Embryology and imaging review of aortic arch anomalies.

Congenital malformations of the thoracic aorta can be discovered on chest radiographs when associated with symptoms or found incidentally. We review the imaging anatomy and associations of many of the aortic arch malformations that can be encountered in adults and highlight key points with regard to their treatment and prognoses. An understanding of the normal and abnormal embryologic development of the aortic arch, with knowledge of their imaging features, may be important for improving diagnostic accuracy and patient care.

Application of modified perfusion technique on one stage repair of interrupted aortic arch in infants: a case series and literature review.

One stage repair of interrupted aortic arch (IAA) associated with cardiac anomalies in neonates and infants is challenging for the entire surgical team. Deep hypothermic circulatory arrest (DHCA) prolongs myocardial and cerebral ischemia and may induce heart, brain, and major organ dysfunction. From May 2004 to May 2006, 13 infants with IAA underwent one stage repair by median sternotomy under DHCA with continuous regional cerebral perfusion (RCP) in Fuwai Children's Heart Center. Median age at operation was 10.4 +/- 6.7 months, and mean body weight was 6.58 +/- 2.15 kg. Temperature of nasopharynx was decreased to 18 degrees C-20 degrees C; rectal temperature was controlled at 19 degrees C-22 degrees C. Flow rate of RCP was maintained with 20-25 ml x kg x min under DHCA combined with RCP. Mean artery pressure (MAP) measuring from right radial artery was 32.5 +/- 5.8 mm Hg, and MAP from femoral artery was 11.2 +/- 3.5 mm Hg. Mean cardiopulmonary bypass (CPB) time was 141.6 +/- 21.7 min, and mean aortic clamp time was 52.3 +/- 10.9 min. Mean duration of RCP was 31.5 +/- 12.4 min. Mean intubation time in intensive care unit (ICU) was 54.7 +/- 12.6 hours, and mean ICU stay was 67.9 +/- 28.4 hours. This report describes our CPB protocol under DHCA using continuous RCP in low weight pediatric patients to minimize neurological complications during one stage IAA repair and summarizes the various CPB managements in recent literature as well.

The American College of Rheumatology 1990 criteria for the classification of Takayasu arteritis.

Criteria for the classification of Takayasu arteritis were developed by comparing 63 patients who had this disease with 744 control patients with other forms of vasculitis. Six criteria were selected for the traditional format classification: onset at age less than or equal to 40 years, claudication of an extremity, decreased brachial artery pulse, greater than 10 mm Hg difference in systolic blood pressure between arms, a bruit over the subclavian arteries or the aorta, and arteriographic evidence of narrowing or occlusion of the entire aorta, its primary branches, or large arteries in the proximal upper or lower extremities. The presence of 3 or more of these 6 criteria demonstrated a sensitivity of 90.5% and a specificity of 97.8%. A classification tree also was constructed with 5 of these 6 criteria, omitting claudication of an extremity. The classification tree demonstrated a sensitivity of 92.1% and a specificity of 97.0%.