Aortic Arch Research Articles

The relationship between regional mechanical properties and hemodynamic indices of the aortic arch: a preliminary study.

This study aimed to investigate the relationship between regional elastic modulus and corresponding hemodynamic indices of healthy aortic arch. Porcine aortic arches (n=18) were obtained from a local abattoir and divided into 24 regions along axial and circumferential directions. Regional elastic modulus was measured by indentation tests, and elastic fiber content was assessed using Elastica van Gieson (EVG) staining. Additionally, a porcine aortic model was reconstructed based on computed tomography angiography (CTA) images, and local hemodynamic indices were calculated by the two-way fluid-structure interaction (FSI) method. The elastic modulus and elastic fiber content were inclined to be lower on the outer curvature of the aortic arch, particularly showing significant differences at the distal end. A negative correlation was found between elastic modulus and time-averaged wall shear stress (TAWSS) ) at the proximal end of the porcine aortic arch. There was a significant positive correlation between elastic modulus and oscillatory shear index (OSI) at the middle of the aortic arch. The regional elastic modulus of healthy porcine aortic arch is associated with local TAWSS and OSI. The hemodynamic environment could be a contributing factor influencing the distribution of the mechanical properties on the arch.

Early Experience With the Nexus Aortic Arch Endograft for Endovascular Treatment of Complex Aortic Arch Pathologies Beyond Standard Indications.

The Nexus stent graft offers a minimally-invasive option for treating aortic arch aneurysms (AArA). Despite strict instructions for use (IFU), it is sometimes applied in complex anatomies for patients who are surgically inoperable or unsuitable for other devices. This study evaluates outcomes in patients treated outside the IFU, providing real-world insights. We analyzed patients treated with the Nexus endograft outside its IFU between January 2022 and August 2024. The primary endpoint was the occurrence of major adverse cardiovascular and cerebral events (MACCE) such as death, stroke, or myocardial infarction. Secondary endpoints included the reasons for outside-IFU implantation, technical success, any aortic-related adverse events and postoperative endoleaks. Thirteen patients underwent endovascular treatment for AArA outside IFU. Five (38.5%) had a post-type A dissection, 5 had de novo AArA (38.5%), and 3 (23%) lacked a landing zone in zones 1 to 3 of the aortic arch for thoracoabdominal aortic repair. Seven patients (54%) received the Nexus One device, while 6 (46%) received the Nexus Duo endograft. No perioperative MACCE occurred. Mean follow-up was 17 ± 12 months, with a 79% survival rate at 1 year. Primary reasons for outside IFU use included an inner ascending length <30 mm and a descending aortic diameter >40 mm in 46% of patients accordingly. Technical success was achieved in all cases. A type Ic endoleak (7%) due to aneurysmatic degeneration of the brachiocephalic artery was identified at 2 years. No further aortic-related adverse events were reported. The Nexus endograft demonstrated a favorable safety profile and promising clinical outcomes at 1 year, even in patients treated outside IFU criteria, with high technical success and no evidence of stroke. Reassessment of certain IFU criteria could enhance the device's applicability. Our findings highlight the potential for expanding the clinical use of the Nexus stent-graft beyond its current IFU, offering a safe and effective alternative for complex aortic arch anatomies. With high technical success and no perioperative cerebrovascular events, these results suggest that carefully selected patients who are otherwise ineligible for surgery may still benefit from endovascular repair. This study provides real-world evidence supporting the reconsideration of IFU criteria, potentially broadening treatment options. The innovation lies in demonstrating that even outside IFU conditions, the Nexus endograft maintains a strong safety profile, paving the way for more inclusive patient selection.

Anatomical Variation of Left Internal Mammary Artery and Thyrocervical Trunk: A Case Report.

We report a rare case of a left internal mammary artery (LIMA) originating from the left thyrocervical trunk (TCT), which arose directly from the aortic arch. A patient in their 70s presented with bilateral distal internal carotid artery aneurysms, diagnosed through computed tomography angiography performed for headache evaluation. Transfemoral cerebral angiography confirmed the aneurysms and incidentally revealed the anomalous origins of the TCT and LIMA, as well as a left vertebral artery directly arising from the aortic arch. This case emphasizes the importance of recognizing such rare anatomical variations prior to diagnostic or interventional procedures. Thorough preoperative evaluation is critical to avoid complications, particularly in coronary artery bypass grafting and head and neck tumor embolization.

Thoracic Endovascular Aortic Repair for Aortic Arch Penetrating Atherosclerotic Ulcer Using Castor Single-Branched Stent-Graft With Zone 2 Landing.

This study evaluated the feasibility and safety of thoracic endovascular aortic repair (TEVAR) for aortic arch penetrating atherosclerotic ulcer (PAU) using Castor single-branched stent-graft with zone 2 landing. Between May 2020 and April 2022, a total of 25 aortic arch PAU patients were treated by TEVAR with Castor single-branched stent-graft. Outcomes included technical success, perioperative and follow-up morbidity and mortality, and patency of left subclavian artery (LSA). All patients had aortic arch PAU with intramural hematoma (IMH). The proximal landing zone for all patients was in zone 2, which was between the distal edge of the left common carotid artery and proximal edge of LSA, in all cases. Technical success was achieved in all cases. During hospitalization after the operation, 1 patient died of gastrointestinal bleeding, and 2 patients (8.0%) had ischemic stroke. At a median follow-up of 29 months (interquartile range [IQR], 24-30 months), 2 (8.0%) patients died, including 1 ischemic stroke and 1 hemorrhagic stroke. One patient (4.0%) had reintervention owing to retrograde type A aortic dissection (RTAD) 2 months after the operation, and was successfully treated with aortic root remodeling, ascending aorta and total aortic arch replacement and frozen elephant trunk procedure. No endoleak or LSA occlusion occurred. The maximal diameter of aorta at proximal (30.2±2.4 mm vs 31.2±3.0 mm; p>0.05) and distal (25.7±2.8 mm vs 24.5±2.3 mm; p>0.05) landing zone showed no significant difference before and after the operation. The TEVAR for aortic arch PAU using Castor single-branched stent-graft is a safe and efficient option with zone 2 landing. For patients with diagnosis of PAU with IMH, TEVAR with Castor single-branched stent-graft presents low mid-term mortality and morbidity rate, which should be considered as an optimal option when proximal landing zone is insufficient and revascularization of left subclavian artery (LSA) is needed. With Castor single-branched stent-graft, LSA could be revascularized easily and accurately.

Presumed aortic thromboembolism in a 13‐year‐old dog, associated with an Amplatz canine duct occluder

AbstractA 13‐year‐old, female, neutered Border Collie visited the neurology department after suffering two separate episodes of hindlimb weakness and pain. The patient responded to rest and analgesia on both occasions, but continued to be reluctant to jump. Previous history reported closure of a patent ductus arteriosus, using an Amplatz canine duct occluder at the age of 1. An electrocardiogram‐gated computed tomography showed a lesion in the aortic arch, which was consistent with a thrombus, and was centred over the Amplatz canine duct occluder. A similar type of lesion was also found in the femoral artery. The recurrent and spontaneously resolving hindlimb weakness was thought to be related to thromboembolism of the external iliac arteries or their branches, associated with the thrombus in the aortic arch. Although rare, thrombus formation is a complication associated with the use of Amplatz type devices in humans, but it has never been reported in dogs with an Amplatz canine duct occluder.

Unusual presentation of anomalous origin of the right pulmonary artery from the ascending aorta: case report.

Anomalous origin of the right pulmonary artery (AORPA) from the ascending aorta is a rare congenital anomaly, representing approximately 0.12% of all congenital heart defects. Early diagnosis and timely intervention are essential to prevent severe complications such as heart failure and pulmonary vascular disease. We report a case of a full term neonate presented with respiratory distress and cyanosis. Echocardiography revealed an anomalous right pulmonary artery (RPA) origin from the ascending aorta, a large patent ductus arteriosus (PDA) with right-to-left shunt, and moderate tricuspid regurgitation. Despite initial management with prostaglandin E1 (PGE1) infusion, discontinuation of the drug led to clinical deterioration characterized by severe metabolic acidosis and low cardiac output syndrome. Resuming PGE1 infusion stabilized the patient's hemodynamics and improved systemic blood flow, allowing for successful surgical repair. In cases of AORPA associated with aortic arch flow reversal, pulmonary hypertension, and inadequate interatrial communication, maintaining PDA patency with PGE1 infusion until surgical repair is critical for survival. The right-to-left flow across the PDA counteracts the steal from the aorta and decompresses the right ventricle, preventing right ventricular failureand maintaining systemic blood flow.

Double Aortic Arch: The Importance of Computed Tomography Diagnosis

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Transapical to Femoral Through-and-Through Wire Technique for Ruptured Aortic Arch Aneurysm Management: Case Report and Review of Literature.

To present a case where the transapical and femoral accesses were used to establish a through-and-through guidewire to deliver branched arch endograft effectively. An 86-year-old male presented with an aortic arch aneurysm rupture was treated with branched arch endograft. Due to tortuous anatomy, several attempts using femoral and axillary routes to navigate the endograft to the proximal landing zone failed. A through-and-through guidewire was established using transapical and femoral accesses to provide sufficient stability for subsequent advancement and delivery of the arch branch endograft. Transapical to femoral through-and-through approach is a feasible adjuvant for delivering aortic endografts in emergent cases, particularly in patients with trackability issues and challenging tortuous anatomy. This technique could be a valuable solution for carefully selected patients where conventional approaches are not viable. Transapical access has been widely used in valvular and elective aortic interventions; however, its application in ruptured scenarios is seldom documented. This case report details the utilisation of transapical access in a ruptured aortic arch aneurysm with a tortuous aorta, where femoral and axillary access have proven inadequate. Establishing a transapical to transfemoral through-and-through wire has provided enhanced stability for precise endograft deployment. Procedural details and outcomes, alongside a review of the literature, underscore the use of transapical access and through-and-through wire in managing complex ruptured pathologies, addressing gaps in the literature concerning its efficacy and safety in urgent high-risk scenarios.

Complex congenital heart and lung defects as a cause of hydrops fetalis in French bulldogs –micro-CT with contrast study

Limited data are available on the causes of hydrops fetalis in dogs. Congenital heart defects may be an important contributing factor. Standard autopsy often fails to provide a comprehensive and accurate diagnosis on very small hearts. This study was carried out on five French bulldog puppies all presenting with advanced hydrops fetalis and four diagnosed with pulmonary hypoplasia at autopsy. The body weight of the dogs ranged from 142 to 687 g and the heart with lungs weighed from 4.5 to 23.6 g. The hearts and pulmonary vessels were filled with barium contrast, and micro-CT scans of the physiologically connected heart and lungs were performed. In all five puppies, we confirmed congenital heart defects including: Puppy #1. Perimembranous ventricular septal defect and aortic dextroposition; Puppy #2. Interrupted aortic arch with aortic valve dysplasia and aortic stenosis; Puppy #3. Tricuspid valve dysplasia and bicuspid pulmonary trunk valve; Puppy #4. Aortic stenosis and ventricular septal defect; Puppy #5. Tricuspid valve dysplasia. Additionally, four puppies had pulmonary vascular hypoplasia. Contrast-enhanced micro-CT can provide highly accurate diagnosis of complex congenital heart and lung defects. Examination of the heart in conjunction with the lungs appears to be a rational approach in animals with hydrops fetalis.

Discussion of Simple vs Complex Aortic Arch Repair in Acute Type-A Aortic Dissection.

Discussion of Simple vs Complex Aortic Arch Repair in Acute Type-A Aortic Dissection.

Detection of Aortic Arch Tears Using Epiaortic Ultrasound During Surgical Management of Acute Type A Aortic Dissection

Detection of Aortic Arch Tears Using Epiaortic Ultrasound During Surgical Management of Acute Type A Aortic Dissection

Effect of lower body ischemia duration in aortic arch surgery under mild-to-moderate hypothermic circulatory arrest

Effect of lower body ischemia duration in aortic arch surgery under mild-to-moderate hypothermic circulatory arrest

Quantitative Electroencephalography Alpha:Delta Ratio and Suppression Ratio Monitoring During Infant Aortic Arch Reconstruction.

During infant aortic arch reconstruction, traditional electroencephalography (EEG) provides only qualitative data limiting neuromonitoring efficacy. Interhemispheric differences in the alpha:delta ratio (ADR) and suppression ratio (SR) measured using quantitative EEG generate numerical trends that may suggest cerebral ischemia. We hypothesized that the ADR and SR during cardiopulmonary bypass (CPB) would correlate with hemodynamics, and that ADR and SR interhemispheric differences would precede neurological injury from infants requiring aortic arch reconstruction. During aortic arch reconstruction, bilateral hemispheric ADRs and SRs were recorded every five minutes in conjunction with mean arterial pressure, temperature, CPB flow, and cerebral oximetry. Data were grouped into the cooling, antegrade cerebral perfusion (ACP), and rewarming periods of CPB. Correlation analysis determined relationships between the ADR, SR, and hemodynamic data. The cumulative interhemispheric ADR and SR differences were calculated during CPB. Neurological injury was defined as clinical/subclinical seizure or stroke. Among 79 infants, the ADRs decreased significantly during rewarming, whereas SRs were significantly greatest during ACP. There was a direct correlation between the ADR and cerebral oximetry (R2=0.734; P<0.001) and an inverse correlation between the SR and temperature (R2=0.882; P<0.001). Eight infants developed neurological injury that was more often preceded by an interhemispheric ADR difference >0.1 (50% vs 7.8%; P=0.01) or SR difference >18% (41.7% vs 4.8%; P=0.008). The ADR and SR correlate with cerebral oximetry and temperature, respectively, and significant interhemispheric differences often preceded neurological injury, suggesting the importance of quantitative EEG monitoring during infant aortic arch reconstruction.

Nitrogen-containing bisphosphonate for vascular calcification: animal experiments, systematic review and meta-analysis

BackgroundThe purpose of our study was to explore the effect of nitrogen-containing bisphosphonate (N-BP) on vascular calcification (VC) through animal experiments and a meta-analysis.MethodsIn our animal experiments, Sprague-Dawley (SD) rats were randomly divided into a control group, a VC group, a low-dose zoledronic acid (ZOL) (20 µg/kg) group and a high-dose ZOL (100 µg/kg) group. The calcification of the aortic arch was observed by alizarin red staining. The calcium content of the aortic arch was measured. In our systematic review and meta-analysis, databases, including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure (CNKI), and the Wanfang database, were searched from their inception to December 20, 2023. Eligible studies comparing N-BP versus no N-BP in the treatment of VC were included.ResultsIn our animal experiment, the red-stained calcification structure in the low-dose ZOL group was slightly reduced and the red-stained calcification structure in the high-dose ZOL group was significantly reduced compared with that in the VC. The calcium content in the low-dose ZOL group was slightly lower than that in the VC group, but the difference was not significant (P = 0.08). The calcium content in the high-dose ZOL group was significantly lower than that in the VC group (P < 0.0001). Our meta-analysis of human studies revealed that N-BP did not reduce the arterial calcification score (P = 0.46). Our meta-analysis of animal studies revealed that N-BP did not significantly reduce the arterial calcification score (P = 0.09), but N-BP reduced the arterial calcification area (P < 0.00001), arterial calcium content (P = 0.009) and PO4 content (P = 0.0001).ConclusionsOur animal experiment revealed that high-dose ZOL inhibited VC, but low-dose ZOL did not significantly inhibit VC. Our meta-analysis of human studies revealed that N-BP was not effective in the treatment of VC, but our meta-analysis of animal studies suggested a role of N-BP in inhibiting VC.

Impact of Lesion Severity in Fetal Cardiac Counseling.

Approximately 1% of all live births in the USA are affected by congenital heart disease (CHD), the leading cause of congenital defect-related illness and infant death. Although technological innovations have improved CHD diagnosis in utero, variation among fetal cardiac counseling practices persists. Our study aims to evaluate physician counseling content based on cardiac defect complexity. We conducted an anonymous survey of providers who perform fetal cardiac counseling. Participants stated their counseling practices for 21 CHD lesions, choosing from postnatal surgical intervention, termination of pregnancy, and/or postnatal palliative comfort care. CHD lesions were divided by severity into three groups. Chi-square tests were performed to assess whether counseling content varied based on provider response to the statement "some life is always better than no life at all." There were 138 respondents, with postnatal surgical intervention counseling frequency consistent among all lesions. Inclusion of termination and palliative/comfort care in counseling increased in frequency as disease severity increased, with the former being counseled more frequently. For tetralogy of Fallot (p = 0.02), interrupted aortic arch (p = 0.03), hypoplastic left heart syndrome (p = 0.03), and pulmonary atresia with intact ventricular septum (p = 0.03), those providers who disagreed with the statement that "some life is always better than no life at all" were more likely to counsel termination of pregnancy and/or palliative care compared to their counterparts. Our study found that the interventions and options included in fetal cardiac counseling vary based on complexity. Moreover, physicians' personal beliefs tended to influence counseling practices in some moderate or severe defects.

Prenatal diagnosis and clinical pregnancy outcome of fetuses with conotruncal defects in a Chinese cohort.

This study aimed to explore genetic etiologies of conotruncal defects (CTDs) in fetuses by analyzing the results of different genetic tests and to assess pregnancy outcomes of fetuses with CTD in a Chinese prenatal cohort. A total of 146 fetuses that underwent invasive prenatal genetic testing for CTD at the prenatal diagnosis center of the International Peace Maternity and Child Health Hospital between January 2018 and December 2022 were retrospectively analyzed. All of them underwent chromosomal microarray analysis (CMA) and karyotype analysis, but only 27 underwent whole-exome sequencing (WES). The results of these different genetic testing methods were collected and compared. Data on pregnancy outcomes and neonate prognosis were obtained from the electronic medical records and postpartum telephone follow-up. Among the 146 fetuses with CTD, the chromosome abnormality rate was 22.6% (33/146), and the detection rate of abnormal chromosomes in CMA and karyotype was 15.8% (23/146). Among the 27 pregnant women who accepted WES, five had pathogenic variants. The detection rate of abnormal chromosomes by CMA was higher in infants with an interrupted aortic arch (IAA) than in the other infant groups (60.0%, χ2 = 11.661, P = 0.045, c2-test or Fisher's exact test). Congenital heart disease is a complex congenital heart disease with an etiology closely related to genetic abnormalities. Therefore, invasive genetic testing and CMA are recommended as first-line tests for all fetuses with CTD detected by prenatal ultrasound, especially IAA. WES should be recommended when necessary.

Safety and validity of extracorporeal fenestration and in situ fenestration in patients with aortic disease involving the left subclavian artery: a prospective, single-center, randomized controlled study

BackgroundThoracic aortic pathologies involving the aortic arch are a great challenge for vascular surgeons. Maintaining the patency of supra-aortic branches while excluding the aortic lesion remains difficult. Thoracic EndoVascular Aortic Repair (TEVAR) with fenestrations provides a feasible and effective approach for this type of disease. The main purpose of this trial is to assess the safety and validity of extracorporeal fenestration and in situ fenestration in patients with aortic disease involving the left subclavian artery.MethodsThis is a prospective, single-center, randomized controlled study. A total of 170 eligible patients will be recruited from The Fourth Affiliated Hospital, Zhejiang University School of Medicine in China and randomized on a 1:1 basis either to the group A (extracorporeal fenestration) or the group B (in situ fenestration). The primary outcome will be the all-cause mortality (30 days). The secondary outcomes will include incidence of secondary intervention (30 days, 6 months, 1 year), incidence of endoleak (30 days, 6 months, 1 year), incidence of major adverse events (MAE) (i.e., immediate procedural success and complications) (30 days, 6 months, 1 year), immediate technical success rate, and all-cause mortality (6 months, 1 year).DiscussionSuppose extracorporeal fenestration non-inferior to in situ fenestration in patients with aortic disease involving the left subclavian artery. This trial aims to demonstrate the safety and validity of extracorporeal fenestration and in situ fenestration in patients with aortic disease involving the left subclavian artery, which is expected to provide a reference for Thoracic EndoVascular Aortic Repair (TEVAR) with fenestrations.Trial registrationClinicalTrials.gov NCT06256757. Registered on February 5, 2024. https://clinicaltrials.gov/study/NCT06256757.

Management Strategies for Truncus Arteriosus: A Comparative Analysis of Staged vs. Primary Repair.

We reviewed the outcomes of truncus arteriosus repair (primary vs. staged repair incorporating bilateral pulmonary artery banding), focusing on survival, reintervention, and functional data. We analyzed 39 patients who underwent a first intervention for truncus arteriosus (staged, n = 19; primary, n = 20) between 1992 and 2022. The median follow-up period was 8.0 (2.2-13.2) years. Survival, freedom from reoperation, and freedom from catheter intervention were estimated using the Kaplan-Meier method. High-risk patients were defined as those with a weight ≤ 2.5kg, ≥ moderate truncal valve regurgitation, interrupted aortic arch, or preoperative shock. In the staged group, patients with a median weight of 2.6kg had a median intensive care unit stay of 5days and no hospital mortality after bilateral pulmonary artery banding. At repair, the staged group had a larger conduit for the right ventricular outflow tract (14 vs. 12mm; P = .008). Catheter intervention on the branch pulmonary artery was required in 67% of patients in the staged group, but right ventricular end-diastolic pressure at follow-up was comparable between the groups (P = .541). Survival rates were higher among high-risk patients in the staged group (87.5% vs. 21.4% at 15years; P = .004) but were comparable between groups for standard-risk patients (P = 1.000). Bilateral pulmonary artery banding was a safe, effective procedure. Reintervention for branch pulmonary artery was common but did not affect functional outcomes. Staged repair may play a pivotal role regarding survival in high-risk patients, and risk stratification is vital.

Prenatal ultrasound diagnosis, associated anomalies and pregnancy outcomes of fetal right aortic arch

ObjectiveThe aim was to summarise the prenatal ultrasound characteristics, associated anomalies and pregnancy outcomes of fetal right aortic arch (RAA) and to discuss the value of prenatal ultrasound diagnosis and prognostic analysis.MethodsWe retrospectively analysed 157 cases of fetal RAA diagnosed via prenatal ultrasound in our hospital from October 2017 to October 2022. RAA features were characterised by comparing prenatal ultrasound data with anatomical casting results after pregnancy termination or postnatal imaging and surgical intervention to analyse the prognosis and misdiagnoses of fetal RAA.ResultsOf the 157 fetal RAA cases, 50 (31.8%) cases were isolated RAA and 107 (68.2%) cases were nonisolated RAA. In terms of typing, 78 cases (49.7%) of right aortic arch-aberrant left subclavian artery (RAA-ALSA) and 75 cases (47.8%) of right aortic arch-mirror branch (RAA-MB), 3 cases (1.9%) of right aortic arch-isolated left subclavian artery (RAA-ILSA) and 1 case (0.6%) of right aortic arch-isolated left innominate artery (RAA-ILINA) were identified, and the incidence of combined cardiac anomalies and chromosomal anomalies was significantly greater in the RAA-MB group than the RAA-ALSA group. The live birth rate was significantly lower in the nonisolated RAA group than the isolated RAA group, and the prognosis of RAA-MB was significantly worse than that of RAA-ALSA. Among the 76 surviving patients, 72 (94.7%) cases were correctly diagnosed via prenatal ultrasound, and 4 (5.3%) cases had missed diagnoses and misdiagnoses. Of the 81 terminated pregnancies, 19 cases received pathological anatomy or vascular casting, including 18 cases with results consistent with the prenatal ultrasound and 1 case with inconsistent results.ConclusionsPrenatal echocardiography is useful for diagnosing fetal RAA. It is also necessary to classify RAA types as accurately as possible and detect the presence of potential cardiac and extracardiac anomalies and genetic abnormalities, which facilitates prenatal counselling and prognostic assessment of fetuses with RAA.

Right Aortic Arch and Aberrant Left Subclavian Artery Presenting with Dysphagia Lusoria: A Case Report and Review of the Literature

Right aortic arch (RAA) occurs in 0.05% to 0.1% of the individuals. Dysphagia lusoria is the difficulty in swallowing due to the compression of the oesophagus due to aberrant vessels. We report a case of aberrant left subclavian artery (ALSA) arising from the RAA resulting in dysphagia in a 59-year-old male. However, he was able to take meals with minimal difficulties. A computerised tomographic scan (CT) of the chest revealed a RAA and an ALSA running posterior to the oesophagus compressing it. Considering that the patient can take meals and maintain his weight, he was managed conservatively.