Arcus Aorta Research Articles

Right sided arcus aorta as a cause of dyspnea and chronic cough

BackgroundRight sided arcus aorta (RSAA) is a rare condition that is usually asymptomatic. Patients may present with exertional dyspnea and chronic cough. A recent article suggested that RSAA should be included in the differential diagnosis of asthma, especially in patients with intractable exertional dyspnea. We aimed to present the clinical, radiologic and spirometric features of thirteen patients with RSAA observed in four years at the Rize Education and Research Hospital and Samsun Chest Diseases and Thoracic Surgery Hospital.MethodsThe characteristics of patients with RSAA, including age, gender, symptoms, radiologic and spirometric findings, were retrospectively evaluated.ResultsA total of thirteen patients were diagnosed with RSAA. Their ages ranged from 17 to 86 years and the male to female ratio was 11:2. Seven of the patients (54%) were symptomatic. The most common symptoms were exertional dyspnea, dysphagia and chronic cough. Five patients had received treatment for asthma with bronchodilators. Spirometry showed intrathoracic tracheal obstruction in five patients.ConclusionsThe RSAA anomaly occurs more frequently than might be estimated from the number of patients who are detected. Patients with intractable exertional dyspnea and chronic cough should be evaluated for the RSAA anomaly by thoracic CT.

Right sided arcus aorta as a cause of dyspnea and chronic cough

Background: Right sided arcus aorta (RSAA) is a rare condition that is usually asymptomatic. Patients may present with exertional dyspnea and chronic cough. A recent article suggested that RSAA should be included in the differential diagnosis of asthma, especially in patients with intractable exertional dyspnea. We aimed to present the clinical, radiologic and spirometric features of thirteen patients with RSAA observed in four years at the Rize Education and Research Hospital and Samsun Chest Diseases and Thoracic Surgery Hospital. Methods: The characteristics of patients with RSAA, including age, gender, symptoms, radiologic and spirometric findings, were retrospectively evaluated. Results: A total of thirteen patients were diagnosed with RSAA. Their ages ranged from 17 to 86 years and the male to female ratio was 11:2. Seven of the patients (54%) were symptomatic. The most common symptoms were exertional dyspnea, dysphagia and chronic cough. Five patients had received treatment for asthma with bronchodilators. Spirometry showed intrathoracic tracheal obstruction in five patients. Conclusions: The RSAA anomaly occurs more frequently than might be estimated from the number of patients who are detected. Patients with intractable exertional dyspnea and chronic cough should be evaluated for the RSAA anomaly by thoracic CT.

Different responses of fluvastatin to cholesterol‐induced oxidative modifications in rabbits: evidence for preventive effect against DNA damage

Hypercholesterolemia is a major risk factor for atherosclerosis and related occlusive vascular diseases. We investigated the effect of low-dose fluvastatin (2 mg kg(-1) day(-1)) on antioxidant enzyme activities [superoxide dismutase (SOD), catalase], vascular reactivity changes and oxidatively induced DNA damage in early stage of atherosclerosis in hypercholesterolemic rabbits. The animals were divided into three groups each composed of 10 rabbits. The control group received a regular rabbit chow diet, and the cholesterol group had hypercholesterolemic diet (2%, 4 weeks). The fluvastatin group was given hypercholesterolemic diet plus fluvastatin. Dietary intake of cholesterol significantly increased total cholesterol levels in rabbits (control, 0.85 ± 0.29; cholesterol, 12.04 ± 4.61; fluvastatin, 8.07 ± 2.72 mmol l(-1)). Hypercholesterolemic diet revealed discernible fatty streaks in arcus aortae. Fluvastatin significantly reduced the areas of the lesions. The diet significantly increased SOD activities in both erythrocyte and tissue. Treatment with fluvastatin normalized the increased activity of SOD in both erythrocyte and aortic tissues from the cholesterol group. Cholesterol feeding decreased the sensitivity to acetylcholine, and treatment with fluvastatin significantly restored the diminished sensitivity to acetylcholine in thoracic aortae. Cholesterol feeding caused oxidatively induced DNA damage in liver tissues determined by the increased levels of 8-hydroxyguanine (8-OH-Gua) and 2,6-diamino-4-hydroxy-5-formamidopyrimidine (FapyGua). Fluvastatin decreased only FapyGua level in liver. In conclusion, our results may suggest that fluvastatin seems to play a protective role on high cholesterol-induced oxidative stress and DNA damage.

Reply to the Editor

We thank Bozok and colleagues for their insightful comments on the technique of innominate artery cannulation during surgical repair of Stanford type A aortic dissection, as described in our recently published article.1Shi E. Gu T. Yu L. Xiu Z. Zhang Z. Wang C. et al.Repair of Stanford type A aortic dissection with ascending aorta and hemiarch replacement combined with stent-graft elephant trunk technique by using innominate cannulation.J Thorac Cardiovasc Surg. 2011; 142: 1458-1463Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar Cannulation of the innominate artery directly2Ji S. Yang J. Ye X. Wang X. Brain protection by using innominate artery cannulation during aortic arch surgery.Ann Thorac Surg. 2008; 86: 1030-1032Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar or with a side graft3Huang F.J. Wu Q. Ren C.W. Lai Y.Q. Yang S. Rui Q.J. et al.Cannulation of the innominate artery with a side graft in arch surgery.Ann Thorac Surg. 2010; 89: 800-803Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar has been shown to be a simple and effective alternative in aortic arch surgery. In our series, 10 patients showed transient neurologic dysfunction, and in most cases this was simple confusion lasting less than 48 hours. No permanent neurologic dysfunction occurred. Transient neurologic dysfunction such as confusion is a frequent complication after cardiac surgery, especially among aged patients. We do not think that our results for brain protection are bad. During total body perfusion, the brain can be perfused through the left carotid artery as well as the right carotid artery. Therefore innominate artery cannulation is safe during surgical repair of Stanford A aortic dissection. We also agree, however, that pressure monitoring makes cerebral perfusion more accurate. The effect of innominate cannulation on cerebral perfusionThe Journal of Thoracic and Cardiovascular SurgeryVol. 144Issue 3PreviewWe congratulate Shi and colleagues1 on their study, “Repair of Stanford Type A Aortic Dissection With Ascending Aorta and Hemiarch Replacement Combined With Stent-Graft Elephant Trunk Technique by Using Innominate Cannulation.” In this study, the flow in the innominate artery during total body perfusion was toward the arcus aorta. During cerebral perfusion, the flow rate was 8 to 10 mL/(kg · min). Transient neurologic deficit occurred in 10 patients, which indicates that this situation is not a focal event but is related to perfusion defect. Full-Text PDF

Surgical management of esophageal atresia and tracheo-esophageal fistula associated with right-sided aortic arc

Surgical management of esophageal atresia and tracheo-esophageal fistula associated with right-sided aortic arc

Early elevation of cardiac troponin I is predictive of short-term outcome in neonates and infants with coronary anomalies or reduced ventricular mass undergoing cardiac surgery

The present study aimed to assess the usefulness of routine monitoring of cardiac troponin I concentrations within 24 hours of surgery (cTn-I<24h) in neonates and infants undergoing cardiac surgery. The added predictive ability of a high peak cTn-I<24h (within the upper quintile per procedure) for a composite outcome, including 30-day mortality and severe morbidity, was assessed retrospectively. The predicted risk for the composite outcome was estimated from a logistic regression model including preoperative and intraoperative variables. Adding a high peak cTn-I<24h to the risk model resulted in reclassification of the predicted risk. It also allowed quantification of the improvement in reclassification and discrimination by the difference between c-indexes, the Net Reclassification and the Integrated Discrimination Indexes (NRI and IDI). Overall, 1023 consecutive patients were included. Adding a high peak cTn-I<24h to the model resulted in no improvement in reclassification or discrimination in the overall population (difference between c-indexes: 0.011 [-0.004 to 0.029], NRI=0.06, P=.22, IDI=0.02, P=.06), except in a subgroup of patients undergoing the arterial switch operation with or without ventricular septal defect closure and/or aortic arc repair, anomalous origin of the left coronary artery from the pulmonary artery repair, truncus arteriosus repair, Norwood procedure, and Sano modification, in whom NRI=0.23 (P=.005) and IDI=0.05 (P<.001). Patients with coronary anomalies and patients with reduced ventricular mass should benefit from the routine monitoring of cTn-I concentrations after surgery for congenital cardiac disease.

Corrected transposition of the great arteries with previously unreported cardiac anomalies : case report

The corrected transposition of the great arteries is a rare congenital cardiac anomaly characterised by atrio-ventricular and ventriculo-arterial discordance and is related to the largest incidence of cardiological complications. We report on a 40-year-old woman with congenitally corrected transposition of the great arteries, situs inversus, atrial septal defect, pulmonary stenosis, right arcus aorta and coronary artery anomalies.

Syncope as Initial Presentation of Kommerell Diverticulum

Kommerell diverticulum (KD) is an aortic arch diverticulum at the origin of an aberrant subclavian artery. It is a rare anatomical anomaly that can be associated with a double aortic arc, a left aortic arch, and anomalous origin of the right subclavian artery or a right aortic arch with anomalous left subclavian artery. We present a case of KD presenting initially as syncope, as well as a review of the literature of this rare syndrome, including diagnosis, imaging techniques, and current surgical treatments.

Periaortitis, Coronary Vasculitis and Retro-Orbital Pseudotumor in a Patient with Immunoglobulin G4-Related Sclerosing Vasculitis

Immunoglobulin G4 (IgG4)-related sclerosing vasculitis is characterized by extensive IgG4-positive plasma cells and T-lymphocyte infiltration of various organs. Serum IgG4 level and immunostaining with anti-IgG4 antibody are useful for the diagnosis. In this article, a 61-year-old male patient who was admitted with the complaints of dyspnea, diffuse edema and chest pain and presented with increased pericardial fluid and serum IgG4 level was reported. Thoracoabdominal computed tomography (CT) scan demonstrated a soft tissue mass starting at arcus aorta and surrounding thoracal and abdominal aorta. After biopsy was obtained, the patient was diagnosed with IgG4-related sclerosing vasculitis.

Triple Cerebral Monitorization in a Highly Risky Arcus Aorta Aneurysm Repair

Triple Cerebral Monitorization in a Highly Risky Arcus Aorta Aneurysm Repair

Intralober Pulmonary Sequestration with Arterial Supply from Two Different Origins: A Case Report

Pulmonary sequestration is a rare anomaly, which does not have a connection with the bronchial system and gets its blood supply, generally, from the aorta or its branches. Anatomically, two different forms were described: intralobar and extralobar. Although 74% of intralobar pulmonary sequestrations get their blood supply from the descending thoracic aorta, they may get their blood supply from different arteries. Furthermore, there is more than one arterial anomaly in 14.8% of cases. We report an intralobar pulmonary sequestration, in which arterial blood supply is from two different origins (Arcus aorta and celiac trunk). To the best of our knowledge, this is the first case in the literature.

A Rare Variation of the Heterotaxy Syndrome

Heterotaxy syndrome is a rare, complex, and confusing type of the situs anomalies. It is not possible to estimate the degree of lateralization, isomerism, and rotational variation in these types of cases. Heart and abdominal organ anatomy is specific to the individual, and it should be defined specifically on the basis of each case due to possible cardiac and extracardiac surgical interventions in patients with heterotaxy syndrome. Here, we present our findings obtained from a 58-year-old female patient with heterotaxy syndrome. The main components of this rare variation consist of right-hand-sided aorta, aortic arc, cardiac apex, gall bladder and left-hand-sided inferior vena cava, stomach, and spleen (polysplenia, 3 foci) according to the midline. Besides, the components include left-dominant liver, right-hand-sided large intestines, and left-hand-sided small intestines.

Transcatheter treatment of interrupted arcus aorta in two adolescents

Transcatheter treatment of interrupted arcus aorta in two adolescents

Evaluation of diagnostic accuracy of computed tomography to assess the angioarchitecture of pulmonary sequestration

Bronchopulmonary sequestration is an unusual congenital malformation consisting of abnormal lung tissue that lacks normal communication with the tracheobronchial tree. The diagnosis of pulmonary sequestration is based on identifying this systemic arterial supply. We aimed to evaluate the sensitivity of multidetector computed tomography in demonstrating the feeding artery and draining veins. Between 2003 and 2008, 8 patients (6 males, 2 females) ranging in age from 5 to 49 years with a diagnosis of pulmonary sequestration were identified. All patients underwent evaluation with chest tomography (spiral or multi detector tomography) and digital subtraction angiography. Aberrant systemic arterial supply was demonstrated in all cases: from the descending thoracic aorta (n= 6); arcus aorta (n= 1), internal mammarial artery (n= 1), intercostal arteries (n= 2) and celiac axis (n= 1). Four patients underwent surgery which confirmed the angioarchitecture depicted on angiography. One patient underwent angiography with embolization using. Computed tomography especially multidetector computed tomography is a powerful noninvasive technique for the detection of pulmonary sequestration.

Two Surgically Treated Patients With Severe Symptoms of Takayasu Arteritis

Takayasu arteritis, also known as the aortitis syndrome, is a panarteritis that affects the arcus aorta and its major branches, seen usually in young women. As Takayasu arteritis has a progressive nature, surgery is usually indicated only in complications of the arteritis. In this report we present two surgically treated cases with severe complications of Takayasu arteritis. We also review the syndrome.

Takayasu Arteritis with Intracranial Involvement Mimicking Epilepsy: Case Report and Review of the Literature

The symptoms of Takayasu arteritis (TA) are related to end organ ischemia. Here we present a patient with convulsions and intracranial involvement. A 15-year-old young woman was admitted with the complaint of convulsions since one and a half months previously. Her physical examination showed absent pulses and unobtainable blood pressure in both arms. Electroencephalography was normal. An arcus aorto-abdominal aortography, performed for TA prediagnosis, revealed that the subclavian artery ended as a stump at its origin on the right and was occluded by tapering on the left. Arcus aorta was normal. The right renal artery was occluded up to 80-90%. Magnetic resonance imaging of the brain revealed abnormal signal intensity in the deep white matter bilaterally. Cerebral catheter angiography showed focal stenosis of cerebral vessels; it was classified as type V according to the classification of the Takayasu Conference of 1994. A diagnosis of TA was made and 1 mg/kg steroid was given, and after a month methotrexate (15 mg/week) was added. On the tenth treatment day her pulse could be revealed. During the control period she had no convulsion. In young patients TA should be kept in mind as a rare cause in convulsion etiology. Intracranial involvement of TA must be evaluated especially if there is a headache and convulsion.

Effect of atorvastatin therapy on oxidant-antioxidant status and atherosclerotic plaque formation

Background:The aim of this study was to determine the oxidant–antioxidant status and lipid peroxidation products, as well as paraoxonase and atherosclerotic plaque formation, in a hypercholesterolemic atherosclerosis rabbit model to investigate the effects of atorvastatin in the atherosclerotic process.Methods:Forty male New Zealand rabbits were divided into four groups, ie, a control group receiving standard pellets, a group receiving atorvastatin therapy, a hypercholesterolemic group receiving an atherogenic diet, and a group receiving both an atherogenic diet and atorvastatin.Results:The atherogenic diet increased the levels of low-density lipoprotein (LDL) thiobarbituric acid reactive substances (1.84 vs 3.79 nmol/mg protein) and LDL-conjugated diene (147 vs 318 μmol/mg protein) after induction of oxidation by Cu2+, despite an increase of superoxide dismutase activity. Treatment with atorvastatin limited LDL oxidation significantly (LDL thiobarbituric acid reactive substances 2.19 nmol/mg protein, LDL-conjugated diene 222 μmol/mg protein). Paraoxonase, which prevents LDL oxidation and inactivates LDL-derived oxidized phospholipids, showed a pronounced decrease in the group receiving the atherogenic diet (110 U/L to 28 U/L), and atorvastatin treatment increased paraoxonase activity. Histological examination of arcus aorta tissues from the hypercholesterolemic group showed abundant plaque formation surrounding and obstructing the lumen, whereas treatment with atorvastatin prevented or limited plaque formation, keeping the plaque thin and localized.Conclusion:Atorvastatin has dramatic antiatherosclerotic effects, part of which seems to be due to the antioxidant features of the parent drug and/or its metabolites, favoring inhibition of LDL oxidation.

Subgross Investigation of the Blood Vessels Originating from Aortic Arch (Arcus aortae) in Spiny Mouse

Subgross Investigation of the Blood Vessels Originating from Aortic Arch (Arcus aortae) in Spiny Mouse

Giant cystic hemolymphangioma of the postmediastinum

Hemolymphangioma of the postmediastinum is very rare. The clinical features and treatment have not been clearly described. We present a case of giant cystic hemolymphangioma of the postmediastinum. A chest roentgenogram revealed an abnormal shadow of the postmediastinum. Computed tomography (CT) of the chest revealed a mediastinal tumor identified a giant non-invasive monomorphic cystic mass, in contact with the tracheal wall, arcus aortae and subclavian artery. The mass had regular borders and spontaneous low density, was homogeneous, and showed no enhancement after administration of contrast medium. Partial excision of the mass was achieved through left thorascopic exploration, Frozen section margin examination suggests hemolymphangioma, which is a benign tumor. Immobilization the surface of remained cyst wall with sclerosing agents. The pathology report was of a hemolymphangioma.

Citicoline and postconditioning provides neuroprotection in a rat model of ischemic spinal cord injury

Ischemic spinal cord injury is a chain of events caused by the reduction and/or cessation of spinal cord blood flow, which results in neuronal degeneration and loss. Ischemic postconditioning is defined as a series of intermittent interruptions of blood flow in the early phase of reperfusion and has been shown to reduce the infarct size in cerebral ischemia. Our study aimed to characterize the relationship between the neuronal injury-decreasing effects of citicoline and ischemic postconditioning, which were proven to be effective against the apoptotic process. Spinal cord ischemia was produced in rats using an intrathoracic approach to implement the synchronous arcus aorta and subclavian artery clipping method. In our study, 42 male Sprague-Dawley rats (309 +/- 27 g) were used. Animals were divided into sham operated, spinal ischemia, citicoline, postconditioning, and postconditioning citicoline groups. Postconditioning was generated by six cycles of 1 min occlusion/5 min reperfusion. A 600 mmol/kg dose of citicoline was given intraperitoneally before ischemia in the citicoline and postconditioning citicoline groups. All rats were sacrificed 96 h after reperfusion. For immunohistochemical analysis, bcl-2, caspase 3, caspase 9, and bax immune staining were performed. Caspase 3, caspase 9, bax, and bcl-2 were used as apoptotic and antiapoptotic markers, respectively. The blood pressure values obtained at the onset of reperfusion were significantly lower than the preischemic values. A difference in immunohistochemical scoring was detected between the caspase 3, caspase 9, bax, and bcl-2 groups. When comparisons between the ischemia (groups 2, 3, 4, and 5) and sham groups (group 1) were performed, a significant increase in caspase 3, caspase 9, bax, and bcl-2 was detected. When comparing the subgroups, the average score of caspase 9 was found to be significantly higher in ischemia group 2. The average score of bcl-2 was also found to be significantly higher in postconditioning and citicoline group 5. It is thus thought that combining citicoline with postconditioning provides protection by inhibiting the caspase pathway and by increasing the antiapoptotic proteins.