, 1 female), at C5 in 19 patients (3 males, 16 females), and at C6 in 300 patients (141 males, 159 females). The left artery entered the FT at C5 in 23 patients (9 males, 14 females) and at C6 in 298 patients (141 males, 157 females). Looking at the relationship between variations of VA origin and the levels of entry to the FT, it was observed that only one of the left VAs originating from the arcus aorta entered the FT at C6 and at C5 in all others. On the right side, there was only one VA originating from the truncus brachiocephalicus, which entered the FT at C3. Of the remaining 248 VAs originating from the subclavian artery, 5 VAs entered the FT at C4, 14 VAs at C5 and 229 VAs at C6. The measurements of VA diameters showed right VA hypoplasia in 14 patients and left VA hypoplasia in 17 patients. Also, the right VA dominance was found in 110 patients and the left VA dominance in 128 patients. A moderate, positive correlation was observed between VA and FT diameters in both sides. A regression analysis showed that a 1 mm change in the right VA diameter was associated with a 75% change in the FT diameter and a 1 mm change in the left VA diameter caused a 72% change in the FT diameter. An understanding of VA variations and FT morphometry is crucial for informed clinical practice. This will clearly affect the success rates of physicians in the diagnosis and treatment of pathologies involving cervical region. The presence of any VA variation in a patient should be investigated on computed tomography or magnetic resonance imaging images prior to surgery.

Clinical significance of serum CDC42 in the prediction of uremic vascular calcification incidence and progression

ABSTRACT Vascular calcification (VC) is prevalent in uremia patients, lacking effective molecular biomarkers. This study was conducted to explore the role of serum cell division cycle 42 (CDC42) in the diagnosis of uremic VC incidence and progression. We enrolled 104 uremia patients and selected arcus aortae calcification (AAC) as the outcome phenotype. Levels of CDC42, 1,25-dihydroxy vitamin D (1,25(OH) 2-D), fibroblast growth factor-23 (FGF-23), and other laboratory parameters in the blood were measured. The receiver operator characteristic curve, the Pearson test, and the multivariate Logistic regression were used for the analysis of CDC42 diagnostic values, correlation analysis, and screening of VC risk factors, respectively. CDC42 was higher in the serum of uremia patients with VC and elevated with the increase in AAC level. Serum CDC42 level>1.025 was predictive of VC incidence with 83.58% sensitivity and 56.76% specificity, and CDC42 level>1.280 was predictive of VC progression with 73.33% sensitivity and 68.18% specificity. Serum CDC42 was positively correlated with 1,25(OH) 2-D and FGF-23. Uremia patients with higher serum CDC42 had a higher probability of VC incidence and progression. Generally, serum CDC42 helped the diagnosis of uremic VC incidence and progression and was an independent risk factor for uremic VC progression.

Abstract Number ‐ 81: Safety and Efficacy of Trans‐carotid Intervention in Multiple Scenarios: Medellin Experience Direct Carotid access.

Introduction Direct carotid puncture has been validated such as an alternative route to reach the intracranial vasculature. However, this approach has not been considered routinely in INR. A believe of higher risk for neurovascular procedures or major accesssite related complications restrict its use. This study was conducted to investigate the feasibility and safety of trans carotid Neurointervention for a variety of pathologies. Methods Since 2018 we implemented a direct carotid access under special considerations to perform a therapeutic approach. A total of 14 patients from our centers were analyzed. Patients were divided into a variety of neurovascular conditions: Carotid Stenting CAS (n = 2), Mechanical Thrombectomy MT (n = 5), AVM´s treatment (n = 2), intracranial Aneurysms treatment (n = 5). Patient demographics, technical data, intervention time, type of intervention, closure device used, local or systemic complications and a patient perception assessment were registered. Results Mean age was 64.3 ± 10.3 years. all cases but two we treated the patients under General Anesthesia GA. Major indication to this approach was : anatomical and access limitations. (in 12 cases wasn’t possible to reach the ICA through femoral or radial access due to extreme aortic arc tortuosity. Two patients with Leriche Syndrome) All cases performed with ultrasound US assistance. A 4 Fr. Micro‐ puncture set were used in all procedures and posteriorly a 6Fr. Introducer was inserted. Technical success in all cases (100%). Two patients presented mild vasospasm and resolved using IA vasodilators. Both CAS were performed without any complications and none embolic protection device used. For MT(n = 5): a SOFIA 6Fr for ADAPT was used in 3 cases with TICI 2b‐3 in all cases. Combined approach ¨Solumbra¨ solitaire and aspiration catheter was used in two cases, one TICI 2a and one TICI 3. For the AVM´s treatment we use a 6Fr guiding catheter and non‐detachable microcatheters to inject Onix with a high grade of obliteration. Five aneurysms were treated with this approach (2 ICA – ophthalmic; 2 MCA and one AcomA) Mean average time of the procedure was 34.5 min. (ranged 9–59 min) just one bleeding complication observed at the closure device use. In all cases but one we use Angio‐Seal 6Fr as closure device, in a single case where we used a ProGlide suture device we had a serious complication at the puncture site. Conclusions Trans Carotid Intervention TCI. was feasible and safe in selected patients in this small series. A multiple variety of neurovascular conditions would be treated successfully by this way improving the learning curve. Complication rates and clinical outcomes were comparable with those in trans femoral or radial approach.

EP17.28: Prenatal diagnosis of anomalous origin of the pulmonary artery and right arcus aorta

EP17.28: Prenatal diagnosis of anomalous origin of the pulmonary artery and right arcus aorta

Morphology of the pattern of branching of the aortic arch (Arcus aortae) in Syrian hamsters (Mesocricetus auratus).

The branching patterns of the aortic arches of 28 adult male and female Syrian hamsters (SH) were thoroughly examined under a stereomicroscope for the first time by using latex injection and corrosion casting to determine their general arrangements and morphological variations as well as their differences and similarities to other rodents and rabbits. Three major arteries, namely, the brachiocephalic trunk (BC), left common carotid artery (CC) and left subclavian artery (SA), originating from the aortic arch (AR), were uniformly noted in SH. The BC was consistently divided into the right SA and the right CA. SA in SH normally releases the internal thoracic, deep cervical, dorsal scapular, vertebral, superficial cervical and supreme intercostal arteries. The costocervical trunk typically consisted of supreme intercostal and internal thoracic arteries and a common trunk for dorsal scapular and deep cervical arteries. To comprehend the comparative morphology of the pattern of branching of AR more completely, our results were compared with previous studies in rodents and rabbits. (1) The general morphology of the great arteries from AR in SH was similar to that in mole rats, rats, mice, porcupines, and gerbils but was essentially different from that in rabbits, guinea pigs, red squirrels, ground squirrels, pacas and chinchillas. (2) The typical pattern of the branching of the subclavian arteries in SH was similar to that in guinea pigs, rats, and rabbits but was different from that of the reported rodents regardless of the origins of the bronchoesophageal and internal thoracic arteries and the composition of the costocervical trunk.

Evaluation of the Effect of Low Cardiac Output Syndrome on Intestinal Flow After Arcus Aorta Surgery in Newborns

Evaluation of the Effect of Low Cardiac Output Syndrome on Intestinal Flow After Arcus Aorta Surgery in Newborns

Postpericardiotomy Syndrome: A Rare Complication Following Double Arcus Aorta Operation

Postpericardiotomy Syndrome: A Rare Complication Following Double Arcus Aorta Operation

High fat / high cholesterol diet does not provoke atherosclerosis in the ω3-and ω6-polyunsaturated fatty acid synthesis–inactivated Δ6-fatty acid desaturase–deficient mouse

ObjectiveAn increased ω6/ω3-polyunsaturated fatty acid ratio in the current Western diet is regarded as a critical epigenetic nutritional factor in the pathogenesis of several human lifestyle diseases, metabolic syndrome, cardiovascular disease, the central nervous system and the female and male reproductive systems. The impact of nutrient ω3-and ω6-PUFAs in the pathogenesis of dyslipoproteinemia and atherosclerosis has been a topic of intense efforts for several decades. Cellular homeostasis of the ω3-and ω6- PUFA pool is maintained by the synthesis of ω3-and ω6-PUFAs from essential fatty acids (EFA) (linoleic and α-linolenic acid) and their dietary supply.In this study, we used the auxotrophic Δ6-fatty acid desaturase- (FADS2) deficient mouse (fads2−/−), an unbiased model congenial for stringent feeding experiments, to investigate the molecular basis of the proposed protective role of dietary ω3-and ω6-PUFAs (Western diet) in the pathogenesis of multifactorial dyslipoproteinemia and atherosclerosis. We focused on the metabolic axis—liver endoplasmic reticulum (ER), serum lipoprotein system (Lp) and aorta vessel wall. Furthermore, we addressed the impact of the inactivated fads2-locus with inactivated PUFA synthesis on the development and progression of extended atherosclerosis in two different mouse mutants with disrupted cholesterol homeostasis, using the apoe−/− and ldlr−/− mutants and the fads2−/− x apoe−/− and fads2−/− x ldlr−/− double mutants. MethodsCohorts of +/+ and fads2−/− mice underwent two long-term dietary regimens: a) a PUFA-free standard chow diet containing only EFAs, essential for viability, and b) a high fat/high cholesterol (HFHC) diet, a mimicry of the human atherogenic “Western” diet. c) To study the molecular impact of PUFA synthesis deficiency on the development and progression of atherosclerosis in the hypercholesterolemic apoe−/− and ldlr−/− mouse models fed PUFA-free regular and sustained HFHC diets, we generated the fads2−/− x apoe−/− and the fads2−/− x ldlr−/− double knockout mutants. We assessed essential molecular, biochemical and cell biological links between the diet-induced modified lipidomes of the membrane systems of the endoplasmic reticulum/Golgi complex, the site of lipid synthesis, the PL monolayer and neutral lipid core of LD and serum-Lp profiles and cellular reactions in the aortic wall. Resultsω3-and ω6-PUFA synthesis deficiency in the fads2−/− mouse causes a) hypocholesterolemia and hypotriglyceridemia, b) dyslipoproteinemia with a shift of high-density lipoprotein (HDL) to very low-density lipoprotein (VLDL)-enriched Lp-pattern and c) altered liver lipid droplet structures. d) Long-term HFHC diet does not trigger atherosclerotic plaque formation in the aortic arc, the thoracic and abdominal aorta of PUFA-deficient fads2−/− mice. Inactivation of the fads2−/− locus, abolishing systemic PUFA synthesis in the fads2−/− x apoe−/− and fads2−/− x ldlr−/− double knockout mouse lines. ConclusionsDeficiency of ω3-and ω6-PUFA in the fads2−/− mutant perturbs liver lipid metabolism, causes hypocholesterolemia and hypotriglyceridemia and renders the fads2−/− mutant resistant to sustained atherogenic HFHC diet. Neither PUFA-free regular nor long-term HFHC-diet impacts the apoe- and LDL-receptor deficiency–provoked hypercholesterolemia and atherosclerotic plaque formation, size and distribution in the aorta. Our study strongly suggests that the absence of PUFAs as highly vulnerable chemical targets of autoxidation attenuates inflammatory responses and the formation of atherosclerotic lesions.The cumulative data and insight into the molecular basis of the pleiotropic functions of PUFAs challenge a differentiated view of PUFAs as culprits or benefactors during a lifespan, pivotal for legitimate dietary recommendations.

Thoracic endograft placement using a transfemoral snare in a patient with angled aortic arch

In complex anatomical challenges, endovascular endograft implantation to the thoracic aorta may not be performed. Various techniques have been put forward for endograft therapy. In this report, we present the effect of femoral snare support for a patient with an aortic arch angle. Thoracic endovascular aneurysm repair (TEVAR) was used for treating a 60-year-old male patient who suffered from severe angulation in the arcus aorta and aneurysmal enlargement of the left subclavian artery and descending aorta. The endovascular graft could not be advanced into the aortic arch with the guidewire because of the aortic arch angle. Therefore, the TEVAR graft distal end was caught with the snare advanced from the femoral artery, and the TEVAR graft was advanced into the aortic arch. The femoral snare technique is a simple and successful method for endograft implantation of the aortic arch disease without the risk of heart trauma, especially in cases with aortic arch tortuosity.

P–779 Vascular stiffness in children born after embryo transfer at 8–9 years of age

Abstract Study question Do 8–9-year-old singletons conceived after frozen (FET) or fresh embryo transfer (Fresh ET) have increased vascular stiffness compared to naturally conceived (NC) children? Summary answer FET and Fresh ET was not associated with increased vascular stiffness or altered cardiovascular autonomic reflexes as compared to NC children. What is known already Normally, vascular stiffness increases during childhood, and in adults with the metabolic syndrome increased vascular stiffness is associated with symptomatic cardiovascular disease. Children conceived after FET and Fresh ET are at risk of being large- and small-for-gestational-age, respectively. Epigenetic modulation during assisted reproductive technologies (ART) has been suggested to influence cardiovascular risk factors, and previous studies have shown that children conceived after ART are at increased risk of insulin resistance, endothelial dysfunction and increased arterial blood pressure. It is not known if ART procedures alter vascular stiffness of children. Study design, size, duration In a cohort study including 8–9 years old singletons conceived after FET, Fresh ET and NC (50 in each group), we used cardiac magnetic resonance imaging (CMR) and cardiovascular autonomic reflex testing (CART) to compare arterial stiffness. The study was powered to detect a difference between groups of aortic distensibility from 8.9 to 8.0, comparable to what is seen in a 5-year older cohort of children (beta 0.80, alpha 0.05). Inclusion period 18 months. Participants/materials, setting, methods Singletons were identified through the Danish IVF Registry and the Medical Birth Registry. NC children were matched by sex and birth year with FET children. Exclusion criteria were congenital heart disease, maternal preeclampsia, gestational diabetes or diabetes mellitus. Artery stiffness was assessed from blood pressure and aortic distensibility, pulse wave velocity (PWV), cardiac output and total peripheral resistance by CMR. CART was investigated non-invasively in 40 children. Measurements were performed blinded to the child group. Main results and the role of chance Maternal age at delivery was higher in the FET (42.5±5.5 years) and Fresh ET (40.5±6.1 years) compared to the NC group (38.2±5.7 years). In the ART groups, mothers were more likely to have a high educational level (FET 50% and Fresh ET 56.2%) compared to mothers in the NC group (30.6%) (both ANOVA-p<0.05). As expected, children conceived after FET had a higher birth weight standard-deviation-score (0.4±1.1+) compared to Fresh ET (–0.1±1.0) and NC (–0.2±1.1). Among study groups, no significant differences were observed in systolic and diastolic blood pressure (FET 109±6/64±6 mmHg; Fresh ET 109±7/65±5 mmHg; NC 108±8/65±5 mmHg; ANOVA-p>0.05). Heart rate was also similar in all study groups (FET 79±12 bpm; Fresh ET 79±9 bpm; NC 78±11 bpm; ANOVA-p>0.05). No significant differences were observed between groups in total aortic PWV (FET 3.69±0.75 m/s; Fresh ET 3.49±0.31 m/s; NC 3.59±0.61 m/s; ANOVA-p>0.05). Aorta ascendens distensibility was similar in study groups (FET 11.12±3.55 10–3mmHg–1; Fresh ET 11.77±2.97 10–3mmHg–1; NC 11.43±2.82 10–3mmHg–1, ANOVA-p> 0.05). Furthermore, distensibility of aorta descendens and aorta abdominalis, PWV of arcus aorta and PWV from aorta descendens to abdominalis, cardiac output, total peripheral resistance and CART were similar in study groups. Outcome variables remained non-significant after adjustment for potential confounders. Limitations, reasons for caution The participation rate was higher in the ART groups (FET 40% and Fresh ET 32%) compared to NC (17%) and hence a selection bias is possible. Data from CART should be interpreted cautiously due to lower number of participating children in these tests. Wider implications of the findings: Our study did not find any associations between FET or Fresh ET compared to NC children and arterial stiffness. Nor, any associations to CART could be made. Further studies are needed in younger adults to better exclude important long-term effects of ART. Trial registration number NCT03719703

Is the Anatomical Type of the Arcus Aorta an Effective Factor for the Success of Endovascular Therapy?

Is the Anatomical Type of the Arcus Aorta an Effective Factor for the Success of Endovascular Therapy?

Acute Decompensated Heart Failure (ADHF) with aortic dissection Stanford A in middle aged man: a case report

Background: Heart failure is a clinical syndrome with shortness of breath, fluid retention, and the heart's structural and functional disorder. Each year, there were 7,2 cases every 1000 people on male and 4,7 cases every 1000 people on the female. Aortic dissection is an emergency disease in which the symptoms are similar to ischemic heart disease, that 38% of patients got misdiagnosed on the first evaluations. Because of the clinical course of heart failure and misdiagnosed aortic dissection that frequently happened, authors are interested in making a case report with both conditions.Case report: A male patient, 39 years old, complained of shortness of breath and epigastrium pain. The patient was diagnosed with Acute Decompensated Heart Failure (ADHF) profile B with emergency hypertension and suspected aortic dissection based on history and physical examination. The patient was also diagnosed with acute kidney injury stage 1. CT angiography showed widening of the aorta ascending until arcus aorta with a Stanford type A aortic dissection diagnosis.Conclusion: The condition of aortic dissection can coincide with acute heart failure. Therefore, a clinician must be aware of the emergency of dissection and know the initial symptoms of dissection. The typical clinical symptoms of dissection lead us to perform imaging studies that ultimately lead to a thoracoabdominal CTA to diagnose the dissection.

Reconstruction of the Aortic Arc through Left Thoracotomy in Patients with Isolated Coarctation and Aortic Arch Hypoplasia

Background. The choice of surgical approach for the reconstruction of aortic arch hypoplasia is a rather controversial issue. Traditionally, left lateral thoracotomy is used to correct aortic coarctation with hypoplasia of one or more arc seg-ments. However, in recent years, more and more clinics have begun widespread use of median sternotomy for the surgical treatment of aortic arch hypoplasia. The purpose of the research was to analyze the immediate and long-term results of surgical treatment of isolated hypoplasia of the aortic arch in infants through left thoracotomy.
 Materials and methods. From 2010 to 2019, 159 infants with coarctation and hypoplasia of one or more segments of the aortic arch underwent reconstruction of the aortic arch at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine and Ukrainian Children’s Cardiac Center. The study included only patients with biventricular physiology and subsequent biventricular correction. There were 108 male patients (68%) and 51 female patients (32%).
 The mean age of the patients was 2.4 ± 0.9 months, the mean body weight was 4.7 ± 2.0 kg. The main method of diagnosis, i.e. determining the defect and assessing the immediate and long-term results, was echocardiographic examination. The study group consisted of 155 patients (97.5%) in whom the reconstruction of the aortic arch was performed through left thoracotomy, in the remaining 4 patients (2.5%) the intervention was performed through median sternotomy.
 
 Results. In-hospital mortality was 0.6% (n = 1). The average time of the operation was 126 ± 40 minutes, the aortic cross-clamp time was 24.7 ± 5.1 minutes. The mean duration of mechanical ventilation after the surgery was 41 ± 15.9 hours.
 The mean follow-up period ranged from 1 month to 13 years. There were no deaths in the long-term period. Ten (6.4%) patients developed aortic arch restenosis in the postoperative period. In 8 patients, the narrowing was treated by endovascular dilatation. Two patients underwent repeated aortic arch repair using median sternotomy. There were no cases of compression of the trachea, main bronchi, neurological complications in the follow-up period.
 
 Conclusions. Reconstruction of the aortic arch hypoplasia through left thoracotomy is an effective and safe treatment option in infants associated with good immediate and long-term results. The study indicates that this surgical strategy can be used in most patients with hypoplasia of the isthmus and distal aortic arch.