ABSTRACT
The aim of this study was to develop and test a technique for scintigraphic examination of the thoracic aorta, which allows for visualizing foci of inflammation. Materials and Methods: The study included 15 patients (median age - 61 [47; 73] years) with aortic dilatation more than 45 mm and thoracic aortic aneurysm who were candidates for surgical treatment. All patients underwent a chest scintigraphy with 99mTc-pyrophosphate 48 h before surgery to identify foci of inflammation in the aortic wall. The new technique included intravenous administration of 370 MBq of a radiopharmaceutical (RP), registration of scintigrams at 3 and 6 h after injection of RP in a tomographic mode combined with X-ray computed tomography. After the image reconstruction, subtraction of the later scintigrams from the early ones was performed, followed by analysis of the final images. The results of scintigraphy were compared with the histological data obtained from intraoperative samples of resected aorta. Results: According to the results of this novel scintigraphic technique, artifacts from the radioactivity of the vascular blood pool were eliminated and pathological RP uptake was identified in 5 (33.3±1.5%) out of 15 examined patients. The "focus/vessel lumen" ratio averaged at 1.47 [1.30; 1.48]. Histological examination of resected aorta samples confirmed the presence of chronic inflammation in 4 (26.7±1.3%) out of 15 patients. Parameters of diagnostic efficiency were: sensitivity - 100%, specificity - 91%, diagnostic accuracy - 93%. Conclusion: The method of scintigraphic diagnostics of inflammatory processes in the aorta using 99mTc-pyrophosphate, supplemented by subtraction of the late from the early images, makes it possible to eliminate artifacts from the radioactivity of the aortic blood pool and to reveal the pathological RP accumulation indicating the areas of inflammation in the aortic wall.
Subject(s)
Diphosphates , Radiopharmaceuticals , Aorta/diagnostic imaging , Humans , Inflammation/diagnostic imaging , Middle Aged , Radionuclide ImagingABSTRACT
The study was aimed at analysing the immediate results of various surgical approaches to prosthetic repair of ascending aortic aneurysms. We analysed the data of 113 patients operated on for an ascending aortic aneurysm from 2008 to 2017. All patients were divided into two comparable groups. Group One patients (n=43) underwent prosthetic repair of the ascending portion of the aorta with formation of a distal anastomosis proximal to the level of the brachiocephalic trunk, Group Two patients (n=70) were subjected to reconstruction of the ascending aorta with aortic arch plasty ('hemiarch'). In the early postoperative period in Group One and Group Two patients, the frequency of adverse cardiac events amounted to 3 (7.0%) and 1 (1.5%) cases (p=0.339), with prolonged mechanical ventilation required in 12 (18.6%) and 6 (8.6%) cases and resternotomy required in 8 (18.6%) and 4 (5.7%) cases, respectively. The postoperative 30-day mortality in the group of isolated prosthetic repair of the ascending aorta amounted to 11.6% (5 cases) and in the group of patients with the hemiarch reconstruction to 3.0% (2 cases). No neurological complications were observed. Hemiarch prosthetic repair of the aorta is an effective and safe surgical method of treatment. This approach does not increase the risks for cardiac, neurological, pulmonary, haemorrhagic complications in the immediate postoperative period as compared with prosthetic repair of only the ascending portion of the aorta.
