RESUMEN
OBJECTIVE: Aortic Dissection (AD) is one of the most fatal acute diseases in cardiovascular diseases, with rapid onset and progression and a high fatality rate. This study aims to investigate the clinical values of non-enhancement peripheral pulse-gating rapid magnetic resonance imaging in deterministic diagnosis of AD. METHODS: Aorta magnetic resonance imaging was performed in 21 healthy volunteers at a 1.5t MR scanner sequences including cardiac-gated and peripheral pulse-gated True-FISP and HASTE were carried out separately. Acquisition Time (TA), Signal to Noise Ratio (SNR), Contrast Noise Ratio (CNR), and entirety of vessel wall blood flow artifacts were measured and compared. A total of 56 AD cases were displayed by non-enhancement peripheral pulse-gating fast MR imaging, and the results were compared with pathological findings or CTA of the aorta. The dissection rupture, tear film, true and false lumen, thrombosis, hydropericardium, and the main branches of AD were evaluated respectively. RESULTS: There were no significant differences in SNR, CNR, entirety of the vessel wall, and blood flow artifact between cardiac-gated and peripheral pulse-gated fast MR imaging. Non-enhancement pulse-gated fast scanning takes less TA time. By the pulse-gated non-enhancement fast MR imaging, the dissection rupture, tear film, true and false cavity, thrombosis, hydropericardium, and the main branches of aortic dissection were shown clearly. Multi-planar and multi-angle scans helped to show the extent of entrapment rupture, whereas partial complex tears or bi-directional tears were slightly less well visualized. CONCLUSION: Non-enhancement peripheral pulse-gated rapid magnetic resonance imaging can be used for deterministic diagnosis of AD.
Asunto(s)
Disección Aórtica , Imagen por Resonancia Magnética , Humanos , Disección Aórtica/diagnóstico por imagen , Masculino , Femenino , Adulto , Persona de Mediana Edad , Imagen por Resonancia Magnética/métodos , Relación Señal-Ruido , Aneurisma de la Aorta/diagnóstico por imagen , Anciano , Reproducibilidad de los Resultados , Adulto Joven , Técnicas de Imagen Sincronizada Cardíacas/métodos , Valores de ReferenciaRESUMEN
AIMS: Patients with aortic dissection have a high prevalence of left ventricular structural alterations, including left ventricular hypertrophy (LVH), but little is known about the impact of sex on this regard. This study compared clinical, cardiac, and prognostic characteristics between men and women with aortic dissection. METHODS: We retrospectively assessed clinical and echocardiographic characteristics, and 1-year mortality in 367 aortic dissection patients (30% women; 66% with Stanford-A) who underwent echocardiography 60âdays before or after the diagnosis of aortic dissection from three Brazilian centers. RESULTS: Men and women had similar clinical characteristics, except for higher age (59.4â±â13.4 vs. 55.9â±â11.6âyears; P â=â0.013) and use of antihypertensive classes (1.4â±â1.3 vs. 1.1â±â1.2; P â=â0.024) and diuretics (32 vs. 19%; P â=â0.004) in women compared with men. Women had a higher prevalence of LVH (78 vs. 65%; P â=â0.010) and lower prevalence of normal left ventricular geometry (20 vs. 10%; P â=â0.015) than men. Logistic regression analysis adjusted for confounding factors showed that women were less likely to have normal left ventricular geometry (odds ratio, 95% confidence intervalâ=â0.42, 0.20-0.87; P â=â0.019) and were more likely to have LVH (odds ratio, 95% confidence intervalâ=â1.91, 1.11-3.27; P â=â0.019). Conversely, multivariable Cox-regression analysis showed that women had a similar risk of death compared to men 1 year after aortic dissection diagnosis (hazard ratio, 95% confidence intervalâ=â1.16, 0.77-1.75; P â=â0.49). CONCLUSION: In aortic dissection patients, women were typically older, had higher use of antihypertensive medications, and exhibited a greater prevalence of LVH compared with men. However, 1-year mortality after aortic dissection diagnosis did not differ between men and women.
Asunto(s)
Disección Aórtica , Hipertrofia Ventricular Izquierda , Remodelación Ventricular , Humanos , Masculino , Femenino , Disección Aórtica/epidemiología , Disección Aórtica/fisiopatología , Disección Aórtica/mortalidad , Persona de Mediana Edad , Estudios Retrospectivos , Factores Sexuales , Anciano , Hipertrofia Ventricular Izquierda/fisiopatología , Hipertrofia Ventricular Izquierda/epidemiología , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Brasil/epidemiología , Prevalencia , Adulto , Factores de Riesgo , Ecocardiografía , Aneurisma de la Aorta/epidemiología , Aneurisma de la Aorta/mortalidad , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/fisiopatología , Pronóstico , Factores de TiempoRESUMEN
We present a case of a ruptured right sinus of Valsalva aneurysm to the right atrium that developed global heart failure over the course of three months, and which was completely resolved through cardiac catheterism, placing an occlusive device at the site of the fistula. Its ethology is discussed, as well as the guidelines for clinical diagnosis and treatment.
Se presenta un caso de aneurisma del seno de Valsalva derecho roto a la aurícula derecha, que en el transcurso de tres meses desarrolló insuficiencia cardiaca global y fue resuelto del todo por medio de intervencionismo, colocando un dispositivo oclusor en el sitio de la fístula. Se discute su etología, así como las pautas para el diagnóstico clínico y el tratamiento.
Asunto(s)
Aneurisma de la Aorta , Rotura de la Aorta , Fístula , Seno Aórtico , Humanos , Rotura de la Aorta/cirugía , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/cirugía , Atrios CardíacosRESUMEN
Quadricuspid aortic valve (QAV) and sinus of Valsalva aneurysm (SVA) are rare congenital anomalies. We report an elderly patient with QAV associated with a ruptured SVA to the right atrium. Transthoracic echocardiographic and computed tomographic images are presented. We emphasize the important role of computed tomography angiography in establishing and confirming the diagnosis and facilitating treatment planning. The patient was successfully operated by a minimally invasive approach.
Asunto(s)
Aneurisma de la Aorta , Válvula Aórtica Cuadricúspide , Seno Aórtico , Humanos , Anciano , Seno Aórtico/diagnóstico por imagen , Seno Aórtico/cirugía , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Válvula Aórtica/anomalías , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/cirugía , EcocardiografíaRESUMEN
INTRODUCTION: Acute type A aortic dissection (AAAD) in late pregnancy is a rare but severe disease. Lack of clinical experience is the main cause of high mortality. This study tries to investigate the multidisciplinary therapeutic strategy for these patients. CASE PRESENTATION: We reported three patients with AAAD in late pregnancy. Sudden chest pain was the main clinical symptom before operation. All three patients and their newborns survived through multidisciplinary approach in diagnosis and treatment. No serious complications occurred during the mid-term follow-up. CONCLUSION: Multidisciplinary diagnosis and treatment strategy play a crucial role in saving the lives of pregnant women with AAAD.
Asunto(s)
Aneurisma de la Aorta , Disección Aórtica , Embarazo , Humanos , Recién Nacido , Femenino , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/cirugía , Resultado del Tratamiento , Disección Aórtica/complicaciones , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/cirugía , Complicaciones Posoperatorias/etiologíaRESUMEN
La sífilis es causada por Treponema pallidum, es reconocida por la variedad de sus manifestaciones clínicas; compromete el sistema nervioso, tegumentario y cardiovascular. Las alteraciones cardiovasculares ocurren en 70% de los casos con sífilis no tratada, el 71% de las aortitis sifilíticas desarrollan aneurismas aórticos y la complicación más frecuente es la insuficiencia aórtica. El tratamiento va dirigido a la enfermedad subyacente, con manejo antibiótico para la sífilis terciaria y las complicaciones tromboembólicas y si requiere reparación quirúrgica. Presentamos un caso poco frecuente de un paciente diagnosticado de infección por el virus de la inmunodeficiencia humana y complicaciones cardiovasculares típicas de la sífilis terciaria, que precisó tratamiento médico y quirúrgico, que fue exitoso. Destacamos la pericia clínica de los profesionales de nuestra institución para diagnosticar e identificar las complicaciones cardiovasculares de la sífilis terciaria.
Syphilis is caused by Treponema pallidum and is recognized by the variety of its clinical manifestations; it involves the nervous, integumentary and cardiovascular systems. Cardiovascular alterations occur in 70% of cases with untreated syphilis, 71% of syphilitic aortitis develop aortic aneurysms and the most frequent complication is aortic insufficiency. Treatment is directed at the underlying disease, with antibiotic treatment for tertiary syphilis and thromboembolic complications and if necessary surgical repair. We present a rare case of a patient diagnosed with human immunodeficiency virus infection and cardiovascular complications typical of tertiary syphilis, who required medical and surgical treatment, which was successful. We highlight the clinical experience of our institution's professionals in the diagnosis and identification of cardiovascular complications of tertiary syphilis.
A sífilis é causada pelo Treponema pallidum e é reconhecida pela variedade de suas manifestações clínicas; ela afeta os sistemas nervoso, tegumentar e cardiovascular. As alterações cardiovasculares ocorrem em 70% dos casos de sífilis não tratada, 71% dos casos de aortite sifilítica desenvolvem aneurismas aórticos e a complicação mais frequente é a insuficiência aórtica. O tratamento é direcionado para a doença subjacente, com tratamento antibiótico para sífilis terciária e complicações tromboembólicas e, se necessário, reparo cirúrgico. Apresentamos um caso raro de um paciente diagnosticado com infecção pelo vírus da imunodeficiência humana e complicações cardiovasculares típicas da sífilis terciária, que precisou de tratamento médico e cirúrgico, que foi bem-sucedido. Apresentamos um caso raro de um paciente com diagnóstico de infecção pelo vírus da imunodeficiência humana e complicações cardiovasculares típicas da sífilis terciária, que necessitou de tratamento médico e cirúrgico, o qual foi bem-sucedido. Destacamos a experiência clínica dos profissionais de nossa instituição no diagnóstico e na identificação das complicações cardiovasculares da sífilis terciária.
Asunto(s)
Humanos , Masculino , Adulto , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Aneurisma de la Aorta/etiología , Insuficiencia de la Válvula Aórtica/etiología , Penicilina G Benzatina/uso terapéutico , Sífilis Cardiovascular/complicaciones , Sífilis Cardiovascular/diagnóstico , Sífilis Cardiovascular/tratamiento farmacológicoRESUMEN
Marfan syndrome is an autosomal dominant hereditary disease that compromises various systems that usually require a multidisciplinary approach. The cause of Marfan syndrome is unknown, but recent genetic studies have related this disease to an extracellular microfibrillar defect located on chromosome 15q15-q21.3. Due to the severity of the signs and symptoms the diagnosis is usually at a very young age. We report a patient with extreme Marfan syndrome with all the particulars that this syndrome offers.
El síndrome de Marfan es una enfermedad hereditaria autosómica dominante que compromete diversos sistemas que habitualmente requieren un enfoque multidisciplinario. La causa del síndrome de Marfan es desconocida, pero recientes estudios genéticos han relacionado esta enfermedad a un defecto microfibrilar extracelular localizado en el cromosoma 15q15-q21,3. Debido a la severidad de los signos y síntomas el diagnóstico suele ser a edad muy temprana. Reportamos un paciente con síndrome de Marfan extremo con todas las particulares que éste síndrome ofrece.
Asunto(s)
Aneurisma de la Aorta , Insuficiencia de la Válvula Aórtica , Síndrome de Marfan , Humanos , Síndrome de Marfan/complicaciones , Síndrome de Marfan/diagnóstico , Síndrome de Marfan/genética , Insuficiencia de la Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/complicaciones , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico por imagen , AortaRESUMEN
Resumen: Los aneurismas de seno de Valsalva son una malformación rara de observar en la práctica clínica. Se presentan a cualquier edad y pueden ser de origen congénito o adquirido. La importancia de su estudio radica en que potencialmente pueden complicarse con rotura y fistulización a otra estructura cardíaca o extracardíaca, con una alta mortalidad asociada. El diagnóstico muchas veces puede ser complejo, pero existen algunos elementos clínicos inespecíficos que pueden orientarnos en su detección y rápido manejo, lo que puede marcar una diferencia en el pronóstico del paciente. Se presenta el caso de un paciente de 49 años con un aneurisma de seno de Valsalva complicado y a continuación una breve revisión del tema.
Abstract: Aneurysms of the sinus of Valsalva are. They occur at any age, either as a congenital or an acquired malformation. They may rupture and form a fístula to other cardiac structures, with a high mortality rate. The clinical case of a 49 year-old patient with a ruptured sinus of Valsalva an a fístula to the right atrium is presented. A brief review of the subject is included.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico por imagen , Rotura de la Aorta/complicaciones , Rotura de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/cirugía , Rotura de la Aorta/cirugía , Seno Aórtico/cirugía , Seno Aórtico/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Ecocardiografía TransesofágicaRESUMEN
Sinus of Valsalva aneurysm is a very uncommon clinical finding and often requires emergency surgery due to its high risk of rupture. This educational text reports the case of a 91-year-old Italian women who was incidentally discovered to have a huge double aneurysm of the sinuses of Valsalva.
Asunto(s)
Aneurisma de la Aorta , Seno Aórtico , Anciano de 80 o más Años , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/cirugía , Femenino , Humanos , Hallazgos Incidentales , Seno Aórtico/diagnóstico por imagen , Seno Aórtico/cirugíaRESUMEN
BACKGROUND: A methodology to identify patients with ascending aortic aneurysm (AsAA) under high risk for aortic growth is not completely defined. OBJETIVE: This research seeks to numerically characterize the aortic blood flow by relating the resulting mechanical stress distribution with AsAA growth. METHODS: Analytical, observational, single-center study in which a computational fluid dynamics (CFD) protocol was applied to aortic computed tomography angiogram (CTA) images of patients with AsAA. Two CTA exams taken at a minimum interval of one year were obtained. From the CTA-gathered images, three-dimensional models were built, and clinical data were registered. Study of velocity field and coherent structures (vortices) was performed aiming to relate them to the presence or absence of aneurysm growth, as well as comparing them to the patients' clinical data. The Kolmogorov-Smirnov test was used to evaluate the normality of the distribution, and the non-parametric Wilcoxon signed-rank test, for non-normal distribution, was used to compare the paired data of the aortic angles. Statistical significance was set at 5%. RESULTS: The incident jet in the aortic wall generated recirculation areas in the posterior region of the jet, inducing complex vortices formation in the group with aneurysm growth, leading to an average pressure increase in the ascending aortic wall between exams. In the group without aneurysm growth, the average pressure decreased. CONCLUSION: This pilot study showed that CFD based on CTA may in the near future be a tool to help identify flow patterns associated with AsAA remodeling process.
FUNDAMENTOS: Uma metodologia para identificação de pacientes portadores de aneurisma de aorta ascendente (AAAs) sob alto risco de remodelamento aórtico não está completamente definida. OBJETIVO: Esta pesquisa objetiva caracterizar numericamente o fluxo sanguíneo aórtico, relacionando a distribuição do estresse mecânico resultante com o crescimento de AAAs. MÉTODOS: Estudo analítico, observacional, unicêntrico, em que um protocolo de fluidodinâmica computacional (CFD - Computacional Fluid Dynamics) foi aplicado a imagens de angiotomografia computadorizada (ATC) de aorta de pacientes portadores de AAAs. Duas ATC de aorta com pelo menos um ano de intervalo foram obtidas. Dados clínicos dos pacientes foram registrados e, a partir das imagens de ATC, foram gerados modelos tridimensionais. Foram realizados estudos do campo de velocidade e estruturas coerentes (vórtices) com o objetivo de relacioná-los ao crescimento ou não do aneurisma e, posteriormente, compará-los com os dados clínicos dos pacientes. O teste de Kolmogorov-Smirnov foi utilizado para avaliar a normalidade da amostra e o teste não-paramétrico Wilcoxon signed-rank foi aplicado para comparações de dados pareados entre os ângulos aórticos. A significância estatística foi fixada em 5%. RESULTADOS: Para o grupo que apresentou crescimento do aneurisma, a incidência do jato na parede aórtica gerou áreas de recirculação posterior ao jato, induzindo à formação de vórtices complexos, ocasionando um incremento na pressão média no endotélio aórtico. O grupo sem crescimento do aneurisma apresentou diminuição na pressão média. CONCLUSÃO: Este estudo piloto mostrou que a CFD baseada em ATC pode, em um futuro próximo, ser uma ferramenta auxiliar na identificação dos padrões de fluxo associados ao processo de remodelamento de AAAs.
Asunto(s)
Aneurisma de la Aorta , Hidrodinámica , Aorta/diagnóstico por imagen , Aneurisma de la Aorta/diagnóstico por imagen , Hemodinámica/fisiología , Humanos , Proyectos PilotoRESUMEN
Sinus of Valsalva aneurysm is a rare cardiac abnormality which can be acquired or of congenital origin. A spontaneous rupture into the right atrium is possible and, if not adequately treated, may result in a progressive heart failure due to the left-to-right intracardiac shunt. If ruptured sinus of Valsalva aneurysm is diagnosed, surgical repair is indicated, and different surgical techniques have been reported. If concomitant aortic regurgitation is present, aortic valve replacement is usually performed. Herein, we describe an uncommon clinical presentation of a ruptured sinus of Valsalva aneurysm which has been corrected by aortic valve reimplantation.
Asunto(s)
Aneurisma de la Aorta , Rotura de la Aorta , Seno Aórtico , Humanos , Seno Aórtico/diagnóstico por imagen , Seno Aórtico/cirugía , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Válvula Aórtica/anomalías , Rotura de la Aorta/diagnóstico por imagen , Rotura de la Aorta/cirugía , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/cirugía , ReimplantaciónRESUMEN
Kawasaki disease (KD) is an inflammatory condition that may affect genetically predisposed individuals in pediatric ages after infectious/environmental triggering. An infrequent finding associated with KD is ascending aortic aneurysm during or after the acute phase of the disease. In this Multimedia presentation, we describe a three-year-old girl submitted to surgical treatment.
Asunto(s)
Aneurisma de la Aorta , Aneurisma Coronario , Síndrome Mucocutáneo Linfonodular , Femenino , Humanos , Niño , Preescolar , Síndrome Mucocutáneo Linfonodular/complicaciones , Síndrome Mucocutáneo Linfonodular/cirugía , Dilatación , Aneurisma Coronario/diagnóstico por imagen , Aneurisma Coronario/etiología , Aneurisma Coronario/cirugía , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/etiología , Aneurisma de la Aorta/cirugíaRESUMEN
OBJECTIVE: The durability of root repair for acute type A aortic dissection is not well studied in the context of aortic insufficiency and stability of the sinuses of Valsalva. We compared clinical and functional outcomes in patients undergoing root repair and replacement for acute type A aortic dissection. METHODS: Of 716 patients undergoing surgery for acute type A aortic dissection, 585 (81.7%) underwent root repair and 131 (18.3%) underwent root replacement. Survival, cumulative incidence of reoperation, aortic insufficiency, and sinuses of Valsalva dilation were compared between the 2 groups. RESULTS: Survival at 1, 5, and 10 years was 84.1% versus 77.3%, 70.8% versus 69.2%, 57.6% versus 58.0% in the root repair and replacement groups, respectively (P = .69). Cumulative incidence of reoperation at 1, 5, and 10 years was 0.0% versus 0.8%, 1.4% versus 3.8%, and 3.4% versus 8.6% in the root repair and root replacement groups, respectively (P = .011). Multivariable Cox regression identified sinuses of Valsalva diameter 45 mm or more as a risk factor for proximal aortic reoperation (hazard ratio, 9.06; 95% confidence interval, 1.26-65.24). In a repeated-measures, linear, mixed-effects model, root replacement was associated with smaller follow-up of sinuses of Valsalva dimensions (ß = -0.66, P < .001). In an ordinal longitudinal mixed model, root replacement was associated with lower severity of postoperative aortic insufficiency (ß = -3.10, P < .001). CONCLUSIONS: Survival is similar, but the incidence of aortic insufficiency and root dilation may be greater after root repair compared with root replacement for acute type A aortic dissection.
Asunto(s)
Aneurisma de la Aorta/cirugía , Disección Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Implantación de Prótesis Vascular , Procedimientos Quirúrgicos Cardíacos , Seno Aórtico/cirugía , Enfermedad Aguda , Adulto , Anciano , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/mortalidad , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/mortalidad , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/fisiopatología , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Recurrencia , Reoperación , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Seno Aórtico/diagnóstico por imagen , Seno Aórtico/fisiopatología , Factores de Tiempo , Resultado del TratamientoRESUMEN
Resumo Fundamentos Uma metodologia para identificação de pacientes portadores de aneurisma de aorta ascendente (AAAs) sob alto risco de remodelamento aórtico não está completamente definida. Objetivo Esta pesquisa objetiva caracterizar numericamente o fluxo sanguíneo aórtico, relacionando a distribuição do estresse mecânico resultante com o crescimento de AAAs. Métodos Estudo analítico, observacional, unicêntrico, em que um protocolo de fluidodinâmica computacional (CFD - Computacional Fluid Dynamics) foi aplicado a imagens de angiotomografia computadorizada (ATC) de aorta de pacientes portadores de AAAs. Duas ATC de aorta com pelo menos um ano de intervalo foram obtidas. Dados clínicos dos pacientes foram registrados e, a partir das imagens de ATC, foram gerados modelos tridimensionais. Foram realizados estudos do campo de velocidade e estruturas coerentes (vórtices) com o objetivo de relacioná-los ao crescimento ou não do aneurisma e, posteriormente, compará-los com os dados clínicos dos pacientes. O teste de Kolmogorov-Smirnov foi utilizado para avaliar a normalidade da amostra e o teste não-paramétrico Wilcoxon signed-rank foi aplicado para comparações de dados pareados entre os ângulos aórticos. A significância estatística foi fixada em 5%. Resultados Para o grupo que apresentou crescimento do aneurisma, a incidência do jato na parede aórtica gerou áreas de recirculação posterior ao jato, induzindo à formação de vórtices complexos, ocasionando um incremento na pressão média no endotélio aórtico. O grupo sem crescimento do aneurisma apresentou diminuição na pressão média. Conclusão Este estudo piloto mostrou que a CFD baseada em ATC pode, em um futuro próximo, ser uma ferramenta auxiliar na identificação dos padrões de fluxo associados ao processo de remodelamento de AAAs.
Abstract Background A methodology to identify patients with ascending aortic aneurysm (AsAA) under high risk for aortic growth is not completely defined Objetive This research seeks to numerically characterize the aortic blood flow by relating the resulting mechanical stress distribution with AsAA growth. Methods Analytical, observational, single-center study in which a computational fluid dynamics (CFD) protocol was applied to aortic computed tomography angiogram (CTA) images of patients with AsAA. Two CTA exams taken at a minimum interval of one year were obtained. From the CTA-gathered images, three-dimensional models were built, and clinical data were registered. Study of velocity field and coherent structures (vortices) was performed aiming to relate them to the presence or absence of aneurysm growth, as well as comparing them to the patients' clinical data. The Kolmogorov-Smirnov test was used to evaluate the normality of the distribution, and the non-parametric Wilcoxon signed-rank test, for non-normal distribution, was used to compare the paired data of the aortic angles. Statistical significance was set at 5%. Results The incident jet in the aortic wall generated recirculation areas in the posterior region of the jet, inducing complex vortices formation in the group with aneurysm growth, leading to an average pressure increase in the ascending aortic wall between exams. In the group without aneurysm growth, the average pressure decreased. Conclusion This pilot study showed that CFD based on CTA may in the near future be a tool to help identify flow patterns associated with AsAA remodeling process.
Asunto(s)
Humanos , Aneurisma de la Aorta/diagnóstico por imagen , Hidrodinámica , Aorta/diagnóstico por imagen , Proyectos Piloto , Hemodinámica/fisiologíaRESUMEN
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.
Asunto(s)
Aneurisma de la Aorta , Fibrinógeno , Albúminas , Aorta , Aneurisma de la Aorta/diagnóstico por imagen , Dilatación Patológica , HumanosRESUMEN
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.
Asunto(s)
Aneurisma de la Aorta/diagnóstico por imagen , Fibrinógeno , Aorta , Dilatación Patológica , AlbúminasRESUMEN
Abstract Although aortic valve replacement remains the gold standard treatment for aortic valve diseases like stenosis (AS) or insufficiency, new surgical methods have been developed with a focus in the reconstruction of the aortic valve rather than replacing it. The Ozaki procedure involves a tailored replacement of each individual valvular leaflet with glutaraldehyde-treated autologous pericardium and aims to reproduce the normal anatomy of the aortic valve. Cases of patients with unicuspid aortic valve treated with the Ozaki procedure are uncommon in the litrature and become even more rare when it comes to concomitant diseases like AS and ascending aorta aneurysm. We present the case of a 21-year-old, fit and asymptomatic male, with unicuspid aortic valve with severe stenosis and ascending aorta dilatation, surgically treated with tricuspidization of the aortic valve with glutaraldehyde-treated autologous pericardium and replacement of the ascending aorta with a straight synthetic graft. Postoperative studies showed a fully functional, neo-tailored tricuspid aortic valve with trivial regurgitation. The patient had an uncomplicated recovery, stayed in the intensive care unit for 2 days and was discharged on the 7th postoperative day.
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Humanos , Masculino , Adulto , Adulto Joven , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas , Aorta , Válvula Aórtica/cirugíaRESUMEN
BACKGROUND: Aneurysm sac remodeling is a complex multifactorial process with unknown factors influencing sac regression after endovascular aortic aneurysm repair (EVAR). We sought to identify factors associated with this process by analyzing data obtained from patients treated with the GORE EXCLUDER endovascular aneurysm repair (EVAR) endoprosthesis from December 2010 to October 2016 enrolled in the Global Registry for Endovascular Aortic Treatment (GREAT). METHODS: All patients enrolled in GREAT with three years CT angiography (CTA) follow-up in each of the three successive years after EVAR were included. The percentage of sac size reduction toward device diameter was calculated and used as a surrogate for sac regression with the formula used being: sac size reduction = ((AAA baseline diameter - AAA diameter at follow-up)/(AAA baseline diameter - device diameter))∗100. The cohort was divided into two groups in accordance with the percentage of aneurysm sac reduction at three years; one with the top quartile of patients and the other with the lowest three quartiles. Demographic and procedural variables were analyzed using univariate and regression modeling to determine factors predictive of sac regression. RESULTS: There were 3265 subjects enrolled with follow-up as of May 2018 of which 526 (16.2%) had three years of CTA surveillance. Overall aneurysm sac size decreased from a mean of 58.0 mm (Std Dev: 10.4, range: 34.2, 100.0) to a mean of 49.3 mm (Std Dev: 14.1, range: 0, 140) for a percentage reduction toward device diameter of a mean 28.2% (Std Dev: 39.0, range: -103.7, 183.9). On multivariate logistic regression model; two factors proved to be statistically significant contributors to a larger percentage reduction in aneurysm sac: a conical neck (odds ratio [OR] = 1.64, P-value = 0.023) and a larger proximal device diameter (OR = 1.09, P-value = 0.023). On the other hand, two factors were negative predictors of sac shrinkage, namely: old age (OR = 0.96, P-value = 0.002) and larger baseline aneurysm sac diameter (OR = 0.98, P-value = 0.028). CONCLUSIONS: Aneurysms with conical necks and larger proximal device neck diameters have an increased percentage change in sac size over time after EVAR. Older age and larger initial diameters of aneurysms were negatively associated with percentage change in sac size as well as sac regression. Further study is needed to determine the clinical utility of these observations and applicability across multiple endoprosthesis platforms.