RESUMEN
INTRODUCTION: The short-term survival rate after single-stage correction of Taussig-Bing anomaly with aortic arch obstruction remains favorable. However, some cases are encountered occasionally in which single-stage correction was not performed during the neonatal period. Accordingly, we evaluated the midterm outcomes of different surgical strategies. METHODS: Seven patients who underwent an arterial switch operation and intraventricular rerouting as definitive surgery between 2007 and 2017 were investigated. Of these 7 patients, 3 had undergone previous pulmonary artery banding and aortic arch reconstruction. RESULTS: The median body weight at definitive surgery was 3.3 kg (range 2.9-8.3 kg). At definitive surgery, the arrest time for single-stage correction (162.3 ± 21.7 min) was significantly shorter than that of staged repair (206.3 ± 5.1 min, p = 0.020). There was no hospital or late death. One patient in both strategy groups underwent aortic reintervention 54 months and 7.1 months after the definitive operation. Neoaortic valve (perinatal pulmonary valve) diameter decreased significantly from the perinatal valve diameter following definitive surgery (median +4.94z and +2.12z, respectively, p = 0.016) but there was no significant difference in the neopulmonary valve (perinatal aortic valve) diameter. Both single-stage correction and staged repair patients showed a similar trend. At the last follow-up, no patient had greater than mild neoaortic or neopulmonary valve regurgitation. CONCLUSION: The surgical outcomes of both single-stage correction and staged correction for Taussig-Bing anomaly with aortic arch obstruction are excellent. Both strategies produce similar changes in the diameter and regurgitation grade of the neoaortic and neopulmonary valves.
Asunto(s)
Aorta Torácica/cirugía , Síndromes del Arco Aórtico/cirugía , Arteriopatías Oclusivas/cirugía , Operación de Switch Arterial , Ventrículo Derecho con Doble Salida/cirugía , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/fisiopatología , Síndromes del Arco Aórtico/diagnóstico por imagen , Síndromes del Arco Aórtico/fisiopatología , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/fisiopatología , Operación de Switch Arterial/efectos adversos , Ventrículo Derecho con Doble Salida/diagnóstico por imagen , Ventrículo Derecho con Doble Salida/fisiopatología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Recuperación de la Función , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Aorta Torácica/diagnóstico por imagen , Síndromes del Arco Aórtico/diagnóstico por imagen , Angiografía Coronaria , Enfermedades del Mediastino/diagnóstico por imagen , Mediastino/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Aorta Torácica/anomalías , Aorta Torácica/fisiopatología , Síndromes del Arco Aórtico/congénito , Síndromes del Arco Aórtico/fisiopatología , Síndromes del Arco Aórtico/cirugía , Trastornos de Deglución/etiología , Humanos , Masculino , Enfermedades del Mediastino/fisiopatología , Enfermedades del Mediastino/cirugía , Mediastino/patología , Persona de Mediana Edad , Ruidos Respiratorios/etiologíaRESUMEN
OBJECTIVES: The aim of the study was to identify the factors associated with repeated arteriovenous fistula (AVF) failure within 1-year, especially the impact of aortic arch calcification (AAC) on patency of AVF. MATERIALS AND METHODS: We retrospectively assessed chest radiography in hemodialysis patients who had undergone initial AVF. The extent of AAC was categorized into four grades (0-3). The association between AAC grade, other clinical variables, and repeated failure of AVF was then analyzed by binary logistic regression analysis. RESULTS: This study included 284 patients (158 males, mean age 61.7 ± 13.1 years). Patients with higher AAC grade were older, had more frequently diabetes mellitus and cardiovascular disease, had lower diastolic blood pressure, and had higher corrected calcium and lower intact parathyroid hormone levels. In multivariate analysis, the presence of higher AAC grade (odds ratio (95% confidence interval): 2.98 (1.43-6.23); p = 0.004), lower mean corrected calcium (p = 0.017), and mean serum albumin level (p = 0.008) were associated with repeated failure of AVF. CONCLUSIONS: The presence of higher AAC grade, lower mean corrected calcium and mean serum albumin level were independently associated with repeated AVF failure within 1 year in hemodialysis patients.
Asunto(s)
Síndromes del Arco Aórtico/fisiopatología , Fístula Arteriovenosa/fisiopatología , Enfermedades Cardiovasculares/fisiopatología , Calcificación Vascular/fisiopatología , Anciano , Aorta Torácica/fisiopatología , Síndromes del Arco Aórtico/terapia , Enfermedades Cardiovasculares/terapia , Femenino , Humanos , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/terapia , Masculino , Persona de Mediana Edad , Diálisis Renal , Factores de Riesgo , Calcificación Vascular/terapiaRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Anciano , Arteria Subclavia/anomalías , Arteria Vertebral/anomalías , Síndromes del Arco Aórtico/fisiopatología , Malformaciones Vasculares/complicacionesRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Anciano , Anciano de 80 o más Años , Síndromes del Arco Aórtico/fisiopatología , Síndromes del Arco Aórtico/cirugía , Síndromes del Arco Aórtico , Dolor/complicaciones , Dolor/diagnóstico , Laparotomía/métodos , Laparotomía/tendencias , Atención Primaria de Salud/métodos , Atención Primaria de Salud/tendencias , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta , Factores de RiesgoRESUMEN
Acute aortic syndrome complicated by both ST-segment elevation myocardial infarction (STEMI) and spinal ischemia is exceedingly rare. We herein report the case of a 66-year-old man who presented with paraparesis after primary percutaneous coronary intervention for STEMI. He was found to have an intramural hematoma of the ascending aorta and a severe dissection in the descending aorta, which led to both STEMI and paraparesis.
Asunto(s)
Angioplastia Coronaria con Balón/efectos adversos , Síndromes del Arco Aórtico/complicaciones , Sistema de Conducción Cardíaco/fisiopatología , Isquemia/etiología , Infarto del Miocardio/terapia , Paraparesia/etiología , Columna Vertebral/irrigación sanguínea , Enfermedad Aguda , Anciano , Angioplastia Coronaria con Balón/métodos , Aorta/patología , Aorta Torácica/patología , Síndromes del Arco Aórtico/fisiopatología , Síndromes del Arco Aórtico/terapia , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Infarto del Miocardio/fisiopatología , Paraparesia/patología , Paraparesia/rehabilitación , Resultado del TratamientoRESUMEN
Neo-aortic arch obstruction (NAAO) is a common complication following the Norwood/Sano procedure (NP) for hypoplastic left heart syndrome (HLHS) and is associated with increased morbidity and mortality. However, there is currently no objective method for predicting which patients will develop NAAO. This study was designed to test the hypothesis that hemodynamic changes from development of NAAO after NP in patients with HLHS will lead to changes in myocardial dynamics that could be detected before clinical symptoms develop with strain analysis using velocity vector imaging. Patients with HLHS who had at least one cardiac catheterization after NP were identified retrospectively. Strain analysis was performed on all echocardiograms preceding the first catheterization and any subsequent catheterization performed for intervention on NAAO. Twelve patients developed NAAO and 30 patients never developed NAAO. Right ventricular strain was worse in the group that developed NAAO (-6.2 vs. -8.6 %, p = 0.040) at a median of 59 days prior to diagnosis of NAAO. Those patients that developed NAAO following NP were significantly younger at the time of first catheterization than those that did not develop NAAO (92 ± 50 vs. 140 ± 36 days, p = 0.001). This study demonstrates that right ventricular GLS is abnormal in HLHS patients following NP and worsening right ventricular strain may be predictive of the future development of NAAO.
Asunto(s)
Síndromes del Arco Aórtico/complicaciones , Ecocardiografía/métodos , Ventrículos Cardíacos/diagnóstico por imagen , Síndrome del Corazón Izquierdo Hipoplásico/cirugía , Procedimientos de Norwood/efectos adversos , Disfunción Ventricular Derecha/etiología , Síndromes del Arco Aórtico/diagnóstico , Síndromes del Arco Aórtico/fisiopatología , Velocidad del Flujo Sanguíneo , Cateterismo Cardíaco , Femenino , Estudios de Seguimiento , Ventrículos Cardíacos/fisiopatología , Humanos , Síndrome del Corazón Izquierdo Hipoplásico/diagnóstico , Lactante , Recién Nacido , Masculino , Complicaciones Posoperatorias , Valor Predictivo de las Pruebas , Pronóstico , Factores de Tiempo , Disfunción Ventricular Derecha/diagnóstico , Disfunción Ventricular Derecha/fisiopatologíaRESUMEN
Studies have shown that patients harboring bicuspid aortic valve (BAV) or bovine aortic arch (BAA) are more likely than the general population to develop ascending aortic aneurysm (AsAA). A thorough quantification of the AsAA tissue properties for these patient groups may offer insights into the underlying mechanisms of AsAA development. Thus, the objective of this study was to investigate and compare the mechanical and microstructural properties of aortic tissues from AsAA patients with and without concomitant BAV or BAA. AsAA (n=20), BAV (n=20) and BAA (n=15) human tissues were obtained from patients who underwent elective AsAA surgery. Planar biaxial and uniaxial failure tests were used to characterize the mechanical and failure properties of the tissues, respectively. Histological analysis was performed to detect medial degenerative characteristics of aortic aneurysm. Individual layer thickness and composition were quantified for each patient group. The circumferential stress-strain response of the BAV samples was stiffer than both AsAA (p=0.473) and BAA (p=0.152) tissues at a low load. The BAV samples were nearly isotropic, while AsAA and BAA samples were anisotropic. The areal strain of BAV samples was significantly less than that of AsAA (p=0.041) and BAA (p=0.004) samples at a low load. The BAA samples were similar to the AsAA samples in both mechanical and failure properties. On the microstructural level, all samples displayed moderate medial degeneration, characterized by elastin fragmentation, cell loss, mucoid accumulation and fibrosis. The ultimate tensile strength of BAV and BAA sampleswere also found to decrease with age. Overall, the BAV samples were stiffer than both AsAA and BAA samples, and the BAA samples were similar to the AsAA samples. The BAV samples were thinnest, with less elastin than AsAA and BAA samples, which may be attributed to the loss of extensibility of these tissues at a low load. No apparent difference in failure mechanics among the tissue groups suggests that each of the patient groups may have a similar risk of rupture.
Asunto(s)
Aorta/fisiopatología , Aneurisma de la Aorta/patología , Aneurisma de la Aorta/fisiopatología , Síndromes del Arco Aórtico/patología , Síndromes del Arco Aórtico/fisiopatología , Enfermedades de las Válvulas Cardíacas/patología , Enfermedades de las Válvulas Cardíacas/fisiopatología , Aorta/patología , Aneurisma de la Aorta/etiología , Síndromes del Arco Aórtico/complicaciones , Válvula Aórtica/anomalías , Válvula Aórtica/patología , Válvula Aórtica/fisiopatología , Enfermedad de la Válvula Aórtica Bicúspide , Fuerza Compresiva , Módulo de Elasticidad , Enfermedades de las Válvulas Cardíacas/complicaciones , Humanos , Técnicas In Vitro , Resistencia al Corte , Resistencia a la TracciónRESUMEN
Presentamos un caso de diagnóstico prenatal de arco aórtico derecho (AAD) aislado y se describe el manejo diagnóstico-clínico de esta entidad. En la exploración ecográfica fetal de una gestante de 20 semanas se detectó un AAD sin otras malformaciones asociadas. Mediante un corte axial del tórax fetal a nivel del plano de tres-vasos-tráquea, se comprobó el trayecto anómalo del arco aórtico, a la derecha de la tráquea. El AAD es una entidad rara (prevalencia del 0,1%) y sus variantes pueden condicionar sintomatología compresiva y estar relacionadas con anomalías cardíacas (hasta 90%) y/o con la microdeleción 22q11 (hasta 46%). El corte ecográfico de tres-vasos-tráquea es fundamental para su diagnóstico prenatal y tras su detección está indicada una evaluación exhaustiva del corazón fetal, distinguir sus variantes y/o un estudio cromosómico-genético específico. En presencia de otras anomalías el pronóstico es pobre; los casos aislados suelen tener una evolución postnatal oligo o asintomática(AU)
We report a case of prenatally diagnosed isolated right aortic arch (RAA) and describe the procedure for its ultrasound-guided diagnosis and clinical management. The ultrasound scan of a 20-week-old fetus revealed an isolated RAA. The diagnosis was achieved using the 3 vessels and trachea view, in which the aortic arch was visualized to the right side of the trachea. RAA is a rare finding (incidence, 0.1%) and its variants may cause compressive symptoms and be associated with congenital heart defects (up to 90%) and/or 22q11 microdeletion (up to 46%). The 3 vessels and trachea view is essential for the prenatal diagnosis of RAA. Detection of this condition must be considered an indication for fetal echocardiography, to distinguish its variants, and a genetic study is also recommended. Isolated RAA is usually asymptomatic, although the outcome of RAA associated with other abnormalities is uncertain(AU)
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Diagnóstico Prenatal/métodos , Ultrasonografía Prenatal/instrumentación , Ultrasonografía Prenatal/métodos , Ultrasonografía Prenatal , Síndromes del Arco Aórtico/complicaciones , Síndromes del Arco Aórtico/diagnóstico , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/diagnóstico , Síndrome de Deleción 22q11/complicaciones , Síndrome de Deleción 22q11/diagnóstico , Ultrasonografía Prenatal/tendencias , Síndromes del Arco Aórtico/fisiopatología , Síndromes del Arco Aórtico , Cardiopatías Congénitas , Ecocardiografía , Síndrome de Deleción 22q11/fisiopatología , Síndrome de Deleción 22q11RESUMEN
We present findings in a 17-year-old with interrupted aortic arch, in whom standard imaging techniques missed functional and morphological problems. Flow-sensitive four-dimensional magnetic resonance (4-D MR) enabled assessment of the complex anatomy and blood-flow characteristics in the entire aorta and direct quantification of blood flow in collateral vessels. Our findings highlight the entire morphological and functional problem of interrupted aortic arch and illustrate the potential of flow-sensitive 4-D MR for surgical planning in congenital heart disease.
Asunto(s)
Aorta Torácica/patología , Aorta Torácica/fisiopatología , Síndromes del Arco Aórtico/patología , Síndromes del Arco Aórtico/fisiopatología , Circulación Colateral , Imagenología Tridimensional/métodos , Angiografía por Resonancia Magnética/métodos , Adolescente , Velocidad del Flujo Sanguíneo , Femenino , Humanos , Aumento de la Imagen/métodos , Interpretación de Imagen Asistida por Computador/métodos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
We report the challenging case of a 1-week-old, term, 2.4 kg neonate with Goldenhar syndrome (including microcephaly, left microtia, left facial palsy, dextro-scoliosis of the cervical spine, and cervico-thoracic levoscoliosis), multiple ventricular septal defects, a type B interrupted aortic arch, a large patent ductus arteriosis, and radiographic and clinical signs concerning for an unstable cervical spine. Our anesthesia team was consulted for perioperative management of this patient during her surgical repair. This case report describes the use of the Air-Q size 1 laryngeal airway (LA) to assist fiberoptic intubation in an ASA 4 neonate with cardiac disease, an anticipated difficult airway with the addition of an unstable cervical spine, as well as the anesthetic techniques used to maintain hemodynamic stability while the airway was secured.
Asunto(s)
Síndromes del Arco Aórtico/terapia , Síndrome de Goldenhar/terapia , Defectos del Tabique Interventricular/terapia , Inestabilidad de la Articulación/terapia , Escoliosis/terapia , Manejo de la Vía Aérea , Síndromes del Arco Aórtico/patología , Síndromes del Arco Aórtico/fisiopatología , Conducto Arterioso Permeable/complicaciones , Conducto Arterioso Permeable/patología , Femenino , Síndrome de Goldenhar/patología , Síndrome de Goldenhar/fisiopatología , Defectos del Tabique Interventricular/patología , Defectos del Tabique Interventricular/fisiopatología , Hemodinámica/fisiología , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Intubación Intratraqueal , Inestabilidad de la Articulación/patología , Inestabilidad de la Articulación/fisiopatología , Imagen por Resonancia Magnética , Escoliosis/patología , Escoliosis/fisiopatología , Columna Vertebral/patología , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To describe a novel method of visualizing the ductal and aortic arches by real-time three-dimensional echocardiography with live xPlane imaging. METHODS: Live xPlane imaging was used to display the ductal- and aortic-arch views in 107 women with singleton pregnancies, including seven cases with suspected congenital heart defects (CHDs). The three vessels and trachea (3VT) view was obtained in such an orientation that either the pulmonary artery or the aorta was parallel to the direction of the ultrasound beam. The xPlane reference line was then placed across the targeted vessel, which in a normal case would provide an image of the corresponding arch view as a dual-image display. RESULTS: Once the 3VT view had been obtained, live xPlane imaging showed the aortic and ductal arches in all 100 normal cases. In seven cases with suspected CHD, the 3VT view was abnormal in five cases and normal in the other two. However, the ductal-arch view demonstrated by live xPlane imaging was abnormal in five cases of conotruncal anomalies and normal in two cases in which conotruncal anomalies were excluded. CHDs were confirmed at autopsy following termination of pregnancy in five cases and on postnatal echocardiography in one case. The heart was found postnatally to be normal in one case of suspected CHD; in this case live xPlane imaging showed that the observed abnormal 3VT view was caused by a tortuous course of the thoracic aorta associated with an abnormal diaphragm. CONCLUSION: Live xPlane imaging is a novel and relatively simple method of visualizing the ductal- and aortic-arch views, and may potentially be a useful tool in the screening of fetal conotruncal and aortic-arch anomalies.
Asunto(s)
Síndromes del Arco Aórtico/diagnóstico por imagen , Ecocardiografía Tridimensional , Corazón Fetal/diagnóstico por imagen , Cardiopatías Congénitas/diagnóstico por imagen , Ultrasonografía Prenatal/métodos , Aborto Inducido , Adulto , Síndromes del Arco Aórtico/embriología , Síndromes del Arco Aórtico/fisiopatología , Velocidad del Flujo Sanguíneo , Femenino , Corazón Fetal/embriología , Corazón Fetal/fisiopatología , Edad Gestacional , Cardiopatías Congénitas/embriología , Cardiopatías Congénitas/fisiopatología , Humanos , Embarazo , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: Aortic arch anomalies (AAA) are rare cardio-vascular anomalies. Right-sided and double-sided aortic arch anomalies (RAAA, DAAA) are distinguished, both may cause airway obstructions. We studied the degree of airway obstruction in infants with AAA by neonatal lung function testing (LFT). PATIENTS AND METHODS: 17 patients (10 RAAA and 7 DAAA) with prenatal diagnosis of AAA were investigated. The median (range) post conception age at LFT was 40.3 (36.6-44.1) weeks, median body weight 3400 (2320-4665) g. Measurements included tidal breathing flow-volume loops (TBFVL), airway resistance (R(aw)) by bodyplethysmography and the maximal expiratory flow at functional residual capacity (V'(max)FRC) by rapid thoracic-abdominal compression (RTC) technique. V'(max)FRC was also expressed in Z-scores, based on published gender-, age and height-specific reference values. RESULTS: Abnormal lung function tests were seen in both RAAA and DAAA infants. Compared to RAAA infants, infants with DAAA had significantly more expiratory flow limitations in the TBFVL, (86% vs. 30%, p<0.05) and a significantly increased R(aw) (pâ=â0.015). Despite a significant correlation between R(aw) and the Z-score of V'(max)FRC (râ=â0.740, p<0.001), there were no statistically significant differences in V'(max)FRC and it's Z-scores between RAAA and DAAA infants. 4 (24%) infants (2 RAAA, 2 DAAA) were near or below the 10(th) percentile of V'(max)FRC, indicating a high risk for airway obstruction. CONCLUSION: Both, infants with RAAA and DAAA, are at risk for airway obstruction and early LFT helps to identify and to monitor these infants. This may support the decision for therapeutic interventions before clinical symptoms arise.
Asunto(s)
Obstrucción de las Vías Aéreas/fisiopatología , Aorta Torácica/anomalías , Aorta Torácica/fisiopatología , Síndromes del Arco Aórtico/fisiopatología , Obstrucción de las Vías Aéreas/diagnóstico , Obstrucción de las Vías Aéreas/etiología , Síndromes del Arco Aórtico/complicaciones , Femenino , Humanos , Lactante , Recién Nacido , Pulmón/fisiopatología , Masculino , Reproducibilidad de los Resultados , Pruebas de Función Respiratoria/métodos , Estudios Retrospectivos , Factores de Riesgo , Sensibilidad y EspecificidadAsunto(s)
Síndromes del Arco Aórtico/complicaciones , Síndromes del Arco Aórtico/diagnóstico , Artritis Reumatoide/complicaciones , Artritis Reumatoide/diagnóstico , Síndromes del Arco Aórtico/prevención & control , Síndromes del Arco Aórtico/fisiopatología , Síndromes del Arco Aórtico , Artritis/complicacionesRESUMEN
Cephalic arch stenosis (CAS) is a unique type of vascular access stenosis. For example, the etiology of CAS is under investigation and the prevalence of CAS can be lower in diabetic patients. Three cases of CAS were identified during our vascular access stenosis surveillance program by blood flow rate measurements using the Delta-H method. We evaluated the prevalence, etiology, relationship with diabetes and functional profile of CAS. To date, this is the first functional report published about this type of stenosis (AU)
La estenosis del cayado o arco de la vena cefálica (EAC) es un tipo peculiar de estenosis del acceso vascular para hemodiálisis. Por ejemplo, y a diferencia de los restantes casos de estenosis, la etiopatogenia de la EAC no está totalmente esclarecida y su prevalencia parece ser inferior en el enfermo diabético. Presentamos tres casos de EAC diagnosticados en nuestra Unidad de Hemodiálisis mediante la aplicación de un programa de monitorización del flujo sanguíneo del acceso vascular utilizando el método Delta-H. Se revisa la prevalencia, la etiopatogenia, la relación con la diabetes mellitus y el perfil funcional de este tipo de estenosis. Hasta la fecha, es el primer estudio funcional efectuado sobre la EAC (AU)
Asunto(s)
Humanos , Catéteres/efectos adversos , Oclusión de Injerto Vascular/fisiopatología , Insuficiencia Renal Crónica/terapia , Diálisis Renal/efectos adversos , Síndromes del Arco Aórtico/fisiopatología , Factores de RiesgoRESUMEN
Partial left atrial ligation before cardiac septation redistributes intracardiac blood flow and produces left ventricular hypoplasia in the chick. We hypothesized that redistributed intracardiac blood flow adversely alters aortic arch development. We ligated the left atrial appendage with a 10-0 nylon suture at stage 21 chick embryos, then reincubated up to stage 34. Sham embryos had a suture tied adjacent to the atrial wall, and normal controls were unoperated. We measured simultaneous atrioventricular (AV) and dorsal aortic (DAo) blood velocities from stage 24 embryos with an ultrasound pulsed-Doppler flow meter; and the left and right third and fourth aortic arch blood flow with a laser-Doppler flow meter. Ventricular and atrial cross-sectional areas were measured from sequential video fields for planimetry. Intracardiac flow patterns were imaged on video by injecting India ink into the vitelline vein. In separate embryos, radiopaque microfil was injected into the cardiovascular system for micro-CT scanning. We analyzed the morphologic characteristics of the heart at stage 34. Active AV and DAo stroke volume (mm(3)), right third and fourth aortic arch blood flow (mm(3)/s) were all decreased in ligated embryos (P < 0.05) when compared with normal and sham embryos. Ventricular end-diastolic volume versus normal and sham embryos decreased by 45% and 46%, respectively (P < 0.05). India ink injection revealed altered right aortic arch flow patterns in the ligated embryos compared with normal embryos. micro-CT imaging confirmed altered arch morphogenesis. Alterations in intracardiac blood flow disrupt both early cardiac morphogenesis and aortic arch selection.
Asunto(s)
Aorta Torácica/anomalías , Síndromes del Arco Aórtico/embriología , Atrios Cardíacos/anomalías , Cardiopatías Congénitas/embriología , Flujo Sanguíneo Regional/fisiología , Animales , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/fisiopatología , Síndromes del Arco Aórtico/diagnóstico por imagen , Síndromes del Arco Aórtico/fisiopatología , Embrión de Pollo , Diástole/fisiología , Lateralidad Funcional/fisiología , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/fisiopatología , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/fisiopatología , Ligadura , Modelos Anatómicos , Sístole/fisiología , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler de PulsoRESUMEN
Congenital absence of the common carotid artery (CCA), internal carotid artery (ICA) and external carotid artery (ECA) is very rare. We present such a rare case in a 53-year-old woman, associated with a saccular aneurysm of anterior communicating artery (ACA) presenting with subarachnoid haemorrhage (SAH). An embryological hypothesis for the anomalies of the aortic arch is proposed. The correlation between the abnormal haemodynamic stress of the circle of Willis caused by the absence of the right ICA and the development of intracranial aneurysm is discussed.
Asunto(s)
Síndromes del Arco Aórtico/complicaciones , Arteria Carótida Común/anomalías , Círculo Arterial Cerebral/anomalías , Aneurisma Intracraneal/etiología , Aneurisma Intracraneal/patología , Síndromes del Arco Aórtico/diagnóstico por imagen , Síndromes del Arco Aórtico/fisiopatología , Presión Sanguínea/fisiología , Arteria Carótida Común/diagnóstico por imagen , Arteria Carótida Externa/anomalías , Arteria Carótida Externa/diagnóstico por imagen , Arteria Carótida Interna/anomalías , Arteria Carótida Interna/diagnóstico por imagen , Angiografía Cerebral , Circulación Cerebrovascular/fisiología , Círculo Arterial Cerebral/diagnóstico por imagen , Círculo Arterial Cerebral/fisiopatología , Resultado Fatal , Femenino , Hemodinámica/fisiología , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Persona de Mediana Edad , Estrés Mecánico , Hemorragia Subaracnoidea/etiología , Hemorragia Subaracnoidea/patología , Hemorragia Subaracnoidea/fisiopatologíaAsunto(s)
Síndromes del Arco Aórtico/fisiopatología , Hemodinámica/fisiología , Aorta Torácica/fisiología , Síndromes del Arco Aórtico/etiología , Síndromes del Arco Aórtico/genética , Humanos , Morfogénesis , Factor de Crecimiento Derivado de Plaquetas/fisiología , Factor A de Crecimiento Endotelial Vascular/fisiologíaRESUMEN
The article deals with analysing the outcomes following surgical management of one hundred and six patients presenting with lesions of the renal arteries. Twenty-eight (25.4%) of the 106 patients operated on for lesions of the renal arteries were found to have a concomitant lesion of the aortic arch branches. Also suggested herein is a method aimed at determining the staging of reconstructive operations on the aortic arch branches and renal arteries, which is based upon the authors' own technique specifically devised for quantitative assessment of tolerance of the brain to ischaemia, i. e., determining the autoregulatory reaction of the cerebral vessels. This would make it possible to determine the sequence of reconstructive interventions to perform on the aortic arch branches and renal arteries, and hence dramatically diminish the rate of postoperative cerebrovascular complications.