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PubMed2006

Ruptured fusiform aneurysm of fenestrated A1 segment of the anterior cerebral artery. Case report and review of the literature.

We present a case report of a 56-year-old woman with a ruptured fusiform aneurysm of a fenestrated A(1) segment of the anterior cerebral artery (ACA). Fenestrated A(1) segments are rare and only a few case reports have been published of a saccular type aneurysm formation. To the best of our knowledge, there have been no documented cases of fusiform aneurysms in these segments.

Aneurysm, Ruptured↗
PubMedDate not supplied

Reversal of fenestration flow during ventricular systole in Fontan patients in junctional or ventricular paced rhythm.

Sinus node dysfunction is relatively common in patients with Fontan palliation for single ventricle congenital heart disease, and such patients often are in junctional rhythm or may have pacemaker systems for bradycardia. Because the physiologic determinants of left atrial pressure play a major role in determining pulmonary blood flow and therefore cardiac output in Fontan patients, the loss of atrioventricular (AV) synchrony in junctional rhythm or demand ventricular pacing in these patients might be expected to influence cardiac output. We report two cases of Fontan patients with the absence of AV synchrony that resulted in reversal of flow through the Fontan fenestration during ventricular systole. In both cases, restoration of AV synchrony by atrial pacing resulted in the elimination of retrograde fenestration flow, increased cardiac output, and improved clinical status.

Cardiac Catheterization↗
PubMed2006

Use of Amplatzer fenestrated atrial septal defect device in a child with familial pulmonary hypertension.

In a 4.5-year-old child with refractory pulmonary arterial hypertension, we performed atrial septostomy with the application of an Amplatzer fenestrated device designed to maintain patency. Continuous intravenous epoprostenol infusion was started concomitantly. Forty-two months after the procedure, the patient had no recurrent syncope and remained in New York Heart Association functional class II. Fenestration of the atrial septum is feasible in children with pulmonary artery hypertension. No conclusion regarding the patient's need for an atrial septal defect can be drawn since concomitant prostanoid therapy was administered. The long-term patency of the atrial communication needs further confirmation and the optimal timing for its application has to be determined.

Cardiac Catheterization↗
PubMed2001

Extreme fenestration of the basilar artery associated with cleft palate, nasopharyngeal mature teratoma, and hypophyseal duplication.

The authors present the case of a newborn girl with extreme fenestration of the basilar artery. This anomaly was found incidentally during MR imaging study for cleft palate and nasopharyngeal teratoma. Magnetic resonance angiography showed a totally duplicated basilar artery with connections at the proximal and distal ends of the artery, suggesting an extreme fenestration. Duplicated pituitary gland was also found on MR imaging.

Abnormalities, Multiple↗
PubMed2002

Extreme fenestration of the right vertebral artery: magnetic resonance angiographic demonstration.

The authors describe an extreme fenestration of the right vertebral artery. This anomaly was found incidentally in a female patient undergoing MR imaging and MR angiography evaluation for severe dizziness and headache. Magnetic resonance angiography showed that the right posterior inferior cerebellar artery originated possibly extracranially and anastomosed with the terminal portion of the right vertebral artery, indicating the presence of an extremely large fenestration. This, to our knowledge, is the first report of MR angiographic demonstration of this variation.

Aged↗
PubMed2001

Outlet fenestration for isolated fourth ventricle with and without an internal shunt.

Conventional shunting of isolated fourth ventricle is notorious for leading to frequent and severe complications. We present four patients with isolated fourth ventricle who have been treated with open posterior fossa surgery together with either outlet fenestration alone or outlet fenestration and a fourth ventricle-spinal subarachnoid space (SSS) shunt. A survey of the relevant literature did not yield any other case reports of fourth ventricle shunting to the SSS under such circumstances. This paper discusses the reasons for choosing this mode of treatment. The main advantage of this technique is that the catheter is inserted along the anatomical long axis of the fourth ventricle. This positioning lessens the possibility of irritating or penetrating the brain stem. Moreover, as a more physiological solution, the shunt does not require a valve system. Because of these advantages, internal fourth ventricle-SSS shunting is proposed as a valid alternative to the "classic" fourth ventriculo-peritoneal shunt.

Cerebrospinal Fluid Shunts↗
PubMed2004

A novel implantation technique for closure of an atypical fenestration connecting the right atrial appendage to an extracardiac conduit by use of a 15 mm Helex device in a patient with total cavopulmonary connection.

We report on a 7-years old patient after total cavopulmonary anastomosis with an extracardiac conduit. An atypical fenestration was created during the operation connecting the right atrial appendage to the extracardiac conduit. Because of arterial desaturation, the fenestration connecting the anterior wall of the extracardiac conduit to the posterior wall of the right atrial appendage was successfully occluded with a 15 mm Helex device by use of a modified implantation technique.

Atrial Appendage↗
PubMed2006

Self-fabricated fenestrated Amplatzer occluders for transcatheter closure of atrial septal defect in patients with left ventricular restriction: midterm results.

To avoid left ventricular failure after transcatheter closure of atrial septal defects in elderly patients with restrictive left ventricular physiology, partial occlusion by fenestrated devices may be an option. If complete defect closure is not possible in these patients, significant reduction of left to right shunting usually results in clinical benefit. We report two patients in whom deterioration of left ventricular function could be avoided by implantation of self-fabricated fenestrated Amplatzer Septal Occluders (ASO) in patients with ongoing restrictive left ventricular physiology. We describe technical preparation of the standard occluder, the specific implantation technique, and the initial and the intermediate term results up to 24 months.

Aged↗
PubMed2000

Healing of fenestration-type defects following treatment with guided tissue regeneration or enamel matrix proteins. An experimental study in monkeys.

The aim of the present study was to evaluate histologically in monkeys the healing in acute fenestration-type defects following treatment with guided tissue regeneration (GTR) or enamel matrix proteins (EMD). Standardized "critical size" fenestration-type defects were produced surgically at the vestibular aspect of teeth 13, 23, 33, 43 in three monkeys (Macaca fascicularis). The vestibular bone plates were removed and the root surfaces were debrided by means of hand instruments in order to completely remove the root cementum. Following root conditioning with ethylenediaminetetraacetate (EDTA), the defects were treated using one of the following therapies: (1) GTR, (2) EMD, or (3) control (coronally repositioned flaps). After 5 months the animals were killed and perfused with 10% buffered formalin for fixation. Specimens containing the defects and surrounding tissues were dissected free, decalcified in EDTA, and embedded in paraffin. Eight-micrometer-thick step serial histological sections were cut in a vestibulo-oral direction, stained with hematoxylin and eosin or oxone-aldehyde-fuchsin-Halmi, and subsequently examined under the light microscope. The results showed that, in the defects treated with GTR, a new connective tissue attachment (i.e., new cementum with inserting collagen fibers) and new bone formation had consistently occurred, whereas, in the defects treated with EMD or with coronally repositioned flaps, new attachment and new bone reformed to a varying extent. The quality of the cementum did not differ after EMD, GTR, or flap surgery. It was concluded that GTR treatment with bioresorbable membranes seems to predictably promote new attachment and new bone formation, whereas the application of EDTA or EMD may also enhance periodontal healing to a certain extent. Further studies with higher numbers of animals and defects are needed in order to definitely clarify the effect of root surface conditioning with EDTA and EMD on periodontal healing.

Absorbable Implants↗
PubMed1985

Granuloma associated with fenestrated tracheostomy tubes.

Four cases of granuloma that caused tracheal obstruction have been presented. In each, although for different reasons, a tracheostomy was performed and a fenestrated tube inserted. We conclude that the insertion of a fenestrated tube was the direct cause of the excessive amount of granuloma that caused tracheal obstruction.

Adult↗
PubMed1994

Spontaneous closure of fenestrations in an interatrial Gore-Tex patch: application to the Fontan procedure.

The concept of the partial Fontan procedure, first described with the adjustable atrial septal defect (ASD) and more recently with the fenestrated technique, has become an accepted approach for the management of high-risk patients undergoing the Fontan procedure. Experience with both techniques has shown that a patent ASD placed in a prosthetic interatrial baffle may close spontaneously over a period of weeks to months. The mechanism and timing of spontaneous closure, as well as the effect of antiplatelet therapy on this process, are poorly understood. To better define this process, the interatrial septum of 15 mongrel dogs was excised and replaced with a fenestrated Gore-Tex (W.L. Gore, Flagstaff, AZ) patch. Postoperative echocardiography confirmed the patency of the ASD and left-to-right shunting. Animals were sacrificed 4 to 6 weeks postoperatively, or sooner if infection or other postoperative complications developed. Eight animals underwent no antiplatelet or anticoagulation therapy postoperatively, and 7 received antiplatelet therapy with aspirin. Patches were removed at the end of the study period and analyzed. By 6 weeks, all 2.7-mm and 4-mm holes had closed spontaneously in all animals that had not received antiplatelet therapy. The earliest closure occurred at 1 week. With antiplatelet therapy, hole closure was found to be delayed but not prevented, and was complete by 6 weeks in all but 1 animal. Histologic examination of the explanted patches revealed that closure was accomplished primarily through the ingrowth of fibrous tissue, accompanied by an inflammatory cell infiltrate.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1985

Fenestration of the internal carotid artery.

Fenestration of the internal carotid artery is very rare. The authors describe two cases of fenestration at the cervical portion of the internal carotid artery that were revealed by angiography. The embryological basis and clinical significance of this anomalous condition are discussed.

Carotid Artery, Internal↗
PubMed1992

Aneurysm of the fenestrated basilar artery: report of two cases.

This report describes two patients with fenestrated basilar artery aneurysms, and one of the patients underwent a postmortem examination. In our cases, the aneurysms arose at the proximal end of the fenestration, which involved the proximal third of the basilar artery. Subtraction angiography and oblique projections were essential in diagnosing the aneurysms. Complete neck clipping was successfully performed through a lateral suboccipital approach in the two cases. Technical aspects of neck clipping of the aneurysm of this unique location are discussed. Pathogenesis of these rare aneurysms is also discussed with clinical and histopathological data.

Adult↗
PubMed2006

Resolution of optic nerve edema and improved visual function after optic nerve sheath fenestration in a patient with osteopetrosis.

PURPOSE: To describe the outcome of a patient with visual loss and optic nerve edema that resulted from osteopetrosis who underwent an optic nerve sheath fenestration (ONSF). DESIGN: Interventional case report. METHODS: A 33-year-old man with osteopetrosis had bilateral visual field loss and optic nerve edema. Computed tomography and magnetic resonance imaging demonstrated open optic canals. Although a lumbar puncture showed a normal opening pressure, there were other findings that were suggestive of increased intracranial pressure. The patient elected to undergo a unilateral optic nerve sheath fenestration. RESULTS: After ONSF, the patient experienced markedly improved visual acuity, visual field, and optic nerve appearance. CONCLUSION: Individuals with visual loss and optic disk edema that is associated with osteopetrosis may benefit from ONSF if the optic canals appear to be open and the optic nerve edema is thought to be related to increased intracranial pressure.

Adult↗
PubMed2026

Physician-Modified Fenestrated Stent-Grafts Planned Using Three-Dimensional Techniques for Complex Aortic Pathology: A Systematic Review and Meta-Analysis.

BACKGROUND: Complex aortic pathology involving the visceral arteries remains a significant therapeutic challenge. Open repair is associated with considerable perioperative risk, particularly in patients with multiple comorbidities, while standard endovascular aneurysm repair (EVAR) is often not feasible because of inadequate proximal sealing zones. Fenestrated and branched endovascular repair (F/BEVAR) represents an established treatment strategy; however, the use of custom-made devices is limited by manufacturing time and availability. Physician-modified stent grafts (PMSGs) have therefore emerged as a pragmatic alternative. Three-dimensional planning techniques have been increasingly used to facilitate accurate graft modification. The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of PMSG procedures planned with three-dimensional techniques. Technical success, target vessel patency, early mortality, endoleak occurrence, and reintervention rates were analyzed. METHODS: A systematic search was conducted in the PubMed/MEDLINE and Embase databases. Studies describing the use of physician-modified fenestrated stent grafts planned with three-dimensional tools were included. Meta-analyses were performed using a random-effects model with restricted maximum likelihood estimation. A logit transformation was used for the analysis of proportions. RESULTS: The analysis included five studies involving 172 patients. The estimated weighted mean follow-up duration was 14.9 months. The overall technical success rate was 92.9% (95% confidence interval [CI]: 84.5-96.9%), with low-to-moderate heterogeneity. Target vessel patency was 96.9% (95% CI: 93.6-98.5%). Early mortality was 5.5% (95% CI: 2.1-13.3%). The incidence of endoleaks was 13.3% (95% CI: 5.8-27.4%), with significant heterogeneity among studies. Reinterventions were reported in 6.6% of patients (95% CI: 2.3-17.5%). CONCLUSION: The results indicate that PMSG procedures planned with three-dimensional techniques are associated with a high rate of technical success and preserved patency of target vessels in patients with complex aortic pathology. The observed variability in endoleak and reintervention rates likely reflects differences in anatomical complexity and patient selection among studies. Further prospective studies are needed to confirm long-term outcomes.

Humans↗
PubMed2006

Coil embolization of "kissing aneurysms" associated with distal basilar artery fenestration.

The authors present an extremely rare case of kissing aneurysms associated with fenestration of the distal basilar artery. The two aneurysms were successfully treated with endovascular coil embolization. We provide two-dimensional (2D) and three-dimensional (3D) angiographic features of the kissing aneurysms, and procedural details of coil embolization. To the best of our knowledge, this is the first demonstration of kissing aneurysms at the fenestrated distal basilar artery.

Angiography, Digital Subtraction↗
PubMed2004

A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas.

OBJECTIVE: To determine the difference between two laparoscopic methods for the management of endometriomas with regard to recurrence of signs and symptoms and pregnancy rate. DESIGN: Prospective, randomized clinical trial. SETTING: Infertility and gynecologic endoscopy units of two medical university hospitals. PATIENT(S): One hundred patients with endometriomas who had either infertility or pelvic pain. INTERVENTION(S): Patients were randomly divided into two groups; one group underwent cystectomy (group 1), and fenestration and coagulation were performed for the other (group 2). MAIN OUTCOME MEASURE(S): A comparison of recurrence of signs and symptoms of endometriomas and pregnancy rates in two groups. RESULT(S): Fifty-two patients were studied in group 1 and 48 in group 2. The recurrence of symptoms, such as pelvic pain and dysmenorrhea, was 15.8% in group 1 and 56.7% in group 2 after 2 years. The rate of reoperation was 5.8% in group 1 and 22.9% in group 2 and these differences were statistically significant. The cumulative pregnancy rate was significantly higher in group 1 (59.4%) than in group 2 (23.3%) at 1-year follow-up. CONCLUSION(S): Laparoscopic cystectomy of endometriomas is a better choice than fenestration and coagulation because the former technique leads to a lower recurrence of signs and symptoms and a lower rate of reoperation and a higher cumulative pregnancy rate than the latter.

Adult↗