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Papers by Vania Anagnostakou

Research paper thumbnail of Acute aortic syndrome: surgical, endovascular or medical treatment

British journal of hospital medicine (London, England : 2005), 2011

Research paper thumbnail of Right Ventricular Outflow Tract Obstruction Caused by Double-Chambered Right Ventricle Presenting in Adulthood

Congenital heart diseases that cause obstruction of the right ventricular outflow tract are often... more Congenital heart diseases that cause obstruction of the right ventricular outflow tract are often difficult to diagnose. We report the case of a 49-year-old man who presented with long-standing shortness of breath on exertion. Imaging revealed right ventricular outflow tract obstruction caused by a double-chambered right ventricle, and he was referred for surgical correction. This case emphasizes both the detailed perioperative evaluation that is needed when diagnosing adults who present with manifestations of congenital heart disease and a method of successful surgical correction that resulted in symptom resolution.

Research paper thumbnail of Creating arteriovenous fistula using an automatic anastomotic device

Journal of Vascular Surgery, 2011

We describe the use of the Cardica C-Port xA Distal Anastomosis System for performing an automate... more We describe the use of the Cardica C-Port xA Distal Anastomosis System for performing an automated, arteriovenous fistula in patients on hemodialysis with end stage renal failure. ( J Vasc Surg 2011;53:531-3.)

Research paper thumbnail of Transternal repair of a giant Morgagni hernia causing cardiac tamponade in a patient with coexisting severe aortic valve stenosis

Journal of Cardiothoracic Surgery, 2011

Background: Foramen of Morgagni hernias have traditionally been repaired by laparotomy, lapascopy... more Background: Foramen of Morgagni hernias have traditionally been repaired by laparotomy, lapascopy or even thoracoscopy. However, the trans-sternal approach should be used when these rare hernias coexist with other cardiac surgical diseases.

Research paper thumbnail of Frozen Elephant Trunk: A technique which can be offered in complex pathology to fix the whole aorta in one setting

Journal of Cardiothoracic Surgery, 2011

We report a case of treating complex aortic pathology with the use of the Frozen Elephant Trunk t... more We report a case of treating complex aortic pathology with the use of the Frozen Elephant Trunk technique in a patient with chronic type B aortic dissecting aneurysm associated with arch and ascending aorta dilatation, proximal aortic disease and coronary disease. The case was further complicated due to the involvement of the abdominal vessels and preexisting femoral to femoral crossover bypass. In addition the patient had a tracheostomy for laryngeal cancer. We emphasize the role of the Frozen Elephant Trunk to fix the whole aorta in one setting with special attention given to the changes taking place in vascular perfusion following correction and reconstitution of the true lumen.

Research paper thumbnail of Surgical treatment of innominate artery and aortic aneurysm: a case report and review of the literature

Journal of Cardiothoracic Surgery, 2013

Innominate artery (IA) aneurysms represent 3% of all arterial aneurysms. Due to the risk of throm... more Innominate artery (IA) aneurysms represent 3% of all arterial aneurysms. Due to the risk of thromboembolic complications and spontaneous rupture, surgical repair is usually recommended on an early elective basis. We present the case of 81-year-old Caucasian male presenting with atypical anterior chest pain secondary to a large innominate artery aneurysm who underwent successful open surgical repair at our institution. In our experience, open correction via median sternotomy with extension into the right neck provides excellent exposure and facilitates rapid reconstruction with good short and long-term outcomes. Minimally invasive and endovascular approaches provide emerging alternatives to open IA aneurysm repair, however further research is required to better define optimal patient selection criteria and determine the long-term outcomes of these novel therapies.

Research paper thumbnail of Acute heart failure caused by a giant hepatocellular metastatic tumor of the right atrium

Journal of Cardiothoracic Surgery, 2011

We present a symptomatic 40-year-old cirrhotic man who presented with sudden onsets of syncope. E... more We present a symptomatic 40-year-old cirrhotic man who presented with sudden onsets of syncope. Echocardiography revealed right ventricular outflow track obstruction caused by a huge right atrial mass. The tumor was surgically excised under cardiopulmonary bypass. Although no primary cancerous lesion in the liver was detected, histopathology revealed that the mass was a metastatic hepatocellular carcinoma. The aim of this report is to show the value of urgent preoperative computed tomography and its contribution in the operative strategy. The importance of urgent surgical treatment with tricuspid valve sparing tumor resection is emphasized even though the prognosis for such patients is dismal. We also discuss the further management options of such rare cases

Research paper thumbnail of Intimal aortic sarcoma mimicking ruptured thoracoabdominal type IV aneurysm. a rare case report and review of the literature

Journal of Cardiothoracic Surgery, 2011

Primary intimal aortic sarcoma represents a very rare and highly lethal medical entity. Diagnosis... more Primary intimal aortic sarcoma represents a very rare and highly lethal medical entity. Diagnosis is made either by embolic events caused by the tumor or by surrounding tissue symptoms such as pain. Herein we report an extremely rare case of a 51-year-old man previously operated for ascending aortic aneurysm, who presented with clinical and radiological findings suggestive of a ruptured thoracoabdominal type IV aneurysm. The patient underwent radical resection of the aorta and surrounding tissue with placement of a composite 4-branched graft. The diagnosis was made by frozen section and regular histopathologic examination of the specimen and the patient received adjuvant chemotherapy. Nine months after surgery the patient is still alive and has no signs of recurrence. We review the literature and discuss the option of postoperative chemotherapy.

Research paper thumbnail of Huge Kommerell's diverticulum associated with type-B aortic dissection

European Journal of Cardio-Thoracic Surgery, 2011

Research paper thumbnail of Right aortic arch with mirror image aplasia of brachiocephalic trunk presented as subclavian steal syndrome

European Journal of Cardio-Thoracic Surgery, 2011

A 49-year-old female presented with subclavian steal syndrome. Angiography and computed tomograph... more A 49-year-old female presented with subclavian steal syndrome. Angiography and computed tomography ) revealed a mirror image right aortic arch with aplasia of the brachiocephalic trunk. An 8-mm Dacron graft was anastomosed between the ascending aorta and common junction of the left common carotid and the subclavian artery to restore the flow . www.elsevier.com/locate/ejcts European Journal of Cardio-thoracic Surgery 40 (2011) 1029-1030 [ ( ) T D $ F I G ]

Research paper thumbnail of Cor Triatriatum presenting as heart failure with reduced ejection fraction: a case report

Journal of …, 2011

Cor triatriatum is a rare congenital cardiac malformation and it usually refers to the left atriu... more Cor triatriatum is a rare congenital cardiac malformation and it usually refers to the left atrium. We report an unusual case of cor triatriatum in a 33 -year old woman presented with congestive heart failure caused by left ventricular systolic dysfunction.

Research paper thumbnail of Emergent Endovascular Repair as Damage Control Step of Aortic Injury After Posterior Spinal Instrumentation

The Annals of Thoracic Surgery, 2010

... Address correspondence to Dr Misthos, 16-18 Markou Avgeri St, Agia Paraskevi, Athens, 15343, ... more ... Address correspondence to Dr Misthos, 16-18 Markou Avgeri St, Agia Paraskevi, Athens, 15343, Greece; e-mail: panmisthos@yahoo.gr. ... DOI: 10.1016/j.athoracsur.2009.07.087 2010;89:1304 Ann Thorac Surg Vania Anagnostakou, Konstantinos Spiliotopoulos and Achilleas ...

Research paper thumbnail of Effects of Interval Cycle Training With or Without Strength Training on Vascular Reactivity in Heart Failure Patients

Journal of Cardiac …, 2011

Background: Exercise training confers beneficial effects on vascular reactivity in patients with ... more Background: Exercise training confers beneficial effects on vascular reactivity in patients with chronic heart failure (CHF). This randomized study compares the effects of interval cycle training combined with strength training versus interval training alone on vascular reactivity in CHF patients. Methods: Twenty-eight consecutive stable CHF patients (23 males, 53 6 10 years, 28.4 6 4.1 kg/m 2 , left ventricular ejection fraction of 37 6 12%) were randomly assigned to 3 times' weekly training sessions for 3 months, consisting of a) 40 minutes of interval cycle training (n 5 14), versus b) 20 minutes of similar interval training plus 20 minutes of strength training of the quadriceps, hamstrings, muscles of the shoulder and biceps brachialis (n 5 14). The work/recovery ratio of each session was 30/60 seconds. The intensity of interval training was set at 50% of the peak workload achieved at the steep ramp test (consisted of a 25-Watt increase on a cycle ergometer every 10 seconds until exhaustion). All patients underwent maximal, symptom-limited cardiopulmonary exercise testing and ultrasound evaluation of vascular reactivity by flow-mediated vasodilation (FMD) before and after the program. Results: A significant improvement in FMD was observed in the combined training group (P 5 0.002), in contrast to the interval training alone group (P 5 NS); the improvement was significantly greater in the combined training than in the interval training alone group (P ! .05). Peak oxygen uptake increased significantly and similarly in both groups, in the interval training group (P 5 .03), and in the combined training group (P 5 .006). No significant correlation was found between FMD improvement and cardiopulmonary exercise parameters. Conclusions: A combined high-intensity, interval cycle exercise with strength training induces a greater beneficial effect on vascular reactivity rather than interval exercise training alone in CHF patients. (J Cardiac Fail 2011;17:585e591)

Research paper thumbnail of Acute aortic syndrome: surgical, endovascular or medical treatment

British journal of hospital medicine (London, England : 2005), 2011

Research paper thumbnail of Right Ventricular Outflow Tract Obstruction Caused by Double-Chambered Right Ventricle Presenting in Adulthood

Congenital heart diseases that cause obstruction of the right ventricular outflow tract are often... more Congenital heart diseases that cause obstruction of the right ventricular outflow tract are often difficult to diagnose. We report the case of a 49-year-old man who presented with long-standing shortness of breath on exertion. Imaging revealed right ventricular outflow tract obstruction caused by a double-chambered right ventricle, and he was referred for surgical correction. This case emphasizes both the detailed perioperative evaluation that is needed when diagnosing adults who present with manifestations of congenital heart disease and a method of successful surgical correction that resulted in symptom resolution.

Research paper thumbnail of Creating arteriovenous fistula using an automatic anastomotic device

Journal of Vascular Surgery, 2011

We describe the use of the Cardica C-Port xA Distal Anastomosis System for performing an automate... more We describe the use of the Cardica C-Port xA Distal Anastomosis System for performing an automated, arteriovenous fistula in patients on hemodialysis with end stage renal failure. ( J Vasc Surg 2011;53:531-3.)

Research paper thumbnail of Transternal repair of a giant Morgagni hernia causing cardiac tamponade in a patient with coexisting severe aortic valve stenosis

Journal of Cardiothoracic Surgery, 2011

Background: Foramen of Morgagni hernias have traditionally been repaired by laparotomy, lapascopy... more Background: Foramen of Morgagni hernias have traditionally been repaired by laparotomy, lapascopy or even thoracoscopy. However, the trans-sternal approach should be used when these rare hernias coexist with other cardiac surgical diseases.

Research paper thumbnail of Frozen Elephant Trunk: A technique which can be offered in complex pathology to fix the whole aorta in one setting

Journal of Cardiothoracic Surgery, 2011

We report a case of treating complex aortic pathology with the use of the Frozen Elephant Trunk t... more We report a case of treating complex aortic pathology with the use of the Frozen Elephant Trunk technique in a patient with chronic type B aortic dissecting aneurysm associated with arch and ascending aorta dilatation, proximal aortic disease and coronary disease. The case was further complicated due to the involvement of the abdominal vessels and preexisting femoral to femoral crossover bypass. In addition the patient had a tracheostomy for laryngeal cancer. We emphasize the role of the Frozen Elephant Trunk to fix the whole aorta in one setting with special attention given to the changes taking place in vascular perfusion following correction and reconstitution of the true lumen.

Research paper thumbnail of Surgical treatment of innominate artery and aortic aneurysm: a case report and review of the literature

Journal of Cardiothoracic Surgery, 2013

Innominate artery (IA) aneurysms represent 3% of all arterial aneurysms. Due to the risk of throm... more Innominate artery (IA) aneurysms represent 3% of all arterial aneurysms. Due to the risk of thromboembolic complications and spontaneous rupture, surgical repair is usually recommended on an early elective basis. We present the case of 81-year-old Caucasian male presenting with atypical anterior chest pain secondary to a large innominate artery aneurysm who underwent successful open surgical repair at our institution. In our experience, open correction via median sternotomy with extension into the right neck provides excellent exposure and facilitates rapid reconstruction with good short and long-term outcomes. Minimally invasive and endovascular approaches provide emerging alternatives to open IA aneurysm repair, however further research is required to better define optimal patient selection criteria and determine the long-term outcomes of these novel therapies.

Research paper thumbnail of Acute heart failure caused by a giant hepatocellular metastatic tumor of the right atrium

Journal of Cardiothoracic Surgery, 2011

We present a symptomatic 40-year-old cirrhotic man who presented with sudden onsets of syncope. E... more We present a symptomatic 40-year-old cirrhotic man who presented with sudden onsets of syncope. Echocardiography revealed right ventricular outflow track obstruction caused by a huge right atrial mass. The tumor was surgically excised under cardiopulmonary bypass. Although no primary cancerous lesion in the liver was detected, histopathology revealed that the mass was a metastatic hepatocellular carcinoma. The aim of this report is to show the value of urgent preoperative computed tomography and its contribution in the operative strategy. The importance of urgent surgical treatment with tricuspid valve sparing tumor resection is emphasized even though the prognosis for such patients is dismal. We also discuss the further management options of such rare cases

Research paper thumbnail of Intimal aortic sarcoma mimicking ruptured thoracoabdominal type IV aneurysm. a rare case report and review of the literature

Journal of Cardiothoracic Surgery, 2011

Primary intimal aortic sarcoma represents a very rare and highly lethal medical entity. Diagnosis... more Primary intimal aortic sarcoma represents a very rare and highly lethal medical entity. Diagnosis is made either by embolic events caused by the tumor or by surrounding tissue symptoms such as pain. Herein we report an extremely rare case of a 51-year-old man previously operated for ascending aortic aneurysm, who presented with clinical and radiological findings suggestive of a ruptured thoracoabdominal type IV aneurysm. The patient underwent radical resection of the aorta and surrounding tissue with placement of a composite 4-branched graft. The diagnosis was made by frozen section and regular histopathologic examination of the specimen and the patient received adjuvant chemotherapy. Nine months after surgery the patient is still alive and has no signs of recurrence. We review the literature and discuss the option of postoperative chemotherapy.

Research paper thumbnail of Huge Kommerell's diverticulum associated with type-B aortic dissection

European Journal of Cardio-Thoracic Surgery, 2011

Research paper thumbnail of Right aortic arch with mirror image aplasia of brachiocephalic trunk presented as subclavian steal syndrome

European Journal of Cardio-Thoracic Surgery, 2011

A 49-year-old female presented with subclavian steal syndrome. Angiography and computed tomograph... more A 49-year-old female presented with subclavian steal syndrome. Angiography and computed tomography ) revealed a mirror image right aortic arch with aplasia of the brachiocephalic trunk. An 8-mm Dacron graft was anastomosed between the ascending aorta and common junction of the left common carotid and the subclavian artery to restore the flow . www.elsevier.com/locate/ejcts European Journal of Cardio-thoracic Surgery 40 (2011) 1029-1030 [ ( ) T D $ F I G ]

Research paper thumbnail of Cor Triatriatum presenting as heart failure with reduced ejection fraction: a case report

Journal of …, 2011

Cor triatriatum is a rare congenital cardiac malformation and it usually refers to the left atriu... more Cor triatriatum is a rare congenital cardiac malformation and it usually refers to the left atrium. We report an unusual case of cor triatriatum in a 33 -year old woman presented with congestive heart failure caused by left ventricular systolic dysfunction.

Research paper thumbnail of Emergent Endovascular Repair as Damage Control Step of Aortic Injury After Posterior Spinal Instrumentation

The Annals of Thoracic Surgery, 2010

... Address correspondence to Dr Misthos, 16-18 Markou Avgeri St, Agia Paraskevi, Athens, 15343, ... more ... Address correspondence to Dr Misthos, 16-18 Markou Avgeri St, Agia Paraskevi, Athens, 15343, Greece; e-mail: panmisthos@yahoo.gr. ... DOI: 10.1016/j.athoracsur.2009.07.087 2010;89:1304 Ann Thorac Surg Vania Anagnostakou, Konstantinos Spiliotopoulos and Achilleas ...

Research paper thumbnail of Effects of Interval Cycle Training With or Without Strength Training on Vascular Reactivity in Heart Failure Patients

Journal of Cardiac …, 2011

Background: Exercise training confers beneficial effects on vascular reactivity in patients with ... more Background: Exercise training confers beneficial effects on vascular reactivity in patients with chronic heart failure (CHF). This randomized study compares the effects of interval cycle training combined with strength training versus interval training alone on vascular reactivity in CHF patients. Methods: Twenty-eight consecutive stable CHF patients (23 males, 53 6 10 years, 28.4 6 4.1 kg/m 2 , left ventricular ejection fraction of 37 6 12%) were randomly assigned to 3 times' weekly training sessions for 3 months, consisting of a) 40 minutes of interval cycle training (n 5 14), versus b) 20 minutes of similar interval training plus 20 minutes of strength training of the quadriceps, hamstrings, muscles of the shoulder and biceps brachialis (n 5 14). The work/recovery ratio of each session was 30/60 seconds. The intensity of interval training was set at 50% of the peak workload achieved at the steep ramp test (consisted of a 25-Watt increase on a cycle ergometer every 10 seconds until exhaustion). All patients underwent maximal, symptom-limited cardiopulmonary exercise testing and ultrasound evaluation of vascular reactivity by flow-mediated vasodilation (FMD) before and after the program. Results: A significant improvement in FMD was observed in the combined training group (P 5 0.002), in contrast to the interval training alone group (P 5 NS); the improvement was significantly greater in the combined training than in the interval training alone group (P ! .05). Peak oxygen uptake increased significantly and similarly in both groups, in the interval training group (P 5 .03), and in the combined training group (P 5 .006). No significant correlation was found between FMD improvement and cardiopulmonary exercise parameters. Conclusions: A combined high-intensity, interval cycle exercise with strength training induces a greater beneficial effect on vascular reactivity rather than interval exercise training alone in CHF patients. (J Cardiac Fail 2011;17:585e591)