Hybrid Transcatheter-Surgical Strategy in Arterial Tortuosity Syndrome

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Hybrid Transcatheter-Surgical Strategy in Arterial Tortuosity Syndrome Giuseppe Santoro, MD, Giuseppe Caianiello, MD, Giovanni Rossi, MD, Gabriella Farina, MD, Maria Giovanna Russo, MD, Raffaele Calabrò, MD The Annals of Thoracic Surgery Volume 86, Issue 5, Pages 1682-1684 (November 2008) DOI: 10.1016/j.athoracsur.2008.04.096 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Moderate aortic arch tortuosity and pseudo-coarctation, as shown by spiral computed tomographic scan. (AAo = ascending aorta; MPA = main pulmonary artery; TA = transverse aortic arch.) The Annals of Thoracic Surgery 2008 86, 1682-1684DOI: (10.1016/j.athoracsur.2008.04.096) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Pulmonary artery angiography showing a severe elongation and kinking of the main pulmonary arteries resulting in bending of their hilar segments (arrows). (B) Severe, discrete stenosis of the left pulmonary artery (black arrow), as imaged by spiral computed tomographic scan. (C) Multiple, long stenoses of the right pulmonary artery branches (white arrows), as imaged by selective intraoperative pulmonary angiography. (DA = descending aorta; LPA = left pulmonary artery; MPA = main pulmonary artery; RPA = right pulmonary artery.) The Annals of Thoracic Surgery 2008 86, 1682-1684DOI: (10.1016/j.athoracsur.2008.04.096) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Line drawing of the surgical procedure. (A) The incision of the pulmonary trunk and the main pulmonary arteries is followed by removal of a segment of their inner circumference (dashed area). (B) The pulmonary arteries after this reductive reconstruction. The Annals of Thoracic Surgery 2008 86, 1682-1684DOI: (10.1016/j.athoracsur.2008.04.096) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Pulmonary angiography after the hybrid transcatheter-surgical approach. (* = left pulmonary artery; ** = right pulmonary artery; MPA = main pulmonary artery.) The Annals of Thoracic Surgery 2008 86, 1682-1684DOI: (10.1016/j.athoracsur.2008.04.096) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions