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1.
J Clin Med ; 13(6)2024 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-38541795

RESUMO

Background: Abdominal aortic aneurysm (AAA) is a chronic inflammatory disease that poses several challenges. Given the increasing evidence that AAA patients are more likely to develop cancer and the importance of its early detection, we strived to develop a non-invasive tool based on serial FDG-PET/CT scan examinations to identify, among AAA patients, those at risk of cancer. Methods: Between 2006 and 2011 we recruited 149 AAA patients, free of cancer at baseline, and followed them until the end of 2021. All patients underwent an FDG-PET/CT scan at inclusion and possibly more scans during follow-up. At each medical imaging examination, the aneurysmal FDG uptake was recorded. Patients were stratified based on their aortic wall PET status (negative/positive). Any occurrence of cancer was reported. A Cox regression analysis and competing-risk modeling were applied to the data. Results: The proportion of AAA patients who developed cancer was 31.5% (mean time to diagnosis was 5.7 ± 3.4 years) and the death rate was 59%. A difference in cancer incidence between PET+ and PET- patients was detected (46.8% vs. 27.3%; HR = 1.96, 95%CI: 1.07-3.57, p = 0.028). Moreover, AAA patients undergoing surgical treatment had a lower risk of cancer than unoperated patients (28% vs. 50%; HR = 0.41, 95%CI: 0.21-0.80, p = 0.009). Conclusions: In AAA patients, diagnostic imaging with an FDG-PET/CT scan can help identify those patients at a higher risk of developing cancer. Moreover, the higher cancer risk in non-surgically treated patients calls for further analysis of associations between aneurysm growth and malignant disease.

2.
Rev Med Liege ; 78(10): 547-549, 2023 Oct.
Artigo em Francês | MEDLINE | ID: mdl-37830318

RESUMO

We report the technique of endoscopic vessel (radial artery and/or vein) harvesting for coronary bypass grafting. Clearly less invasive, this endoscopic approach therefore offers the following advantages for the patient: limited postoperative pain and therefore faster rehabilitation in terms of mobility, less postoperative care, the absence of a long scar and therefore a lower risk of surgical complications with a better aesthetic result, while allowing a quality and a permeability of the graft similar to those obtained after a classic surgical harvest.


Nous rapportons ici la technique de prélèvement endoscopique des vaisseaux (artère radiale et veine saphène) que nous réalisons pour la chirurgie des pontages coronaires. Nettement moins invasive, cette voie endoscopique offre, dès lors, comme avantages pour le patient : des douleurs postopératoires limitées et donc une rééducation plus rapide en termes de mobilité, des soins postopératoires moindres, l'absence de longue cicatrice et donc un moindre risque de complication du site opératoire avec un meilleur résultat esthétique, tout en permettant une qualité et une perméabilité du greffon similaires à celles obtenues après un prélèvement chirurgical classique.


Assuntos
Artéria Radial , Veia Safena , Humanos , Artéria Radial/transplante , Veia Safena/transplante , Coleta de Tecidos e Órgãos , Ponte de Artéria Coronária/métodos , Endoscopia/métodos
3.
Rev Med Liege ; 78(4): 218-226, 2023 Apr.
Artigo em Francês | MEDLINE | ID: mdl-37067839

RESUMO

In the past 20 years, there has been a real development of aortic valve repair techniques with an increasing number of publications describing the long-term benefits of aortic valve repair in terms of survival, freedom from major adverse valve related-events and reoperations. Aortic valve repair can now be considered as a valuable alternative to prosthetic valve replacement in patients with dystrophic ascending aorta pathology associated or not to aortic insufficiency with pliable leaflets. In this paper, the authors describe the state of the art of aortic valve repair and present their clinical experience with aortic valve repair surgery in the university hospital center of Liege from April 2021 to September 2022.


Les techniques de réparation de la valve aortique se sont considérablement développées ces 20 dernières années. Plusieurs publications confirment les bénéfices à long terme de ces techniques en termes de survie, d'absence de complications majeures et de réinterventions pour récidive d'insuffisance aortique. La réparation de la valve aortique apparaît ainsi comme une véritable alternative au remplacement valvulaire aortique prothétique chez certains patients qui présentent une pathologie dystrophique de l'aorte ascendante associée ou non à une insuffisance aortique sur valve souple. Dans cet article, les auteurs parcourent la littérature actuelle sur le sujet et décrivent leur expérience clinique avec la chirurgie de réparation de la valve aortique au sein du centre hospitalier universitaire de Liège d'avril 2021 à septembre 2022.


Assuntos
Aneurisma Aórtico , Procedimentos Cirúrgicos Cardíacos , Humanos , Aneurisma Aórtico/complicações , Aneurisma Aórtico/patologia , Aneurisma Aórtico/cirurgia , Valva Aórtica/cirurgia , Aorta/patologia , Aorta/cirurgia , Hospitais , Resultado do Tratamento
4.
Acta Chir Belg ; : 1-7, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36424303

RESUMO

OBJECTIVES: Full median sternotomy (FMS) is the common surgical access for patients undergoing replacement of the ascending aorta (AA) with or without aortic valve replacement (AVR). The right anterior mini-thoracotomy (RAMT) approach has been increasingly adopted for AVR. This approach has been shown to decrease blood loss and hospital length of stay (LOS) compared with FMS. The RAMT approach may also be beneficial in selected patients requiring AA procedures with or without AVR. We present our initial clinical experience of patients who have undergone a RAMT for supracommissural replacement of the tubular AA with or without AVR. METHODS: This is a single-center retrospective review of 10 patients who underwent an elective RAMT for replacement of the tubular AA with or without AVR between November 2019 and January 2022. Clinical outcomes evaluated include 30-day mortality, intensive care and hospital LOS, time to extubation, operative times, as well as postoperative complications such as stroke and bleeding. RESULTS: Median cross-clamp and cardiopulmonary bypass times were 109 and 148 min, respectively. Median time to extubation was 2.5 h and median intensive care unit and hospital stay were 2 and 10 days, respectively. There were two re-thoracotomies for postoperative bleeding and two cases of sub-xiphoidal pericardial drainage for pericardial effusion. There were no strokes and no in-hospital nor 30-day mortalities. CONCLUSIONS: The replacement of the AA with or without concomitant AVR can be performed through a RAMT in carefully selected patients. However, the safety of this approach, as compared to full/partial median sternotomy, remains to be proven.


Key questions: Can ascending aorta surgery with or without aortic valve replacement be safely performed via right thoracotomy?Key Findings: A good experience of right thoracotomy approach helps performing ascending aorta surgery via that access in carefully selected patients.Take home message: Center with expertise in right thoracotomy can performed ascending aorta surgery through that access in carefully selected patients. However, the safety of this approach, as compared to full or partial median sternotomy, remains to be proven.

5.
Echocardiography ; 38(12): 2129-2131, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34820893

RESUMO

In case of valvular infective endocarditis, the infection is mainly localized on the flow side of the valves or at damaged valvular endothelium. We describe a rare case of an aortic valvular ineffective endocarditis with an aortic-valve vegetation situated on the aortic side of the valve. We believe this is the first description of this unusual localization of vegetations in a native aortic valve.


Assuntos
Insuficiência da Valva Aórtica , Endocardite Bacteriana , Endocardite , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Endocardite/diagnóstico por imagem , Endocardite Bacteriana/diagnóstico por imagem , Humanos
6.
Infect Dis (Lond) ; 53(3): 189-195, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33356719

RESUMO

BACKGROUND: Streptococcus agalactiae (GBS) infective endocarditis (IE) is a rare clinical entity. It is associated with a high mortality rate compared to other streptococci endocarditis. The aim of this study is to define the clinical characteristics, treatment and outcomes of a series of eight non-pregnant adults with GBS IE managed by a combination of antibiotics and surgery at our institution. METHODS: We retrospectively reviewed the medical records of all adult patients with a definite diagnosis of IE by Duke modified criteria and who underwent surgery at our centre between January 2008 and December 2018. RESULTS: A total of 190 patients underwent surgery for IE during the study period. Eight cases of GBS IE were identified, including six males and two females. The mean aged was 54 years (range, 32-68). Seven cases suffered native valve endocarditis and one involved an aortic bioprosthesis. Seven patients had underlying comorbidities. Furthermore, four patients had experienced serious complications. Of these, the most common were heart failure, septic shock, and cerebral emboli. Vegetations tended to be large, very mobile, and pedunculated. Most of the patients were treated with penicillin plus an aminoglycoside. Surgery was emergently performed in one patient and urgently performed in seven patients. In- hospital mortality rate was 37.5%. CONCLUSION: GBS IE is a virulent disease with an aggressive clinical course. It mostly affects patients with debilitating diseases. Early surgery should be considered to prevent the development of serious complications. However, overall mortality rate remains high despite surgical treatment.


Assuntos
Endocardite Bacteriana , Endocardite , Infecções Estreptocócicas , Adulto , Idoso , Endocardite/cirurgia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae
7.
Ann Thorac Surg ; 110(4): e315-e317, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32213310

RESUMO

Aberrant origin of the coronary artery from the opposite sinus of Valsalva is a rare congenital coronary anomaly associated with increased risk of myocardial ischemia and sudden death in young patients. We report a case of resuscitated sudden cardiac death in a patient with an anomalous origin of the right coronary artery, arising from the left sinus of Valsalva and coursing between the ascending aorta and the pulmonary artery. Successfully coronary arterial bypass grafting using the left radial artery was performed. Despite the risk of fatal issue, surgical management of patient with this coronary anomaly still remains controversial.


Assuntos
Anormalidades Múltiplas , Ponte de Artéria Coronária , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/cirurgia , Parada Cardíaca/etiologia , Seio Aórtico/anormalidades , Adulto , Morte Súbita Cardíaca , Humanos , Masculino
8.
Ann Thorac Surg ; 103(3): e239-e240, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28219556

RESUMO

Immunoglobulin G4-related systemic disease (IgG4-RSD) is a recognized emerging entity characterized by chronic fibroinflammation that can affect every organ but rarely affects the cardiovascular system. We report a rare case of IgG4-RSD involving an aortic valve that resulted in rapid progression of an aortic valvular stenosis and was successfully treated by aortic valve replacement and corticosteroids.


Assuntos
Estenose da Valva Aórtica/cirurgia , Imunoglobulina G/sangue , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/etiologia , Fibrose , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Plasmócitos/imunologia
9.
Clin Nucl Med ; 41(1): 28-33, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26447376

RESUMO

BACKGROUND: Aortitis is a generic term defined as an inflammatory condition involving the aortic wall, of infectious or noninfectious origin. This inflammatory process may deteriorate the aortic wall, resulting in potentially life-threatening vascular complications. Therefore, it is important to establish a diagnosis as early as possible. PATIENTS AND METHODS: During a 4-year period, 428 consecutive patients referred to our department for aortic diseases underwent FDG PET/CT examinations. Among these, 18 patients (4.2%) were suspected to have aortitis. All of them had an initial positive FDG PET/CT uptake occurring in the aorta and major branches as evaluated by visual analysis of images and assessed with the final diagnosis of aortitis. During follow-up, after surgery and/or upon immunosuppressive treatment, each of these patients underwent a second PET/CT that was compared with the initial evaluation. In all cases, normalization of FDG uptake was correlated with clinical improvement. CONCLUSIONS: Our study aimed to illustrate the potential clinical value of functional monitoring with PET/CT in the management of aortitis. FDG PET/CT constitutes a valuable imaging modality to establish an early diagnosis, monitor disease progression and treatment, and evaluate vascular complication and relapse. We highlight the importance of an early detection of inflammatory large-vessel pathology, which may represent a major threat.


Assuntos
Aortite/diagnóstico por imagem , Fluordesoxiglucose F18 , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Idoso , Aorta/diagnóstico por imagem , Aortite/terapia , Aortografia , Progressão da Doença , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
10.
Aorta (Stamford) ; 1(2): 110-6, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26798682

RESUMO

BACKGROUND: To evaluate the feasibility and the safety of performing urgent (within 24 hours) carotid endarterectomy in patients with carotid stenosis presenting with repetitive transient ischemic attacks or progressing stroke. METHODS: Thirty consecutive patients underwent urgent carotid endarterectomy for repetitive transient ischemic attacks (N = 12) or progressing stroke (N = 18) according to the following criteria: two or more transient ischemic attacks or a fluctuating neurological deficit over a period of less than 24 hours (progressing stroke), no impairment of consciousness, no cerebral infarct larger than 1.5 cm in diameter on computed tomography and a carotid artery stenosis of 70% or more on the appropriate side, diagnosed by echodoppler ultrasonography and/or arteriography. Patients with cerebral hemorrhage were excluded. All patients were examined pre- and postoperatively by the same neurologist and surgery was performed by the same vascular surgeon. All the patients underwent a cerebral CT scan within 5 days after surgery. RESULTS: There were 19 men and 11 women. The mean age was 71 ± 7.6 years. The time delay of surgery after the onset of transient ischemic attacks or progressing stroke averaged 19.4 ± 11.5 hours. For patients suffering progressive stroke, one developed a fatal ischemic stroke 24 hours after surgery, five showed no improvement of their neurological status after surgery, but none worsened. Twelve patients experienced significant improvement of their neurological status with an European Stroke Scale of 77.9 ± 25.2 at admission and 95.8 ± 4.6 at discharge, and all but one of those patients had a Barthel's index value over 85/100 at discharge. The 12 patients with repetitive transient ischemic attacks had an uneventful postoperative outcome. The mean duration of follow-up was 3.4 ± 1.2 years. No patient developed another transient ischemic attack or ischemic stroke during the follow-up period. CONCLUSIONS: The results of our series documented the feasibility and the safety of performing urgent (within 24 hours) carotid endarterectomy in patients presenting with repetitive transient ischemic attacks or progressing stroke. This procedure seems to us to be justified by the fact that waiting for surgery may lead to the development of a more profound deficit or another stroke in these neurologically unstable patients whose only chance for neurological recovery is in the early phase.

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