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2.
Medicine (Baltimore) ; 99(11): e19186, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176045

RESUMEN

Obese individuals are apt to develop Stanford A acute aortic dissection (AAD) complicated with acute lung injury (ALI), but the mechanism is still not well defined. We aim to investigate whether oxidative stress and inflammatory are involved in the aortic dissection lung injury caused by obesity.Seventy-nine patients were categorized into AAD with obesity group (n = 17) and AAD without obesity group (n = 62) according to body mass index (BMI). Inflammatory reactions including interleukin 1ß (IL-1ß), tumor necrosis factor-α (TNF-α), IL-6, C-reactive protein (CRP) and white blood cell (WBC) count, and oxidative stress including malondialdehyde (MDA), superoxide dismutase were determined using enzyme-linked immunosorbent assays and chemiluminescence. All the patients received ascending aorta replacement combined with total arch replacement and stented elephant trunk. The postoperative complications were recorded.The incidence of preoperative hypoxemia (94.1% vs 35.5%, P < .01) and postoperative ALI (88.2% vs 40.3%, P < .01) in obese patients was significantly higher than that in non-obese patients. Besides, the ICU stay (119.2 ±â€Š59.2 vs 87.8 ±â€Š31.2 h, P < .01) and hospitalization duration (18.8 ±â€Š8.5 vs 14.3 ±â€Š8.1d, P = .048) were increased in the obese patients with AAD. The expression of IL-1ß, TNF-α, IL-6, CRP, and WBC was remarkably increased (P < .01) in obese group compared with non-obese group.Oxidative stress and inflammatory response may be involved in the process of ALI of aortic dissection caused by obesity, which provides new ideas for the treatment of ALI of the aortic dissection.


Asunto(s)
Lesión Pulmonar Aguda/cirugía , Aneurisma Disecante/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Hipoxia/etiología , Obesidad/complicaciones , Lesión Pulmonar Aguda/diagnóstico por imagen , Adulto , Anciano , Aneurisma Disecante/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Implantación de Prótesis Vascular/métodos , Índice de Masa Corporal , Estudios de Cohortes , Femenino , Hospitales Universitarios , Humanos , Hipoxia/fisiopatología , Modelos Lineales , Masculino , Persona de Mediana Edad , Obesidad/diagnóstico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/fisiopatología , Cuidados Preoperatorios , Pronóstico , Valores de Referencia , Estudios Retrospectivos , Medición de Riesgo , Análisis de Supervivencia , Resultado del Tratamiento
4.
Vasc Endovascular Surg ; 54(3): 288-291, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31896319

RESUMEN

We present a case of an 87-year-old female with new-onset hoarseness of unclear etiology. Imaging demonstrated a penetrating aortic ulcer (PAU) in the proximal descending thoracic aorta with an associated pseudoaneurysm that enlarged to a depth of 32 mm over 2 years. This patient was diagnosed with hoarseness being secondary to left recurrent laryngeal nerve (LRLN) palsy, a variant of Ortner syndrome. Patient was treated with endovascular stent-grafting successfully covering of the PAU and pseudoaneurysm with zone 3 proximal landing zone. The patient had moderate improvement in hoarseness after 1 year of follow-up. Endovascular repair is indicated for symptomatic patients with PAUs complicated by enlarging pseudoaneurysms or rupture. Endovascular treatment is effective with low procedural morbidity and mortality. In this case, the PAU and associated pseudoaneurysm at the level of the ligamentum arteriosum caused compression on the LRLN, resulting in a nerve palsy and hoarseness. This case highlights the importance of vascular imaging for patients presenting with unclear etiology of hoarseness or other signs of LRLN palsy. Therefore, aortic arch abnormalities, a variant of Ortner syndrome, even though rare, should be on the differential diagnosis of new onset hoarseness.


Asunto(s)
Aneurisma Falso/complicaciones , Aneurisma de la Aorta Torácica/complicaciones , Ronquera/etiología , Úlcera/complicaciones , Parálisis de los Pliegues Vocales/etiología , Anciano de 80 o más Años , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Femenino , Ronquera/diagnóstico , Ronquera/fisiopatología , Humanos , Recuperación de la Función , Resultado del Tratamiento , Úlcera/diagnóstico por imagen , Úlcera/cirugía , Parálisis de los Pliegues Vocales/diagnóstico por imagen , Parálisis de los Pliegues Vocales/fisiopatología , Calidad de la Voz
5.
J Cardiothorac Surg ; 15(1): 13, 2020 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-31924243

RESUMEN

BACKGROUND: We examined the outcome of debranching thoracic endovascular aortic repair (d-TEVAR) without sternotomy for distal aortic arch aneurysm in patients aged ≥75 years. METHODS: Patients who underwent d-TEVAR or TAR for aortic arch aneurysm between 2008 and 2015 at our hospital and aged ≥75 years were included. Age, sex, left ventricular ejection fraction, preoperative creatinine level, diabetes, cerebrovascular disease, and chronic obstructive pulmonary disease were matched using PS. RESULTS: Among 74 patients (d-TEVAR: 51, TAR: 23), 17 patients in each group were matched. No difference in surgical outcome was detected between the d-TEVAR and TAR groups, including 30-day death (0% vs. 0%), hospital death (5.8% vs. 0%: p = 0.31) and incidence of cerebral infarction (5.8% vs. 7.6%: p = 0.27) as well as the long-term outcomes of 5-year survival (92.8% vs. 74.8%: p = 0.30) and 5-year aorta-related event-free rate (88.2% vs. 100%: p = 0.15). Average duration of ICU stay (1.3 ± 1.1 days vs. 5.6 ± 1.3 days: p = 0.025) and hospital stay (16.5 ± 5.2 days vs. 37.7 ± 19.6 days: p = 0.017) were significantly shorter in the d-TEVAR group. CONCLUSION: Our results indicated that d-TEVAR is less invasive without affecting long-term outcome up to 5 years. Although the number of the patients included in the study was small, debranching TEVAR could be one of the treatments of the choice in the elderly, especially with comorbidities.


Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/métodos , Procedimientos Endovasculares/métodos , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Estudios de Casos y Controles , Infarto Cerebral/epidemiología , Femenino , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Complicaciones Posoperatorias/epidemiología , Supervivencia sin Progresión , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento
6.
J Cardiovasc Surg (Torino) ; 61(2): 250-255, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31985188

RESUMEN

BACKGROUND: Patients with aortic root ectasia and bicuspid aortic valve benefit of the treatment with aortic valve sparing procedure, with excellent long-term results. The Sleeve-procedure is one of the options in patients with aortic root diseases and it might be suitable for patients with a bicuspid valve. METHODS: From October 2006 to December 2018, 42 consecutive patients with bicuspid aortic valve and aortic root ectasia/aneurysm, with or without aortic regurgitation, were surgically treated with the Sleeve-procedure. RESULTS: In 20 patients (48%) leaflets surgery was necessary and consisted of raphe mobilization/resection in 17 patients, plication of both leaflets in 2 patients and a two-commissures resuspension in 1 patient. During a mean clinical follow-up time of 4.4±3.1 years, the survival rate was 100%, 1 patient required a reoperation at 6.1 years postoperatively, with an overall freedom from reoperation of 94±5%. The rest of the patients (41/42), had no more than mild residual aortic valve regurgitation. With a mean follow-up of 4.3±1.7 years the magnetic resonance imaging performed in 26 patients, did not show signs of aortic wall herniation through the key-holes or persisting creases of the aortic wall inside the prosthesis. CONCLUSIONS: Patients with aortic root disease and bicuspid aortic valve may be treated with Sleeve technique with excellent midterm results. However, a longer follow-up is required before drawing any solid conclusion.


Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Insuficiencia de la Válvula Aórtica/cirugía , Válvula Aórtica/anomalías , Procedimientos Quirúrgicos Cardíacos/métodos , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Monitoreo Fisiológico/métodos , Adulto , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/mortalidad , Procedimientos Quirúrgicos Cardíacos/mortalidad , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Imagen por Resonancia Cinemagnética/métodos , Masculino , Persona de Mediana Edad , Tratamientos Conservadores del Órgano , Estudios Retrospectivos , Medición de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
7.
World Neurosurg ; 133: 188-191, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31605857

RESUMEN

BACKGROUND: Cerebrospinal fluid (CSF) drainage reduces the risk of paraplegia in thoracoabdominal aortic aneurysm (TAAA) repair. Intracranial hemorrhage after TAAA repair has been reported as a rare complication of CSF drainage; however, spinal subarachnoid hematoma has never been reported. Here, we present a case of lumbosacral subarachnoid hematoma after CSF drainage in TAAA repair. CASE DESCRIPTION: The patient was a 76-year-old man who was hospitalized for TAAA repair. Just before the operation, a CSF drainage catheter was inserted into the L4/5 vertebral interspace. Continuous CSF drainage was performed during the operation. The CSF drain was clamped just after the operation, and the drainage catheters were removed at 24 hours after the operation. On postoperative day 1, the patient experienced pain and paralysis in both lower limbs that worsened over time. Magnetic resonance imaging of the brain and spinal cord was indicative of a spinal subarachnoid hematoma. Removal of hematoma with thoracolumbar and lumbosacral laminectomy was performed, and immediately after the surgery, the pain and paralysis in both lower limbs improved. Six months after the removal of the hematoma, the paralysis in both lower limbs completely resolved and the patient achieved the preinjury activity level. CONCLUSIONS: We present a rare case of lumbosacral subarachnoid hematoma after CSF drainage in TAAA repair. We should consider spinal subarachnoid hematoma when paralysis in the lower limbs occurs after CSF drainage.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/cirugía , Paraplejía/etiología , Hemorragia Subaracnoidea/etiología , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Drenaje/efectos adversos , Humanos , Imagen por Resonancia Magnética , Masculino , Paraplejía/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Médula Espinal/diagnóstico por imagen , Hemorragia Subaracnoidea/diagnóstico por imagen , Procedimientos Quirúrgicos Vasculares/efectos adversos
9.
Vasc Endovascular Surg ; 54(2): 162-164, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31707948

RESUMEN

Hybrid thoracic endovascular aortic repair with surgical arch debranching is an accepted method for total arch reconstruction. Although off-pump arch debranching is increasingly used as a prophylactic adjunct to endovascular arch repair extending into landing zone 0, this technique is seldom performed with a ministernotomy due to a steep learning curve among surgeons. Herein, we report our standard technique for off-pump hybrid total aortic arch repair using a ministernotomy.


Asunto(s)
Aneurisma Disecante/cirugía , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Esternotomía/métodos , Aneurisma Disecante/diagnóstico por imagen , Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Procedimientos Endovasculares/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
10.
AJR Am J Roentgenol ; 214(3): 679-686, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31869250

RESUMEN

OBJECTIVE. The aim of this study was to investigate the association between the tortuosity of the targeted aortic segment (TAS) for stent-graft implantation and distal stent-graft-induced new entry (SINE) after thoracic endovascular aortic repair (TEVAR) for aortic dissection or intramural hematoma. MATERIALS AND METHODS. We retrospectively analyzed data from 70 patients who underwent TEVAR using a single stent-graft between 2006 and 2016, and the tortuosity index of the TAS was measured. The patients were divided into high and low TAS tortuosity groups according to the median value of the tortuosity index. The incidence of distal SINE was compared between the two groups. RESULTS. The cumulative incidence of distal SINE at 2 years after TEVAR was 39% in patients in the high TAS tortuosity group and 7% in patients in the low TAS tortuosity group. The incidence of distal SINE was higher in patients in the high TAS tortuosity group than in those in the low TAS tortuosity group (p < 0.01, log-rank test). Multivariate Cox regression showed a higher risk of distal SINE in the high TAS tortuosity group (adjusted hazard ratio, 4.56 [95% CI, 1.40-14.86]; p = 0.01). CONCLUSION. Patients with high TAS tortuosity have a higher incidence of distal SINE after TEVAR. More caution must be exercised during follow-up of patients with high TAS tortuosity after TEVAR.


Asunto(s)
Aneurisma Disecante/cirugía , Aorta Torácica/anomalías , Aneurisma de la Aorta Torácica/cirugía , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/cirugía , Implantación de Prótesis Vascular/métodos , Procedimientos Endovasculares , Hematoma/cirugía , Stents , Aneurisma Disecante/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Femenino , Hematoma/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
11.
Braz J Cardiovasc Surg ; 34(6): 769-771, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31793254

RESUMEN

Aortic arch anomalies are not clinically important unless they cause compression symptoms due to aneurysmatic dilatation. Aortic anomalies need to be treated when they cause complex thoracic aortic diseases, and the treatment approach has evolved over time from open surgical methods, which have high mortality and morbidity rates, to hybrid methods. A case of a 68-year-old male patient with complex aortic arch anomaly treated with hybrid arch repair is reported in this study. Aortic branches were common carotid trunk and aberrant right subclavian artery with a saccular aneurysm.


Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Anomalías Cardiovasculares/cirugía , Arteria Subclavia/anomalías , Procedimientos Quirúrgicos Vasculares/métodos , Anciano , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Anomalías Cardiovasculares/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Humanos , Masculino , Arteria Subclavia/diagnóstico por imagen , Arteria Subclavia/cirugía
12.
Ann Vasc Surg ; 62: 30-34, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31201976

RESUMEN

BACKGROUND: The Heli-FX EndoAnchor (EA) system is a transmural aortic fixation device with Federal Drug Administration (FDA) approval for treatment of endoleaks, endograft migration, or high-risk seal zones. Published data are primarily from industry-sponsored registries highlighting safety and efficacy. Our objective is to evaluate real-world outcomes of EA usage after FDA approval across a variety of stent grafts and indications at a single institution. METHODS: We retrospectively reviewed our prospectively maintained aneurysm database for patients undergoing endovascular aortic repair (EVAR) with Heli-FX EAs. Technical success was defined as successful EA deployment, while procedural success was defined as absence of endoleak on completion aortogram. Cohorts were divided by indication and outcomes assessed via review of clinical and radiographic data. RESULTS: From 2016 to 2018, 37 patients underwent EA fixation. We divided the cohort by indication: Group A (prior EVAR with endoleak), B (intraoperative type 1A endoleak), C (high-risk seal zone), and D (thoracic EVAR). In Group A (n = 11), all endoleaks were type 1A and a mean of 10 EAs were deployed with 100% technical and 45.4% procedural success. Two perioperative reinterventions were performed (translumbar coil embolization and proximal graft extension with bilateral renal artery stents). At a mean 10.6 months of follow-up, 45.4% of patients had persistent endoleaks, with 100% aortic-related survival. In Group B (n = 10), a mean of 8.7 EAs were used with 100% technical and procedural success. One immediate adverse event occurred (right iliac dissection from wire manipulation, treated with a covered stent). At 13.6-month mean follow-up, there was significant sac regression (mean 9.75 mm) with no type 1A endoleaks. In Group C (n = 10), a mean of 9.5 EAs were deployed with 100% technical and procedural success. At 11.2-month mean follow-up, there were no residual endoleaks and significant sac regression (mean 3.4 mm). Overall survival was 100%. In Group D (n = 6), a mean of 8.3 EAs were used with 83.3% technical and 66.6% procedural success. One immediate adverse event occurred, in which an EA embolized to the left renal artery. At 9.4-month mean follow-up, overall survival was 83.3% with a mean 2.2-mm increase in sac diameter. CONCLUSIONS: Early experience suggests that EAs effectively treat intraoperative type 1A endoleaks and high-risk seal zones, with significant sac regression and no proximal endoleaks on follow-up. In patients treated for prior EVAR with postoperative type 1A endoleaks, fewer than half resolved after EA attempted repair. Further experience and longer term follow-up will be necessary to determine which patients most benefit from postoperative EA fixation.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Procedimientos Endovasculares/instrumentación , Stents , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Implantación de Prótesis Vascular/efectos adversos , California , Bases de Datos Factuales , Endofuga/etiología , Endofuga/terapia , Procedimientos Endovasculares/efectos adversos , Femenino , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/terapia , Humanos , Masculino , Diseño de Prótesis , Retratamiento , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
13.
Ann Vasc Surg ; 62: 496.e9-496.e13, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31394245

RESUMEN

Large artery stenosis of the arm or leg arteries or the cervical arteries has been described in giant cell arteritis (GCA); aortic involvement, nevertheless, is less frequent, even if imaging tools such as positron emission tomography (PET) computed tomography have increased the frequency in the observation of aortic involvement. A 56-year-old female with a medical history of GCA presented to our emergency department with an unruptured voluminous thoracoabdominal aortic aneurysm (TAAA). The fluorodeoxyglucose PET demonstrated the presence of high inflammatory activity. The patient underwent endovascular correction using a "sandwich technique." The 3-month control CT scan shows complete aneurysm exclusion. In high risk for surgery patients with GCA, the endovascular treatment with parallel stent graft of TAAA is safe and feasible.


Asunto(s)
Aneurisma de la Aorta Torácica/etiología , Arteritis de Células Gigantes/complicaciones , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Aortografía/métodos , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Angiografía por Tomografía Computarizada , Procedimientos Endovasculares/instrumentación , Femenino , Arteritis de Células Gigantes/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Tomografía de Emisión de Positrones , Stents , Resultado del Tratamiento
14.
Ann Vasc Surg ; 62: 474-483, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31449934

RESUMEN

BACKGROUND: Complications after thoracic endovascular aortic repair (TEVAR) are common. Even after a successful TEVAR, a late endoleak (>30 days) can occur. The objective of this study is to summarize the current evidence and, if lacking, the need of evidence regarding the incidence and predictive factors for type 1b endoleak in patients with aortic aneurysm treated with TEVAR. METHODS: A systematic review of the literature was performed on endoleak type 1b, in patients with aortic aneurysm, after TEVAR. The PubMed and Embase databases were systematically searched for articles regarding endoleak type 1b up to January 2019. The main subjects discussed are the incidence, risk factors, treatment, and prognosis. RESULTS: About 722 articles were screened, and 16 articles were included in this review. The reported incidence of endoleak is between 1.0% and 15.0%, with a mean follow-up duration of at least 1 year. Type 1b endoleak is associated with an increased aortic tortuosity index (>0.15 cm-1). No significant difference is found in relation to age and gender. Treatment is required in most cases (22/27) and is usually performed with distal extension of the stent graft (21/27). There are no data regarding stent graft oversizing, length of distal landing zone, and differences between devices or the prognosis for patients with type 1b endoleak. CONCLUSIONS: Limited literature is available on the occurrence of type 1b endoleak after TEVAR. A tortuous aorta can be associated as a predictive factor for the occurrence of type 1b endoleak. Data clearly delineating the anatomic variables predicting type 1b endoleak should be examined and listed. Likewise, the impact of more recent conformable devices to prevent complications like type 1b endoleaks from occurring should be elucidated.


Asunto(s)
Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Prótesis Vascular/efectos adversos , Endofuga/epidemiología , Procedimientos Endovasculares/efectos adversos , Migración de Cuerpo Extraño/epidemiología , Stents/efectos adversos , Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/epidemiología , Implantación de Prótesis Vascular/instrumentación , Endofuga/diagnóstico por imagen , Procedimientos Endovasculares/instrumentación , Femenino , Migración de Cuerpo Extraño/diagnóstico por imagen , Humanos , Incidencia , Masculino , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
16.
Clin Anat ; 33(1): 117-123, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31576608

RESUMEN

Current knowledge of the aortic root geometric anatomy and its surgical implications remain limited. We analyzed multiple predefined parameters of the aortic root to increase our understanding of the geometric changes that occur in normal and aneurysmal transformations. Between November 2003 and September 2015, the aortic roots of 107 healthy subjects (control group) and 105 annuloaortic ectasia (AAE) patients (AAE group) were analyzed using multiplanar reformatted computed tomographic images. The intercommissural distance (ICD), sinus width (SW), and sinus volume (SV) of the left (LCS), right (RCS), and noncoronary sinuses (NCS) of Valsalva were adopted as study parameters. In the control group, all study parameters of the LCS were smaller than those of the RCS and the NCS. In the AAE group, all parameters of the LCS were significantly smaller than those of the RCS or NCS, but the RCS and NCS parameters were similar. Proportionately less LCS enlargement relative to either the RCS or NCS was observed in root aneurysm(AAE group) than in the control group. We observed a distinct aortic root geometric pattern which was characterized by the LCS being smaller than either the RCS or NCS, while the latter were similar. This geometric configuration was significantly accentuated in AAE patients due to the greater disproportionate disparity in the LCS relative to either the RCS or NCS than in the roots of normal control subjects. Clin. Anat. 32:117-123, 2019. © 2019 Wiley Periodicals, Inc.


Asunto(s)
Aneurisma de la Aorta Torácica/diagnóstico por imagen , Válvula Aórtica/diagnóstico por imagen , Seno Aórtico/diagnóstico por imagen , Adulto , Anciano , Válvula Aórtica/anatomía & histología , Estudios de Casos y Controles , Femenino , Humanos , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Interpretación de Imagen Radiográfica Asistida por Computador , Seno Aórtico/anatomía & histología , Tomografía Computarizada por Rayos X
17.
Angiol Sosud Khir ; 25(4): 173-180, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-31855215

RESUMEN

Described herein is a clinical case report regarding treatment of a 70-year-old male patient presenting with a late complication following endoprosthetic repair for a Stanford type B dissecting thoracic aortic aneurysm. The man was admitted to our hospital for persistent type IIb endoleak and an increased diameter of the aorta in its thoracic and thoracoabdominal portions. Two years previously, he had endured endoprosthetic repair of the thoracic aorta. The findings of computed tomography revealed negative dynamics manifesting as an increase in the diameter of the false channel of the arch and descending thoracic aorta with persistent type IIb endoleak. He was subjected to elimination of abdominal aortic dissection and type IIb endoleak with partial prosthetic repair of the descending thoracic portion of the aorta by means of prosthetic repair of the lower thoracic portion of the aorta between the stent graft and linear vascular Dacron prosthesis. The postoperative period was complicated by transient acute renal failure and paraparesis of the lower limbs. The patient was discharged on POD 14, with no endoleaks revealed on control computed tomography 3 months thereafter.


Asunto(s)
Aneurisma Disecante/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Endofuga/cirugía , Procedimientos Endovasculares/efectos adversos , Lesión Renal Aguda/etiología , Anciano , Aneurisma Disecante/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Prótesis Vascular , Implantación de Prótesis Vascular/métodos , Endofuga/diagnóstico por imagen , Endofuga/etiología , Procedimientos Endovasculares/métodos , Humanos , Masculino , Paraparesia/etiología , Stents , Resultado del Tratamiento
18.
BMC Infect Dis ; 19(1): 959, 2019 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-31711418

RESUMEN

BACKGROUND: An infected aneurysm of the thoracic aorta is a rare clinical condition with significant morbidity and mortality. Patients with fast-growing aortic aneurysms show a high incidence of rupture. Gram-positive organisms, such as the Staphylococcus and Enterococcus species, are the most common cause of infection. CASE PRESENTATION: A 91-year-old man presented at our facility with high grade fever and tachypnea, which he had experienced for the previous two days. He had a history of end-stage renal disease and had been undergoing regular chest computed tomography (CT) follow-up for a left lower lung nodule. CT imaging with intravenous contrast media showed a thoracic aortic aneurysm with hemothorax. Rupture of the aneurysm was suspected. CT imaging performed a year ago showed a normal aorta. Blood samples showed a Bacillus cereus infection. The patient was successfully treated for a mycotic aortic aneurysm secondary to Bacillus cereus bacteremia. CONCLUSIONS: Here, we report a rare of an infected aneurysm of the thoracic aorta probably caused by Bacillus cereus. Although infected aneurysms have been described well before, an aneurysm infected with Bacillus cereus is rare. Bacillus cereus, a gram-positive spore-building bacterium, can produce biofilms, which attach to catheters. It has recently emerged as a new organism that can cause serious infection.


Asunto(s)
Aneurisma Infectado/microbiología , Aorta Torácica/microbiología , Aorta Torácica/patología , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Bacillus cereus/aislamiento & purificación , Administración Intravenosa , Administración Oral , Anciano de 80 o más Años , Aneurisma Infectado/tratamiento farmacológico , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Fluoroquinolonas/administración & dosificación , Fluoroquinolonas/uso terapéutico , Hemotórax/diagnóstico por imagen , Humanos , Masculino , Insuficiencia Respiratoria , Choque Séptico/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vancomicina/administración & dosificación , Vancomicina/uso terapéutico
19.
J Cardiothorac Surg ; 14(1): 184, 2019 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-31684975

RESUMEN

BACKGROUND: Traditional aortic arch replacement surgery must be performed under moderate or deep hypothermia (22-28 °C) and circulatory arrest. Hypothermia and hypoperfusion can cause damage to the nervous system; therefore, postoperative brain and spinal cord complications are common. Improvements in surgical techniques are necessary to solve this problem. Herein, we report a method of total aortic arch replacement that can be performed at a core temperature of 34 °C, similar to other simple cardiac operations. CASE PRESENTATION: Four patients underwent surgery with this technique (3 males and 1 female, aged 48 to 67 years). Computed tomography angiography performed at admission showed a total aortic dissection, resulting in a diagnosis of Stanford type A aortic dissection. The patients underwent emergency aortic sinus remodelling, ascending aortic replacement, modified aortic arch replacement, and elephant trunk stenting. No patients had neurological complications. During a follow-up of more than 1-month, no patients had aortic valve regurgitation or anastomotic leak. CONCLUSIONS: This technique can increase the operating temperature by approximately 6 to 12 °C and reduce the circulatory arrest time by approximately 18 to 28 min. All of the patients recovered well without any neurological complications, demonstrating the feasibility and safety of this technique. We believe that this technique can serve as a good alternative strategy for managing aortic dissection and aneurysm, especially for young surgeons who are acquiring experience in arch replacement surgery.


Asunto(s)
Aneurisma Disecante/cirugía , Aneurisma de la Aorta Torácica/cirugía , Anciano , Aneurisma Disecante/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Implantación de Prótesis Vascular , Temperatura Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Stents , Tomografía Computarizada por Rayos X , Procedimientos Quirúrgicos Vasculares/métodos
20.
Heart Surg Forum ; 22(5): E401-E404, 2019 Sep 24.
Artículo en Inglés | MEDLINE | ID: mdl-31596720

RESUMEN

Since the discovery of penicillin, the incidence of tertiary syphilis dramatically has decreased. However, cases of cardiovascular complications of syphilis still are present. Ascending aortic aneurysms are some of the most devastating complications. Nonetheless, syphilitic aortitis (SA) can appear and should be suspected in patients with syphilis and aortic aneurysm. We report a case of a 57-year-old patient with a large ascending aortic aneurysm with cartilage and rib erosion. The purpose of this article is to discuss the particular surgical aspects of this unusual case.


Asunto(s)
Aorta/cirugía , Aneurisma de la Aorta Torácica/cirugía , Sífilis Cardiovascular/complicaciones , Sífilis/complicaciones , Pared Torácica , Aorta/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/etiología , Implantación de Prótesis Vascular , Puente Cardiopulmonar , Ecocardiografía , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Fracturas de las Costillas/diagnóstico por imagen , Serodiagnóstico de la Sífilis , Pared Torácica/diagnóstico por imagen , Tomografía Computarizada por Rayos X
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