Trombo flotante en el arco aórtico, una causa poco frecuente de isquemia de miembros inferiores / Floating thrombus in the aortic arch, a rare cause of lower limb ischemia

Resumen La oclusión arterial aguda de los miembros inferio res es una urgencia médica y quirúrgica por su morbi mortalidad. Presentamos el caso de un hombre de 59 años que ingresó al servicio de urgencias por un dolor agudo y difuso del miembro inferior izquierdo causado por extensos coágulos obstructivos en las arterias del miembro inferior izquierdo. Siendo improbable la cau sa ateromatosa tras realización de la angioscopia de miembros inferiores, se sospechó un origen cardíaco. La ecografía cardiaca no mostró anomalías, sin embargo, la angiotomografía torácica reveló un trombo flotante en el arco aórtico. El paciente fue tratado quirúrgica mente con colocación de una endoprótesis aórtica sin complicaciones.

Abstract Acute arterial occlusion of the lower limbs is a medi cal and surgical emergency due to its morbi-mortality. We present the case of a 59-year-old man admitted to the emergency department for acute and diffuse pain in the left lower limb caused by extensive obstructive clots in the arteries of this limb. Since atheromatous cause was unlikely after angioscopy of the lower limbs, a car diac origin was suspected. Echocardiogram was normal, however, thoracic angiotomography revealed a floating thrombus in the aortic arch. The patient was treated surgically with placement of an aortic endoprosthesis without complications.

Looking for a definition of aortic dilatation in overweight and obese individuals: body surface area-indexed values versus height-indexed diameters / En búsqueda de la definición de dilatación aórtica en individuos con sobrepeso y obesidad: rol de la indexación por altura. Análisis del Registro MATEAR

Abstract Introduction: Patient's body size is a significant determinant of aortic dimensions. Overweight and obesity underestimate aortic dilatation when indexing diameters by body surface area (BSA). We compared the indexation of aortic dimensions by height and BSA in subjects with and without overweight to determine the upper normal limit (UNL). Methods: The MATEAR study was a prospective, observational, and multicenter study (53 echocardiography laboratories in Argentina). We included 879 healthy adult individuals (mean age: 39.7 ± 11.4 years, 399 men) without hypertension, bicuspid aortic valve, aortic aneurysm, or genetic aortopathies. Echocardiograms were acquired and proximal aorta measured at the sinus of Valsalva (SV), sinotubular junction (STJ), and ascending aorta (AA) levels (EACVI/ASE guidelines). We compared absolute and indexed aortic diameters by height and BSA between groups (men with body mass index [BMI] < 25 and BMI ≥ 25, women with BMI < 25 and BMI ≥ 25). Results: Indexing of aortic diameters by BSA showed significantly lower values in overweight and obese subjects compared to normal weight in their respective gender (for women: SV 1.75 cm/m2 in BMI < 25 vs. 1.52 cm/m2 in BMI between 25 and 29.9 vs. 1.41 cm/m2 in BMI ≥ 30; at the STJ: 1.53 cm/m2 vs. 1.37 cm/m2 vs. 1.25 cm/m2; and at the AA: 1.63 cm/m2 vs. 1.50 cm/m2 vs. 1.37 cm/m2; all p < 0.0001 and for men, all p < 0.0001). These differences disappeared when indexing by height in both gender groups (all p = NS). Conclusion: While indexing aortic diameters by BSA in obese and overweight subjects underestimate aortic dilation, the use of aortic height index (AHI) yields a similar UNL for individuals with normal weight, overweight, and obesity. Therefore, AHI could be used regardless of their weight.

Resumen Introducción: El tamaño corporal es un determinante significativo de las dimensiones aórticas. El sobrepeso lleva a subestimar la dilatación aórtica. La altura (A) permanece estable durante la adultez, por lo que sería útil para indexar diámetros aórticos en pacientes obesos, aunque desconocemos los valores normales. Comparamos la indexación de diámetros aórticos por (IA) y superficie corporal (SC) en sujetos con y sin sobrepeso para determinar el límite superior normal (LSN, P97.5). Método: Se realizó un registro nacional, prospectivo, en 53 centros de Argentina. Se realizaron ecocardiogramas a 528 sujetos con índice de masa corporal (IMC) > 25 y 351 sujetos con IMC ≤ 25 seleccionados al azar. La población se subdividió en cuatro grupos según sexo e IMC y se compararon diámetros aórticos absolutos e indexados. Resultados: Se incluyeron 879 individuos (39.7 ± 11.4 años, 399 hombres). La indexación de los diámetros aórticos por SC mostró valores significativamente más bajos en sujetos con sobrepeso y obesidad en comparación con los de peso normal en cada sexo. Estas diferencias desaparecieron al indexar por altura en ambos géneros (todos p = NS). El LSN de los diámetros IA fue de 2.20 cm/m para senos, 1.99 cm/m para unión sino-tubular (UST) y 2.09 cm/m para aorta ascendente. Conclusiones: La indexación de los diámetros aórticos por SC en individuos con sobrepeso y obesidad subestima la dilatación aórtica. El IA permite establecer un LSN sin tener en cuenta el aumento espurio de la SC determinado por la grasa corporal. Podría ser utilizado en ambos sexos y de manera independiente del peso.

Reemplazo endovascular aórtico en un paciente con enfermedad de válvula aórtica bicúspide / Endovascular aortic replacement in a patient with bicuspid aortic valve disease

Resumen Un varón de 49 años ingresó en la unidad de cuidados coronarios, con antecedentes de miocardiopatía dilatada, con función sistólica del ventrículo izquierdo gravemente deteriorada y estenosis aórtica grave de origen bicúspide, sintomático para síncope, ángor y disnea de reciente diagnóstico. Durante la internación evolucionó con shock cardiogénico que requirió doble soporte inotrópico. Por presentar alto riesgo quirúrgico y elevada probabilidad de rechazo ante un eventual trasplante cardiaco, según sus estudios de histocompatibilidad, se procedió al reemplazo transcatéter de la válvula aortica, con evolución favorable.

Abstract A 49-year-old male with a history of left ventricular systolic function dilated cardiomyopathy and severe symptomatic bicuspid aortic stenosis recently diagnosed (syncope, chest pain and dyspnea) was admitted to the coronary care unit. During hospitalization, he developed cardiogenic shock requiring double inotropic support. High surgical risk and an elevated chance of graft rejection contraindicated surgical replacement or heart transplant. We performed a transcatheter aortic valve replacement with a favorable evolution.

Concomitant Transcatheter Transfemoral Double Native Valve Replacement for Severe Aortic Stenosis and Severe Mitral Stenosis with Mitral Annular Calcification

Concomitant mitral and aortic valve stenosis in a patient with mitral annular calcification and porcelain aorta poses a unique problem to the surgical team. Transcatheter aortic and mitral valve replacements in native valves offer a viable option for such selected group of patients. We present the case of a 54-year-old male who presented with severe aortic stenosis (AS) and severe mitral stenosis (MS) but was deemed high risk for surgery owing to intense calcification of the aorta and mitral annular calcification, and successfully underwent transcatheter double native valve replacement.

Nefroprotección en frío para reparo de ectasia aórtica y aneurismas ilíacos bilaterales ante la presencia de riñón ectópico pélvico / Cold nephroprotection for repair of aortic ectasia and bilateral iliac aneurysms in the presence of pelvic ectopic kidney

Resumen Los riñones ectópicos pélvicos solitarios asociados a degeneración aneurismática de las arterias ilíacas y la aorta abdominal son eventos muy raros. Los enfoques quirúrgicos para la corrección de aneurismas con compromiso renal son un desafío por la falta de consenso actual, en especial cuando cursan con riñones ectópicos pélvicos solitarios funcionales asociados. Por tal motivo, una de las estrategias que ha demostrado buenos resultados a corto y mediano plazo es la nefroprotección en frío, la cual puede ser usada con seguridad en estos pacientes. En el caso que se presenta, se evidenció una ectasia aórtica con aneurismas ilíacos bilaterales asociados con un riñón ectópico pélvico solitario en un paciente masculino de 75 años, con hipertensión arterial y dislipidemia. Se realizó una reconstrucción aortoilíaca bilateral y una reconstrucción de la arteria hipogástrica, además de reimplante de la arteria renal ectópica bajo irrigación renal en frío, sin complicaciones y preservación de la función renal.

Abstract Solitary pelvic ectopic kidneys associated with aneurysmal degeneration of the iliac arteries and abdominal aorta are very rare events. Surgical approaches for the correction of aneurysms with renal involvement are challenging due to the lack of current consensus, especially when they are associated with functional solitary pelvic ectopic kidneys. For this reason, one of the strategies that has shown good results in the short and medium term is cold nephroprotection, which can be used safely in these patients. In the present case, aortic ectasia with bilateral iliac aneurysms associated with a solitary pelvic ectopic kidneys was evidenced in a 75-year-old male patient with arterial hypertension and dyslipidemia. Bilateral aortoiliac reconstruction was performed with hypogastric artery reconstruction and reimplantation of the ectopic renal artery under cold renal irrigation, without complications and preservation of renal function.

A Rare Catastrophe: Three Cases of Aortic Root Dehiscence after Surgery

Abstract Ascending aortic pathologies may be life-threatening. Postoperative aortic root dehiscence is a very rare but extremely dangerous complication with a high mortality rate, and redo surgery is mandatory due to high risk of spontaneous rupture. We present three cases that had undergone Bentall procedure and had postoperative aortic root dehiscence. One of the patients presented with hemiplegia caused by septic embolus while the others had mild symptoms. Dr. Yakut's modified Bentall procedure, the flanged technique, was performed for each patient in redo surgery. Two patients were successfully discharged from the hospital, but one died due to intracranial hemorrhage and multiple organ failure.

Ministernotomy in Aortic Root and Arch Surgery: Early Outcomes

ABSTRACT Introduction: Minimally invasive methods have become more preferred in cardiac surgery today. In this study, the comparative results of patients who underwent an aortic root, arch or hemiarch replacement by ministernotomy and full sternotomy in our clinic are presented. Methods: Between January 2017 and October 2019, a series of operations including aortic root, ascending aorta, and aortic arch replacements were performed on 278 patients. The ministernotomy technique was used in 25 of them. Twenty patients who underwent full sternotomy were selected and matched to this group for comparison. Results: The ministernotomy group had a longer cross-clamping time (128.3±30.8 vs. 104.7±23.4 min, P=0.007) but the total operating time was similar in the two groups (249.76±28.56 vs. 248.25±37.53 min, P=0.879). The number of red blood cell (RBC) transfusions per patient was higher in the full sternotomy group (4.65±3.74 vs. 2.44±1.85 unit, P=0.020). The ministernotomy group had shorter ventilation times (7.60±4.88 vs. 32.30±32.25 h, P<0.001) and shorter ICU stay (1.56±0.58 vs. 3.35±1.46 d, P<0.001). The 30-day mortality was 0% in the ministernotomy group. Conclusion: Early results of our study show that, in combined or isolated aortic root, ascending aorta, and aortic arch surgeries, ministernotomy can be applied with relatively safety and low mortality and morbidity rates.

Surgical Strategy for Protecting Major Branch Arteries during Thoracic Endovascular Aortic Repair for Shaggy Descending Aortic Aneurysms / 日本心臓血管外科学会雑誌

Surgery for a shaggy aortic aneurysm requires a meticulous strategy to prevent embolic complications since the complications are associated with longer length of hospital stay and higher mortality. However, until now, there are no established treatment options to prevent embolic complications. We report a case of a 75-year-old man with a descending aortic aneurysm and a shaggy aorta who underwent thoracic endovascular aortic repair (TEVAR) with major branch artery protection. During the procedure, we placed balloon catheters in the left subclavian and left common iliac arteries, a filter device in the superior mesenteric artery, and a sheath at the ostium of the right common iliac artery. The patient did not develop embolic or other complications and was discharged on the eighth postoperative day. Our strategy of using the balloon occlusion technique and filter placement at the major vessels effectively prevented embolic complications during TEVAR for a shaggy aorta.

Surgical Case of Tuberculous Abdominal Aortic Aneurysm and Thoracic Aortic Aneurysm with Miliary Tuberculosis / 日本心臓血管外科学会雑誌

A 48-year-old woman was scheduled to undergo wrist surgery at the orthopedic surgery clinic. She was adventitiously diagnosed with miliary tuberculosis and saccular-type aneurysms in the suprarenal abdominal aorta and descending thoracic aorta during preoperative examination. Consequently, she received antituberculosis medications. However, the abdominal aortic aneurysm had enlarged rapidly 2 months later. Accordingly, we used an artificial graft patch bonded with rifampicin for the abdominal aortic aneurysm and resected the aneurysm and reconstructed the aorta through partial extracorporeal circulation by clamping the descending thoracic aorta and infrarenal abdominal aorta. Finally, we performed a thoracic endovascular aortic repair of the thoracic aortic aneurysm. Culture of the samples from the wall of the abdominal aortic aneurysm indicated Mycobacterium tuberculosis; therefore, the patient was diagnosed with a tuberculous aneurysm of the aorta. Her postoperative course was good, and she was discharged on day 36. At postoperative month 7, the patient is still on antituberculosis medications and has not experienced a recurrence.

Successful Use of a Stent-Graft for Treating a Pseudoaneurysm Located at the Anastomosis of the Ascending Aorta and the Great Saphenous Vein / 日本心臓血管外科学会雑誌

Takayasu Arteritis causes annuloaortic ectasia and coronary ostial stenosis, which may necessitate open heart surgery. However, pseudoaneurysms are sometimes observed postoperatively, making subsequent treatment difficult. We report thoracic endovascular aortic repair of a pseudoaneurysm of the ascending aorta with an anastomosis of the great saphenous vein in a 61-year-old female with a history of multiple open-heart procedures. Thirty years earlier, she underwent aortic valve replacement and coronary artery bypass surgery for aortic regurgitation, and right coronary ostial stenosis. Eleven years after surgery, an ascending aortic aneurysm was found and Bentall's surgery was performed. Multiple open thoracotomies were subsequently performed. Postoperatively, a pseudoaneurysm was found at the anastomosis between the ascending aorta and the great saphenous vein. The patient was transferred to the emergency room owing to hemoptysis and was diagnosed with a ruptured pseudoaneurysm at the anastomosis of the ascending aorta and the great saphenous vein. By inserting a stent graft into the ascending aorta, we avoided further complications and her prognosis was good. She was discharged on postoperative day 18 and did not experience any end leak for a year. Thoracic endovascular aortic repair in the ascending aorta is a minimally invasive procedure that may be useful for high-risk patients.

Particularidades dos Pacientes com Arterite de Takayasu em Idade Mais Avançada: Estudo Coorte, Retrospectivo e Transversal / Characteristics of Older Patients with Takayasu's Arteritis: A Two-Center, Cross-Sectional, Retrospective Cohort Study

Resumo Fundamentos Poucos estudos avaliaram pacientes idosos com Arterite de Takayasu (AT). Objetivo Avaliar o progresso de AT em diferentes grupos etários em seus possíveis efeitos sobre o tratamento medicamentoso e atividade da doença. Métodos este estudo transversal, retrospectivo, do tipo coorte incluiu 66 pacientes com AT. Os pacientes foram entrevistados, e dados dos 12 meses anteriores foram coletados dos prontuários médicos eletrônicos. Os pacientes foram divididos em quatro quartis de acordo com idade atual, e comparados quanto aos dados clínicos e laboratoriais, tratamento, comorbidades, status da doença, e status funcional. Um p<0,05 foi estabelecido como estatisticamente significativo. Resultados Os grupos foram definidos como Q1(22-36 anos, n=16), Q2(37-42 anos, n=18), Q3(43-49 anos, n=17), e Q4(51-66 anos, n=15). A frequência de pacientes com atividade da doença, fadiga, comorbidades e comprometimentos vasculares, e o índice de extensão da doença (DEI. Tak) foram comparáveis entre os grupos. Pacientes com idade mais avançada apresentaram maior duração da doença (p=0,001) e maior comprometimento do status funcional (Q2 versus Q3, p=0,003); menos pacientes usaram prednisona (Q1:43,8%; Q2:33,3%; Q3:11,8%; e Q4:6,7%; p=0,049) e agentes imunossupressores [Q1:100,0%; Q2:66,7%; Q3:58,8% e Q4:46,7%; Q1 versus Q3 (p=0,043) e Q1 versus Q4 (p=0,005) nas análises post-hoc]. Além disso, os níveis de danos da doença, sintomas de uma nova ocorrência de AT, e complicações nos 12 meses precedentes não foram diferentes entre os grupos. Conclusão Pacientes com AT e idade mais avançada requerem mínima intervenção medicamentosa e apresentam maior comprometimento no status funcional, o que pode ser atribuído a fatores relacionados ao envelhecimento.

Abstract Background Few studies have assessed elderly patients with Takayasu's arteritis (TAK). Objectives To evaluate the progression of TAK in different age groups and its possible effects on drug treatment and disease activity. Methods This cross-sectional and retrospective cohort study included 66 TAK patients. Patients were interviewed and data of the 12 preceding months were collected from electronic medical records. The patients were divided into four quartiles according to current age and compared for clinical and laboratory data, treatment, comorbidities, disease status, and functional status. Statistical significance was set at p<0.05. Results The groups were Q1(22-36 years, n=16), Q2(37-42 years, n=18), Q3(43-49 years, n=17), and Q4(51-66 years, n=15). The frequency of patients with disease activity, fatigue, comorbidities and vascular impairments, and the TAK disease extent index were also comparable between the groups. With age, disease duration was longer (p=0.001), fewer patients used prednisone (Q1:43.8%, Q2:33.3%, Q3:11.8%, and Q4:6.7%; p=0.049) and immunosuppressive drugs [Q1:100.0%, Q2:66.7%, Q3:58.8%, and Q4:46.7%; Q1 versus Q3 (p=0.043), and Q1 versus Q4 (p=0.005) in post-hoc analyses], and patients had greater functional status impairment (Q2 versus Q3, p=0.003). In addition, the levels of disease damage, new TAK symptoms, and complications in the preceding 12 months were not different between the groups. Conclusions Older patients with TAK require minimal drug treatment, and have greater impairment of functional status, which may be attributed to aging-related factors.

Takayasu Arteritis as a Secondary Cause of Arterial Hypertension

Abstract Takayasu arteritis (TA) is a rare type of vasculitis that affects mainly the aorta and its major branches. It is highly similar to giant cell arteritis (GCA), and differentiation between them may not be achieved even by histological examination. Arterial hypertension is typical of TA and is caused by stenosis of the renal arteries. Here we report the case of a 59-year-old woman, with a history of dyslipidemia and anemia, seen in the Internal Medicine department for resistant hypertension. Evaluation of secondary causes led to stenosis of the renal arteries. Assessment of target organ involvement was performed by computed tomography angiograph which revealed ectasia of the aortic arch and ascending aorta, tortuous course of the brachiocephalic trunk and the proximal portion of the right common carotid artery; positron-emission tomography which showed diffuse increased uptake in the ascending aorta, compatible with large vessels vasculitis. The patient was submitted to aortic valve replacement with a biological prosthesis combined with myocardial revascularization (Bentall-De Bono procedure). Aortic biopsy specimens showed anatomical and pathological features of GCA and TA. Due to persistently uncontrolled hypertension, prednisone 60 mg was initiated,with significant improvement in patient's condition.

Reduction of vascular reactivity in rat aortas following pilocarpine-induced status epilepticus

Abstract Objective: The authors investigated changes in vascular reactivity in rats following pilocarpine-induced status epilepticus. Method: Male Wistar rats weighing between 250g and 300g were used. Status epilepticus was induced using 385 mg/kg i.p. pilocarpine. After 40 days the thoracic aorta was dissected and divided into 4 mm rings and the vascular smooth muscle reactivity to phenylephrine was evaluated. Results: Epilepsy decreased the contractile responses of the aortic rings to phenylephrine (0.1 nM-300 mM). To investigate if this reduction was induced by increasing NO production with/or hydrogen peroxide L-NAME and Catalase were used. L-NAME (N-nitro-L arginine methyl ester) increased vascular reactivity but the contractile response to phenylephrine increased in the epileptic group. Catalase administration decreased the contractile responses only in the rings of rats with epilepsy. Conclusions: Our findings demonstrated for the first time that epilepsy is capable of causing a reduction of vascular reactivity in rat aortas. These results suggest that vascular reactivity reduction is associated with increased production of Nitric Oxide (NO) as an organic attempt to avoid hypertension produced by excessive sympathetic activation.

Lesões traumáticas de aorta em zona rural: série de casos com manifestações tardias e revisão dos aspectos terapêuticos / Traumatic aorta injuries in a rural area: late manifestations and review of therapeutic aspects

Resumo As lesões traumáticas da aorta (LTA) torácica estão associadas a altas taxas de morbimortalidade. São classificadas de acordo com a extensão do dano, e a angiotomografia computadorizada tem as maiores sensibilidade e especificidade para identificar o grau de lesão e potenciais lesões associadas. As estratégias terapêuticas para LTA são baseadas no tipo de lesão, na extensão e nas lesões associadas. Pode auxiliar na definição de conduta também o grau de estabilidade do paciente, podendo ser manejo cirúrgico convencional, endovascular (TEVAR) ou conservador em casos selecionados. Entre os pacientes com anatomia vascular adequada, a cirurgia endovascular está associada a melhor sobrevida e a menos riscos. O objetivo deste artigo foi descrever uma série de quatro casos acompanhados em serviço terciário, em um estado com poucos serviços de alta complexidade. A terapêutica endovascular foi empregada como método preferencial. Os pacientes apresentaram evolução favorável sem complicações até a alta e encontram-se em acompanhamento ambulatorial.

Abstract Traumatic thoracic aortic injuries (TTAI) are associated with high rates of morbidity and mortality. They are classified according to the extent of damage and computed tomography angiography has the highest sensitivity and specificity for identifying the degree of injury and potential associated lesions. Treatment strategies for TTAI are based on the type and extent of injury and associated lesions. The patient's degree of stability can also help to define the choice of treatment, which can be conventional or endovascular surgery (EVAR) or even conservative management in selected cases. Among patients with adequate vascular anatomy, endovascular surgery is associated with better survival and fewer risks. The objective of this article is to describe a series of four cases followed up at a tertiary service in a Brazilian state that has few centers that provide high complexity care. Endovascular therapy was employed as the preferred method. All four patients had favorable outcomes, with no complications up to discharge, and are currently in outpatient follow-up.

Lower Body Perfusion Reduces the Morbidity of Postoperative Acute Kidney Injury in Type A Dissection: A Propensity-Matched Analysis

ABSTRACT Introduction: Lower body perfusion (LBP) is a technique used to provide blood perfusion to distal organs and spinal cord during circulatory arrest. However, the effect of LBP on the prognosis of aortic arch surgery, especially on postoperative renal function, remains unclear. Methods: A total of 304 patients with acute type A aortic dissection who underwent total aortic arch replacement combined with frozen elephant trunk implantation between May 2016 and December 2021 were retrospectively analyzed. The patients were divided into LBP group (group L, n=85) and non-LBP group (group NL, n=219). Routine lower body circulatory arrest was applied during operation in group NL, and antegrade LBP combined was applied during operation in group L. Perioperative data were recorded. Propensity score matching was used for statistical analysis. Results: After propensity score matching, 85 pairs of patients were successfully matched. Two groups significantly differed in circulatory arrest time (six minutes vs. 30 minutes, P=0.000), cross-clamping time (101 minutes vs. 92 minutes, P=0.010), minimum nasopharyngeal temperature (29.4ºC vs. 27.2ºC, P=0.000), and highest lactate value during cardiopulmonary bypass (2.3 μmol/L vs. 4.1 μmol/L, P=0.000). Considering the postoperative indicators, the drainage volume (450 mL vs. 775 mL, P=0.000) and the incidence of level I acute kidney injury (23.5% vs. 32%, P=0.046) in group L was lower than those in group NL. Conclusion: LBP resulted as a safe and feasible approach in aortic arch surgery, as it could significantly shorten the circulatory arrest time, which might reduce the incidence of postoperative level I acute kidney injury.

Aneurisma aórtico abdominal infeccioso por Salmonella en un paciente con diabetes mellitus / Infected abdominal aortic aneurysm due to Salmonella in a patient with diabetes mellitus

Resumen Presentamos el caso de un paciente de edad avanzada, con diabetes mellitus descompensada, quien presentó un cuadro clínico de fiebre y dolor abdominal recurrente, tras lo cual fue diagnosticado con un aneurisma infeccioso de la aorta abdominal, los cuales representan solamente un 1% de todos los aneurismas. El paciente fue sometido a resección quirúrgica del aneurisma, injerto con dacrón impregnando con rifampicina y tratamiento antibiótico intravenoso. La microbiología del aneurisma confirmó infección por Salmonella. Actualmente, el paciente se encuentra asintomático y sin evidencia laboratorial de proceso inflamatorio.

Abstract We present a case of an elderly patient with uncontrolled diabetes mellitus, who presented with recurrent fever and abdominal pain, after which he was diagnosed with an infected abdominal aortic aneurysm, which represents only 1% of all aneurysms. The patient underwent surgical resection of the aneurysm, rifampicine-impregnated Dacron graft placement and intravenous antibiotic treatment. Microbiology reported Salmonella infection in the aneurysm. Currently, the patient is asymptomatic and without laboratory evidence of inflammatory process.

Asymptomatic Acute Dissection of the Abdominal Aorta as a Rare Complication of Takayasu Disease

The present study describes a case of a 24-year-old who had an asymptomatic acute dissection of the abdominal sub-renal aorta along with an inflammatory syndrome suggestive of Takayasu disease. Aortic dissection is a rare complication of Takayasu's disease that has only been reported a few times in the literature. The type of aortic dissection (type III b, according to the classification of De Bakey and Stanford) confirmed by computed tomography scan of the aorta (CT scan) in our patient. The patient underwent conservative medical treatment.

Aortic Root and Distal Arch Management During Type A Aortic Dissection Repair: Expanding Horizons

ABSTRACT The management of Type A aortic dissection has evolved over a period of a decade or so, and contemporary reports are suggesting a paradigm shift from a conservative approach to complete excision of the diseased aorta including root and distal arch. Improved cardiopulmonary bypass perfusion techniques, better understanding of the cerebral perfusion, and wide-ranging obtainability of prosthetic conduits gave surgical teams numerous choices. With improving outcomes and maturing surgical techniques, surgeons are performing extensive resections of the diseased aorta, but there is no standard protocol as far as the extent of the proximal and distal diseased aortic tissue resection is concerned. Aortic root replacement is associated with good early- and long-term outcomes and proffered solution in young and stable patients, for that reason many busy centres are endorsing total arch replacement in complex distal aortic dissections. This systemic review is discussing contemporary literature and associated pros and cons during surgical decision-making for these high-risk cases.

Antioxidant Actions of Thymoquinone, Silymarin, and Curcumin on Experimental Aortic Ischemia-Reperfusion Model in Wistar Albino Rats

ABSTRACT Introduction: Medical improvements are needed to prevent ischemia-reperfusion injury in thoracoabdominal aortic surgery. The aim of this study was to determine the antioxidant effects of thymoquinone, silymarin, and curcumin against ischemia-reperfusion injury associated with abdominal aorta. Methods: Twenty-five Wistar albino rats were included in the study. Sham, control, and treatment (thymoquinone, silymarin, and curcumin) groups were set in equal numbers. Ischemia-reperfusion was applied by clamping (120 minutes) and de-clamping (60 minutes) the infrarenal aorta of all groups, except the sham group. Before reperfusion, thymoquinone, silymarin, and curcumin were given intraperitoneally to the treatment groups. After reperfusion, blood samples were taken from the right ventricle. Total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) were studied in serum samples and histopathological examination was performed on the gastrocnemius muscle. Results: There was a significant difference in TOS and OSI values between the control and sham groups. Both values were found higher in the control group than in the sham group (P<0.05). OSI values were found to be lower in the thymoquinone group compared to the control group (P<0.05). All three parameters were found to be lower in the silymarin group than in the control group (P<0.05). TAS and TOS levels were found to be higher in the curcumin group than in the control group (P<0.05). There was no histopathological difference between the groups. Conclusion: Silymarin and thymoquinone administration decreases oxidative stress in experimental aortic ischemia-reperfusion injury. Antioxidant effect of curcumin was lower than silymarin and thymoquinone.

Abnormal Origin of the Pulmonary Artery from the Ascending Aorta in the Neonate

ABSTRACT The anomalous origin of one pulmonary artery from the ascending aorta is a rare congenital heart disease, generally diagnosed based on the clinical information and on echocardiographic and computed tomography angiography findings. Here we report two neonates successfully treated with surgery early in life.