The Impact of Intimal Tear Location and Partial False Lumen Thrombosis in Acute Type B Aortic Dissection Apoorva Girish, MD, Muralidhar Padala, PhD,

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The Impact of Intimal Tear Location and Partial False Lumen Thrombosis in Acute Type B Aortic Dissection Apoorva Girish, MD, Muralidhar Padala, PhD, Kanika Kalra, MD, Bryant V. McIver, MD, Ravi K. Veeraswamy, MD, Edward P. Chen, MD, Bradley G. Leshnower, MD The Annals of Thoracic Surgery Volume 102, Issue 6, Pages 1925-1932 (December 2016) DOI: 10.1016/j.athoracsur.2016.05.020 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Creation of porcine acute type B aortic dissection. (A) The intact porcine heart and aorta are harvested to the level of the renal arteries. (B) A saline bleb is injected between the intima and medial layers. (C) Manual palpation is used to propagate the saline to dissect the intimal and media layers. (D) Hemostats are used to bluntly expand the dissection circumferentially around the aorta. The Annals of Thoracic Surgery 2016 102, 1925-1932DOI: (10.1016/j.athoracsur.2016.05.020) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Anatomic subtypes of acute type B aortic dissection. Model A: single proximal tear, no distal tear. Model B: single distal tear, no proximal tear. Model C: single proximal and single distal tear. Models A through C have a patent false lumen. Model D: single proximal and distal tear, proximal partial false lumen thrombosis occluding entry tear. Model E: single proximal and distal tear, distal partial false lumen thrombosis occluding distal tear. The Annals of Thoracic Surgery 2016 102, 1925-1932DOI: (10.1016/j.athoracsur.2016.05.020) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Method of partial false lumen thrombosis. (A) A 40 × 12 × 5 mm piece of styrofoam is inserted into the false lumen through the intimal tear. (B) Styrofoam occlusion of the intimal tear. The Annals of Thoracic Surgery 2016 102, 1925-1932DOI: (10.1016/j.athoracsur.2016.05.020) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (Left) Schematic depiction (R = reservoir) and (right) photograph of ex vivo porcine acute type B aortic dissection flow loop. The Annals of Thoracic Surgery 2016 102, 1925-1932DOI: (10.1016/j.athoracsur.2016.05.020) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Arterial waveform produced by the ex vivo porcine acute type B aortic dissection flow loop. (D = diastolic; S = systolic.) The Annals of Thoracic Surgery 2016 102, 1925-1932DOI: (10.1016/j.athoracsur.2016.05.020) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions