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1.
Angiol Sosud Khir ; 26(3): 173-178, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063765

RESUMO

Presented herein is a clinical case report regarding a repeat intervention for a type II dissecting thoracoabdominal aortic aneurysm treated by means of a hybrid technique in a 76-year-old male patient with a single kidney, having 9 years previously endured resection of an aneurysm of the infrarenal aortic portion. The first stage consisted in prosthetic repair of the thoracoabdominal aortic aneurysm by an oblique anastomosis, with the second stage (7 days thereafter) being endoprosthetic repair of the descending thoracic aorta. The findings of check-up computed tomography at 16 months postoperatively demonstrated no negative dynamics.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Rim Único , Idoso , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Humanos , Masculino
2.
Angiol Sosud Khir ; 26(3): 82-101, 2020.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-33063755

RESUMO

A surgical intervention for type A acute aortic dissection is the only effective method of treatment making it possible to prevent the development of life-threatening complications and to attain clinical recovery of the patient. Supracoronary replacement of the ascending aorta and the proximal portion of the aortic arch is considered to be the classical and most commonly used method of an open operative intervention. On the one hand, it is technically the simplest and shortest operation, and on the other, this surgical technique is often accompanied by long-term proximal and distal complications, and first of all those caused by a persistent false lumen. The accumulated surgical experience and contemporary operative techniques, as well as advances of intensive therapy in treatment of type A acute aortic dissection make it possible to currently perform more extensive primary resections in order to improve the remote results. Total aortic arch replacement, including the use of the 'frozen elephant trunk' technique leads to fast thrombosis of the false lumen, preventing progression of the disease of the thoracic aorta and promoting its positive remodelling. The article describes the perioperative therapeutic policy accepted and pursued in our medical facility, also presenting the authors' opinion on the role and place of the 'frozen elephant trunk' technique in rendering medical care for patients with type A acute aortic dissection.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aorta , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Humanos , Procedimentos Cirúrgicos Vasculares
3.
Zhonghua Wai Ke Za Zhi ; 58(8): 604-607, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727191

RESUMO

Aortic dissection is a life-threatening cardiovascular disease. Multi-center registration databases for aortic dissection have been established in many countries. The International Registry of Acute Aortic Dissection has produced a number of research results, which had a significant impact on the diagnosis and treatment of aortic dissection worldwide. The Society for Thoracic Surgeons Adult Cardiac Surgery Database summarizes perioperative data on aortic dissection. German Registry for Acute Aortic Dissection Type A has made remarkable achievements in the neurological protection and organ perfusion of type A aortic dissection. The Nordic Consortium for Acute Type A Aortic Dissection provides guidelines for perioperative administration of aortic dissection. However, the first Registry of Aortic Dissection in China (Sino-RAD) has not reported any new aortic dissection data in the past five years, although it has proposed a number of pathogenic characteristics of Chinese people. Therefore, it is necessary to establish our own aortic dissection database.


Assuntos
Aneurisma Dissecante , Aneurisma Aórtico , Sistema de Registros , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aneurisma Dissecante/terapia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/cirurgia , Aneurisma Aórtico/terapia , Humanos
4.
J Card Surg ; 35(10): 2832-2834, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32667075

RESUMO

The nuance of operative decision making for those in need of emergent operation during coronavirus disease 2019 (COVID-19) pandemic is increasingly complex in the absence of robust data or guidelines. We present two cases of thoracic aortic emergencies with COVID-19 disease who survived high-risk operations to highlight the potential for successful outcomes even in situations compounding patient disease, morbid operation, and the added risk associated with virulent disease in the pandemic time.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Emergências , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Vasculares/métodos , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/epidemiologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Período Pós-Operatório , Período Pré-Operatório , Tomografia Computadorizada por Raios X
5.
Ann Vasc Surg ; 68: 497-504, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32599111

RESUMO

BACKGROUND: Acute aortic dissection (AAD) is the most devastating aortic pathology, and the incidence is increasing worldwide. However, the occurrence and development of AAD are unpredictable. A thorough understanding of the serum metabolic landscape through metabolomic analysis may help identify new biomarkers for AAD and offers new insights into its prevention and evaluation. METHODS: Nineteen patients with Stanford type A aortic dissection and 20 healthy individuals were enrolled in this study. We use global and targeted mass spectrometry-based metabolomics to investigate the serum metabolomics profiles, and the data were analyzed by principal component analysis and orthogonal partial least squares discriminant analysis. RESULTS: Initial untargeted metabolomics analysis revealed significant changes of lipids and polar metabolites in patients with AAD. Alterations of the phosphatidylcholine metabolic pathway were further observed by targeted metabolomics. Trimethylamine N-oxide (TMAO) levels were obviously increased in patients with AAD compared with controls (P < 0.005), whereas the levels of carnitine (P < 0.005), choline, and betaine (P < 0.05) were decreased. Furthermore, TMAO levels were associated with disease severity in AAD and correlated positively with C-reactive protein levels (r = 0.537, P = 0.018), IL-6 levels (r = 0.546, P = 0.016), D-dimer levels (r = 0.694, P = 0.001), and maximum aortic diameter on admission (r = 0.748, P = 0.002). CONCLUSIONS: Patients with AAD showed a predominant and consistent change of metabolites levels, especially the compounds in the phosphatidylcholine metabolic pathway. TMAO could potentially serve as a biomarker for the auxiliary diagnosis and evaluation of AAD.


Assuntos
Aneurisma Dissecante/sangue , Aneurisma Aórtico/sangue , Metabolômica , Metilaminas/sangue , Fosfatidilcolinas/sangue , Doença Aguda , Adulto , Aneurisma Dissecante/diagnóstico , Aneurisma Aórtico/diagnóstico , Biomarcadores/sangue , Estudos de Casos e Controles , Cromatografia Líquida de Alta Pressão , Feminino , Humanos , Lipidômica , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Valor Preditivo dos Testes
6.
Nat Rev Cardiol ; 17(11): 718-731, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32518358

RESUMO

Cardiovascular disease complicates 1-4% of pregnancies - with a higher prevalence when including hypertensive disorders - and is the leading cause of maternal death. In women with known cardiovascular pathology, such as congenital heart disease, timely counselling is possible and the outcome is fairly good. By contrast, maternal mortality is high in women with acquired heart disease that presents during pregnancy (such as acute coronary syndrome or aortic dissection). Worryingly, the prevalence of acquired cardiovascular disease during pregnancy is rising as older maternal age, obesity, diabetes mellitus and hypertension become more common in the pregnant population. Management of cardiovascular disease in pregnancy is challenging owing to the unique maternal physiology, characterized by profound changes to multiple organ systems. The presence of the fetus compounds the situation because both the cardiometabolic disease and its management might adversely affect the fetus. Equally, avoiding essential treatment because of potential fetal harm risks a poor outcome for both mother and child. In this Review, we examine how the physiological adaptations during pregnancy can provoke cardiometabolic complications or exacerbate existing cardiometabolic disease and, conversely, how cardiometabolic disease can compromise the adaptations to pregnancy and their intended purpose: the development and growth of the fetus.


Assuntos
Fenômenos Fisiológicos Cardiovasculares , Diabetes Gestacional/metabolismo , Hipertensão Induzida pela Gravidez/fisiopatologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Gravidez/fisiologia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/fisiopatologia , Síndrome Coronariana Aguda/terapia , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/fisiopatologia , Aneurisma Dissecante/terapia , Anti-Hipertensivos/uso terapêutico , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Aspirina/uso terapêutico , Débito Cardíaco , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Cardiomiopatias/terapia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/terapia , Progressão da Doença , Endocardite/diagnóstico , Endocardite/fisiopatologia , Endocardite/terapia , Feminino , Humanos , Hipertensão/fisiopatologia , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Idade Materna , Obesidade Materna/metabolismo , Obesidade Materna/fisiopatologia , Inibidores da Agregação de Plaquetas/uso terapêutico , Pré-Eclâmpsia/fisiopatologia , Pré-Eclâmpsia/prevenção & controle , Pré-Eclâmpsia/terapia , Gravidez/metabolismo , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/terapia , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Gravidez em Diabéticas/metabolismo , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/fisiopatologia
7.
Ann Thorac Surg ; 110(5): e421-e423, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32437675

RESUMO

A patient underwent surgery for acute type A aortic dissection. Testing for SARS-CoV-2 was positive. The postoperative course was complicated by a mixed viral and bacterial pneumonia with bilateral infiltration, treated with antibiotics and hydroxychloroquine, without any need for reintubation. The patient recovered and finally could be discharged. This report shows the feasibility for surgical treatment of acute aortic disease in patients with COVID-19.


Assuntos
Aneurisma Dissecante/etiologia , Aneurisma da Aorta Torácica/etiologia , Betacoronavirus , Tratamento Conservador/métodos , Infecções por Coronavirus/complicações , Gerenciamento Clínico , Pneumonia Viral/complicações , Doença Aguda , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/terapia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/terapia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Humanos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Tomografia Computadorizada por Raios X
10.
Ann Thorac Surg ; 110(5): e405-e407, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32333849

RESUMO

As of April 7, 2020, approximately 1,300,000 cases and 80,000 deaths related to coronavirus disease 2019 (COVID-19) have been reported in more than 180 countries/territories. Health care infrastructures and resources, particularly as it relates to the care of the most critically ill patients, are currently being strained globally. In this context, however, there has been little clinical guidance or information regarding life-threatening conditions requiring emergency operation that cannot be delayed. We present a case of acute type A aortic dissection in a patient with COVID-19 to highlight the clinical implications of a true emergent procedure during the COVID-19 outbreak.


Assuntos
Aneurisma Dissecante/etiologia , Aneurisma da Aorta Torácica/etiologia , Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Tomografia Computadorizada por Raios X
11.
Ann Thorac Surg ; 110(3): 1055-1059, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32339506

RESUMO

PURPOSE: There is a high incidence of complications after conventional open thoracic aortic arch replacement. Stent graft thoracic endovascular repair for aortic aneurysms has few complications. Vascular variability of the aortic arch branch is high and individualized aortic arch stent graft is required. We present our experience using 3-dimensional print-assisted fabrication of individualized stent grafts. DESCRIPTION: According to the patient's computed tomography angiography results before surgery, the aortic arch was printed 3-dimensionally and then an individualized stent graft was sewn. The prepared stents were placed in the descending aorta and the partial branches of the arch, and then released. EVALUATION: Intraoperative stent placement was successful. The deep hypothermic circulatory arrest time was only 5 minutes. The patient recovered well after surgery and no neurological complications occurred. Postoperative computed tomography angiography showed good stent expansion and no endoleak. CONCLUSIONS: Three-dimensional printing-assisted fabrication of a stent graft can be used for endovascular repair of the total aortic arch. This technology can be employed to construct individualized aortic arch stents accurately for different patients before surgery.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Endovasculares/métodos , Impressão Tridimensional , Procedimentos Cirúrgicos Reconstrutivos/métodos , Stents , Aneurisma Dissecante/diagnóstico , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico , Prótese Vascular , Angiografia por Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese
12.
Emerg Med Clin North Am ; 38(2): 453-498, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32336336

RESUMO

Nontraumatic chest pain is a frequent concern of emergency department patients, with causes that range from benign to immediately life threatening. Identifying those patients who require immediate/urgent intervention remains challenging and is a high-risk area for emergency medicine physicians where incorrect or delayed diagnosis may lead to significant morbidity and mortality. This article focuses on the 3 most prevalent diagnoses associated with adverse outcomes in patients presenting with nontraumatic chest pain, acute coronary syndrome, thoracic aortic dissection, and pulmonary embolism. Important aspects of clinical evaluation, diagnostic testing, treatment, and disposition and other less common causes of lethal chest pain are also discussed.


Assuntos
Dor no Peito/diagnóstico , Serviço Hospitalar de Emergência , Gestão de Riscos , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/terapia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/terapia , Dor no Peito/etiologia , Dor no Peito/terapia , Humanos , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Gestão de Riscos/métodos
13.
Interact Cardiovasc Thorac Surg ; 30(5): 739-745, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32163575

RESUMO

OBJECTIVES: Although skeletal muscle quantity is linked to surgical outcomes, quality remains unexamined. In this study, we evaluated whether skeletal muscle quality and quantity could predict surgical outcomes in acute type A aortic dissection (ATAAD). METHODS: Skeletal muscle quality and quantity were evaluated using computed tomography (CT) values and the psoas muscle mass index, respectively. From May 2004 to December 2017, 324 ATAAD patients underwent aortic replacement after CT scans and psoas muscle mass index measurements. Patients were grouped into intramuscular fat (IMF; n = 55) and non-IMF (n = 269) deposition groups. RESULTS: The mean ages of the patients were 72.3 ± 9.7 and 66.8 ± 12.1 years (P = 0.002), and hospital mortality rates were 3.6% (2/55) and 7.4% (20/269; P = 0.393) for IMF and non-IMF deposition groups, respectively. IMF deposition was a risk factor for a deterioration in activities of daily living at discharge by multivariable analysis [odds ratio 0.33, 95% confidence interval (CI) 0.16-0.69; P = 0.003]. The mean follow-up was 43.9 ± 36.8 months. The 5-year survival was significantly worse for the IMF deposition group (IMF 73.8% vs non-IMF 88.2%; P = 0.010). The multivariable Cox proportional hazard analysis showed that IMF deposition significantly predicted poor survival (hazard ratio 3.26, 95% CI 1.47-7.24; P = 0.004), unlike psoas muscle mass index and age. CONCLUSIONS: Skeletal muscle quality, defined by IMF deposition, was an independent predictor of overall survival and postoperative activities of daily living dependence risk in patients undergoing surgery for ATAAD. Thus, IMF deposition may be an additional risk factor for estimating late outcomes of ATAAD surgery.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Músculo Esquelético/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Atividades Cotidianas , Idoso , Aneurisma Dissecante/diagnóstico , Aneurisma da Aorta Torácica/diagnóstico , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
14.
Interact Cardiovasc Thorac Surg ; 30(5): 724-731, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32073125

RESUMO

OBJECTIVES: Treating aortic arch aneurysms with conventional open surgical and endovascular stent graft procedures is challenging due to the complex anatomy of the arch and the arteries arising from it that nourish the brain. Cerebral protection is of the utmost importance during the treatment of thoracic aneurysms involving the aortic arch. METHODS: Between May 2014 and November 2018, 7 patients with thoracic aortic aneurysms involving the aortic arch who underwent aortic arch cervical debranching with our technique were reviewed retrospectively. Because all the patients being considered for conventional surgical aortic arch replacement had serious comorbidities, they were selected to receive hybrid therapy. The mean age of the patients was 71.2 ± 9.4 years. One patient was a woman and 6 patients were men. One patient was given general anaesthesia; the remaining 6 patients had a regional block. A crossover temporary bypass was performed between the external carotid arteries with a 6-mm polytetrafluoroethylene graft for cerebral protection in all patients. Thoracic endovascular aortic repair (TEVAR) was successfully performed in all patients except 1 following debranching. RESULTS: Neurological complications did not occur during the procedures. Patients were followed for a mean of 18.3 ± 4.9 months. One female patient died of exacerbating chronic obstructive pulmonary disease within the first follow-up year. Three other patients died: 1 died of natural causes; 1 died of pneumonia followed by multiorgan failure; and 1 died of myocardial infarction during the mid-term follow-up period. The remaining patients are still being followed and are event free. CONCLUSIONS: Endovascular treatment of thoracic aortic diseases involving the aortic arch is facilitated when the aortic arch is debranched. Our cerebral protection method with a temporary crossover bypass between the external carotid arteries provides continuous pulsatile blood flow to the brain; hence, neurologically, it is a reliable procedure. The follow-up results of the patients who underwent aortic arch cervical debranching followed by TEVAR depended on their comorbidities.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Artéria Carótida Externa/cirurgia , Procedimentos Endovasculares/métodos , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico , Aneurisma da Aorta Torácica/diagnóstico , Artéria Carótida Externa/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Estudos Cross-Over , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
Ann Thorac Surg ; 110(3): 790-798, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32035913

RESUMO

BACKGROUND: In 2011, the Japanese Registry of Acute Aortic Dissection (JRAD) was started in accordance with the model of the International Registration of Acute Aortic Dissection. The aim of this study was to report actual clinical early and midterm outcomes of treatment for acute type A aortic dissection in Japan. METHODS: Between 2011 and 2016, 1217 patients (67.9 years-old, 584 male, 241 >80 years old) who had acute type A aortic dissection within 14 days after the onset of symptoms were enrolled. RESULTS: Among 75% patients managed surgically, 68% underwent surgical procedure with cardiopulmonary bypass. Surgery was not indicated in 25% patients. Overall, 12% died in the hospital, 10.8% after surgical treatment and 16.6% after medical treatment. Multivariable analysis of in-hospital mortality revealed the following risk factors: age older than 80 years (odds ratio, 2.37; P < .01); shock vital status on arrival (odds ratio, 1.89; P = .01); disturbance of consciousness, including coma (odds ratio, 3.32; P < .01); and cardiac arrest, for which resuscitation was needed on arrival (odds ratio, 4.86; P < .01). CONCLUSIONS: JRAD data revealed the actual clinical setting for the treatment of acute type A dissection in Japan. Early surgical results were favorable, with a low in-hospital morality rate, and midterm outcomes in selected medically treated patients were equivalent. Preoperative severe conditions, including shock, need for preoperative cardiopulmonary resuscitation, and disturbance of consciousness, as well as advanced age, were risk factors for in-hospital mortality even though the referral interval was brief.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/mortalidade , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/mortalidade , Ponte Cardiopulmonar , Feminino , Mortalidade Hospitalar , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Razão de Chances , Avaliação de Processos e Resultados em Cuidados de Saúde , Sistema de Registros , Resultado do Tratamento
18.
Vasc Med ; 25(1): 63-77, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32000633

RESUMO

Aortic aneurysms were the primary cause of nearly 10,000 deaths in 2014 according to data from the Centers for Disease Control and may involve segments of the thoracic or abdominal aorta. Thoracic aortic aneurysms and dissections are more commonly associated with an underlying genetic etiology. In the past several decades, in parallel with the burst of new genome sequencing technologies, a number of genetic aortopathies have been identified. These have provided important insights into the molecular mechanisms of aneurysmal disease, but pose challenges in clinical practice as there are limited consensus recommendations at this time. In this review, we aim to address the pathophysiology, clinical presentation, and treatment considerations in the key heritable thoracic aortopathies.


Assuntos
Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/terapia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/terapia , Técnicas de Diagnóstico Molecular , Aneurisma Dissecante/genética , Aneurisma Aórtico/genética , Tomada de Decisão Clínica , Técnicas de Apoio para a Decisão , Predisposição Genética para Doença , Humanos , Fenótipo , Valor Preditivo dos Testes , Fatores de Risco , Resultado do Tratamento
19.
Medicine (Baltimore) ; 99(3): e18796, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011481

RESUMO

RATIONALE: Type A aortic dissection (TAAD) is a life-threatening disorder yet it is hard to diagnose. The dissection might extend to the coronary artery causing ST-segment elevation myocardial infarction (STEMI). Physicians might not recognize this particularly early in its presentation and patients proceed to receive the primary percutaneous coronary intervention. We present such a case and found that the marked pressure difference between the radial and ascending aortae could be a useful clue for diagnosing the aortic dissection-related myocardial infarction. PATIENT CONCERNS: A 58-year-old male was presented to our emergency department for the complaint of left side chest pain that lasted for an hour with concomitant hypotension. STEMI was diagnosed at that time. DIAGNOSIS: The emergent primary percutaneous intervention was performed. When the diagnostic catheter was advanced to the ascending aorta, the systolic aorta pressure became 20 mm Hg higher than radial systolic pressure. Due to the abnormally large pressure differential between the peripheral radial artery and central ascending aorta, TAAD was suspected. INTERVENTIONS: After angiography and computer tomography confirmed the diagnosis of TAAD, the patient was sent for emergent surgery. OUTCOMES: The patient was died because of extensive dissection and shock. LESSONS: We present such a case and found that the marked pressure difference between the radial and ascending aortae during catheterization could be a useful clue for diagnosing the aortic dissection-related myocardial infarction. This clue had hinted our speedy examination of the occluded coronary artery and dissection flap, and led to an early and accurate diagnosis.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Aneurisma Dissecante/cirurgia , Aorta , Pressão Sanguínea , Cateteres , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia
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