Clinical characteristics and placental pathology analysis of 14 cases of pregnancy with aortic dissection/aortic aneurysm / 中华病理学杂志

Objective: To investigate the pathological changes of placenta in pregnant women with aortic dissection/aneurysm and their relationship with clinical features. Methods: The placental samples of 14 pregnant women with aortic dissection/aneurysm diagnosed from January 2012 to October 2021 and 10 normal placental samples of pregnant women from January 2021 to December 2021 at Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China were selected. Routine H&E staining and immunohistochemistry were used to analyze the histological features under light microscope. The clinical data were also analyzed. Results: The age of 14 pregnant patients with aortic dissection/aneurysm for placental examination ranged from 22 to 38 years (median, 28 years). The gestational ages ranged from 22 to 39 weeks (median, 34 weeks). The pregnancy of second trimester was noted in 2 cases, and the third trimester in 12 cases. All cases were singleton pregnancy. Seven cases were Stanford type A aortic dissection, 6 cases were Stanford type B aortic dissection, and one case was aortic root aneurysm. Four of the pregnant women underwent aortic dissection surgery after caesarean section, three underwent caesarean section after aortic dissection surgery, and seven underwent both caesarean section and aortic dissection procedures. Among the newborns, 2 cases were full-term birth, and 12 cases were premature birth. Twelve cases had alive newborns, and 2 cases stillbirths. Fetal/placental weight ratio (FPR)<10th percentile was in 5 cases and FPR>90th percentile in one case. Compared with the normal group, accelerated villus maturation and distal villus dysplasia were more frequently found in pregnancy with aortic dissection group (P<0.05). There was no significant difference in villi infarction and decidua vascular lesions between the two groups (P>0.05), nor was there correlation between the type of aortic dissection and distal villus dysplasia and accelerated villus maturation of placentas (P>0.05). The number of villous interstitial blood vessels in the placentas of pregnancy with aortic dissection group was significantly fewer than that in the normal control group (P<0.01). Conclusions: There are considerable pathological changes in the placentas of pregnant women with aortic dissection/aneurysm. The main histological features are accelerated villus maturation and distal villus dysplasia, which are manifestations of villous ischemia and hypoxia, and also a part of the placental pathological manifestations of maternal vascular dysperfusion.

Sudden death caused by aortic dissection: 63 cases of forensic pathological analysis / 法医学杂志

OBJECTIVE@#To explore the cause of death, clinical manifestations and forensic pathological features of death cases caused by aortic dissection.@*METHODS@#Sixty-three cases of aortic dissection were selected from forensic medical center, Sun Yat-sen University from 2001 to 2011 and retrospectively analyzed.@*RESULTS@#The patients were mostly young and middle-aged male, aged from 30 to 49 years old. The DeBakey type II was the most common pathological type and the main cause of death was pericardial tamponade. The most common symptom was abdominal pain. However, the location of aorta dissection did not always correlate with the location of pain. Some cases showed no obvious clinical symptoms. The rupture was usually located in ascending aorta with atherosclerosis and pathological changes of hypertension.@*CONCLUSION@#It is significant for diagnosis and evaluation the cause of death of aortic dissection by knowing the clinical symptoms and forensic pathological features.

Analysis of 21 autopsy cases of aortic dissection with disputes / 法医学杂志

OBJECTIVE@#To explore procedures and methods of forensic investigation for the death cases of aortic dissection with disputes.@*METHODS@#Twenty-one death cases of aortic dissection with disputes from 2006 to 2011 were collected. All the data were analyzed to investigate the reasons and features of the disputes.@*RESULTS@#The main causes of the disputes were clinical misdiagnosis or slight force. The pathologic type of De Bakey (I and II) or Stanford A were common in each case. For the cases dying of aortic dissection, it was significantly important to detect the rupture of entry and exit and observe the dissection of arterial wall.@*CONCLUSION@#The main causes of clinical misdiagnosis are insufficient experiences, careless observation and curtness in medical treatment. The difficult points in these cases are confirmation of the relationships between injury and disease, the primary affection and complication.

Aneurisma do Seio de Valsalva direito causando compressão coronariana extrínseca / Aneurisma del Seno de Valsalva derecho causando compresión coronaria extrínseca / Right Sinus of Valsalva Aneurysm causing extrinsic coronary compression

O Aneurisma do Seio de Valsalva (ASV) é um distúrbio cardíaco raro. É mais frequentemente um defeito congênito, mas pode ser adquirido. A doença de Takayasu é uma causa extremamente rara desse distúrbio. A maioria dos casos de ASV não-roto é assintomática. A compressão da artéria coronária esquerda é uma manifestação não usual da doença, que pode causar angina, infarto do miocárdio ou morte. Esse relato de caso descreve um paciente negro de 19 anos, do sexo masculino, apresentando um ASV direito não-roto causado por doença de Takayasu, manifestado através de síndrome coronariana aguda, tratada cirurgicamente com sucesso.

Sinus of Valsalva aneurysm is a rare cardiac disorder. It is more frequently a congenital, but it may also be an acquired condition. Takayasu's disease is an extremely rare cause of this disorder. Most cases of unruptured sinus of Valsalva aneurysm are asymptomatic. Compression of the left coronary artery is an unusual manifestation of the disease that can cause angina, myocardial infarction or death. This report describes a 19-year-old black male with an unruptured right sinus of Valsalva aneurysm caused by Takayasu's disease and manifested by an acute coronary syndrome, successfully treated by surgery.

Aneurisma del Seno de Valsalva (ASV) es un disturbio cardíaco raro. Con mayor frecuencia se trata de un defecto congénito, pero puede ser adquirido. La enfermedad de Takayasu es una causa extremadamente rara de este disturbio. La mayoría de los casos de ASV no roto es asintomática. La compresión de la arteria coronaria izquierda es una manifestación no usual de la enfermedad, que puede causar angina, infarto de miocardio o muerte. Este informe de caso describe un paciente negro, de 19 años, del sexo masculino, presentando un ASV derecho no roto causado por enfermedad de Takayasu, manifestado a través de síndrome coronario agudo, tratado quirúrgicamente con éxito.

Tratamento endovascular nos aneurismas verdadeiros e na dissecção aórtica do tipo B: fase intra-hospitalar, seguimento de médio prazo e uma reflexão sobre seleção de pacientes / Endovascular treatment of aortic aneurysms and type B dissections: in-hospital results, mid-term follow-up and a consideration of patient selection

Introdução: O tratamento endovascular das doenças da aorta é procedimento estabelecido, mas com resultados tardios e diferenças nos resultados entre diferentes grupos demográficos ainda desconhecidos. Método: No período de dezembro de 1996 a dezembro de 2004, 92 pacientes com aneurismas verdadeiros ou úlcera penetrante de aorta em posição torácica (G1) e 130 pacientes com dissecção aórtica do tipo B ou hematoma intramural (G2) foram submetidos a tratamento endovascular primário ou secundário. Na fase hospitalar, sucesso clínico foi considerado como exclusão da lesão, sem morte ou conversão cirúrgica. Falência tardia foi definida pela ocorrência de morte por qualquer causa, conversão cirúrgica ou reintervenção. Resultados: A média de idade do G1 foi de 65 ± 11 anos e de 56 ± 11 anos no G2 (P < 0,0001). Quanto aos dados demográficos, destacou-se a alta frequência de acidente vascular cerebral prévio no G1 (8,7% vs. 0; P = 0,0007). Sucesso clínico do procedimento foi obtido em 71% do G1 e em 84% dos pacientes do G2 (P = 0,02), com maior mortalidade intra-hospitalar no G1 (14% vs. 4,6%; P = 0,01). Complicações neurológicas foram semelhantes (6,5% vs. 3%; P = 0,32), com discreto predomínio de paraplegia no G1 (3,2% vs. 0,8%; P = 0,3). Em seguimento de 33 ± 27 meses, falência tardia foi atingida em 60% (28/47) dos pacientes do G1 e em 43% (31/74) do G2 (P = 0,09). Conclusão: Resultados em pacientes com aneurismas verdadeiros submetidos a tratamento endovascular são discretamente inferiores aos de pacientes com dissecção aórtica do tipo B. Isso pode ser explicado pelas diferenças demográficas entre os grupos e pelas dificuldades técnicas inerentes à anatomia. O conhecimento dessas peculiaridades permite a melhor seleção de pacientes nos quais o procedimento será eficaz em reduzir a mortalidade.

Background: Endovascular treatment of thoracic aortic diseases is a well established procedure although late results and differences among demographic groups are unknown. Method: From December/1996 to December/ 2004, 92 patients with true aneurysms or penetrating ulcers (G1) and 130 patients with type B dissection or intramural hematoma (G2) were submitted to primary or complementary endovascular treatment. Clinical success was defined as sustained technical success without death or surgical conversion. Late failure was defined as death of any cause, surgical conversion or re-intervention. Results: G1 mean age was 65 ± 11 years and 56 ± 11 years in G2 (P < 0.0001). A high frequency of previous stroke was observed in G1 (8.7% vs. 0; P = 0.0007). Clinical success was observed in 71% in G1 and 84% in G2 (P = 0.02) with higher in-hospital death rates in G1 (14% vs. 4.6%; P = 0.01). Neurologic complications were similar (6.5% vs. 3%, respectively; P = 0.32), with a mild prevalence of paraplegia in G1 (3.2% vs. 0.8%; P = 0.3). Late failure rates of 60% were observed in G1 and 43% in G2 (P = 0.09) at 33 ± 27 months of follow-up. Conclusions: Endovascular treatment in patients with true aneurysms may be slightly inferior to those achieved in patients with type B dissection. This might be due to demographic differences between groups and technical difficulties related to aortic anatomy. The knowledge and understanding of these peculiarities enables better patient selection for theprocedure resulting in decreased mortality rates.

Coexistence of congenital subaortic and sinus of valsalva aneurysms.

We report a rare association of an aneurysm of the sinus of Valsalva and a subaortic aneurysm. Congenital defective union of the aortic wall and ventricular muscle with the fibrous ring is probably the explanation for this condition.

Aneurisma congênito do seio de Valsalva esquerdo / Congenital left sinus of Valsalva aneurysm

Säo descritos dois casos de aneurisma congênito do seio de Valsalva (ACSV) esquerdo, näo rompidos, incidentalmente achados. Apresentam-se conceitos recentes a respeito da morfogênese e da incidência de ACSV. Ressaltam-se a importância de tais achados, por sugerirem, além de sua raridade, uma incidência de ACSV maior do que a atualmente estimada

Aortic dissection: an autopsy experience

Aortic dissection was confirmed in 33 patients at autopsy at the University Hospital of the West Indies between 1975 and 1988. Twenty-five cases were acute and 8 chronic and the diagnosis was made ante-mortem in 5 cases overall. The high risk of rupture of proximal dissections involving the ascending aorta into the pericardial sac is clear, and the overriding importance of systemic hypertension is once again confirmed. An unusual finding was the higher proportion of females to males. A higher index of suspicion should permit an antemortem diagnosis and appropriate therapy in a larger proportion of patients

Aneurisma gigante da croça aórtica / Giant aneurysm of the aortic arch

Os autores relatam um caso de um paciente masculino, apresentando quadro clínico de volumosa massa aneurismática precordial de muito longa duraçäo. Säo enfocados os achados clínicos do acompanhamento do enfermo até a ruptura espontânea do aneurisma para o exterior, apontando os dados anamnésticos e os achados histopatológicos fortemente para uma etiologia luética

Aneurisma de la aorta abdominal / Abdominal aortic aneurysm

La arterioesclerosis es una de las causas de muerte mas comunes en personas mayores de 40 anos. Una de sus manifestaciones es el aneurisma de la aorta abdominal. En este trabajo se presenta la experiencia en el diagnostico y tratamiento del aneurisma de la aorta abdominal (AAA) en el Hospital Universitario de Cartagena durante el lapso comprendido entre enero de 1982 y diciembre de 1987. La causa mas comun del AAA fue la arterioesclerosis; se presento con mas frecuencia en varones, y la decada mas afectada fue de 60 a 70 anos. La mayoria de los pacientes electivos fueron asintomaticos y el metodo de diagnostico mas usado fue la ecografia; el aortograma solo lo utilizamos en 1 paciente. La complicacion operatoria mas comun fue la embolia arterial y la hemorragia. La mortalidad en 26 casos electivos fue de 11.5% (3 casos) y el 4 casos de aneurismas rotos, la mortalidad fue del 75% (3 casos). El injerto mas utilizado fue el de dacron en pantalon. Se hizo una revision de la literatura mundial fijando la atencion especialmente en los cambios en la tecnica quirurgica y en los avances terapeuticos de esta entidad