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Journal articles on the topic 'Isthmic repair'

Author: Grafiati

Published: 4 June 2025

Last updated: 15 July 2025

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1

Menon, Poornima Jayadev, and Kevin Walsh. "A Case Series Describing Percutaneous Management of Aortic Isthmic Atresia." Vascular and Endovascular Surgery 54, no. 5 (2020): 463–66. http://dx.doi.org/10.1177/1538574420921280.

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Aortic isthmic atresia is a severe form of aortic coarctation where there is loss of luminal communication at the aortic isthmus. The primary approach for correcting aortic isthmic atresia has been surgical repair of the coarctation. A small number of case series have shown that percutaneous correction of aortic isthmic atresia is possible. We describe 3 cases of aortic isthmic atresia that was successfully treated using a percutaneous approach. Our cases ranged in age between 42 and 51 years, and they all had hypertension. In our case series, 2 patients were successfully treated with radiofrequency perforation and 1 patient had anterograde recanalization performed using a stiff wire. Our patients have been followed up for between 2 and 4 years post-procedure, and they continue to do well. The success of percutaneous management in this case series adds to the small but increasing amount of data available in support of endovascular management of aortic isthmic atresia in adult patients.

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2

Nair, Priya Pratapan. "An isthmic ectopic pregnancy - Atypical presentation." RMC Global Journal 1 (January 18, 2025): 31–33. https://doi.org/10.25259/rmcgj_5_2024.

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The most dreadful gynecological crisis, ectopic pregnancy (EP), affects 2% of pregnancies. Almost 85% to 95% of ectopic pregnancy implants in the ampulla of the fallopian tube, the next most common area of implantation is in the isthmus (12%). In the isthmic pregnancy, the tubal wall is damaged beyond repair. There are multiple factors responsible for tubal ectopic pregnancy; a combination of structural tubal anomalies and tubal dysfunction has been mainly postulated. Isthmic ectopic pregnancy commonly ruptures into the broad ligament due to the position of the tube near the fundus, and an ampullary pregnancy ruptures in the abdominal cavity. Nowadays, systemic methotrexate can be used as a conservative medical method to treat many ectopic pregnancies. Here, we present a case of a multigravida with 5 weeks amenorrhea with an atypical presentation of isthmic tubal unruptured ectopic pregnancy, which was initially diagnosed as being an ovarian ectopic pregnancy, but the timely intervention helped save the life of a patient with minimum morbidity.

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3

Minor, Adrienne, Benjamin R. Klein, Mareshah N. Sowah, Kayla Etienne, and Allan D. Levi. "Pars Interarticularis Fractures Treated with Minimally Invasive Surgery: A Literature Review." Journal of Clinical Medicine 13, no. 2 (2024): 581. http://dx.doi.org/10.3390/jcm13020581.

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Recurrent stress on the isthmic pars interarticularis often leads to profound injury and symptom burden. When conservative and medical management fail, there are various operative interventions that can be used. The current review details the common clinical presentation and treatment of pars injury, with a special focus on the emerging minimally invasive procedures used in isthmic pars interarticularis repair. PubMed and Google Scholar database literature reviews were conducted. The keywords and phrases that were searched include but were not limited to; “history of spondylolysis”, “pars interarticularis”, “pars defect”, “conventional surgical repair of pars”, and “minimally invasive repair of pars”. The natural history, conventional presentation, etiology, risk factors, and management of pars interarticularis injury are discussed by the authors. The surgical interventions described include the Buck’s repair, Morscher Screw-Hook repair, Scott’s Wiring technique, and additional pedicle screw-based repairs. Minimally invasive techniques are also reviewed, including the Levi technique. Surgical intervention has been proven to be safe and effective in managing pars interarticularis fractures. However, minimally invasive techniques often provide additional benefit to patients such as reducing damage of surrounding structures, decreasing postoperative pain, and limiting the time away from sports and other activities.

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4

Zhang, Tao, Lihua Ma, Hua Liu, Chengwei Yang, and Songkai Li. "Comparing the Wiltse approach and classical approach of pedicle screw and hook internal fixation system for direct repair of lumbar spondylolysis in young patients: A case-control study." Medicine 102, no. 37 (2023): e34813. http://dx.doi.org/10.1097/md.0000000000034813.

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The aim of this study was to investigate the clinical effect of direct isthmus repair via Wiltse approach and classical approach in the treatment of simple lumbar spondylolysis in young patients. Thirty-three patients with simple lumbar spondylolysis underwent direct isthmic repair via the Wiltse approach (n = 17) or the classical approach (n = 16). The operation time, intraoperative blood loss, postoperative drainage volume, hospital stay, fusion rate, visual analogue scale (VAS), and the Oswestry disability index were evaluated and compared between the 2 groups. The amount of intraoperative blood loss, postoperative drainage volume, and the duration of hospital stay in the Wiltse group were lower than those in the classical group (P < .05). There was no significant difference in Oswestry disability index score between the Wiltse group and the classical group at 3 months, 6 months, and 1 year after operation, but the visual analogue scale score in the Wiltse group was lower than that in the classical group at 6 months after surgery (P < .05). The Wiltse approach was comparable to the classical approach in terms of bone graft fusion time and fusion rate. The Wiltse approach for isthmus repair can achieve the same or even better clinical effect than the classical approach, and the Wiltse approach is more minimally invasive. Pedicle screw-hook internal fixation system combined with autogenous iliac bone graft via Wiltse approach is a feasible, safe, and effective minimally invasive surgical method for the repair of isthmic spondylolysis in young patients.

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5

Gao, Yongjian, Chen Zhao, Lei Luo, et al. "Surgical Reduction and Direct Repair Using Pedicle Screw-Rod-Hook Fixation in Adult Patients with Low-Grade Isthmic Spondylolisthesis." Pain Research and Management 2022 (August 10, 2022): 1–7. http://dx.doi.org/10.1155/2022/8410519.

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Background. Although direct pars repair using a pedicle screw-rod-hook system has achieved satisfactory results in patients with spondylolysis, its application in adults with low-grade isthmic spondylolisthesis is rarely reported. Objective. To assess the surgical effect of reduction and direct repair surgery with a pedicle screw-rod-hook system combined with autogenous bone grafts in adult patients with low-grade isthmic spondylolisthesis. Methods. Sixty-four adult patients with low-grade isthmic spondylolisthesis underwent reduction and direct repair using a pedicle screw-rod-hook system in our department from September 2009 to April 2018. The clinical efficacy was evaluated by clinical and radiological assessments. Results. The average follow-up was 52.15 ± 9.96 months. The visual analog scale (VAS) scores (VAS-lumbar and VAS-leg) and Oswestry Disability Index (ODI) at the final follow-up (FFU) were significantly lower than the preoperative levels P < 0.05 . The modified Prolo score was “excellent” for 60 patients (93.75%) and “good” for 4 patients (6.25%). The slip distance and slipping percentage showed significant decreases postoperatively and FFU compared to preoperatively P < 0.05 . There were no significant differences in the disc height, slip angle, and range of motion of the surgical intervertebral space or upper intervertebral space between preoperation and FFU P < 0.05 . Successful bony fusion had a 96.86% success rate. Conclusion. Reduction of slip and direct repair using pedicle screw-rod-hook fixation combined with autogenous iliac bone grafting in adult patients with low-grade isthmic spondylolisthesis is a safe and effective technique.

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6

Pierangeli, Angelo, Bruno Turinetto, Roberto Galli, Ilaria Caldarera, Rossella Fattori, and Giampaolo Gavelli. "Delayed Treatment of Isthmic Aortic Rupture." Cardiovascular Surgery 8, no. 4 (2000): 280–83. http://dx.doi.org/10.1177/096721090000800407.

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Traumatic rupture of the thoracic aorta is a life-threatening injury with a high mortality, and is difficult to manage in polytraumatized patients. Between 1980 and 1998. 50 patients were admitted to our Department with acute traumatic aortic rupture (TAR). The site of lesion was usually isthmic (86% of patients). From 1980 to 1992, 21 patients (Group I) underwent emergency surgical repair; from 1992 to January 1998, 29 patients (Group II) underwent intensive medical treatment, except one who was haemodynamically unstable and died 8 h after the trauma from a massive haemothorax before an emergency thoracotomy could be attempted. The aortic rupture was followed up by MRI or CT scan. Twenty-one patients in Group II underwent aortic repair an average of 8.6 months after the injury. In two patients the operation was expedited because of an enlarging aortic aneurysm. In Group I the postoperative mortality was 19%, three patients developed postoperative paraplegia and one acute renal failure. In Group II there were no postoperative deaths and no major complications.

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7

Carlestål, Emelie, Anders Thorell, Lott Bergstrand, Francis Wilamowski, Anders Franco-Cereceda, and Christian Olsson. "High Prevalence of Thoracic Aortic Dilatation in Men with Previous Inguinal Hernia Repair." AORTA 10, no. 03 (2022): 122–30. http://dx.doi.org/10.1055/s-0042-1749172.

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Abstract Background Identifying a useful marker for thoracic aortic dilatation (TAD) could help improve informed clinical decisions, enhance diagnosis, and develop TAD screening programs. Inguinal hernia could be such a marker. This study tested the hypothesis that the thoracic aorta is larger and more often dilated in men with previous inguinal hernia repair versus nonhernia controls. Methods Four hundred men each with either previous inguinal hernia repair or cholecystectomy (controls) were identified to undergo chest computed tomography to measure the diameter of the thoracic aorta in the aortic root, ascending, isthmic, and descending aorta and to provide self-reported health data. Presence of TAD (root or ascending diameter > 45 mm; isthmic or descending diameter > 35 mm) and thoracic aortic diameters were compared between groups and associations explored using uni- and multivariable statistical methods. Results Complete data were obtained from 470/718 (65%) eligible participants. TAD prevalence was significantly higher in the inguinal hernia group: 21 (10%) versus 6 (2.4%), p = 0.001 for proximal TAD, 29 (13%) versus 21 (8.3%), p = 0.049 for distal TAD, and 50 (23%) versus 27 (11%), p < 0.001 for all aortic segments combined. In multivariable analysis, previous inguinal hernia repair was independently associated with dilatation of the proximal aorta (odds ratio 5.3, 95% confidence interval 1.8–15, p = 0.003). Contrarily, mean thoracic aortic diameters were similar (root and ascending aorta) or showed clinically irrelevant differences (isthmus and descending aorta). Conclusion TAD, but not increased aortic diameters on average, was common and significantly more prevalent in men with previous inguinal hernia repair. Hernia could be a marker condition associated with increased prevalence of TAD. Ultimately, TAD screening could consider hernia as a possible selection criterion.

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8

Madkour, Amr, tamer metwally, and mohammed agamy. "Pars Repair in Isthmic Spondylolysis in the Young Adults." Egyptian Spine Journal 31, no. 1 (2019): 27–35. http://dx.doi.org/10.21608/esj.2019.12979.1102.

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9

Raudenbush, Brandon L., Reid C. Chambers, Michael P. Silverstein, and Ryan C. Goodwin. "Indirect pars repair for pediatric isthmic spondylolysis: a case series." Journal of Spine Surgery 3, no. 3 (2017): 387–91. http://dx.doi.org/10.21037/jss.2017.08.08.

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10

Shamsa, Kamran, Joseph K. Perloff, Eric Lee, Robert S. Wirthlin, Irena Tsui, and Steven D. Schwartz. "Retinal Vascular Patterns After Operative Repair of Aortic Isthmic Coarctation." American Journal of Cardiology 105, no. 3 (2010): 408–10. http://dx.doi.org/10.1016/j.amjcard.2009.09.046.

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11

Morelos, Oscar, and Alfredo O. Pozzo. "Selective instrumentation, reduction and repair in low-grade isthmic spondylolisthesis." International Orthopaedics 28, no. 3 (2004): 180–82. http://dx.doi.org/10.1007/s00264-003-0530-1.

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12

FERNANDEZ, C., F. FONTAN, C. DEVILLE, F. MADONNA, and D. THIBAUD. "Long-term evaluation of direct repair of traumatic isthmic aortic transection." European Journal of Cardio-Thoracic Surgery 3, no. 4 (1989): 327–34. http://dx.doi.org/10.1016/1010-7940(89)90031-6.

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13

Di Salvo, Giovanni, Jennifer Fumanelli, Serena Graziano, et al. "Stress Echocardiography in the Follow-Up of Young Patients with Repaired Aortic Coarctation." Journal of Clinical Medicine 13, no. 18 (2024): 5587. http://dx.doi.org/10.3390/jcm13185587.

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Background: Aortic coarctation (CoA) is a congenital heart disease affecting 5–8% of patients, with long-term complications persisting despite successful correction. Stress echocardiography (SE) is increasingly used for evaluating cardiac function under stress, yet its role in repaired CoA remains under-explored. Objective: This study aimed to assess the predictive value of SE and myocardial strain in repaired CoA patients with a history of hypertension without significant gradients or with borderline gradients at rest. Methods: Between June 2020 and March 2024, we enrolled 35 consecutive CoA patients with successful repairs and either a history of hypertension or borderline Doppler gradients. Baseline and peak exercise echocardiographic measurements, including left ventricular mass index (LVMi) and global longitudinal strain (LVGLS), were recorded. Patients were followed for up to 4 years. Results: At baseline, the positive SE group had higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) compared to the negative SE group. The positive SE group also exhibited significantly higher basal and peak trans-isthmic gradients. Positive SE was found in 45.7% of patients, with 68.7% of these requiring re-intervention during follow-up. A peak trans-isthmic gradient > 61 mmHg during exercise predicted recoarctation with 100% sensitivity and 71% specificity (AUC = 0.836, p < 0.004). Conclusions: SE identifies at-risk patients post-CoA repair, aiding in early intervention. A peak trans-isthmic gradient > 61 mmHg during exercise is a strong predictor of recoarctation. These findings support incorporating SE into routine follow-up protocols for CoA patients, particularly those with a history of hypertension and borderline gradients, to improve long-term outcomes and quality of life.

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14

Ben Hammamia, M., M. Ben Mrad, J. Ziadi, et al. "Endovascular repair of traumatic aortic isthmic rupture: Early and mid-term results." JMV-Journal de Médecine Vasculaire 45, no. 5 (2020): 254–59. http://dx.doi.org/10.1016/j.jdmv.2020.06.007.

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15

Lee, Y. S., G. O. Chong, Y. H. Lee, and D. G. Hong. "Single Port Repair of Defect at Isthmic Area during Single Port Laparoscopic Huge Myomectomy." Journal of Minimally Invasive Gynecology 21, no. 6 (2014): S115. http://dx.doi.org/10.1016/j.jmig.2014.08.399.

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16

Pressler, Axel, Katrin Esefeld, Johannes Scherr, et al. "Structural Alterations of Retinal Arterioles in Adults Late After Repair of Aortic Isthmic Coarctation." American Journal of Cardiology 105, no. 5 (2010): 740–44. http://dx.doi.org/10.1016/j.amjcard.2009.10.070.

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17

Champain, S., Th David, Ch Mazel, A. Mitulescu, and W. Skalli. "Long-term outcomes evaluation after pars defect repair in adult low-grade isthmic spondylolithesis." European Journal of Orthopaedic Surgery & Traumatology 17, no. 4 (2007): 337–47. http://dx.doi.org/10.1007/s00590-007-0198-0.

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18

Bozzani, Antonio, Vittorio Arici, Giuseppe Rodolico, Massimo Borri Brunetto, and Angelo Argenteri. "Endovascular Exclusion of Aortobronchial Fistula and Distal Anastomotic Aneurysm after Extra-Anatomic Bypass for Aortic Coarctation." Texas Heart Institute Journal 44, no. 1 (2017): 55–57. http://dx.doi.org/10.14503/thij-15-5542.

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The treatment of choice for aortic coarctation in adults remains open surgical repair. Aortobronchial fistula is a rare but potentially fatal late sequela of surgical correction of isthmic aortic coarctation via the interposition of a graft.The endovascular treatment of aortobronchial fistula is still under discussion because of its high risk for infection, especially if the patient has a history of cardiovascular prosthetic implantation. Patients need close monitoring, most notably those with secondary aortobronchial fistula. We discuss the case of a 65-year-old man who presented with the combined conditions, and we briefly review the relevant medical literature.

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19

Mertens, Renato, Fernando Velásquez, Nicolás Mertens, et al. "Higher Prevalence of Bovine Aortic Arch Configuration in Patients Undergoing Blunt Isthmic Aortic Trauma Repair." Annals of Vascular Surgery 67 (August 2020): 67–70. http://dx.doi.org/10.1016/j.avsg.2019.10.080.

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Maitrias, P., D. Belhomme, T. Caus, and T. Reix. "Hybrid treatment of an isthmic aneurysm and subclavian ectasia after successful recoarctation repair with ventral aorta." European Journal of Cardio-Thoracic Surgery 47, no. 3 (2014): 581. http://dx.doi.org/10.1093/ejcts/ezu222.

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21

David, Thierry, Sabina Champain, and Wafa Skalli. "113. Long-Term Outcome Evaluation after PARS Defect Repair in Adults with Low-grade Isthmic Spondylolithesis." Spine Journal 8, no. 5 (2008): 57S—58S. http://dx.doi.org/10.1016/j.spinee.2008.06.135.

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Marrocco-Trischitta, Massimiliano M., and Rodrigo M. Romarowski. "Re: “Higher Prevalence of Bovine Aortic Arch Configuration in Patients Undergoing Blunt Isthmic Aortic Trauma Repair”." Annals of Vascular Surgery 65 (May 2020): e291-e292. http://dx.doi.org/10.1016/j.avsg.2020.01.002.

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23

Matsuo, Kumiyo, Dai Asada, Hisaaki Aoki, and Futoshi Kayatani. "Successful bailout stenting for critical aortic coarctation in a premature baby weighing 590 g." BMJ Case Reports 16, no. 6 (2023): e255215. http://dx.doi.org/10.1136/bcr-2023-255215.

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Severe aortic coarctation (CoA) is a critical congenital heart disease that requires surgery as the first-line treatment in neonates. However, in very small premature infants, aortic arch repair has a relatively high mortality and morbidity rate. Bailout stenting is an alternative method that can be performed safely and effectively with low morbidity.We present a case of severe CoA in a premature baby, a monochorionic twin with selective intrauterine growth restriction. The patient was born at 31 weeks of gestation with a birth weight of 570 g. Seven days following her birth, she experienced anuria due to critical neonatal isthmic CoA. She underwent a stent implantation procedure at term neonatal, weighing 590 g. She had good dilatation of the coarcted segment with no complications. Follow-up at infancy showed no CoA recurrence. This is the world’s smallest case of stenting for CoA.

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Crepaz, Roberto, Roberto Cemin, Cristina Romeo, et al. "Factors affecting left ventricular remodelling and mechanics in the long-term follow-up after successful repair of aortic coarctation." Cardiology in the Young 15, no. 2 (2005): 160–67. http://dx.doi.org/10.1017/s104795110500034x.

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Aims: To identify factors predisposing to abnormal left ventricular geometry and mechanics in 52 patients after successful repair of aortic coarctation. Methods and results: We evaluated left ventricular remodelling, systolic midwall mechanics, and isthmic gradient by echo-Doppler, systemic blood pressure at rest/exercise and by ambulatory blood pressure monitoring, and the aortic arch by magnetic resonance imaging. Echocardiographic findings were compared with those of 142 controls. The patients with aortic coarctation showed an increased indexed left ventricular end-diastolic volume, increased mass index, increased ratio of mass to volume and systolic chamber function. The contractility, estimated at midwall level, was increased in 21 percent of the patients. In 26 (50 percent) of the patients, we found abnormal left ventricular geometry, with 9 percent showing concentric remodelling, 33 percent eccentric hypertrophy, and 8 percent concentric hypertrophy. These patients were found to be older, underwent a later surgical repair, and to have higher systolic blood pressures at rest and exercise as well as during ambulatory monitoring. The relative mural thickness and mass index of the left ventricle showed a significant correlation with different variables on uni- and multivariate analysis. Age and diastolic blood pressure at rest are the only factors associated with abnormal left ventricular remodelling. Conclusions: Patients who have undergone a seemingly successful surgical repair of aortic coarctation may have persistently abnormal geometry with a hyperdynamic state of the left ventricle. This is more frequent in older patients, and in those with higher diastolic blood pressures.

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Poncelet, Alain J., Arnaud Henkens, Thierry Sluysmans, et al. "Distal Aortic Arch Hypoplasia and Coarctation Repair: A Tailored Enlargement Technique." World Journal for Pediatric and Congenital Heart Surgery 9, no. 5 (2018): 496–503. http://dx.doi.org/10.1177/2150135118780611.

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Background: Several techniques have been described to correct coarctation associated with distal arch hypoplasia. However, in neonates, residual gradients are frequently encountered and influence long-term outcome. We reviewed our experience with an alternative technique of repair combining carotid–subclavian angioplasty and extended end-to-end anastomosis. Methods: From 1998 through 2014, 109 neonates (median age, 9 days) with coarctation and distal arch hypoplasia (n = 106) or type A interrupted aortic arch (n = 3) underwent repair using this technique. Thirty patients had isolated lesions (group 1), 44 associated ventricular septal defect (group 2), and 35 associated complex cardiac lesions (group 3). Median follow-up was 98 months. Results: Repair was performed via left thoracotomy in 97%. There was one procedural-related death (0.9%) and overall five patients died during index admission (4.6%). Ten deaths were recorded at follow-up. Actuarial five-year survival was 86% (100% in group 1, 91% group 2, and 66% in group 3). Recurrent coarctation (clinical or invasive gradient >20 mm Hg) developed in 15 patients, all but 2 successfully treated by balloon dilatation. Freedom from any reintervention (dilatation or surgery) at five years was 86%. Only two patients were on antihypertensive drugs at last follow-up. Conclusions: This combined technique to correct distal arch hypoplasia and isthmic coarctation results in low mortality and acceptable recurrence rate. It preserves the left subclavian artery and allows enlargement of the distal arch diameter. Late outcome is excellent with very low prevalence of late arterial hypertension.

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Yamashita, MD, Kazuta, Kosaku Higashino, MD, PhD, Toshinori Sakai, MD, PhD, et al. "The reduction and direct repair of isthmic spondylolisthesis using the smiley face rod method in adolescent athlete: Technical note." Journal of Medical Investigation 64, no. 1.2 (2017): 168–72. http://dx.doi.org/10.2152/jmi.64.168.

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27

Davidovic, Lazar, Momcilo Colic, Igor Koncar, et al. "Endovascular repair of aortic aneurysm: Preliminary results." Srpski arhiv za celokupno lekarstvo 137, no. 1-2 (2009): 10–17. http://dx.doi.org/10.2298/sarh0902010d.

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Introduction. Endovascular aneurysm repair (EVAR) has been introduced into clinical practice at the beginning of the 90's of the last century. Because of economic, political and social problems during the last 25 years, the introduction of this procedure in Serbia was not possible. Objective. The aim of this study was to present preliminary experiences and results of the Clinic for Vascular Surgery of the Serbian Clinical Centre in Belgrade in endovascular treatment of thoracic and abdominal aortic aneurysms. Methods. The procedure was performed in 33 patients (3 female and 30 male), aged from 42 to 83 years. Ten patients had a descending thoracic aorta aneurysm (three atherosclerotic, four traumatic - three chronic and one acute as a part of polytrauma, one dissected, two penetrated atherosclerotic ulcers), while 23 patients had the abdominal aortic aneurysm, one ruptured and two isolated iliac artery aneurysms. The indications for EVAR were isthmic aneurismal localisation, aged over 80 years and associated comorbidity (cardiac, pulmonary and cerebrovasular diseases, previous thoracotomy or multiple laparotomies associated with abdominal infection, idiopatic thrombocitopaenia). All of these patients had three or more risk factors. The diagnosis was established using duplex ultrasonography, angiography and MSCT. In the case of thoracic aneurysm, a Medtronic-Valiant? endovascular stent graft was implanted, while for the abdominal aortic aneurysm Medtronic-Talent? endovascular stent grafts with delivery systems were used. In three patients, following EVAR a surgical repair of the femoral artery aneurysm was performed, and in another three patients femoro-femoral cross over bypass followed implantation of aortouniiliac stent graft. Results. During procedure and follow-up period (mean 1.6 years), there were: one death, one conversion, one endoleak type 1, six patients with endoleak type 2 that disappeared during the follow-up period, one early graft thrombosis. No other complications, including aneurysm expansion, collapse, deformity and migration of the endovascular stent grafts, were registered. Conclusion. According to all medical and economic aspects, we recommend EVAR to treat acute traumatic thoracic aortic aneurysm, as well as in elderly and high-risk patients with abdominal or thoracic aneurysms, when open surgery is related to a significantly higher mortality and morbidity.

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Panico, G., S. Mastrovito, E. Bonetti, F. Fanfani, G. Scambia, and U. Catena. "Caesarean scar defect and retained products of conception (RPOC): a step-by-step combined hysteroscopic and laparoscopic treatment." Facts, Views and Vision in ObGyn 16, no. 3 (2024): 351–53. http://dx.doi.org/10.52054/fvvo.16.3.031.

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Background: Uterine scar defect (also called uterine niche or isthmocele) associated to retained products of conception (RPOC) is an uncommon occurrence following caesarean section. Typically, the primary indicator is abnormal vaginal bleeding, and an accurate diagnosis can be established through ultrasound evaluation. Several surgical and endoscopic treatments have been described. Objectives: To show a step-by-step video of combined hysteroscopic and laparoscopic approach to perform isthmocele repair in a patient with caesarean scar defect and RPOC. Materials and Methods: We report a case of a 34-year-old patient who was referred to our Digital Hysteroscopic Clinic (DHC) for abnormal vaginal bleeding and persistent pelvic pain, three months after a caesarean section. A single-step diagnostic approach through transvaginal ultrasound and diagnostic hysteroscopy revealed the presence of an isthmic uterine niche within the caesarean scar area, containing a poorly vascularised heterogeneous hyperechoic focal mass measuring 33x11x33 millimetres. Main outcome measures: Removal of RPOC and surgical complications. Results: All retained placental tissue was removed and the uterine wall defect was corrected. No complications occurred and the patient was discharged two days after the procedure. Patient was asymptomatic at 3 months follow up and ultrasound and hysteroscopy showed a reconstituted uterine wall. Conclusion: An integrated hysteroscopic and laparoscopic approach seems to be an effective conservative method to remove RPOC and perform isthmocele repair with optimal surgical results.

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Snyder, Laura A., Harry Shufflebarger, Michael F. O'Brien, Harjot Thind, Nicholas Theodore, and Udaya K. Kakarla. "Spondylolysis outcomes in adolescents after direct screw repair of the pars interarticularis." Journal of Neurosurgery: Spine 21, no. 3 (2014): 329–33. http://dx.doi.org/10.3171/2014.5.spine13772.

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Object Isthmic spondylolysis can significantly decrease functional abilities, especially in adolescent athletes. Although treatment can range from observation to surgery, direct screw placement through the fractured pars, or Buck's procedure, may be a more minimally invasive procedure than the more common pedicle screw-hook construct. Methods Review of surgical databases identified 16 consecutive patients treated with Buck's procedure from 2004 to 2010. Twelve patients were treated at Miami Children's Hospital and 4 at Barrow Neurological Institute. Demographics and clinical and radiographic outcomes were recorded and analyzed retrospectively. Results The 16 patients had a median age of 16 years, and 14 were 20 years or younger at the time of treatment. Symptoms included axial back pain in 100% of patients with concomitant radiculopathy in 38%. Pars defects were bilateral in 81% and unilateral in 19% for a total of 29 pars defects treated using Buck's procedure. Autograft or allograft augmented with recombinant human bone morphogenetic protein as well as postoperative bracing was used in all cases. Postoperatively, symptoms resolved completely or partially in 15 patients (94%). Of 29 pars defects, healing was observed in 26 (89.6%) prior to 1 revision surgery, and an overall fusion rate of 97% was observed at last radiological follow-up. There were no implant failures. All 8 athletes in this group had returned to play at last follow-up. Conclusions Direct screw repair of the pars interarticularis defect as described in this series may provide a more minimally invasive treatment of adolescent patients with satisfactory clinical and radiological outcomes, including return to play of adolescent athletes.

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Dai, L. Y., L. S. Jia, W. Yuan, B. Ni, and H. B. Zhu. "Direct repair of defect in lumbar spondylolysis and mild isthmic spondylolisthesis by bone grafting, with or without facet joint fusion." European Spine Journal 10, no. 1 (2001): 78–83. http://dx.doi.org/10.1007/s005860000205.

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Pacileo, Giuseppe, Carlo Pisacane, Giovanna M. Russo, Roberto M. Di Donato, Carlo Vosa, and Raffaele Calabrò. "Left ventricular mechanics after early successful repair of aortic coarctation." Cardiology in the Young 5, no. 4 (1995): 310–18. http://dx.doi.org/10.1017/s1047951100002766.

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SummaryA successful aortic coarctectomy performed beyond early infancy is followed, even in the long term, by persistence of left ventricular hypertrophy and by diastolic dysfunction, although systolic function is often increased. In this study we investigated whether earlier coarctectomy provides better preservation of left ventricular function. Experimental studies on the myocardial response to pressure overload show that neonates and young infants develop a functionally advantageous combination of myocytic hyperplasia (together with mild hypertrophy) and increased angiogenesis. Older patients, in contrast, generate myocytic hypertrophy in isolation, setting the scene for ventricular dysfunction. Cross-sectional echo-Doppler evaluation of left ventricular size, shape, mass and systolic and diastolic function was made in 13 patients a mean of 44±36 months (range 11 days-10 years) after successful coarctectomy in the first year of life. They were compared to 11 age, body surface area and gender-matched control subjects. In all patients, left ventricular mass normalized for body surface area was significantly greater than in the control group (66.2±12.3 vs 43±l2 p=0.0001). There was no correlation between left ventricular mass normalized for body surface area and age at operation, follow-up duration, degree of residual isthmic gradient, peak systolic wall stress, systolic blood pressure or left ventricular shape. No significant differences were noted between the two groups in regard to transverse diameter of the aortic arch, left ventricular afterload (meridional end-systolic wall stress), volume and shape (both in systole and diastole), systolic performance (fractional shortening and ejection fraction) and contractility (rate-corrected velocity of fiber shortening to meridional end-systolic wall stress relationship). Furthermore, no significant differences were found with respect to indices of mitral (including peak filling rate normalized to mitral stroke volume) and pulmonary venous flow, suggesting normal diastolic function. Repair of aortic coarctation in the first year of life promotes a more complete recovery of left ventricular function (particularly diastolic) than that reported after coarctectomy at older age, despite persistence of moderate ventricular hypertrophy.

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Tatsumura, Masaki, Shun Okuwaki, Hisarnori Gamada, et al. "Erratum for A Novel Technique for Pars Defect Direct Repair with a Modified Smiley Face Rod for Spondylolysis and Isthmic Spondylolisthesis." Spine Surgery and Related Research 7, no. 5 (2023): 473. http://dx.doi.org/10.22603/ssrr.2023-0021-er.

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Schlenzka, D., S. Seitsalo, M. Poussa, and K. �sterman. "Operative treatment of symptomatic lumbar spondylolysis and mild isthmic spondylolisthesis in young patients: direct repair of the defect or segmental spinal fusion?" European Spine Journal 2, no. 2 (1993): 104–12. http://dx.doi.org/10.1007/bf00302712.

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Güven, Koray, Izzet Rozanes, Murat Kayabali, Murat Aksoy, Kemal Ayalp, and Bülent Acunaş. "Endovascular repair of an abdominal aortic aneurysm in a patient with horseshoe kidney demonstrating the nonend artery nature of an accessory isthmic artery." European Journal of Radiology Extra 67, no. 3 (2008): e125-e128. http://dx.doi.org/10.1016/j.ejrex.2008.05.015.

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Liu, Xinyu, Lianlei Wang, Suomao Yuan, Yonghao Tian, Yanping Zheng, and Jianmin Li. "Multiple-level lumbar spondylolysis and spondylolisthesis." Journal of Neurosurgery: Spine 22, no. 3 (2015): 283–87. http://dx.doi.org/10.3171/2014.10.spine14415.

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OBJECT Lumbar spondylolysis and isthmic spondylolisthesis occur most commonly at only one spinal level. The authors report on 13 cases of lumbar spondylolysis with spondylolisthesis at multiple levels. METHODS During July 2007–March 2012, multiple-level spondylolysis associated with spondylolisthesis was diagnosed in 13 patients (10 male, 3 female) at Qilu Hospital of Shandong University. The mean patient age was 43.5 ± 14.6 years. The duration of low-back pain was 11.7 ± 5.1 months. Spondylolysis occurred at L-2 in 2 patients, L-3 in 4 patients, L-4 in all patients, and L-5 in 5 patients. Spondylolysis occurred at 3 spinal levels in 3 patients and at 2 levels in 10 patients. All patients had spondylolisthesis at 1 or 2 levels. Japanese Orthopaedic Association and visual analog scale scores were used to evaluate preoperative and postoperative neurological function and low-back pain. All patients underwent pedicle screw fixation and interbody fusion or direct pars interarticularis repair. RESULTS Both low-back pain scores improved significantly after surgery (p < 0.05). Postoperative radiographs or CT scans showed satisfactory interbody fusion or pars interarticularis healing. No breakage, dislodging, or loosening of the pedicle screw hardware was observed for any patient. CONCLUSIONS Multiple-level lumbar spondylolysis and spondylolisthesis occurred more often in men. Most multiplelevel lumbar spondylolysis occurred at 2 spinal levels and was associated with sports, trauma, or heavy labor. Multiplelevel lumbar spondylolysis occurred mostly at L3–5; associated spondylolisthesis usually occurred at L-4 and L-5, mostly at L-4. The treatment principle was the same as that for single-level spondylolisthesis.

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Carnevali, Ileana, Laura Libera, Annamaria Chiaravalli, et al. "Somatic Testing on Gynecological Cancers Improve the Identification of Lynch Syndrome." International Journal of Gynecologic Cancer 27, no. 7 (2017): 1543–49. http://dx.doi.org/10.1097/igc.0000000000001010.

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ObjectiveRecent data from the literature indicate gynecological cancers (GCs) as sentinel cancers for a diagnosis of Lynch syndrome (LS). Clinical approaches to identifying LS have low sensitivity, whereas somatic tests on GCs may be a more sensitive and cost-effective strategy.MethodsA series of 78 GCs belonging to 74 patients sent to the Genetic Counselling Service were investigated using microsatellite instability, immunohistochemical expression of mismatch repair (MMR) genes, and MLH1 promoter methylation.ResultsThe presence of microsatellite instability was observed in 67.5% of GCs, and the absence of immunohistochemical expression of at least 1 of the 4 MMR proteins was observed in 71.4% of GCs, showing 96.1% concordance between the methods. Methylation analysis using methylation specific multiplex ligation-dependent probe amplification performed on 35 samples revealed MLH1 promoter hypermethylation in 18 cases (54%). Molecular analysis identified 36 LS carriers of MMR variants (27 pathogenetic and 9 variants of uncertain significance), and, interestingly, 3 LS patients had MLH1 methylated GC.With regard to histological features, LS-related GCs included endocervical cancers and also histological types different from the endometrioid cancers. The presence of peritumoral lymphocytes in GCs was statistically associated with LS tumors.ConclusionsSomatic analysis is a useful strategy to distinguish sporadic from LS GC. Our data allow the identification of a subset of LS patients otherwise unrecognized on the basis of clinical or family history alone. In addition, our results indicate that some clinicopathological features including age of GC diagnosis; presence of peritumoral lymphocytes; isthmic, endocervical sites, and body mass index value could be useful criteria to select patients for genetic counseling.

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Schlenzka, Dietrich, Ville Remes, Ilkka Helenius, et al. "Direct repair for treatment of symptomatic spondylolysis and low-grade isthmic spondylolisthesis in young patients: no benefit in comparison to segmental fusion after a mean follow-up of 14.8 years." European Spine Journal 15, no. 10 (2006): 1437–47. http://dx.doi.org/10.1007/s00586-006-0072-5.

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Douglas, William I., Monesha Gupta, Michael H. Hines, and John T. Bricker. "Neonatal Coarctation Repair With a Long Isthmus: The Isthmus Patch." Annals of Thoracic Surgery 94, no. 2 (2012): 651–53. http://dx.doi.org/10.1016/j.athoracsur.2011.12.078.

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Kopp, Reinhard, Eckart Kreuzer, Martin Oberhoffer, Karin Anna Herrmann, Karl-Walter Jauch, and Bruno Reichart. "Endovascular Treatment of a Symptomatic Suture Aneurysm Caused by an Aortic Isthmus Restenosis." Vascular 14, no. 3 (2006): 161–64. http://dx.doi.org/10.2310/6670.2006.00026.

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After operative treatment of aortic isthmus stenoses, late complications, such as aneurysm formation or aortic restenosis, might occur, with relevant morbidity and mortality rates during open surgical reintervention. We report on the endovascular repair of a symptomatic suture aneurysm caused by an aortic isthmus restenosis by thoracic aortic stent graft implantation and additional intraoperative balloon dilatation. Based on our experience, endovascular repair of thoracic aortic aneuryms caused by native aortic isthmus stenosis or postcoarctation restenosis is a valuable treatment option, especially in symptomatic patients with an imminent risk of rupture or a difficult immediate transthoracic surgical approach. Long-term follow-up is required to assess the durability of the stent graft treatment.

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Pachuliia, Olga V., Vladislava V. Khalenko, Margarita O. Shengeliia, and Olesya N. Bespalova. "Biomechanisms of cervical remodeling and current approaches to maturity assessment." Journal of obstetrics and women's diseases 72, no. 1 (2023): 81–95. http://dx.doi.org/10.17816/jowd114934.

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The cervical remodeling process is unique and consists of softening, ripening, dilation at fetal birth, and repair to the original state, which is a dense long tubular structure. In this review, the problem of impaired cervical remodeling is discussed in both preterm birth and delayed transformation, which leads to the unpreparedness of the cervix for childbirth and prolongation of pregnancy. Histological, immunological and structural dynamic changes in the cervix begin long before delivery and are noted as early as the first trimester of gestation. There are a few ways to assess the maturity of the cervix. In the second and third trimester, in order to predict preterm birth, these are ultrasound cervicometry and a cervical phosphorylated insulin-like growth factor binding protein-1 test. At full term, in order to determine its readiness for delivery, this is a palpation assessment. Inadequate assessment of the cervical characteristics is one of the factors of untimely prevention of preterm birth, and at full term leads to inappropriate choice of method of preparation for labor. It is necessary to develop new approaches to the comprehensive assessment of the cervix, using existing methods, and to discover new ways to assess its maturity. In this review, the problem of cervical maturation diagnosis is considered based on literature data from such databases as PubMed, ResearchGate, and Google Scholar, as well as from electronic resources of the M. Gorky Scientific Library (St. Petersburg State University, Russia). This review analyzes data on molecular, biochemical and histophysiological processes occurring during cervical maturation at all stages of gestation. It is generally accepted that the main role in cervical changes at all stages of gestation is played by: collagen fiber restructuring / desorganization, decreased concentrations of collagen and elastin, high molecular weight hylauronic acid cleavage, increased aquaparin level and tissue hydrophilicity, increased cervical vascularization, as well as changes in glycosaminoglycan and matrix metalloproteinase content. Palpatory technique and ultrasound cervicometry are the most common methods of determining the cervical length, which have insufficient sensitivity, probably because they do not cover all pathogenetic pathways of remodeling and cannot assess all cervical characteristics. Improvement of efficiency is possible through the introduction of combined techniques and the use of promising methods such as elastography, ultrasound diagnosis of the cervix with Doppler assessment of its vessels, determination of a disintegrin and metalloprotease with thrombospondin-like repeats-1 and placental 1-microglobulin in cervical secretion, and relaxin in maternal blood. Understanding the molecular, biochemical and histophysiological processes that occur during cervical remodeling is crucial for predicting preterm birth, diagnosing isthmic-cervical insufficiency, understanding the lack of timely cervical readiness, and choosing tactics the method of preinduction and induction of labor if necessary. The lack of clinical methods and their lack of objectivity require a combined approach and the search for new prognostic markers of cervical maturation.

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Iosifescu, Andrei George, Alina Teodora Timișescu, Bogdan Prodan, Alexandru Popescu, and Vlad Anton Iliescu. "Acute Type A Aortic Dissection and Coarctation: Single-Stage Repair Using a Clamshell Incision and a Systematic Literature Review." Heart Surgery Forum 25, no. 5 (2022): E822—E828. http://dx.doi.org/10.1532/hsf.5035.

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Background: Aortic coarctation (CoAo) may be discovered only when complicated by acute type A aortic dissection (ATAAD). We present a case with a one-stage repair of this pathologic association and review the relevant literature focusing on the surgical choices. Case report: A 43-year-old man presented with acute thoracic pain. Computed tomography and echocardiography demonstrated CoAo, ATAAD type II, an ascending aorta aneurysm, and moderate regurgitation of a bicuspid aortic valve. Emergency surgery was performed. A clamshell incision, cardiopulmonary bypass with dual arterial cannulation (axillo-femoral), CoAo repair (by resection-interposition), and supracoronary aorta replacement were performed. Four years later, the patient was healthy and asymptomatic. Review: Thirty surgical cases of ATAAD with CoAo repair after the dissection onset were included. Iatrogenic dissections and formerly repaired CoAo without surgical indication were excluded. Results: The mean patient age was 27.8 ± 12 years; there was a male predominance (76.7%). The patients frequently presented with ascending aorta aneurysm (86.2%), bicuspid aortic valve (69%), and type II dissection (79.3%); dissection never extended below the CoAo. The one-stage treatment (15 patients; 55.5%) included 12 surgical repairs of CoAo (mostly by ascending-to-descending aorta extra-anatomic bypass; 58.3%) and three balloon angioplasties. In patients with uncorrected CoAo at the onset of cardiopulmonary bypass, double arterial perfusion was used in 55.5%. Conclusions: One-stage repair (hybrid or surgical), double arterial perfusion, and extra-anatomic ascending-to-descending aorta bypass are the most common options for treating ATAAD-CoAo. The clamshell incision provides excellent access for an extended arch procedure and facilitates anatomic isthmus repair.

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Nevvazhay, Timofey, Katja Zeppenfeld, Charlotte Brouwer, and Mark Hazekamp. "Intraoperative cryoablation in late pulmonary valve replacement for tetralogy of Fallot." Interactive CardioVascular and Thoracic Surgery 30, no. 5 (2020): 780–82. http://dx.doi.org/10.1093/icvts/ivaa013.

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Abstract Ventricular tachyarrhythmia (VT) is a major cause of late morbidity and mortality in patients who underwent surgical repair of tetralogy of Fallot. The majority of VTs are monomorphic macro-reentrant VT (MVT) and depend on slow conducting areas of diseased myocardium bordered by unexcitable tissue (anatomical isthmuses). Myocardial fibrosis due to surgical incisions, patch material and valve annuli are typical boundaries of anatomical isthmuses (AI). The conducting myocardium between the pulmonary valve and ventricular septum defect patch is called isthmus 3, and the majority of MVTs originate from this area. During pulmonary valve replacement, there is excellent exposure of isthmus 3. Importantly, after pulmonary valve replacement, the homograft may cover important parts of isthmus 3, which makes percutaneous catheter ablation at a later stage impossible. In all patients who need pulmonary valve replacement late after tetralogy of Fallot repair, preoperative electrophysiology study and electroanatomical mapping can identify patients with inducible MVT or slow conduction carrying high risk of MVT. In these patients, intraoperative cryoablation of isthmus 3 should be performed and bidirectional conduction block across the cryoablation line should be demonstrated by intraoperative differential pacing.

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Swolin, K. "Video. Electro-microsurgery, D: Repair of unicornuate uterus and salpingosis isthmica nodosa." Human Reproduction Update 2, no. 2 (1996): 192. http://dx.doi.org/10.1093/humupd/2.2.192.

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Bowden, Sylvie, and Graham Roche-Nagle. "Fenestrated endovascular abdominal aortic aneurysm repair with concomitant horseshoe kidney." BMJ Case Reports 14, no. 1 (2021): e236755. http://dx.doi.org/10.1136/bcr-2020-236755.

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Horseshoe kidney, representing abnormal fusion of the inferior renal poles, is a rare anatomic anomaly posing challenges in the setting of surgical abdominal aortic aneurysm repair. Historically, open repair has been the favoured surgical approach. However, due to the location of the renal isthmus and wide-ranging variation in anomalous renal vasculature, endovascular aneurysm repair (EVAR) has emerged as a popular, less invasive alternative. We describe one of the first published cases of two-fenestration EVAR in a patient with concomitant horseshoe kidney, followed by a discussion of current trends in surgical management. With the increasing availability to customise fenestrated grafts to patients’ unique anatomy, this advanced EVAR technique may emerge as the preferred approach in certain cases.

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Papavassiliou, Douvas, Xanthopoulos, Loupou, Dervisis, and Arvanitis. "Abdominal aortic aneurysm in association with horseshoe kidney." Vasa 35, no. 4 (2006): 249–51. http://dx.doi.org/10.1024/0301-1526.35.4.249.

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We report the preoperative diagnosis and surgical treatment of an abdominal aortic aneurysm (AAA) in association with a horseshoe kidney (HSK) in a 70-year-old man. Through a median laparotomy a vascular tube graft was successfully used for repair the AAA. The extensive parenchymal isthmus overlying the aneurysm remained intact.

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Harichane, Y., A. Hirata, S. Dimitrova-Nakov, et al. "Pulpal Progenitors and Dentin Repair." Advances in Dental Research 23, no. 3 (2011): 307–12. http://dx.doi.org/10.1177/0022034511405322.

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Mesenchymal stem cells are present in the dental pulp. They have been shown to contribute to dentin-like tissue formation in vitro and to participate in bone repair after a mandibular lesion. However, their capacity to contribute efficiently to reparative dentin formation after pulp lesion has never been explored. After pulp exposure, we have identified proliferative cells within 3 zones. In the crown, zone I is near the cavity, and zone II corresponds to the isthmus between the mesial and central pulp. In the root, zone III, near the apex, at a distance from the inflammatory site, contains mitotic stromal cells which may represent a source of progenitor cells. Stem-cell-based strategies are promising treatments for tissue injury in dentistry. Our experiments focused on (1) location of stem cells induced to leave their quiescent state early after pulp injury and (2) implantation of pulp progenitors, a substitute for classic endodontic treatments, paving the way for pulp stem-cell-based therapies.

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Maillo, Veronica, Celia de Frutos, Peadar O’Gaora, et al. "Spatial differences in gene expression in the bovine oviduct." Reproduction 152, no. 1 (2016): 37–46. http://dx.doi.org/10.1530/rep-16-0074.

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The aim of this study was to compare the transcriptome of the oviductal isthmus of pregnant heifers with that of cyclic heifers as well as to investigate spatial differences between the transcriptome of the isthmus and ampulla of the oviduct in pregnant heifers. After synchronizing crossbred beef heifers, those in standing oestrus (=Day 0) were randomly assigned to cyclic (non-bred, n=6) or pregnant (artificially inseminated, n=11) groups. They were slaughtered on Day 3 and both oviducts from each animal were isolated and cut in half to separate ampulla and isthmus. Each portion was flushed to confirm the presence of an oocyte/embryo and was then opened longitudinally and scraped to obtain epithelial cells which were snap-frozen. Oocytes and embryos were located in the isthmus of the oviduct ipsilateral to the corpus luteum. Microarray analysis of oviductal cells revealed that proximity to the corpus luteum did not affect the transcriptome of the isthmus, irrespective of pregnancy status. However, 2287 genes were differentially expressed (P<0.01) between the ampulla and isthmus of the oviduct ipsilateral to the corpus luteum in pregnant animals. Gene ontology revealed that the main biological processes overrepresented in the isthmus were synthesis of nitrogen, lipids, nucleotides, steroids and cholesterol as well as vesicle-mediated transport, cell cycle, apoptosis, endocytosis and exocytosis, whereas cell motion, motility and migration, DNA repair, calcium ion homeostasis, carbohydrate biosynthesis, and regulation of cilium movement and beat frequency were overrepresented in the ampulla. In conclusion, large differences in gene expression were observed between the isthmus and ampulla of pregnant animals at Day 3 after oestrus.

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Morisaki, Akimasa, Etsuji Sohgawa, Hiromichi Fujii, Kokoro Yamane, and Toshihiko Shibata. "Fenestrated Endovascular Repair with Debranching Technique for Blunt Traumatic Isthmus Injury." Annals of Vascular Diseases 11, no. 4 (2018): 565–68. http://dx.doi.org/10.3400/avd.cr.18-00088.

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Kim, Joung Taek, Young Sam Kim, Yong Han Yoon, Cheol Wong Kang, Wan Ki Baek, and Do Hyun Kim. "Aortic Isthmus Narrowing after Endovascular Repair of Acute Traumatic Aortic Transection." Vascular Specialist International 34, no. 3 (2018): 77–81. http://dx.doi.org/10.5758/vsi.2018.34.3.77.

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Marcheix, Bertrand, Camille Dambrin, Jean-Philippe Bolduc, et al. "Endovascular repair of traumatic rupture of the aortic isthmus: Midterm results." Journal of Thoracic and Cardiovascular Surgery 132, no. 5 (2006): 1037–41. http://dx.doi.org/10.1016/j.jtcvs.2006.07.004.

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