This case series presents 7 cases of congenital aortic diseases assessed using cardiac computed tomography angiography (CCTA). CCTA provided detailed visualization of vascular structures and spatial relationships that were important for diagnosis and surgical planning. The cases included vascular rings, interrupted arches, coarctation and hypoplasia. CCTA allowed early diagnosis and treatment. Multi-imaging is important for assessing these complex anomalies and guiding management, like surgical or endovascular interventions. Three-dimensional CCTA images provided valuable information for optimal diagnosis and surgical planning.
A rara associação de drenagem anômala total de veias pulmonares e cor triatri...gisa_legal
This document describes a rare case of a patient with both total anomalous pulmonary venous connection (TAPVC) and cor triatriatum. A pre-operative cineangiocardiogram ruptured the membrane dividing the left atrium in cor triatriatum, improving hemodynamics. Successful corrective surgery was then performed, involving resection of the cor triatriatum membrane and anastomosis of the left atrium to the pulmonary veins. At a six month follow up, the patient was doing well with mild residual effects.
The document describes a case of a 3-week-old infant referred for tachypnea. Chest x-ray showed cardiomegaly and normal pulmonary vascularity. Aortogram showed normal aorta but retrograde filling of the left coronary artery from collaterals, with the proximal left coronary draining into the pulmonary artery rather than the aorta. The most likely diagnosis is Bland-White-Garland Syndrome, a rare condition where one coronary artery, usually the left, originates from the pulmonary artery rather than the aorta.
This document discusses various aortic diseases and considerations for their assessment and treatment. It begins by outlining the objectives to discuss different aortic conditions, including acute syndromes, aneurysms, genetic diseases, and tumors. It then covers important anatomical considerations like the thoracic and abdominal divisions of the aorta. Subsequent sections provide details on endovascular zones, normal dimensions, histology, pathologies, clinical exam findings, imaging modalities like CT and their roles in evaluating the aorta.
Loops Around the Heart – A Giant Snakelike Right Coronary Artery Ectasia with...komalicarol
Coronary artery dilatation is an uncommon finding and is incidentally found during diagnostic coronary angiography or at necropsy.
The pathogenesis of dilatation of coronary arteries is still not very
well understood and therapeutic strategies are not clear. It is useful to know the difference between aneurysm and ectasia. In this
report we demonstrate the diagnostic workup of an asymptomatic
patient with a remarkable snakelike dilatation of the right coronary
artery with unique convolute. For the first time we used intracoronary injection and simultaneous echocardiographic visualization
of contrast agent (Sonovue) to proof a fistula to the coronary sinus.
Like our patient, most of the patients are asymptomatic in absence
of coronary artery disease and we decided on a conservative approach because of his very complex anatomy
Thoracic outlet syndrome is caused by compression of the neurovascular structures passing through the thoracic outlet. It has three subtypes depending on whether the brachial plexus, subclavian vein, or subclavian artery is compressed. Diagnosis involves clinical maneuvers to reproduce symptoms and imaging like ultrasound, MRI, CT or angiography. Ultrasound is useful for assessing blood flow changes during maneuvers but other modalities show the full thoracic outlet anatomy. Treatment depends on subtype but may include surgery or endovascular procedures, with follow-up ultrasound to monitor outcomes.
Presentation1, radiological imaging of karrtegner,s syndrome.Abdellah Nazeer
Kartagener syndrome is a type of primary ciliary dyskinesia characterized by a clinical triad of sinusitis, situs inversus, and bronchiectasis. Radiological findings can demonstrate the mirror-image reversal of organ positioning (situs inversus) as well as signs of chronic sinusitis and bronchiectasis including mucus plugging. Computed tomography is particularly useful for evaluating the bronchiectasis morphology and associated findings like mosaic perfusion patterns or tree-in-bud signs of infection. Differential diagnosis includes other causes of impaired mucociliary clearance and immunodeficiencies.
IMAGES OF A COMPLEX CASE OF MULTIPLE ANEURYSMAL DISEASE IN A 58 YEAR OLD MAN
IMMAGINI DI UN CASO COMPLESSO DI MALATTIA POLINEURISMATICA
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
This document describes a case report of a 70-year-old man found to have a giant left atrial myxoma, which is a rare type of heart tumor. Trans-thoracic echocardiography revealed a large irregular mass occupying the entire left atrium. The patient underwent successful surgical excision of the mass. Pathological examination confirmed it was a left atrial myxoma measuring 7.5 x 4.5 x 2.5 cm. Follow-up echocardiography showed no remaining tumor and normal heart function. While rare in the elderly, left atrial myxomas should be considered as a potential cause of cardiac symptoms even in older patients.
A rara associação de drenagem anômala total de veias pulmonares e cor triatri...gisa_legal
This document describes a rare case of a patient with both total anomalous pulmonary venous connection (TAPVC) and cor triatriatum. A pre-operative cineangiocardiogram ruptured the membrane dividing the left atrium in cor triatriatum, improving hemodynamics. Successful corrective surgery was then performed, involving resection of the cor triatriatum membrane and anastomosis of the left atrium to the pulmonary veins. At a six month follow up, the patient was doing well with mild residual effects.
The document describes a case of a 3-week-old infant referred for tachypnea. Chest x-ray showed cardiomegaly and normal pulmonary vascularity. Aortogram showed normal aorta but retrograde filling of the left coronary artery from collaterals, with the proximal left coronary draining into the pulmonary artery rather than the aorta. The most likely diagnosis is Bland-White-Garland Syndrome, a rare condition where one coronary artery, usually the left, originates from the pulmonary artery rather than the aorta.
This document discusses various aortic diseases and considerations for their assessment and treatment. It begins by outlining the objectives to discuss different aortic conditions, including acute syndromes, aneurysms, genetic diseases, and tumors. It then covers important anatomical considerations like the thoracic and abdominal divisions of the aorta. Subsequent sections provide details on endovascular zones, normal dimensions, histology, pathologies, clinical exam findings, imaging modalities like CT and their roles in evaluating the aorta.
Loops Around the Heart – A Giant Snakelike Right Coronary Artery Ectasia with...komalicarol
Coronary artery dilatation is an uncommon finding and is incidentally found during diagnostic coronary angiography or at necropsy.
The pathogenesis of dilatation of coronary arteries is still not very
well understood and therapeutic strategies are not clear. It is useful to know the difference between aneurysm and ectasia. In this
report we demonstrate the diagnostic workup of an asymptomatic
patient with a remarkable snakelike dilatation of the right coronary
artery with unique convolute. For the first time we used intracoronary injection and simultaneous echocardiographic visualization
of contrast agent (Sonovue) to proof a fistula to the coronary sinus.
Like our patient, most of the patients are asymptomatic in absence
of coronary artery disease and we decided on a conservative approach because of his very complex anatomy
Thoracic outlet syndrome is caused by compression of the neurovascular structures passing through the thoracic outlet. It has three subtypes depending on whether the brachial plexus, subclavian vein, or subclavian artery is compressed. Diagnosis involves clinical maneuvers to reproduce symptoms and imaging like ultrasound, MRI, CT or angiography. Ultrasound is useful for assessing blood flow changes during maneuvers but other modalities show the full thoracic outlet anatomy. Treatment depends on subtype but may include surgery or endovascular procedures, with follow-up ultrasound to monitor outcomes.
Presentation1, radiological imaging of karrtegner,s syndrome.Abdellah Nazeer
Kartagener syndrome is a type of primary ciliary dyskinesia characterized by a clinical triad of sinusitis, situs inversus, and bronchiectasis. Radiological findings can demonstrate the mirror-image reversal of organ positioning (situs inversus) as well as signs of chronic sinusitis and bronchiectasis including mucus plugging. Computed tomography is particularly useful for evaluating the bronchiectasis morphology and associated findings like mosaic perfusion patterns or tree-in-bud signs of infection. Differential diagnosis includes other causes of impaired mucociliary clearance and immunodeficiencies.
IMAGES OF A COMPLEX CASE OF MULTIPLE ANEURYSMAL DISEASE IN A 58 YEAR OLD MAN
IMMAGINI DI UN CASO COMPLESSO DI MALATTIA POLINEURISMATICA
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
This document describes a case report of a 70-year-old man found to have a giant left atrial myxoma, which is a rare type of heart tumor. Trans-thoracic echocardiography revealed a large irregular mass occupying the entire left atrium. The patient underwent successful surgical excision of the mass. Pathological examination confirmed it was a left atrial myxoma measuring 7.5 x 4.5 x 2.5 cm. Follow-up echocardiography showed no remaining tumor and normal heart function. While rare in the elderly, left atrial myxomas should be considered as a potential cause of cardiac symptoms even in older patients.
Occurrence of a mural thrombus in a diseased descending thoracic aorta (atherosclerotic or aneurysmal) is a well-known and commonly encountered vascular entity. However, thrombus formation in a normal appearing descending thoracic aorta (NADTA) is rarely reported in literature so far. We present an
unusual case report with a brief literature review of an aortic mural thrombus (AMT) in descending thoracic aorta in a young male. He presented at our center in the emergency department with acute onset abdominal pain and underwent a contrast enhanced CT scan that confirmed mural thrombus in
NADTA.
The CT images show a high-attenuation collection displacing the heart to the right, indicating hemopericardium or blood in the pericardial sac. Figure 3B further shows a brightly enhancing structure near a surgical clip on the distal posterior descending coronary artery, consistent with a pseudoaneurysm causing the hemorrhage. The findings are most consistent with hemopericardium developing several days after coronary bypass surgery.
This case report describes an 82-year-old male who developed intracardiac shunts following a redo aortic valve replacement surgery. Doppler echocardiography detected shunts from the left ventricle outflow tract across the membranous septum into the right atrium, right ventricle, and left atrium. The anatomical basis for this complication is the proximity and relationship of the thin membranous septum to the aortic root, tricuspid valve, and ventricular chambers. Aggressive debridement during valve surgery can cause injury and necrosis of the membranous septum, leading to fistula formation over time. While the shunts were initially small and asymptomatic, they could enlarge
Pulmonary Arteriovenous Malformation Presenting As An Enlarging Lung Mass And...Bassel Ericsoussi, MD
The document describes a case of a patient who presented with hemoptysis and an enlarging lung mass secondary to a pulmonary arteriovenous malformation (PAVM). Imaging including CT scan and pulmonary angiogram revealed a 3cm PAVM in the right upper lobe of the lung supplied by the right upper lobe pulmonary artery and draining into the right upper lobe pulmonary vein. The patient underwent successful coil embolization of the PAVM. PAVMs are rare but potentially life-threatening abnormalities that can present as lung nodules or masses and cause complications like hemoptysis if not treated.
This study analyzed surgical factors that may contribute to the development of junctional ectopic tachycardia (JET) after surgery for congenital heart defects. The study reviewed 343 patients who underwent repair of tetralogy of Fallot, truncus arteriosus, ventricular septal defect, or atrioventricular septal defect. Resection of muscle bundles, higher bypass temperatures, and relief of right ventricular outflow tract obstruction through the right atrium were independently associated with increased risk of postoperative JET. Relieving obstruction through the right atrium may cause direct trauma or hemorrhage to the conduction system, a potential mechanism for JET. Surgical techniques that avoid extensive muscle resection and excessive traction should be applied
Ventricular Tachycardia in Chronic Myocardial Contusion Interest of Multimoda...asclepiuspdfs
Ventricular tachycardia (VT) is a rhythmic emergency due to the poor hemodynamic tolerance, the possibility of transformation into ventricular fibrillation, and the occurrence of sudden death. It is a late complication after thoracic trauma due to ventricular remodeling and scar tissue fibrosis, the main arrhythmogenic substrate. The case we report is that of an 80-year-old patient admitted to our unit for lipothymic discomfort that has been evolving for several months. In this antecedent, we find a violent thoracic traumatism 23 years ago by accident of the public way. On admission, it has a stable hemodynamics; the surface electrocardiogram inscribes a sinus rhythm with diffuse negative T waves and reassuring biology. A few hours after his hospitalization, the discomfort will reappear with unsupported TV. Coronary angiography eliminates an ischemic cause with non-significant atheroma of the bisector. Echocardiography demonstrates a particular aspect of hypertrophy of the left ventricular apex with normal contractile function. Cardiac magnetic resonance imaging shows myocardial fibrosis in this area of hypertrophy and the cardiac computed tomography with three-dimensional reconstruction allows to visualize partial apical inferior disinsertion with an interventricular septum with a thin wall on the right ventricular slope calcified in places with an inlet opening closing in systole. The mechanism of TV in our patient is related to myocardial fibrosis and ventricular remodeling secondary to myocardial contusion 23 years ago. In this context, an implantable automatic defibrillator has been set up with half-yearly monitoring.
The document describes a case involving a chest x-ray and pulmonary angiogram findings in a 57-year-old female patient who presented with chest pain two weeks following a hemorrhagic stroke. The pulmonary angiogram shows multiple filling defects in the left main pulmonary artery and its branches, consistent with pulmonary embolism. While anticoagulation is usually the standard therapy for pulmonary embolism, it is contraindicated in this patient due to her recent stroke. Therefore, the best management option is placement of an inferior vena cava filter to prevent further pulmonary emboli while existing clots dissolve, as anticoagulation cannot be used due to her recent hemorrhagic stroke.
extracranial and intracranial cerebral collateral circulation .pptxDr.Ahmed M Khalaf
Collaterals between intracranial and extracranial circulation
leptomeningeal anastomosis
circle of wills
acute stroke
venous collateral circulation
primary secondary tertiary collaterals
orbital plexus
tectal plexus
IMAGING METHODS TO ASSESS THE STRUCTURE OF COLLATERALS
ct angiography
CTA
MRA
transcranial doppler TCD
Augmentation of cerebral blood flow in acute stroke
pathophysiology
This document discusses imaging of pathologies of the aortic vessels. It begins with the normal anatomy of the thoracic and abdominal aorta, including branches. It then discusses various pathologies such as aneurysms, dissections, and intramural hematomas. Imaging features of these conditions on various modalities such as CT, MRI, and angiography are provided. Complications related to the pathologies and classifications are also summarized.
presentation will give a idea about management of thoracoabdominal aortic aneurysm, including detail of investigation and treatment options available today.
Radiological evaluation of takayasu arteritis Dr. muhammad Bin Zulfiqar Servi...Dr. Muhammad Bin Zulfiqar
Radiological evaluation of takayasu arteritis Dr. muhammad Bin Zulfiqar Services Institute of Medical Sciences Services Hospital Lahore
In this presentation we will discuss the role of imaging in TA.
This document discusses several types of congenital heart diseases that cause cyanosis, including transposition of the great arteries, truncus arteriosus, total anomalous pulmonary venous connection, single ventricle, and double outlet right ventricle. Imaging modalities like CT and MRI play an important role in the diagnosis and surgical planning of these conditions by precisely demonstrating vascular anatomy and associated anomalies.
Vertebral artery pseudo-aneurysms and dissections are known to occur as a result of mechanical
manipulations of the cervical region, traumatic injury, spontaneously and iatrogenic injury because of central
venous catheterization. Central venous lines have become an integral part of patient care, but they are
not without complications. Vertebral artery injury (leading to pseudo-aneurysm and dissection) is one of
the rarer complications of central venous catheter placement. We report a case of inadvertent vertebral
artery catheterization during a dialysis catheter placement which subsequently demonstrated arterial
blood. Duplex ultrasound and computed tomographic (CT) scan confirmed vertebral artery catheterization.
It was successfully treated with open surgical technique by the vascular surgeon because of the size of
catheter and subsequent requirement of artery repair. There were no neurological sequelae. Open surgical
repair remains the gold standard of treatment. Endovascular repair of vertebral artery pseudo-aneurysms
has been described with promising outcomes, but long-term results are lacking. This case report describes
the rare iatrogenic event of vertebral artery injury and reviews its etiology, diagnosis, complications, and management.
This document discusses various diseases of the pericardium, heart, and thoracic aorta as assessed through non-invasive imaging techniques. It covers conditions such as pericarditis, pericardial cysts, cardiac tumors including myxomas, angiosarcomas and lymphomas. Diseases of the thoracic aorta explored are aortic dissection, aneurysms, and rupture. Key imaging modalities discussed are echocardiography, CT, MRI, nuclear medicine scans.
This document discusses aortic aneurysms and dissections. It covers risk factors, clinical presentations, diagnostic imaging and treatment. Key points include: thoracic aortic dissections have high mortality if undiagnosed; imaging modalities like CT, MRI and TEE are useful for diagnosis but presentations can be atypical; hypertension is a major risk factor; pain is the most common symptom but neurological symptoms, syncope or abdominal pain may occur instead.
This document provides information on imaging of aortic dissection, including:
1. CT is the most sensitive imaging method for detecting aortic dissection, showing features like an intimal flap separating the true and false lumens.
2. Risk factors include hypertension, male sex, advanced age, and connective tissue disorders. Acute aortic dissections are classified as Stanford type A or B.
3. Management decisions are based on details of the dissection like entry/exit points and branch vessel involvement that affect outcomes.
Surgery for aneurysmal right coronary fistula and constrictive pericarditis Abdulsalam Taha
CRCM, March 2014
View on scirp.org
Abstract:
Coronary artery fistula (CAF) is a direct communication between a coronary artery and the lumen of any of the cardiac chambers, the coronary sinus, the pulmonary artery, the superior vena cava or the proximal pulmonary veins. The majority of these fistulas are congenital in origin although they may occasionally be detected after cardiac surgery. Congenital CAF is a rare anomaly and aneurysmal formation in the fistula is even rarer. Majority of CAF are isolated lesions, however, congenital or acquired heart diseases may coexist. Herein, we report a case of huge congenital aneurysmal right CAF connected to the right atrium in an Iraqi man of 62 associated with tuberculous effusive-constrictive pericarditis to whom off pump pericardiectomy was performed followed by ligation of right coronary artery and vein graft implantation to its posterior descending branch under cardiopulmonary bypass. To the best of our knowledge, such association was not previously reported. CAF can be repaired surgically with minimum risk and excellent outcome. Surgery is advised whenever coronary fistula is diagnosed unless it is very small to avoid the potential complications.
Key words: coronary artery fistula, ectasia, aneurysm, pericarditis, pericardiectomy
Current Ms word generated power point presentation covers major details about the micronuclei test. It's significance and assays to conduct it. It is used to detect the micronuclei formation inside the cells of nearly every multicellular organism. It's formation takes place during chromosomal sepration at metaphase.
What is greenhouse gasses and how many gasses are there to affect the Earth.moosaasad1975
What are greenhouse gasses how they affect the earth and its environment what is the future of the environment and earth how the weather and the climate effects.
Occurrence of a mural thrombus in a diseased descending thoracic aorta (atherosclerotic or aneurysmal) is a well-known and commonly encountered vascular entity. However, thrombus formation in a normal appearing descending thoracic aorta (NADTA) is rarely reported in literature so far. We present an
unusual case report with a brief literature review of an aortic mural thrombus (AMT) in descending thoracic aorta in a young male. He presented at our center in the emergency department with acute onset abdominal pain and underwent a contrast enhanced CT scan that confirmed mural thrombus in
NADTA.
The CT images show a high-attenuation collection displacing the heart to the right, indicating hemopericardium or blood in the pericardial sac. Figure 3B further shows a brightly enhancing structure near a surgical clip on the distal posterior descending coronary artery, consistent with a pseudoaneurysm causing the hemorrhage. The findings are most consistent with hemopericardium developing several days after coronary bypass surgery.
This case report describes an 82-year-old male who developed intracardiac shunts following a redo aortic valve replacement surgery. Doppler echocardiography detected shunts from the left ventricle outflow tract across the membranous septum into the right atrium, right ventricle, and left atrium. The anatomical basis for this complication is the proximity and relationship of the thin membranous septum to the aortic root, tricuspid valve, and ventricular chambers. Aggressive debridement during valve surgery can cause injury and necrosis of the membranous septum, leading to fistula formation over time. While the shunts were initially small and asymptomatic, they could enlarge
Pulmonary Arteriovenous Malformation Presenting As An Enlarging Lung Mass And...Bassel Ericsoussi, MD
The document describes a case of a patient who presented with hemoptysis and an enlarging lung mass secondary to a pulmonary arteriovenous malformation (PAVM). Imaging including CT scan and pulmonary angiogram revealed a 3cm PAVM in the right upper lobe of the lung supplied by the right upper lobe pulmonary artery and draining into the right upper lobe pulmonary vein. The patient underwent successful coil embolization of the PAVM. PAVMs are rare but potentially life-threatening abnormalities that can present as lung nodules or masses and cause complications like hemoptysis if not treated.
This study analyzed surgical factors that may contribute to the development of junctional ectopic tachycardia (JET) after surgery for congenital heart defects. The study reviewed 343 patients who underwent repair of tetralogy of Fallot, truncus arteriosus, ventricular septal defect, or atrioventricular septal defect. Resection of muscle bundles, higher bypass temperatures, and relief of right ventricular outflow tract obstruction through the right atrium were independently associated with increased risk of postoperative JET. Relieving obstruction through the right atrium may cause direct trauma or hemorrhage to the conduction system, a potential mechanism for JET. Surgical techniques that avoid extensive muscle resection and excessive traction should be applied
Ventricular Tachycardia in Chronic Myocardial Contusion Interest of Multimoda...asclepiuspdfs
Ventricular tachycardia (VT) is a rhythmic emergency due to the poor hemodynamic tolerance, the possibility of transformation into ventricular fibrillation, and the occurrence of sudden death. It is a late complication after thoracic trauma due to ventricular remodeling and scar tissue fibrosis, the main arrhythmogenic substrate. The case we report is that of an 80-year-old patient admitted to our unit for lipothymic discomfort that has been evolving for several months. In this antecedent, we find a violent thoracic traumatism 23 years ago by accident of the public way. On admission, it has a stable hemodynamics; the surface electrocardiogram inscribes a sinus rhythm with diffuse negative T waves and reassuring biology. A few hours after his hospitalization, the discomfort will reappear with unsupported TV. Coronary angiography eliminates an ischemic cause with non-significant atheroma of the bisector. Echocardiography demonstrates a particular aspect of hypertrophy of the left ventricular apex with normal contractile function. Cardiac magnetic resonance imaging shows myocardial fibrosis in this area of hypertrophy and the cardiac computed tomography with three-dimensional reconstruction allows to visualize partial apical inferior disinsertion with an interventricular septum with a thin wall on the right ventricular slope calcified in places with an inlet opening closing in systole. The mechanism of TV in our patient is related to myocardial fibrosis and ventricular remodeling secondary to myocardial contusion 23 years ago. In this context, an implantable automatic defibrillator has been set up with half-yearly monitoring.
The document describes a case involving a chest x-ray and pulmonary angiogram findings in a 57-year-old female patient who presented with chest pain two weeks following a hemorrhagic stroke. The pulmonary angiogram shows multiple filling defects in the left main pulmonary artery and its branches, consistent with pulmonary embolism. While anticoagulation is usually the standard therapy for pulmonary embolism, it is contraindicated in this patient due to her recent stroke. Therefore, the best management option is placement of an inferior vena cava filter to prevent further pulmonary emboli while existing clots dissolve, as anticoagulation cannot be used due to her recent hemorrhagic stroke.
extracranial and intracranial cerebral collateral circulation .pptxDr.Ahmed M Khalaf
Collaterals between intracranial and extracranial circulation
leptomeningeal anastomosis
circle of wills
acute stroke
venous collateral circulation
primary secondary tertiary collaterals
orbital plexus
tectal plexus
IMAGING METHODS TO ASSESS THE STRUCTURE OF COLLATERALS
ct angiography
CTA
MRA
transcranial doppler TCD
Augmentation of cerebral blood flow in acute stroke
pathophysiology
This document discusses imaging of pathologies of the aortic vessels. It begins with the normal anatomy of the thoracic and abdominal aorta, including branches. It then discusses various pathologies such as aneurysms, dissections, and intramural hematomas. Imaging features of these conditions on various modalities such as CT, MRI, and angiography are provided. Complications related to the pathologies and classifications are also summarized.
presentation will give a idea about management of thoracoabdominal aortic aneurysm, including detail of investigation and treatment options available today.
Radiological evaluation of takayasu arteritis Dr. muhammad Bin Zulfiqar Servi...Dr. Muhammad Bin Zulfiqar
Radiological evaluation of takayasu arteritis Dr. muhammad Bin Zulfiqar Services Institute of Medical Sciences Services Hospital Lahore
In this presentation we will discuss the role of imaging in TA.
This document discusses several types of congenital heart diseases that cause cyanosis, including transposition of the great arteries, truncus arteriosus, total anomalous pulmonary venous connection, single ventricle, and double outlet right ventricle. Imaging modalities like CT and MRI play an important role in the diagnosis and surgical planning of these conditions by precisely demonstrating vascular anatomy and associated anomalies.
Vertebral artery pseudo-aneurysms and dissections are known to occur as a result of mechanical
manipulations of the cervical region, traumatic injury, spontaneously and iatrogenic injury because of central
venous catheterization. Central venous lines have become an integral part of patient care, but they are
not without complications. Vertebral artery injury (leading to pseudo-aneurysm and dissection) is one of
the rarer complications of central venous catheter placement. We report a case of inadvertent vertebral
artery catheterization during a dialysis catheter placement which subsequently demonstrated arterial
blood. Duplex ultrasound and computed tomographic (CT) scan confirmed vertebral artery catheterization.
It was successfully treated with open surgical technique by the vascular surgeon because of the size of
catheter and subsequent requirement of artery repair. There were no neurological sequelae. Open surgical
repair remains the gold standard of treatment. Endovascular repair of vertebral artery pseudo-aneurysms
has been described with promising outcomes, but long-term results are lacking. This case report describes
the rare iatrogenic event of vertebral artery injury and reviews its etiology, diagnosis, complications, and management.
This document discusses various diseases of the pericardium, heart, and thoracic aorta as assessed through non-invasive imaging techniques. It covers conditions such as pericarditis, pericardial cysts, cardiac tumors including myxomas, angiosarcomas and lymphomas. Diseases of the thoracic aorta explored are aortic dissection, aneurysms, and rupture. Key imaging modalities discussed are echocardiography, CT, MRI, nuclear medicine scans.
This document discusses aortic aneurysms and dissections. It covers risk factors, clinical presentations, diagnostic imaging and treatment. Key points include: thoracic aortic dissections have high mortality if undiagnosed; imaging modalities like CT, MRI and TEE are useful for diagnosis but presentations can be atypical; hypertension is a major risk factor; pain is the most common symptom but neurological symptoms, syncope or abdominal pain may occur instead.
This document provides information on imaging of aortic dissection, including:
1. CT is the most sensitive imaging method for detecting aortic dissection, showing features like an intimal flap separating the true and false lumens.
2. Risk factors include hypertension, male sex, advanced age, and connective tissue disorders. Acute aortic dissections are classified as Stanford type A or B.
3. Management decisions are based on details of the dissection like entry/exit points and branch vessel involvement that affect outcomes.
Surgery for aneurysmal right coronary fistula and constrictive pericarditis Abdulsalam Taha
CRCM, March 2014
View on scirp.org
Abstract:
Coronary artery fistula (CAF) is a direct communication between a coronary artery and the lumen of any of the cardiac chambers, the coronary sinus, the pulmonary artery, the superior vena cava or the proximal pulmonary veins. The majority of these fistulas are congenital in origin although they may occasionally be detected after cardiac surgery. Congenital CAF is a rare anomaly and aneurysmal formation in the fistula is even rarer. Majority of CAF are isolated lesions, however, congenital or acquired heart diseases may coexist. Herein, we report a case of huge congenital aneurysmal right CAF connected to the right atrium in an Iraqi man of 62 associated with tuberculous effusive-constrictive pericarditis to whom off pump pericardiectomy was performed followed by ligation of right coronary artery and vein graft implantation to its posterior descending branch under cardiopulmonary bypass. To the best of our knowledge, such association was not previously reported. CAF can be repaired surgically with minimum risk and excellent outcome. Surgery is advised whenever coronary fistula is diagnosed unless it is very small to avoid the potential complications.
Key words: coronary artery fistula, ectasia, aneurysm, pericarditis, pericardiectomy
Current Ms word generated power point presentation covers major details about the micronuclei test. It's significance and assays to conduct it. It is used to detect the micronuclei formation inside the cells of nearly every multicellular organism. It's formation takes place during chromosomal sepration at metaphase.
What is greenhouse gasses and how many gasses are there to affect the Earth.moosaasad1975
What are greenhouse gasses how they affect the earth and its environment what is the future of the environment and earth how the weather and the climate effects.
The use of Nauplii and metanauplii artemia in aquaculture (brine shrimp).pptxMAGOTI ERNEST
Although Artemia has been known to man for centuries, its use as a food for the culture of larval organisms apparently began only in the 1930s, when several investigators found that it made an excellent food for newly hatched fish larvae (Litvinenko et al., 2023). As aquaculture developed in the 1960s and ‘70s, the use of Artemia also became more widespread, due both to its convenience and to its nutritional value for larval organisms (Arenas-Pardo et al., 2024). The fact that Artemia dormant cysts can be stored for long periods in cans, and then used as an off-the-shelf food requiring only 24 h of incubation makes them the most convenient, least labor-intensive, live food available for aquaculture (Sorgeloos & Roubach, 2021). The nutritional value of Artemia, especially for marine organisms, is not constant, but varies both geographically and temporally. During the last decade, however, both the causes of Artemia nutritional variability and methods to improve poorquality Artemia have been identified (Loufi et al., 2024).
Brine shrimp (Artemia spp.) are used in marine aquaculture worldwide. Annually, more than 2,000 metric tons of dry cysts are used for cultivation of fish, crustacean, and shellfish larva. Brine shrimp are important to aquaculture because newly hatched brine shrimp nauplii (larvae) provide a food source for many fish fry (Mozanzadeh et al., 2021). Culture and harvesting of brine shrimp eggs represents another aspect of the aquaculture industry. Nauplii and metanauplii of Artemia, commonly known as brine shrimp, play a crucial role in aquaculture due to their nutritional value and suitability as live feed for many aquatic species, particularly in larval stages (Sorgeloos & Roubach, 2021).
ESR spectroscopy in liquid food and beverages.pptxPRIYANKA PATEL
With increasing population, people need to rely on packaged food stuffs. Packaging of food materials requires the preservation of food. There are various methods for the treatment of food to preserve them and irradiation treatment of food is one of them. It is the most common and the most harmless method for the food preservation as it does not alter the necessary micronutrients of food materials. Although irradiated food doesn’t cause any harm to the human health but still the quality assessment of food is required to provide consumers with necessary information about the food. ESR spectroscopy is the most sophisticated way to investigate the quality of the food and the free radicals induced during the processing of the food. ESR spin trapping technique is useful for the detection of highly unstable radicals in the food. The antioxidant capability of liquid food and beverages in mainly performed by spin trapping technique.
The debris of the ‘last major merger’ is dynamically youngSérgio Sacani
The Milky Way’s (MW) inner stellar halo contains an [Fe/H]-rich component with highly eccentric orbits, often referred to as the
‘last major merger.’ Hypotheses for the origin of this component include Gaia-Sausage/Enceladus (GSE), where the progenitor
collided with the MW proto-disc 8–11 Gyr ago, and the Virgo Radial Merger (VRM), where the progenitor collided with the
MW disc within the last 3 Gyr. These two scenarios make different predictions about observable structure in local phase space,
because the morphology of debris depends on how long it has had to phase mix. The recently identified phase-space folds in Gaia
DR3 have positive caustic velocities, making them fundamentally different than the phase-mixed chevrons found in simulations
at late times. Roughly 20 per cent of the stars in the prograde local stellar halo are associated with the observed caustics. Based
on a simple phase-mixing model, the observed number of caustics are consistent with a merger that occurred 1–2 Gyr ago.
We also compare the observed phase-space distribution to FIRE-2 Latte simulations of GSE-like mergers, using a quantitative
measurement of phase mixing (2D causticality). The observed local phase-space distribution best matches the simulated data
1–2 Gyr after collision, and certainly not later than 3 Gyr. This is further evidence that the progenitor of the ‘last major merger’
did not collide with the MW proto-disc at early times, as is thought for the GSE, but instead collided with the MW disc within
the last few Gyr, consistent with the body of work surrounding the VRM.
The binding of cosmological structures by massless topological defectsSérgio Sacani
Assuming spherical symmetry and weak field, it is shown that if one solves the Poisson equation or the Einstein field
equations sourced by a topological defect, i.e. a singularity of a very specific form, the result is a localized gravitational
field capable of driving flat rotation (i.e. Keplerian circular orbits at a constant speed for all radii) of test masses on a thin
spherical shell without any underlying mass. Moreover, a large-scale structure which exploits this solution by assembling
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light in the same manner as an equipotential (isothermal) sphere. Thus, the need for dark matter or modified gravity theory is
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BREEDING METHODS FOR DISEASE RESISTANCE.pptxRASHMI M G
Plant breeding for disease resistance is a strategy to reduce crop losses caused by disease. Plants have an innate immune system that allows them to recognize pathogens and provide resistance. However, breeding for long-lasting resistance often involves combining multiple resistance genes
2. Introduction
Article Reference
2
1. Congenital aortic diseases (CAoD)
encompass a wide variety of disorders that
range from asymptomatic findings to life-
threatening conditions. Multiple imaging
techniques are available for the assessment
of CAoD.
2. Transthoracic echocardiography (TTE) is
generally used as the first approach in these
pathologies, but cardiac computed
tomography angiography (CCTA) provides a
more adequate visualization of vascular
structures with optimal spatial resolution,
being the first-line imaging modality.
3. In this case series, we present seven
case reports of CAoD, including vascular
rings, interrupting arches, aortic coarctation,
and hypoplasia, highlighting the
fundamental role played by the CCTA in the
timely diagnosis and management of these
abnormalities.
3. Case Presentation
3
Case 1. A 3-year-old male with a history of recurrent
pneumonia, inspiratory stridor, and dysphagia. On arrival, the
patient presented tachypneic (35 breaths/min), and had an
oxygen saturation of 87% on room air.
Cardiac physical examination revealed regular rate and
rhythm, with an opening snap and aortic systolic ejection
murmur. Preliminary laboratory work revealed normal values.
The initial TTE demonstrated a right-sided aortic arch. A
CCTA was then requested to investigate this finding,
revealing a complete vascular ring made up of a right aortic
arch without obstructions, a left Kommerell diverticulum,
interventricular septal aneurysm with a septal defect of 6mm,
and a retroesophageal persistent ductus arteriosus (PDA)
(Figure 1A-D).
Management was a surgical ligation of the ligamentum
arteriosum, and resection of Kommerell diverticulum
4. Case Presentation
Investigations
Article Reference
4
Case 2. An 18-month-old female presented
difficulty breathing, acrocyanosis, and
diaphoresis during breastfeeding and
repeated episodes of respiratory distress
over the last 6 months. Cardiac exam
revealed regular rate and rhythm, without
cardiac murmurs, and pulse oximetry was
93% on room air. An initial echocardiogram
ruled out any cardiac malformation. A CCTA
was performed and evidenced a complete
loose vascular ring made up of a left aortic
arch, a right Kommerell diverticulum, and a
right ligamentum arteriosum (Figure 2A-D).
Treatment was a hybrid repair with surgical
ligation of the ligamentum arteriosum, and
resection of Kommerell diverticulum
5. Case Presentation
Management
5
Case 3. A four-day-old infant born at full term after a normal
pregnancy began to manifest increased work of breathing,
generalized pallor, and a decreased level of consciousness.
Cardiac exam revealed regular rate and rhythm, with an aortic
systolic ejection murmur, and pulse oximetry was 94% on both
upper limbs and 80% in lower limbs.
Preliminary laboratory work did not reveal any abnormalities. An
initial echocardiogram showed a tubular structure connecting
the left pulmonary artery to the descending aorta. An aortic
coarctation was suspected and a CCTA was performed,
displaying an interrupted aortic arch type A and PDA with slight
stenosis that connected the origin of the left pulmonary artery
with the upper descending aorta, which lies beyond the
interruption. The PDA was double-ligated, and the interrupted
aortic arch was repaired
6. Case Presentation
Management
6
Case 4. A five-day-old infant with no prior findings arrived at the
emergency department with sudden circulatory shock. He had
been discharged from a local clinic after an uncomplicated vaginal
delivery.
A TTE was performed, showing a discontinuous aortic arch and a
large ventricular septal defect. CCTA demonstrated an interrupted
aortic arch type B and a right isolated subclavian artery, left
ventricular outflow tract obstruction, pulmonary trunk dilatation,
and interventricular septal defect of 10x5.6mm. Three-
dimensional volume-rendered image showed the interruption
occurring beyond the origin of the right and left common carotid.
The left subclavian artery arises beyond the interruption. Patent
PDA continued with the descending aorta. The right isolated
subclavian artery originates from the right pulmonary artery.
Surgical correction was performed, with mobilization of the
descending aorta, and wide anastomosis
7. Case Presentation
Management
7
Case 5. A 50-year-old man presented with a history of resistant
hypertension and long-standing claudication. Relevant findings
upon initial examination were a mid-systolic murmur in the
interscapular area and delayed femoral pulses.
A chest x-ray showed mild cardiomegaly and notching of the
inferior aspects of the ribs. A TTE revealed left ventricular
hypertrophy and in the suprasternal plane data compatible with
coarctation of the aorta were visualized, so a CCTA was
performed, showing a focal severe coarctation in the descending
aorta, with multiple collateral arteries. The three-dimensional
volume-rendered image in the left lateral view showed prominent
internal mammary arteries due to severe coarctation of the aorta
Two overlapping self-expanding stents were implanted, followed
by a balloon angioplasty
8. Case Presentation
Management
8
Case 6. A 3-day-old male infant was referred to
cardiology due to poor feeding, tachypnea, and
lethargy, physical examination revealed a systolic
murmur. He had been discharged at 24 hours after
an uncomplicated vaginal delivery.
Diagnosis of hypoplastic left heart syndrome was
made after the initial TTE that showed dilation of
right cavities, mitral atresia, and hypoplasia of left
cavities. The CCTA displayed the ascending aorta
and aortic arch with preductal coarctation
associated with hypoplastic left ventricular
syndrome. Three-dimensional CCTA demonstrates
diffuse hypoplasia of the aortic root, ascending
aorta, and aortic arch (Figure 6). Ultra-fast low-
dose high pitch CCTA allowed visualization of the
aortic arch for surgical planning. Surgical resection
of the coarctation area and end-to-end
anastomosis were performed
9. Case Presentation
Management
9
Case 7. A 9-month-old male presented to the
emergency room with acrocyanosis and
inadequate weight gain. Physical examination
showed inspiratory stridor, and no murmurs
were detected. An initial echocardiogram
demonstrated pulmonary atresia and
interventricular septal defect. CCTA provided the
diagnosis of a complete vascular ring made up
of a right (dominant) and left aortic arches, with
pulmonary atresia, right aortic arch with an
aberrant left subclavian artery, and left
ligamentum arteriosum. Three-dimensional
CCTA showed the trachea and esophagus fully
surrounded by two patent aortic arches (Figure
7A-D). Through catheterization, a stent was
placed in the left aortic arch
10. Discussion
10
CAoD comprise an uncommon spectrum of vascular
anomalies, which includes obstructions in the aortic arch
(coarctation, hypoplasia, and interruption) and vascular
rings. Echocardiography, cardiac magnetic resonance
imaging, and computed tomography angiography are
important imaging modalities used to identify and
diagnose aortic arch variants and anomalies.
We present seven case reports of CAoD in which the
clinical manifestations throughout the cases are
discussed, highlighting the heterogeneity of the symptoms
and the importance of using high-resolution imaging
modalities.
Adequate assessment allows early diagnosis of the
aortic diseases , which are often inversely
proportional to their severity.
Multi-imaging techniques are indispensable for the
assessment of CAoD, as they demonstrate the
complex aortic arch anomalies and provide an
adequate evaluation of the surrounding structures,
such as the heart, trachea, and esophagus.
CCTA three-dimensional reconstructions provide
detailed images of vascular rings, Kommerell
diverticulum and avoid more complex procedures,
such as bronchoscopy and barium esophagogram.
11. Discussion
Article Reference
11
Multislice computed tomography angiography provides detailed information of the structure of the
vessel; it is outstanding in displaying the distal aortic arch, brachiocephalic artery, and the spatial
relationship between the trachea, bronchi, and aortic arch. 3D-static images and rotated
reconstruction images can be generated by CT, which provide specific information of a certain
site and can be rotated from every direction for analyzing pre and postoperative anatomy
changes.
Three-dimensional volume-rendered images of arterial anatomy are a valuable tool for optimal
diagnosis and surgical planning, as observed in many of our cases.
Three-dimensional printing has been shown to have a positive impact on the preoperative
planning of corrective surgery, due to the excellent geometric information that it provides. (10,6)
Familiarity with the spectrum of anomalies encompassed in the aortic arch is essential for a
timely diagnosis, and the basic knowledge of the different imaging modalities used in these
pathologies is extremely important, as they significantly guide the management, which includes
surgical and percutaneous interventions.
12. Learning Points
12
1. Cardiovascular computed
tomography is first-line
noninvasive imaging modality in
the diagnosis, selection of
optimal surgical planning and
follow-up of congenital aortic
diseases.
2. The choice of imaging
modality for an individual
patient should be
determined by age,
diagnosis, and clinical
condition.
13. References
Article Reference
13
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