Endovascular chimney technique for aortic arch
pathologies treatment: a systematic review and meta-analysis.
Anderson demonstrated that in human embryos, the protrusion forms in the dorsal wall of the aortic sac between aortic arch
arteries 4 and 6 and partitions the distal portion of the OFT. In this study, at CS16, the protrusion extended into the nonmyocardial portion of the OFT and septated it into the aorta and pulmonary trunk.
Chest x-ray revealed dextrocardia with aortic arch
on right side.
The aortic arch
was modeled from a set of DICOM files obtained from the Visible Human Project's CT scans of a middle-aged female.
The left aortic arch
with aberrant right subclavian artery (LRSCA) is the most common congenital aortic arch
anomaly, occurring in roughly 1 of every 200 people.
Interrupted aortic arch
(IAA) is a congenital malformation characterized by complete luminal dissociation between the ascending and descending aorta, accounting for less than 1% of all cases of congenital heart disease2 with incidence rate of 3 per million live births per annum.3 Although primarily considered a diagnosis of infancy, with high mortality rate of 75% by 10 days and 90% at 12 months of life (without surgical correction), there have been upto 40 cases reported in the adult cardiac literature.3,4
Based on a general assessment of the findings in the literature, the extension of goiter below the level of the aortic arch
or toward the posterior mediastinum seems to be the most important anatomical factor that influences the decision for using the extra-cervical approach.
Kessler et al., "Superiority of transesophageal echocardiography in detecting aortic arch
atheromatous disease: identification of patients at increased risk of stroke during cardiac surgery," Journal of Cardiothoracic and Vascular Anesthesia, vol.
On the contrary a more aggressive approach with open aortic surgical repair under extracorporeal circulation and hypothermic arrest has been proposed as a definite treatment of aortic arch
The predictive factors for sternotomy include involvement of the posterior mediastinum, the extension of the goiter into the aortic arch
, recurrent goiters, an ectopic thyroid, superior vena cava obstruction, malignancy with local involvement, and emergent airway obstruction [1,2].
The use of the left classic BTS in the setting of a right aortic arch
created a source of pulmonary blood flow that could grow along with her.
Associated cardiac defects were present in 82 (39.2%) patients, right aortic arch
was the most common lesion presented in 36 (17.2%) patients, major aorto-pulmonary collaterals in 15 (7.2%), bilateral superior vena cava (SVC) in 10 (4.8%) and patent ductus arteriosus in 6 (2.9%) patients.