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Paper 3
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
The right subclavian artery usually arises from the brachiocephalic trunk. An aberrant right subclavian artery arises directly from the aortic arch after the left subclavian artery and then passes back towards the right side, frequently posterior to the oesophagus and hence can cause an indentation.
Cardiovascular system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
The thoracic aorta commences at the aortic valve and passes into the abdomen by passing through the diaphragmatic hiatus at the level of the T12 vertebral body. It is divided into the ascending aorta, aortic arch and descending aorta. Major vessels arise from the ascending aorta and arch. The right and left coronary arteries arise from the root of the ascending aorta close to the aortic valve cusps. The aortic arch gives rise to three large vessels that supply the head and neck region and the upper limbs: the brachiocephalic artery (also known as the brachiocephalic trunk or innominate artery), the left common carotid artery and the left subclavian artery. The brachiocephalic artery divides and give rise to the right common carotid and right subclavian arteries. Each common carotid artery divides into the internal and external carotid arteries. The vertebral artery arises as the first branch of the subclavian artery on each side. The subclavian artery passes laterally to continue as the axillary artery at the lateral border of the first rib. The axillary artery continues down the arm and at the inferior margin of the teres major muscle it becomes the brachial artery. At the cubital fossa the brachial artery divides into the radial and ulnar arteries, which continue down the forearm to the hand.
Carotid Doppler
Published in Swati Goyal, Essentials of Abdomino-Pelvic Sonography, 2018
Three branches of aortic arch: Brachiocephalic trunk —Right common carotid artery—Right subclavian artery—Right vertebral arteryLeft common carotid arteryLeft subclavian artery—Left vertebral artery
Conventional aortic root vs valve-sparing root replacement surgery in aortic dilatation syndromes: a comparison of mortality and postoperative complications
Published in Expert Review of Cardiovascular Therapy, 2023
Hashrul N Rashid, Omar Chehab, Harriet Hurrell, Vitaliy Androshchuk, Agata Sularz, Tiffany Patterson, Gianluca Lucchese, Simon Redwood
The first step of the David procedure is the excision of the aneurysmal aortic sinuses and a portion of ascending aorta according to the extension of the dilatation [23]. Superiorly, the incision is performed proximal to the right brachiocephalic trunk, generally at the level of the sinotubular junction if the ascending aorta is not involved, whilst the inferior incision is performed around 3 to 5 mm superior to the aortic annulus [24]. In most patients, the coronary arteries are resected and later reimplanted onto the Dacron graft, replacing the aortic root. Variations to this are rare and may include preservation of low-lying coronary arteries (within 3 mm above the aortic annulus), which is more common in patients with BAV anatomy, and the aortic root is dissected above and surrounding the coronary arteries.
New Model for the Assessment of Transcatheter Aortic Valve Replacement Devices in Sheep
Published in Journal of Investigative Surgery, 2022
John P. Carney, Jill Schappa Faustich, Matthew T. Lahti, Paul E. Ashworth, Agustin P. Dalmasso, Yuriy Moklyak, Richard W. Bianco
Animals were sedated with 0.04 mg/kg atropine IM, 10 mg/kg Ketamine IM and 2–6 mg/kg propofol IV. Animals were intubated, maintained on isoflurane at 2–4% for the duration of surgery and monitored for heart rate, mean blood pressure, fixed pupil location, corneal reflex absence, and oxygen saturation to ensure proper anesthesia. Surgery was performed in the right decubitus position with left 3rd intercostal space thoracotomy to expose the heart and the aorta. The animals were anticoagulated and placed on CPB using standard techniques [13–16]. The animal was cooled to 28˚C, and the aorta was cross clamped proximal to the junction of the brachiocephalic trunk. A partial transverse aortotomy was made. The native aortic annulus was measured and the modified annuloplasty material was cut into three appropriately sized sections. These sections were then implanted directly below each of the three native aortic valve leaflets, using interrupted 3-0 braided polyester mattress stitches, as illustrated in Figure 2A. A photograph of the annuloplasty segments sewn to the aortic annulus is provided in Figure 2B. The aortotomy was closed and the animal was warmed and bypass cannulas removed. Postoperatively, the animals recovered under the care of a veterinarian and received Ketoprofen 1–2 mg/kg IM or Carprofen 2–4 mg/kg IM, as needed for pain management.
Primary pericardial mesothelioma: a case report of a patient treated with an immune checkpoint inhibitor as the second-line treatment
Published in Acta Oncologica, 2021
Otso Arponen, Virpi Salo, Annika Lönnberg, Leila Vaalavirta, Hannu Koivu, Paul Nyandoto
The patient was readmitted to our hospital nearly one year and two months (D519) after the previous checkup. The routine laboratory values were within their expected ranges, but the chest radiograph showed that the heart profile had enlarged again, there was pericardial fluid visible and the pericardium was thickened on TTE. A repeated CT scan (D522) showed nodular changes in pericardium raising the suspicion of a malignancy, or alternatively pericardial tuberculosis. A cardiac MRI was performed (D525); it revealed that the pericardial space was filled with nodular enhancing tissue. The initial pathological report of the pericardial sample that was obtained through an open pericardial biopsy (D530) gave inconclusive findings, i.e., possible mesothelioma or mesothelial proliferation. A subsequent analysis of this sample by a specialist pathologist confirmed the diagnosis of epithelioid mesothelioma (D559). An open cardiac surgery with circulatory bypass was performed (D610), however, there were macroscopic infiltrations to the heart muscle and only the anterior pericardium could be resected. Although the frozen section samples of the brachiocephalic trunk lymph nodes showed no evidence of metastasis, lymph node metastasis was later detected in one of these nodes. The surgical pathological sample of the pericardium confirmed the diagnosis of epithelioid mesothelioma.