Endovascular repair of blunt aortic injury in a patient with situs inversus and dextrocardia

Bilello, John F.; Birnbaum, Peter L.; Venugopal, Chandra; Fong, Lam-Kiu

doi:10.1016/j.jvs.2011.03.220

Cited by 3 publications

(4 citation statements)

References 9 publications

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“…It occurs in approximately 2/10,000 live births. Although endovascular repair of the descending thoracic aorta in situs inversus totalis has been reported, 7) we are not aware of any report regarding aortic arch rerouting and TEVAR concomitant with off-pump coronary artery bypass grafting in a patient with situs inversus totalis. In addition, we are not aware of any report that situs inversus totalis has relevance to an aortic arch aneurysm either.…”

Section: Discussionmentioning

confidence: 96%

Aortic Arch Rerouting and OPCAB in a Patient With Situs Inversus Totalis

et al. 2014

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SummaryEndovascular therapy approaches for aortic aneurysm have lowered the mortality and morbidity rates even in highrisk patients; moreover, these approaches are applied in the management of aortic arch pathologies by transposition of the supra-aortic branches. We present the case of a 75-year-old female patient with situs inversus totalis on hemodialysis. The patient underwent off-pump aortic arch rerouting and thoracic endovascular aortic repair concomitant with coronary artery bypass grafting for distal aortic arch aneurysm and ischemic heart disease. (Int Heart J 2014; 55: 278-279) Key words: Endovascular therapy, Minimally invasive procedure A lthough hypothermic circulatory arrest with various forms of cerebral perfusion techniques has decreased the incidence of neurological complications in conventional aortic arch surgery, total arch replacement continues to be associated with significant mortality and morbidity in high-risk patients.1) Recent studies have demonstrated that less invasive approaches using thoracic endovascular aortic repair (TEVAR) of the aortic arch are feasible in patients who are considered to be at high risk for conventional surgical approaches. 2) Case ReportA frail, 75-year-old woman with situs inversus totalis undergoing hemodialysis due to diabetic nephropathy was referred to our institution for the management of a rapidly expanding distal aortic arch aneurysm, which was detected on chest radiography (Figure 1). In addition, she complained of mild chest discomfort during dialysis. Computed tomography (CT) confi rmed a saccular distal aortic arch aneurysm ( Figure 2A) and an incidentally detected left adrenal tumor, which was diagnosed as a pheochromocytoma by a series of serological examinations. Coronary angiography revealed 90% stenosis in the proximal portion of the interventricular branch of the left coronary artery, which is the counterpart of the left anterior descending artery. The patient had no pyrexia, and the infl ammatory parameters were within normal limits on hematological examination. She was also suffering from chronic sinusitis. Bilateral radial and brachial arteries had been used for multiple arteriovenous shunt operations for the preceding 18 years, but all of them had occluded subsequently, and a permanent blood access catheter inserted via the left internal jugular vein was used for hemodialysis.Considering her advanced age, comorbidities, and frailty, off-pump total arch rerouting and endovascular stent grafting with coronary artery bypass grafting were scheduled. We decided to use a saphenous vein to graft the coronary artery in order to shorten the operation time and minimize bleeding. During surgery, the ascending aorta was side-clamped with decreased pressure by snaring the inferior vena cava, a side-toside anastomosis was performed between a trifurcated graft (Hemashield; Maquet, Fairfi eld, NJ, USA) and the aorta, and subsequently, the brachiocephalic and carotid arteries were reconstructed in an end-to-end fashion. In-situ reconstruction of the s...

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Section: Discussionmentioning

confidence: 96%

Aortic Arch Rerouting and OPCAB in a Patient With Situs Inversus Totalis

et al. 2014

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“…To the best of our knowledge, only two cases of SIT and dextrocardia coexisting with BTAI at the aortic isthmus have been reported [ 2 , 3 ]. One patient was successfully treated with open repair, and the other was treated with TEVAR.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, in their case of SIT and dextrocardia coexisting with BTAI which was treated with TEVAR, Bilello et al . reported that the anomalous anatomy of their patient did not hinder TEVAR and that the preoperative planning differed only with regard to the placement of the arterial catheter in the left wrist instead of the right [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…SIT has an incidence of 1/10 000 [ 1 ]. Although the coexistence of SIT with dextrocardia and blunt thoracic aortic injury (BTAI) is rare, some cases that were repaired via right thoracotomy or treated with thoracic endovascular aortic repair (TEVAR) have been reported [ 2 , 3 ]. We herein describe a rare case of BTAI in a patient with SIT and dextrocardia, which was successfully subjected to open repair through a right thoracotomy.…”

Section: Introductionmentioning

confidence: 99%

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Aortic injury repair in a patient with situs inversus totalis and dextrocardia

Ishimine

Ishigami

Chida

et al. 2022

Journal of Surgical Case Reports

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Situs inversus totalis (SIT) with dextrocardia is a rare autosomal recessive disorder. We herein describe a blunt thoracic aortic injury (BTAI) in a patient with SIT and dextrocardia. An 18-year-old girl who was injured by a fall presented to our hospital. Computed tomography (CT) revealed a traumatic pseudoaneurysm at the aortic isthmus. Open aortic repair was performed through a right thoracotomy. No abnormal findings were observed on CT 1 year after the surgery. Open aortic repair of BTAI can be safely performed through a right thoracotomy in patients with SIT and dextrocardia.

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A Case of Acute Traumatic Aortic Injury of a Right-sided Aortic Arch with Rupture of an Aberrant Left Subclavian Artery

Taif

Kalbani

2013

Radiology Case

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Acute traumatic aortic injury is a potentially lethal condition with most patients die at the scene of the accidents. Rapid deceleration due to motor vehicle accidents is the commonest mechanism of injury. These injuries can be successfully repaired in the few patients who survive the initial trauma if proper diagnosis and rapid treatment are provided. The occurrence of acute traumatic aortic injury in patients with congenital abnormality of the aortic arch has been rarely reported; however, it renders the diagnosis and treatment more difficult. In this paper, we describe an extremely rare case of aortic injury in a young patient who had a right sided aortic arch with rupture of an aberrant left subclavian artery. The patient was suspected to have a Kommerell's diverticulum in the aberrant subclavian artery origin. This injury resulted in an unusually huge pseudoaneurysm involving part of the mediastinum and extending into the neck. Unfortunately; patient succumbed in spite of surgical intervention.

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Endovascular repair of blunt aortic injury in a patient with situs inversus and dextrocardia

Cited by 3 publications

References 9 publications

Aortic Arch Rerouting and OPCAB in a Patient With Situs Inversus Totalis

Aortic Arch Rerouting and OPCAB in a Patient With Situs Inversus Totalis

Aortic injury repair in a patient with situs inversus totalis and dextrocardia

A Case of Acute Traumatic Aortic Injury of a Right-sided Aortic Arch with Rupture of an Aberrant Left Subclavian Artery

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