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Aorta Torácica , Rotura de la Aorta , Humanos , Rotura de la Aorta/diagnóstico por imagen , Rotura de la Aorta/etiología , Rotura de la Aorta/cirugía , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Aorta Torácica/lesiones , Masculino , Angiografía por Tomografía Computarizada , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
BACKGROUND: Postoperative computed tomography imaging surveillance is an essential component of care after acute type A aortic dissection (ATAAD) repair. Prognostic imaging factors after ATAAD repair have not been systematically reviewed. METHODS AND RESULTS: We performed a systematic review to summarize postoperative computed tomography measurements including aortic diameter, cross-sectional area, volume, growth rate, and false lumen thrombosis in addition mid- to long-term clinical outcomes after ATAAD repair. Searches were conducted in Medline, Embase, and CENTRAL in October 2022. Studies were included if they reported clinical outcomes such as mortality or aortic reintervention after 1 year and included aforementioned computed tomography findings. Studies of chronic aortic dissection and studies of exclusive patient populations such as those with connective tissue diseases were excluded. Risk of bias was assessed with the Newcastle-Ottawa Scale. Searches retrieved 6999 articles. Sixty-eight studies met inclusion criteria (7885 patients). Extended repairs were associated with improved false lumen thrombosis, decreased aortic growth rate, and decreased rates of reintervention but not improved survival. Growth rates of the aorta post-ATAAD repair were highest in the descending thoracic aorta. The most frequent prognostic imaging factors reported were a patent/partially thrombosed false lumen and postoperative aortic diameter >40 to 45 mm. CONCLUSIONS: Established measurements of positive aortic remodeling, including complete false lumen thrombosis and stabilization of postoperative aortic diameter and growth are the most studied prognostic indicators for improved clinical outcomes after ATAAD repair. Growth rate of the aorta remains significant after ATAAD repair. Future studies should prospectively evaluate and compare prognostic factors for improved surveillance and management.
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Disección Aórtica , Humanos , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico por imagen , Enfermedad Aguda , Resultado del Tratamiento , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Angiografía por Tomografía Computarizada , Pronóstico , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/diagnóstico por imagenRESUMEN
INTRODUCTION: Aortic arch complex atheromatosis is a source of cerebral embolism. A percentage of lacunar infarct could be of embolic etiology, especially due to microemboli of the aortic arch. CASE REPORT: We present the case of a 63-year-old hypertensive man suffering from dysarthria-clumsy hand syndrome for a right hemispheric minor ischemic stroke. The patient developed sequential acute thromboembolism of the left lower and right upper limbs. Computed tomography angiography revealed an aortic arch thrombus. Vascular surgery was successfully performed. CONCLUSION: This case highlights the importance of considering embolic sources in lacunar syndromes, especially at the level of the aortic arch.
TITLE: Síndrome de disartria-mano torpe y embolias agudas secuenciales múltiples de las extremidades como forma de presentación de un trombo del cayado aórtico.Introducción. La ateromatosis del complejo del arco aórtico es una fuente de embolia cerebral. Un porcentaje de infartos lacunares podría ser de etiología embólica, especialmente debidos a microembolias del arco aórtico. Caso clínico. Presentamos el caso de un varón hipertenso de 63 años con síndrome de disartria-mano torpe por un ictus isquémico minor hemisférico derecho. El paciente desarrolló un tromboembolismo agudo secuencial de los miembros inferior izquierdo y superior derecho. La angiografía por tomografía computarizada reveló un trombo en el arco aórtico. La cirugía vascular se llevó a cabo con éxito. Conclusión. Este caso destaca la importancia de considerar las fuentes embólicas en los síndromes lacunares, especialmente en el arco aórtico.
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Aorta Torácica , Disartria , Humanos , Masculino , Persona de Mediana Edad , Disartria/etiología , Aorta Torácica/diagnóstico por imagen , Mano/irrigación sanguínea , Síndrome , Enfermedad Aguda , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/complicacionesRESUMEN
BACKGROUND: It is challenging to simultaneously conduct total endovascular repair and reconstruct the left subclavian artery (LSA) and isolated left vertebral artery (ILVA) in patients who had an ILVA and required zone 2 anchoring. This pilot study reported the initial application experience of thoracic endovascular aortic repair (TEVAR) with a proximal zone 2 landing for aortic arch reconstruction in patients with ILVA. METHODS: This study was a retrospective consecutive single-center case series analysis, which involved four patients with ILVA who required zone 2 anchoring and received TEVAR combined with a single-branched stent graft and concomitant on-table fenestration between March 2021 and December 2022. RESULTS: The postoperative follow-up period was 6-27 months, and no postoperative deaths or other primary complications occurred. There were no signs of a stroke or spinal cord ischemia, as well as no chest or back pain. The postoperative computed tomography angiography showed unobstructed ILVA and LSA, no stent stenosis and displacement, and no signs of endoleak. CONCLUSION: The outcome suggested that this technique might be a feasible, safe, and alternative treatment for such patients. Further studies with larger samples and longer follow-up periods are needed to confirm our findings.
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Aorta Torácica , Procedimientos Endovasculares , Stents , Arteria Vertebral , Humanos , Proyectos Piloto , Masculino , Procedimientos Endovasculares/métodos , Estudios Retrospectivos , Femenino , Anciano , Persona de Mediana Edad , Aorta Torácica/cirugía , Aorta Torácica/diagnóstico por imagen , Arteria Vertebral/cirugía , Aneurisma de la Aorta Torácica/cirugía , Diseño de Prótesis , Implantación de Prótesis Vascular/métodos , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Arteria Subclavia/cirugía , Angiografía por Tomografía Computarizada , Resultado del Tratamiento , Reparación Endovascular de AneurismasRESUMEN
We introduce a new computational framework that utilises Pulse Wave Velocity (PWV) extracted directly from 4D flow MRI (4DMRI) to inform patient-specific compliant computational fluid dynamics (CFD) simulations of a Type-B aortic dissection (TBAD), post-thoracic endovascular aortic repair (TEVAR). The thoracic aortic geometry, a 3D inlet velocity profile (IVP) and dynamic outlet boundary conditions are derived from 4DMRI and brachial pressure patient data. A moving boundary method (MBM) is applied to simulate aortic wall displacement. The aortic wall stiffness is estimated through two methods: one relying on area-based distensibility and the other utilising regional pulse wave velocity (RPWV) distensibility, further fine-tuned to align with in vivo values. Predicted pressures and outlet flow rates were within 2.3 % of target values. RPWV-based simulations were more accurate in replicating in vivo hemodynamics than the area-based ones. RPWVs were closely predicted in most regions, except the endograft. Systolic flow reversal ratios (SFRR) were accurately captured, while differences above 60 % in in-plane rotational flow (IRF) between the simulations were observed. Significant disparities in predicted wall shear stress (WSS)-based indices were observed between the two approaches, especially the endothelial cell activation potential (ECAP). At the isthmus, the RPWV-driven simulation indicated a mean ECAP>1.4 Pa-1 (critical threshold), indicating areas potentially prone to thrombosis, not captured by the area-based simulation. RPWV-driven simulation results agree well with 4DMRI measurements, validating the proposed pipeline and facilitating a comprehensive assessment of surgical decision-making scenarios and potential complications, such as thrombosis and aortic growth.
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Modelos Cardiovasculares , Análisis de la Onda del Pulso , Humanos , Análisis de la Onda del Pulso/métodos , Procedimientos Endovasculares/métodos , Disección Aórtica/fisiopatología , Disección Aórtica/cirugía , Simulación por Computador , Aorta Torácica/cirugía , Aorta Torácica/fisiología , Aorta Torácica/fisiopatología , Aorta Torácica/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Velocidad del Flujo Sanguíneo/fisiología , Hemodinámica/fisiología , Reparación Endovascular de AneurismasRESUMEN
PURPOSE: Anatomical understanding is an important basis for medical teaching, especially in a surgical context. The interpretation of complex vascular structures via two-dimensional visualization can yet be difficult, particularly for students. The objective of this study was to investigate the feasibility of an MxR-assisted educational approach in vascular surgery undergraduate education, comparing an MxR-based teaching-intervention with CT-based material for learning and understanding the vascular morphology of the thoracic aorta. METHODS: In a prospective randomized controlled trial learning success and diagnostic skills following an MxR- vs. a CT-based intervention was investigated in 120 thoracic aortic visualizations. Secondary outcomes were motivation, system-usability as well as workload/satisfaction. Motivational factors and training-experience were also assessed. Twelve students (7 females; mean age: 23 years) were randomized into two groups undergoing educational intervention with MxR or CT. RESULTS: Evaluation of learning success showed a mean improvement of 1.17 points (max.score: 10; 95%CI: 0.36-1.97). The MxR-group has improved by a mean of 1.33 [95% CI: 0.16-2.51], against 1.0 points [95% CI: -0.71- 2.71] in the CT-group. Regarding diagnostic skills, both groups performed equally (CT-group: 58.25 ± 7.86 vs. MxR-group:58.5 ± 6.60; max. score 92.0). 11/12 participants were convinced that MxR facilitated learning of vascular morphologies. The usability of the MxR-system was rated positively, and the perceived workload was low. CONCLUSION: MxR-systems can be a valuable addition to vascular surgery education. Further evaluation of the technology in larger teaching situations are required. Especially regarding the acquisition of practical skills, the use of MxR-systems offers interesting application possibilities in surgical education.
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Aorta Torácica , Educación de Pregrado en Medicina , Humanos , Femenino , Masculino , Proyectos Piloto , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/anatomía & histología , Estudios Prospectivos , Adulto Joven , Educación de Pregrado en Medicina/métodos , Adulto , Realidad Aumentada , Estudios de Factibilidad , Tomografía Computarizada por Rayos X , Procedimientos Quirúrgicos Vasculares/educación , Competencia Clínica , Anatomía/educaciónRESUMEN
BACKGROUND: Mega-aortic syndrome including aortic arch and descending aortic aneurysm is a challenging surgical case. Because the aorta continuously dilates, creating the distal anastomosis sites becomes an issue. Despite the developments in endovascular techniques including frozen elephant trunk, in the case of mega-aortic syndrome or mycotic aneurysm, extensive surgical repair is still a strong armamentarium. Our patient had a mega-aorta with chronic aortic dissection. Herein, we show tips regarding concurrent ascending, aortic arch, and descending aortic replacement via posterolateral thoracotomy for this relatively young patient. CASE PRESENTATION: A 46-year-old man with chronic kidney disease had chronic type A aortic dissection with an extensively dilated thoracic aorta from the distal ascending to the descending aorta measuring 63 mm in diameter and abdominal aorta measuring 50 mm. The short segment of the distal descending aorta was narrowed to 36 mm. The patient underwent a concurrent replacement of the distal ascending aorta, aortic arch, and descending aorta via a posterolateral thoracotomy. The patient was extubated on postoperative day (POD) 1 and discharged home without serious complications such as stroke, respiratory failure, or renal failure on POD 18. The 1-year follow-up computed tomography did not find issues in the anastomosis sites; however, the abdominal aorta enlarged from 50 to 58 mm. The patient underwent a thoracoabdominal aortic replacement and recovered well without any complications. CONCLUSIONS: Good exposure and meticulous organ protection methods are key to a safe concurrent replacement of the ascending, aortic arch, and descending aorta via posterolateral thoracotomy.
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Aorta Torácica , Aneurisma de la Aorta Torácica , Disección Aórtica , Implantación de Prótesis Vascular , Toracotomía , Humanos , Masculino , Persona de Mediana Edad , Disección Aórtica/cirugía , Disección Aórtica/complicaciones , Toracotomía/métodos , Aorta Torácica/cirugía , Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/complicaciones , Implantación de Prótesis Vascular/métodos , Tomografía Computarizada por Rayos X , Enfermedad CrónicaRESUMEN
BACKGROUND: Coarctation of the aorta (CoA) is the most common undiagnosed congenital heart defect during prenatal screening. High false positive and false negative rates seriously affect prenatal consultation and postnatal management. The objective of the study was to assess the utility of various measurements to predict prenatal CoA and to derive a diagnostic algorithm. METHODS: One hundred and fifty-four fetuses with suspected CoA who presented at Fuwai Hospital between December 2017 and August 2021 were enrolled and divided into confirmed CoA cases (n = 47) and false positive cases (n = 107), according to their postnatal outcomes. The transverse aortic arch, isthmus, and descending aorta were measured in the long-axis view of the aortic arch. The angle between the transverse aortic arch (TAO) and the descending aortic arch (DAO) was defined as the TAO-DAO angle and measured in the long axis or sagittal view. Based on the database in GE Voluson E10 and the formula (Z = [Formula: see text]), the standard score (Z-score) of the dimensions of the aorta were calculated in relation to the gestational age. The main echocardiographic indices were combined to design a 3-step diagnostic protocol. The TAO-DAO angle was used as the first step in the diagnostic model. The diameter of the transverse arch and the Z-score of the isthmus were the second step. The third-step indices included a Z-score of the transverse arch, diameter of the isthmus, distance from the left subclavian artery (LSA) to left common carotid artery (LCCA), the ratio of isthmus diameter and LSA diameter and ratio of the distances (the distance between the LSA and LCCA to the distance between the right innominate artery and LCCA). The receiver operating characteristic (ROC) curve determined the predictive capability of each diagnostic parameter, and the kappa test determined the diagnostic accuracy of the proposed model. RESULTS: The cases with confirmed CoA had thinner transverse arches (1.92 ± 0.32 mm vs. 3.06 ± 0.67 mm, P = 0.0001), lower Z-scores of the isthmus (-8.97 ± 1.45 vs. -5.65 ± 1.60, P = 0.0001), smaller TAO-DAO angles (105.54 ± 11.51° vs. 125.29 ± 8.97°, P = 0.0001) and larger distance between the LSA and LCCA (4.45 ± 1.75 mm vs. 2.74 ± 1.07 mm, P = 0.0001) than the false positive cases. The area under the curve (AUC) was 0.947 (95% CI 0.91-0.98) for the TAO-DAO angle ≤ 115.75°, 0.942 (95% CI 0.91-0.98) for the transverse arch diameter ≤ 2.31 mm, 0.937 (95% CI 0.90-0.98) for the Z-score of the isthmus ≤ -7.5, and 0.975 (95% CI 0.95-1.00) for the 3-step diagnostic protocol with 97.8% sensitivity and 97.2% specificity. The kappa test showed that the model's diagnostic accuracy was consistent with postnatal outcomes (kappa value 0.936, P = 0.0001). CONCLUSIONS: The 3-step diagnostic protocol included the three most useful measurements and the additional indices with appropriate cut-off values. The algorithm is useful for the detection of aortic coarctation in fetuses with a high degree of accuracy. TRIAL REGISTRATION: Retrospectively registered.
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Aorta Torácica , Coartación Aórtica , Ecocardiografía , Ultrasonografía Prenatal , Humanos , Coartación Aórtica/diagnóstico por imagen , Femenino , Embarazo , Aorta Torácica/diagnóstico por imagen , Estudios Retrospectivos , Algoritmos , Edad GestacionalRESUMEN
AIMS: Thoracic aortic diameter is modulated by various factors including both physiological and pathological mechanisms. The aim of this study was to explore the determinants of thoracic aortic size focusing on arterial blood pressure and physical activity in normotensive and hypertensive individuals. METHODS: Ascending and descending aortic diameters were measured in participants of the Copenhagen General Population Study using thoracic CT angiography. To assess the relation between arterial blood pressure and thoracic aortic diameters, individuals with diabetes, hypercholesterolemia, smoking, and prescribed antihypertensive medication were excluded. Intensity of physical activity was recorded based on self-reported questionnaire data. RESULTS: A total of 1214 normotensive and 284 hypertensive individuals were examined. In all individuals, male sex, older age, and body surface area were associated with higher diameters of the ascending and descending aorta ( P â<â0.01). In normotensive individuals, hard physical activity >â4âh/week was independently associated with higher thoracic aortic diameters (ascending ß:1.09[0.52;1.66] and descending ß : 0.47[0.14;0.80], both P â<â0.01), whereas higher systolic blood pressure was not associated with thoracic aortic diameters (ascending P â=â0.12 and descending p â=â0.33). In hypertensive individuals, higher systolic blood pressure (per 10âmmHg) was independently associated with higher thoracic aortic diameters (ascending ß : 0.55[0.17;0.94] and descending ß : 0.23[0.10;0.37] mm/10âmmHg, both P â<â0.01), whereas hard physical activity was not associated with higher aortic diameters (ascending P â=â0.11 and descending P â=â0.51). CONCLUSION: In normotensive individuals hard physical activity, and in hypertensive individuals increasing systolic blood pressure are factors each independently associated with larger thoracic aortic size. These findings suggest a context sensitive mode of aortic vascular response to size modulating adaptation.
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Aorta Torácica , Presión Sanguínea , Hipertensión , Humanos , Masculino , Hipertensión/fisiopatología , Femenino , Persona de Mediana Edad , Aorta Torácica/fisiopatología , Aorta Torácica/diagnóstico por imagen , Anciano , Presión Sanguínea/fisiología , Ejercicio Físico , AdultoAsunto(s)
Algoritmos , Aorta Torácica , Tomografía Computarizada por Rayos X , Humanos , Aorta Torácica/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Inteligencia Artificial , Dosis de Radiación , Estudios Longitudinales , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Radiografía Torácica/métodos , Estudios Transversales , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND Ortner syndrome, or cardiovocal syndrome, is a left recurrent laryngeal nerve palsy secondary to cardiovascular causes. Aortic pseudoaneurysm is a rare life-threatening condition resulting from weakening of the aortic wall. Clinical presentation of aortic pseudoaneurysm is highly variable. Hoarseness is often caused by benign conditions; however, it can be the first symptom of an underlying serious condition requiring immediate diagnosis and management. CASE REPORT We report a series of 2 patients with sudden hoarseness as the first symptom of an aortic arch pseudoaneurysm. Two men, with ages of 76 and 60 years, had sudden hoarseness a few weeks before. Laryngoscopy showed a left vocal cord palsy in both cases. A computed tomography (CT) scan showed a thoracic aortic pseudoaneurysm located at the aortic arch compressing the left recurrent laryngeal nerve. Both patients were treated with endovascular aortic repair. The first patient underwent a carotid-subclavian artery bypass, and the left subclavian artery was closed with a vascular plug device. He was discharged a week later, with persistent hoarseness. In the second case, subclavian artery occlusion and pseudoaneurysm embolization with coils were performed. Control CT scan confirmed the procedure's success. However, after an initial favorable evolution, the patient had severe non-vascular complications and finally died. CONCLUSIONS Considering these 2 cases and those reported in the literature, aortic origin should be considered in the differential diagnosis of hoarseness, particularly when it appears suddenly. Thoracic endovascular aortic repair is a feasible option for those patients with penetrating aortic ulcer or pseudoaneurysm located in the aortic arch.
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Aneurisma Falso , Ronquera , Parálisis de los Pliegues Vocales , Humanos , Masculino , Ronquera/etiología , Aneurisma Falso/terapia , Aneurisma Falso/complicaciones , Aneurisma Falso/diagnóstico por imagen , Parálisis de los Pliegues Vocales/etiología , Parálisis de los Pliegues Vocales/diagnóstico , Anciano , Persona de Mediana Edad , Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/diagnóstico , Tomografía Computarizada por Rayos X , Aorta Torácica/diagnóstico por imagenRESUMEN
PURPOSE: A translation of the initial observation of vertebral arteria lusoria reported by Hyrtl in 1859 is followed by a review of all cases published until May 2023 to identify the anatomical and clinical features characterizing the typical form of this rare variant. METHODS: PubMed, Google Scholar, and Google queries were performed with "vertebral arteria lusoria", "retroesophageal vertebral artery", and "aberrant vertebral artery" as keywords (in English, German, and French). A feature was considered typical when present in at least 75% of analyzed cases. A case of incidentally discovered vertebral arteria lusoria illustrates the typical form of the variant. RESULTS: The analysis of 56 publications yielded 66 observations of right-sided vertebral arteria lusoria published between 1859 and May 2023. A small caliber, a retro-esophageal location, and passage through the foramen transversarium of C7 were typical. There was no evidence of association with clinical symptoms or other cardiovascular anomalies. CONCLUSION: A typical vertebral arteria lusoria is an incidentally discovered nondominant aberrant right VA originating from the proximal descending aorta and following a retro-esophageal course to enter the C7 foramen transversarium, without associated aortic arch branching anomalies or congenital cardiovascular pathologies.
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Arteria Vertebral , Humanos , Arteria Vertebral/anomalías , Arteria Vertebral/diagnóstico por imagen , Historia del Siglo XIX , Masculino , Variación Anatómica , Arteria Subclavia/anomalías , Arteria Subclavia/diagnóstico por imagen , Femenino , Hallazgos Incidentales , Aorta Torácica/anomalías , Aorta Torácica/diagnóstico por imagen , Persona de Mediana EdadRESUMEN
This study aimed to investigate the acute changes in proximal aortic distensibility, a measure of aortic stiffness, induced by acute exercise in participants with and without heart failure (HF). Participants with HF (n = 24) and without HF (n = 26) underwent cardiovascular magnetic resonance (CMR) (1.5 T) imaging at rest and after submaximal supine bicycle ergometry. The participants were further categorized into HF with reduced ejection fraction (HFrEF) (n = 14) and HF with preserved ejection fraction (n = 10) based on the left ventricular ejection fraction. At rest and immediately after exercise, cine CMR images of the cross-sectional ascending and descending aorta at the pulmonary artery bifurcation level were obtained to determine aortic distensibility (AoD), with lower AoD indicating greater aortic stiffness. Differences in means of values at rest and before and after exercise were compared using the nonparametric Wilcoxon sign test. There was no significant difference in AoD at rest between subjects with HF and controls. However, immediately after exercise, participants with HF but not controls exhibited a significant reduction in AoD, indicating higher aortic stiffness related to exercise (median [interquartile range] for the ascending aorta: 3.16 (1.26) × 10-3 mm Hg-1 to 2.39 (1.57) × 10-3 mm Hg-1 and the descending aorta: 4.19 (2.58) × 10-3 mm Hg-1 to 2.96 (1.79) × 10-3 mm Hg-1) (both p = 0.023). This decrease was particularly observed in participants with HFrEF but not in those with HF with preserved ejection fraction. Exercise-induced aortic stiffness, detectable by noninvasive CMR, may contribute to unfavorable ventricular-vascular interactions during exercise in participants with HF, especially HFrEF.
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Prueba de Esfuerzo , Ejercicio Físico , Insuficiencia Cardíaca , Imagen por Resonancia Cinemagnética , Volumen Sistólico , Rigidez Vascular , Humanos , Insuficiencia Cardíaca/fisiopatología , Rigidez Vascular/fisiología , Masculino , Imagen por Resonancia Cinemagnética/métodos , Femenino , Persona de Mediana Edad , Volumen Sistólico/fisiología , Prueba de Esfuerzo/métodos , Ejercicio Físico/fisiología , Anciano , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/fisiopatología , Función Ventricular Izquierda/fisiologíaAsunto(s)
Aorta Torácica , Recurrencia , Humanos , Aorta Torácica/diagnóstico por imagen , Calcificación Vascular/diagnóstico por imagen , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/etiología , Enfermedades de la Aorta/diagnóstico por imagen , Masculino , Radiografía Torácica , Calcinosis/diagnóstico por imagen , Femenino , Tomografía Computarizada por Rayos X , AncianoRESUMEN
BACKGROUND: Aortic arch disease is a major cause of acute dissections. Surgical replacement is the current curative treatment for aortic arch disease. While traditional aortic cannulation ensures lower body perfusion, axillary cannulation offers optimum cerebral perfusion. AIM: To evaluate the outcomes of aortic and axillary cannulation methods in hemiarch replacements, focusing on postoperative perfusion and survival. MATERIALS AND METHODS: A retrospective analysis was conducted on 91 patients who underwent hemiarch replacement surgery between February 2007 and October 2016. Patients were divided into two groups based on the cannulation method: aortic cannulation (54 patients) and axillary cannulation (37 patients). Data regarding preoperative, intraoperative, and postoperative parameters were analyzed, including demographics, surgical outcomes, and complications. RESULTS: Demographic analysis showed comparable characteristics between the two groups, with notable differences in aortic disease severity and classification. Patients in the axillary group had a larger ascending aorta diameter (57.7 ± 10.8 mm vs. 51.8 ± 5.7 mm, p = 0.002) and a higher prevalence of acute dissections (27.0% (n = 10) vs. 3.7% (n = 2), p = 0.001). Cerebral protection methods varied significantly between the two groups (p < 0.001). Antegrade cerebral perfusion was used in 37.8% (n = 14) of the axillary group compared to 3.7% (n = 2) of the central group. The central cannulation group had a higher proportion of patients with temperatures under 20 °C (98.1% (n = 53) vs. 21.6% (n = 8), p < 0.001), whereas the axillary group maintained higher temperatures (24 -28 °C) in 68.6% (n = 23) of cases. AV repair/replacement was more frequent in the aortic cannulation group (48.2% (n = 26) vs. 18.9% (n = 7), p = 0.013). No significant disparities were observed in operative mortality or intraoperative complications. Statistical analysis showed no significant differences between the two groups in the in-hospital outcomes, but renal complications were more prevalent in the axillary cannulation group with 21.6% (n = 8) experiencing acute kidney injury compared to 9.3% (n = 5) in the central group (p = 0.098). The overall survival rate was slightly higher in the aortic cannulation group at various follow-up periods, yet no statistically significant difference was found between the two groups. CONCLUSION: We found no significant differences in safety and efficacy between axillary cannulation and aortic cannulation in hemiarch replacement procedures.
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Disección Aórtica , Arteria Axilar , Implantación de Prótesis Vascular , Cateterismo Periférico , Complicaciones Posoperatorias , Humanos , Estudios Retrospectivos , Femenino , Masculino , Persona de Mediana Edad , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/mortalidad , Resultado del Tratamiento , Anciano , Factores de Riesgo , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/mortalidad , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Complicaciones Posoperatorias/etiología , Factores de Tiempo , Circulación Cerebrovascular , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/mortalidad , Aorta Torácica/cirugía , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/fisiopatologíaRESUMEN
BACKGROUND: This study aims to identify a morphological indicator of aortic dissection (AD) based on the geometrical characteristics of the thoracic aorta. METHODS: We evaluated computed tomographic angiograms of 63 samples with AD (22 with type A AD, 41 with type B AD) and 71 healthy samples. Via centerline extraction and spatial transformation, the spatial entanglement of the aorta was minimized, and the expanded 2D aortic morphology was obtained. The 2D morphology of the thoracic aorta was fit to a circle. The applicability of the fitting circle method for identifying aortic dissection was verified by multivariable logistic regression analysis. RESULTS: Via the 3D coordinate transformation algorithm, the optimal aortic view was obtained. On this view, the geometrical characteristics of the thoracic aortas of the healthy controls were similar to a portion of a circle (sum of residuals: 3502.45 ± 2566.71, variance: 86.23 ± 56.60), while that of AD samples had poorer similarity to the circle (sum of residuals: 5404.78 ± 3891.69, variance: 129.90 ± 90.09). This difference was significant (p < 0.001). A logistic regression model showed that increased deformation of the thoracic aorta was a significant indicator of aortic dissection (odds ratio: 1.35, p = 0.034). CONCLUSIONS: The morphology of the healthy thoracic aorta could be fit to a circle, while that of the dissected aorta had poorer similarity to the circle. The statistics of the circle are an effective indicator of aortic deformation in AD. TRIAL REGISTRATION: This study is registered in the Chinese Clinical Trial Registry (ChiCTR2000029219).
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Aorta Torácica , Aneurisma de la Aorta Torácica , Disección Aórtica , Aortografía , Angiografía por Tomografía Computarizada , Valor Predictivo de las Pruebas , Interpretación de Imagen Radiográfica Asistida por Computador , Humanos , Disección Aórtica/diagnóstico por imagen , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/patología , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Anciano , Estudios de Casos y Controles , Adulto , Estudios Retrospectivos , Tomografía Computarizada MultidetectorRESUMEN
We experienced an extremely rare case of blunt traumatic aortic arch pseudoaneurysm( BTAAPA) and report it with literature review. A 40-year-old asymptomatic man with chest X-ray abnormality visited our hospital. Contrast-enhanced computed tomography( CT) scans revealed saccular aortic-isthmus aneurysm, and BTAAPA was diagnosed because of a history of multiple severe traffic trauma 21 years before. The patient underwent replacement of the distal aortic arch and proximal descending aorta under partial cardiopulmonary bypass through left posterolateral thoracotomy. The postoperative course was uneventful. BTAAPA is exceedingly uncommon, and our comprehensive literature search identified only 9 cases including the present case. The age at diagnosis was 10 to 76 years, 7 cases were males, and most of the traumas were due to traffic accidents. The present case had the longest duration (21 years) from the trauma to the diagnosis. Six patients underwent thoracic endovascular aortic repair with good prognosis.
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Aneurisma Falso , Aorta Torácica , Heridas no Penetrantes , Humanos , Masculino , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Aneurisma Falso/etiología , Adulto , Aorta Torácica/lesiones , Aorta Torácica/cirugía , Aorta Torácica/diagnóstico por imagen , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/cirugía , Heridas no Penetrantes/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
The anatomical features spanning from the aortic arch to the proximal carotid artery and the associated cardiovascular risks might significantly influence the development of right carotid plaque. Our research aimed to compare these anatomical and risk factors between individuals with no carotid plaque and those with moderate right-side carotid plaque within a Korean cohort. We conducted a retrospective, cross-sectional analysis involving 413 participants, categorized into a normal group (n = 339) and a right moderate carotid plaque group (defined as > 50% stenosis based on NASCET criteria) (n = 74). We collected data on cardiovascular risk factors and conducted laboratory tests. A 3D model of the carotid artery was constructed using cranio-cervical computed tomography angiography (CTA) data through semi-automated software. Measurements taken on this 3D model included the common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA), and carotid artery bifurcation (CAB) in terms of maximal vascular diameter, sectional area, angles of carotid bifurcation and ICA, and carotid tortuosity. When compared with the normal group, individuals in the right moderate carotid plaque group exhibited smaller angles at the carotid bifurcation, larger CCA diameter and sectional area (p < 0.01), advanced age, and a higher incidence of hypertension, diabetes, and stroke history (p < 0.05), along with reduced glomerular filtration rate (GFR) (p < 0.001). Multivariate analysis revealed that the sectional area of the bifurcation, calcification of the aortic bulb, and GFR were independently associated with the presence of right moderate carotid plaque (p < 0.01). Statistical analyses disclosed significant differences in both clinical risk factors and geometric changes in the region extending from the aortic arch to the proximal carotid artery among subjects with right moderate carotid plaque when compared to those without.
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Aorta Torácica , Arteria Carótida Interna , Angiografía por Tomografía Computarizada , Humanos , Masculino , Femenino , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/patología , Persona de Mediana Edad , Anciano , Factores de Riesgo , Estudios Retrospectivos , Estudios Transversales , Arteria Carótida Interna/diagnóstico por imagen , Arteria Carótida Interna/patología , Placa Aterosclerótica/diagnóstico por imagen , Placa Aterosclerótica/patología , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/patologíaRESUMEN
BACKGROUND: Aortic conduit and reservoir functions can be directly measured by four-dimensional flow (4D flow) cardiovascular magnetic resonance (CMR). METHODS: Twenty healthy controls (10 young and 10 age-gender-matched old controls) and 20 patients with heart failure with preserved ejection fraction (HFpEF) were recruited. All had 4D flow CMR. Flow was quantified at the ascending and descending aorta levels. In addition, at the ascending aorta level, we quantified systolic flow displacement (FDs) and systolic flow reversal ratio (sFRR). The aortic conduit function was defined as the relative drop in systolic flow from the ascending to the descending aorta (∆Fs). Aortic reservoir function was defined as descending aortic diastolic stroke volume (DAo SVd). RESULTS: Both ∆Fs (R=0.51, p=0.001) and DAo SVd (R=-0.68, p=0.001) were significantly associated with ageing. Native T1 (R=0.51, p=0.001) and extracellular volume (R=0.51, p=0.001) showed maximum association with ∆Fs. ∆Fs significantly increased in HFpEF versus age-gender-matched controls (41±8% vs 52±12%, p=0.02). In multiple regression, only ∆Fs and DAo SVd were independent predictors of the estimated glomerular filtration rate (model R=0.77, p=0.0001). FDs was significantly associated with ∆Fs (R=0.4, p=0.01) and DAo SVd (R=-0.48, p=0.002), whereas sFRR was mainly associated with DAo SVd (R=-0.46, p=0.003). CONCLUSION: Both aortic conduit and reservoir function decline with age and this decline in aortic function is also independently associated with renal functional decline. Ascending aortic turbulent flow signatures are associated with loss of aortic conduit and reservoir functions. Finally, in HFpEF, aortic conduit and reservoir function demonstrate progressive decline. TRIALS REGISTRATION NUMBER: NCT05114785.
Asunto(s)
Relevancia Clínica , Insuficiencia Cardíaca , Volumen Sistólico , Función Ventricular Izquierda , Femenino , Humanos , Masculino , Aorta/diagnóstico por imagen , Aorta/fisiopatología , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/fisiopatología , Velocidad del Flujo Sanguíneo/fisiología , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/diagnóstico , Imagen por Resonancia Cinemagnética/métodos , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiologíaRESUMEN
Background: The descending aorta velocity is important predictor of aortic disease in children and can be very helpful in some clinical and surgical decision making. Aim: The purpose of this study is to assess the normative values of descending aorta velocity among children from South-East Nigeria. It also aimed to assess the correlation between age, body surface area and mean velocity across the descending aorta. Methods: This is a cross-sectional study where the descending aorta velocity of one hundred and eleven children were enrolled consecutively using digitized two-dimensional and Doppler echocardiography. Results: A total of 111 children had echocardiography to study their cardiac structures and compute their mean scores of their descending aorta velocity. The mean velocity across the descending aorta was 1.3±0.2m/s with maximum and minimum velocities of 2.06 and 0.84cm respectively. The mean descending aorta velocity in males (1.37±0.24 m/s) was significantly higher than that in females (1.24±0.18); (Student T test 3.09, p = 0.03). There was no correlation between age and mean velocity across the descending aorta (Pearson correlation coefficient; -0.03, p = 0.7) nor between body surface area and descending aorta velocity (correlation coefficient 0.01, p= 0.8). Conclusions: The presented normalized values of the descending aorta velocity using a digitized two-dimensional and Doppler echocardiography among healthy children will serve as a reference values for further studies and can be applied for clinical and surgical use in children with various cardiac anomalies.