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1.
BMJ Case Rep ; 12(11)2019 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-31767601

RESUMO

Kommerell's diverticulum is a relatively rare congenital aortic arch anomaly. A 56-year-old man presented with complaint of gradually progressive hoarseness of voice since 6 months. Clinical examination revealed no evidence of palpable neck mass or cervical lymphadenopathy. Indirect laryngoscopy showed right vocal cord in median position and was immobile during phonation with normal left vocal cord. This was followed by contrast-enhanced CT (CECT) of the neck and upper chest for further evaluation. CT scan showed features of right vocal cord palsy. CECT also showed right-sided aortic arch with aberrant origin of the left subclavian artery. Aneurysmal dilatation of the aortic arch was noted at the take off of aberrant left subclavian artery suggesting Kommerell's diverticulum. Therefore, diagnosis of right vocal cord palsy due to compression of the right recurrent laryngeal nerve (RLN) by Kommerell's diverticulum was kept. Left RLN palsy did not occur in this case because the left RLN likely courses around the normal segment of the aortic arch just proximal to the origin of the left subclavian artery. As the patient was mildly symptomatic, he was kept on conservative treatment with close follow-up. The present case report highlights importance of the inclusionn of the superior mediastinum on CT scan in case of suspected vocal cord palsy to exclude vascular causes of RLN paralysis.


Assuntos
Aorta Torácica/anormalidades , Síndromes do Arco Aórtico/complicações , Paralisia das Pregas Vocais/congênito , Humanos , Masculino , Mediastino/diagnóstico por imagem , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Paralisia das Pregas Vocais/diagnóstico por imagem
2.
Gynecol Obstet Fertil Senol ; 47(10): 726-731, 2019 10.
Artigo em Francês | MEDLINE | ID: mdl-31494313

RESUMO

OBJECTIVE: To investigate prenatal diagnosis characteristics and pregnancy outcomes associated with isolated right aortic arch (RAA). METHODS: A retrospective study including fetuses with isolated RAA, managed between January 2010 and February 2018. Cases were identified from the ultrasound databases of the expert pediatric cardiologists, who made the aforementioned diagnosis. All fetuses were examined by a fetal medicine imaging expert to exclude any extracardiac abnormality. A systematic review was performed to assess the prenatal diagnosis and outcomes of fetuses with isolated RAA. RESULTS: Fifty-six fetuses were diagnosed with an isolated RAA. An isolated double aortic arch (DAA) was diagnosed in one fetus. Mean gestational age at diagnosis was 24 weeks. The sex ratio (boy/girl) was 0.89. No significant abnormality was detected in invasive tests (karyotype and FISH or microarray). Only one fetus was misdiagnosed with isolated RAA. He was the only symptomatic (stridor) newborn baby and was later diagnosed with DAA. Four studies were included in our systematic review representing 115 cases of isolated RAA. One significant chromosomal abnormality was detected: a 22q11 deletion in a newborn baby who had a postnatal finding of a soft palate cleft. There was one major obstetric complication: an intrauterine fetal demise at 41 gestational weeks. CONCLUSION: Diagnosis of isolated RAA can be challenging. Invasive tests are to be discussed. The diagnosis of isolated RAA should not change obstetric monitoring. Nevertheless, an echocardiography should be performed systematically in these new newborn babies within their first month of life.


Assuntos
Síndromes do Arco Aórtico/diagnóstico por imagem , Síndromes do Arco Aórtico/embriologia , Resultado da Gravidez , Ultrassonografia Pré-Natal , Adulto , Síndromes do Arco Aórtico/genética , Fissura Palatina/genética , Ecocardiografia , Feminino , Deleção de Genes , Humanos , Recém-Nascido , Masculino , Palato Mole , Gravidez , Estudos Retrospectivos
3.
4.
Genesis ; 57(7-8): e23326, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31299141

RESUMO

While common in the general population, the developmental origins of "normal" anatomic variants of the aortic arch remain unknown. Aortic arch development begins with the establishment of the second heart field (SHF) that contributes to the pharyngeal arch arteries (PAAs). The PAAs remodel during subsequent development to form the mature aortic arch and arch vessels. Retinoic acid signaling involving the biologically active metabolite of vitamin A, plays a key role in multiple steps of this process. Recent work from our laboratory indicates that the E3 ubiquitin ligase Hectd1 is required for full activation of retinoic acid signaling during cardiac development. Furthermore, our study suggested that mild alterations in retinoic acid signaling combined with reduced gene dosage of Hectd1, results in a benign aortic arch variant where the transverse aortic arch is shortened between the brachiocephalic and left common carotid arteries. These abnormalities are preceded by hypoplasia of the fourth PAA. To further explore this interaction, we investigate whether reduced maternal dietary vitamin A intake can similarly influence aortic arch development. Our findings indicate that the incidence of hypoplastic fourth PAAs, as well as the incidence of shortened transverse arch are increased with reduced maternal vitamin A intake during pregnancy. These studies provide new insights as to the developmental origins of these benign aortic arch variants.


Assuntos
Aorta Torácica/embriologia , Síndromes do Arco Aórtico/etiologia , Fenômenos Fisiológicos da Nutrição Materna , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Deficiência de Vitamina A/metabolismo , Vitamina A/metabolismo , Animais , Aorta Torácica/anormalidades , Aorta Torácica/anatomia & histologia , Feminino , Camundongos , Gravidez , Ubiquitina-Proteína Ligases/genética , Ubiquitina-Proteína Ligases/metabolismo
5.
Interact Cardiovasc Thorac Surg ; 29(5): 818-819, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31317173

RESUMO

A right-sided descending aorta with a left aortic arch is a rare congenital anomaly in which the aortic arch crosses the midline from the left side of the trachea coursing to the descending aorta in the right thoracic cavity. The surgical repair of an interrupted aortic arch with a right-sided descending aorta carries great risks of bronchial and oesophageal obstruction. Herein, we describe a case of successful surgical repair of an interrupted aortic arch with a right-sided descending aorta using the swing-back and trap-door techniques.


Assuntos
Aorta Torácica/anormalidades , Síndromes do Arco Aórtico/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Síndromes do Arco Aórtico/congênito , Síndromes do Arco Aórtico/diagnóstico , Feminino , Humanos , Recém-Nascido , Tomografia Computadorizada por Raios X
7.
Cardiol Young ; 29(3): 412-413, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30714551

RESUMO

Aortic arch anomalies are rare congenital cardiovascular malformations. We present a case of a 9-year-old asymptomatic boy with an unusual, unknown arch anomaly.


Assuntos
Aorta Torácica/anormalidades , Síndromes do Arco Aórtico/congênito , Síndromes do Arco Aórtico/diagnóstico , Doenças Assintomáticas , Criança , Diagnóstico Diferencial , Humanos , Masculino , Tomografia Computadorizada por Raios X
8.
Fetal Pediatr Pathol ; 38(3): 195-205, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30729837

RESUMO

OBJECTIVE: To investigate right aortic arches (RAA) quantitatively and risk-stratify fetuses with RAA prenatally. METHOD: A total of 143 singleton fetuses were enrolled. Four measurements were studied, including the angle and distance between the aortic arch (AO) and ductal arch (DA), the diameters of the AO and DA, and the distance growth rate (DGR). RESULT: A significant increase in mean distance was observed in the study group (4.89 ± 1.07 mm) compared to the control group (1.62 ± 0.33 mm, p<.01). The distance increased from the second (1.52 ± 0.35 mm, p<.01, 4.06 ± 0.78 mm, p<.01) to third trimester (1.71 ± 0.29 mm, p<.01, 5.13 ± 1.10 mm, p<.01) in the normal and study groups. Fetuses with abnormalities in addition to RAAs had significantly lower growth rates (12.4 ± 5.2%) than those with an isolated RAA (33.7 ± 12.0%). CONCLUSION: Parameters, especially DGR, may be clinically significant. DGR may be restricted when an RAA exists with other malformations. Decreasing DGR in fetuses with RAAs suggests the presence of other malformations.


Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Síndromes do Arco Aórtico/diagnóstico por imagem , Malformações Vasculares/diagnóstico por imagem , Feminino , Feto/diagnóstico por imagem , Humanos , Gravidez , Cuidado Pré-Natal/métodos , Diagnóstico Pré-Natal/métodos , Estudos Retrospectivos , Ultrassonografia Pré-Natal/métodos
9.
Ann Thorac Surg ; 107(1): e41-e43, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30009804

RESUMO

Interrupted right aortic arch is a rare congenital cardiovascular anomaly typically associated with other forms of congenital heart disease. We report two cases of interrupted right aortic arch associated with isolated left pulmonary artery and bilateral ductus arteriosus in the first case and with truncus arteriosus in the second case. Computed tomography was complementary to echocardiography in delineating the anatomic details in both cases, informing surgical repair with reconstruction of a left aortic arch in the first case and right arch in the second case.


Assuntos
Síndromes do Arco Aórtico/cirurgia , Angiografia por Tomografia Computadorizada , Permeabilidade do Canal Arterial/cirurgia , Ecocardiografia Doppler , Imageamento Tridimensional , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tronco Arterial/cirurgia , Síndromes do Arco Aórtico/complicações , Síndromes do Arco Aórtico/diagnóstico por imagem , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/diagnóstico por imagem , Feminino , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Humanos , Recém-Nascido , Masculino , Diagnóstico Pré-Natal , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Taquipneia/etiologia , Tronco Arterial/diagnóstico por imagem
10.
Ultrasound Obstet Gynecol ; 54(1): 96-102, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30125417

RESUMO

OBJECTIVES: To report our experience with fetal diagnosis of right aortic arch (RAA) variants based on the ductus arteriosus (DA) anatomy and brachiocephalic vessel branching pattern in relation to the trachea, and to establish whether the echocardiographic 'V-shaped' or 'U-shaped' appearance of the junction between the DA and aortic arch (AA) in the fetal upper mediastinal view is sufficiently accurate for assessment of fetal AA anatomy. METHODS: This was a retrospective study of pregnancies with a prenatal diagnosis of fetal RAA that had postnatal confirmation of AA anatomy, referred to our tertiary center during 2011-2017. Prenatal and postnatal medical records, including echocardiographic and computed tomography (CT)/magnetic resonance imaging (MRI) scan reports, were reviewed, and cardiac and extracardiac abnormalities and the results of genetic testing were recorded. RESULTS: Of 55 consecutive pregnancies with a prenatal diagnosis of fetal RAA, six were lost to follow-up, one was terminated and three were excluded due to lack of postnatal confirmation of AA anatomy. Of the remaining 45 pregnancies, AA anatomy was assessed postnatally by CT in 39, by MRI in one and by direct examination at cardiac surgery in five. A U-shaped appearance was found in 37/45 (82.2%) patients, all of which had a complete vascular ring (CVR). Of these 37 patients, on postnatal confirmation, 21 (56.8%) had RAA with Kommerell's diverticulum, left posterior ductus arteriosus (LPDA) and aberrant left subclavian artery (ALSA) (RAA/LPDA/ALSA), 11 (29.7%) had a double AA (DAA), four (10.8%) had RAA with Kommerell's diverticulum, LPDA and mirror-image (MI) branching (RAA/LPDA/MI), and one (2.7%) had RAA with Kommerell's diverticulum, LPDA and aberrant left innominate artery (ALIA) (RAA/LPDA/ALIA). A V-shaped appearance was found in 3/45 (6.7%) patients, all of which had RAA with right DA not forming a CVR and MI branching. In the 5/45 (11.1%) fetuses with neither U- nor V-shaped appearance, RAA with left anterior DA arising from the left innominate artery and MI branching, not forming a CVR, was found. Twelve (26.7%) fetuses had a congenital heart defect (CHD). RAA forming a CVR (U-shaped appearance) was associated with a septal defect in 6/37 (16.2%) fetuses, while RAA not forming a CVR (V-shaped appearance or no U- or V-shaped appearance) was associated with major CHD in 6/8 (75.0%) fetuses. CONCLUSIONS: In fetuses with RAA, V-shaped appearance of the junction between the DA and AA indicates only that the transverse AA and DA run together on the same side of the thorax (trachea) while a U-shaped appearance is always a sign of a CVR. Among fetuses with a CVR, RAA/LPDA/MI is more frequent than described previously. Finally, RAA forming a CVR is not usually associated with complex CHD, as opposed to RAA not forming a CVR. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Aorta Torácica/diagnóstico por imagem , Síndromes do Arco Aórtico/diagnóstico por imagem , Ecocardiografia/métodos , Coração Fetal/anormalidades , Diagnóstico Pré-Natal/normas , Adulto , Aorta Torácica/anormalidades , Síndromes do Arco Aórtico/patologia , Anormalidades Cardiovasculares/diagnóstico por imagem , Canal Arterial/diagnóstico por imagem , Feminino , Doenças Fetais/diagnóstico por imagem , Coração Fetal/diagnóstico por imagem , Testes Genéticos/métodos , Idade Gestacional , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/patologia , Humanos , Imagem por Ressonância Magnética/métodos , Cuidado Pós-Natal/estatística & dados numéricos , Gravidez , Diagnóstico Pré-Natal/métodos , Estudos Retrospectivos , Artéria Subclávia/anormalidades , Artéria Subclávia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia Pré-Natal/estatística & dados numéricos , Anel Vascular/diagnóstico por imagem , Anel Vascular/patologia
11.
Cardiol Young ; 29(1): 85-87, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30360770

RESUMO

In this report, a unique case of a symptomatic vascular ring formed by right aortic arch, aberrant left subclavian artery, and left ligamentum arteriosus in which there is atresia of the proximal left subclavian artery is described. Imaging modalities were non-diagnostic and the patient was sent to surgery based on strong clinical suspicion. Her anatomy was delineated in the operating room and the ring was successfully repaired.


Assuntos
Aorta Torácica/anormalidades , Síndromes do Arco Aórtico/diagnóstico por imagem , Artéria Subclávia/anormalidades , Anel Vascular/diagnóstico por imagem , Anormalidades Múltiplas , Criança , Ecocardiografia , Feminino , Humanos , Imageamento Tridimensional , Imagem por Ressonância Magnética , Anel Vascular/cirurgia
13.
Gen Thorac Cardiovasc Surg ; 67(3): 336-339, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29934726

RESUMO

Vascular rings are congenital anomalies of the aortic arch, which may cause compression of the trachea and esophagus. Compression symptoms usually present in infants and children. Adult presentations are quite rare, and compression symptoms may not be relieved by surgical correction due to tracheal remodeling and malacia caused by a long-standing compression. Here, we present an adult case of symptomatic vascular ring formed by the right aortic arch and persistent left ligamentum arteriosus. Respiratory symptoms were predominantly due to severe tracheal stenosis caused by tracheal wall thickening through remodeling during long-standing compression, and were relieved by surgery with transection of the persistent followed by resection and reconstruction of the trachea.


Assuntos
Traqueia/cirurgia , Estenose Traqueal/cirurgia , Anel Vascular/cirurgia , Aorta Torácica , Síndromes do Arco Aórtico , Feminino , Humanos , Pessoa de Meia-Idade , Estenose Traqueal/diagnóstico por imagem , Estenose Traqueal/etiologia , Anel Vascular/diagnóstico por imagem
14.
J Pediatr ; 204: 66-70, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30292491

RESUMO

OBJECTIVE: To establish the impact that timing of diagnosis and place of birth have on neonatal outcomes in those with readily treatable critical congenital heart disease. STUDY DESIGN: This was a population-based study with a complete national cohort of live-born infants with transposition of the great arteries and aortic arch obstruction in New Zealand between 2006 and 2014. Timing of diagnosis, place of birth, survival to surgery, in-hospital events, and neonatal mortality were reviewed. Live births with a gestation of ≥35 weeks and without associated major extracardiac anomalies were included for analysis. RESULTS: A total of 166 live-born infants with transposition of the great arteries and 87 with aortic arch obstruction were included. Antenatal detection increased from 32% in the first 3 years to 47% in the last 3 years (P = .05). During the same period, neonatal mortality decreased from 9% to 1% (P = .02). No deaths occurred after surgical intervention. An antenatal diagnosis was associated with decreased mortality (1/97 [1%] vs 11/156 [7%]; P = .03) and birth outside the surgical center was associated with increased risk of mortality (11/147 [7%] vs 1/106 [1%]; P = .02). Those with an antenatal diagnosis required fewer hours of mechanical ventilation (P = .02) and had shorter durations of hospital stay (P = .05) compared with those diagnosed >48 hours after birth. CONCLUSIONS: The mortality risk for transposition of the great arteries and critical aortic arch obstruction is greatest before cardiac surgery. Improved antenatal detection allowing delivery at a surgical center is associated with reduced mortality.


Assuntos
Síndromes do Arco Aórtico/mortalidade , Mortalidade Infantil/tendências , Diagnóstico Pré-Natal/estatística & dados numéricos , Transposição dos Grandes Vasos/mortalidade , Síndromes do Arco Aórtico/complicações , Síndromes do Arco Aórtico/diagnóstico , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Nova Zelândia , Gravidez , Fatores de Tempo , Transposição dos Grandes Vasos/complicações , Transposição dos Grandes Vasos/diagnóstico
16.
Arq Bras Cardiol ; 111(5): 666-673, 2018 11.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30281694

RESUMO

BACKGROUND: Congenital heart diseases are the most common type of congenital defects, and account for more deaths in the first year of life than any other condition, when infectious etiologies are ruled out. OBJECTIVES: To evaluate survival, and to identify risk factors in deaths in newborns with critical and/or complex congenital heart disease in the neonatal period. METHODS: A cohort study, nested to a randomized case-control, was performed, considering the Confidence Interval of 95% (95% CI) and significance level of 5%, paired by gender of the newborn and maternal age. Case-finding, interviews, medical record analysis, clinical evaluation of pulse oximetry (heart test) and Doppler echocardiogram were performed, as well as survival analysis, and identification of death-related risk factors. RESULTS: The risk factors found were newborns younger than 37 weeks (Relative Risk - RR: 2.89; 95% CI [1.49-5.56]; p = 0.0015), weight of less than 2,500 grams (RR: 2.33 [; 95% CI 1.26-4.29]; p = 0.0068), occurrence of twinning (RR: 11.96 [95% CI 1.43-99.85]; p = 0.022) and presence of comorbidity (RR: 2.27 [95% CI 1.58-3.26]; p < 0.0001). The incidence rate of mortality from congenital heart disease was 81 cases per 100,000 live births. The lethality attributed to critical congenital heart diseases was 64.7%, with proportional mortality of 12.0%. The survival rate at 28 days of life decreased by almost 70% in newborns with congenital heart disease. The main cause of death was cardiogenic shock. CONCLUSION: Preterm infants with low birth weight and comorbidities presented a higher risk of mortality related to congenital heart diseases. This cohort was extinguished very quickly, signaling the need for greater investment in assistance technology in populations with this profile.


Assuntos
Aorta Torácica/anormalidades , Síndromes do Arco Aórtico/mortalidade , Cardiopatias Congênitas/mortalidade , Brasil , Estudos de Casos e Controles , Estudos de Coortes , Comorbidade , Estado Terminal , Doenças em Gêmeos/mortalidade , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Oximetria/mortalidade , Gravidez , Nascimento Prematuro/mortalidade , Fatores de Risco , Análise de Sobrevida
17.
Cardiol Young ; 28(12): 1489-1490, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30221608

RESUMO

A male neonate with d-transposition of the great arteries was diagnosed with the concomitant anomaly of left circumflex aortic arch and right-sided ductus arteriosus, which formed a vascular ring. Initial postnatal echocardiography had demonstrated an obscured aortic isthmus mimicking coarctation of the aorta, which could be a diagnostic clue to circumflex aortic arch.


Assuntos
Síndromes do Arco Aórtico/diagnóstico por imagem , Anel Vascular/diagnóstico por imagem , Diagnóstico Diferencial , Canal Arterial , Humanos , Recém-Nascido , Masculino , Transposição dos Grandes Vasos , Anel Vascular/cirurgia
18.
Pediatr Cardiol ; 39(8): 1650-1655, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30167747

RESUMO

The purpose of the study was to explore the prognosis, as well as antenatal ultrasonic features of isolated left subclavian artery (ILSCA) and isolated left brachiocephalic trunk (ILBCT) malformations, in order to improve prognosis and provide guidance for prenatal diagnosis. The origin and routing of cephalic and cervical vessels were observed in patients diagnosed with right aortic arch or right arterial duct arch in our hospital from March 2015 to March 2017, and the spectrum features related to ILSCA and ILBCT were analyzed. Fetuses diagnosed as ILSCA, or, and ILBCT were followed up for 3 months after birth. At the same time, a literature review was carried out for ILBCT and ILSCA in Pubmed. In our study, two cases with ILSCA and ILBCT were both diagnosed prenatally. They are not accompanied by other congenital malformations or chromosome abnormalities. No abnormality was found during postnatal follow-up except that left radial pulsation was weakened and blood pressure of the left upper limb decreased in baby with ILSCA. In baby with ILBCT, in addition to these abnormal changes, the left common carotid artery pulse disappearance too. In pubmed, three of 12 ILSCA or ILBCT did not have other congenital malformation or chromosome abnormalities. They were not diagnosed until the age of 3, 10, and 47 because of school exams or atypical symptoms, such as headaches, chest pain. Symptom of ILBCT or ILSCA without other abnormality is silent, and therefore they cannot be diagnosed timely after birth prenatal diagnosis is necessary for they can be treated in time.


Assuntos
Síndromes do Arco Aórtico/diagnóstico por imagem , Tronco Braquiocefálico/anormalidades , Artéria Subclávia/anormalidades , Ultrassonografia Pré-Natal/métodos , Aorta Torácica/diagnóstico por imagem , Tronco Braquiocefálico/diagnóstico por imagem , Feminino , Humanos , Masculino , Gravidez , Prognóstico , Artéria Subclávia/diagnóstico por imagem
19.
BMJ Case Rep ; 20182018 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-30185450

RESUMO

A 72-year-old man presented with epistaxis on two occasions requiring admission. Prior to performing a bilateral sphenopalatine artery ligation diathermy, anaesthetic concern was raised regarding what the patient described as a 'congenital aortic aneurysm', with an overlying scar secondary to explorative surgery as a child. The abnormality was a cervical aortic arch (CAA). CAA is a rare vascular anomaly, which most commonly manifests as a pulsatile neck mass. In this case, we discuss the differential diagnosis for a pulsatile neck mass and considerations to be made in the workup. We also highlight the importance of cardiovascular risk factor management in patients with CAA.


Assuntos
Aorta Torácica/anormalidades , Síndromes do Arco Aórtico/diagnóstico , Idoso , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Síndromes do Arco Aórtico/complicações , Síndromes do Arco Aórtico/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Diagnóstico Diferencial , Humanos , Ligadura/métodos , Masculino , Pescoço/patologia
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