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1.
Medicine (Baltimore) ; 98(50): e18241, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852089

RESUMO

T helper 17 (Th17) cells are related to the progression of aortic dissection. This study aimed to determine whether circulating Th17 levels are associated with the prognosis of acute Stanford type B aortic dissection (STBAD) after thoracic endovascular aortic repair (TEVAR).A cohort study was performed and STBAD patients (n = 140) received TEVAR were enrolled, the circulating Th17 levels were measured and the patients were divided into low and high Th17 groups, and 36 months of follow-up was performed. The data for mortality, survival outcomes, heart structure and function changes, aortic regurgitation prevalence, and aortic remodeling outcomes were recorded.Lower mortality and fewer complications were observed in the low Th17 group than in the high Th17 group in the third year of follow-up. In addition, the low Th17 group exhibited better cardiac remodeling and cardiac function when compared with that in the high Th17 group in the second to third year after TEVAR. Aortic reflux was improved in both groups but was more pronounced in the low Th17 group. During follow-up, the true lumen of the proximal thoracic aorta at the level of the celiac trunk in both the low and high Th17 groups continuously enlarged and was more pronounced in the low Th17 group.Circulating Th17 cells were related to cardiac and aortic remodeling and prognosis during STBAD after TEVAR. Anti-inflammatory therapy may be useful for STBAD patients who have undergone TEVAR.


Assuntos
Aneurisma Dissecante/sangue , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/sangue , Procedimentos Endovasculares/métodos , Células Th17/patologia , Remodelação Vascular , Doença Aguda , Adulto , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/cirurgia , Angiografia por Tomografia Computadorizada , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Tempo
3.
Medicine (Baltimore) ; 98(43): e17662, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651892

RESUMO

RATIONALE: Acute Type-A aortic dissection (AD) is a challenging clinical emergency. Despite advances in diagnosis and surgical techniques, the high surgical mortality rate of the condition persists. As a result of similarities in clinical symptoms, AD can mimic acute myocardial infarction (AMI). In this paper, we report 2 cases of patients with acute AD manifesting as inferior AMI. PATIENT CONCERNS: Two patients with undetected AD were misdiagnosed with AMI; in such patients, the administration of thrombolytic therapy has disastrous consequences. DIAGNOSES: The patients were initially diagnosed with AMI in the emergency room, and then diagnosed with AD during catheterization. INTERVENTIONS: The patients were transferred to the cardiac catheterization laboratory for primary coronary angiography. The initial attempt to selectively engage the coronary ostium was unsuccessful. Subsequent computed tomography angiography (CTA) confirmed AD from the aortic root to the abdominal aorta and dissection violations of the coronary ostium. The patients underwent emergency aortic root replacement. OUTCOMES: One patient recovered and was discharged 2 weeks later. At a 1-year follow-up examination, CTA indicated that this patient had made a full recovery. The other patient died 6 days after surgery. LESSONS: As a result of similarities in clinical symptoms, AD can mimic AMI. Rapid diagnosis and treatment of AD is crucial. Difficulty during catheter engagement should raise the suspicion of acute Type-A AD.


Assuntos
Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/cirurgia , Diagnóstico Diferencial , Evolução Fatal , Feminino , Humanos , Infarto Miocárdico de Parede Inferior/diagnóstico , Masculino , Pessoa de Meia-Idade
5.
Medicine (Baltimore) ; 98(38): e17173, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567956

RESUMO

BACKGROUND: Serum alkaline phosphatase (ALP) is related to vascular calcification and is known to have a prognostic impact in various cohorts. However, evidence in patients undergoing thoracic endovascular aortic repair (TEVAR) is lacking. Thus, we hypothesized that preoperative serum ALP level could be used for predicting adverse events after TEVAR. METHODS: We retrospectively reviewed 167 patients who underwent TEVAR between February 2013 and December 2016. Patients were classified into tertiles according to preoperative ALP level (<69, 69-92, and >92 IU/L). The composite of morbidity and mortality (composite MM) was defined as the presence of one or more of the following: myocardial infarction, cerebrovascular accident, dialysis requirement, pulmonary complication, infection, and mortality within 1 year after TEVAR. The incidence of composite MM was compared among the 3 tertiles, and stepwise logistic regression analysis was performed to evaluate the predictors for composite MM. RESULTS: The incidence of composite MM was 14.5% in the first tertile group, 17.9% in the second tertile group, and 35.7% in the third tertile group (P = .016). The third tertile of ALP level (odds ratio [OR] 1.766, 95% confidence interval [CI] 1.074-2.904, P = .025) and emergency TEVAR (OR 2.369, 95% CI 1.050-5.346, P = .038) remained as independent predictors of composite MM. CONCLUSIONS: Our data showed an independent relationship between high preoperative ALP levels and adverse outcomes in patients undergoing TEVAR. This finding might suggest a potential role of ALP level as a risk stratification marker.


Assuntos
Fosfatase Alcalina/sangue , Aorta Torácica/cirurgia , Procedimentos Endovasculares/efeitos adversos , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
6.
Vnitr Lek ; 65(7-8): 506-514, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31487994

RESUMO

Acute aortic syndromes are emergent life-threatening conditions affecting the aorta, which actual incidence is difficult to determine. Mortality of untreated patients increases steadily over time, so early diagnosis and initiation of therapy are crucial. Management of patients in Czech Republic follow, similar as in other European countries, the European Society of Cardiology guidelines from 2014, which were updated in 2018. The basis for diagnosis consists of history, physical examination, ECG, determination of vital signs, hemodynamic status and stratification of dia-gnosis probability by ADD-RS (aortic dissection detection risk score). This is followed by a series of laboratory and imaging examinations, of which the D-dimer, CT aortography and echocardiography are the most important. Recent studies show the benefit of combination of ADD-RS with D-dimer or measurement of ascendant aorta diameter by echocardiography. New emerging biomarkers are currently under investigation. Thanks to advances in technology, magnetic resonance imaging could take place as emergent diagnostic tool in the future. Initial therapy depends on the hemodynamic status of the patient. It must be followed by definitive therapy. In this publication we summarize the approach to a patient with acute aortic syndrome in the emergency department focusing on aortic dissection as its most common type.


Assuntos
Aneurisma Dissecante , Aneurisma Aórtico , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/terapia , Aorta , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/terapia , República Tcheca , Serviço Hospitalar de Emergência/estatística & dados numéricos , Europa (Continente) , Humanos , Síndrome
8.
Medicine (Baltimore) ; 98(29): e16303, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335676

RESUMO

To investigate the incidence, outcomes, and risk factors of postoperative acute respiratory distress syndrome (ARDS) in patients undergoing surgical repair for acute type A aortic dissection.This retrospective study involved 270 patients who underwent surgical repair for acute type A aortic dissection between January 2009 and December 2015. Data on clinical characteristics and outcomes were collected. Patients who immediately died after surgery and with preoperative myocardial dysfunction were excluded. The included patients were divided into the ARDS (ARDS patients who met the Berlin definition) and non-ARDS groups. Primary outcome was postoperative ARDS, according to the 2012 Berlin definition for ARDS and was reviewed by 2 qualified physicians with expertise in critical care and cardiac surgery. Outcomes of interest were the incidence and severity of risk factors for ARDS in this population, and perioperative outcomes and survival rates were compared with patients with or without ARDS.A total of 233 adult patients were enrolled into this study; of these, 37 patients (15.9%) had ARDS. Three, 20, and 14 patients had mild, moderate, and severe ARDS, respectively, according to the Berlin definition, with no significant difference in age, sex, and underlying disease. The ARDS group had lower mean oxygenation index (OI) than the non-ARDS group in the first 3 days post-surgery and demonstrated an improvement in lung function after the fourth day. Postoperative complication risks were higher in the ARDS group than in the non-ARDS group. However, no significant difference was observed in in-hospital mortality between the 2 groups (10.8% vs 5.6%, P = .268). Additionally, there was also no significant difference in the 3-year mortality rate between the 2 groups (P of log-rank test = .274). Postoperative hemoglobin level (odds ratio [OR]: 0.78; 95% confidence interval [CI]: 0.62-0.99) and perioperative blood transfusion volume (OR: 1.07; 95% CI: 1.03-1.12) were associated with ARDS risk.Postoperative ARDS after type A aortic dissection repair surgery was associated with risks of postoperative complications but not with risk of in-hospital mortality or 3-year mortality. A higher perioperative blood transfusion volume and a lower postoperative hemoglobin level may be risk factors for ARDS.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/diagnóstico , Transfusão de Sangue , Hemoglobinas/análise , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Adulto , Idoso , Aneurisma Dissecante/diagnóstico , Aneurisma Aórtico/complicações , Gasometria/métodos , Transfusão de Sangue/métodos , Transfusão de Sangue/estatística & dados numéricos , Cuidados Críticos , Análise Fatorial , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Síndrome do Desconforto Respiratório do Adulto/sangue , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/mortalidade , Testes de Função Respiratória/métodos , Medição de Risco/métodos , Fatores de Risco , Taxa de Sobrevida , Procedimentos Cirúrgicos Vasculares/métodos
9.
Medicine (Baltimore) ; 98(28): e16442, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305471

RESUMO

RATIONALE: Visceral arterial pseudoaneurysms are rare but important vascular entities because of their inclination to cause life-threatening hemorrhage. They were commonly reported to be associated with trauma, infection, inflammatory disease, or occurred as postoperative complication. To date, there has been no published report of a superior mesenteric artery (SMA) branch pseudoaneurysm rupture mimicking acute pancreatitis in a patient with acute type B aortic dissection. PATIENT CONCERNS: The patient's medical history, clinical information, imaging findings including follow-up computed tomography angiography (CTA), and treatment are reported. A 51-year-old male presenting with epigastric pain and fever was found to have an enlarged pancreatic head and obscure fatty space around it on abdominal nonenhanced CT. He has medical history of anaphylactoid purpura and uncontrolled hypertension. His serum lipase and amylase were both within normal limits. Thoracoabdominal CTA following a sudden blood pressure drop attributed to the accurate diagnosis. DIAGNOSES: He was diagnosed with acute type B aortic dissection involving SMA and retroperitoneal hemorrhage secondary to SMA branch pseudoaneurysm rupture. INTERVENTIONS: The patient was successfully treated by thoracic endovascular aortic repair without additional branch intervention. OUTCOMES: Follow-up CTA at 3 months later demonstrated that the endoprothesis is well positioned with no endoleaks, and SMA branch pseudoaneurysm disappeared. LESSONS: We report a rare and complicated case presenting with SMA branch pseudoaneurysm rupture and acute type B aortic dissection. CTA is vital in the diagnosis of such vessel pathology. We must inspect carefully to ensure that no small lesions are missed.


Assuntos
Aneurisma Dissecante/diagnóstico , Falso Aneurisma/diagnóstico , Aneurisma Roto/diagnóstico , Aneurisma Aórtico/diagnóstico , Artéria Mesentérica Superior , Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Falso Aneurisma/complicações , Falso Aneurisma/cirurgia , Aneurisma Roto/complicações , Aneurisma Roto/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Pancreatite/diagnóstico
10.
Biomed Res Int ; 2019: 4919416, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31321237

RESUMO

Purpose: Imaging artifacts are frequently encountered when performing clinical echocardiography. Based on our review of the literature, two-dimensional linear artifacts are mainly reported in the ascending aorta in patients with suspected aortic dissections. However, pulmonary artery artifacts that mimic pulmonary artery dissection have not been discussed. We herein report our experience with children and adults with preexisting heart conditions and pulmonary artery imaging artifacts. Methods: The study population comprised 10 patients with heart disease who were treated at our hospital from March 2015 to September 2017. Nine patients were children with congenital heart disease, mainly patent ductus arteriosus (n = 8), and one patient was an adult with pulmonary artery hypertension. Transthoracic echocardiography was performed in all patients. Results: We confirmed the diagnosis in six patients during a surgical operation for other indications and in four patients by computed tomographic pulmonary angiography. The most common pulmonary imaging artifact was observed from the left high parasternal view (9/10, 90%). Most of the artifacts were diagonally oriented (8/10, 80%), and a few were horizontally oriented. Half of the artifacts were located in the main pulmonary arteries with mild pulmonary artery dilatation. Pulmonary hypertension was seen only in the adult patient. The thymus gland was clearly seen in young patients. Conclusion: Pulmonary artery imaging artifacts in patients with preexisting heart disease during echocardiographic examination can mimic pulmonary artery dissection. Understanding the types and origins of these ultrasound artifacts is important to avoid a false-positive diagnosis.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Cardiopatias/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Estenose de Artéria Pulmonar/diagnóstico por imagem , Adolescente , Adulto , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/fisiopatologia , Artefatos , Criança , Pré-Escolar , Ecocardiografia/métodos , Feminino , Cardiopatias/diagnóstico , Cardiopatias/fisiopatologia , Cardiopatias/cirurgia , Humanos , Lactente , Masculino , Estenose de Artéria Pulmonar/diagnóstico , Estenose de Artéria Pulmonar/fisiopatologia , Ultrassonografia/efeitos adversos , Ultrassonografia/métodos , Adulto Jovem
11.
Int Heart J ; 60(4): 845-848, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31308322

RESUMO

The aim of this study was to summarize the clinical experience of postoperative extracorporeal membrane oxygenation (ECMO) support in Stanford type A aortic dissection (STAAD) patients.We retrospectively reviewed 246 consecutive acute STAAD patients undergoing operations at our institution from January 2012 to December 2016. Postoperative ECMO was used in 7 patients. There were 5 males and 2 females with a mean age of 43.1 ± 9.3 years. All 7 patients with acute STAAD underwent ascending aorta replacement and total arch repair with a self-designed stent graft (Micropart Corp, Shanghai, China). Concomitant procedures were aortic root replacement in 1 patient and coronary artery bypass grafting (CABG) in 2 patients. All patients received veno-arterial ECMO through the femoral artery and vein. Five patients were extubated before being removed from ECMO. The mean ECMO supporting time was 244.5 ± 57.8 hours. All 7 patients were successfully weaned from ECMO support, and 6 (85.7%) patients survived to discharge. The average hospital time was 26.3 ± 8.8 days. One patient died of cardiac arrest after being weaned from ECMO. Two patients underwent reoperation for bleeding and 1 patient showed transient delirium. The remaining patients all survived during a median follow-up of 19 months.ECMO provides a good temporary cardiopulmonary support in STAAD patients with refractory cardiogenic shock after surgery for aortic dissection. The early use of ECMO and preventing its complications actively can improve the patient survival rate.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Oxigenação por Membrana Extracorpórea/métodos , Adulto , Aneurisma Dissecante/diagnóstico , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico , Angiografia por Tomografia Computadorizada , Ecocardiografia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
13.
J Invasive Cardiol ; 31(7): E233, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31257223

RESUMO

Coronary angiography in a 44-year-old woman shows chronic dissection of the left sinus of Valsalva, totally obscuring the LMCA, with good collaterals supplying the left coronary system from the right coronary artery.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Aórtico/complicações , Oclusão Coronária/etiologia , Vasos Coronários/diagnóstico por imagem , Seio Aórtico , Adulto , Aneurisma Dissecante/diagnóstico , Aneurisma Aórtico/diagnóstico , Doença Crônica , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Oclusão Coronária/diagnóstico , Feminino , Humanos
14.
BMJ Case Rep ; 12(6)2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31164384

RESUMO

A 61-year-old woman with no prior medical illness presented with acute onset stroke symptoms. She had no chest pain at the time of presentation. However, CT angiogram showed an extensive aortic dissection, resulting in hypoperfusion of the right cerebral hemisphere and thus causing stroke symptoms. Due to this finding, tissue plasminogen activator was not given and a negative outcome was avoided.


Assuntos
Aneurisma Dissecante/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Administração Intravenosa , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Feminino , Fibrinolíticos/administração & dosagem , Fibrinolíticos/uso terapêutico , Humanos , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/etiologia , Ativador de Plasminogênio Tecidual/administração & dosagem , Ativador de Plasminogênio Tecidual/uso terapêutico
15.
Cesk Patol ; 55(2): 115-119, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31181944

RESUMO

We present macroscopic and microscopic findings in a case of chronic dissecting aneurysm of ascending aorta and aortic arch associated with isolated tears of aortic wall without its rupture in a 71-year-old female presenting with minimal clinical symptomatology. Aneurysmal dilation of the aorta was caused not only by the bridging of the vascular wall based on the presence of an organizing intramural thrombus in the false lumen between the separated layers, but also by a wide flat defect in the aortic intima and media with the preservation of the aortic wall integrity due to fibrotical alteration of tunica adventicia. Histologic examination of the thoracic aorta detected cystic medial degeneration with mild atherosclerosis.


Assuntos
Aneurisma Dissecante , Trombose , Idoso , Aneurisma Dissecante/diagnóstico , Aorta/anormalidades , Feminino , Humanos , Trombose/diagnóstico
16.
Vasc Endovascular Surg ; 53(7): 547-557, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31248351

RESUMO

BACKGROUND: Acute aortic dissection (AD) is a lethal vascular disease, accounting for over 90% cases of acute aortic syndrome. Despite advances in understanding associated risk factors, the long-term prognosis for AD patients is still poor. Several prognostic biomarkers have been used for AD as per the IRAD, such as older age (>70 years), onset of chest pain and hypotension, but they are not effective in all patients. Instead, C-reactive protein (CRP) is a consistent inflammatory marker. CRP levels are abnormally increased in AD. However, the prognostic value of serum CRP level in AD remains unclear. OBJECTIVE: To perform a systematic review and meta-analysis (registration no CRD42017056205) to evaluate whether CRP is a biomarker associated with in-hospital mortality in type-A AD. METHODS: PubMed, Web of Science, CNKI, SciELO, and EMBASE were searched for papers published from January 2000 to October 2017 for studies on the prognostic role of CRP at admission in type-A AD patients. Outcome data were extracted and pooled hazard ratios (HRs) were calculated. RESULTS: 18 (N = 2875 patients) studies met the inclusion criteria. Elevated CRP level was associated with a significantly increased risk of in-hospital mortality in patients with type-A AD (HR = 1.15, 95% CI: 1.06-1.25, p = 0.001). The pooled sensitivity of CRP in type-A AD patients was 77% (95% CI 69%-84%, p < 0.001), and the specificity was 72% (95% CI 66%-78%, p < 0.001). CONCLUSION: Elevated CRP level is significantly associated with increased risks of in-hospital mortality in patients with type-A AD. CRP is a convenient prognostic factor in type-A AD patients.


Assuntos
Aneurisma Dissecante/sangue , Aneurisma Dissecante/mortalidade , Aneurisma Aórtico/sangue , Aneurisma Aórtico/mortalidade , Proteína C-Reativa/análise , Mortalidade Hospitalar , Mediadores da Inflamação/sangue , Admissão do Paciente , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/cirurgia , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Fatores de Tempo , Regulação para Cima
17.
Tex Heart Inst J ; 46(2): 130-132, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31236079

RESUMO

Acute aortic dissection can be complicated by malperfusion syndromes, including ischemia of the lower limbs. In some cases, delayed correction of leg ischemia leads to reperfusion injury, potentially resulting in renal failure. We describe the case of a 64-year-old woman who presented with acute aortic dissection manifesting itself as lower-limb ischemia. During and after aortic surgery with cardiopulmonary bypass, the patient developed myonephropathic metabolic syndrome. Hyperkalemia was corrected and acute kidney injury was prevented by infusing large volumes of intravenous fluids and administering human atrial natriuretic peptide. Peripheral bypass surgery was unnecessary. This case suggests that restoring blood flow to an ischemic leg by means of adjunctive perfusion during aortic repair with cardiopulmonary bypass is a viable way to overcome the biochemical instability associated with prolonged ischemia, especially hyperkalemia in the early phase of reperfusion.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Ponte Cardiopulmonar/métodos , Isquemia/terapia , Extremidade Inferior/irrigação sanguínea , Perfusão/métodos , Traumatismo por Reperfusão/prevenção & controle , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Isquemia/diagnóstico , Isquemia/etiologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
18.
Rev Gastroenterol Peru ; 39(1): 88-90, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31042244

RESUMO

Hypoxic hepatitis is an uncommon cause of hepatic damage characterized by a centrolobular necrosis. Its pathophysiology remains unclear. Aortic dissection is a rare but frequently catastrophic event. It is caused by an aortic intimal tear with propagation of a false channel in the media. Depending on the site and extension, it can cause hypoperfusion of any organ leading to cellular ischemia and necrosis. We are presenting a case of hypoxic hepatitis in a patient with an extensive aortic dissection who present to the emergency department.


Assuntos
Aneurisma Dissecante/complicações , Hepatite/etiologia , Isquemia/etiologia , Fígado/irrigação sanguínea , Dor Abdominal/etiologia , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/fisiopatologia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Dispneia/etiologia , Emergências , Evolução Fatal , Hepatite/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
19.
Zhonghua Wai Ke Za Zhi ; 57(5): 326-330, 2019 May 01.
Artigo em Chinês | MEDLINE | ID: mdl-31091585

RESUMO

Despite the improvements in the diagnosis and management during the past six decades, acute aortic dissection (AAD) remains a life-threatening condition associated with significant morbidity and mortality rates. Due to the relatively rare occurrence of AAD, several clinical registries have been established to gain insights into this lethal disease in a large number of patients, such as the International Registry of Acute Aortic Dissection (IRAD), the German Registry for Acute Aortic Dissection Type A (GERAADA), and the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database Aortic Section. This review aims to interpret and compare the latest results of the IRAD, STS and GERAADA database. It focuses on several controversial and key issues in the diagnosis and management of acute aortic dissection in hope of providing some insights and references for cardiovascular professionals engaged in the care of this deadly disease.


Assuntos
Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/terapia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/terapia , Sistema de Registros , Doença Aguda , Procedimentos Cirúrgicos Cardíacos , Humanos
20.
Braz J Cardiovasc Surg ; 34(5): 596-604, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31112020

RESUMO

Aortic dissection (AD) has been recognized to be associated with an inflammatory process. Clinical observations demonstrated that patients with AD had an elevated interleukin (IL)-6 level in comparison to hypertensive or healthy controls. Adverse events such as acute lung injury, postimplantation syndrome, and death are associated with an elevated IL-6 level. Thus, circulating IL-6 could be a reliable biomarker for the diagnosis of AD and for the eveluation of the therapeutic outcomes and the prognosis of AD patients. Therapeutic interventions aiming at attenuating the inflammatory status by IL-6 neutralization could effectively decrease the IL-6 level and thus reverse the progression of the disorder of AD patient. Endovascular aortic repair can effectively control the inflammatory cytokines. Selective antegrade cerebral perfusion with deep hypothermic circulatory arrest during aortic arch replacement shows better neuroprotectve effect with an improved IL-6 level of the cerebrospinal fluid. These results facilitate the understanding of the etiology of AD and guide the directions for the treatment of acute AD in the future. More effective therapeutic agents developed based on the theories of IL-6 signaling involved in the mechasims of AD are anticipated.


Assuntos
Aneurisma Dissecante/metabolismo , Aneurisma Aórtico/metabolismo , Interleucina-6/análise , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/terapia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/terapia , Citocinas/análise , Humanos , Valor Preditivo dos Testes , Prognóstico , Valores de Referência , Fatores de Tempo
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