Cardiovascular surgeons operate on all the blood vessels to repair damage caused by diseases or disorders of the cardiovascular system.
Many times, a diagnosis of cardiovascular problem begins with your primary care doctor, who refers you to a cardiovascular surgeon.
Cardiovascular surgeons perform many different types of interventions including heart valve repair and replacement, heart defect repair, coronary artery bypass, aneurysm repair, trans-myocardial laser revascularization, and heart transplantation. In our practice we deal with all the cardio vascular problems, including thoraco-abdominal aneurysms, aortic dissection acute or chronic, supra renal abdominal aortic aneurysms, all stroke patients, mesenteric and visceral arty revascularisation and all peripheral vascular interventions.
All information on dissection found here: https://sherifsultan.ie/aortic-dissection/
4-Dimensional Magnetic Resonance Imaging (4D-MRI)
4D-MRI is used to determine the compliance of the aortic wall, the wall shear stresses which is the stresses from movement of the blood in the vessels and peaks in blood flow speeds. Patients with aortic dissection may have an underlying reason as to why the layers in their artery separate. This will show as an abnormal compliance, leading to abnormal sheer stresses and blood flow. Through measurement of aortic diameter during diastole and systole at several transverse planes throughout the artery, is called arterial compliance. Application of 4D MRI in this way is novel, carried out by my highly skilled research team. Patients will undergo a specialised aortic 4D-MRI in the state of the art MRI suite at the Galway Clinic, and data will be analysed by this team.
Kinetic elephant trunk
Literature, as well as experience points to the fact that aortic dissection is a dynamic in its time course. To adequately treat this disease, it is necessary to understand pressure within the aorta, perfusion and stabilization. Dissection involved the section of the aorta closest to the heart is a highly invasive, and sometimes risky operation. To combat this, I have adopted a more simplistic and consistent method of approach, which works for patients who are visiting for the first time, or in those who have has a previous aortic intervention. It is known as the Kinetic Elephant Trunk Technique.
The term Elephant Trunk Technique was adopted some years ago and is used in those with extensive disease in their aorta. It consists of two stages: firstly open surgery to replace a portion of the aorta. A portion of graft is then extended into the descending aorta for the second stage, where an endovascular stent is placed after this section . This technique can also be carried out as a single stage, known as frozen elephant trunk technique. The Kinetic Elephant Trunk Technique utilizes the Flow Modulator , which is an open mesh endovascular stent device.
Previous studies have shown the flow modulation is effective in treating chronic symptomatic aortic dissection, with no aortic ruptures or aortic-related deaths, no neurological events no incidences of end-organ ischaemia, paraplegia or renal insult . Morphological analysis exhibited dissection remodelling by a reduction in longitudinal length of the dissected aorta, and false lumen volume .
- Kavanagh EP, Jordan F, Hynes N, Elhelali A, Devane D, Veerasingam D, Sultan S. Hybrid repair versus conventional open repair for aortic arch dissection (Protocol). Cochrane Database of Systematic Reviews. 2018, Issue 1. Art. No.: CD012920. DOI: 10.1002/14651858.CD012920.
- Sultan S, Kavanagh EP, Stefanov F, Sultan M, Elhelali A, Costache V, Diethrich E, Hynes N; Global MFM Collaborators. Endovascular management of chronic symptomatic aortic dissection with the Streamliner Multilayer Flow Modulator: Twelve-month outcomes from the global registry. J Vasc Surg 2017 Apr;65(4):940–50.