Reconstruction Of Branches Research Articles

An image segmentation and point cloud registration combined scheme for sensing of obscured tree branches

Automated robots are emerging as a solution for labor-intensive fruit orchard management. Three-dimensional (3D) reconstruction of tree branches is a fundamental requirement for robots to perform tasks like pruning and fruit harvesting. Current branch sensing methods often rely on planar segmentation with limited 3D information or computationally expensive point cloud segmentation, which may not be suitable for natural orchards with obscured tree branches. This study proposes a novel scheme that reconstructs occluded branches from RGB-D (Red-Green-Blue-Depth) images by integrating the point clouds converted from planar segmentation masks and depth images. The proposed approach extends the existing 2D branch sensing techniques to 3D, leveraging multi-view information. The deep learning models DeeplabV3+ and Pix2pix are employed to generate the segmentation masks, separately. And the Fast Global Registration (FGR) is used to register the multi-view point clouds. The results demonstrate that the output point clouds have at least a 24 % increase in the number of corresponding points after FGR. Furthermore, the time cost per hundred corresponding points is reduced by 85 % and 69 % when using the DeepLabV3 + and Pix2pix-based schemes, respectively, compared to the PointNet++ approach. These findings indicate that the proposed scheme significantly improves the sensing of occluded branches in terms of output richness and computational efficiency, making it applicable to natural orchard working spaces.

Aortic arch branch-prioritized reconstruction for type A aortic dissection surgery.

Acute Stanford type A aortic dissection (STAAD) is a fatal condition requiring urgent surgical intervention. Owing to the complexity of the surgical process, various complications, such as neurological disorders, are common. In this study, we prioritized the reconstruction of aortic arch branches during surgery and investigated the association between prioritizing the branches and the postoperative outcomes of patients with STAAD. Ninety-seven patients were included in the observational study and underwent total arch replacement and frozen elephant trunk technique between January 2018 and June 2021. Of these, 35 patients underwent the branch-priority technique, and 62 patients underwent the classic technique. By analyzing the perioperative outcomes, we compared the differences between the two techniques. The branch priority group had significantly shorter cardiopulmonary bypass and ventilator times and earlier postoperative wake-up times than the classic group. Additionally, the ICU stay time was shorter, with a significant decrease in neurological complications and 24 h drainage in the branch priority group compared to the classic group. The branch priority technique can effectively provide better brain protection, resulting in earlier awakening of patients after surgery, reduced neurological complications, shorter ventilation time and decreased ICU hospitalization time. Therefore, it is recommended for use in aortic dissection surgeries.

EVALUATION OF A LOW-COST PHOTOGRAMMETRIC SYSTEM FOR THE RETRIEVAL OF 3D TREE ARCHITECTURE

Abstract. Reconstruction of major branches of a tree is an important first step for the monitoring of tree sway and assessment of structural stability. Photogrammetric systems can provide a low-cost alternative for the acquisition of three-dimensional data, while also enabling long-term monitoring of a tree of interest. This study introduces a low-cost photogrammetric system based on two Raspberry Pi cameras, which is used to reconstruct the tree architecture for the purpose of stability monitoring. Images of five trees are taken at a range of distances and the resulting point clouds are evaluated in terms of point density and distribution with the reference to TLS. While the photogrammetric point clouds are sparse, it was found that they are capable of reconstructing the tree trunk and lower-order branches, which are most relevant for sway monitoring and tree stability assessment. The most optimal distance for the reconstruction of the relevant branches was found to be 9–10 m, with a baseline of 120 cm.

Outcomes of Castor Single-Branched Stent Graft for Reconstruction of Multiple Supra-Aortic Branches in Aortic Arch Disease.

To report the outcomes of a combination of Castor single-branched stent grafts with other techniques for the reconstruction of multiple supra-aortic branches in aortic arch disease. Between December 2019 and December 2021, 20 patients with aortic arch disease underwent thoracic endovascular aortic repair (TEVAR) at our institution using a Castor single-branched stent graft combined with the fenestration, chimney, or bypass techniques. Thoracic endovascular aortic repair is indicated for complicated or acute type B aortic dissection (TBAD), nonruptured aneurysms with a maximum aneurysm diameter >5.5 cm or showing rapidly expanded, ruptured, or threatened aneurysms, and penetrating aortic ulcers (PAUs) with a maximal aortic diameter >5.5 cm or with PAUs >10 mm deep or >20 mm in diameter. Preoperative, intraoperative, and postoperative clinical data were recorded. The median age of the patients was 56 (range=52-69 years) years, and 19 patients were men. Seven patients underwent the Castor single-branched stent graft and left common carotid artery (LCCA) chimney technique, 8 patients underwent the Castor single-branched stent graft and fenestration technique, and 5 patients underwent the Castor single-branched stent graft and bypass technique. The technical success rate was 100%. Major adverse events included 2 endoleaks, 1 spinal cord ischemia, and 1 early-stage retrograde type A aortic dissection. No cerebral stroke-related complications were observed. The mortality rate was 10% (2/20 patients). One patient with thoracic aortic aneurysm (TAA) died because of a sudden decrease in oxygen saturation and blood pressure after surgery. Relatives declined autopsy, and the cause of death was not determined. Another patient died of a retrograde type A dissection after surgery. The median follow-up period was 6 months (range=3.5-12 months). During follow-up, 1 patient with type I endoleak underwent thoracotomy again after a year. The remaining patients recovered well. The combination of a Castor single-branched stent graft with fenestration, chimney, or bypass techniques may be an effective treatment for preserving multiple supra-aortic branches in aortic arch disease. This study introduced three methods of reconstruction of multiple supra-aortic branches using a Castor single-branched stent graft (Castor single-branched stent graft combined with fenestration, chimney, or bypass technique) and analysed their advantages and shortcomings to provide experience for the future treatment of aortic arch diseases.

A technique for a single-stage off-pump repair of Kommerell diverticulum with antegrade branch vessel reconstruction.

Kommerell diverticula (KD) are uncommon. When a KD is identified, repair is indicated if symptomatic or if interval growth is demonstrated. Because of their rarity, no standardized technique has been established. Approaches reported have various limitations that include multiple operative stages, need for cardiopulmonary bypass (CPB) or circulatory arrest, or reconstruction of arch branches with retrograde flow, and at times relying on a single inflow. The technique presented addresses most of these limitations.

Detection and Reconstruction of Passion Fruit Branches via CNN and Bidirectional Sector Search.

Accurate detection and reconstruction of branches aid the accuracy of harvesting robots and extraction of plant phenotypic information. However, the complex orchard background and twisting growing branches of vine fruit trees make this challenging. To solve these problems, this study adopted a Mask Region-based convolutional neural network (Mask R-CNN) architecture incorporating deformable convolution to segment branches in complex backgrounds. Based on the growth posture, a branch reconstruction algorithm with bidirectional sector search was proposed to adaptively reconstruct the segmented branches obtained by an improved model. The average precision, average recall, and F1 scores of the improved Mask R-CNN model for passion fruit branch detection were found to be 64.30%, 76.51%, and 69.88%, respectively, and the average running time on the test dataset was 0.75 s per image, which is better than the compared model. We randomly selected 40 images from the test dataset to evaluate the branch reconstruction. The branch reconstruction accuracy, average error, average relative error of reconstructed diameter, and mean intersection-over-union (mIoU) were 88.83%, 1.98 px, 7.98, and 83.44%, respectively. The average reconstruction time for a single image was 0.38 s. This would promise the proposed method to detect and reconstruct plant branches under complex orchard backgrounds.

Hepatic venous territory mapping in living donor liver transplantation using right liver graft: an objective parameter for venous reconstruction.

This study evaluated the clinical implication of hepatic venous territory mapping in living donor liver transplantation. Living donor liver transplantations performed using right graft since 2017 were included. Hepatic venous volume mapping was started in 2019. Risk factors for graft failure and overall survival were analyzed. Analysis for factors related to occlusion of reconstructed vein was performed. Among 445 patients included, 213 underwent hepatic venous mapping. Hepatic venous mapping itself was not a significant factor for graft (hazard ratio [HR], 0.958; 95% confidence interval [CI], 0.441-2.082; P = 0.913) and overall survival (HR, 0.627; 95% CI, 0.315-1.247; P = 0.183). Inferior hepatic vein occlusion was a significant risk factor for both graft survival (HR, 8.795; 95% CI, 1.628-47.523; P = 0.012) and overall survival (HR, 11.13; 95% CI, 2.460-50.300; P = 0.002). In a subgroup with middle hepatic vein reconstruction, occlusion was a significant risk factor for overall survival (HR, 3.289; 95% CI, 1.304-8.296; P = 0.012). In patients with middle hepatic vein reconstruction whose venous territory volumes were measured, right anterior volume of ≥300 cm3 was protective for vein occlusion (OR, 0.317; 95% CI, 0.152-0.662; P = 0.002). In patients with V5 reconstruction, V5 volume of ≥150 cm3 was protective for vein occlusion (OR, 0.253; 95% CI, 0.087-0.734; P = 0.011). Inferior and middle hepatic vein reconstruction has significant impact on clinical outcome. Hepatic venous territory mapping can provide an objective measure for successful reconstruction of venous branches.

Endovascular surgery for thoracic aortic pathologies involving the aortic arch.

BackgroundAortic arch pathologies are serious clinical conditions associated with a very dismal prognosis. Traditional open surgery has a high mortality and is not suitable for critically ill patients. Recently years, endovascular treatment of thoracic aorta has made rapid progress and has been gradually applied to the treatment of aortic arch pathologies. However, maintaining cerebral blood flow during endovascular treatment of aortic arch lesions remains a challenge at this time. This study aims to evaluate the feasibility, efficacy, and safety of endovascular treatment of thoracic aortic pathologies involving the aortic arch, and to present initial experience with this technique.MethodsFrom October 2016 to December 2020, patients who met the inclusion criteria were enrolled. All patients underwent thoracic endovascular aortic repair with the proximal landing zone of the stent-graft in the aortic arch at Ishimaru zones 0–1, in which cerebral flow needs to be maintained during surgery, and the supra-aortic branches were reconstruction with either in situ fenestration or the chimney technique.ResultsA total of 62 cases with lesions involving the arch were treated with endovascular surgery. Total supra-aortic branches reconstruction was successfully performed in 51 cases, the left carotid artery (LCA) and the innominate artery reconstruction were performed in eight cases, the left subclavian artery (LSA) and the LCA were reconstructed in three patients. Among them, the in situ fenestration or chimney repair technique for the LSA was successful performed in 42 and 12 cases. However, in 20 patients, attempts to reconstruction the LSA using the fenestration technique were unsuccessful due to tortuous and angulated vessels. Early mortality was 6.45%. No neurological complications related to surgery occurred. Computer tomography images at post-operative follow-up (mean 3.51 months) confirmed patency of all branch stents without any signs of endoleaks, migration, conversion to retrograde dissection or receive open-heart surgery.ConclusionThe endovascular technique is an effective, feasible, safe and repeatable method to reconstruct the aortic arch, which allows for the reconstruction of the supra-aortic branches.

Early clinical outcomes of retrograde in situ branched stent grafting for complex aortic arch aneurysms

ObjectiveTo evaluate the early outcomes of retrograde in situ branched stent grafting (RIBS) using the gutter balloon technique for complex aortic arch aneurysms (CAAs). MethodsThe RIBS technique is an in situ needle fenestration procedure during thoracic endovascular aortic repair with the reconstruction of cervical branches. The double RIBS (D-RIBS) for the reconstruction of the left common carotid artery and the brachiocephalic artery using the gutter balloon technique was performed in 30 high-risk patients. We describe the early clinical results of the D-RIBS technique for CAAs. Primary end points were technical success and 30-day mortality. Secondary end points were postoperative complications, rates of endoleaks, overall survival, aneurysm-related death, and reinterventions. ResultsThe mean age was 77.1 ± 6.6 years, and the mean maximum minor-axis aneurysmal diameter was 65.9 ± 8.9 mm. Twenty-six patients underwent D-RIBS for elective arch aortic aneurysm, and four patients were for reintervention after zone 2 thoracic endovascular aortic repair failure. Stent graft puncture was performed 60 times from the common carotid arteries, and technical success was achieved in all cases (100%). Postoperative complications included cerebral infarction in two patients (6.7%) and recurrent nerve palsy in one patient (3.3%). The 30-day mortality was 0%. During the median follow-up period of 14 months (6-56 months), overall survival at 12 months was 92.3% without any aneurysm-related death. Type 1 b and type 2 endoleaks were observed in one each, and no reintervention was encountered. ConclusionsEarly clinical outcomes of the D-RIBS for high-risk patients with CAAs are acceptable. The gutter balloon method enables safe and reliable fenestration. Further studies and dedicated devices are warranted.

Terrestrial laser scanning to reconstruct branch architecture from harvested branches

Abstract Quantifying whole branch architecture is critical to understanding tree function, for example, branch surface area controls woody gas exchange. Yet, due to measurement difficulty, branch architecture of small diameter branches (e.g. <10 cm ) is modelled, subsampled or ignored. Methods that use terrestrial laser scanning (TLS) are now being widely applied to analyse tree and plot‐level tree architecture; however, resolving small diameter branches in‐situ remains a challenge. Currently, it is suggested that accurate reconstruction of small diameter branches can only be achieved by harvest and measurement in controlled conditions. Here we present a new TLS workflow for rapid and accurate reconstruction of complete branch architecture from harvested branches. The workflow sets out scan configuration, post‐processing (including a novel reflectance filter) and fitting of quantitative structure models (QSM) to reconstruct topologically coherent branch models. This is demonstrated on 595 branches (scanned indoors to negate the impact of wind) and compared with 65 branches that were manually measured (i.e. with measuring tape and callipers). Comparison of a suite of morphological and topological traits reveals a good agreement between TLS‐derived metrics and manual measurements where RMSE (%RMSE) for total branch length = 0.7 m (10%), volume = 0.09 L (43%), surface area = 0.04 m2 (26%) and N tips = 6.4 (35%). Scanning was faster and invariant to branch size compared with manual measurements which required significantly more personnel time. We recommend measuring a subsample of tip widths to constrain the QSM taper function as the TLS workflow tends to overestimate tip width. The workflow presented here allows for a rapid characterisation of branch architecture from harvested branches. Increasing the number of branches analysed (e.g. many branches from a single tree or branches from many species globally) could allow for a comprehensive analysis of the ‘missing link’ between the leaves and larger diameter branches.

Устранение дефекта лицевого нерва после паротидэктомии петлей сурального графта: клинический случай

In this article we present our experience in the reconstruction of multiple branches of the facial nerve by a loop of sural nerve graft on a patient with gigantic recurrent parotid adenoma. In the original technique of Kikabuchi et al., one end of the grafted nerve is sutured with the stumps of the facial nerve branches in an end-to-side manner through epineural windows made on the nerve graft. In contrast with this approach, we sutured the graft branches with the stumps of the facial nerve branches in an end-to-end manner. Functional recovery of all branches and satisfactory facial expression (House–Brackmann Grade I–II) were obtained within 2 years postoperatively. This technique is a useful option for facial nerve reconstruction managing multiple branches.

Right hepatic arterial girdle around the common hepatic duct in liver donors: technical considerations for successful living donor liver transplantation.

Variations in hepatic arterial anatomy can result in multiple arterial trunks in the graft liver. We describe our experience in dealing with five right lobe liver donors where in the right hepatic artery (RHA) branches were passing anterior and posterior to the common hepatic duct (CHD) forming an arterial girdle around it. Five of 771 right lobe living donor liver transplants (January 2012 and March 2020) demonstrated the RHA girdle around the CHD. Three patients had the typical girdle resulting in two graft arteries which were reconstructed using arterial Y grafts. Arterial girdle was formed by the right anterior hepatic artery branches in one patient resulting in 3 graft arteries of which two were reconstructed using a Y graft. One donor had the arterial girdle and an accessory artery from SMA giving rise to 3 graft arteries. Two of them were ligated (brisk back bleed), and one was reconstructed. All donors (median follow-up 17 months, range 6-60 months) had an uneventful postoperative recovery. No vascular or biliary complications were encountered in the recipients. One recipient died due to sepsis and multiorgan failure, while the other 4 recipients recovered uneventfully and continue to have stable graft function. Adhering to safe surgical principles during RHA mobilization, ligation of minor arterial branches, and precise reconstruction of multiple major branches can ensure successful outcomes in the donor and recipient in this scenario.

A Novel Fenestrating Device: Quick Fenestrater for Reconstructing Supra-aortic Arteries In Situ During Thoracic Endovascular Aortic Repair

BackgroundIn situ fenestration (ISF) is an effective approach for reconstructing supra-aortic branches during thoracic endovascular aortic repair (TEVAR). A dedicated device is needed for ISF. MethodsThe Quick Fenestrater (QF) underwent in vitro, animal-based, and initial clinical testing. In vitro, the polytetrafluoroethylene and Dacron aortic endografts were fenestrated using the QF, and the structure of the graft, fenestration hole, and shed particulate material were evaluated. Eight white swine had QF-aided ISF combined with TEVAR and bridge-stent implantation. The outcomes were assessed using intraoperative angiography and biopsy. Finally, 13 patients were treated with QF-assisted ISF combined with TEVAR, and the success rate, technical details, and intra- and postoperative complications were recorded. ResultsThe endograft structure was not damaged during in vitro testing. The fenestration hole was clean, and no particulate material was detected. In animal studies, all animals survived, the supra-aortic arteries were patent, and the endografts and bridge stents had normal morphology. In clinical studies, the technical success rate was 100%, and no fenestration-related neurologic complications or death occurred. One patient had a local access-related hematoma perioperatively and recovered after conservative treatment. Three patients had type III endoleaks, which resolved with no additional treatment. During a mean follow-up of 22.1 ± 6 months, no thoracic complications were identified, and the bridge stents were patent with no endoleaks. No adverse cerebrovascular events, cardiovascular events, or death occurred. ConclusionsQF-assisted ISF is a safe and effective method for the reconstruction of supra-aortic branches during TEVAR. Intermediate-term follow-up results validate the application of the novel fenestration device.

Three-dimensional reconstruction of guava fruits and branches using instance segmentation and geometry analysis

In unstructured environments, harvesting robots may collide with disorderly growing branches, thus reducing the success rate of harvesting. This study introduces a fruit and branch detection and three-dimensional (3D) reconstruction method for obstacle avoidance path planning of robots. A new architecture for instance segmentation was developed by replacing the backbone of Mask R-CNN with a tiny network, referred to as “tiny Mask R-CNN”. The tiny Mask R-CNN was trained with a small number of images and used to detect guava fruits and branches. Each detected fruit and branch were converted into a 3D point cloud. It was then hypothesized that guava fruits could be represented by 3D spheres and irregular branches can be approximated by a finite number of 3D cylindrical segments. Based on the proposed hypothesis, a random sample consensus-based sphere fitting method and a principal component analysis-based cylindrical segment fitting method were investigated to reconstruct the fruits and branches from the point clouds. A guava dataset with 304 RGB-D images was collected from the fields and used to validate the developed method. The results showed that the detection F1 score of the tiny Mask R-CNN was 0.518; the F1 score for fruit reconstruction was approximately 0.851 and 0.833 under the 2D- and 3D-fruit metrics, respectively; and the F1 score for branch reconstruction was approximately 0.394 and 0.415 under the 2D- and 3D-branch metrics, respectively. These results confirm that the proposed method can effectively reconstruct the fruits and branches and can, therefore, be used to plan an obstacle avoidance path for harvesting robots.

Inferior Vena Cava and Venous Outflow Reconstruction in Living Donor Liver Transplantation in Children: A Single-Center Retrospective Study and Literature Review.

BackgroundIn this report, we present technical problems and solutions used in the reconstruction of the inferior vena cava and graft venous outflow during living donor liver transplantation (LDLT) in children.Material/MethodsIn 65 grafts out of 379 liver transplantations from living donors, reconstruction of multiple hepatic venous branches and/or IVC was necessary. In 4 cases, cryopreserved deceased donor venous grafts were used for the reconstruction of the IVC and/or HV.ResultsFollow-up ranged from 2 months to 17.8 years (median 7.2 years). In 4 children, liver re-transplantation was required for a reason not related to venous outflow (biliary complications in 3 patients, graft insufficiency caused by small-for-size syndrome). Two patients died: 1 due to tumor recurrence and 1 due to multi-organ failure. Fifty-nine patients are alive with good liver function. One patient (1.5%) after deceased donor venous graft reconstruction showed symptoms of venous outflow obstruction, which was successfully treated with endovascular balloon angioplasty and stent placement. The remaining 59 transplanted patients do not show any signs of venous outflow obstruction.ConclusionsIn most cases, the reconstruction of multiple hepatic veins of living donor allografts can successfully be done with local venoplasty, while using cold-stored vein grafts may be helpful in selected cases of LDLT.

Major Aortic Reconstruction with the Replacement of Supra-Aortic Branches: Successful Surgical Treatment of Takayasu Arteritis Initially Presented as Congestive Heart Failure.

Takayasu arteritis (TA) is a rare, large vessel vasculitis that affects aorta, its major branches, and occasionally pulmonary arteries. Patients with TA can present with constitutional features and/or various symptoms and signs caused by morphological changes in the blood vessels affected by the inflammatory process. Corticosteroids (CS) and immunosuppressives (IS) are the first line treatment for active TA. Open surgery remains a treatment of choice for TA patients with moderate-to-severe aortic regurgitation (AR) and ascending aortic aneurysm (AAA). We present a 26-year-old female diagnosed with an advanced stage of TA, initially presented as congestive heart failure. Due to a progressive course of the disease (AR 3+, AAA 5.5 cm), surgery of the Aortic valve and root (Bentall procedure), with total arch reconstruction and replacement of supra-aortic branches was performed. The patient has had an uneventful recovery during the postoperative course with no complications at one year follow-up. Normal left ventricle (LV) diameter, LV ejection fraction 67%, and a trace of AR were seen on the last echocardiography.

Treatment of Diabetic Foot Ulcer with Tibial Transverse Transport Combined with Antibiotic Bone Cement, a Case Report

Diabetic foot is one of the most difficult complications of diabetes and the main cause of non-traumatic amputation, accounting for 85% of all non-traumatic amputations. [1-2], We report a case of diabetic foot ulcer treated with transverse tibial transport combined with bone cement implantation. The ulcer healed and the effect was good. Case presentation: A 65-year-old man has been diagnosed with Type 2 diabetes for more than 20 years, combined with Type 2 diabetic neurological complications and type 2 diabetic eye complications. Two years ago, his right thumb was removed due to foot ulcers. 20 days ago, The second toe of the right foot was removed due to an ulcer. When he entered our hospital for treatment, the back of the right foot and the sole of the foot had large ruptures. After thorough debridement and transverse tibial transport combined with bone cement placement, the wound healed well. Conclusion: In the treatment of diabetic foot ulcers, it is very important to restore the blood supply of the affected limb. Tibial transverse transport promotes the reconstruction of anastomotic branches below the knee joint, and the induced membrane technology can improve local blood supply. The combination of the two can provide an economical and effective way for the treatment of diabetic foot, which is worthy of our continued exploration.

Successful Repair of Superior Mesenteric Artery Aneurysm with Reconstruction of Branches.

Superior mesenteric artery aneurysms (SMAAs) are rare and potentially life-threatening. Whether surgical or endovascular repair is performed, mesenteric ischemic complication is the greatest concern. A 56-year-old gentleman with SMAA underwent surgical resection with reconstruction of the superior mesenteric artery (SMA) and its branches using the great saphenous vein with several techniques, including island reconstruction of the branches, staged segmental cross-clamping, and an external shunt, to reduce the mesenteric ischemia time. The postoperative course was uneventful with no signs of mesenteric ischemia. A computed tomography scan showed that all grafts to the SMA and its branches were patent.

Sensing and Automation in Pruning of Apple Trees: A Review

Pruning is one of the most important tree fruit production activities, which is highly dependent on human labor. Skilled labor is in short supply, and the increasing cost of labor is becoming a big issue for the tree fruit industry. Meanwhile, worker safety is another issue in the manual pruning. Growers are motivated to seek mechanical or robotic solutions for reducing the amount of hand labor required for pruning. Identifying tree branches/canopies with sensors as well as automated operating pruning activity are the important components in the automated pruning system. This paper reviews the research and development of sensing and automated systems for branch pruning in apple production. Tree training systems, pruning strategies, 3D structure reconstruction of tree branches, and practice mechanisms or robotics are some of the developments that need to be addressed for an effective tree branch pruning system. Our study summarizes the potential opportunities for automatic pruning with machine-friendly modern tree architectures, previous studies on sensor development, and efforts to develop and deploy mechanical/robotic systems for automated branch pruning. We also describe two examples of qualified pruning strategies that could potentially simplify the automated pruning decision and pruning end-effector design. Finally, the limitations of current pruning technologies and other challenges for automated branch pruning are described, and possible solutions are discussed.

Single-Stage Surgical Repair of Kommerell Diverticulum with Annuloaortic Ectasia via a Median Sternotomy: Frozen Elephant Trunk Technique with an Antler-Like Shape Reconstruction of Arch Branches

We present here a case of Kommerell diverticulum (KD) with annuloaortic ectasia, in which single-stage surgical repair was performed via a median sternotomy using frozen elephant trunk (FET) technique. We used this technique for the following reasons: firstly, we could perform surgery only via a median sternotomy without thoracotomy; secondly, we were able to deliver the FET using a guidewire through the severely angulated aortic arch. We here investigate this technique as it could potentially be a good treatment option of KD.