• Coarctation of the aorta (CoA) is a relatively common defect that accounts for 5-8% of all congenital heart defects. (medscape.com)
  • Coarctation of the aorta may occur as an isolated defect or in association with various other lesions, most commonly bicuspid aortic valve and ventricular septal defect (VSD). (medscape.com)
  • The diagnosis of coarctation of the aorta may be missed unless an index of suspicion is maintained, and diagnosis is often delayed until the patient develops congestive heart failure (CHF) , which is common in infants, or hypertension , which is common in older children. (medscape.com)
  • This article discusses the pathology, pathophysiology, clinical features, noninvasive and invasive evaluation, and therapy in patients with coarctation of the aorta. (medscape.com)
  • Coarctation of the aorta may be defined as a constricted aortic segment that comprises localized medial thickening, with some infolding of the medial and superimposed neointimal tissue. (medscape.com)
  • In the past, coarctation of the aorta has been described as preductal (or infantile) type or postductal (or adult) type, depending on whether the coarctation segment is proximal or distal to the ductus arteriosus, respectively. (medscape.com)
  • The classic coarctation of the aorta is located in the thoracic aorta distal to the origin of the left subclavian artery at about the level of the ductal structure. (medscape.com)
  • Bicuspid aortic valve may be seen in nearly two thirds of infants with coarctation of the aorta, whereas only 30% of those who present in childhood have such an anomaly. (medscape.com)
  • Mitral valve anomalies, although less common than those of the aortic valve, are also associated with coarctation of the aorta. (medscape.com)
  • Sometimes, coarctation of the aorta is a complicating feature of a more complex cyanotic heart defect, such as transposition of the great arteries , Taussig-Bing anomaly, double-inlet left ventricle, tricuspid atresia with transposition of the great arteries, and hypoplastic left heart syndrome . (medscape.com)
  • Some patients with coarctation of the aorta may have cerebral aneurysms, predisposing them to cerebrovascular accidents with severe hypertension later in life. (medscape.com)
  • Coarctation of the aorta is the most common cardiac defect associated with Turner syndrome . (medscape.com)
  • Coarctation of the aorta is a localized narrowing of the aortic lumen that results in upper-extremity hypertension, left ventricular hypertrophy, and, if severe, malperfusion of the abdominal organs and lower extremities. (msdmanuals.com)
  • Coarctation of the aorta accounts for 6 to 8% of congenital heart anomalies. (msdmanuals.com)
  • Coarctation of the aorta usually occurs at the proximal thoracic aorta just beyond the left subclavian artery and just across from the opening of the ductus arteriosus. (msdmanuals.com)
  • A 44 year old man who presented with a history of chest pain and dyspnoea was found to have an aneurysm of the aortic root, aortic valve insufficiency, and coarctation of the aorta. (biomedcentral.com)
  • RESULTADOS: Pressões da aorta proximal e distal à oclusão foram semelhantes nos três grupos. (scielo.org)
  • The EP wave disappeared after proximal descending aorta clamped and gradually recovered after the patent segmental arteries reattached. (bvsalud.org)
  • This proximal descending portion of aorta gives rise to the visceral and the parietal branches above the aortic hiatus at the diaphragm. (lookformedical.com)
  • Sensory ganglia of spinal nerves are fusiform swellings situated on the posterior root of each spinal nerve just proximal to the root's junction with a corresponding anterior root. (medscape.com)
  • However, rarely, a coarcted segment is present in the lower thoracic or abdominal aorta. (medscape.com)
  • A 4.2 cm-sized saccular thoracic aortic aneurysm (arrow) involving the aortic arch in initial computed tomography (CT) angiography (A) and intra-op angiography (B). Initial CT angiography showed 5.6 cm sized infrarenal abdominal aorta (C). Both pathologies were present in the three-dimensional reconstructive image (D). (vsijournal.org)
  • Coarctation rarely involves the abdominal aorta. (msdmanuals.com)
  • In one patient, cord ischemia developed that manifested as early postoperative left leg weakness occurring after concomitant open infrarenal abdominal and endovascular TAA repair. (mssm.edu)
  • Both of these patients had previous abdominal aortic aneurysm repair, and both required long grafts to exclude an extensive area of their thoracic aortas. (mssm.edu)
  • Materials and Methods: Endovascular treatment was performed in 316 patients with aneurysms or pseudoaneurysms of the abdominal aorta or iliac arteries between March 2006 and January 2022. (bvsalud.org)
  • Thoracic and abdominal aorta were replaced in a staged fashion. (bvsalud.org)
  • Spinal cord protection during TEVAR: primum non nocere. (harvard.edu)
  • Simultaneous EVAR and TEVAR can be considered for patients with AAA and saccular TAA in the upper thoracic aorta. (vsijournal.org)
  • A comparison of thoracoabdominal aortic aneurysms open repair in patients with or without "shaggy aorta" / Rinaldi, E. (unisr.it)
  • Spinal cord ischemia after endovascular repair of thoracic aortic aneurysms (TAAs) has also been reported. (mssm.edu)
  • More common causes are aneurysms of the aorta or ischemia after aortic surgery, compression of vascular structures by tumors, thrombosis or embolism and arterio-venous malformations. (fortunejournals.com)
  • A spinal cord infarction occurs much more frequently as a result of blockages in the arteries caused by tumors, aortic aneurysms or aortic dissections. (medicinelearners.com)
  • A spinal cord infarction is an emergency and is a complication of various vascular diseases such as aortic aneurysms, arteriosclerosis or others. (medicinelearners.com)
  • The cerebrospinal fluid (CSF) pressure increases during clamping further decreasing the perfusion pressure of the spinal cord. (cochrane.org)
  • Cerebrospinal fluid drainage (CSFD) may increase the perfusion pressure to the spinal cord and hence reduce the risk of ischaemic spinal cord injury. (cochrane.org)
  • Treatment of vascular myelopathy or spinal ischemia primarily involves improving spinal perfusion. (fortunejournals.com)
  • This may minimize the risk or degree of ischemia-reperfusion injury even if no selective organ perfusion was applied. (authorea.com)
  • Haemodynamic management to avoid hypotension and maintain spinal cord perfusion is critical. (wfsahq.org)
  • In the period immediately following injury, principles of advanced trauma and life support need to be adhered to, but also a focus on rapid immobilisation of the spine and optimisation of the patient's haemodynamics to maintain spinal cord perfusion is also necessary. (wfsahq.org)
  • Potential immediate affects of secondary SCI include neuronal injury, neuroinflammation, breakdown of blood-spinal cord barrier (BSCB), ischemic dysfunction, oxidative stress, and daily-life function complications. (wikipedia.org)
  • Complications have been observed to arise in animal models from the need to cross clamp the aorta. (wikipedia.org)
  • however, critical complications such as ischemic colitis or spinal cord ischemia are rare, even in bilateral IIA occlusion. (bvsalud.org)
  • Some complications related to the ET technique have been reported, such as kinking of the ET, spinal cord ischemia, thromboembolic complications, entrapment of the trunk in the dissected aortic lumen, and splitting of the anastomosis due to enlargement of the false lumen. (biomedcentral.com)
  • The aorta-iliac bypass was established, then distal descending aorta was perfused in a retrograde fashion via bypass graft. (bvsalud.org)
  • For instance, ischemia-reperfusion SCI involves the interruption of blood flow to the spinal cord. (wikipedia.org)
  • The present study was undertaken to study the effects of exogenous H2S on ischemia/reperfusion (I/R) injury of spinal cord and the underlying mechanisms. (biomedcentral.com)
  • Ischemia/reperfusion (I/R) injury of the spinal cord is a dynamic process that frequently occurs during a variety of clinical situations such as thoracoabdominal aortic surgery or spinal cord injury [ 1 ]. (biomedcentral.com)
  • Surgery for an aortic aneurysm requires clamping the aorta, the biggest artery in the body. (cochrane.org)
  • During aortic aneurysm surgery, cross-clamping can lead to inadequate blood supply to the spinal cord resulting in neurological deficit. (cochrane.org)
  • To determine the effect of CSFD during thoracic and thoracoabdominal aortic aneurysm (TAAA) surgery on the risk of developing spinal cord injury. (cochrane.org)
  • Patients with degenerative aortic aneurysm, thrombus measurement in non-aneurysmal aortic segments (≤40 mm), atheroma thickness ≥5 mm, and finger-like thrombus projection were included in the SA group, whereas the others were included in the non-shaggy aorta group (NSA group). (unisr.it)
  • 743 wordsMinimization of end organ ischemia is a key tenet in successful thoracoabdominal aortic aneurysm (TAAA) surgery. (authorea.com)
  • The study included the patients with aneurysm and dissection of thoracic aorta. (scardio.ru)
  • Magnetic resonance angiography revealed that the ET was entrapped in an isolated dissecting aortic aneurysm, which obstructed blood flow, thus causing ischemia. (biomedcentral.com)
  • In 1983, Hans Borst described the elephant trunk (ET) technique for aneurysm of the thoracic aorta, which had the advantage of making the second operation much easier [ 1 ]. (biomedcentral.com)
  • To evaluate the effect of aorta-iliac bypass total thoracoabdominal aorta aneurysm repair to spinal cord function. (bvsalud.org)
  • From June 2014 to April 2015, 31 patients underwent total thoracoabdominal aorta aneurysm repair were treated with aorta-iliac bypass technique. (bvsalud.org)
  • There is a transient function loss of spinal cord during the aorta-iliac bypass total thoracoabdominal aorta aneurysm repair. (bvsalud.org)
  • The knowledge of the arterial blood supply to the spinal cord is very important in planning the procedures of the spinal cord treatment as well as in animal experiments. (intechopen.com)
  • A complete understanding of the anatomy of the arterial blood supply to the spinal cord is critical for the anatomists and clinicians to determinate the advantages and disadvantages of each animal model for next studies. (intechopen.com)
  • Various pathological conditions, including surgical treatments, traumatic injuries, embolism, malformations and tumors, result in severe changes in the arterial blood supply to the spinal cord [ 1 ]. (intechopen.com)
  • This investigation reviews the occurrence of spinal cord ischemia after endovascular repair of descending TAAs at the Mount Sinai Medical Center. (mssm.edu)
  • Whereas arterial occlusion in the spinal region quickly becomes symptomatic by neurological deficits, venous outflow obstruction may be clinically unnoticed for much longer and usually manifests as a slowly progressive neurological deficit. (fortunejournals.com)
  • In the recently published case report by Haynes et al, intraarticular thrombolysis with tissue plasminogen activator (t-PA) in combination with verapamil and an antiplatelet agent (Eptifibatide) was performed for acute occlusion of the anterior spinal artery in a 52-year-old patient. (fortunejournals.com)
  • Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a tool to temporarily halt exsanguination in trauma patients with noncompressible torso or pelvic injuries. (openanesthesia.org)
  • Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. (openanesthesia.org)
  • The American Association for the Surgery of Trauma's Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry recently compared the effectiveness of REBOA to open aortic occlusion (AO) in 114 patients across 8 trauma centers. (openanesthesia.org)
  • Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) provides a new tool in selected patients for the management of non-compressible torso hemorrhage. (bmj.com)
  • Some experimental treatments, including systemic hypothermia, have been performed in isolated cases in order to draw attention to the need for further preclinical and clinical studies to help clarify the role of hypothermia in acute spinal cord injury. (wikipedia.org)
  • Acute spinal cord ischemia syndrome is a rare condition comprising a small fraction of neurovascular accidents, the majority of which occur within the cerebral circulation. (biomedcentral.com)
  • In this case report, we review acute spinal cord ischemia syndrome and consider the pathophysiology, diagnostic measures and prognostic factors associated with patient recovery. (biomedcentral.com)
  • Acute spinal cord ischemia syndrome with atypical patterns of sensory deficit is uncommon. (biomedcentral.com)
  • Acute spinal cord ischemia syndrome (ASCIS) is predictably due primarily to pathology in the anterior spinal artery, its feeders or its branches. (biomedcentral.com)
  • Initial management of acute spinal cord trauma is key to reducing secondary injury and morbidity. (wfsahq.org)
  • A jet lesion on the wall of the aorta distal to the coarctation site may also be present. (medscape.com)
  • The classic presentation for anterior spinal artery ischemia or infarct is sensory deficits in the following pattern: distal to the lesion, pain and temperature are lost bilaterally (owing to the involvement of anterolateral spinothalamic tracts), but light touch, vibration and position sense are preserved (owing to sparing of dorsal columns). (biomedcentral.com)
  • Predictably, the syndrome of symptoms varies with the level of the spinal cord in which the lesion occurs. (biomedcentral.com)
  • Evaluating for a sensory level using a pin to detect pain sensation is more sensitive to detect a spinal level originating from a lesion in the spinothalamic tract. (emcrit.org)
  • Motor weakness may be used to evaluate the level of a spinal lesion that involves the corticospinal tract. (emcrit.org)
  • Thus, a central spinal cord lesion may cause neurologic deficits in a descending order. (emcrit.org)
  • This condition is usually caused by a lesion in the upper BRAIN STEM which injures the descending cortico-spinal and cortico-bulbar tracts. (lookformedical.com)
  • Predictors and outcomes of spinal cord injury following complex branched/fenestrated endovascular aortic repair in the US Aortic Research Consortium. (harvard.edu)
  • Some argue that early surgery might further deprive an already injured spinal cord of oxygen, but most studies show no difference in outcomes between early (within three days) and late surgery (after five days), and some show a benefit to earlier surgery. (wikipedia.org)
  • In these 10 patients, the authors demonstrated the feasibility of further endovascular repairs of the distal aneurysmal aorta following frozen elephant trunk with excellent short-term outcomes. (dicardiology.com)
  • Access to these specialist spinal units has been shown to decrease mortality, decrease length of stay, and improve overall health, functional, and social outcomes. (wfsahq.org)
  • Spinal ischemia in traumatized patients is rarely described, and when it occurs, it is usually associated with direct trauma to the spine and consecutive vascular injury. (fortunejournals.com)
  • It occurs at the isthmus of the aorta (distal aortic arch between the left subclavian and the site of the ligamentum arteriosus) where there is a discrete narrowing [ 1 ]. (biomedcentral.com)
  • In short: If the blood flow to the spinal cord is stopped by a blocked vessel or a blood clot, the dreaded spinal shock occurs. (medicinelearners.com)
  • Epidural cooling saddles, surgically placed over acutely traumatized spinal cord tissue, have been used to evaluate potentially beneficial effects of localized hypothermia, with and without concomitant glucocorticoids. (wikipedia.org)
  • The OECs were taken from the patient's olfactory bulbs in his brain and then grown in the lab, these cells were then injected above and below the impaired spinal tissue. (wikipedia.org)
  • Reduced blood flow to the spinal cord which is supplied by the anterior spinal artery and the paired posterior spinal arteries. (harvard.edu)
  • The spinal circulation comprises two paired posterior spinal arteries running down the dorsum of the cord and a single anterior artery found in the median fissure. (biomedcentral.com)
  • First described by Spiller in 1909 [ 2 ], thrombosis of the anterior spinal artery is often due to fracture of a cervical vertebra or a cervical hyperextension injury. (biomedcentral.com)
  • Up to eight radicular arteries are established during development and supply the anterior spinal artery, the largest of which is the artery of Adamkiewicz between T9 and T11. (biomedcentral.com)
  • Mid-thoracic levels are most vulnerable to ischemia (for example, as a result of thrombosis) as there is only one radicular artery supplying the anterior spinal artery in this region, and sparse anastomoses. (biomedcentral.com)
  • The territory of the anterior spinal artery covers the anterolateral and corticospinal tracts, but not the dorsal columns. (biomedcentral.com)
  • During these reattachments, antegrade pulsatile blood flow to the spinal cord was guaranteed not only via the Adamkiewicz artery but also the collateral network, which ultimately minimizes spinal cord ischemia. (authorea.com)
  • REBOA involves inserting a balloon catheter through the femoral artery and advancing it to the aorta, where the balloon is typically inflated under fluoroscopic guidance in specific zones (see below) depending on the type of injury (Figure 1 and Table 1). (openanesthesia.org)
  • A sudden increase in afterload may cause left ventricular dilation, increased pulmonary artery pressures, and myocardial ischemia, especially in patients with coronary artery disease. (openanesthesia.org)
  • It should be borne in mind that certain segments of the spinal cord are particularly susceptible to ischemia due to the sometimes low collateral supply to the anterior spinal artery. (medicinelearners.com)
  • Arteriosclerosis or an embolism can restrict the blood supply to the anterior (belly) located anterior spinal artery and the posterior (back) located spinal artery. (medicinelearners.com)
  • The second trial of 33 patients reported that a combination of CSF drainage and papaverine in the region of the spinal cord (intrathecally) reduced the rate of postoperative neurological deficit compared to controls. (cochrane.org)
  • The neurologic deficit resolved 12 hours after spinal drainage, steroid bolus, and the maintenance of hemodynamic stability. (mssm.edu)
  • The prognosis of spinal ischemia depends on the severity of the neurologic deficit that presents at the beginning [5]. (fortunejournals.com)
  • To date, no case has been described in the literature in which traumatized patients developed vascular myelopathy with a time delay without the presence of direct spinal trauma or direct vertebral vascular injury. (fortunejournals.com)
  • Spinal vascular involvement associated with vasculitis should also be considered as a cause. (medicinelearners.com)
  • Compression by intervertebral discs or embolization of disc fragments can also cause ischemia (often without a history of trauma). (biomedcentral.com)
  • Primary injury is the damage from the initial mechanical trauma to the spinal cord resulting from direct cord compression, haemorrhage, traction forces, or penetrating trauma. (wfsahq.org)
  • There was clear evidence of collateral circulation to the descending thoracic aorta via the subclavian and intercostal arteries. (biomedcentral.com)
  • In 2014 Darek Fidyka underwent pioneering spinal surgery that used nerve grafts, from his ankle, to 'bridge the gap' in his severed spinal cord and olfactory ensheathing cells (OECs) to stimulate the spinal cord cells. (wikipedia.org)
  • This chapter compares the arterial spinal cord blood supply of the frequently used species (pig, dog, cat, rabbit and rat) in experimental spinal cord injury and in human. (intechopen.com)
  • Various treatments are used to reduce the ischaemic insult to the spinal cord including temporary blood shunts (such as distal atriofemoral bypass and re-connection of intercostal and lumbar vessels), pharmaceutical interventions (to protect the heart and cerebral blood vessels), epidural cooling and CSF drainage. (cochrane.org)
  • All of the studies used CSF drainage in addition to other measures of spinal cord protection. (cochrane.org)
  • Spinal cord protective measures (ie, cerebrospinal fluid drainage, steroids, prevention of hypotension) should be used for patients with the aforementioned risk factors undergoing endovascular TAA repair. (mssm.edu)
  • Nevertheless, the obtained level of spinal cord protection seems to be more significant with cerebrospinal fluid drainage. (scielo.org)
  • These assessment findings are most consistent with which of the following types of spinal cord injury?flucuation in the water seal chamber - ✔✔Which of the following is an expected finding in a pt with a tube thoracstomy connected to a chest drainage system? (browsegrades.net)
  • Therefore, a sensory level to light touch may be absent unless both of these are involved (e.g., a complete injury that involves all spinal cord tracts). (emcrit.org)
  • This may cause the discomfort which warns the surgeon about the danger of rupture or retrograde dissection of the aorta. (scardio.ru)
  • Total arch repair (TAR) has become a mainstay of the surgical management of complex pathologies of the ascending aorta and aortic arch, in particular acute Type A aortic dissections (ATAAD). (authorea.com)
  • Dr. Joseph S. Coselli specializes in the clinical evaluation and surgical treatment of diseases of the aorta, including the aortic valve and root, ascending aorta, aortic arch, descending thoracic aorta, and thoracoabdominal aorta. (bcm.edu)
  • He has performed more than 7,500 surgical repairs of the aorta and over 3,300 open repairs of the thoracoabdominal aorta, for which he is the world's most experienced surgeon. (bcm.edu)
  • A surgical procedure that entails removing all ( laminectomy ) or part (laminotomy) of selected vertebral lamina to relieve pressure on the SPINAL CORD and/or SPINAL NERVE ROOTS. (lookformedical.com)
  • among them, the presence of 'shaggy aorta' (SA), an extensive and irregular atheroma within the aorta. (unisr.it)
  • Surgery is currently used to provide stability to the injured spinal column or to relieve pressure from the spinal cord. (wikipedia.org)
  • Muscle weakness (involvement of the corticospinal tract) and sensory loss occur at the spinal cord segmental levels of infarct. (biomedcentral.com)
  • Spinal nerves and corresponding sensory dermatomes are shown above. (emcrit.org)
  • Patients with partial cord involvement may fail to display a sensory level. (emcrit.org)
  • Ganglia may be divided into sensory ganglia of spinal nerves (spinal or posterior root ganglia) and cranial nerves and autonomic ganglia. (medscape.com)
  • Nerves to the cervical cord are located closest to the middle of the cord, whereas nerves to the sacrum are located farthest towards the edges of the spinal cord. (emcrit.org)
  • Lhermitte's sign (an electric-shock sensation elicited by neck flexion that runs down the spine and sometimes into the limbs) suggests involvement of the posterior columns of the cervical spinal cord. (emcrit.org)
  • The further it runs up to the cervical cord, the more bodily functions are affected and fail. (medicinelearners.com)
  • In recent years various techniques have been inspired and refined to reduce the duration and risk of visceral ischemia such as mild, moderate, or deep hypothermic repair with left heart bypass, or complete or partial cardiopulmonary bypass combined with selective perfusions to vital viscera, the lower extremities and the spinal cord. (authorea.com)
  • The effects of exogenous H2S on I/R injury were examined by using assessment of hind motor function, spinal cord infarct zone by Triphenyltetrazolium chloride (TTC) staining. (biomedcentral.com)
  • Compared to I/R injury groups, H 2 S pretreatment had reduced spinal cord infarct zone, improved hind motor function in rats. (biomedcentral.com)