Patterns of collateral arteries to the spinal cord after thoraco-abdominal aortic aneurysm repair.

OBJECTIVES: Our goal was to evaluate postoperative patterns of collateral arteries to the spinal cord during occlusion of the segmental arteries supplying the artery of Adamkiewicz (AKA). METHODS: Between April 2011 and December 2022, a total of 179 patients underwent thoraco-abdominal aortic aneurysm repair; 141 had an identifiable AKA on preoperative multidetector computed tomography scans, 40 underwent thoraco-abdominal aortic aneurysm replacement (TAAR) and 101 underwent thoracic endovascular aortic repair (TEVAR). New postoperative collateral blood pathways invisible on preoperative contrast-enhanced computed tomography scans were identified in 42 patients (10 patients who had TAAR vs 32 patients who had TEVAR) who underwent preoperative and postoperative multidetector computed tomography scanning for AKA identification. RESULTS: The thoracodorsal and segmental arteries were the main collateral pathways in both groups. Th9-initiated collaterals were the most common. Collaterals from the internal thoracic artery were observed in the TEVAR group but not in the TAAR group. One patient in the TEVAR group experienced postoperative paraparesis, which was not observed in the TAAR group. Postoperative paraplegia was more common in the non-Th9-origin group, but this difference was not significant. CONCLUSIONS: Thoracodorsal and segmental arteries may be important collateral pathways after TEVAR and TAAR. For thoracodorsal arteries, preserving the thoracodorsal muscle during the approach would be crucial; for segmental arteries, minimizing the area to be replaced or covered would be paramount. An AKA not initiated at the Th9 level poses a high risk of postoperative paraplegia.

Research and development of an electron beam focusing system for a high-brightness X-ray generator.

A new type of rotating anticathode X-ray generator, where an electron beam of up to 60 keV irradiates the inner surface of a U-shaped Cu anticathode, has achieved a beam brilliance of 130 kW mm(-2) (at 2.3 kW). A higher-flux electron beam is expected from simulation by optimizing the geometry of a combined-function-type magnet instead of the fringing field of the bending magnet. In order to minimize the size of the X-ray source the electron beam has been focused over a short distance by a new combined-function bending magnet, whose geometrical shape was determined by simulation using the Opera-3D, General Particle Tracer and CST-STUDIO codes. The result of the simulation clearly shows that the role of combined functions in both the bending and the steering magnets is important for focusing the beam to a small size. FWHM sizes of the beam are predicted by simulation to be 0.45 mm (horizontal) and 0.05 mm (vertical) for a 120 keV/75 mA beam, of which the effective brilliance is about 500 kW mm(-2) on the supposition of a two-dimensional Gaussian distribution. High-power tests have begun using a high-voltage 120 kV/75 mA power supply for the X-ray generator instead of 60 kV/100 mA. The beam focus size on the target will be verified in the experiments.

Diagnostic value of cardiac CT in the evaluation of bicuspid aortic stenosis: comparison with echocardiography and operative findings.

OBJECTIVE: This study was conducted to assess the diagnostic value of cardiac CT for the evaluation of patients with bicuspid aortic valve disease. MATERIALS AND METHODS: Fifty consecutive patients with aortic stenosis who underwent surgical valve repair between September 2005 and November 2006 were examined by ECG-gated CT and echocardiography. A 64-MDCT scanner was used. The image findings regarding the number of leaflets (bicuspid or tricuspid) were compared against the intraoperative findings and were statistically analyzed by one-way univariate analysis of variance. The aortic valve area (AVA) was also measured by CT and echocardiography, and the measured values were statistically compared by use of the paired Student's t test. RESULTS: Seventeen patients had a bicuspid aortic valve, and 33 had a tricuspid aortic valve. In 10 of the 50 patients, echocardiography was unable to depict the type of aortic valve because of extensive calcification. The sensitivity, specificity, positive predictive value, and negative predictive value for the detection of a bicuspid aortic valve were 76.5%, 60.6%, 68.4%, and 95.2%, respectively, for echocardiography and 94.1%, 100%, 100%, and 97.1%, respectively, for CT. The CT findings were not significantly different from the intraoperative findings (p = 0.99), but the echocardiographic findings were (p < 0.05). The AVA measurements obtained by CT and echocardiography were 0.940 ± 0.44 cm(2) and 0.659 ± 0.234 cm(2), respectively, showing a significant difference (p < 0.05). CONCLUSION: ECG-gated cardiac CT is useful for the accurate morphologic assessment of bicuspid aortic stenosis, especially in patients with severe valve calcification.

Performance of an electron gun for a high-brightness X-ray generator.

A prototype thermionic electron gun for a high-brightness X-ray generator has been developed. Its extraction voltage and design current are 60 kV and 100 mA (DC), respectively. The X-ray generator aims towards a maximum brilliance of 60 kW mm(-2). The beam sizes at the rotating anticathode must therefore be within 1.0 mm x 0.1 mm and a small beam emittance is required. The fabricated electron gun optimizes an aperture grid and a Whenelt electrode. The performance of the prototype electron gun measured using pulsed-beam tests is as follows: maximum beam current, 85.7 mA; beam focus size at the rotating anticathode, 0.79 mm x 0.13 mm. In DC beam tests, FWHM beam sizes were measured to be 0.65 mm x 0.08 mm at the rotating anticathode with a beam current of 45 mA. The beam current recently reached approximately 60 mA with some thermal problems.

Transaortic mitral valve repair combined with a modified Bentall procedure in a patient with Marfan's syndrome: report of a case.

We report a case of transaortic mitral valve repair combined with aortic root and arch replacement in a patient with Marfan's syndrome. Preoperative computed tomography and echocardiography showed acute aortic dissection (DeBakey type 1), severe aortic regurgitation, annuloaortic ectasia, and mild mitral regurgitation (MR). We performed artificial chordae implantation to the anterior mitral leaflet (AML) through the aortic root, followed by insertion of an aortic composite graft and replacement of the aortic arch. The patient is well 55 months after the operation, with minimal MR. We think that the transaortic approach is a good alternative for exposure and correction of the AML and its apparatus in special circumstances.