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1.
BMC Cardiovasc Disord ; 21(1): 562, 2021 11 22.
Article in English | MEDLINE | ID: mdl-34809569

ABSTRACT

BACKGROUND: Aberrant right subclavian artery (ARSA) with associated Kommerell diverticulum (KD) is a rare congenital aortic disease. KD patients have a high risk of rupture, dissection, and compression of adjacent structures. Although several treatment options have been proposed (traditional surgery, hybrid operation, and endovascular intervention), a consensus regarding optimal surgical management has not yet been established. CASE PRESENTATION: A case of successful hybrid repair of distal aortic arch dissection aneurysm by dissecting KD and ARSA with debranching of right and left common carotid arteries, left subclavian artery, and stent grafting was presented. CONCLUSIONS: The hybrid operation is suitable for elderly patients or those with high risks. Along with intervention, the hybrid operation needs to be developed as a minimally invasive method.


Subject(s)
Aortic Aneurysm/surgery , Aortic Diseases/surgery , Aortic Dissection/surgery , Blood Vessel Prosthesis Implantation , Cardiovascular Abnormalities/surgery , Diverticulum/surgery , Subclavian Artery/abnormalities , Adult , Aortic Dissection/diagnostic imaging , Aortic Dissection/etiology , Aortic Aneurysm/diagnostic imaging , Aortic Aneurysm/etiology , Aortic Diseases/congenital , Aortic Diseases/diagnostic imaging , Aortography , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/adverse effects , Cardiovascular Abnormalities/complications , Cardiovascular Abnormalities/diagnostic imaging , Computed Tomography Angiography , Diverticulum/congenital , Diverticulum/diagnostic imaging , Humans , Male , Stents , Subclavian Artery/diagnostic imaging , Subclavian Artery/surgery , Treatment Outcome
2.
Comput Methods Programs Biomed ; 182: 105041, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31465978

ABSTRACT

BACKGROUND AND OBJECTIVE: A gap still exists in the hemodynamic effect of intra-aortic balloon pump (IABP), venoarterial extracorporeal membrane oxygenation (VA-ECMO), and VA-ECMO plus IABP on the blood perfusion of the coronary artery, brain, and lower limb; the relation between heart flow and ECMO flow; and the wall stress of vessels. METHODS: A finite-element model of the aorta, ECMO, and IABP was proposed to calculate the mechanical response via fluid-structure interaction. Heart failure (HF), IABP, ECMO, and ECMO plus IABP were utilized to study the effect of support models. RESULTS: For the pressure curve, VA-ECMO weakened the dicrotic notch of pressure compared with HF and the pulsatile index (0.494 vs. 0.706 vs. 0.471 vs. 0.613). IABP, ECMO, and ECMO plus IABP increased the perfusion of the coronary, brain, and renal artery compared with HF. However, ECMO and ECMO plus IABP clearly reduced the blood flow of the left arteria femoralis compared to that of the right arteria femoralis (ECMO: 194.04 vs. 730.80 mL/min; ECMO plus IABP: 342.15 vs. 947.22 mL/min). In addition, the flow of ECMO accessed the renal artery more than the left ventricular flow. Greater ventricular flow perfused to the renal artery at a diastolic period for ECMO plus IABP, especially at the time points of 2.192 s and 2.304 s. Compared to the velocity distribution with ECMO, the flow of the right arteria femoralis was increased in the process of IABP-on. According to these four cases, the stress of the vascular wall was increased for ECMO support at the systolic period. The peak wall stress of ECMO is increased by 20% at 1.68 s. CONCLUSIONS: ECMO plus IABP is more conducive to the blood supply than other cases from the result of numerical simulation. The location of blood intersection was generated in the region of the renal artery, which is estimated carefully.


Subject(s)
Aorta/physiology , Extracorporeal Membrane Oxygenation , Hemodynamics , Intra-Aortic Balloon Pumping/instrumentation , Finite Element Analysis , Humans
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