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1.
BMC Cardiovasc Disord ; 20(1): 37, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996146

RESUMO

BACKGROUND: The Starr-Edwards ball valve prosthesis was successfully introduced in 1961-62 and largely used for aortic and mitral valve replacement. Even if Starr-Edwards valves have been widely replaced in clinical practice by other mechanical valves, they define a standard concerning long-term durability. CASE PRESENTATION: We describe the case of a 55-year-old man referred to our Department to perform a cardiac computed tomography (CCT), to better evaluate a severe dilation of ascending aorta discovered at echocardiography. The patient had been surgically treated 46 years earlier to correct a supra-cristal type ventricular septal defect. Both mitral and aortic valves were replaced, respectively due to bacterial mitral endocarditis and a fibrous sub-valvular aortic stenosis. In addition, the right coronary artery (RCA) was found to arise from the left coronary sinus. CONCLUSION: We report the longest lasting durability (46 years) of aortic and mitral Starr-Edwards valves successfully implanted in a patient simultaneously carrying a malignant anomalous origin of RCA.


Assuntos
Valva Aórtica/cirurgia , Anomalias dos Vasos Coronários/complicações , Comunicação Interventricular/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Valva Mitral/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico por imagem , Comunicação Interventricular/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Fatores de Tempo , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(48): e18169, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770266

RESUMO

INTRODUCTION: Sinus of Valsalva aneurysm (SVA) protruding into the mitral anterior leaflet is an extremely rare clinical condition; herein, we present a case of unruptured noncoronary SVA protruding into the mitral anterior leaflet. PATIENT'S CONCERNS: A 46-year-old male was referred to hospital for exertional dyspnea. DIAGNOSIS: Transthoracic echocardiography (TTE) and coronary computed tomography angiography (CTA) suggested a noncoronary SVA protruding into the mitral anterior leaflet, causing mitral regurgitation and aortic insufficiency. INTERVENTIONS: The aneurysm was resected and the aortic and mitral valves were replaced with mechanical valves via a transaortic approach. OUTCOMES: Postoperative recovery was uneventful. CONCLUSIONS: A rare noncoronary SVA protruding into the mitral anterior leaflet can be diagnosed via TTE and CTA. Transaortic mitral surgery is feasible in patients with a dilated aortic annulus ring and mitral valve diseases.


Assuntos
Aneurisma Aórtico , Insuficiência da Valva Aórtica , Dispneia , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral , Valva Mitral , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/fisiopatologia , Aneurisma Aórtico/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Dispneia/diagnóstico , Dispneia/etiologia , Dispneia/fisiopatologia , Ecocardiografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/fisiopatologia , Resultado do Tratamento
5.
Braz J Cardiovasc Surg ; 34(5): 627-629, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719015

RESUMO

A 27-year-old woman with sudden back pain was transported to our hospital. Abdominal ultrasonography revealed pregnancy of 28 weeks' gestation. Computed tomography demonstrated a type A aortic dissection. Because of progressive fetal deterioration, an emergency cesarean section was forced to perform. The next day, simple hysterectomy followed by an aortic procedure was completed. Valve-sparing aortic replacement and total arch replacement were employed as central operations. The mother and baby are well 9 months postoperatively. Although the strategy for acute type A aortic dissection during pregnancy is controversial, collaborations among neonatologists, obstetricians, and cardiovascular surgeons can ensure mother and infant survival.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Complicações Cardiovasculares na Gravidez/cirurgia , Adulto , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Cesárea , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Resultado da Gravidez , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Cardiovasc Intervent Radiol ; 42(12): 1786-1794, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31555850

RESUMO

PURPOSE: It has been hypothesized that microstents which are used to prevent coil protrusion in the treatment of cerebral aneurysms may have flow diverting and therefore occlusive effects. In a rabbit elastase aneurysm model, we investigated the aneurysm occlusion rate and vessel reaction of a braided Accero stent prototype with porosity in the lower range of other available (non-flow-diverter) microstents. METHODS: Ten aneurysms were induced the right subclavian artery in New Zealand white rabbits and treated with the Accero stent prototype. In each subject, a second stent was implanted in the abdominal aorta to cover the origins of branch arteries. Angiographic follow-up and explantation of the devices and aneurysms for histological analysis were performed after 3 months (n = 5) and 6 months (n = 5). RESULTS: Grades I (< 50%) and II (> 50%) occlusion rates were observed in 9 (90%) and 1 (10%) of ten aneurysms treated with the stent device. The mean reduction in contrast filling at 6 months was 42.1% (p = .02). Neointima thickness was significantly higher in the subclavian artery than in the abdominal aorta after 3 (p = .03), whereas not after 6 months (p = .1). No cases of inadequate wall apposition, branch artery occlusion or stent thrombosis were observed. CONCLUSION: The present study showed flow remodelling properties of the device prototype with progredient aneurysm occlusion. A larger in vivo study with induced aneurysm should be done to confirm these results.


Assuntos
Aneurisma Aórtico/terapia , Stents , Grau de Desobstrução Vascular/fisiologia , Angiografia , Animais , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/fisiopatologia , Modelos Animais de Doenças , Desenho de Equipamento , Feminino , Coelhos , Artéria Subclávia/diagnóstico por imagem , Resultado do Tratamento
9.
J Radiol Case Rep ; 13(7): 21-28, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31558964

RESUMO

A previously well 81-year-old Chinese male presented with hoarseness and low back pain for one month. Chest radiography at presentation revealed widening of the mediastinal silhouette. Nasopharyngoscopy detected left vocal cord paralysis. CT aortogram revealed a large saccular aortic arch aneurysm with a dissection flap extending distally down to the aortic bifurcation. The combination of clinical and imaging findings was consistent with cardiovocal syndrome. In view of good premorbid function, surgical repair was offered, and the patient underwent surgical repair and recovered well with no further back pain. A review of cases of cardiovocal syndrome suggest that prognosis of recurrent laryngeal nerve paralysis is dependent on the degree and duration of compression, and usually persists despite treatment of the underlying aneurysm.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Dor nas Costas/etiologia , Rouquidão/etiologia , Idoso de 80 Anos ou mais , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Humanos , Masculino , Síndrome , Tomografia Computadorizada por Raios X/métodos , Paralisia das Pregas Vocais/etiologia
10.
J Med Vasc ; 44(5): 340-343, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31474345

RESUMO

Arterial involvement in Behçet's disease is rare. The exceptional aortic isthmus location is difficult to treat. We report the case of a young man in whom an aortic isthmus aneurysm revealed Behçet's disease. In this exceptional situation, we opted for classical open surgical repair despite current preference for endovascular treatment.


Assuntos
Aneurisma Aórtico/etiologia , Síndrome de Behçet/complicações , Adulto , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Síndrome de Behçet/diagnóstico por imagem , Implante de Prótese Vascular , Humanos , Masculino , Resultado do Tratamento
11.
Semin Vasc Surg ; 32(1-2): 73-80, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540660

RESUMO

The use of autologous femoral veins for in situ reconstruction of the aortoiliac segment is an effective technique to treat native aorta or prosthetic graft infections. The indications, technical details, and outcomes of this procedure are detailed. Graft infection involving the aortic segment, while rare, remains one of the most challenging vascular surgery conditions to treat. The original technique of "neo-aortoiliac surgery" with in situ autologous vein grafts has evolved over the past 25 years and remains a worthwhile alternative for the treatment of aortic graft infections, with lower mortality rates compared with other extra-anatomic or in situ surgical options. Acceptance of this surgical option is due to low graft re-infection rates, rare graft disruption, and low long-term aneurysmal degeneration. Excision of the femoral veins is associated with acceptable rates of lower limb edema. The use of an autologous femoral vein graft can be considered the standard of care in selected patients for the management of aortic graft infections. Optimal management of patients with aortic graft infections requires consideration of all potential therapeutic options because no single modality can be used, and individualizing treatment according to the clinical condition will yield the best patient outcomes.


Assuntos
Aneurisma Infectado/cirurgia , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Veia Femoral/transplante , Infecções Relacionadas à Prótese/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aorta/diagnóstico por imagem , Aorta/microbiologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/microbiologia , Implante de Prótese Vascular/instrumentação , Tomada de Decisão Clínica , Remoção de Dispositivo , Humanos , Seleção de Pacientes , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Reoperação , Fatores de Risco , Resultado do Tratamento
12.
Heart Surg Forum ; 22(4): E287-E288, 2019 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-31398093

RESUMO

The rupture of sinus of Valsalva aneurysm (SVA) into the pericardial cavity is extremely rare and fatal. A 52-year-old man presented with an abrupt onset of chest pain and dizziness. An echocardiography and a computed tomographic angiography revealed a giant aneurysm of the noncoronary sinus (NCS) (maximum, 70 mm) and pericardial effusion in favor of tamponade with a moderate degree of aortic insufficiency. On the way to the operating room, he suffered cardiac arrest, and extracorporeal cardiopulmonary resuscitation (ECPR) was initiated immediately. While he was prepared for surgery, the patient was supported by extracorporeal life support (ECLS) until cardiopulmonary bypass (CPB) was initiated. The sinus defect was reconstructed using a Dacron patch, followed by resection of the aneurysm. ECLS and CPB were discontinued successfully in the operating room. This study reports a case of an extracardiac rupture of SVA and the successful completion of surgery following ECPR.


Assuntos
Aneurisma Aórtico/cirurgia , Ruptura Aórtica/cirurgia , Reanimação Cardiopulmonar/métodos , Oxigenação por Membrana Extracorpórea/métodos , Doenças Raras/cirurgia , Seio Aórtico/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Angiografia por Tomografia Computadorizada , Ecocardiografia Transesofagiana , Parada Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/diagnóstico por imagem , Doenças Raras/diagnóstico por imagem , Seio Aórtico/diagnóstico por imagem
13.
Ann Thorac Cardiovasc Surg ; 25(5): 265-273, 2019 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-31378750

RESUMO

PURPOSE: Our study aimed to investigate the potential pathogenetic theories of different phenotype prevalence in bicuspid aortopathy. METHODS: A total of 407 bicuspid aortic valve (BAV) patients with aortic dilation were retrospectively reviewed. Association was determined between aortic valve lesion types and aortic configurations to confirm the homogeneous BAV subsets, and then, dominance analysis was used to evaluate the relative importance of two components of aortic valve lesion (BAV phenotype and valvular dysfunction) that associated with aortic configurations in each subgroup. RESULTS: Dominance analysis showed that Type-1 LR was the dominant contributor (79.0% and 79.6%) associated with the higher prevalence of the dilation of aortic root (AoR) and ascending aorta (AAo) in BAV patients with Type-1 LR and aortic regurgitation (AR) or aortic stenosis (AS) + AR. However, AS was the main contributor (60.0%) associated with the raised incidence of the dilation of AAo and proximal aortic arch (PArc) in Type-0 LAT and AS. CONCLUSIONS: Different dominant pathogenetic theory determined the phenotype of BAV aortopathy. In patients of Type-1 LR with AR, inherent disposition is mainly responsible for the higher frequency of AoR dilation. Valve-related hemodynamics determined greater prevalence of the dilation of AAo and PArc in patients of Type-0 LAT with AS.


Assuntos
Aneurisma Aórtico/epidemiologia , Insuficiência da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/epidemiologia , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/epidemiologia , Adulto , Idoso , Aorta/diagnóstico por imagem , Aorta/patologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/patologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Pequim/epidemiologia , Dilatação Patológica , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/patologia , Doenças das Valvas Cardíacas/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Prevalência , Estudos Retrospectivos
14.
Cardiovasc Intervent Radiol ; 42(10): 1488-1493, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31363897

RESUMO

PURPOSE: We presented a new method of sac embolization using n-butyl-cyanoacrylate (NBCA) with balloon occlusion of the aorta (SEBOA) that can facilitate decreasing flow rate of the involved branches with the goal of type 2 endoleak resolution after endovascular aortic repair (EVAR). TECHNIQUE: This technique is demonstrated in six patients who required type 2 endoleak treatment including previous technical failure. A transarterial approach was performed in four patients and transabdominal direct puncture in two. Technical success was defined as complete embolization of both involved branches and sac on postoperative CT. Sacography under balloon occlusion of the aorta demonstrated decreased flow rate of the all involved branches in all patients. SEBOA was performed using 25 or 33% of NBCA diluted with lipiodol. Technical success was obtained in 3 of 6 patients, and one major complication was observed with adhesion of NBCA to the microcatheter resulting in foreign body retention. CONCLUSION: SEBOA may help solve the difficulty of type 2 endoleak treatment after EVAR as decreased flow rate of the involved branches under balloon occlusion of the aorta was achieved in all patients. However, protocols regarding concentration of NBCA or using other embolic materials are needed to improve the success rate.


Assuntos
Aneurisma Aórtico/terapia , Oclusão com Balão/métodos , Embolização Terapêutica/métodos , Endoleak/terapia , Procedimentos Endovasculares/métodos , Idoso , Aorta/diagnóstico por imagem , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Embucrilato/administração & dosagem , Endoleak/complicações , Endoleak/diagnóstico por imagem , Óleo Etiodado/administração & dosagem , Feminino , Humanos , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
J Comput Assist Tomogr ; 43(5): 770-774, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31425308

RESUMO

BACKGROUND: Follow-up with computed tomographic angiography is recommended after endovascular aneurysm repair, exposing patients to significant levels of radiation and iodine contrast medium. Dual-energy computed tomography allows virtual noncontrast (VNC) images to be reconstructed from contrast-enhanced images using a software algorithm. If the VNC images are a good-enough approximation of true noncontrast (TNC) images, a reduction in radiation dose can be ensured through omitting a TNC scan. PURPOSE: To compare image quality of VNC images reconstructed from arterial phase and venous phase dual-energy computed tomographic angiography to TNC images and to assess which one is more suitable to replace TNC images. METHODS: Sixty-three consecutive patients were examined using a dual-energy computed tomography as elective follow-up after endovascular aneurysm repair. The examination protocol included 1 unenhanced and 2 contrast-enhanced scans (80 kV/Sn140 kV) of the aorta. Virtual noncontrast data sets were reconstructed from the arterial (A-VNC) and venous (V-VNC) phase scans, respectively. Mean attenuation and image noise were measured for TNC, A-VNC, and V-VNC images within regions of interest at 2 levels in the aorta, the liver, retroperitoneal fat, and psoas muscle. Subjective image quality was assessed on a 4-point scale by 2 blinded readers. RESULTS: The differences between A-VNC and TNC, and between A-VNC and V-VNC, were substantial aorta at the level of diaphragm and aorta at the level of renal arteries. The difference between V-VNC and TNC was, on the other hand, very small and not statistically significant for the renal artery aorta. For liver, fat, and muscle tissue, there were significant differences between both A-VNC and V-VNC compared with TNC, but findings were similar between A-VNC and V-VNC. CONCLUSIONS: Virtual noncontrast images based on venous-phase scans appear to be a more accurate representation of TNC scans than VNC images based on arterial-phase scans.


Assuntos
Aneurisma Aórtico/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Imagem Radiográfica a Partir de Emissão de Duplo Fóton/métodos , Idoso , Algoritmos , Aneurisma Aórtico/cirurgia , Meios de Contraste , Procedimentos Endovasculares , Feminino , Humanos , Iohexol , Masculino , Estudos Prospectivos , Interpretação de Imagem Radiográfica Assistida por Computador
17.
Scand Cardiovasc J ; 53(5): 274-279, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31290700

RESUMO

Background. Aortic dissection (AD) and abdominal aortic aneurysm (AAA) share the same risk factors. Whereas the incidence of AAA is falling, it is unclear whether population-based incidences of acute type A and B AD have changed. The aim of this study was to investigate incidences of AD subtypes over time. Methods. Citizens in the municipality of Malmö, Sweden, diagnosed with AD in 2000-2004 and 2014-2016 were identified through the in-patient, clinical, and forensic autopsy registers. Results. The overall and gender-specific incidences of acute type A and B AD were stable over time. The overall autopsy rate declined from 25.2% in 2000-2004 to 16.1% in 2014-2016 (p = .0001) and patients with acute type A AD were more often encountered at autopsy (78% of cases) during the first time period, compared to 43% of cases during the second time period (p = .005), when the ratio of acute type A: acute type B AD was 2.6: 1. The proportion of individuals <65 years of age tended to be higher in acute type A AD compared to acute type B AD (p = .07). The frequencies of hypertension and smoking were 90% and 91%, respectively, in type A AD, and 86% and 86%, respectively in type B AD. Conclusions. Population-based incidences of acute type A and type B AD were stable over time, but the decreasing autopsy rate has led to a lower proportion of AD diagnosed at autopsy. Primary prevention towards hypertension and smoking seem necessary to reduce AD incidence.


Assuntos
Aneurisma Dissecante/epidemiologia , Aneurisma Aórtico/epidemiologia , Doença Aguda , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/mortalidade , Aneurisma Aórtico/cirurgia , Autopsia , Criança , Pré-Escolar , Feminino , Humanos , Hipertensão/epidemiologia , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Fumar/efeitos adversos , Fumar/epidemiologia , Suécia/epidemiologia , Fatores de Tempo , Adulto Jovem
18.
Biomed Res Int ; 2019: 9104680, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31263710

RESUMO

Background: The pathogenesis of abdominal aortic aneurysm (AAA) is characterized by atherosclerosis with chronic inflammation in the aortic wall. Montelukast is a selective cys-LT 1 receptor antagonist that can suppress atherosclerotic diseases. We evaluated the in vitro properties of montelukast and its in vivo activities in an angiotensin II-infused apolipoprotein E-deficient (apoE-/-) AAA mouse model. Methods: The mouse monocyte/macrophage cell line J774A.1 was used in vitro. M1 macrophages were treated with montelukast, and gene expressions of inflammatory cytokines were measured. Macrophages were cultured with montelukast, then gene expressions of arginase-1 and IL (interleukin)-10 were assessed by quantitative polymerase chain reaction, arginase-1 was measured by fluorescence-activated cell sorting, and IL-10 concentration was analyzed by enzyme-linked immunosorbent assay. In vivo, one group (Mont, n=7) received oral montelukast (10 mg/kg/day) for 28 days, and the other group (Saline, n=7) was given normal Saline as a control for the same period. Aortic diameters, activities of matrix metalloproteinases (MMPs), cytokine concentrations, and the number of M2 macrophages were analyzed. Results: Relative to control, montelukast significantly suppressed gene expressions of MMP-2, MMP-9, and IL-1ß, induced gene expressions of arginase-1 and IL-10, enhanced the expression of the arginase-1 cell surface protein, and increased the protein concentration of IL-10. In vivo, montelukast significantly decreased aortic expansion (Saline vs Mont; 2.44 ± 0.15 mm vs 1.59 ± 0.20 mm, P<.01), reduced MMP-2 activity (Saline vs Mont; 1240 µM vs 755 µM, P<.05), and induced infiltration of M2 macrophages (Saline vs Mont; 7.51 % vs 14.7 %, P<.05). Conclusion: Montelukast induces M2 macrophage polarization and prevents AAA formation in apoE-/- mice.


Assuntos
Acetatos/uso terapêutico , Aneurisma Aórtico/tratamento farmacológico , Polaridade Celular , Macrófagos/metabolismo , Quinolinas/uso terapêutico , Receptores de Leucotrienos/metabolismo , Acetatos/farmacologia , Animais , Aorta/efeitos dos fármacos , Aorta/enzimologia , Aorta/patologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/patologia , Arginase/genética , Arginase/metabolismo , Linhagem Celular , Polaridade Celular/efeitos dos fármacos , Quimiocinas/metabolismo , Regulação da Expressão Gênica/efeitos dos fármacos , Mediadores da Inflamação/metabolismo , Peptídeos e Proteínas de Sinalização Intercelular/metabolismo , Interleucina-10/genética , Interleucina-10/metabolismo , Macrófagos/efeitos dos fármacos , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Camundongos Endogâmicos C57BL , Quinolinas/farmacologia , Fator de Necrose Tumoral alfa/farmacologia
19.
Presse Med ; 48(9): 956-967, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31327542

RESUMO

Aortitis, defined by aortic parietal thickening, is noted in about 50% of patients with giant cell arteritis (GCA). Aortic structural lesions, ectasia or aneurism, may occur with or without inflammatory aspect of the aorta, sometimes since the diagnosis of GCA, but more frequently during follow-up. Assessment of aortic involvement, which has to be searched in each patient at the diagnosis of GCA, can be assessed using aortic imaging, angio-CT, angio-MRI or PET-CT. Prognosis of aortitis and its complications remains poorly known, but mortality due to serious events like aneurism rupture or aortic dissection, could be potentially reduced with precocious diagnosis and regular monitoring. Treatment of GCA-related aortitis is based on high-dose glucosteroids, with an initial prednisone dose at 0.7 mg/kg/d, as recommended by the French Study Group for large vessel vasculitis (GEFA). Aortic ectasia and aneurisms have to be monitored, in order to propose aortic surgery in the best conditions as possible.


Assuntos
Aortite/diagnóstico por imagem , Arterite de Células Gigantes/diagnóstico por imagem , Corticosteroides/administração & dosagem , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/etiologia , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/etiologia , Aneurisma Aórtico/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/etiologia , Ruptura Aórtica/cirurgia , Aortite/complicações , Aortite/tratamento farmacológico , Aortite/patologia , Angiografia por Tomografia Computadorizada , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/tratamento farmacológico , Arterite de Células Gigantes/patologia , Fidelidade a Diretrizes , Humanos , Imagem por Ressonância Magnética , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Prednisona/administração & dosagem , Prognóstico , Ultrassonografia Doppler
20.
Eur Radiol ; 29(12): 6396-6404, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31278573

RESUMO

Acute aortic syndromes comprise a group of potentially fatal conditions that result from weakening of the aortic vessel wall. Pre-emptive surgical intervention is currently reserved for patients with severe aortic dilatation, although abundant evidence describes the occurrence of dissection and rupture in aortas with diameters below surgical thresholds. Modern imaging techniques (such as hybrid PET-CT and 4D flow MRI) afford the non-invasive assessment of anatomic, hemodynamic, and molecular features of the aorta, and may provide for a more accurate selection of patients who will benefit from preventative surgical intervention. In the current review, we summarize evidence and considerations regarding predictive aortic imaging and highlight evolving imaging modalities that have shown promise to improve risk assessment for the occurrence of dissection and rupture. KEY POINTS: • Guidelines for the preventative management of aortic disease depend on maximal vessel diameters, while these have shown to be poor predictors for the occurrence of catastrophic acute aortic events. • Evolving imaging modalities (such as 4D flow MRI and hybrid PET-CT) afford a more comprehensive insight into anatomic, hemodynamic, and molecular features of the aorta and have shown promise to detect vessel wall instability at an early stage.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Imagem Tridimensional/métodos , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Aorta/diagnóstico por imagem , Humanos , Medição de Risco
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