Management of floating thrombus in the aortic arch

OBJECTIVE Floating aortic thrombus is an underrecognized source of systemic emboli and carries a life-threatening risk of stroke when located in the aortic arch. Optimal treatment is not established in available guidelines. We report our experience in managing floating thrombi in the aortic arch. METHODS Consecutive patients diagnosed with a floating aortic arch thrombus at a tertiary referral center between January 2008 and December 2014 were reviewed. Perioperative and midterm outcomes were assessed. RESULTS Ten patients (8 female) with a median age of 56 years (range, 47-82 years) were identified. Eight patients presented with a symptomatic embolic event, and 2 patients were asymptomatic. One patient presenting with stroke due to embolic occlusion of all supra-aortic vessels died 2 days after admission. Three patients (2 asymptomatic and 1 unfit for surgery) were treated conservatively by anticoagulation, leading to thrombus resolution in 2 patients. In the third patient, the thrombus persisted despite anticoagulation, resulting in recurrent embolic events. The remaining 6 patients underwent open thrombectomy of the aortic arch during deep hypothermic circulatory arrest. All patients treated by surgery had an uneventful postoperative course with no recurrent thrombus or embolic event during follow-up. Median follow-up of all patients was 17 months (range, 11-89 months). CONCLUSIONS Floating aortic arch thrombus is a dangerous source of systemic emboli. Surgical removal of the thrombus is easy to perform and followed by good clinical results. Conservative treatment with anticoagulation may be considered in asymptomatic, inoperable or high-risk patients.

The story of Cedar Hollow, 1750-1900.

Mode of access: Internet.

Tower of Babel, center: men laying bricks on an arch

Pieter Bruegel the Elder; oil on panel

The old Dutch burying ground of Sleepy Hollow in North Tarrytown, New York; a record of the early gravestones and their inscriptions.

"In 1926 the History Research Society of the Tappan Zee had published ... 'The old Dutch burying ground of Sleepy Hollow' ... a partial record."

The land of Sleepy Hollow, and the home of Washington Irving; a series of photogravure representations, with descriptive letter-press by J. L. Williams; together with Irvings̓ "Legend of Sleepy Hollow", with illustrations by F. O. C. Darley and selections from "The chronicle of Wolferts̓ roost.

"The photogravure illustrations in this volume are reproduced by the Photogravure company of New York, from negatives taken directly from nature by Dr. J. L. Williams."

Purification of americium chloride solutions by mercury cathode electrolysis /

A process has been developed for the removal of chromium, copper, iron, manganese, nickel, lead, tin, and zinc impurities from an acid aqueous solution of americium chloride using a mercury cathode cell operating at 5-10 amperes and 16-18 volts. The americium is not affected. The process may also be used to remove other impurity elements.

The witch of Bramble Hollow; a drama in four acts ...

Mode of access: Internet.

In a hollow of the hills /

Mode of access: Internet.

An address, delivered at the consecration and installation of Mount Zion Royal Arch Chapter, in Stoughton, Mass. August 22, A.L.5821. ...

Last page lists "Officers of Mount Zion Royal Arch Chapter. Installed August 22d, AN. R. AR. M. 2356."

In a hollow of the hills, and other tales,

Mode of access: Internet.

Chronicles of Tarrytown and Sleepy Hollow.

Mode of access: Internet.

The boy scout treasure hunters; or, The lost treasure of Buffalo Hollow,

Mode of access: Internet.

History and by-laws of Richmond Royal Arch Chapter No. 3, A.F. & A.M., Richmond, Virginia, with a list of officers and members;

On cover: 1792-1911.