Citations

BACKGROUND AND OBJECTIVES: The artery of Davidoff and Schechter (ADS) is a dural branch of the posterior cerebral artery, supplying the falcotentorial junction. It is not commonly depicted on angiography due to its small size; thus, its visibility is usually indicative of a pathology, such as a dural arteriovenous fistula (DAVF). Recognizing the ADS as a feeder could be vital in enhancing management success, and understanding its anatomy is important for preventing complications during embolization or microsurgery. We present a scoping review of DAVFs fed by the ADS followed by an illustrative case report encountered at our institution. METHODS: An extensive literature review was conducted using PubMed, Embase, Web of Science, Scopus, and Cochrane databases. The search included the keywords: “Davidoff,” “Schechter,” “Davidoff and Schechter,” “dural branch,” “tentorial branch,” “medial branch,” and “meningeal branch,” in combination with “arteriovenous fistula,” “posterior cerebral artery,” and “superior cerebellar artery.” Only articles published in English or Spanish were included, with no restriction on publication date. Case reports and series were further screened based on best relevance. Data extraction and synthesis were performed in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. RESULTS: A total of 16 articles describing 32 cases of DAVFs supplied by the ADS were identified. The most common onset was headache (43.8%), followed by altered mental status (21.2%). Most DAVFs were classified as high grade based on Borden/Cognard scales. Transarterial embolization was the most used treatment (81.3%), achieving complete occlusion in 76.9% of cases. Among patients with complete occlusion, approximately half experienced full resolution of symptoms. In a mean follow-up of 27.4 months (IQR: 30), 2 cases reported complications due to reflux of the embolic agent. CONCLUSION: A comprehensive understanding of the ADS's angioarchitecture is essential to take full advantage of this artery's features in the treatment, mitigating potential complications and optimizing patient outcomes.

Mitral regurgitation (MR) in lung transplant (LTx) recipients is a rare but complex cardiopulmonary phenomenon. The overlap between symptoms of MR and post-LTx complications, such as primary graft dysfunction, complicates its diagnosis and management. This systematic review aims to characterize the incidence, pathophysiology, presentation, and management of MR in LTx patients. We conducted a literature search in PubMed, Web of Science, Scopus, and Embase. The search yielded 133 studies, of which 11 were included. Data regarding MR development, clinical presentation, echocardiographic findings, and management strategies were extracted and analyzed. Perioperative MR, occurring during or immediately post-LTx, was frequently attributed to the systolic anterior motion of the mitral valve (MV) occurring in the setting of hypovolemia and/or inotrope usage. Later postoperative MR, on the other hand, was associated with reverse ventricular remodeling and mitral annular dilation, although some variability in the literature was present. Preexisting MR or ventricular dysfunction, elongated MV leaflets, and bilateral LTx procedure appeared to be risk factors for MR development. Management was dependent on the timing of MR and its pathophysiology, where systolic anterior motion–related MR was treated with medical therapy, whereas postoperative MR often required MV interventions. In conclusion, the diagnosis of MR in LTx patients is complicated by its symptomatic overlap with other post-LTx complications. Echocardiographic monitoring in patients with preexisting MR, regardless of severity, is essential for early identification and management. Further research is needed to better understand the underlying mechanisms and refine management strategies for MR in this population.