Head Vessels Research Articles

Experience with Zone 2 Arch Replacement Followed by Thoracic Endovascular Aortic Repair.

Transverse open aortic arch replacement remains a complex operation. A simplified arch replacement into zone 2, with debranching the head vessels proximally, creates a suitable landing zone for future endovascular repair and is increasing in popularity as of late. Still, limited data exist to assess contemporary rates of morbidity and mortality. Therefore, we aim to evaluate current outcomes for patients who underwent open zone 2 aortic arch replacement. All patients who underwent zone 2 arch replacement at a single academic institution from January 2019 to June 2023 were assessed. Indication for operation was either aneurysmal disease (n = 37), acute aortic syndrome (n = 38), or residual arch/descending thoracic aorta dissection (n = 67). Patient demographics and operative characteristics were evaluated, and the frequency of subsequent thoracic endovascular aortic repair (TEVAR) was noted. Mortality and major morbidity were then assessed. A total of 142 patients underwent open zone 2 arch replacement. Median cardiopulmonary bypass, cross-clamp, and deep hypothermic circulatory arrest times for the entire cohort were 195, 122, and 36.5 minutes, respectively. Concomitant frozen elephant trunk was performed in 45.1% of the cohort (n = 64). In-hospital mortality was 7.8% (n = 11) for the entire cohort. Spinal cord ischemia occurred in 3.5% (n = 5); these patients all received frozen elephant trunks and had neurologic recovery by discharge. Stroke occurred in 9.2% (n = 13) of the study cohort. A total of 38.7% (n = 55) went on to get subsequent TEVAR, with median time to TEVAR of 52 days (8, 98.5). Zone 2 arch replacement allows staged repair of the thoracic aorta and readily accommodates future TEVAR therapy. This option for the treatment of the aortic arch can be performed safely in a wide variety of patient pathologies. Given the safety of this operation, cardiac surgeons should utilize this approach more frequently.

Vascular Labeling of Extracranial Head and Neck Vessels Using Silicone Dye Injection: An Effective Method for Cadaver-Based Facial Surgery Training

Abstract Background Silicone dye injection is a well-described technique for studying vascular anatomy. Plastic surgeons routinely participate in cadaveric workshops and are involved in the preparation of vascular-labeled cadavers. However, sparse literature is available on dye studies of extracranial head and neck vessels, even with anatomists, and the preparation of these cadavers is a daunting task. Materials and Methods In this study, we describe a straightforward technique of silicone dye injection for extracranial head and neck vasculature and its application for filler injection training and other plastic surgical procedure demonstrations on cadavers. We used six soft-embalmed cadavers. The common carotid arteries and internal jugular veins were cannulated with infant feeding tubes. The vessels that could lead to dye extravasation into intracranial vessels and upper limbs were ligated. The vasculature was irrigated with water and then injected with color-coded silicone dyes (red: arterial; blue: venous). The solvent-to-catalyst ratios were varied to identify the ideal combination. Injected specimens were dissected 24 hours later to identify the staining quality. Results A clear demarcation of the extracranial head and neck vasculature in all cadavers was seen. The best solvent-to-catalyst ratio was identified in cadavers with the best staining of both large and small-sized blood vessels (<1 mm) with no dye spillage from arteries to the veins. Conclusion Silicone dye injection with the described technique can give excellent and predictable results. The technique also uses less quantity of dye, and the intracranial structures are spared, which can be used for other studies; hence, there is more economical utilization of cadavers.

OCTA quantitative assessment of exercise-induced variations and recovery in retinal microvasculature of healthy subjects with or without masks

PurposeTo investigate the impact of exercise and mask-wearing on retinal microvasculature using optical coherence tomography angiography (OCTA). MethodsA total of 30 healthy volunteers were enrolled and tasked with physical exercise to reach 75–80 % maximum heart rates. Swept-source OCTA was performed on the macular region and optic nerve head (ONH) in participants with no mask, surgical mask, or N95 mask at quiescent conditions (Step 1) and 0 min, 10 min, 20 min, and 30 min post-exercise (Steps 2–5, respectively). The functional vessel density (VD), including the superficial and deep plex (SP and DP) in the macular area and the superficial plex (SP), nerve fiber plex, and small vessels in the optic nerve head, were measured. ResultsUnder quiescent conditions, the functional VD of SP and DP exhibited significant reduction with surgical and N95 masks in the foveal area (P < 0.05). In step 2 (immediately after training) with or without masks, functional VD of SP and nerve fiber both showed significant reduction in the inside disc and peripapillary area, small functional VD of nerve fiber in the ONH showed significant reduction in peripapillary area (P < 0.05). These changes had been recovered in Step 5 (30 min post-exercise) in all groups (no-mask, surgical mask and N95 mask groups) (P > 0.05). ConclusionsMask-wearing and physical exercise reduce retinal functional VD in macular and ONH areas. The retinal vasoconstriction induced by exercise tends to recover after rest for approximately 30 min. Our research provides insights into mask-wearing and physical exercise's immediate retinal microvasculature effects, hinting at systemic microvascular changes.

Management of Vataja Shirashula with W.S.R Tension Headache - A Case Report

Shiras is also known as Uttamanga is the most vital part of our body. In Ayurveda, Shiro rogas are not restricted to pain or discomfort seen around cranial vault and but also the disorders of brain as such Headache is the most frequent and troublesome reason to seek medical help in our day to day life. In Ayurveda classics shirashoola is having prime importance among other shirorogas. Vataja shirashoola According to charaka samhita is defined as severe pain in head, temples, between eyebrows, dizziness, stiffness in the neck, discomfort in ear, throbbing pain of blood vessels in head .relieves on hot and unctuous things, on tight bandage. According to W.H.O 70% population suffers from tension headache. In this pandemic this percentage is increased more. There are various reasons like – emotional stress, lockdown ,unemployment, sedentary life style etc leading to a growth in tension headache cases. So this case is selected for study with rasnadi shirolepa and dashamula pratimarshya nasya and aswhaganda ksheerapaka.

Assessment of Time Lag Between Blood Flow, Retinal Nerve Fiber Layer Thickness and Visual Field Sensitivity Changes in Glaucoma.

This study investigates the temporal relationship between blood flow changes and alterations in retinal nerve fiber layer thickness (RNFLT) and mean deviation (MD) in individuals with glaucoma. Blood flow, measured by mean blur rate in optic nerve head vessels (MBRv) and tissues (MBRt) using laser speckle flowgraphy (LSFG)-NAVI, was analyzed using structural equation models (SEMs). SEMs assessed whether the previous rate of one parameter predicted the current rate of the other parameter, adjusted for its own rate in the previous time interval. Data from 345 eyes of 174 participants were gathered from visits every six months. Rates of change of both MBRv and MBRt were significantly predicted by their own rate in the previous time interval and by the rate of change of MD in the previous time interval (P < 0.001 and P = 0.043, respectively), but not by the rate of MD in the concurrent interval (P = 0.947 and P = 0.549), implying that changes in MD precede changes in blood flow. Rates of change of RNFLT were predicted by their own previous rate and the rate of change of MBRv and MBRt in either the previous interval (P = 0.002 and P = 0.008) or the concurrent interval (P = 0.001 and P = 0.018), suggesting that MBR may change before RNFLT. The evidence supports a temporal sequence where MD changes precede blood flow changes, which, in turn, may precede alterations in RNFLT.

Stimulus type and duration affect magnitude and evolution of flicker-induced hyperemia measured by laser speckle flowgraphy at the optic disc and peripapillary vessels

Neurovascular coupling is a vital mechanism employed by the cerebrovascular system, including the eye, to regulate blood flow in periods of neuronal activation. This study aims to investigate if laser speckle flowgraphy (LSFG) can detect coupling response elicited by flickering light stimuli and how variations in stimulus type and duration can affect the magnitude and evolution of blood flow in the optic nerve head (ONH) and peripapillary vessels. Healthy adults were exposed to two types of 10-Hz flicker stimuli: a photopic negative response-like stimulus (PhNR-S) or a visual evoked potential-like stimulus (VEP-S)—each presented in separate 10- and 60-s epochs. Both PhNR-S and VEP-S significantly increased ONH blood flow (p < 0.001) immediately after flicker cessation, with a trend of 60-s stimuli (PhNR-S = 11.6%; VEP-S = 10.4%) producing a larger response than 10-s stimuli (PhNR-S = 7.5%; VEP-S = 6.2%). Moreover, exposure to 60-s stimuli elicited a significantly prolonged ONH hyperemic response, especially with PhNR-S. Lastly, stimulation with either 60-s stimuli elicited a robust increase in blood flow within the peripapillary arterioles (p < 0.01) and venules (p < 0.01) as well. Flicker stimulation with common visual electrophysiology stimuli (PhNR-S and VEP-S) induced a demonstrable increase in ONH and peripapillary vessel blood flow, which varied with flicker duration. Our results validate that LSFG is a robust method to quantify flicker-induced hyperemic responses and to study neurovascular coupling in humans.

Outcomes of Head and Neck Free Tissue Transfer Requiring Vein Grafting: Systematic Review and Meta-analysis.

To systematically review the literature to determine the prevalence of free flap failure in head and neck free flaps requiring vein grafting. Search strategies created in collaboration with a medical librarian were implemented using PubMed, Cochrane, Scopus, Web of Science, and Google Scholar from inception to August 2022. The population of interest included adult and pediatric patients undergoing reconstruction of oncologic or traumatic head and neck defects with a free flap requiring a vein graft that presents the success/failure rate. The primary outcome was the flap failure rate, and the secondary outcome was the flap compromise/revision rate. Inclusion and exclusion criteria were designed to capture all study designs. Initially, 2778 articles were identified by the search strategy. Two reviewers independently performed the review, data extraction for analysis, and a quality assessment. Primary Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. Meta-analysis was performed using a random effects model. Eleven studies of 789 flaps were included for data extraction. Random effects meta-analysis resulted in an estimated prevalence of free flap failure of 12.30% (95% confidence interval: 6.39%-19.49%, I2 = 77.4%). Taking into account that head and neck free tissue transfers that require a vein graft are typically associated with more challenging reconstructions and the lack of a suitable alternative, vein grafts appear to be a reliable method for bridging the gap between the flap and recipient vessels in head and neck free tissue transfer when indicated.

Ruptures of arterial aneurysms of the brain and stenosis of the carotid basin: clinic, diagnosis

Objective – to investigate the clinical and morphological characteristics of the manifestations of the rupture of arterial aneurysms of the brain in patients with occlusive-stenotic lesions of the cerebral arteries.Materials and methods. 1147 case histories of patients with aneurysmal disease of the cerebral arteries who underwent comprehensive examination and treatment in the Department of Neurosurgical Pathology of Head and Neck Vessels with X-ray Surgical Department «Romodanov Institute of Neurosurgery NAMS of Ukraine» since 2006 until 2022. The medical histories of 126 patients who were included in this study and divided into two groups were studied in detail. The criteria for inclusion in the main group (38 men and 25 women) were: surgical treatment; rupture of arterial aneurysm the presence (proven using instrumental examination methods) of occlusive-stenotic lesions.The criteria for inclusion in the control group (38 men and 25 women) were: surgical treatment; rupture of arterial aneurysm; absence (proven by means of instrumental examination methods) of occlusive-stenotic lesions; the gender and age distribution had to match the main group.Among the patients included in this study, there were 76 men (60.32 %) and 50 women (39.68 %). The age of the patients varied from 31 to 77 years. The average age of patients ‒ 55.9 ± 0.76 years. Results. The Hunt‒Hess severity of patients was approximately the same between the main and control groups. When evaluated by the World Federation of Neurologican Surgeons (WFNS) and Glasgow Coma scale (GCS), more patients in the control group had a lighter score. Aneurysms of the anterior cerebral-anterior connecting artery complex prevailed in both groups. A higher frequency of arterial aneurysms of the middle cerebral artery was revealed among patients of the main group (main group ‒ 27.0 %, comparison group 15.8 %). The higher number of multiple aneurysms in the main group (the main group ‒ 25.4 %, the controlgroup ‒ 12.7 %) and the smaller number of miliary aneurysms and the larger number of large aneurysms in the main group may indicate the predominance of congenital etiological factors common to both pathologies in the development of the disease until the rupture of the arterial aneurysm.Conclusions. Gender differences were established with a predominance of men among patients of the main group (60.32 %). The average age of men with occlusive-stenotic lesions was lower than that of women (men – 54.3±0.94 years, women – 58.3±1.19 years). The difference in age is especially pronounced in the subgroup of the main group where the severity of stenosis is 50‒75 % (men ‒ 48.3 years; women ‒ 62.0 years).The neurological status of patients with a hemorrhagic stroke, as a result of the rupture of an arterial aneurysm, is significantly aggravated by occlusive-stenotic lesions due to the occurrence of chronic brain ischemia. The worst prognosis is in men with a ruptured arterial aneurysm and a 50‒75 % stenotic lesion.

Spontaneous Oropharyngeal Bleeding Caused by Lingual Artery Pseudo-Aneurysm.

Spontaneous oropharyngeal bleeding is an uncommon but serious medical emergency mainly caused by accidental trauma or post-tonsillectomy. In extremely rare cases, it can be attributed to arterial pseudoaneurysm (PA) of head and neck vessels. The authors present the case of a young female patient presenting with recurring spontaneous oropharyngeal bleeding who was found to have a lingual artery PA on angiography. Due to the active nature of the hemorrhage and extensive blood loss, embolization of the tonsillar branch of the lingual artery was successfully performed. When evaluating patients with spontaneous oropharyngeal bleeding, one should suspect the presence of an arterial PA, especially if the bleeding recurs following initial conventional interventions.

Novel, intermediate-fidelity simulator for aortic arch surgery for the cardiothoracic surgical trainee.

Training cardiothoracic surgeons in open aortic surgery is challenging due to limited operator experience, low patient volume and technically demanding skills to be performed within a deep thoracic cavity. Surgical simulation has become a cornerstone of cardiothoracic surgical training and has been shown to improve skill acquisition and performance in the operating theatre. Due to the complexity of aortic surgery, there is a paucity of simulators that are concomitantly accessible and of sufficient fidelity. The purpose of this study was to develop a reproducible, intermediate-fidelity simulator for aortic surgery. This novel simulator was constructed from plastic storage containers to simulate the depth of a thoracic cavity. Head vessels and distal arch were reconstructed within the stimulator with synthetic Dacron polyester grafts to maximize model fidelity. A porcine or bovine heart was used for the simulation of aortic root replacement and anastomosis to the distal arch graft. The simulator was reproduced in a wet-lab skills session at an annual Australian cardiothoracic trainee meeting. Qualitative feedback was obtained from the current cardiothoracic trainees. It is a feasible model for the practice of aortic surgery. As the surgical education paradigm shifts towards simulation, this easily reproducible, intermediate-fidelity model provides an effective avenue to equip the trainee for the operating room and is a method of surgical training that can be considered by colleges.

Experimental analysis of femoral head intraosseous vascular anastomosis in the treatment of porcine subcapital femoral neck fractures

IntroductionFemoral neck fractures are challenging injuries associated with a compromised blood supply to the femoral head, leading to a high risk of avascular necrosis and poor clinical outcomes. This study aimed to investigate the efficacy of femoral head intraosseous vascular anastomosis in the treatment of porcine sub-capital femoral neck fractures. MethodsTen Landrace pigs were used as experimental animal models. The femoral head was completely removed after femoral neck sub-cephalic fracture. It was fixed on the medial side of the knee joint, and the blood supply to the femoral head was reconstructed by anastomosing the femoral head vessels. One week later, blood flow in the femoral head was observed by borehole, digital subtraction angiography examination, and hematoxylin and eosin staining. Further, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling tests were performed to detect pathological changes in the femoral head. ResultsAfter one-week, digital subtraction angiography of the femoral head revealed a blood circulation rate of 70 %, and the blood seepage rate of the borehole was 80 %. Hematoxylin and eosin staining and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labelling test results showed that necrosis of bone marrow cells in the experimental group was significantly improved compared to that in the control group. DiscussionThis study highlights the potential benefits of femoral head intraosseous vascular anastomosis in the treatment of porcine sub-capital femoral neck fractures. Further research and clinical trials are warranted to validate these findings and to explore the translational potential of this technique in human patients.

Acute ischaemic larger artery stroke presenting as a subcortical lesion with grey matter sparing: a case report

Large artery infarctions classically involve both white matter and grey matter in the distribution of the occluded artery. Rarely, large artery infarctions can present as isolated white matter lesions. We describe a 38-year-old, right-hand dominant woman, who presented with sudden onset right face-arm-leg weakness together with expressive aphasia. Neuroimaging demonstrated changes restricted to the white matter in the distribution of the left middle cerebral artery territory. Vascular imaging of her head and neck vessels showed irregular narrowing of the intracranial portions of the left internal carotid artery. Vasculitis was suspected due to these findings on imaging, and she was initially treated with steroids. However, due to the negative vasculitis work-up and an inadequate response, the steroids were discontinued, and she was treated with antiplatelets and statins. Early stroke rehabilitation commenced while inward.Large artery ischaemic strokes can rarely present as white matter lesions when there is adequate collateral circulation, which leads to the sparing of the grey matter.

Polystyrene nanoplastics induce developmental impairments and vasotoxicity in zebrafish (Danio rerio)

The exponential use of plastics has significantly increased environmental pollution by nanoplastics (NPs). In the aquatic environment, NPs interact and bioaccumulate in the biota, posing a potential ecotoxicological risk. The present study investigated the developmental toxicity, vasotoxicity, cytotoxicity, ROS induction, and behavioral impairments in zebrafish (Danio rerio) exposed to environmentally relevant polystyrene NPs (PS-NPs) concentrations (0.04, 34 ng L-1, and 34 μg L-1) for 144 h through multiple biomarkers response (mortality, frequency of spontaneous contractions, heart rate, and morphological changes). Furthermore, vasotoxicity (head, yolk sac, tail, and branchial vessels) was evaluated using the transgenic zebrafish tg(Fli1:eGFP). Results showed that PS-NPs interacted mainly with zebrafish chorion, gills, tail, and larvae head. PS-NPs at 34 ng L-1 and 34 μg L-1 induced neurotoxicity (decreased frequency of spontaneous contractions), cardiotoxicity (bradycardia), and morphological changes in the eyes and head, indicating that PS-NPs induce developmental impairments in zebrafish. In addition, cytotoxicity in the caudal region (34 ng L-1), ROS production, decreased mean swimming speed, and distance covered were observed in all tested concentrations. PS-NPs also induced vasotoxicity (yolk sac region) in transgenic zebrafish. Overall, the present study demonstrates the harmful effects of PS-NPs on the early developmental stages of freshwater fish, indicating their environmental risk.

TaG-Net: Topology-aware Graph Network for Centerline-based Vessel Labeling.

Anatomical labeling of head and neck vessels is a vital step for cerebrovascular disease diagnosis. However, it remains challenging to automatically and accurately label vessels in computed tomography angiography (CTA) since head and neck vessels are tortuous, branched, and often spatially close to nearby vasculature. To address these challenges, we propose a novel topology-aware graph network (TaG-Net) for vessel labeling. It combines the advantages of volumetric image segmentation in the voxel space and centerline labeling in the line space, wherein the voxel space provides detailed local appearance information, and line space offers high-level anatomical and topological information of vessels through the vascular graph constructed from centerlines. First, we extract centerlines from the initial vessel segmentation and construct a vascular graph from them. Then, we conduct vascular graph labeling using TaG-Net, in which techniques of topology-preserving sampling, topology-aware feature grouping, and multi-scale vascular graph are designed. After that, the labeled vascular graph is utilized to improve volumetric segmentation via vessel completion. Finally, the head and neck vessels of 18 segments are labeled by assigning centerline labels to the refined segmentation. We have conducted experiments on CTA images of 401 subjects, and experimental results show superior vessel segmentation and labeling of our method compared to other state-of-the-art methods.

Improving the depiction of small intracranial vessels in head computed tomography angiography: a comparative analysis of deep learning reconstruction and hybrid iterative reconstruction.

This study aimed to evaluate the ability of deep learning reconstruction (DLR) compared to that of hybrid iterative reconstruction (IR) to depict small vessels on computed tomography (CT). DLR and two types of hybrid IRs were used for image reconstruction. The target vessels were the basilar artery (BA), superior cerebellar artery (SCA), anterior inferior cerebellar artery (AICA), and posterior inferior cerebellar artery (PICA). The peak value, ΔCT values defined as the difference between the peak value and background, and full width at half maximum (FWHM), were obtained from the profile curves. In all target vessels, the peak and ΔCT values of DLR were significantly higher than those of the two types of hybrid IR (p < 0.001). Compared to that associated with hybrid IR, the FWHM of DLR was significantly lower in the SCA (p < 0.001), AICA (p < 0.001), and PICA (p < 0.001). In conclusion, DLR has the potential to improve visualization of small vessels.

Evaluation of optic nerve head vessels density changes after phacoemulsification cataract surgery using optical coherence tomography angiography.

To evaluate optic nerve head (ONH) vessel density (VD) changes after cataract surgery using optical coherence tomography angiography (OCTA). This was a prospective observational study. Thirty-four eyes with mild/moderate cataracts were included. ONH scans were obtained before and 3mo after cataract surgery using OCTA. Radial peripapillary capillary (RPC) density, all VD, large VD and retinal nerve fiber layer thickness (RNFLT) in total disc, inside disc, and different peripapillary sectors were assessed and analyzed. Image quality score (QS), fundus photography grading and best-corrected visual acuity (BCVA) were also collected, and correlation analyses were performed between VD change and these parameters. Compared with baseline, both RPC and all VD increased in inside disc area 3mo postoperatively (from 47.5%±5.3% to 50.2%±3.7%, and from 57.87%±4.30% to 60.47%±3.10%, all P<0.001), but no differences were observed in peripapillary area. However, large VD increased from 5.63%±0.77% to 6.47%±0.72% in peripapillary ONH region (P<0.001). RPC decreased in inferior and superior peripapillary ONH parts (P=0.019, <0.001 respectively). There were obvious negative correlations between RPC change and large VD change in inside disc, superior-hemi, and inferior-hemi (r=-0.419, -0.370, and -0.439, P=0.017, 0.044, and 0.015, respectively). No correlations were found between VD change and other parameters including QS change, fundus photography grading, postoperative BCVA, and postoperative peripapillary RNFLT. RPC density and all VD in the inside disc ONH region increase 3mo after surgery in patients with mild to moderate cataract. No obvious VD changes are found in peripapillary area postoperatively.

Using high-density perimetry to explore new approaches for characterizing visual field defects

High-density threshold perimetry has found that conventional static threshold perimetry misses defects due to undersampling. However, high-density testing can be both slow and limited by normal fixational eye movements. We explored alternatives by studying displays of high-density perimetry results for angioscotomas in healthy eyes—areas of reduced sensitivity in the shadows of blood vessels. The right eyes of four healthy adults were tested with a Digital Light Ophthalmoscope that gathered retinal images while presenting visual stimuli. The images were used to infer stimulus location on each trial. Contrast thresholds for a Goldmann size III stimulus were measured at 247 locations of a 13°×19° rectangular grid, with separation 0.5°, extending from 11° to 17° horizontally and −3° to +6° vertically, covering a portion of the optic nerve head and several major blood vessels. Maps of perimetric sensitivity identified diffuse regions of reduced sensitivity near the blood vessels, but these showed moderate structure–function agreement that was only modestly improved when effects of eye position were accounted for. An innovative method termed slice display was used to locate regions of reduced sensitivity. Slice display demonstrated that many fewer trials could yield similar structure–function agreement. These results are an indication that test duration might be reduced dramatically by focusing on location of defects rather than maps of sensitivity. Such alternatives to conventional threshold perimetry have the potential to map the shape of defects without the extensive time demands of high-density threshold perimetry. Simulations illustrate how such an algorithm could operate.

ISUOG Practice Guidelines (updated): fetal cardiac screening.

ISUOG Practice Guidelines (updated): fetal cardiac screening.

Outcomes of surgery for coarctation of the aorta based on a new classification system.

To evaluate early- and long-term outcomes of the surgical treatment for coarctation of the aorta based on a new classification system. A retrospective clinical review of 111 patients with coarctation of the aorta who underwent surgery (March 2011 to August 2020) was performed. We categorised coarctation of the aorta into type I, with all three head vessels tightly packed; type II, with the left subclavian artery separated from the two other head vessels; and type III, with all three head vessels separated from one another. Each type included subtype a, with a short isthmic portion, and subtype b, with a long isthmic portion. The median patient age and weight at operation were 8 (range, 1-1490) days and 3.2 (range, 1.9-18.5) kg, respectively. Extended end-to-end anastomosis was performed via sternotomy in 54, via thoracotomy in 12, end-to-side anastomosis in 31, autologous main pulmonary artery patch augmentation in 12, and modified end-to-end anastomosis combined with subclavian artery flap aortoplasty in two patients. There was one (0.9%) case of early mortality and 12 (10.8%) cases of post-operative complications. Two (1.8%) late deaths occurred during follow-up. Five (4.5%) patients underwent balloon dilatation and three (2.7%) underwent reoperation for restenosis of coarctation of the aorta. All patients with type Ia (21 patients, 18.9%) underwent extended end-to-end anastomosis via sternotomy or thoracotomy. According to the early and late outcomes observed in this study, surgical treatment of coarctation of the aorta using the new classification system could be safe and low risk.

Truncus Arteriosus and Absent Ascending Aorta With Unusual Head and Neck Vessel Origins

We describe a neonate with a unique variant of truncus arteriosus with interrupted aortic arch, an absent ascending aorta, persistent right dorsal aorta, and an unusual brachiocephalic artery pattern in which all head and neck vessels were supplied from the ductal arch-descending aorta continuum. (Level of Difficulty: Beginner.)