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  1. Haranal M, Srimurugan B, Sivalingam S
    PMID: 33957784 DOI: 10.1177/02184923211015092
    BACKGROUND: Vascular rings are aortic arch anomalies with a spectrum of manifestations ranging from asymptomatic lesions detected incidentally to an acute presentation secondary to tracheo-esophageal compression. Circumflex retro-esophageal aortic arch is an extreme form of true vascular ring. It remains an uncharted territory to many surgeons.

    METHODS: A comprehensive search of peer reviewed journals was completed based on the key words, "Circumflex aorta," "Circumflex retro-esophageal aorta" and "circumflex arch" using Google scholar, Scholars Portal Journals and PubMed. The reference section for each article found was searched to obtain additional articles. Literature on the circumflex aorta was reviewed starting from the embryogenesis to the latest management strategies.

    RESULTS: Right circumflex aorta is more prevalent compared to left circumflex aorta. It can occur in isolation or in association with other intracardiac lesions. Mainly presents in children, however reported in adults too. The presentation may vary from asymptomatic lesion to acute respiratory distress secondary to airway compression. Computerized tomography (CT) and magnetic resonance imaging (MRI) are important tools in delineating the vascular anatomy. Aortic uncrossing is the definitive procedure. However, the role of concomitant tracheobronchopexy is emerging. Native tissue-to-tissue anastomosis is commonly preferred, but cases of extra-anatomic grafts are reported.

    CONCLUSION: Circumflex aorta is amenable to complete repair. Preoperative delineation of anatomy is important for successful surgical outcome. Division of the retro-esophageal segment is crucial in relieving the compressive symptoms. In addition, tracheobronchopexy is helpful in addressing residual tracheomalacia but this accounts for a high-risk surgery.

  2. Haranal M, Srimurugan B, Dinh DM, Sivalingam S
    Indian J Thorac Cardiovasc Surg, 2021 Sep;37(5):526-532.
    PMID: 34511759 DOI: 10.1007/s12055-021-01206-0
    Berry syndrome is a rare congenital cardiac anomaly, characterized by distal aortopulmonary window, hypoplasia or interruption of the aortic arch, intact ventricular septum, and aortic origin of the right pulmonary artery and patent ductus arteriosus. Anatomic depiction of each component is important for the diagnosis. Single-stage surgical repair is challenging but feasible with good survival outcomes. The available literature on this anomaly is limited. Hence, this paper aims at reviewing the literature on Berry syndrome.
  3. Haranal M, Sivalingam S, Borhanuddin BK, Srimurugan B, Latiff HA
    JTCVS Tech, 2023 Feb;17:151-152.
    PMID: 36820341 DOI: 10.1016/j.xjtc.2022.08.023
  4. Haranal M, Abdul-Aziz KA, Latiff HA, Srimurugan B, Sivalingam S
    Indian J Thorac Cardiovasc Surg, 2021 Nov;37(6):673-675.
    PMID: 34776664 DOI: 10.1007/s12055-021-01184-3
    Retro-esophageal circumflex aortic arch is a rare form of vascular ring. Majority of cases occur in isolation without any intracardiac lesions. Only a few cases of left circumflex aorta have been reported in the literature. We present a case of left circumflex aorta with associated arch hypoplasia and coarctation, ventricular septal defect, who underwent single-stage repair.
  5. Katewa A, Haranal M, Madkaiker AN, Saxena S, Srimurugan B, Patel R, et al.
    Indian J Thorac Cardiovasc Surg, 2023 Sep;39(5):497-500.
    PMID: 37609615 DOI: 10.1007/s12055-023-01525-4
    Double outlet both ventricles is a rare abnormal ventriculo-arterial malformation in which both great arterial trunks are committed to both the ventricles, albeit now being recognized with increasing frequency. Patients with the lesion present with a spectrum of clinical manifestations. The size and location of the interventricular communication dictate the feasibility of biventricular repair. Literature on the malformation, however, is sparse. We report our experience with five patients, all of whom underwent successful surgical biventricular repair.
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