RESUMO
Pseudocoarctation of the aorta (PCOA) is a rare anomaly of the aortic arch and its presentation is often an incidental finding. We present the case of a 66-year-old patient with a history of high blood pressure, who was admitted for surgical management of bicuspid aortic valve disease with severe insufficiency and who was incidentally detected to have a PCOA. It was decided to manage the latter conservatively and go ahead with surgical aortic valve replacement, to address the problem that led to his admission to the hospital. The patient had a favorable postoperative course and was discharged in a stable condition with an advice for periodic follow-up as out-patient consultations.
RESUMO
Background Bicuspid aortic valve patients have an increased risk of aortic dilatation. A deficit of nitric oxide synthase has been proposed as the causative factor. No correlation between flow-mediated dilation and aortic diameter has been performed in patients with bicuspid aortic valves and normal aortic diameters. Being a hereditary disease, we compared echocardiographic features and endothelial function in these patients and their first-degree relatives. Methods Comprehensive physical examinations, routine laboratory tests, transthoracic echocardiography, and measurements of endothelium-dependent and non-dependent flow-mediated vasodilatation were performed in 18 bicuspid aortic valve patients (14 type 1 and 4 type 2) and 19 of their first-degree relatives. Results The first-degree relatives were younger (36.7 ± 18.8 vs. 50.5 ± 13.9 years, p = 0.019) with higher ejection fractions (64.6% ± 1.7% vs. 58.4% ± 9.5%, p = 0.015). Aortic diameters indexed to body surface area were similar in both groups, the except the tubular aorta which was larger in bicuspid aortic valve patients (19.3 ± 2.7 vs. 17.4 ± 2.2 mm·m-2, p = 0.033). Flow-dependent vasodilation was similar in both groups. A significant inverse correlation was found between non-flow-dependent vasodilation and aortic root diameter in patients with bicuspid aortic valve ( R = -0.57, p = 0.05). Conclusions Bicuspid aortic valve patients without aortopathy have larger ascending aortic diameters than their first-degree relatives. Endothelial function is similar in both groups, and there is no correlation with ascending aorta diameter. Nonetheless, an inverse correlation exists between non-endothelial-dependent dilation and aortic root diameter in bicuspid aortic valve patients.
Assuntos
Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Valva Aórtica/anormalidades , Família , Doenças das Valvas Cardíacas/complicações , Adulto , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/epidemiologia , Aortografia , Doença da Válvula Aórtica Bicúspide , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/diagnóstico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Uruguai/epidemiologia , VasodilataçãoRESUMO
A 65-year-old male with medical history of hyperlipidemia, type 2 diabetes mellitus, and arterial hypertension well controlled by glibenclamide, and amlodipine plus enalapril for about a decade was referred to our service because of the recent fndings in aortography (Figure 1: A, B, and C). He was not a smoker, neither a heavy alcohol drinker, and had chronic lumbar pain related to degenerative spondyloarthropathy. Previous imaging studies had showed narrowing of the disc space and reduction of the diameter of spinal canal on L4 and L5. During evaluation of control, an incidental image was observed in the right side of his pelvis, and the aortography was done. On presentation, BMI was 33 kg/m2, temperature was 36°C, blood pressure was 120x80 mmHg, with 80 bpm and 14 irpm, and there were no signifcant physical fndings on abdominal region. Laboratory fndings (normal ranges) revealed unremarkable blood counts and thyroid function; total cholesterol 289 (<200 mg/dL), HDL 54 (30-60 mg/ dL), LDL 206 (100-190 mg/dL), and tryglicerides 147 (<180 mg/dL); glucose 70 (70-99 mg/dL), uric acid 8.7 (2.5-7.0 mg/dL), urea 57 (14-50 mg/dL) with creatinine clearance 129.6 (≥129 ml/min); and PSA 0.5 (<4.0 ng/mL). After a successful open invasive procedure, he was discharged to outpatient.
Varón de 65 años con antecedentes médicos de hiperlipidemia, diabetes tipo 2. mellitus, e hipertensión arterial bien controlada por glibenclamida, y Amlodipine plus enalapril durante aproximadamente una década se refirió a nuestro servicio debido a los hallazgos recientes en aortografía (Figura 1: A, B y C). No era un fumador, ni un gran bebedor de alcohol, y tenía Dolor lumbar relacionado con espondiloartropatía degenerativa. Anterior Los estudios de imagen han mostrado estrechamiento del espacio discal y reducción. del diámetro del canal espinal en L4 y L5. Durante la evaluación del control, se observó una imagen incidental en el lado derecho de su pelvis, y la Se realizó una aortografía. En la presentación, el IMC fue de 33 kg / m2, temperatura. fue de 36 ° C, la presión arterial fue de 120x80 mmHg, con 80 bpm y 14 irpm, y no hubo hallazgos físicos significativos en la región abdominal. Los hallazgos de laboratorio (rangos normales) revelaron recuentos sanguíneos sin complicaciones y la función tiroidea; colesterol total 289 (<200 mg / dL), HDL 54 (30-60 mg / dL), LDL 206 (100-190 mg / dL) y tryglicerides 147 (<180 mg / dL); glucosa 70 (70-99 mg / dL), ácido úrico 8.7 (2.5-7.0 mg / dL), urea 57 (14-50 mg / dL) con aclaramiento de creatinina 129.6 (≥129 ml / min); y PSA 0.5 (<4.0 ng / mL). Después un procedimiento invasivo abierto exitoso, fue dado de alta como paciente ambulatorio
Assuntos
Humanos , Masculino , Idoso , Aortografia , Artéria Ilíaca , Aneurisma , Dor , Região LombossacralRESUMO
Aneurysms of the sinus of Valsalva (SV) and the atrial septum are a rare association. We report the case of a 28-year-old woman, who was admitted to our department complaining of progressive dyspnea of 10 days of evolution, five hours previous to her admission to the hospital; she presented sudden oppressive anterior chest pain, accompanied by palpitations. The presence of rupture of the right SV to the right atrium was clinically confirmed, by echocardiography and hemodynamic studies. In addition, an associated atrial septal aneurysm was found. She underwent surgical correction through sinusplasty without requiring aortic valve replacement. The patient presented persistent postoperative atrioventricular block, which required a permanent pacemaker. Clinical evolution was satisfactory. To our knowledge, this case is a rare combination of two isolated malformations, without previous events that could explain the rupture of the right SV.
Los aneurismas del seno de Valsalva y del septum interauricular son una asociación rara. Informamos el caso de una mujer de 28 años de edad con un cuadro de disnea progresiva en los últimos 10 días, al cual se agregó dolor precordial opresivo, cinco horas previas a su ingreso. Se comprobó clínicamente, por ecocardiografía y hemodinamia la presencia de ruptura del seno de Valsalva derecho hacia el atrio derecho. Un hallazgo interesante fue la presencia de un aneurisma del septum interauricular asociado. La paciente fue sometida a corrección quirúrgica con plastía del seno de Valsalva, sin requerir reemplazo valvular aórtico. En el postoperatorio presentó bloqueo aurículo-ventricular persistente, requiriendo implante de marcapaso definitivo. Su evolución fue satisfactoria. Este es un caso de una rara asociación de dos malformaciones aisladas.
Assuntos
Adulto , Feminino , Humanos , Septo Interatrial , Aneurisma Aórtico/complicações , Ruptura Aórtica/complicações , Átrios do Coração , Aneurisma Cardíaco/complicações , Seio Aórtico , Ruptura EspontâneaRESUMO
A arteriografia é um exame radiológico invasivo que permite ver as características da luz das artérias tronculares e de pequenos ramos musculares e colaterais, tornando possível constatar alterações parietais mínimas através da injeção intravascular de meio de contraste. Apesar do grande desenvolvimento tecnológico que experimentou nas últimas décadas, tem limitações para definir a extensão da obstrução e o leito arterial pósobstrução na Doença Arterial Oclusiva de Membros Inferiores (DAO). Alguns estudos já analisaram a arteriografia quanto à visibilização do leito distal em pacientes com DAO femoropoplítea, porém nenhum estudou a extensão do segmento ocluído no território aortoilíaco utilizando a arteriografia intra-operatória com injeção distal de contraste como teste padrão. Este estudo clínico, prospectivo, conduzido no Serviço de Cirurgia Vascular do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, foi desenvolvido para avaliar a arteriografia pré-operatória em sua capacidade de detectar a real extensão das oclusões arteriais, e o leito arterial distal a estas. A Ecografia com Doppler colorido também foi avaliada nesses mesmos aspectos. A extensão da oclusão foi definida como sendo a distância entre o ponto de oclusão e o ponto de reenchimento (PR) da luz arterial, e o leito distal (LD) definido como o conjunto de todas as artérias que mantêm continuidade com este ponto de reenchimento. Todos os pacientes incluídos foram submetidos, em mesmo intervalo determinado de tempo, a uma Arteriografia com injeção de meio de contraste Proximal à obstrução (AP), uma Ecografia com Doppler colorido (Eco-Doppler) e ao padrão-ouro para diagnóstico do PR e LD, que é a Arteriografia com injeção de contraste Distal à obstrução (AD). Foram estudados 47 membros inferiores, de 33 pacientes. Trinta e quatro casos de doença aortoilíaca e 13 casos de doença arterial infrainguinal femoropoplítea. A AP detectou o verdadeiro PR em apenas 53,2%...
Arteriography is an invasive method of imaging the vascular system that allows assessment of the intraluminal characteristics of the arteries. It detects minimal arterial wall changes with intravascular injections of contrast agents. Dispite significant advances in lasts decades, some pitfalls remain in determining the extension of arterial occlusions and the run-off vessels in cases of arterial occlusive disease in the lower extremities (LEAOD). Some authors have already studied the extension of the disease, by arteriography, in patients with femoropopliteal disease; nevertheless, none of them has so far used the Intraoperative Distal Prebypass Arteriography (IDA) as the goldstandard in patients with disease in the aortoiliac territory. This study is a clinical, prospective trial, developed by the Division of Vascular Surgery at the University of Sao Paulo to analyse the pre-operative arteriography (POA) in its capacity of showing the true extension of the arterial occlusion and the run-off vessels in LEAOD. The Duplex Ultrasound Arterial Mapping (DUAM) was also tested in the same situations. Extension of the arterial occlusion was defined as the length between the point where the contrast agent leaves the main vessel, and the point where the contrast come back to it, in the arterial system, the later called Refilling Point (RP). Run-off was defined as the sum of the distal arteries continuous with the RP. All of the patients included in this study were subjected in a determined time interval to a POA, a DUAM and a IDA. Forty seven lower extremities were studied in 33 patients (34 with aortoiliac, and 13 with femoropopliteal disease). POA detected the true RP in 53% of the instances, with a bad reprodutibility of the gold-standard (k = 0,44, P > 0,001). The DUAM detected the RP 74,5%, with a good results reprodutibliity (k = 0,68, P < 0,001). In the assessment of run-off vessels POA and DUAM have detected, respectively, 125 and 167 of the 183...