Dr. Forouzan Nia performed TEVAR and false lumen (FL) occlusion using an Atrial Septal Defect (ASD) Closure Device on a patient who had previously had Bentall and Aortic arch replacement (AVR) and debranching at another center.
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CTA Patient :
*Patient History* (According to patient) Patient is hospitalized at Afshar hospital patient has abdomen and chest pain shortness in breathing history of bental, aortic arch replacement & aortic arch debranching by Dr Foroozan nia 3 years ago History of kidney stone borderline hypertensive Cr: 1 Age: 58
*Anatomical Measurements* (According to CTA dated: 9 Sept 2021, Salar sizing date: 11 Sept 2021) Tri-lumen TBD starting distal to the LSA, 9cm dilatation in the aortic isthmus pleural effusion in the left side TL compressed to less than 5mm in the inferior descending thoracic aorta SMA and L renal artery perfused from the TL celiac and R renal artery perfused from the FL several large entry tears noted in the visceral aorta dissection extends to the infra-renal aorta inferior abdominal aorta and iliacs are healthy
*Proposed Treatment Strategy* a TEVAR plan was arranged for the patient back in 2018, but was aborted even after the patient purchased the devices Therefore, emergent TEVAR is recommended, from the dacron arch graft in Zone 2 up to the celiac trunk with two devices Also, we should consider placing an ASD device in the FL in the inferior descending thoracic aorta in order to occlude the FL and prevent retrograde perfusion of the FL
*Procedural complexity* Low peri-procedural technical risk
The plan based on the available data is to be taken in the context of a suggestion only. The confirmation of the measurements and the decision as to whether to proceed with this plan in whole, in part, or not at all, rests with the physician.