Duke Cameron, MD Division of Cardiac SurgeryCerebrovascular Arteries Individualized approach...

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Duke Cameron, MD Division of Cardiac Surgery Division of Cardiac Surgery

Transcript of Duke Cameron, MD Division of Cardiac SurgeryCerebrovascular Arteries Individualized approach...

Page 1: Duke Cameron, MD Division of Cardiac SurgeryCerebrovascular Arteries Individualized approach Descending Thoracic Aorta Abdominal Aorta Visceral/lliac Arteries 4.5-5 cm or rapidly expanding

Duke Cameron, MDDivision of Cardiac SurgeryDivision of Cardiac Surgery

Page 2: Duke Cameron, MD Division of Cardiac SurgeryCerebrovascular Arteries Individualized approach Descending Thoracic Aorta Abdominal Aorta Visceral/lliac Arteries 4.5-5 cm or rapidly expanding

No financial disclosures

No disclosures

No financial disclosures

Acknowledgement of Drs.Vricella, Black and Dietz

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Page 3: Duke Cameron, MD Division of Cardiac SurgeryCerebrovascular Arteries Individualized approach Descending Thoracic Aorta Abdominal Aorta Visceral/lliac Arteries 4.5-5 cm or rapidly expanding

Loeys-Dietz Syndrome

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Page 4: Duke Cameron, MD Division of Cardiac SurgeryCerebrovascular Arteries Individualized approach Descending Thoracic Aorta Abdominal Aorta Visceral/lliac Arteries 4.5-5 cm or rapidly expanding

LDS Aortopathy

• Root Aneurysm• Root Aneurysm

• Arterial Tortuosity

• Dissection/Rupture at• Dissection/Rupture atyoung age and smallaortic sizeaortic size

• Peripheral aneurysms• Peripheral aneurysms

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Page 5: Duke Cameron, MD Division of Cardiac SurgeryCerebrovascular Arteries Individualized approach Descending Thoracic Aorta Abdominal Aorta Visceral/lliac Arteries 4.5-5 cm or rapidly expanding

Aortic Root Replacement in LDS

5 79 LDS operations

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Operative Experience with LDS

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ARR in LDS: Operative Technique

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Bentall Reimplantation VSRR

Page 8: Duke Cameron, MD Division of Cardiac SurgeryCerebrovascular Arteries Individualized approach Descending Thoracic Aorta Abdominal Aorta Visceral/lliac Arteries 4.5-5 cm or rapidly expanding

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Page 9: Duke Cameron, MD Division of Cardiac SurgeryCerebrovascular Arteries Individualized approach Descending Thoracic Aorta Abdominal Aorta Visceral/lliac Arteries 4.5-5 cm or rapidly expanding

Concomitant Procedures

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Page 10: Duke Cameron, MD Division of Cardiac SurgeryCerebrovascular Arteries Individualized approach Descending Thoracic Aorta Abdominal Aorta Visceral/lliac Arteries 4.5-5 cm or rapidly expanding

Operative Results

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Page 11: Duke Cameron, MD Division of Cardiac SurgeryCerebrovascular Arteries Individualized approach Descending Thoracic Aorta Abdominal Aorta Visceral/lliac Arteries 4.5-5 cm or rapidly expanding

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Late Results

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No reoperations for AR in trileaflet David VSRRs

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Special Considerations

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Page 14: Duke Cameron, MD Division of Cardiac SurgeryCerebrovascular Arteries Individualized approach Descending Thoracic Aorta Abdominal Aorta Visceral/lliac Arteries 4.5-5 cm or rapidly expanding

Coronary artery button aneurysms

“Hershey Kiss” aneurysms

Page 15: Duke Cameron, MD Division of Cardiac SurgeryCerebrovascular Arteries Individualized approach Descending Thoracic Aorta Abdominal Aorta Visceral/lliac Arteries 4.5-5 cm or rapidly expanding

Arch Reinterventions in LDS

Mos

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Page 16: Duke Cameron, MD Division of Cardiac SurgeryCerebrovascular Arteries Individualized approach Descending Thoracic Aorta Abdominal Aorta Visceral/lliac Arteries 4.5-5 cm or rapidly expanding

LVOT Pseudoaneurysm

• Typically arising from subanular• Typically arising from subanularsutures in NC sinus, thru aorto-mitral apron

• Can be PSA or fistula to LA or• Can be PSA or fistula to LA orRA

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Page 17: Duke Cameron, MD Division of Cardiac SurgeryCerebrovascular Arteries Individualized approach Descending Thoracic Aorta Abdominal Aorta Visceral/lliac Arteries 4.5-5 cm or rapidly expanding

Conclusions: ARR in LDS

• Low operative risk (0% mortality)

• Valve sparing operations have good• Valve sparing operations have goodearly and midterm results

• High re-intervention rate• High re-intervention rate

• Close surveillance necessary postop• Close surveillance necessary postop

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Recommendations

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Aorta and Peripheral Arteries Anatomy Visualization

Aorta and Peripheral Arteries Anatomy Visualization

Tuberculous Pseudoaneurysm of the Descending Thoracic Aorta … · 2016. 1. 12. · Tuberculous Pseudoaneurysm of the Descending Thoracic Aorta from Tuberculous Aortitis 564 J Korean

Tuberculous Pseudoaneurysm of the Descending Thoracic Aorta … · 2016. 1. 12. · Tuberculous Pseudoaneurysm of the Descending Thoracic Aorta from Tuberculous Aortitis 564 J Korean

Safe & e˜ ective - Dr. Mark Stengler, N.M.D. · testosterone levels were found to have a higher risk of atherosclerosis in the carotid arteries, abdominal aorta, and thoracic aorta.

Safe & e˜ ective - Dr. Mark Stengler, N.M.D. · testosterone levels were found to have a higher risk of atherosclerosis in the carotid arteries, abdominal aorta, and thoracic aorta.

British Non-specific arteritis ofthe aorta and its ... · of the aorta and any of its main branches. Cases of aortitis affecting the descending aorta, described as 'elongate coarctation'

British Non-specific arteritis ofthe aorta and its ... · of the aorta and any of its main branches. Cases of aortitis affecting the descending aorta, described as 'elongate coarctation'

Endovascular AAA Repair (PDF)...What Is the Aorta? The aorta is the artery that carries blood directly from the heart. Blood then flows from the aorta into smaller arteries that supply

Endovascular AAA Repair (PDF)...What Is the Aorta? The aorta is the artery that carries blood directly from the heart. Blood then flows from the aorta into smaller arteries that supply

BRANCH GRAFT FOR PROXIMAL DESCENDING THORACIC AORTA · 2018. 11. 1. · BRANCH GRAFT FOR PROXIMAL DESCENDING THORACIC AORTA Gustavo S. Oderich MD Chair, Vascular and Endovascular

BRANCH GRAFT FOR PROXIMAL DESCENDING THORACIC AORTA · 2018. 11. 1. · BRANCH GRAFT FOR PROXIMAL DESCENDING THORACIC AORTA Gustavo S. Oderich MD Chair, Vascular and Endovascular

1: ARTERIES 1 - Wiley...1 1 Coronary arteries 2 Ascending & arch of aorta 4 Internal carotid artery, vertebrobasilar system & circle of Willis 8 Ophthalmic artery 10 External carotid

1: ARTERIES 1 - Wiley...1 1 Coronary arteries 2 Ascending & arch of aorta 4 Internal carotid artery, vertebrobasilar system & circle of Willis 8 Ophthalmic artery 10 External carotid

Cardiovascular System - Napa Valley College · Blood Vessels – Arteries and Veins Arteries – always carry blood away from the heart and usually carry O 2-rich blood. Aorta —

Cardiovascular System - Napa Valley College · Blood Vessels – Arteries and Veins Arteries – always carry blood away from the heart and usually carry O 2-rich blood. Aorta —

Transposition of the Great Arteries - pdfs.semanticscholar.org · Transposition of the Great Arteries (TGA) Simplified definition: aorta comes off of the RV, pulmonary artery comes

Transposition of the Great Arteries - pdfs.semanticscholar.org · Transposition of the Great Arteries (TGA) Simplified definition: aorta comes off of the RV, pulmonary artery comes

Postradiogenic occlusion of the infrarenal aorta and the iliac … · 2018-05-08 · Postradiogenic occlusion of the infrarenal aorta and the iliac arteries step by step case presentation

Postradiogenic occlusion of the infrarenal aorta and the iliac … · 2018-05-08 · Postradiogenic occlusion of the infrarenal aorta and the iliac arteries step by step case presentation

The Role of Collagen in the Aorta’s Structure · Aorta is usually divided into five sections: a) the ascend-ing aorta, b) the arch of aorta, c) the descending aorta, d) the thoracic

The Role of Collagen in the Aorta’s Structure · Aorta is usually divided into five sections: a) the ascend-ing aorta, b) the arch of aorta, c) the descending aorta, d) the thoracic

Big Data in Aortic Surgery: Update on the STS Aortic Database 1330. Desai. Aorta... · Aortic Arch. Descending Aorta. Thoracoabdominal Aorta. Procecdure Type. Mortality by Procedure

Big Data in Aortic Surgery: Update on the STS Aortic Database 1330. Desai. Aorta... · Aortic Arch. Descending Aorta. Thoracoabdominal Aorta. Procecdure Type. Mortality by Procedure

Normal Aortic Anatomy - University of MichiganRight subclavian artery Innominate artery Right common carotid artery Descending aorta (thoracic portion) Aorta (abdominal portion) Inferior

Normal Aortic Anatomy - University of MichiganRight subclavian artery Innominate artery Right common carotid artery Descending aorta (thoracic portion) Aorta (abdominal portion) Inferior

Normal Aortic AnatomyAortic arch Ascending aorta Right subclavian artery Innominate artery Right common carotid artery Descending aorta (thoracic portion) Aorta (abdominal portion)

Normal Aortic AnatomyAortic arch Ascending aorta Right subclavian artery Innominate artery Right common carotid artery Descending aorta (thoracic portion) Aorta (abdominal portion)

AORTA = ΑΕΙΡΩ = HOLDING UP View Image · 1.Type A (DeBakey types I and II), ascending aorta involved 2.Type B (DeBakey type III), descending aorta involved •Penetrating atherosclerotic

AORTA = ΑΕΙΡΩ = HOLDING UP View Image · 1.Type A (DeBakey types I and II), ascending aorta involved 2.Type B (DeBakey type III), descending aorta involved •Penetrating atherosclerotic

TEVAR for ruptured descending thoracic aortic aneurysm ... · TEVAR for ruptured descending thoracic aortic aneurysm: case report TEVAR para aneurisma roto da aorta torácica descendente:

TEVAR for ruptured descending thoracic aortic aneurysm ... · TEVAR for ruptured descending thoracic aortic aneurysm: case report TEVAR para aneurisma roto da aorta torácica descendente:

Evaluation of the Aorta Indications and Iliac Arteriesjeffline.jefferson.edu/jurei/conference/pdfs/abdominal/10 - 330 to 400… · Evaluation of the Aorta and Iliac Arteries George

Evaluation of the Aorta Indications and Iliac Arteriesjeffline.jefferson.edu/jurei/conference/pdfs/abdominal/10 - 330 to 400… · Evaluation of the Aorta and Iliac Arteries George

Aortic Root Replacement - Professional · Chapter 33 Aortic Root Replacement 527 the ascending aorta, 8 (11 percent) the aortic arch, and 27 (38 percent) the descending thoracic aorta.

Aortic Root Replacement - Professional · Chapter 33 Aortic Root Replacement 527 the ascending aorta, 8 (11 percent) the aortic arch, and 27 (38 percent) the descending thoracic aorta.

Arteriovenous fistula between descending aorta: and left ... · Arteriovenous fistula between descending aorta: and left inferior pulmonary vein Congenital systemic arteriovenous

Arteriovenous fistula between descending aorta: and left ... · Arteriovenous fistula between descending aorta: and left inferior pulmonary vein Congenital systemic arteriovenous

The rupture of descending thoracic aorta due to the necrosis of ...

The rupture of descending thoracic aorta due to the necrosis of ...