ABSTRACT
BACKGROUND: We investigated the safety and efficacy of physician-modified thoracic endovascular aortic repair using a low-profile device for aortic arch lesions. METHODS: A total of 42 consecutive patients (mean age 67.2 ± 12.7 years; 32 men) with aortic arch lesions were treated by physician-modified thoracic endovascular aortic repair using a low-profile device (Zenith Alpha Thoracic Endovascular Graft) with four scallops or 13 fenestrations for the common carotid artery and 38 fenestrations or 30 branches for the left subclavian artery. The aortic repair indications were acute type B aortic dissection (n = 17, 40.5%), degenerative aneurysm (n = 14, 33.3%), chronic dissection aneurysmal degeneration (n = 4, 9.5%), and ulcer-like projection (n = 2, 4.8%). The mean iliac artery diameter was 7.6 ± 1.1â mm. RESULTS: There were no branches covered unintentionally or patients who died and suffered from severe spinal cord ischemia perioperatively. One patient (2.4%) experienced a postoperative minor stroke with full neurological recovery. The mean follow-up time was 18 ± 11 months, with 28 patients (66.7%) having at least 12 months. One access-related complication (2.4%) occurred. Two residual Ia (4.8%) and three residual IIIa (7.1%) endoleaks were treated by reintervention. There were no open repair conversions, ruptures, or other aortic complications. CONCLUSION: Physician-modified thoracic endovascular aortic repair using the low-profile device may be a safe, feasible, and time-saving method for preserving the cervical artery and has high reproducibility and anatomical reconstruction. However, its durability requires long-term follow-up.
Subject(s)
Aortic Aneurysm, Thoracic , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Male , Humans , Middle Aged , Aged , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Blood Vessel Prosthesis/adverse effects , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Aortic Aneurysm, Thoracic/complications , Stents/adverse effects , Endovascular Aneurysm Repair , Blood Vessel Prosthesis Implantation/adverse effects , Reproducibility of Results , Treatment Outcome , Postoperative Complications/etiology , Time Factors , Retrospective StudiesABSTRACT
Papillary fibroelastoma (PFE) accounts for approximately 8% of benign primary cardiac tumors. PFE frequently develops in the left heart system, such as the aortic valve and the mitral valve. We report a case of a giant PFE in the right ventricle. The patient was an 83-year-old woman with a history of chronic atrial fibrillation, diabetes, and hypertension. She had experienced palpitation and shortness of breath for several years. A giant mobile tumor was observed in the right ventricle by transthoracic echocardiography, and its extirpation was performed. Intraoperatively, a giant tumor of 3 cm in diameter was observed on the right ventricular side of the posterior tricuspid leaflet. As the tumor strongly adhered to the tendinous cords, it was unavoidable to resect the tendinous cords. Thus, a tricuspid valve repair was performed in addition to the tumor extirpation. The patient was diagnosed with papillary fibroelastoma by pathological examination.
