Valve-sparing aortic root replacement is increasingly used in selected patients with acute aortic dissection and preserved valve anatomy. We present the case of a 52-year-old man with acute Stanford type A aortic dissection extending from the aortic root to the iliac bifurcation with arch involvement; this was complicated by severe aortic insufficiency and right lower extremity malperfusion. The patient underwent emergent valve-sparing root replacement using the David technique combined with zone 2 arch reconstruction under hypothermic circulatory arrest and selective antegrade cerebral perfusion. Intraoperative echocardiography confirmed excellent valve function with trace residual regurgitation. The postoperative course was notable for transient vasoplegia and re-exploration without bleeding, followed by uneventful recovery and discharge on postoperative day 11. This case highlights the feasibility of combining valve-sparing root replacement with zone 2 arch reconstruction in the acute setting of Stanford type A dissection with malperfusion, allowing restoration of true lumen flow while preserving native valve function.
Coronary artery anomalies can be divided into anomalies of origin, course, or terminations of any of the epicardial coronary arteries. Coexistence of anomalous origin of the left circumflex artery with retroaortic course and anomalous origin of left anterior descending artery arising from the right coronary sinus with interarterial course is an exceedingly rare anatomical configuration. In the presence of this anomaly, conventional catheter angiography is challenging due to technical reasons and may lead to an inadvertent misdiagnosis of significant stenosis or occlusion of the coronary artery. This case highlights the importance of coronary computed tomography angiography in identifying a rare coronary artery anomaly and providing guidance for future endovascular or surgical procedures.
This 58-minute webcast features a conversation on the "State of the Art in Pericardial Disease"-the focus of Issue 22.2 on the theme of pericardial disease. Led by the issue's editor, the discussion engages the authors on emerging themes and lessons learned while researching and writing the articles. View the video at https://vimeo.com/1204339129/42dd65d78b.
A circumaortic renal vein is a congenital vascular anomaly involving an additional renal vein that traverses posterior to the aorta in addition to the normal renal vein traversing anterior to the aorta.12 In aortic surgery, it is common to ligate the left renal vein (LRV) to aid in surgical exposure, which is typically inconsequential due to collateral venous channels. We report a case of a circumaortic LRV with the preaortic branch ligated during abdominal aortic aneurysm (AAA) surgery and, as a result, retroaortic LRV hypertrophy was observed during follow-up.
This case describes a 55-year-old man who presented with complaints of claudication in his left upper limb. Computed tomography angiography revealed a rare anatomical variant in which the left vertebral artery originated from the left thyrocervical trunk.
