RESUMO
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.
Assuntos
Aorta Torácica , Ecocardiografia Doppler , Humanos , Masculino , Feminino , Estudos Transversais , Criança , Nigéria , Pré-Escolar , Ecocardiografia Doppler/métodos , Velocidade do Fluxo Sanguíneo/fisiologia , Aorta Torácica/diagnóstico por imagem , Valores de Referência , Lactente , AdolescenteRESUMO
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.
Assuntos
Falso Aneurisma , Rouquidão , Paralisia das Pregas Vocais , Humanos , Masculino , Rouquidão/etiologia , Falso Aneurisma/terapia , Falso Aneurisma/complicações , Falso Aneurisma/diagnóstico por imagem , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/diagnóstico , Idoso , Pessoa de Meia-Idade , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Tomografia Computadorizada por Raios X , Aorta Torácica/diagnóstico por imagemRESUMO
Mutations in fibrillin 1 (FBN1) is the main cause of Marfan syndrome (MFS) with thoracic aortic aneurysm (TAA) as the main complication. Activation of the complement system plays a key role in the formation of thoracic and abdominal aortic aneurysms. However, the role of the complement system in MFS-associated aortic aneurysms remains unclear. In this study, we observed increased levels of complement C3a and C5a in the plasma of MFS patients and mouse, and the increased deposition of the activated complement system product C3b/iC3b was also observed in the elastic fiber rupture zone of 3-month-old MFS mice. The expression of C3a receptor (C3aR) was increased in MFS aortas, and recombinant C3a promoted the expression of cytokines in macrophages. The administration of a C3aR antagonist (C3aRA) attenuated the development of thoracic aortic aneurysms in MFS mice. The increased inflammation response and matrix metalloproteinases activities were also attenuated by C3aRA treatment in MFS mice. Therefore, these findings indicate that the complement C3a/C3aR inhibition alleviates the formation of aortic aneurysm in Marfan syndrome mice.
Assuntos
Adipocinas , Aneurisma da Aorta Torácica , Complemento C3a , Fibrilina-1 , Síndrome de Marfan , Receptores de Complemento , Animais , Feminino , Humanos , Masculino , Camundongos , Adipocinas/genética , Aorta Torácica/patologia , Aneurisma da Aorta Torácica/prevenção & controle , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/metabolismo , Aneurisma da Aorta Torácica/patologia , Complemento C3a/antagonistas & inibidores , Complemento C3a/metabolismo , Citocinas/metabolismo , Modelos Animais de Doenças , Fibrilina-1/genética , Mediadores da Inflamação/metabolismo , Macrófagos/metabolismo , Macrófagos/efeitos dos fármacos , Síndrome de Marfan/complicações , Síndrome de Marfan/genética , Síndrome de Marfan/tratamento farmacológico , Camundongos Endogâmicos C57BL , Receptores de Complemento/antagonistas & inibidores , Receptores Acoplados a Proteínas G , Transdução de SinaisRESUMO
Torilis japonica (TJ) fruit, is a herb that is traditionally used for erectile dysfunction (ED). Given the shared mechanisms of ED and hypertension through vascular smooth muscle, we hypothesized that TJ would be effective in vasodilation and blood pressure reduction. This study confirmed the authenticity of TJ samples via DNA barcoding and quantified the main active compound, torilin, using HPLC. TJ was extracted with distilled water (TJW) and 50% ethanol (TJE), yielding torilin contents of 0.35 ± 0.01% and 2.84 ± 0.02%, respectively. Ex vivo tests on thoracic aortic rings from Sprague-Dawley rats showed that TJE (3-300 µg/mL) induced endothelium-independent, concentration-dependent vasodilation, unlike TJW. Torilin caused concentration-dependent relaxation with an EC50 of 210 ± 1.07 µM. TJE's effects were blocked by a voltage-dependent K+ channel blocker and alleviated contractions induced by CaCl2 and angiotensin II. TJE inhibited vascular contraction induced by phenylephrine or KCl via extracellular CaCl2 and enhanced inhibition with nifedipine, indicating involvement of voltage-dependent and receptor-operated Ca2+ channels. Oral administration of TJE (1000 mg/kg) significantly reduced blood pressure in spontaneously hypertensive rats. These findings suggest TJ extract's potential for hypertension treatment through vasorelaxant mechanisms, though further research is needed to confirm its efficacy and safety.
Assuntos
Pressão Sanguínea , Endotélio Vascular , Frutas , Extratos Vegetais , Ratos Sprague-Dawley , Vasodilatação , Animais , Ratos , Vasodilatação/efeitos dos fármacos , Extratos Vegetais/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Masculino , Frutas/química , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/metabolismo , Anti-Hipertensivos/farmacologia , Vasodilatadores/farmacologia , Aorta Torácica/efeitos dos fármacos , Aorta Torácica/metabolismo , Ratos Endogâmicos SHR , Músculo Liso Vascular/efeitos dos fármacos , Músculo Liso Vascular/metabolismo , Hipertensão/tratamento farmacológico , Hipertensão/metabolismo , Hipertensão/fisiopatologiaRESUMO
BACKGROUND: Women with thoracic aortic aneurysms within the arch or descending thoracic aorta have poorer survival than men. Sex differences in relative thoracic aortic aneurysm size may account for some of the discrepancy. The aim of this study was to explore whether basing clinical management on aneurysm size index (maximum aneurysm diameter/body surface area) rather than aneurysm size can restore equality of survival by sex. METHODS: The Effective Treatments for Thoracic Aortic Aneurysms (ETTAA; ISRCTN04044627) study was a prospective, observational cohort study. Adults referred to National Health Service hospitals in England with new/existing arch or descending thoracic aorta aneurysms greater than or equal to 4 cm in diameter were followed from March 2014 to March 2022. Baseline characteristics and survival to intervention and overall were compared for men and women. Survival models were used to assess the association between all-cause survival and sex, with and without adjustment for aneurysm diameter or aneurysm size index. RESULTS: A total of 886 thoracic aortic aneurysm patients were recruited: 321 (36.2%) women and 565 (63.8%) men. The mean(s.d.) aneurysm diameter was the same for women and men (5.7(1.1) versus 5.7(1.2) cm respectively; P = 0.751), but the mean(s.d.) aneurysm size index was greater for women than for men (3.32(0.80) versus 2.83(0.63) respectively; P < 0.001). Women had significantly worse survival without intervention: 110 (34.3%) women and 135 (23.9%) men (log rank test, P < 0.001). All-cause mortality remained greater for women after adjustment for diameter (HR 1.65 (95% c.i. 1.35 to 2.02); P < 0.001), but was attenuated after adjustment for aneurysm size index (HR 1.11 (95% c.i. 0.89 to 1.38); P = 0.359). Similar results were found for all follow-up, with or without intervention, and findings were consistent for descending thoracic aorta aneurysms alone. CONCLUSION: Guidelines for referral to specialist services should consider including aneurysm size index rather than diameter to reduce inequity due to patient sex.
Assuntos
Aneurisma da Aorta Torácica , Humanos , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/terapia , Feminino , Masculino , Idoso , Estudos Prospectivos , Pessoa de Meia-Idade , Inglaterra/epidemiologia , Fatores Sexuais , Disparidades em Assistência à Saúde/estatística & dados numéricos , Aorta Torácica/patologiaRESUMO
BACKGROUND: Despite advances in diagnostic and treatment modalities, there is a need for predictive markers for recurrent strokes. OBJECTIVES: This study aimed to investigate the relationship between aortic arch calcification (AAC) and stroke recurrence in stroke patients during a one-year follow-up. METHODS: All stroke patients who experienced their first event were evaluated for participation in the study. Patients who experienced recurrent strokes during the one-year follow-up were recorded. AAC was assessed by chest radiography. Based on the occurrence of recurrent strokes the patients were divided into two groups. AAC was classified into four categories according to its degree, and the presence of AAC was included in the statistical analysis. The relationship between AAC and recurrent stroke was assessed using a receiver operating characteristic curve. A significance level of <0.05 was deemed acceptable for all statistical analyses. RESULTS: A total of 203 patients were included in the study (46.8% female, mean age 69±12.3). Recurrent stroke was detected in 49 patients. AAC, hypertension, and atrial fibrillation were more frequent in patients with recurrent stroke. Patients with recurrent stroke had a lower glomerular filtration rate and a higher red cell distribution width (RDW). In multivariate regression analysis, AAC (hazard ratio [HR], 3.544; 95% CI:1.653-7.598, p=0.001) and RDW (HR,1.214; 95% CI:1.053-1.400, p=0.008) were identified as independent predictors of recurrent stroke. CONCLUSION: The presence of AAC (≥ grade 1) and RDW were found to be significantly associated with the development of recurrent stroke within one year. These findings may have prognostic significance in the follow-up of stroke patients.
FUNDAMENTO: Apesar dos avanços nas modalidades de diagnóstico e tratamento, há necessidade de marcadores preditivos para acidente vascular cerebral (AVC) recorrentes. OBJETIVOS: Este estudo teve como objetivo investigar a relação entre calcificação do arco aórtico (CAA) e recorrência de AVC em pacientes com AVC durante o acompanhamento de um ano. MÉTODOS: Todos os pacientes com AVC que sofreram seu primeiro evento foram avaliados para participação no estudo. Foram registrados pacientes que sofreram AVC recorrentes durante o acompanhamento de um ano. A CAA foi avaliada por radiografia de tórax. Com base na ocorrência de AVC recorrente, os pacientes foram divididos em dois grupos. A CAA foi classificada em quatro categorias de acordo com o seu grau, e a presença de CAA foi incluída na análise estatística. A relação entre CAA e AVC recorrente foi avaliada por meio de uma curva característica de operação do receptor. Um nível de significância <0,05 foi considerado aceitável para todas as análises estatísticas. RESULTADOS: Um total de 203 pacientes foram incluídos no estudo (46,8% mulheres, média de idade 69±12,3). AVC recorrente foi detectado em 49 pacientes. CAA, hipertensão e fibrilação atrial foram mais frequentes em pacientes com AVC recorrente. Pacientes com AVC recorrente apresentaram menor taxa de filtração glomerular e maior largura de distribuição de glóbulos vermelhos (RDW). Na análise de regressão multivariada, CAA (hazard ratio [HR], 3,544; IC 95%:1,653-7,598, p=0,001) e RDW (HR,1,214; IC 95%:1,053-1,400, p=0,008) foram identificados como preditores independentes de AVC recorrente. CONCLUSÃO: A presença de CAA (≥ grau 1) e RDW foram significativamente associadas ao desenvolvimento de AVC recorrente dentro de um ano. Esses achados podem ter significado prognóstico no acompanhamento de pacientes com AVC.
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Aorta Torácica , Recidiva , Acidente Vascular Cerebral , Humanos , Feminino , Masculino , Aorta Torácica/diagnóstico por imagem , Idoso , Acidente Vascular Cerebral/diagnóstico por imagem , Pessoa de Meia-Idade , Fatores de Risco , Calcificação Vascular/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Radiografia Torácica , Idoso de 80 Anos ou mais , Valor Preditivo dos Testes , Seguimentos , Calcinose/diagnóstico por imagemRESUMO
BACKGROUND: Cellular communication among different types of vascular cells is indispensable for maintaining vascular homeostasis and preventing atherosclerosis. However, the biological mechanism involved in cellular communication among these cells and whether this biological mechanism can be used to treat atherosclerosis remain unknown. We hypothesized that endothelial autophagy mediates the cellular communication in vascular tissue through exosome-mediated delivery of atherosclerosis-related genes. METHODS: Rapamycin and adeno-associated virus carrying Atg7 short hairpin RNA under the Tie (TEK receptor tyrosine kinase) promoter were used to activate and inhibit vascular endothelial autophagy in high-fat diet-fed ApoE-/- mice, respectively. miRNA microarray, in vivo and in vitro experiments, and human vascular tissue were used to explore the effects of endothelial autophagy on endothelial function and atherosclerosis and its molecular mechanisms. Quantitative polymerase chain reaction and miRNA sequencing were performed to determine changes in miRNA expression in exosomes. Immunofluorescence and exosome coculture experiments were conducted to examine the role of endothelial autophagy in regulating the communication between endothelial cells and smooth muscle cells (SMCs) via exosomal miRNA. RESULTS: Endothelial autophagy was inhibited in thoracic aortas of high-fat diet-fed ApoE-/- mice. Furthermore, rapamycin alleviated high-fat diet-induced atherosclerotic burden and endothelial dysfunction, while endothelial-specific Atg7 depletion aggravated the atherosclerotic burden. miRNA microarray, in vivo and in vitro experiments, and human vascular tissue analysis revealed that miR-204-5p was significantly increased in endothelial cells after high-fat diet exposure, which directly targeted Bcl2 to regulate endothelial cell apoptosis. Importantly, endothelial autophagy activation decreased excess miR-204-5p by loading miR-204-5p into multivesicular bodies and secreting it through exosomes. Moreover, exosomal miR-204-5p can effectively transport to SMCs, alleviating SMC calcification by regulating target proteins such as RUNX2 (runt-related transcription factor 2). CONCLUSIONS: Our study revealed the exosomal pathway by which endothelial autophagy protects atherosclerosis: endothelial autophagy activation transfers miR-204-5p from endothelial cells to SMCs via exosomes, both preventing endothelial apoptosis and alleviating SMC calcification. REGISTRATION: URL: https://www.chictr.org.cn/; Unique identifier: ChiCTR2200064155.
Assuntos
Aterosclerose , Autofagia , Comunicação Celular , Modelos Animais de Doenças , Exossomos , Camundongos Endogâmicos C57BL , Camundongos Knockout para ApoE , MicroRNAs , Miócitos de Músculo Liso , MicroRNAs/metabolismo , MicroRNAs/genética , Exossomos/metabolismo , Exossomos/genética , Animais , Aterosclerose/patologia , Aterosclerose/genética , Aterosclerose/metabolismo , Aterosclerose/prevenção & controle , Humanos , Miócitos de Músculo Liso/metabolismo , Miócitos de Músculo Liso/patologia , Masculino , Camundongos , Células Endoteliais da Veia Umbilical Humana/metabolismo , Células Endoteliais da Veia Umbilical Humana/patologia , Células Endoteliais/metabolismo , Células Endoteliais/patologia , Proteína 7 Relacionada à Autofagia/metabolismo , Proteína 7 Relacionada à Autofagia/genética , Células Cultivadas , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/patologia , Placa Aterosclerótica , Doenças da Aorta/patologia , Doenças da Aorta/genética , Doenças da Aorta/prevenção & controle , Doenças da Aorta/metabolismo , Técnicas de Cocultura , Transdução de Sinais , Aorta Torácica/metabolismo , Aorta Torácica/patologia , Dieta HiperlipídicaRESUMO
Extreme Lateral Interbody Fusion (XLIF) is currently used in the clinical treatment of thoracic spine disorders and has achieved desirable results. In this study, we selected CT images of the thoracic spine from 54 patients and divided the intervertebral spaces into six regions (A, I, II, III, IV, P) using the Moro method. We observed the adjacent relationships between the thoracic spine and surrounding tissues such as the scapula, esophagus, thoracic aorta, and superior vena cava. We made four main findings: firstly, when the scapulae were symmetrical on both sides, over 80% of patients had the T1-4 II-III region obstructed by the scapulae; secondly, when the esophagus was located on the left side of the vertebral body, 3.7% to 24.1% of patients had the T4-9 region located in the II-III zone; furthermore, when the thoracic aorta was on the left side of the vertebral body, over 80% of individuals in the T4-9 segment occupied the II-III region, with the values being 55.5% and 20.4% for T9/10 and T10/11, respectively; finally, the superior vena cava was located on the right side of the T4/5 vertebra, with 3.7% of individuals having it in the II-III region, while on the left side of T5-9, 3.7% to 18.5% of individuals had it in the II-III region. Based on these findings, we suggest that XLIF should not be performed on the T1-4 vertebrae due to scapular obstruction. Selecting the left-sided approach for XLIF in the T4-11 segments may risk injuring the thoracic aorta, esophagus, and superior vena cava, while the T11/12 segment is considered safe and feasible. Choosing the right-sided approach for XLIF may pose a risk of injuring the superior vena cava in the T4/5 segment, but it is safe and feasible in the T5-12 segments.
Assuntos
Fusão Vertebral , Vértebras Torácicas , Tomografia Computadorizada por Raios X , Humanos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Vértebras Torácicas/anatomia & histologia , Fusão Vertebral/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Idoso , Adulto , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/anatomia & histologia , Aorta Torácica/cirurgia , Escápula/diagnóstico por imagem , Escápula/anatomia & histologia , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/anatomia & histologia , Esôfago/diagnóstico por imagem , Esôfago/anatomia & histologia , Esôfago/cirurgiaRESUMO
INTRODUCTION: Dissection or rupture of the aorta is accompanied by high mortality rates, and there is a pressing need for better prediction of these events for improved patient management and clinical outcomes. Biomechanically, these events represent a situation wherein the locally acting wall stress exceed the local tissue strength. Based on recent reports for polymers, we hypothesized that aortic tissue failure strength and stiffness are directly associated with tissue mass density. The objective of this work was to test this novel hypothesis for porcine thoracic aorta. METHODS: Three tissue specimens from freshly harvested porcine thoracic aorta were treated with either collagenase or elastase to selectively degrade structural proteins in the tissue, or with phosphate buffer saline (control). The tissue mass and volume of each specimen were measured before and after treatment to allow for density calculation, then mechanically tested to failure under uniaxial extension. RESULTS: Protease treatments resulted in statistically significant tissue density reduction (sham vs. collagenase p = 0.02 and sham vs elastase p = 0.003), which in turn was significantly and directly correlated with both ultimate tensile strength (sham vs. collagenase p = 0.02 and sham vs elastase p = 0.03) and tangent modulus (sham vs. collagenase p = 0.007 and sham vs elastase p = 0.03). CONCLUSIONS: This work demonstrates for the first time that tissue stiffness and tensile strength are directly correlated with tissue density in proteolytically-treated aorta. These findings constitute an important step towards understanding aortic tissue failure mechanisms and could potentially be leveraged for non-invasive aortic strength assessment through density measurements, which could have implications to clinical care.
Assuntos
Aorta Torácica , Resistência à Tração , Animais , Suínos , Aorta Torácica/fisiologia , Elastase Pancreática/metabolismo , Colagenases , Proteólise , Rigidez Vascular/fisiologia , Estresse MecânicoRESUMO
A 74-year-old male entered the hospital with a medical history of an aortic arch and a descending thoracic aneurysm. To prevent arm ischaemia after the frozen elephant trunk procedure, a left subclavian artery to left common carotid artery anastomosis was performed. The postoperative period was complicated by sepsissternal infection and mediastinitis. We decided to perform a combined total aortic root and aortic arch replacement with 3 cryopreserved homografts. In addition, the "reverse arch technique" was applied to adapt the distal anastomosis. The operation is associated with a high risk of mortality in the postoperative period.
Assuntos
Aorta Torácica , Aneurisma da Aorta Torácica , Humanos , Masculino , Idoso , Aneurisma da Aorta Torácica/cirurgia , Aorta Torácica/cirurgia , Reoperação , Implante de Prótese Vascular/métodos , Implante de Prótese Vascular/efeitos adversos , Aloenxertos , Prótese Vascular/efeitos adversos , Anastomose Cirúrgica/métodos , Artéria Subclávia/cirurgia , Criopreservação/métodosRESUMO
OBJECTIVES: To evaluate the impact of previous cardiac surgery (PCS) on clinical outcomes after reoperative extended arch repair for acute type A aortic dissection. METHODS: This study included 37 acute type A aortic dissection patients with PCS (PCS group) and 992 without PCS (no-PCS group). Propensity score-matching yielded a subgroup of 36 pairs (1:1). In-hospital outcomes and mid-term survival were compared between the 2 groups. RESULTS: The PCS group was older (56.7 ± 14.2 vs 52.2 ± 12.6 years, P = 0.036) and underwent a longer cardiopulmonary bypass (median, 212 vs 183 min, P < 0.001) compared with the no-PCS group. Operative death occurred in 88 (8.6%) patients, exhibiting no significant difference between groups (13.5% vs 8.4%, P = 0.237). Major postoperative morbidity was observed in 431 (41.9%) patients, also showing no difference between groups (45.9% vs 41.7%, P = 0.615). Moreover, the multivariable logistic regression analysis revealed that PCS was not significantly associated with operative mortality (adjusted odds ratio 2.58, 95% confidence interval 0.91-7.29, P = 0.075) or major morbidity (adjusted odds ratio 1.92, 95% confidence interval 0.88-4.18, P = 0.101). The 3-year cumulative survival rates were 71.1% for the PCS group and 83.9% for the no-PCS group (log-rank P = 0.071). Additionally, Cox regression indicated that PCS was not significantly associated with midterm mortality (adjusted hazard ratio 1.40, 95% confidence interval 0.44-4.41, P = 0.566). After matching, no significant differences were found between groups in terms of operative mortality (P > 0.999), major morbidity (P > 0.999) and midterm survival (P = 0.564). CONCLUSIONS: No significant differences were found between acute type A aortic dissection patients with PCS and those without PCS regarding in-hospital outcomes and midterm survival after extended arch repair.
Assuntos
Aneurisma da Aorta Torácica , Dissecção Aórtica , Procedimentos Cirúrgicos Cardíacos , Reoperação , Humanos , Dissecção Aórtica/cirurgia , Dissecção Aórtica/mortalidade , Masculino , Feminino , Pessoa de Meia-Idade , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/mortalidade , Idoso , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Complicações Pós-Operatórias/epidemiologia , Aorta Torácica/cirurgia , Resultado do Tratamento , Doença Aguda , Adulto , Implante de Prótese Vascular/métodos , Implante de Prótese Vascular/efeitos adversos , Pontuação de PropensãoRESUMO
OBJECTIVES: To report experience with a Relay® stent-graft custom-made platform in treating different aortic arch pathology in 2 high-volume aortic centres. METHODS: A retrospective analysis of all patients treated between July 2016 and July 2023 with custom-made Relay® stent-graft (custom-made device). Underlying aortic arch pathology was an aneurysm, penetrating aortic ulcer, and dissection. Three custom-made device designs were used: proximal scallop, fenestrations, and inner branches. The endpoints were technical success, perioperative stroke, death, and reintervention rate. RESULTS: Thirty-five patients (89% males) with a mean age of 70 ± 11 years were treated.Indication for treatment was penetrating aortic ulcer in 14 patients (40%), aneurysm in 11 patients (31%) and aortic dissection in 10 patients (29%). The technical success rate was 100%. Twenty-eight patients (80%) had proximal sealing in zone 0, and 7 (20%) had proximal sealing in zone 1. Nine patients (25.6%) had proximal scallops, 9 (25.6%) had 1 big fenestration and 17 (48.8%) had a branched device; 1 with single branch, 15 with double branches and 1 with triple branches. Thirty patients (86%) had previous or simultaneous left subclavian artery revascularization. No patient died during 30 days. Two patients (5.7%) had stroke postoperatively; both recovered without disabling deficits. The mean follow-up was 35 ± 26 months. Six patients (17.1%) died during follow-up. One patient required reinforcement of the bridging stent in the left common carotid artery and one additional vascular plugging of the left subclavian artery. Three patients received distal extension. CONCLUSIONS: The Relay® stent-graft custom-made platform showed a good performance in our study with a high technical success rate, low perioperative stroke and mortality, and low reintervention rates during the follow-up.
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Aorta Torácica , Implante de Prótese Vascular , Prótese Vascular , Desenho de Prótese , Stents , Humanos , Masculino , Idoso , Feminino , Estudos Retrospectivos , Aorta Torácica/cirurgia , Aorta Torácica/diagnóstico por imagem , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodos , Pessoa de Meia-Idade , Resultado do Tratamento , Idoso de 80 Anos ou mais , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/instrumentação , Doenças da Aorta/cirurgiaRESUMO
The following video tutorial presents the surgical correction of the left circumflex aortic arch in a 6-month-old boy with severe respiratory distress and stridor. The diagnosis was confirmed using cardiac catheterization and computed tomography. Intraoperative bronchoscopy showed marked compression of the trachea. An operation was planned to translocate the aortic arch anteriorly and to close the atrial septal defect. After a median sternotomy, the mediastinal structures were carefully mobilized and dissected. The trachea was carefully mobilized and the right ligamentum arteriosum was clipped and divided. Control of the aortic arch vessels, as well as the aberrant right subclavian artery from the right descending aorta, was achieved using vessel loops. An arterial line inserted in the femoral artery was connected to the heart-lung machine. Hence the surgical procedure was undertaken in selective antegrade cerebral perfusion combined with distal body perfusion, avoiding the need for deep hypothermic arrest. Careful mobilization of the complete course of the proximal and distal sections of the circumflex arch allowed its translocation from its retro-oesophageal course. The aortic stump distal to the left subclavian artery was closed by running polypropylene suture. An appropriate site on the ascending aorta was selected to ensure tension- and torsion-free anastomoses. Postoperative bronchoscopy confirmed relief of the tracheal compression.
Assuntos
Aorta Torácica , Humanos , Masculino , Aorta Torácica/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/anormalidades , Lactente , Artéria Subclávia/cirurgia , Artéria Subclávia/anormalidades , Tomografia Computadorizada por Raios X , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
Total endovascular aortic arch repair is nowadays a promising alternative for selected patients with aortic arch disease. These endovascular procedures are technically challenging and require a diligent planning among all members of a multidisciplinary "Aorta Team" integrating cardiovascular anesthesiologists. In fact, endovascular aortic arch repair is a major challenge for anesthesiologists because of the risk of hemodynamic instability, cerebral events and acute kidney injury. In order to achieve the success, it is fundamental to discuss each patient in an individual basis, including perioperative management and care, and to be aware of surgical steps and their potential complications. Considering our previous experience with endovascular thoracoabdominal aortic surgery, we herein summarize our experience with anesthetic management of patients who underwent total endovascular aortic arch repair and its principal outcomes.
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Aorta Torácica , Procedimentos Endovasculares , Humanos , Procedimentos Endovasculares/métodos , Aorta Torácica/cirurgia , Idoso , Masculino , Feminino , Pessoa de Meia-Idade , Implante de Prótese Vascular/métodos , Anestesia/métodos , Resultado do Tratamento , Equipe de Assistência ao Paciente/organização & administração , Idoso de 80 Anos ou mais , Aneurisma da Aorta Torácica/cirurgiaRESUMO
INTRODUCTION: Blunt thoracic aortic injuries (BTAI) once had mortality rates up to 32%, but the advent of thoracic endovascular aortic repair (TEVAR) has significantly improved outcomes. However, concerns persist regarding long-term devicerelated complications, device integrity in aging aortas, and the criteria for selecting patients for endovascular repair. We aimed to assess BTAI treatment strategies based on injury grade and their associated outcomes. METHODS: A systematic search of MedLine and Scopus databases was conducted to identify original articles published after 2013, which provided information on injury characteristics, outcomes, secondary effects, and reinterventions following BTAI. We classified aortic injuries following the SVS Clinical Practice Guidelines. RESULTS: We included 28 studies involving 1888 BTAI patients, including 5 prospective studies. Most patients were under 45 years old (86.4%), and grade III injuries were the most common (901 patients), followed by grades I and II (307 and 291 patients, respectively). TEVAR was performed in 1458 patients, mainly with grade III and IV injuries (1040 patients). Approximately half of the grade I injuries (153 of 307) were treated with TEVAR. Thirty-day mortality rate was 11.2%, primarily due to associated injuries. Aortic-related deaths were reported in 21 studies, with an overall rate of 2.2%, but none occurred beyond the first 30 days. Partial or complete coverage of the left subclavian artery was performed in 522 patients, with 27.9% requiring immediate or delayed revascularization. Aortic reintervention rates were relatively low (3.9%). CONCLUSION: TEVAR effectively treats BTAI grades III and IV, with potential benefit for some grade II injuries with more aggressive early intervention. Despite SVS guidelines suggesting conservative management for grade I injuries, there is a substantial rate of intervention with positive outcomes and low mortality. Long-term follow-up data, extending up to almost 20 years, reveal the durability of grafts, aortic remodeling, and minimal reintervention and complications.
Assuntos
Aorta Torácica , Procedimentos Endovasculares , Lesões do Sistema Vascular , Ferimentos não Penetrantes , Humanos , Ferimentos não Penetrantes/cirurgia , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/terapia , Aorta Torácica/lesões , Aorta Torácica/cirurgia , Procedimentos Endovasculares/métodos , Lesões do Sistema Vascular/cirurgia , Lesões do Sistema Vascular/mortalidade , Resultado do Tratamento , Adulto , Traumatismos Torácicos/cirurgia , Traumatismos Torácicos/mortalidade , Traumatismos Torácicos/terapiaRESUMO
We present the case of 60s male who underwent ductus arteriosus closure at the age of 10. He presented with hoarseness and a 25 mm-sized saccular aortic aneurysm was identified at the site of the closed ductus through the computed tomography( CT). The patient successfully underwent 1-debranch thoracic endovascular aortic repair resulting in improved hoarseness. While rare, several reports have documented aneurysm formation long after ductus arteriosus closure. Recent studies highlight favorable outcomes with endovascular repair. Despite its rarity, aneurysmal formation after ductus closure remains a serious complication. Given the increasing population of patients with prior ductus arteriosus closure and the discontinuation of long-term follow-up, awareness of the complication of aneurysmal formation is crucial. Not only congenital cardiologists but also general physicians should consider this differential diagnosis for patients presenting with symptoms such as hoarseness or back pain and a history of ductus closure.
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Aneurisma da Aorta Torácica , Procedimentos Endovasculares , Humanos , Masculino , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Canal Arterial/diagnóstico por imagem , Canal Arterial/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Permeabilidade do Canal Arterial/cirurgia , Permeabilidade do Canal Arterial/diagnóstico por imagem , Aorta Torácica/cirurgia , Aorta Torácica/diagnóstico por imagem , Resultado do Tratamento , Correção Endovascular de AneurismaRESUMO
BACKGROUND: The outcomes of Thoracic Endovascular Aortic Repair (TEVAR) vary depending on thoracic aortic pathologies, comorbidities. This study presents our comprehensive endovascular experience, focusing on exploring the outcome in long term follow-up. METHODS: From 2006 to 2018, we conducted TEVAR on 97 patients presenting with various aortic pathologies. This retrospective cohort study was designed primarily to assess graft durability and secondarily to evaluate mortality causes, complications, reinterventions, and the impact of comorbidities on survival using Kaplan-Meier and Cox regression analyses. RESULTS: The most common indication was thoracic aortic aneurysm (n = 52). Ten patients had aortic arch variations and anomalies, and the bovine arch was observed in eight patients. Endoleaks were the main complications encountered, and 10 of 15 endoleaks were type I endoleaks. There were 18 reinterventions; the most of which was TEVAR (n = 5). The overall mortality was 20 patients, with TEVAR-related causes accounting for 12 of these deaths, including intracranial bleeding in three patients. Multivariant Cox regression revealed chronic renal diseases (OR = 11.73; 95% CI: 2.04-67.2; p = 0.006), previous cardiac operation (OR = 14.26; 95% CI: 1.59-127.36; p = 0.01), and chronic obstructive pulmonary diseases (OR = 7.82; 95% CI: 1.43-42.78; p = 0.001) to be independent risk factors for 10-year survival. There was no significant difference in the survival curves of the various aortic pathologies. In the follow-up period, two non-symptomatic intragraft thromboses and one graft infection were found. CONCLUSION: Comorbidities can increase the risk of TEVAR-related mortality without significantly impacting endoleak rates. TEVAR is effective for severe aortic pathologies, though long-term graft durability may be compromised by its thrombosis and infection.
Assuntos
Aorta Torácica , Procedimentos Endovasculares , Humanos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Procedimentos Endovasculares/métodos , Aorta Torácica/cirurgia , Idoso , Implante de Prótese Vascular/métodos , Implante de Prótese Vascular/efeitos adversos , Resultado do Tratamento , Doenças da Aorta/cirurgia , Doenças da Aorta/mortalidade , Complicações Pós-Operatórias/epidemiologia , Adulto , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/mortalidade , Seguimentos , Fatores de Tempo , Correção Endovascular de AneurismaRESUMO
Background: Abnormalities of aortic arch include variables related to structure, location, anatomical relationships and collateral vessels. This group includes the malformation known as "interrupted aortic arch". During fetal life, oxygenated blood is provided by materno-fetal circulation and own fetal circulation. Case report.: This work discuss of female fetus born without any vital signs at 38th week by 34-years-old primigravida affected by gestational diabetes and anemia gravidarum. Pregnancy was regular. Labor and cardiotocographic tracings were regular, natural delivery; however, at the time of umbilical cord severing the baby went into cardiocirculatory arrest. Autopsy findings were: - hypertrophied right ventricle; - no morphological changes in interventricular septum, - ascending aorta physiologically arose from the left ventricle; after the emergence of the left subclavian artery and the anonymous trunk, it suddenly stopped at cul de sac. Thoracic tract arose as a collateral branch of the pulmonary artery. In addition, Botallo duct was patent. Thus, the diagnosis of death was interruption of aortic arch resulting in cardiogenic shock and irreversible cardiovascular collapse. Conclusion: In filed case, newborn presented "type B" interruption. Interruption manifests itself between left common carotid artery and the left subclavian artery. Descending aorta arose from the pulmonary trunk. So that, in this case, right ventricle provided systemic circulation. At delivery, with the severing of the umbilical cord and physiological closure of the Botallo ductus, acute right heart failure and shock occurred. This work aims to be a cue for scientific community, in order to assist clinical and diagnostic knowledge using autopsy data with expost perspective.
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Aorta Torácica , Humanos , Feminino , Aorta Torácica/anormalidades , Recém-Nascido , Gravidez , Adulto , Evolução Fatal , Choque Cardiogênico/etiologiaRESUMO
BACKGROUND: The prevention of obesity represents a major health and socio-economic challenge. Nutraceuticals are regularly highlighted for their beneficial effects in preventing the metabolic disturbances associated with obesity. However, few studies have described the combined action of nutraceutical mixtures combining polyphenols with alkaloids. OBJECTIVE: The aim of this study was to evaluate the effects of long-term dietary supplementation with a mixture of Berberine, Citrus and Apple extracts (BCA) in the primary prevention of obesity and its metabolic and vascular complications in the obese Zucker rat, a spontaneous model of genetic obesity and insulin resistance. METHODS: Sixteen 8-week-old obese Zucker male rats were randomly divided into two groups: all rats received oral gavage daily either with water, untreated obese (U-ObZ) or BCA (BCA-ObZ) mixture for thirteen weeks. Morphological and metabolic parameters were measured along the study. Cumulative concentration-response curves to insulin, acetylcholine and phenylephrine were determined on isolated thoracic aorta. Colon permeability measurements were performed using the Ussing chamber technique. Fecal samples collected at the beginning and the end of the protocol were used as a template for amplification of the V3-V4 region of the 16S rDNA genes. RESULTS: BCA supplementation reduced weight gain (p<0.05) and food intake (p<0.05) in the BCA-ObZ group rats compared to the U-ObZ group rats. It also improved glucose tolerance (p<0.001) and decreased fasting insulin and Homeostasis model assessment index (p<0.05). Through ex vivo experiments, the BCA mixture enhanced significantly aortic insulin relaxation (p<0.01), reduced α1-adrenoceptor-mediated vasoconstriction (p<0.01), and decreased distal colon permeability. Moreover, short-chain fatty acid producers such as Bacteroides, Blautia, and Akkermansia were found to be increased by the BCA mixture supplementation. CONCLUSION: The results showed that a 13-week-supplementation with BCA mixture prevented weight gain and improved glucose metabolism in obese Zucker rats. We also demonstrated that BCA supplementation improved vascular function, colonic barrier permeability and gut microbiota profile.