Aortic arch anomalies - Vascular ring (Developmental basis)

Images are from Freedom's CHD Textbook of Angiography Vol. II (1997) p.948.
Based on Edwards Hypothetical Double Arch.
Numbers in lower diagram indicate possible sites of regression. Vascular anomalies occur according to the site of regression.

Normal left arch - 1, 7 regress.
Right arch with mirror-image branching - 2,8 regress.
Left arch with aberrant RSCA - 1, 3 regress.
Right arch with aberrant LSCA - 2,6 regresss.
Figure out other vascular anomalies...similarly:
   Double arch - both arches patent
   Double arch with atresia of a segement of left arch
   Double arch with atresia of a segement of right arch
   Left arch with right descending aorta
   Left arch with isolation of RSCA
   Right arch with left ductus (retroesophageal)
   Right arch with isolation of LSCA
   Right arch with aberrant left innominate artery
   Right arch with isolation of left innominate artery


Anti-Arrhythmic Sickness Video (+playlist)

Coarctation Prediction: Carotid-Subclavian Artery Index

Images are from Eur J Cardiothorac Surg 2008;34:1051-6.
CSA index was proposed in Dodge-Khatami et al. Ann Thorac Surg 2005;80:1852-7.
CSA index = Diameter of distal transverse aorta/Length of distal transverse aorta.


TPA (Alteplase) for Femoral Pulse Loss after Cardiac Catheterization

Am J Cardiol 2003;91:908-910

Bolus 0.1 mg/kg over 5-10 min, followed by 0.5 mg/kg/hr x 2 hrs.
Resume Heparin at 17 Units/kg/hr for at least 4 hrs after Alteplase infusion completes.
(Heparin infusion may be continued without interruption during Alteplase infusion).

If there is no improvement at about 4-6 hrs from first dose of Alteplase, repeat dose may be given. Important to give heparin infusion for at least 4-6 hrs after completion of any dose of Alteplase. (To deal with increased thrombotic tendency after Alteplase therapy.


Normal Values for Term, Newborn

Click on the image to enlarge