RESUMEN
Ascending aortic aneurysm (AAoA) is a silent disease with high mortality; however, the factors associated with a worse prognosis are not completely understood. The objective of this observational, longitudinal, single-center study was to identify the hemodynamic patterns and their influence on AAoA growth using computational fluid dynamics (CFD), focusing on the effects of geometrical variations on aortic hemodynamics. Personalized anatomic models were obtained from angiotomography scans of 30 patients in two different years (with intervals of one to three years between them), of which 16 (53%) showed aneurysm growth (defined as an increase in the ascending aorta volume by 5% or more). Numerically determined velocity and pressure fields were compared with the outcome of aneurysm growth. Through a statistical analysis, hemodynamic characteristics were found to be associated with aneurysm growth: average and maximum high pressure (superior to 100 Pa); average and maximum high wall shear stress (superior to 7 Pa) combined with high pressure (>100 Pa); and stress load over time (maximum pressure multiplied by the time interval between the exams). This study provides insights into a worse prognosis of this serious disease and may collaborate for the expansion of knowledge about mechanobiology in the progression of AAoA.
RESUMEN
Fundamentos: O aneurisma de aorta ascendente é uma doença silenciosa, com alta mortalidade, cujos fatores relacionados ao seu crescimento não são totalmente conhecidos. O padrão hemodinâmico na aorta ascendente aneurismática pode estar associado a um maior risco de complicação. O objetivo deste estudo foi identificar variáveis do escoamento sanguíneo, determinadas numericamente que poderiam estar associadas ao crescimento do aneurisma de aorta ascendente. Método: Estudo observacional, longitudinal, retrospectivo e unicêntrico. Modelos anatomia-específicos foram obtidos através de imagens de duas angiotomografias de aorta realizadas com intervalo de um a três anos. A partir de estudo numérico por fluidodinâmica computacional, buscou-se padrões de escoamento presentes na primeira angiotomografia associados ao crescimento do aneurisma (definido pelo aumento do volume da aorta ascendente em 5% ou mais), através dos testes qui-quadrado e Exato de Fisher. Admitiu-se erro alfa de 5% e consideraram-se significantes valores de p ≤ 0,05. Resultados: Trinta pacientes foram incluídos no estudo, dos quais 16 (53,3%) apresentaram crescimento do aneurisma. O crescimento do aneurisma foi associado às seguintes variáveis: alta pressão relativa na parede (≥ 100 Pa); alta tensão cisalhante na parede (≥ 7 Pa) combinada com alta pressão relativa; e carga de tensão cisalhante. Conclusão: Este estudo demonstrou associação entre as variáveis de alta pressão relativa e alta tensão cisalhante, obtidas através da fluidodinâmica computacional, e o crescimento do aneurisma de aorta ascendente(AU)
Background: Ascending aortic aneurysm is a silent disease, with high mortality, whose factors related to its growth are not fully known. The hemodynamic pattern in the ascending aorta may be associated with a higher risk of complications. The aim of this study was to identify blood flow variables, numerically obtained that could be related to ascending aortic aneurysm growth. Methods: Observational, longitudinal, single-center study. Specific anatomy models were obtained through images of two angiotomographies of the aorta performed one to three years apart. Based on a numerical study by computational fluid dynamics, flow patterns present in the first angiotomography associated with aneurysm growth (defined as an increase in the volume of the ascending aorta ≥ 5%) were sought, using the chi-square test and Fisher's exact test. An alpha error of 5% was admitted and p values ≤ 0.05 were considered significant. Results: 30 patients were included in the study, of which 16 (53.3%) had aneurysm growth. Aneurysm growth was related to: high relative pressure (≥ 100 Pa); high shear stress (≥ 7 Pa) in the intersection region with the high relative pressure region; and stress load over time. Conclusion: This study demonstrated an association between the variables of high relative pressure and high shear stress, obtained through computational fluid dynamics, and ascending aortic aneurysm growth(AU)
Asunto(s)
Humanos , Aorta , Simulación por Computador , Aneurisma de la Aorta Ascendente , Hemodinámica , Estudios Longitudinales , Angiografía por Tomografía ComputarizadaRESUMEN
BACKGROUND: The surgical approach to pathologies of the Ascending Thoracic Aorta (ATA) that compromise aortic root and the aortic arch is currently one of the most complex interventions in the spectrum of cardiac surgery, where circulatory arrest with cerebral perfusion plays an important role for Success postoperative and patient survival. CASE PRESENTATION: We present the case of a 57-year-old patient with the only history of arterial hypertension and an ATA Aneurysm that compromised segment of the aortic root up to segment 2 of the aortic arch. A successful Bentall surgery was performed, debranching supra-aortic vessels with Total Circulatory Arrest with Deep Hypothermic Cerebral Perfusion-Antegrade Bilateral. CONCLUSIONS: With the advent of new anesthetic and neuroprotection techniques, perioperative imaging protocols, advanced hemodynamic monitoring, and invaluable advances in perfusion and Extracorporeal Circulation with circulatory arrest, they have made this surgical challenge a valuable tool for today's cardiovascular surgeon.
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SUMMARY OBJECTIVE: The predictive value of the fibrinogen-to-albumin ratio has been evidenced in coronary artery disease. Available data demonstrated that inflammation and oxidative stress are the relevant mechanisms of ascending aortic aneurysm formation and dilatation. The fibrinogen-to-albumin ratio reflects oxidative stress and inflammation. This study investigated the correlation between fibrinogen-to-albumin ratio and ascending aortic aneurysm. METHODS: A total of 250 consecutive patients with ascending aortic aneurysm and 250 consecutive patients with normal ascending aortic diameter were included in the study using comprehensive transthoracic echocardiography. All data and fibrinogen-to-albumin ratio were compared between two groups. RESULTS: The fibrinogen-to-albumin ratio levels were significantly higher in ascending aortic aneurysm group compared with normal ascending aortic diameter group (p<0.001). Also, there was significantly positive correlation between the diameter of the ascending aorta and the fibrinogen-to-albumin ratio (p<0.001). CONCLUSION: Fibrinogen-to-albumin ratio is associated with ascending aortic aneurysm and may serve as blood marker for identifying high-risk patients.
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Aneurisma de la Aorta/diagnóstico por imagen , Fibrinógeno , Aorta , Dilatación Patológica , AlbúminasRESUMEN
Giant ascending aortic aneurysm is a rare condition. In this paper, we present an uncommon case of giant ascending aortic aneurysm with a maximal diameter of 14 cm in a 77-year-old woman presenting with unusual symptoms. The patient underwent a successful surgery involving ascending aortic replacement, and was discharged without any complication. After discharge, she was followed regularly and no major problem was observed in her control visits. To the best of our knowledge, our case is the largest ascending aortic aneurysm reported to date in the existing literature.
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Aneurisma de la Aorta , Síndrome de la Vena Cava Superior , Anciano , Aorta/diagnóstico por imagen , Aorta/cirugía , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular , Puente Cardiopulmonar , Femenino , Humanos , Síndrome de la Vena Cava Superior/etiología , Tomografía Computarizada por Rayos XRESUMEN
Abstract Giant ascending aortic aneurysm is a rare condition. In this paper, we present an uncommon case of giant ascending aortic aneurysm with a maximal diameter of 14 cm in a 77-year-old woman presenting with unusual symptoms. The patient underwent a successful surgery involving ascending aortic replacement, and was discharged without any complication. After discharge, she was followed regularly and no major problem was observed in her control visits. To the best of our knowledge, our case is the largest ascending aortic aneurysm reported to date in the existing literature.
Asunto(s)
Humanos , Femenino , Anciano , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico por imagen , Síndrome de la Vena Cava Superior/etiología , Aorta/cirugía , Aorta/diagnóstico por imagen , Puente Cardiopulmonar , Tomografía Computarizada por Rayos X , Implantación de Prótesis VascularRESUMEN
OBJECTIVE: Ascending thoracic aortic aneurysm (ATAA) in patients with bicuspid aortic valve (BAV) commonly dilate asymmetrically compared with patients with tricuspid aortic valve (TAV). This discrepancy in aneurysm geometry led us to hypothesize that microarchitectural differences underlie the observed asymmetric dilatation pattern. The purpose of this study was to characterize the microarchitectural distinctions of the extracellular matrix of the 2 phenotypes with a focus on the proportion of radially oriented elastin and collagen fibers in different circumferential aortic regions. METHODS: Aortic tissue rings were obtained just distal to the sinotubular junction from patients with BAV or TAV undergoing elective aneurysm repair. They were sectioned into three circumferentially based regions according to adjacent aortic sinus segment (left coronary sinus [L], right coronary sinus [R], or noncoronary sinus [N]). Multiphoton microscopy was used to quantify and characterize the number of radially oriented elastin and collagen fibers. RESULTS: There were fewer radially oriented fibers in medial region N and medial-intimal region R of BAV-ATAAs when compared with TAV-ATAAs (medial region N, amplitude of angular undulation of elastin = 10.67° ± 1.35° vs 15.58° ± 1.91°; P = .041; medial-intimal region R, amplitude of angular undulation of elastin = 9.83° ± 0.83° vs 14.72° ± 1.64°; P = .015). Conversely, fibers became more radially oriented in the medial-intimal region L of BAV-ATAA when compared with TAV-ATAA (amplitude of angular undulation of collagen = 18.67° ± 0.95° vs 14.56° ± 1.37°; P = .041). CONCLUSIONS: The differential pattern of fiber orientation noted between L and N-R regions help explain the unique pattern of greater curvature dilatation of BAV-ATAA. The distinctions noted in matrix microarchitecture may form the basis of differing aneurysm geometries and aortic wall integrities in ATAAs arising in these different valve morphologies.
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Aorta Torácica/patología , Aneurisma de la Aorta Torácica/etiología , Válvula Aórtica/anomalías , Matriz Extracelular/ultraestructura , Enfermedades de las Válvulas Cardíacas/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Aorta Torácica/fisiopatología , Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/fisiopatología , Enfermedad de la Válvula Aórtica Bicúspide , Elasticidad , Femenino , Enfermedades de las Válvulas Cardíacas/diagnóstico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Introducción: La enfermedad aneurismática de la aorta ascendente (EAAA) se caracteriza por su baja frecuencia, comportamiento heterogéneo, riesgo de rotura y disección, que conllevan elevada mortalidad, por lo que la cirugía electiva es fundamental. Se han desarrollado diversos procedimientos quirúrgicos, considerándose la técnica de Bentall el estándar de referencia. Se describe la mortalidad hospitalaria de la EAAA tratada quirúrgicamente mediante el procedimiento de Bentall. Material y métodos: Estudio descriptivo en el que se incluyeron 23 pacientes con EAAA operados entre el 1 de marzo de 2005 y el 30 de septiembre de 2008; la información fue obtenida de los expedientes clínicos. Resultados: Los 23 pacientes correspondieron a 1.2 % de las cirugías efectuadas. Edad media de 46 años (rango 16 a 74), sexo masculino 83 %. Etiología: degeneración inespecífica de la capa media con implicación valvular 43 %, aorta bivalva 22 %, síndrome de Marfán, de Turner y aneurismas posestenóticos, 9 % cada uno. Enfermedad de Takayasu y espondilitis anquilosante, 4 % cada uno. Enfermedad cardiaca asociada en seis (26 %): coartación aórtica (2), cardiopatía isquémica (1), comunicación interauricular (1), insuficiencia mitral severa (1) y rodete subaórtico (1). Procedimientos realizados: cirugía de Bentall 20 (87 %), aortoplastia con prótesis valvular tres (13 %). Complicaciones: sangrado anormal con reintervención 17 %, neumonía nosocomial 13 %, arritmias 13 %, choque séptico 9 %. Mortalidad tres (13 %): choque séptico y fibrilación ventricular. Conclusiones: La mortalidad hospitalaria para la cirugía de Bentall fue semejante a la registrada en otros centros especializados. Los eventos relacionados con la patología aórtica, técnica quirúrgica, prótesis valvular aórtica y la disfunción ventricular izquierda, obligan a realizar estudios de seguimiento a largo plazo.
BACKGROUND: Ascending aortic aneurysm disease (AAAD) shows a low frequency, heterogeneous behavior, high risk of rupture, dissection and mortality, making elective surgery necessary. Several procedures have been developed, and the Bentall technique is considered as the reference standard. The objective was to describe the hospital mortality of AAAD surgically treated using the Bentall procedure. METHODS: We carried out a descriptive study. Included were 23 patients with AAAD who were operated on between March 1, 2005 and September 30, 2008 at our hospital. Data were obtained from clinical files, and descriptive statistics were selected for analysis. RESULTS: The study population was comprised of 23 patients with an average age of 46 years; 83% were males. Etiology was nonspecific degeneration of the middle layer with valve implication in 43%, bivalve aorta in 22%, Marfan syndrome, Turner's syndrome and poststenotic aneurysms each represented 9%, and Takayasu disease and ankylosing spondylitis 4% each. Associated heart disease was reported in six (26%) patients as follows: aortic coarctation (2), ischemic cardiopathy (1), atrial septal defect (1), severe mitral insufficiency (1) and subaortic membrane (1). Procedures carried out were Bentall surgery in 20 (87%) patients and aortoplasty with valve prosthesis in three (13%) patients. Complications reported were abnormal bleeding with mediastinal exploration (17%), nosocomial pneumonia (13%), arrhythmia (13%), and septic shock (9%). Mortality was reported in three (13%) patients due to septic shock and ventricular fibrillation. CONCLUSIONS: Surgical mortality with the Bentall procedure is similar to published results by other specialized centers. Events related to the basic aortic pathology, surgical technique, aortic valve prosthesis and left ventricular dysfunction encourage longterm studies with follow-up.