RESUMEN
Cholesterol crystal (CC) embolism is a disease in which CCs from atherosclerotic lesions embolize peripheral arteries, causing organ dysfunction. In this case, a patient with spontaneously ruptured aortic plaques (SRAPs) identified by non-obstructive general angioscopy (NOGA) may have developed a CC embolism. This is the first report of a CC embolism in a patient with SRAPs identified using NOGA, which further supports the previously speculated pathogenesis of CC embolism due to SRAPs.
Asunto(s)
Angioscopía , Embolia por Colesterol , Placa Aterosclerótica , Humanos , Embolia por Colesterol/complicaciones , Embolia por Colesterol/diagnóstico , Angioscopía/métodos , Placa Aterosclerótica/complicaciones , Placa Aterosclerótica/diagnóstico , Placa Aterosclerótica/diagnóstico por imagen , Masculino , Rotura de la Aorta/complicaciones , Rotura de la Aorta/diagnóstico , Rotura Espontánea , AncianoRESUMEN
A young female patient presented with complaints of breathlessness and palpitations since 2 years. On clinical examination, there was a loud continuous murmur at the right sternal border.Transthoracic echocardiography and colour Doppler showed a tunnel-like structure originating from the aneurysmal right coronary sinus and opening into the right atrium with left to right shunt. Coronary angiography revealed a large tunnel beginning in right coronary sinus and terminating in the right atrium and right coronary artery (RCA) was seen originating from the tunnel. Cardiac catheterisation revealed normal pulmonary artery pressure. CT and 3D-reconstructed images delineated the extracardiac course of the tunnel.Various treatment modalities including percutaneous transcatheter approach and surgical treatment were taken into consideration, but because of the close proximity of RCA from the tunnel opening, surgical closure was preferred.
Asunto(s)
Aneurisma de la Aorta , Rotura de la Aorta , Cardiopatías Congénitas , Seno Aórtico , Humanos , Femenino , Seno Aórtico/diagnóstico por imagen , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/cirugía , Ecocardiografía , Rotura de la Aorta/diagnósticoRESUMEN
An 80-year-old woman who was an active smoker with neglected long-term hypertension, but no known previous aortic or connective tissue disorders, presented to the emergency department complaining of sudden chest pain associated with cardiogenic shock.
Asunto(s)
Rotura de la Aorta , Femenino , Humanos , Anciano de 80 o más Años , Rotura de la Aorta/diagnóstico , Rotura de la Aorta/etiología , Rotura de la Aorta/cirugía , Aorta , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Servicio de Urgencia en Hospital , Choque Cardiogénico/diagnóstico , Choque Cardiogénico/etiologíaRESUMEN
BACKGROUND: Sinus of Valsalva aneurysm (SVA) is an extremely rare condition, and its rupture causes acute symptoms such as chest pain and dyspnea. Ruptured SVA is frequently associated with other congenital defects. CASE PRESENTATION: A 37-year-old male presented with SVA originating from the left coronary sinus that ruptured into the interventricular septum. SVA was diagnosed by echocardiography, cardiac computed tomography and magnetic resonance imaging, and confirmed during the operation. CONCLUSIONS: SVA is a rare cardiac abnormality which can lead to severe clinical symptoms upon rupture. Immediate surgery is necessary to repair the ruptured SVA.
Asunto(s)
Aneurisma de la Aorta , Enfermedades de la Aorta , Disección Aórtica , Rotura de la Aorta , Seno Coronario , Seno Aórtico , Tabique Interventricular , Masculino , Humanos , Adulto , Seno Aórtico/diagnóstico por imagen , Seno Aórtico/cirugía , Seno Aórtico/patología , Tabique Interventricular/diagnóstico por imagen , Tabique Interventricular/cirugía , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/cirugía , Enfermedades de la Aorta/complicaciones , Rotura de la Aorta/diagnóstico , Rotura de la Aorta/diagnóstico por imagenRESUMEN
A case of cardioembolic stroke in a patient with sinus of Valsalva aneurysm. The patient presented with chief complaints of syncope, with slurring of speech and a history of deviation of angle of mouth to the right side, which resolved over one day. Examination revealed no focal neurological deficit. CT Brain revealed a lacunar infarct over the left frontal cortex. Echocardiography showed sinus of Valsalva aneurysm of the non-coronary cusp. Hence a diagnosis of cardioembolic stroke secondary to thrombus present in the sinus of Valsalva of the aneurysm was considered. This is a rare presentation of Sinus of Valsalva as a cardioembolic stroke.
Asunto(s)
Aneurisma de la Aorta , Rotura de la Aorta , Accidente Cerebrovascular Embólico , Seno Aórtico , Humanos , Rotura de la Aorta/complicaciones , Rotura de la Aorta/diagnóstico , Seno Aórtico/diagnóstico por imagen , Accidente Cerebrovascular Embólico/complicaciones , Aneurisma de la Aorta/complicaciones , Ecocardiografía/efectos adversosRESUMEN
Abdominal aortic aneurysms are found in up to 6% of men and 1.7% of women over the age of 65 years and are usually asymptomatic. The natural history of aortic aneurysms is continued dilation leading to rupture, which is associated with an overall 80% mortality. Of the patients with ruptured aneurysms that undergo intervention, half will not survive their hospitalization. Reduction in aneurysm mortality is therefore achieved by prophylactic repair during the asymptomatic period. On a population-based level, this is supported by abdominal aortic aneurysm screening programs. Approximately 60% of abdominal aortic aneurysms are confined to the infrarenal portion of the aorta and are amenable to repair with off-the-shelf endovascular devices. Endovascular techniques have now replaced open surgery as the primary modality for aneurysm repair.
Asunto(s)
Aneurisma de la Aorta Abdominal , Rotura de la Aorta , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Masculino , Humanos , Femenino , Anciano , Resultado del Tratamiento , Implantación de Prótesis Vascular/métodos , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/cirugía , Aorta , Rotura de la Aorta/diagnóstico , Rotura de la Aorta/etiología , Rotura de la Aorta/cirugía , Factores de RiesgoRESUMEN
A 47-year-old previously healthy man was referred to a local hospital with chest tightness, oliguria, and lower extremity edema for seven days. An initial investigation revealed acute heart failure and kidney injury. The patient was intensively treated with cardiac and renal replacement therapy, and cardiorenal function improved one week later. Two months later, echocardiography was performed because chest tightness and edema had not resolved. Echocardiography showed Valsalva sinus rupture, and the patient was transferred to our center. Myocardial calcification was observed in the left ventricular wall on computed tomography after admission. The patient underwent cardiac surgery and recovered smoothly. At the three-year follow up, the patient was asymptomatic with normal renal function and serum electrolytes. Imaging revealed a significant reduction in diffuse calcification of the left ventricular wall. This case indicates that this rare form of reversible myocardial calcification may be associated with acute heart and renal failure caused by Valsalva sinus rupture. The results of this case will guide clinicians about further management and timely referral of such patients to appropriate specialties.
Asunto(s)
Aneurisma de la Aorta , Rotura de la Aorta , Insuficiencia Cardíaca , Seno Aórtico , Aneurisma de la Aorta/cirugía , Rotura de la Aorta/complicaciones , Rotura de la Aorta/diagnóstico , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/etiología , Humanos , Riñón/fisiología , Masculino , Persona de Mediana Edad , Seno Aórtico/diagnóstico por imagen , Seno Aórtico/cirugíaRESUMEN
Mortality remains high after emergency open surgery for a ruptured abdominal aortic aneurysm (RAAA). The aim of the present study was to assess, if intravenous (IV) Interferon (IFN) beta-1a improve survival after surgery by up-regulating Cluster of differentiation (CD73). This is a multi-center phase II double-blind, 2:1 randomized, parallel group comparison of the efficacy and safety of IV IFN beta-1a vs. placebo for the prevention of death after open surgery for an infra-renal RAAA. All study patients presented a confirmed infra-renal RAAA, survived the primary emergency surgery and were treated with IFN beta-1a (10 µg) or matching placebo for 6 days after surgery. Major exclusion criteria included fatal hemorrhagic shock, chronic renal replacement therapy, diagnosed liver cirrhosis, severe congestive heart failure, advanced malignant disease, primary attempt of endovascular aortic repair (EVAR), and per-operative suprarenal clamping over 30 min. Main outcome measure was all-cause mortality at day 30 (D30) from initial emergency aortic reconstruction. The study was pre-maturely stopped due to a reported drug-drug interaction and was left under-powered. Out of 40 randomized patients 38 were included in the outcome analyses (27 IFN beta-1a and 11 placebo). There was no statistically significant difference between treatment groups at baseline except more open-abdomen and intestinal ischemia was present in the IFN beta-1a arm. D30 all-cause mortality was 22.2% (6/27) in the IFN beta-1a arm and 18.2% (2/11) in the placebo arm (OR 1.30; 95% CI 0.21-8.19). The most common adverse event relating to the IFN beta-1a was pyrexia (20.7% in the IFN beta-1a arm vs. 9.1% in the placebo arm). Patients with high level of serum CD73 associated with survival (P = 0.001) whereas the use of glucocorticoids and the presence of IFN beta-1a neutralizing antibodies associated with a poor CD73 response and survival. The initial aim of the trial, if postoperative INF beta-1a treatment results on better RAAA survival, could not be demonstrated. Nonetheless the anticipated target mechanism up-regulation of CD73 was associated with 100% survival. According to present results the INF beta-1a induced up-regulation of serum CD73 was blocked with both use of glucocorticoids and serum IFN beta-1a neutralizing antibodies. The study was pre-maturely stopped due to interim analysis after a study concerning the use if IV IFN beta-1a in ARDS suggested that the concomitant use of glucocorticoids and IFN beta-1a block the CD73 induction. Trial registration: ClinicalTrials.gov NCT03119701. Registered 19/04/2017 (retrospectively registered).
Asunto(s)
5'-Nucleotidasa/metabolismo , Adyuvantes Inmunológicos/uso terapéutico , Aneurisma de la Aorta Abdominal/terapia , Rotura de la Aorta/terapia , Interferón beta-1a/uso terapéutico , Procedimientos Quirúrgicos Vasculares , Adyuvantes Inmunológicos/efectos adversos , Administración Intravenosa , Anciano , Anciano de 80 o más Años , Anticuerpos Neutralizantes/sangre , Aneurisma de la Aorta Abdominal/inmunología , Aneurisma de la Aorta Abdominal/metabolismo , Aneurisma de la Aorta Abdominal/mortalidad , Rotura de la Aorta/diagnóstico , Rotura de la Aorta/inmunología , Rotura de la Aorta/mortalidad , Método Doble Ciego , Interacciones Farmacológicas , Terminación Anticipada de los Ensayos Clínicos , Urgencias Médicas , Femenino , Finlandia , Proteínas Ligadas a GPI/metabolismo , Glucocorticoides/efectos adversos , Humanos , Interferón beta-1a/efectos adversos , Interferón beta-1a/inmunología , Masculino , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Regulación hacia Arriba , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/mortalidadRESUMEN
OBJECTIVES: Patient injury claims data and insurance records provide detailed information on patient injuries. This study aimed to identify the errors and adverse events that led to patient injuries in vascular surgery for the treatments of abdominal aortic aneurysms (AAA) and iliac artery aneurysms (IAA) in Finland. The study also assessed the severity and preventability of the injuries. MATERIALS AND METHODS: A retrospective analysis of Finnish Patient Insurance Centre's insurance charts of compensated patient injuries in the treatment of AAA and IAA. Records of all compensated patient injury claims involving AAA and IAA between 2004 and 2017 inclusive were reviewed. Contributing factors to injury were identified and classified. The injuries were assessed for their preventability by using the WHO Surgical Safety Checklist correctly. The degree of harm was graded by Clavien-Dindo classification. RESULTS: Twenty-six patient injury incidents were identified in the treatment of 23 patients. Typical injuries involved delays in diagnosis or treatment, errors in surgical technique or injuries to adjacent anatomic organs. Three (13.0%) patients died due to patient injury. Two deaths were caused by delays in diagnosis of ruptured abdominal aortic aneurysm (RAAA) and the third death was due to missed diagnosis of post-operative myocardial infarction. Retained foreign material caused injuries to two (8.7%) patients. One (4.3%) patient had a severe postoperative infection. Three (13.0%) patients experienced an injury to an adjacent organ. One patient had a bilateral and another a unilateral above-the-knee amputation due to patient injury. Three injuries were considered preventable. Most harms were grade IIIb Clavien-Dindo classification in which injured patients required a surgical intervention under general anesthesia. CONCLUSIONS: Compensated patient injuries involving the treatment of AAA and IAA are rare, but are often serious. Injuries were identified during all stages of care. Most injuries involved open surgical procedures.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Aneurisma Ilíaco/cirugía , Complicaciones Intraoperatorias/epidemiología , Errores Médicos/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Vasculares/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/mortalidad , Rotura de la Aorta/diagnóstico , Rotura de la Aorta/mortalidad , Diagnóstico Tardío , Femenino , Finlandia/epidemiología , Humanos , Aneurisma Ilíaco/mortalidad , Seguro de Salud , Complicaciones Intraoperatorias/economía , Masculino , Errores Médicos/economía , Errores Médicos/mortalidad , Persona de Mediana Edad , Complicaciones Posoperatorias/economía , Complicaciones Posoperatorias/mortalidad , Sistema de Registros , Estudios RetrospectivosRESUMEN
BACKGROUND: Coronavirus disease 2019 (COVID-19) has become a global pandemic which may compromise the management of vascular emergencies. An uncompromised treatment for ruptured abdominal aortic aneurysm (rAAA) during such a health crisis represents a challenge. This study aimed to demonstrate the treatment outcomes of rAAA and the perioperative prevention of cross-infection under the COVID-19 pandemic. METHODS: In cases of rAAA during the pandemic, a perioperative workflow was applied to expedite coronavirus testing and avoid pre-operative delay, combined with a strategy for preventing cross-infection. Data of rAAA treated in 11 vascular centers between January-March 2020 collected retrospectively were compared to the corresponding period in 2018 and 2019. RESULTS: Eight, 12, and 14 rAAA patients were treated in 11 centers in January-March 2018, 2019, and 2020, respectively. An increased portion were treated at local hospitals with a comparable outcome compared with large centers in Guangzhou. With EVAR-first strategy, 85.7% patients with rAAA in 2020 underwent endovascular repair, similar to that in 2018 and 2019. The surgical outcomes during the pandemic were not inferior to that in 2018 and 2019. The average length of ICU stay was 1.8 ± 3.4 days in 2020, tending to be shorter than that in 2018 and 2019, whereas the length of hospital stay was similar among 3 years. The in-hospital mortality of 2018, 2019, and 2020 was 37.5%, 25.0%, and 14.3%, respectively. Three patients undergoing emergent surgeries were suspected of COVID-19, though turned out to be negative after surgery. CONCLUSIONS: Our experience for emergency management of rAAA and infection prevention for healthcare providers is effective in optimizing emergent surgical outcomes during the COVID-19 pandemic.
Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/cirugía , COVID-19/prevención & control , Infección Hospitalaria/prevención & control , Control de Infecciones , Procedimientos Quirúrgicos Vasculares , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico , Rotura de la Aorta/diagnóstico , COVID-19/diagnóstico , COVID-19/transmisión , COVID-19/virología , Prueba de COVID-19 , China , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/transmisión , Infección Hospitalaria/virología , Urgencias Médicas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Seguridad del Paciente , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos , Flujo de TrabajoRESUMEN
OBJECTIVE: Thoracic endovascular aortic repair (TEVAR) is increasingly utilized in the management of acute type B aortic intramural hematoma (TBIMH). Optimal timing for intervention has not been described. The aim of this study was to evaluate TEVAR timing on postoperative aortic remodeling. METHODS: A retrospective chart review was performed on patients who underwent TEVAR for TBIMH from January 2008 to September 2018. Imaging was reviewed pre- and postoperatively. Primary data points included true lumen diameter (TLD) and total aortic diameter (TAD) at the site of maximal pathology. Primary endpoint was aortic remodeling evidenced by a TAD/TLD ratio closest to 1.0. Secondary outcome was occurrence of aortic-related adverse events and mortality (AREM): aortic rupture, aortic-related death, progression to dissection, or need for aortic reintervention within 12 months. Patients undergoing emergent TEVAR (within 24 hours, 'eTEVAR') were compared with the remainder - delayed TEVAR ('dTEVAR'). RESULTS: We analyzed 71 patients that underwent TEVAR for TBIMH; 25 underwent emergent TEVAR and 46 patients underwent dTEVAR (median, 5.5 days; range, 2-120 days). There were no differences in demographics and comorbidities, and patients did not differ in presenting IMH thickness (12.6 ± 3.1 vs 11.3 ± 4.1 mm; P = .186) nor presenting TAD/TLD ratio (1.535 ± 0.471 vs 1.525 ± 0.397; P = .928) for eTEVAR and dTEVAR groups, respectively. eTEVAR patients had larger average presenting maximal descending aortic diameter (45.8 ± 14.3 vs 38.2 ± 7.5 mm; P = .018) and higher incidence of penetrating aortic ulcer on presenting computed tomography angiography (52.0% vs 21.7%; P = .033). Thirty-day mortality was 2 of 25 (8.0%) for eTEVAR and 2 of 45 (4.4%) for dTEVAR (P = .602). Postoperative aortic remodeling was more complete in the dTEVAR group (1.23 ± 0.12 vs 1.33 ± 0.15; P = .004). Case-control matching (controlling for presenting descending aortic diameter and penetrating aortic ulcer) on 30 patients still showed better aortic remodeling in the dTEVAR group (1.125 ± 0.100 vs 1.348 ± 0.42; P < .001). The incidence of AREM was higher in the eTEVAR (6/25; 24.0%) group compared with the dTEVAR group (2/46; 4.3%). At 12 months, freedom from AREM was higher in the dTEVAR group (95.7% vs 76.0%; P = .011). Postoperative TAD/TLD ratio was the best predictor for late aortic-related adverse events (area under the receiver operator characteristic = 0.825; P = .003). CONCLUSIONS: TEVAR for acute TBIMH within 24 hours of admission is associated with lower aortic remodeling and higher occurrence of late AREM. Delaying TEVAR when clinically possible could improve aortic remodeling and aortic-related outcomes.
Asunto(s)
Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/complicaciones , Rotura de la Aorta/cirugía , Procedimientos Endovasculares/métodos , Hematoma/etiología , Remodelación Vascular , Anciano , Disección Aórtica/diagnóstico , Disección Aórtica/cirugía , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/fisiopatología , Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/diagnóstico , Rotura de la Aorta/complicaciones , Rotura de la Aorta/diagnóstico , Aortografía , Prótesis Vascular , Angiografía por Tomografía Computarizada , Femenino , Estudios de Seguimiento , Hematoma/diagnóstico , Humanos , Masculino , Periodo Posoperatorio , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Abdominal aortic aneurysm (AAA) represents an important public health problem. The early detection and treatment as well as follow-up of an AAA are important to reduce the high mortality rate associated with its rupture. Despite the decline of the prevalence of AAA in the last decades, the latest international recommendations have reaffirmed that screening in men remains cost-effective. In contrast, the data and recommendations for women are unclear. The best method for AAA screening is abdominal ultrasound. The aim of this paper is to present an up-to-date review of the indications for AAA screening based on the latest recommendations.
L'anévrisme de l'aorte abdominale (AAA) reste toujours un problème de santé publique malgré les progrès technologiques réalisés dans sa prise en charge. Le diagnostic précoce et le traitement ainsi que le suivi d'un AAA sont importants pour prévenir le taux de mortalité très élevé associé à sa rupture. Bien que la prévalence de l'AAA ait diminué ces dernières décennies, les dernières recommandations internationales ont réaffirmé qu'un dépistage chez les hommes reste rentable. En revanche, les données et les recommandations concernant la femme ne sont pas claires. L'examen de choix pour le dépistage des AAA est l'échographie abdominale. Cet article vise à mettre à jour les indications de dépistage de l'AAA en fonction des dernières recommandations.
Asunto(s)
Aneurisma de la Aorta Abdominal , Rotura de la Aorta , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/epidemiología , Rotura de la Aorta/diagnóstico , Rotura de la Aorta/epidemiología , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Tamizaje Masivo , UltrasonografíaAsunto(s)
Traumatismos Abdominales , Rotura de la Aorta , Oclusión con Balón , Intubación e Inducción de Secuencia Rápida/métodos , Choque Hemorrágico , Traumatismos Torácicos , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/etiología , Traumatismos Abdominales/fisiopatología , Accidentes de Tránsito , Adolescente , Rotura de la Aorta/diagnóstico , Rotura de la Aorta/etiología , Rotura de la Aorta/fisiopatología , Rotura de la Aorta/terapia , Oclusión con Balón/efectos adversos , Oclusión con Balón/instrumentación , Oclusión con Balón/métodos , Catéteres/efectos adversos , Análisis de Falla de Equipo , Traumatismos Faciales/diagnóstico , Traumatismos Faciales/etiología , Resultado Fatal , Humanos , Masculino , Huesos Pélvicos/diagnóstico por imagen , Huesos Pélvicos/lesiones , Resucitación/métodos , Choque Hemorrágico/etiología , Choque Hemorrágico/fisiopatología , Choque Hemorrágico/terapia , Traumatismos Torácicos/etiología , Traumatismos Torácicos/fisiopatología , Traumatismos Torácicos/terapiaRESUMEN
It remains difficult to predict when which patients with abdominal aortic aneurysm (AAA) will require surgery. The aim was to study the accuracy of geometric and biomechanical analysis of small AAAs to predict reaching the threshold for surgery, diameter growth rate and rupture or symptomatic aneurysm. 189 patients with AAAs of diameters 40-50 mm were included, 161 had undergone two CTAs. Geometric and biomechanical variables were used in prediction modelling. Classifications were evaluated with area under receiver operating characteristic curve (AUC) and regressions with correlation between observed and predicted growth rates. Compared with the baseline clinical diameter, geometric-biomechanical analysis improved prediction of reaching surgical threshold within four years (AUC 0.80 vs 0.85, p = 0.031) and prediction of diameter growth rate (r = 0.17 vs r = 0.38, p = 0.0031), mainly due to the addition of semiautomatic diameter measurements. There was a trend towards increased precision of volume growth rate prediction (r = 0.37 vs r = 0.45, p = 0.081). Lumen diameter and biomechanical indices were the only variables that could predict future rupture or symptomatic AAA (AUCs 0.65-0.67). Enhanced precision of diameter measurements improves the prediction of reaching the surgical threshold and diameter growth rate, while lumen diameter and biomechanical analysis predicts rupture or symptomatic AAA.
Asunto(s)
Aorta Abdominal/patología , Aneurisma de la Aorta Abdominal/diagnóstico , Rotura de la Aorta/diagnóstico , Fenómenos Biomecánicos , Aprendizaje Automático , Modelos Cardiovasculares , Algoritmos , Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/cirugía , Área Bajo la Curva , Toma de Decisiones Clínicas , Angiografía por Tomografía Computarizada , Manejo de la Enfermedad , Humanos , Pronóstico , Curva ROC , Tomografía Computarizada por Rayos XRESUMEN
Aneurysm of the sinus of Valsalva is a rare cardiac condition, which could be either acquired or congenital. The most frequent complication is a rupture into right cavities or more rarely into left cavities or pericardium. Rupture could be either asymptomatic or poorly tolerated with hemodynamic instability, acute heart failure or sudden death. We report the case of a 24-year-old patient with no past medical history presenting with a partially ruptured sinus of Valsalva into the pericardium and in whom the initial diagnosis was idiopathic pericardial effusion; we describe diagnostic modalities and management.
Asunto(s)
Aneurisma de la Aorta , Rotura de la Aorta , Derrame Pericárdico , Seno Aórtico , Adulto , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/diagnóstico por imagen , Rotura de la Aorta/diagnóstico , Rotura de la Aorta/diagnóstico por imagen , Humanos , Derrame Pericárdico/etiología , Pericardio , Seno Aórtico/diagnóstico por imagen , Adulto JovenRESUMEN
Rupture risk stratification is critical for incidentally detected intracranial aneurysms. Here we developed and validated an institutional nomogram to solve this issue. We reviewed the imaging and clinical databases for aneurysms from January 2015 to September 2018. Aneurysms were reconstructed and morphological features were extracted by the Pyradiomics in python. Multiple logistic regression was performed to develop the nomogram. The consistency of the nomogram predicted rupture risks and PHASES scores was assessed. The performance of the nomogram was evaluated by the discrimination, calibration, and decision curve analysis (DCA). 719 aneurysms were enrolled in this study. For each aneurysm, twelve morphological and nine clinical features were obtained. After logistic regression, seven features were enrolled in the nomogram, which were SurfaceVolumeRatio, Flatness, Age, Hyperlipemia, Smoker, Multiple aneurysms, and Location of the aneurysm. The nomogram had a positive and close correlation with PHASES score in predicting aneurysm rupture risks. AUCs of the nomogram in discriminating aneurysm rupture status was 0.837 in a separate testing set. The calibration curves fitted well and DCA demonstrated positive net benefits of the nomogram in guiding clinical decisions. In conclusion, Pyradiomics derived morphological features based institutional nomogram was useful for aneurysm rupture risk stratification.
Asunto(s)
Aneurisma/diagnóstico , Rotura de la Aorta/diagnóstico , Medición de Riesgo , Accidente Cerebrovascular/diagnóstico , Anciano , Aneurisma/diagnóstico por imagen , Aneurisma/epidemiología , Aneurisma/patología , Rotura de la Aorta/diagnóstico por imagen , Rotura de la Aorta/epidemiología , Rotura de la Aorta/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nomogramas , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/patologíaRESUMEN
This case demonstrates a rare but catastrophic complication of transcatheter aortic valve replacement (TAVR). In an era where TAVR is now indicated in low-risk patients, serious complication rates are less frequent. It exemplifies the importance of preparedness for vascular injury, with readiness for vascular covered stenting and potential bail-out strategies.
Asunto(s)
Rotura de la Aorta , Estenosis de la Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Rotura de la Aorta/diagnóstico , Rotura de la Aorta/etiología , Rotura de la Aorta/cirugía , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/cirugía , Humanos , Factores de Riesgo , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: Previous studies have suggested that finite element analysis (FEA) can estimate the rupture risk of an abdominal aortic aneurysm (AAA); however, the value of biomechanical estimates over measurement of AAA diameter alone remains unclear. This study aimed to compare peak wall stress (PWS) and peak wall rupture index (PWRI) in participants with ruptured and asymptomatic intact AAAs. METHODS: The reproducibility of semiautomated methods for estimating aortic PWS and PWRI from CT images was assessed. PWS and PWRI were estimated in people with ruptured AAAs and those with asymptomatic intact AAAs matched by orthogonal diameter on a 1 : 2 basis. Spearman's correlation coefficient was used to assess the association between PWS or PWRI and AAA diameter. Independent associations between PWS or PWRI and AAA rupture were identified by means of logistic regression analyses. RESULTS: Twenty individuals were included in the analysis of reproducibility. The main analysis included 50 patients with an intact AAA and 25 with a ruptured AAA. Median orthogonal diameter was similar in ruptured and intact AAAs (82·3 (i.q.r. 73·5-92·0) versus 81·0 (73·2-92·4) mm respectively; P = 0·906). Median PWS values were 286·8 (220·2-329·6) and 245·8 (215·2-302·3) kPa respectively (P = 0·192). There was no significant difference in PWRI between the two groups (P = 0·982). PWS and PWRI correlated positively with orthogonal diameter (both P < 0·001). Participants with high PWS, but not PWRI, were more likely to have a ruptured AAA after adjusting for potential confounders (odds ratio 5·84, 95 per cent c.i. 1·22 to 27·95; P = 0·027). This association was not maintained in all sensitivity analyses. CONCLUSION: High aortic PWS had an inconsistent association with greater odds of aneurysm rupture in patients with a large AAA.