Extraanatomic Bypass to Supraceliac Abdominal Aorta for Complex Thoracic Aortic Obstruction Manikala Vinod Kumar, MS, Shiv Kumar Choudhary, MCh, Sachin.

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Presentation transcript:

Extraanatomic Bypass to Supraceliac Abdominal Aorta for Complex Thoracic Aortic Obstruction Manikala Vinod Kumar, MS, Shiv Kumar Choudhary, MCh, Sachin Talwar, MCh, Parag Gharde, DM, Manoj Sahu, MD, Sanjeev Kumar, MD, Dinesh Chandra, MCh, Rachit Saxena, MCh, Lokender Kumar, BS, Balram Airan, MCh The Annals of Thoracic Surgery Volume 101, Issue 4, Pages 1552-1557 (April 2016) DOI: 10.1016/j.athoracsur.2015.10.080 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Schematic diagram of extraanatomic bypass to the supraceliac abdominal aorta shows the graft being placed anterior to the superior vena cava by the side of the right atrium and tunneled posterior to the inferior vena cava and brought into the peritoneal cavity by a separate opening in the diaphragm nearer to the crura. The Annals of Thoracic Surgery 2016 101, 1552-1557DOI: (10.1016/j.athoracsur.2015.10.080) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Preoperative sagittal oblique multiplaner reconstructed computed tomography image of the thoracic aorta shows diffuse disease, with irregular wall calcification and aneurysmal dilatation of the ascending aorta (AA) and arch, as well as significant stenotic lesion of the middle descending thoracic aorta (DTA). Note is also made of the bioprosthetic aortic valve in situ. *Replaced aortic valve. **Calcification. (AbA = abdominal aorta; D = distal anastomosis; LA = left atrium; LV = left ventricle; LVOT = left ventricular outflow tract; P = proximal anastomosis; RV = right ventricle; V = ventral aorta.) The Annals of Thoracic Surgery 2016 101, 1552-1557DOI: (10.1016/j.athoracsur.2015.10.080) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Postoperative (redo Bentall + hemiarch replacement + ventral aorta repair) coronal oblique virtual reformatted computed tomography image of the patient in Fig 2 shows normal a dimension of the ascending aorta and arch. A 12-mm graft was used in this small-statured woman (patient 14 in Table 1; weight, 30 kg; body surface area, 1.27 m2; ejection fraction, 0.30) with pressure gradients of 30 mm Hg across the narrowed segment. Heavy calcification at the distal site precluded the use of a larger graft. There were no residual gradients in postoperative period. (AA = ascending aorta; AbA = abdominal aorta; D = distal anastomosis; DTA = descending thoracic aorta; LV = left ventricle; P = proximal anastomosis; V = Ventral aorta.) The Annals of Thoracic Surgery 2016 101, 1552-1557DOI: (10.1016/j.athoracsur.2015.10.080) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions