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Frozen Elephant Trunk: a technique which can be offered in complex pathology to fix the whole aorta in one setting.

Kokotsakis J, Anagnostakou V, Kratimenos T, Ashrafian H, Athanasiou T - J Cardiothorac Surg (2011)

Bottom Line: We report a case of treating complex aortic pathology with the use of the Frozen Elephant Trunk technique in a patient with chronic type B aortic dissecting aneurysm associated with arch and ascending aorta dilatation, proximal aortic disease and coronary disease.The case was further complicated due to the involvement of the abdominal vessels and preexisting femoral to femoral crossover bypass.In addition the patient had a tracheostomy for laryngeal cancer.We emphasize the role of the Frozen Elephant Trunk to fix the whole aorta in one setting with special attention given to the changes taking place in vascular perfusion following correction and reconstitution of the true lumen.

View Article: PubMed Central - HTML - PubMed

Affiliation: Cardiac Surgery Department, Evangelismos General Hospital, Athens, Greece.

ABSTRACT
We report a case of treating complex aortic pathology with the use of the Frozen Elephant Trunk technique in a patient with chronic type B aortic dissecting aneurysm associated with arch and ascending aorta dilatation, proximal aortic disease and coronary disease. The case was further complicated due to the involvement of the abdominal vessels and preexisting femoral to femoral crossover bypass. In addition the patient had a tracheostomy for laryngeal cancer.We emphasize the role of the Frozen Elephant Trunk to fix the whole aorta in one setting with special attention given to the changes taking place in vascular perfusion following correction and reconstitution of the true lumen.

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Pre-operative images of the aorta. (a.) 3D CT reconstruction demonstrating the dissecting type B aneurysm and the dilatation of the arch and ascending aorta (b.) 3D CT reconstruction image of the dissected abdominal aorta and the patent femoro-femoral bypass graft (c.) Axial CT image showing the origin of the celiac trunk from the true lumen (d.) Axial CT image demonstrating the origin of the left renal artery from the false lumen and right renal artery from the true lumen.
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Figure 1: Pre-operative images of the aorta. (a.) 3D CT reconstruction demonstrating the dissecting type B aneurysm and the dilatation of the arch and ascending aorta (b.) 3D CT reconstruction image of the dissected abdominal aorta and the patent femoro-femoral bypass graft (c.) Axial CT image showing the origin of the celiac trunk from the true lumen (d.) Axial CT image demonstrating the origin of the left renal artery from the false lumen and right renal artery from the true lumen.

Mentions: Preoperative evaluation included a coronary angiogram that revealed 90% stenosis of the proximal Left Anterior Descending (LAD) artery and total occlusion of the Right Coronary Artery (RCA). Transthoracic echocardiographic analysis revealed moderate (2+/4+) aortic regurgitation with left ventricular ejection fraction of 50%. Carotid duplex ultrasound scan demonstrated mild (<50%) carotid artery stenosis. Computed tomographic angiography (CTA) (Figure 1a and 1b) identified a degenerative aneurysm of the ascending aorta (5 cm) and aortic arch (5 cm) which had a bovine configuration (common origin of the innominate and left common carotid artery). There was also post-dissection type B aneurysm of the descending aorta (9 cm) starting just below the left subclavian artery and tapering to the celiac trunk. There was severe compression of the true lumen from the false lumen, the celiac and right renal artery originated from the true lumen (Figure 1b and 1c, superior mesenteric artery from both lumens, left renal artery from the false lumen (Figure 1d). The right femoral artery was perfused from the false lumen while the left from the compressed true lumen and the functioning femoral-femoral bypass.


Frozen Elephant Trunk: a technique which can be offered in complex pathology to fix the whole aorta in one setting.

Kokotsakis J, Anagnostakou V, Kratimenos T, Ashrafian H, Athanasiou T - J Cardiothorac Surg (2011)

Pre-operative images of the aorta. (a.) 3D CT reconstruction demonstrating the dissecting type B aneurysm and the dilatation of the arch and ascending aorta (b.) 3D CT reconstruction image of the dissected abdominal aorta and the patent femoro-femoral bypass graft (c.) Axial CT image showing the origin of the celiac trunk from the true lumen (d.) Axial CT image demonstrating the origin of the left renal artery from the false lumen and right renal artery from the true lumen.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3117693&req=5

Figure 1: Pre-operative images of the aorta. (a.) 3D CT reconstruction demonstrating the dissecting type B aneurysm and the dilatation of the arch and ascending aorta (b.) 3D CT reconstruction image of the dissected abdominal aorta and the patent femoro-femoral bypass graft (c.) Axial CT image showing the origin of the celiac trunk from the true lumen (d.) Axial CT image demonstrating the origin of the left renal artery from the false lumen and right renal artery from the true lumen.
Mentions: Preoperative evaluation included a coronary angiogram that revealed 90% stenosis of the proximal Left Anterior Descending (LAD) artery and total occlusion of the Right Coronary Artery (RCA). Transthoracic echocardiographic analysis revealed moderate (2+/4+) aortic regurgitation with left ventricular ejection fraction of 50%. Carotid duplex ultrasound scan demonstrated mild (<50%) carotid artery stenosis. Computed tomographic angiography (CTA) (Figure 1a and 1b) identified a degenerative aneurysm of the ascending aorta (5 cm) and aortic arch (5 cm) which had a bovine configuration (common origin of the innominate and left common carotid artery). There was also post-dissection type B aneurysm of the descending aorta (9 cm) starting just below the left subclavian artery and tapering to the celiac trunk. There was severe compression of the true lumen from the false lumen, the celiac and right renal artery originated from the true lumen (Figure 1b and 1c, superior mesenteric artery from both lumens, left renal artery from the false lumen (Figure 1d). The right femoral artery was perfused from the false lumen while the left from the compressed true lumen and the functioning femoral-femoral bypass.

Bottom Line: We report a case of treating complex aortic pathology with the use of the Frozen Elephant Trunk technique in a patient with chronic type B aortic dissecting aneurysm associated with arch and ascending aorta dilatation, proximal aortic disease and coronary disease.The case was further complicated due to the involvement of the abdominal vessels and preexisting femoral to femoral crossover bypass.In addition the patient had a tracheostomy for laryngeal cancer.We emphasize the role of the Frozen Elephant Trunk to fix the whole aorta in one setting with special attention given to the changes taking place in vascular perfusion following correction and reconstitution of the true lumen.

View Article: PubMed Central - HTML - PubMed

Affiliation: Cardiac Surgery Department, Evangelismos General Hospital, Athens, Greece.

ABSTRACT
We report a case of treating complex aortic pathology with the use of the Frozen Elephant Trunk technique in a patient with chronic type B aortic dissecting aneurysm associated with arch and ascending aorta dilatation, proximal aortic disease and coronary disease. The case was further complicated due to the involvement of the abdominal vessels and preexisting femoral to femoral crossover bypass. In addition the patient had a tracheostomy for laryngeal cancer.We emphasize the role of the Frozen Elephant Trunk to fix the whole aorta in one setting with special attention given to the changes taking place in vascular perfusion following correction and reconstitution of the true lumen.

Show MeSH
Related in: MedlinePlus