Combined cardiac-neurosurgical treatment of acute aortic dissection, stroke, and coma.

Coma or stroke with secondary brain malperfusion is usually considered a strong contraindication for emergent surgical treatment of acute aortic dissection. Herein, we present the case of a 30-year-old woman who presented with sudden left hemiplegia and level-7 coma on the Glasgow Coma Scale. Transthoracic echocardiography showed type A aortic dissection. Although the patient was unable to communicate, her family approved an emergency Bentall operation. She regained consciousness but developed anisocoria and Glasgow Coma Scale level-4 coma 30 hours after the operation. Computed tomography showed massive cerebral infarction with hernia of the uncus gyri hippocampi. Emergency surgical cerebral decompression was performed. The patient survived; after 1 year, she had full mental acuity and minor left motor sequelae.

Systemic inflammatory markers in patients with aortic sclerosis.

The aim of the study was to evaluate several mediators of inflammation in patients with aortic sclerosis in relation to severity of cardiovascular disease. Serum level of cytokines, soluble intracellular adhesion molecule 1, matrix metalloproteinase (MMP) 2 and 9 and their tissue inhibitor TIMP-1, were measured by ELISA and MMPs activity by zymography in 51 aortic sclerosis patients. The increase in MMPs expression positively correlated with their gelatinase activity; also there was a positive correlation between MMP-9 and TIMP-1 serum levels. Moreover, IL-6 concentration positively correlated with both serum level and activity of MMP-9. The level of IL-6 and IL-1Ra were higher in patients with a great burden of atherosclerosis. Noteworthy, statistically significant higher levels of IL-6 were noticed for patients with coronary artery disease. There was a significant increase in IL-6 serum level as well as a significant decrease in IL-1Ra for patients with a history of myocardial infarction. A trend toward higher concentration of inflammatory mediators was noticed in relation to the increase in severity of the aortic valve disease. Our results support the hypothesis of an "inflammatory pattern" associated with AS pathology and suggest the persistence of a chronic inflammation in patients who experienced acute coronary events.

[Pulmonary embolism--complication of proximal deep venous thrombosis in colorectal cancer. Diagnosis and management]. / Tromboembolismul pulmonar--complicatie a tromboflebitei proximale paraneoplazice în cadrul neoplasmului colo-rectal. abordare diagnostica si terapeutica.

We present the case of a 57 years old male, without cardiovascular history, with colorectal cancer and proximal deep venous thrombosis, who develops a massive pulmonary embolism. The surgical treatment consists in embolectomy of right ventricle, pulmonary trunk, left and right pulmonary artery. The specifics of the case is discussed: etiology and prevention of pulmonary embolism (caval filter) and treatment: the contraindications of thrombolytic therapy and the indications and perspectives of surgical treatment.

C-reactive protein, prothrombotic imbalance and endothelial dysfunction in acute coronary syndromes without ST elevation.

UNLABELLED: Inflammation is considered a crucial step in the pathogenesis of acute coronary syndromes (ACS). C-reactive protein (CRP) is proposed to be included in risk stratification of ACS patients. However, it is not yet known if CRP is only a risk marker, or merely a risk factor in the development of ACS. Our study looked at the links between inflammation and the prothrombotic factors present in patients with ACS without ST elevation. MATERIAL AND METHODS: 86 patients (pts), 46 men (53.4%), mean age = 58.2+/-12.4 years-old, with acute coronary syndromes (unstable angina and NSTEMI). The following parameters were measured in all pts on admission: CRP, fibrinogen, blood white cell count, and coagulation parameters: coagulation factor V and VIII, von Willebrand factor (vWf), antithrombin III (AT III), D-dimers (DD), C and S proteins. RESULTS: Mean CRP in the study group was 22.42+/-19.81 mg/dl (limits 1.40-88.8 mg/dl). We worked with quartiles of CRP plasmatic levels, in order to see how magnitude of inflammation correlates with different coagulation and fibrinolysis parameters. When comparing the 1st with the 4th CRP quartiles, we noted that important inflammation (4th quartile) was associated with higher factor von Willebrand (141.3 vs 108.9%, p<0.05), factor 5 (127.5% vs 88%, p<0.01), factor 8 (121.5 vs 117.1%, p=0.04), lower AT III (101.6 vs 118.2%, p<0.05), lower protein C and S. The associations did not keep for PAI-I or D-dimers, which might be associated with the lack of sensibility of fibrinolysis markers in the early period after thrombosis. CONCLUSIONS: Inflammation, as quantified by CRP, appears to be associated with a significant prothrombotic status and endothelial dysfunction (as reflected by high von Willebrand factor).

New insights into the pathogenesis and prognosis of aortic sclerosis.

Aortic valve disease includes a wide spectrum of conditions, from leaflets thickening to hemodynamically significant aortic stenosis and is one of the most important causes of morbidity and mortality worldwide. Studies performed during the last years bring consistent evidence that these lesions of the aortic valves share remarkable similarities with atherosclerotic lesions. They also reveal new risk factors for its development, which are superposed in fact with the major risk factors for atherosclerosis. Moreover, large prospective studies reported an increased risk for cardiovascular events and for total and cardiovascular mortality in patients with aortic sclerosis. Hence, recent papers also propose therapeutic targets, using statins for delaying the progression of the disease.

Subclinical atherosclerosis, carotid intima-media thickness and the cardiovascular risk.

The refinement and the improvement of the cardiovascular risk factors assessment became one of the high priorities in the global approach of cardiovascular diseases. Recent studies showed that increased carotid intima media thickness (IMT) is a relatively simple noninvasive marker of the global atherosclerotic disease, even in the asymptomatic stage. There is a strong link between IMT and both traditional and emerging cardiovascular risk factors, and IMT also predicts the occurrence of major cardiovascular events. Thus, IMT, as a marker of subclinical atherosclerosis, might improve the risk assessment in asymptomatic patients at risk.

Anterolateral papillary muscle rupture: diagnosis and successful treatment (a case report).

We report the case of a young man presenting with chest pain, dyspnea, and syncope in whom transthoracic and transesophageal echocardiography helped to diagnose anterolateral papillary muscle rupture. After cardiac catheterization (which confirmed the severe mitral regurgitation and showed two vessel coronary disease), mitral valve replacement was performed together with coronary bypass grafting.