Derek R. Brinster

Treatment of Infolding Related to the Gore TAG Thoracic Endoprosthesis

The present report describes three cases of thoracic aortic endograft infolding or collapse involving the Gore TAG system. The cases include a penetrating aortic injury, a blunt aortic injury, and a symptomatic type B dissection. In the first case, infolding occurred in a delayed fashion after a normal-appearing 3-month follow-up computed tomographic angiogram. In the other two cases, infolding occurred during the immediate postoperative phase. One of the patients underwent explantation and surgical repair. The other two underwent endovascular repair of the infolded endograft by placement of a balloon-expandable stent in one case and a self-expanding stent in the other.

Open Heart Surgery for Removal of Polymethylmethacrylate After Percutaneous Vertebroplasty

We describe a 73-year-old woman who had a right atrial-inferior vena caval thrombus and pulmonary thromboembolism develop after percutaneous vertebroplasty with methylmethacrylate. Our patient subsequently underwent open-heart surgery to effectively remove the bulk of the foreign material. This case illustrates the need for close monitoring of patients undergoing percutaneous vertebroplasty and emphasizes the importance of prompt diagnosis and treatment.

Endovascular Repair of Blunt Thoracic Aortic Injuries

Blunt traumatic aortic injury is a highly fatal injury caused from rapid deceleration of the thorax. Most victims do not survive to obtain emergency medical care. Immediate open surgical repair had been the standard of care for decades, but more recent strategies and the emergence of thoracic aortic endografting have changed protocols for the treatment of this highly lethal lesion. This article reviews the current treatment of blunt thoracic aortic injury and the use of thoracic aortic stent grafting for this patient population.

Lupus aortitis leading to aneurysmal dilatation in the aortic root and ascending aorta.

Systemic lupus erythematosus (SLE) is an autoimmune disease in which organs, tissues, and cells undergo damage mediated by tissue-binding autoantibodies and immune complexes. We describe the case of a 23-year-old African American woman with a history of recurrent pneumonias. Computed tomography, magnetic resonance imaging (MRI), and echocardiographic evaluations, as well as clinical and laboratory findings, indicated a diagnosis of SLE with inflammatory aortitis secondary to SLE vasculitis. A repeat MRI revealed a rapidly expanding aortic root and ascending aorta that required prompt operative repair. The ascending aorta and aortic root were replaced with a mechanical valved conduit, and a coronary artery bypass to the posterior descending artery was performed because of related erosion into the intima of the right coronary ostium. The patient has done well postoperatively. Aortitis and aortic aneurysms are an uncommon manifestation of SLE, and a literature search revealed an apparent association between aortic aneurysms and steroid medications for SLE. This case is the first report of aortitis resulting in a nondissecting aortic root aneurysm in an SLE patient without a history of steroid use, indicating that all SLE patients, including those without a history of steroid use, require screening for aortic disease to improve surgical outcomes and to prevent fatal complications.

Simplified Technique of Total Aortic Arch Replacement With Minimal Circulatory and Myocardial Ischemia

This manuscript describes the initial experience of 15 patients undergoing aortic arch replacement using a modification of the trifurcate arch technique described by Spielvogel and coworkers [1]. This technique provides continuous antegrade cerebral perfusion and minimal myocardial ischemia with mild hypothermia.

Central Aortic Cannulation for Stanford Type A Aortic Dissection with the Use of Three-Dimensional and Two-Dimensional Transesophageal Echocardiography

There is still significant disagreement among surgeons about the best method for arterial cannulation to institute cardiopulmonary bypass (CPB) in patients with acute type A aortic dissection (STAADs). This study aimed to provide support for central aortic cannulation as a viable and preferable option, as it reduces time to institute CPB, operative times, and decreases the complexity of the procedure.

Type A Dissection Involving Intimo-Intimal Intussusception Through the Aortic Valve.

The presentation, evaluation, management, and outcome of a case of type A circumferential dissection involving repeated retrograde intussusception of the intimal flap through the aortic valve is described in this case report. Fewer than 20 intimo-intimal intussusception cases have been described since the first report was published by Hufnagel in 1962, and outcomes have typically been poor because of delays in diagnosis. This case shows the potential for a positive outcome when the diagnosis of intimo-intimal intussusception is entertained and confirmed early in the course of treatment. Preoperative computed tomography and intraoperative transesophageal echocardiography were essential in diagnosis and operative planning.

Transapical Arterial Cannulation for Salvage Cardiopulmonary Bypass in Transcatheter Aortic Valve Replacement

Hemodynamic instability during transcatheter aortic valve replacement procedures may require transient cardiopulmonary bypass for support. In patients with severe atherosclerosis, peripheral cannulation may not be possible. This method of direct left ventricle cannulation during transapical TAVR is a facile means to provide arterial inflow.

Aggressive Progression of Penetrating Atheromatous Ulcer of the Descending Thoracic Aorta

The treatment of acute aortic pathologies continues to evolve with enhanced imaging capabilities. This case report highlights the rapid progression of penetrating atherosclerotic ulcer to pseudoaneurysm development and subsequent treatment with thoracic endovascular stent graft.