PMC10064447_01
Preoperative: (A) Chest ray; (B) Cardiac ultrasound; (C-F) CT of coronary artery + thoracic and abdominal aorta [(C) Front position; (D) Tumor waist; (E) Lower border of the tumor; (F) Pulmonary bifurcation].
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F1
A chest x-ray indicated an enlarged, tumor-like swelling in the right cardiac border and a metal shadow (Figure 1A). A cardiac ultrasound indicated that the breadth of the aortic sinus was approximately 63 mm, the sinus junction had disappeared, the aortic arch diameter was 37 mm, and the descending aortic diameter was 28 mm (Figure 1B). The right anterior border of the ascending aorta presented with an aortic aneurysm-like structure measuring approximately 72 mm x 84 mm (Figures 1C-F).
Angiography suggested that the shape of the ascending aortic sinus and the left and right coronary arteries were normal, that there was a crack at the junction of the ascending aorta, and of tumor-like deposits of a contrast agent (A,B). First, the blood pressure was reduced to approximately 70/40 mmHg. Then, a Lunderquist guidewire was fixed intra-aneurysmally, and the sheath was angled and delivered through the sheath into the atrial defect occluder. Intra-aortic angiography showed a complete sealing of the breach (C). After gradually increasing the pressure to 90/60 and 130/85 mmHg, the blocker was replaced and reimaged and placed in the normal position, and then the wire was rotated to release the blocker (D,E). Finally, the vehicle was observed for 5 min. A complete occlusion and good aortic valve function and occluder placement were confirmed (F).
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F2
The sinus duct junction was seen on the side of the greater curvature of the ascending aorta with a tumor-like deposit of contrast (Figures 2A,B). Intra-aortic angiography showed a complete closure of the breach (Figure 2C). After gradually increasing the pressure to 90/60 and 130/85 mmHg, the blocker was placed in the normal position on separate angiograms, and the wire was then rotated to release the blocker (Figures 2D,E). A complete occlusion and good aortic valve function and occluder position were confirmed (Figure 2F).
Preoperative: (A) Chest ray; (B) Cardiac ultrasound; (C-F) CT of the coronary artery + thoracic and abdominal aorta [(C) Front position; (D) Tumor waist; (E) Lower border of the tumor; (F) Pulmonary bifurcation)].
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F3
A postoperative chest x-ray showed no obvious abnormalities (Figure 3A). AAP occluder was normal and the internal diameter of the ascending aorta had reduced (Figure 3B). A postoperative CT of the thoracic and abdominal aorta indicated that the occluder was in a normal position (Figures 3C-F).