Tratamiento endovascular con técnica de chimenea para patologías del arco aórtico / Endovascular management with chimney technique for pathologies ofthe aortic arch

Introducción. La patología del arco aórtico se ha tratado principalmente con cirugía por vía abierta, pero con una alta morbimortalidad. Las técnicas endovasculares híbridas y las reconstrucciones en "chimenea" son una técnica válida y segura para disminuir el riesgo y la mortalidad. Métodos. Se presentan dos pacientes con patología del arco aórtico y contraindicación de manejo quirúrgico abierto, atendidos en el Servicio de Cirugía Vascular, Hospital Universitario Clínica de San Rafael, Bogotá, D.C., Colombia. Resultados. Se realizaron dos procedimientos endovasculares del arco aórtico para tratar un aneurisma torácico roto y una úlcera aórtica sintomática, con cubrimiento de los troncos supra aórticos con una endoprótesis y canalización de los vasos supra aórticos con prótesis cubiertas y uso de la "técnica de chimenea", de manera exitosa. Discusión. La patología del arco aórtico es de alta complejidad y se asocia con una morbimortalidad elevada por lo que, en los últimos 20 años se han desarrollado diferentes técnicas utilizando procedimientos percutáneos. Conclusión. La "técnica de chimenea" se puede realizar de una manera mínimamente invasiva en pacientes con patología del arco aórtico, no candidatos para cirugía abierta, con resultados exitosos.

Introduction. Aortic arch pathology has been treated mainly by open surgery, but with high morbidity and mortality. Hybrid endovascular techniques and "chimney" reconstructions are a valid and safe techniques to reduce risk and mortality. Method. Two patients with pathology of the aortic arch and contraindication for open surgical management, treated at the Vascular Surgery Service, Hospital Universitario Clínica de San Rafael, Bogotá, Colombia, are presented. Results. Two endovascular aortic procedures were performed successfully to treat a ruptured thoracic aneurysm and a symptomatic aortic ulcer, with coverage of the supra-aortic trunks with an endoprosthesis and cannulation of the supra-aortic vessels with covered prostheses and use of the "chimney technique". Discussion. The pathology of the aortic arch is highly complex and is associated with high morbidity and mortality, being the reason that during the last 20 years, different techniques have been developed using percutaneous procedures. Conclusions. The "chimney technique" can be performed with successful results in a minimally invasive manner in patients with pathology of the aortic arch, who are not candidates for open surgery

Diagnóstico y manejo del síndrome aórtico agudo / Diagnostic and management of acute aortic syndrom

El síndrome aórtico agudo incluye un grupo de patologías graves de la aorta, con una mortalidad hasta del 90% en los primeros 40 días tras el inicio de los síntomas. Según la localización de la lesión el tratamiento puede ser médico o quirúrgico, el cual ha demostrado mejorar el pronóstico de estos pacientes tanto a corto como a largo plazo. El diagnóstico oportuno es esencial para incrementar la supervivencia y disminuir la tasa de complicaciones relacionadas; no obstante, debido a la baja incidencia y presentación clínica en ocasiones inespecífica, l diagnóstico puede retrasarse u obviarse, ocasionando consecuencias catastróficas para los pacientes. Este artículo se centrará en el abordaje diagnóstico del síndrome aórtico agudo tipo A, además de ofrecer una breve revisión respecto al tratamiento médico y quirúrgico de estas patologías.

Acute aortic syndrome includes a group of serious aortic pathologies, with a mortality rate of up to 90% in the first 40 days after the onset of symptoms. Depending on the location of the lesion, the treatment will be medical or surgical which has been shown to improve the prognosis of these patients both in the short- and long-term. Timey diagnosis is essential to increase survival and decrease the rate of related complications; however, due to the low incidence and sometimes non-specific clinical picture, the diagnosis can be delayed or missed, leading to catastrophic consequences for the patients. This article will focus on the diagnostic approach of type A acute aortic syndrome, in addition to offering a brief review regarding the medical and surgical treatment of these pathologies.

Endovascular treatment of coarctation of the aorta with a self-expanding endoprosthesis: how i do it using the braile dominus ® coarctation aorta device

Abstract The coarctation of the aorta is a relatively highly prevalent congenital heart disease and may be diagnosed as an underline cause of hypertension in adolescents and adults. The gold standard treatment for coarctation of the aorta in these patients is being replaced - from open surgery to endovascular therapy. Some prostheses have been developed to treat the coarctation with less acute and chronic complications. The Dominus® Coarctation Aorta (Braile Biomédica) is the first self-expandable prosthesis created specifically to treat coarctation of the aorta, reducing possible acute complications, like aortic rupture or aortic dissection. Here, we discuss the step-by-step method for using this prosthesis.

Survival of mother and infant following treatment of acute Stanford type B aortic dissection with endovascular repair under local anesthesia in second trimester: a case report / 中华围产医学杂志

We report the diagnosis and treatment of a pregnant woman with acute Stanford type B aortic dissection in the second trimester who underwent thoracic endovascular aortic repair under local anesthesia and later gave birth to a live neonate. The patient was admitted due to acute upper back pain at 27 weeks of gestation, who was diagnosed as acute Stanford type B aortic dissection. Thoracic endovascular aneurysm repair was performed with low radiation dose under local anesthesia. A live neonate was born through cesarean section at 33 +6 gestational weeks due to the flat baseline of the fetal heart monitor, with a birth weight of 1 840 g and Apgar score of 9 at 1 min. The neonate was discharged after a 20-day treatment. During the follow-up of 12 months, the infant grew and developed well, and covered stent was well placed in the mother without leakage in the distal or proximal ends of the stent or any other complications.

Efficacy of thoracic endovascular aortic repair for treatment of Stanford type B traumatic aortic dissection / 中华创伤杂志

Objective:To investigate the clinical efficacy of thoracic endovascular aortic repair (TEVAR) in treating Stanford type B traumatic aortic dissection (TAD).Methods:A retrospective case series study was conducted to analyze the clinical date of 26 patients with Stanford type B TAD admitted to Nantong First People's Hospital from June 2011 to December 2019. There were 21 males and 5 females, aged 35-83 years [(56.2±12.9)years]. All patients mainly suffered from chest and back trauma and were treated with TEVAR. The operation time, intraoperative blood loss, intraoperative heparin dosage, duration of ICU stay and postoperative organ complications were collected. The changes of brain natriuretic peptide, urea nitrogen and creatinine were compared before operation and at one day after operation. The CT angiography (CTA) was performed to mainly detect the location of stent, reverse tearing, paraplegia and internal leakage at 6 months after TEVAR. The aortic CTA was used to measure the maximum diameter of aortic dissecting aneurysm and true lumen diameter of distal aorta before operation and at 6 months after operation, and the diameter changes were compared to determine the aortic remodeling after TEVAR.Results:All patients were followed up for 6-36 months [(25.9±6.3)months]. The operation time was 60-200 minutes [(96.7±30.7)minutes], the intraoperative blood loss was 20-45 ml [(31.1±6.8)ml], the dosage of heparin was 0-0.53 mg/kg [(0.4±0.1)mg/kg], the postoperative ICU stay was 1-7 days [(4.7±1.3)days]. Seven patients developed pulmonary infections after operation and showed significant improvement after closed thoracic drainage, airway management and anti-infection treatment. Two patients had abnormal renal function after operation and received medical therapy for improvement. There was no significant difference in brain natriuretic peptide, urea nitrogen and creatinine between before operation and one day after operation ( P>0.05). At 6 months after operation, the CTA showed that the stent position was satisfactory and there were no serious complications such as reverse tearing and paraplegia. Of one patient with type I endoleak, the tumor did not further expand and his condition was stable. At 6 months after operation, the diameter of dissecting aneurysm [(34.4±5.0)mm] was smaller than that before operation [(38.2±5.6)mm], the true lumen of distal stent [(26.8±4.6)mm] was larger than that before operation [(22.6±6.0)mm] ( P<0.05 or 0.01). Conclusion:For Stanford type B TAD, TEVAR has no significant effect on cardiac function and renal function, with no severe complications and good aortic remodeling.

Contained rupture of an aortic arch aneurysm in a patient with syphilitic aortitis. A case report / Ruptura contida de um aneurisma do arco aórtico em paciente com aortite sifilítica. Um relato de caso

Abstract Syphilitic aortitis is a rare complication of tertiary syphilis, which can lead to aortic aneurysm formation, aortic valvular insufficiency, and ostial coronary stenosis. Syphilis has re-emerged worldwide over recent decades and vascular surgeons should be aware of its cardiovascular manifestations. Atypical clinical presentation, such as hemoptysis and a computed tomography angiography pattern of a thicker aneurysmal wall with ulcer-like aneurysm projections, should raise suspicion of syphilitic aortic aneurysm. An early diagnosis and appropriate surgical and medical therapies significantly contribute to successful treatment and favorable prognosis. Herein is reported the case of an 82-year-old male patient, positive for syphilis infection, with impending aortic arch aneurysm rupture treated with a hybrid arch repair. After 7 months, the patient was brought to the emergency room in cardiac arrest. Unsuccessful cardiopulmonary resuscitation maneuvers were performed, and an autopsy showed cardiac tamponade due to rupture of the ascending aorta.

Resumo A aortite sifilítica é uma complicação rara da sífilis terciária, que pode levar a formação de aneurisma aórtico, insuficiência valvar aórtica e estenose ostial coronariana. Ao longo das últimas décadas, a sífilis ressurgiu ao redor do mundo, e os cirurgiões vasculares devem estar atentos às suas manifestações cardiovasculares. Apresentações clínicas atípicas, como a hemoptise, e um padrão na angiotomografia computadorizada de parede aneurismática mais grossa com projeções de aneurisma com aparência de úlcera devem levantar a suspeita de aneurisma sifilítico da aorta. O diagnóstico precoce e terapias cirúrgica e clínica adequadas contribuem significativamente para um tratamento bem-sucedido e prognóstico favorável. Relatamos o caso de um paciente do sexo masculino, de 82 anos, que apresentou infecção por sífilis com ruptura iminente de aneurisma do arco aórtico. Ele foi tratado com reparo híbrido do arco. Após 7 meses, o paciente deu entrada na emergência com parada cardiorrespiratória. As manobras de reanimação cardiopulmonar foram realizadas, mas não obtiveram sucesso, e a autópsia mostrou tamponamento cardíaco devido à ruptura da aorta ascendente.

Complicaciones venosas centrales asociadas al aneurisma de aorta abdominal roto / Central Venous Complications Associated with Ruptured Abdominal Aortic Aneurysm

RESUMEN La ruptura del aneurisma de aorta abdominal (AAA) representa una verdadera emergencia quirúrgica. Asociada con dolor abdominal, hipotensión e incluso shock, exige una transferencia inmediata a una sala de operaciones adecuadamente equipada para tratar el aneurisma en forma efectiva y sin demora. Ocasionalmente puede manifestarse como resultado de su relación con estructuras adyacentes. Dos complicaciones venosas asociadas con el AAA roto son la fístula aortocava y la compresión de la vena cava inferior (VCI). Los autores informan casos particulares de fístula aortocava y compresión de VCI con trombosis venosa profunda (TVP) por AAA roto. Los cuatro pacientes fueron tratados mediante reparación endovascular. Además de discutir las circunstancias asociadas con las complicaciones venosas por AAA, los autores también discuten la estrategia de tratamiento adoptada y las posibles alternativas.

ABSTRACT Ruptured abdominal aortic aneurysms (rAAAs) represent a real surgical emergency. In the presence of abdominal pain, hypotension or even shock, patients require emergency transfer to an operating room adequately equipped to treat the aneurysm effectively and without delay. Occasionally, symptoms are the consequence of involvement of the adjacent structures, Aortocaval fistula and compression of the inferior vena cava (IVC) are venous complications associated with rAAAs. We report cases of aortocaval fistula and IVC compression with deep venous thrombosis (DVT) due to rAAA. The four patients underwent endovascular repair. The circumstances associated with the venous complications of rAAA, the treatment strategy used and the therapeutic options are described.

Abdominal aortic aneurysms that have ruptured or are at imminent risk of rupture / Aneurismas de aorta abdominal rotos e com risco iminente de ruptura

Abstract The rupture of an abdominal aortic aneurysm (AAA) is considered a high-risk surgical emergency, given the catastrophic consequences and high mortality rate. The objective of this pictorial essay is to illustrate the radiological signs that indicate rupture or imminent rupture. To that end, we describe cases treated at our facility and present a brief review of the literature on the topic. The clinical diagnosis of imminent AAA rupture can be difficult, because patients are usually asymptomatic or have nonspecific pain complaints. In the subsequent follow-up, it is possible to identify radiological signs that indicate instability or rupture itself and thus change the prognosis. Computed tomography is the modality of choice for evaluating an AAA and abdominal pain in the emergency setting. It is therefore essential that the radiologist immediately identify the imaging findings that indicate AAA rupture or the imminent risk of such rupture.

Resumo A ruptura de aneurisma da aorta abdominal (AAA) é considerada uma emergência cirúrgica de altíssimo risco, pelas consequências catastróficas e pelo alto índice de mortalidade. Este ensaio iconográfico tem como objetivo ilustrar os sinais radiológicos que indiquem ruptura ou a sua iminência. Utilizamos casos atendidos no nosso serviço e apresentamos breve revisão bibliográfica acerca do tema. O diagnóstico clínico da iminência de ruptura de AAA pode ser difícil, visto que os pacientes são normalmente assintomáticos ou apresentam queixas álgicas inespecíficas. No controle evolutivo, podem ser identificados sinais radiológicos que indiquem instabilidade ou a própria ruptura e, dessa forma, mudar o prognóstico do paciente. Como a tomografia computadorizada é a modalidade de escolha para a avaliação dos AAAs e da dor abdominal no cenário da emergência, torna-se imprescindível o reconhecimento precoce pelo radiologista dos achados de imagem que indiquem aneurismas rotos ou com risco iminente de ruptura.

Aortic rupture during endovascular repair of a postoperative coarctation pseudoaneurysm in an adult: Emergency lifesaving stent graft implantation

We present a case with aortic rupture during an operation of thoracic endovascular aortic repair of an anastomotic pseudoaneurysm. This happened after the use of a low-pressure remodeling balloon inside the covered part of the deployed endografts. It was successfully treated with a second more centrally in the aortic arch-implanted endograft with full coverage of the left subclavian artery orifice. This patient had a history of surgically operated aortic coarctation.

Descending Aortic Rupture after Frozen Elephant Trunk Technique for Dissected Aortic Arch Aneurysm / 日本心臓血管外科学会雑誌

We report a 41-year-old man who presented with a ruptured dissecting aneurysm of the descending aorta. He had undergone aortic root replacement for an acute aortic dissection (Stanford type A) ; 8 months later, he had undergone total arch replacement with insertion of a frozen elephant trunk (FET) due to enlargement of the chronic dissecting aneurysm of the arch. FET-induced new entry and incomplete thrombosis occurred postoperatively. Three months after FET insertion, he developed an aortic rupture that required emergency replacement of the descending aorta. The patient tolerated the procedure well and was discharged 16 days after the operation.

Mid-Term Results of Using the Seal Thoracic Stent Graft in Cases of Aortopathy: A Single-Institution Experience / 대한흉부외과학회지

BACKGROUND: The endovascular approach to aortic disease treatment has been increasingly utilized in the past 2 decades. This study aimed to determine the long-term results of using the Seal thoracic stent graft. METHODS: We retrospectively reviewed the outcomes of patients who underwent thoracic endovascular aortic repair or a hybrid procedure using the Seal thoracic stent graft (S&G Biotech, Seongnam, Korea) from January 2008 to July 2018 at a single institution. We investigated in-hospital mortality and the incidence of postoperative complications. We also investigated the mid-term survival rate and incidence of aorta-related complications. RESULTS: Among 72 patients with stent grafts, 15 patients underwent the hybrid procedure and 21 underwent emergency surgery. The mean follow-up period was 37.86±30.73 months (range, 0–124 months). Five patients (6.9%) died within 30 days. Two patients developed cerebrovascular accidents. Spinal cord injury occurred in 2 patients. Postoperative renal failure, postoperative extracorporeal membrane oxygenation support, and pneumonia were reported in 3, 1, and 6 patients, respectively. Stent-related aortic complications were observed in 5 patients (6.8%). The 1- and 5-year survival and freedom from stent-induced aortic event rates were 81.5% and 58.7%, and 97.0% and 89.1%, respectively. CONCLUSION: The use of the Seal thoracic stent graft yielded good mid-term results. Further studies are needed to examine the long-term outcomes of this device.

Perforación aorto-esofágica, diagnóstico clínico e imaginológico: reporte de dos casos clínicos con manejo endovascular / Aorto-esophagic perforation, clinical and imaging diagnosis: report of two cases managed by endovascular technique

La perforación concomitante de esófago y aorta se puede presentar después de la ingestión de cuerpos extraños. El reparo aórtico por técnica endovascular, a pesar de ser reciente, es un tratamiento de primera línea por tratarse de un abordaje poco invasivo, rápido y que permite la estabilización hemodinámica, en comparación con la reparación abierta tradicional. Se presentan dos casos de perforación aórtica, en los cuales se llevó a cabo el reparo endovascular con éxito. El primer paciente sufrió una ruptura contenida de la aorta torácica, secundaria a la ingestión de un cuerpo extraño (espina de pescado), y presentó mediastinitis. El segundo paciente sufrió una ruptura aórtica en el arco distal a la arteria subclavia, la cual se corrigió por vía endovascular, pero desarrolló una fístula aorto-esofágica y, finalmente, murió

Concomitant esophageal and aortic perforation has been described in the literature as major complications of foreign body ingestion. Although it has not been widely studied, aortic endovascular repair is the first line of treatment, for it is less invasive, faster and allows early patient stabilization, as compared with the traditional open repair. We present two cases managed successfully with endovascular repair of the aortic perforation. The first case had a contained rupture of the thoracic aorta caused by the ingestion of a foreign body (fish bone) and developed mediastinitis. The second case had an aortic rupture in the arc distal to the subclavian artery, managed with endovascular but he developed an aortoesophageal fistula which was finally lethal.

Caracterización demográfica y epidemiológica de aneurismas intracraneales en un hospital de Quito, Ecuado / Demographic and epidemiological characterization of intracranial aneurysms in a hospital in Quito, Ecuador

INTRODUCCIÓN. La ruptura aneurismática ha sido responsable de hasta el 85 % de hemorragia subaracnoidea de origen no traumático, lo que ha producido altas tasas de morbimortalidad y altos costos hospitalarios, el diagnóstico oportuno y detallado de la localización y el tamaño del aneurisma ha determinado el manejo adecuado del paciente, ya sea invasivo o expectante. OBJETIVO. Analizar el comportamiento de una serie de casos de aneurismas intracraneales rotos y no rotos en cuanto a tamaño, localización sexo y edad. MATERIALES Y MÉTODOS. Estudio retrospectivo de la historia clínica única del informe radiológico de 155 pacientes diagnosticados de aneurisma intracraneal por panangiografía cerebral con sustracción digital como gold estánda que mejoró la calidad de imagen, en el Hospital de Especialidades Carlos Andrade Marín, periodo enero del 2015 a agosto de 2018. RESULTADOS. De los 155 pacientes con un total de 204 aneurismas intracraneales de los cuales (122; 204), accidentados y (82; 204), no accidentados, el 72,0% se presentó en mujeres. Los mayores porcentajes de ruptura de acuerdo con su localización, fueron: arteria comunicante posterior 34,0 %, arteria cerebral media 26,0 % y arteria comunicante anterior 15,0%. En cuanto a los aneurismas no accidentados, las localizaciones más frecuente fueron: arteria cerebral media 33,0%, arteria comunicante posterior 23,0% y segmento termino carotideo 12,0%. El 65% de aneurismas presentó roturas con diámetros iguales o mayores a 5 mm. La edad promedio de diagnóstico fue 56 años rango; 17 ­ 90. CONCLUSIÓN. Analizando los porcentajes de comportamiento de ruptura en cuanto a tamaño y localización de nuestra cohorte y comparándola con las referidas en la bibliografía revisada se pudo concluir que el comportamiento de ruptura aneurismática fue distinto dependiendo de la región poblacional estudiada.

INTRODUCTION. Aneurysmal rupture has been responsible for up to 85% of subarachnoid hemorrhage of non-traumatic origin, which has produced high morbidity and mortality and high hospital costs, the timely diagnosis, the detail of the location and size of the aneurysm has been adequate, either invasive or expectant. OBJECTIVE. Analyze the behavior of a series of cases of broken and unruptured intracranial aneurysms in terms of size, location, sex and age. MATERIALS AND METHODS. Retrospective study of the unique clinical history of the radiological report of 155 patients diagnosed with intracranial aneurysm by brain panangiography with digital subtraction as a gold standard that improved image quality, at the Carlos Andrade Marín Specialties Hospital, January 2015 to August 2018. RESULTS. Of the 155 patients with a total of 204 intracranial aneurysms of which (122; 204), injured and (82; 204), not injured, 72,0% occurred in women. The highest rupture percentages according to their location were: posterior communicating artery 34,0%, middle cerebral artery 26,0% and anterior communicating artery 15,0%. As for non-accident aneurysms, the most frequent locations were: 33,0% mean brain artery, 23,0% posterior communicating artery and 12,0% carotid segment. 65,0% of aneurysms presented ruptures with diameters equal to or greater than 5 mm. The average age of diagnosis was 56 years range; 17 - 90. CONCLUSION. Analyzing the percentages of rupture behavior in terms of size and location of our cohort and comparing it with those referred in the reviewed bibliography, it was concluded that the behavior of aneurysmal rupture was different depending on the population region studied.

Spontaneous rupture of right gastroepiploic artery aneurysm: a rare cause of hemorrhagic shock. case report

ABSTRACT CONTEXT: Aneurysms of the gastroepiploic arteries are seen only rarely. They are usually diagnosed during autopsy or laparotomy in patients with hemodynamic instability. Although the operation to treat this condition is relatively easy, delay in making the diagnosis affects the course of the disease. Case Report: A 57-year-old woman was admitted to the emergency department with abdominal pain and unconsciousness. A computed tomography scan showed extravasation of contrast agent at the headcorpus junction of the pancreas, and the patient underwent exploratory laparotomy under general anesthesia. During laparotomy, aneurysmatic rupture of the right gastroepiploic artery was detected. Control over bleeding was achieved by ligating the right gastroepiploic artery at its origin. The aneurysm was also resected and sent for pathological examination. CONCLUSION: Especially in cases of unidentified shock, splanchnic artery aneurysms should be kept in mind. Moreover, in the light of the data in the literature, the possibility of death should be taken into account seriously and, if feasible, prophylactic aneurysmectomy should be performed.

A Case of Spontaneous Ascending Aortic Rupture Which Was Difficult to Distinguish from Stanford Type A Acute Aortic Dissection / 日本心臓血管外科学会雑誌

A 77-year-old man was admitted to our hospital with sudden anterior chest pain followed by shock. An echocardiography showed enlargement of the sinus of Valsalva, severe aortic regurgitation and pericardial effusion. A chest CT scan showed a crescent sign in the ascending aorta. The preoperative diagnosis was a ruptured Stanford type A acute aortic dissection and an emergency operation was performed. In the operative findings, a bloody pericardial effusion, a hematoma around the ascending aorta and a tear (less than 2 cm) of the ascending aorta just distal area of the sinotubular junction were observed. In this case, since the enlargement of the sinus of Valsalva and the severe aortic regurgitation were observed, we performed a replacement of the ascending aorta including the aortic root with an artificial vascular graft (J graft 28 mm) and a biological valve (Magna EASE 25 mm). The pathologic examinations revealed a rupture of ascending aorta in all layers and a hematoma outside the adventitia. The pathologic diagnosis showed a spontaneous aortic rupture. The postoperative course was good and he was discharged 1 month after the surgery. A spontaneous aortic rupture is defined as an aortic rupture without a trauma, an aneurysm or a dissection. It is rare but fatal and it is said that surgical treatment is necessary. We report a successful surgical case of the spontaneous aortic rupture which was difficult to distinguish from a Stanford A type acute aortic dissection.

Aortic Injury during Transforaminal Lumbar Interbody Fusion

Aortic injury during transforaminal lumbar interbody fusion (TLIF) is a rare but severe complication. We experienced aortic injury during TLIF at L3–4 with a 59-year-old woman diagnosed with an adjacent segment disease at L3–4. Severe bleeding occurred during disc space expansion, and the blood pressure dropped to 60/40 mmHg. The patient’s vital sign stabilized after compression with gauze and Gelfoam in addition to blood transfusion. The patient was treated with endovascular repair using a percutaneous technique after intertransverse fusion at L3–4 was completed. She recovered and is being followed-up in the outpatient department.

Simultaneous “traumatic Gerbode” and aortic rupture due to blunt chest trauma.

The Gerbode defect is characterized by a perimembranous ventricular septal defect between the left ventricle and the right atrium. This intracardiac shunt is a congenital defect but may be iatrogenic after valve surgery or atrioventricular node ablation, may be the result of endocarditis or may be traumatic. It is really rarely encountered as sequelae of non‑penetrating heart trauma, and their clinical manifestations may often be unrecognized in the multi‑injured patient. However, they are serious complications, and their diagnostic approach is not always feasible. We hereby present a case of a young man with the left ventricle to the right atrium communication after blunt thoracic trauma due to a car accident and concomitant rupture of the thoracic aorta. We present also the case and the ways of treatment according to the international bibliography.

A Spontaneous Rupture of the Ascending Aorta / 日本心臓血管外科学会雑誌

<p>The patient was 62-year-old woman was brought to the emergency room with chest pain and dyspnea. Computed tomography revealed a hematoma around the ascending aorta, a notch in the aortic wall, pericardial effusion and a hematoma around the pulmonary artery. We diagnosed early thrombotic type of acute aortic dissection. An ascending aorta replacement was performed via median sternotomy under hypothermic circulatory arrest. Upon operation, there was a 1.0 cm intimal tear just above the left main trunk and there was no specific evidence of aortic dissection. So we diagnosed spontaneous aortic rapture. Her postoperative course was uneventful and she was discharged 18 days after surgery.</p>

Secondary publication Sudden Aortic Rupture in Ehlers-Danlos Syndrome Type IV / 대한법의학회지

Ehlers-Danlos syndrome type IV (EDS IV) is a hereditary disorder of the connective tissue, characterized by easy bruising, thin skin with visible veins, and spontaneous rupture of the large arteries, uterus, or bowel. EDS IV is caused by mutations of the gene for type III procollagen (COL3A1), resulting in insufficient collagen production or a defect in the structure of collagen. EDS IV can have fatal complications such as the rupture of great vessels or organs, which can cause hemorrhaging and sudden unexpected death. Here, we report a case of a 43-year-old female who collapsed after a struggle with a neighbor. In this patient, the bifurcation of the bilateral common iliac artery ruptured, with no evidence of trauma, inflammation, or atherosclerosis. Genetic analysis of COL3A1 showed the presence of a c.2771G>A (p.Gly924Arg) mutation, which may be associated with EDS IV. The forensic pathologist should consider the possibility that the spontaneous visceral or arterial rupture was caused by EDS IV. Genetic analysis is not currently a routine procedure during autopsy. However, in this case, we suggest that the patient possibly had an underlying EDS IV condition, and we recommended family members of the deceased to seek genetic analysis and counseling.