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1.
Int Heart J ; 60(6): 1373-1380, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666449

RESUMO

It has been shown in previous studies that Chinese patients with acute aortic dissection (AD) were approximately 10 years younger than patients from western countries. However, there is a lack of studies concerning the age-related differences in clinical characteristics and outcomes in Chinese patients with acute AD. A total of 1,061 patients with AD (570 type A and 491 type B AD) were enrolled between 2006 and 2008. The clinical characteristics were compared between the patients in our study and those in the International Registry of Acute Aortic Dissection (IRAD). Compared with patients in the IRAD, those in our study were relatively younger, comprised more males, and had a higher proportion of Marfan syndrome but received fewer surgical interventions. When stratified by 10-year age, younger patients were more likely to have type A AD, familial AD, and Marfan syndrome, whereas older patients tended to comprise more females and type B AD. As age increased, the proportion of surgical intervention gradually decreased regardless of the type of AD. During a median follow-up of 2.2 years, 147 patients died, of whom 94 (63.9%) had type A AD and 53 (36.1%) had type B AD. Long-term mortality increased with increasing age, especially in patients above 70 years old. Furthermore, the recurrence rate of AD was higher in both the young and the older patients. In conclusion, compared with western patients with AD, Chinese patients have distinct characteristics and more attention should be paid to the young and older patients because of their high long-term mortality and recurrence rate.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Dissecante/terapia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/terapia , Grupo com Ancestrais do Continente Asiático , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/epidemiologia , Aneurisma Aórtico/epidemiologia , Aneurisma da Aorta Torácica/epidemiologia , China , Feminino , Humanos , Masculino , Síndrome de Marfan/epidemiologia , Pessoa de Meia-Idade , Recidiva , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
2.
Clin Interv Aging ; 14: 1227-1241, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413553

RESUMO

Purpose: Abdominal aortic aneurysm (AAA) demonstrates many features of autoimmune diseases. Y chromosome, sex-determining region of the Y chromosome (SRY) gene, androgen receptor (AR) gene, and androgen appear as potential candidates for influence of the male immune function. This study investigated Y chromosome numbers, SRY gene, AR gene, and androgen levels in male AAAs. We also investigated the correlation between Y chromosome loss (LOY) ratio, SRY expression, androgen levels, and age. Patients and methods: We investigated LOY by fluorescence in situ hybridization (FISH) in 37 AAAs and compared with 12 patients with abdominal aortic atherosclerotic occlusive disease (AOD) and 91 healthy controls (HC). We investigated SRY and AR expression at mRNA level by real-time PCR in peripheral T lymphocytes in AAA compared with AOD and HC, and AR protein levels by immunohistochemistry (IHC) in AAA. LOY, SRY expression, androgen levels, and age were examined for correlations using the Spearman's rank correlation coefficient. Results: LOY ratio in peripheral T lymphocytes was significantly higher in the AAA group compared with the HC (9.11% vs 5.56%, P<0.001) and AOD groups (9.11% vs 6.42%, P=0.029). The SRY mRNA expression in peripheral T lymphocytes was 4.7-fold lower expressed in the AAA group than in the HC group (P<0.001). Free plasma testosterone levels were lower in the AAA group compared with the HC group (P=0.036), whereas sex hormone-binding globulin levels were higher (P=0.020). LOY ratio and expression of SRY mRNA level increased with age in the AAA group (R=0.402 and, R=0.366, respectively). A significant correlation between AR mRNA level (R=0.692) and aortic diameter was detected. Simultaneously, in AAA tissue, the rate of LOY increased with age (R=0.547) and also positively associated with LOY in peripheral blood T lymphocytes (R=0.661). Conclusion: This study identified a prominent Y chromosome loss in male AAAs, which is correlated to age, lower level of SRY expression and free testosterone, providing a new clue for the mechanisms of AAA.


Assuntos
Androgênios/sangue , Aneurisma Dissecante/epidemiologia , Aneurisma da Aorta Abdominal/epidemiologia , Cromossomos Humanos Y/fisiologia , Receptores Androgênicos/genética , Proteína da Região Y Determinante do Sexo/genética , Fatores Etários , Idoso , Feminino , Humanos , Hibridização in Situ Fluorescente , Masculino , Pessoa de Meia-Idade , RNA Mensageiro , Aberrações dos Cromossomos Sexuais
3.
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
8.
Medicine (Baltimore) ; 98(6): e14486, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30732220

RESUMO

Serum albumin (SA) is associated with inflammation and thrombosis, which are involved in acute aortic dissection (AAD). Our aim was to investigate the effect of SA level on survival in patients with AAD.We analyzed 777 patients with AAD. The patients were divided into hypoalbuminemia and non-hypoalbuminemia groups according to their AAD Stanford classification. Multivariable Cox regression was used to investigate the association between SA levels and in-hospital mortality in type A and B AAD.A total of 103 (13.3%) patients died in-hospital. The in-hospital mortality in type A and B patients with hypoalbuminemia was higher compared to those without (type A: 34.2% vs 13.9%, P <.001; type B: 7.9% vs 1.6%, P = .001). Kaplan-Meier analysis showed that survival was significantly lower in patients with hypoalbuminemia compared to those without, regardless of AAD type (type A: log-rank χ = 14.71; P <.001; Type B: log-rank χ = 10.42; P = .001). After adjusting for confounding factors, hypoalbuminemia was an independent predictor of in-hospital mortality in patients with either type A (HR, 2.492; 95% confidence interval [CI], 1.247-4.979; P = .010) or type B (HR, 8.729; 95% CI, 1.825-41.736; P = .007).SA is independently associated with increased in-hospital mortality in both type A and B AAD.


Assuntos
Aneurisma Dissecante/sangue , Aneurisma Dissecante/mortalidade , Albumina Sérica/análise , Adulto , Idoso , Aneurisma Dissecante/epidemiologia , Biomarcadores , Feminino , Mortalidade Hospitalar , Humanos , Hipoalbuminemia/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco
9.
Vascular ; 27(3): 324-337, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30621507

RESUMO

OBJECTIVES: Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare disease with an incidence of 0.06%. The purpose of the meta-analysis was to identify the outcomes associated with the various treatment options in the management of asymptomatic and symptomatic patients with SISMAD. METHODS: Eligible studies were selected by searching PubMed, EMBASE, and Cochrane Library. Endpoints were outcome of asymptomatic patients treated conservatively, resolution of symptoms according to the treatment approach, rate of symptomatic patients switched from conservative to the endovascular and/or open repair, characteristics of the dissected lesion, and findings regarding the remodeling of superior mesenteric artery. RESULTS: We identified 30 studies including 729 patients. Among them, 608 (83.4%) were symptomatic and were managed with conservative (438/72%), and/or endovascular (139/22.8%) and/or open treatment (31/5%). The remaining were asymptomatic and they were treated solely conservatively. A high rate of resolution of symptoms (92.8%) was noted for patients treated conservatively. Conversion from conservative treatment to either endovascular or open procedure was required in 12.3% and 4.4%, respectively. Resolution of symptoms was observed in 100% for those treated with open procedure and 88.8% for those treated endovascularly. The pooled rate of bowel ischemia in patients treated conservatively was 3.75% (95% confidence interval = 1.15-7.27). Complete remodeling was achieved in 32% and partial in 26% of those who were treated conservatively. CONCLUSIONS: The majority of symptomatic patients with SISAMD were treated conservatively and showed an uncomplicated course and only a small percentage required conversion to endovascular or open repair. This might highlight the benign course of the disease.


Assuntos
Aneurisma Dissecante/terapia , Tratamento Conservador , Procedimentos Endovasculares , Artéria Mesentérica Superior/cirurgia , Procedimentos Cirúrgicos Vasculares , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/epidemiologia , Aneurisma Dissecante/fisiopatologia , Tratamento Conservador/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/fisiopatologia , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Remodelação Vascular , Procedimentos Cirúrgicos Vasculares/efeitos adversos
10.
Eur J Cardiothorac Surg ; 55(2): 345-350, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30657909

RESUMO

OBJECTIVES: Acute Type A aortic dissection exhibits poor in-hospital outcomes after emergency surgery. Evaluation of risk predictors for in-hospital major adverse outcomes (MAO) is key to reducing the mortality rate and improving the quality of care. METHODS: We enrolled 70 patients who presented with postoperative MAO and 195 patients who recovered well. Through univariate and multivariate analyses, clinical characteristics were compared between the patients in the 2 groups. RESULTS: In-hospital mortality was 6.4% in this series. The patients in the MAO group were older and had a higher frequency of coronary artery involvement by dissection (60.0% vs 21.0%) (P < 0.05). Preoperatively, when compared to the group of patients without MAO, the patients in the MAO group were more likely to have a neurological deficit (18.6% vs 9.7%) and, to a certain extent, lower limb symptoms encompassing visceral and renal malperfusion (20.0% vs 8.2%) (P < 0.05). Compared to patients with MAO, patients without MAO experienced longer duration from initial onset of symptoms to surgery and had an ascending aorta with a larger diameter. In patients with MAO, the average durations of cardiopulmonary bypass (CPB), cardiac arrest and hypothermic circulatory arrest were much longer than those in patients with no MAO (all P < 0.001). Multivariate analysis showed that in-hospital adverse outcomes were associated with older age [odds ratio (OR) = 1.047 (1.008-1.087), P < 0.05], presentation of lower limb symptoms prior to surgery [OR = 2.905 (1.109-7.608), P < 0.05] and long CPB duration [OR = 1.011 (1.005-1.018), P < 0.01]. When patients with acute Type A aortic dissection experienced a duration from symptom onset to surgery [OR = 0.993 (0.987-0.999), P < 0.05] or had an ascending aorta with a large diameter [OR = 0.942 (0.892-0.995), P < 0.05], the number of postoperative adverse events decreased significantly. CONCLUSIONS: At a centre that has a large caseload, where practitioners can become proficient through experience as well as training, good outcomes can be dependably produced in patients with acute Type A aortic dissection and without malperfusion syndromes. For patients presenting with these risk features, MAO need to be anticipated, and the incidence of a composite end point of major adverse events remains unsatisfactory.


Assuntos
Aneurisma Dissecante , Aneurisma Aórtico , Complicações Pós-Operatórias/epidemiologia , Adulto , Aneurisma Dissecante/epidemiologia , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/cirurgia , Aorta/cirurgia , Aneurisma Aórtico/epidemiologia , Aneurisma Aórtico/mortalidade , Aneurisma Aórtico/cirurgia , Ponte Cardiopulmonar , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Fatores de Risco
12.
Am J Cardiol ; 123(2): 249-253, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30477805

RESUMO

The pathophysiology of spontaneous coronary artery dissection (SCAD) is heterogeneous, associated with systemic arteriopathies and inflammatory diseases, and often compounded by environmental precipitants, genetics, or stressors. However, the frequency of these associated conditions with SCAD on a population level remains unknown. Therefore, the objective of this analysis was to evaluate heterogeneous phenotypes of SCAD in the United States using data from the Nationwide Inpatient Sample collected from January 1, 2004, to September 31, 2015. Among 66,360 patients diagnosed with SCAD, the mean age was 63.1 ± 13.2 years and 44.2% were women. A total of 3,415 (5.14%) had depression, 670 (1.0%) had rheumatoid arthritis, 640 (0.96%) had anxiety, 545 (0.82%) had a migraine disorder, 440 (0.66%) used steroids, 385 (0.58%) had malignant hypertension, 280 (0.42%) had systemic lupus erythematosus, 250 (0.38%) had cocaine abuse, 215 (0.32%) had hypertensive heart or renal disease, 130 (0.19%) had coronary spasm, 105 (0.16%) had fibromuscular dysplasia, 85 (0.13%) had Crohn's disease, 75 (0.11%) had celiac disease, 60 (0.09%) had adult autosomal dominant polycystic kidney disease, 60 (0.09%) had hormone replacement therapy, 55 (0.08%) had sarcoidosis, 55 (0.08%) had amphetamine abuse, 15 (0.02%) had granulomatosis polyangiitis, 10 (0.02%) had α1-antitrypsin deficiency, 10 (0.02%) had Marfan syndrome, 10 (0.02%) had Ehlers-Danlos syndrome, 10 (0.02%) had Kawasaki disease, 10 (0.02%) had polyarteritis nodosa, and 5 (0.01%) had multiparity. In conclusion, most cases of SCAD had no apparent concomitant arteriopathy, inflammatory disorder, or evident risk factor.


Assuntos
Aneurisma Dissecante/epidemiologia , Aneurisma Coronário/epidemiologia , Vasos Coronários/lesões , Distribuição por Idade , Doenças Autoimunes/epidemiologia , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Doenças do Tecido Conjuntivo/epidemiologia , Bases de Dados Factuais , Feminino , Humanos , Enteropatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia
13.
Int J Cardiol ; 274: 299-302, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30309682

RESUMO

OBJECTIVE: To investigate the association between fluoroquinolones use and development of aortopathy. METHODS: A systematic review and meta-analysis was conducted following PRISMA and MOOSE guidelines for reporting systematic reviews of observational studies. Multiple databases were searched and two authors independently screened studies for eligibility. Newcastle Ottawa scale was used to assessed the quality of included studies. Primary outcome of interest was development of aortic aneurysm or dissection among fluoroquinolones users in comparison to non-users. An inverse variance model meta-analysis was used to pool odds ratio or hazards ratio from included studies to calculate the overall effect estimate. Pre specified subgroups analyses were also conducted to explore sources of heterogeneity. RESULTS: Three observational studies that enrolled 941,639 subjects met the inclusion criteria and were included in the final analysis. All studies were of a good methodological quality. Current use of fluoroquinolones, defined as within 60 days from development of the primary outcome, was associated with significantly elevated risk of developing aortic aneurysm and/or dissection in comparison to controls, (OR = 2.04; 95% CI [1.67, 2.48]). There was only a mild degree of between study heterogeneity, I2 = 33%. The association remains robust among all subgroups analyses. CONCLUSION: Our findings indicate that current fluoroquinolone use was significantly associated with increased risk of aortic aneurysm and dissection. Health care providers need to be aware of this serious association and use fluoroquinolones judiciously in order to minimize the risk of the serious sequela of aortopathy.


Assuntos
Aneurisma Dissecante/induzido quimicamente , Aneurisma Aórtico/induzido quimicamente , Fluoroquinolonas/efeitos adversos , Medição de Risco , Aneurisma Dissecante/epidemiologia , Antibacterianos/efeitos adversos , Aneurisma Aórtico/epidemiologia , Infecções Bacterianas/tratamento farmacológico , Saúde Global , Humanos , Incidência , Fatores de Risco
14.
Eur J Cardiothorac Surg ; 55(2): 201-209, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30084969

RESUMO

This systemic review of the literature and meta-analysis examined the current state of the evidence in long-term outcomes for and/or against aortic valve reimplantation (RAV) versus composite valve graft (CVG) intervention in patients with an acute type A dissection. Descriptive statistics were used to summarize the baseline characteristics of patients across studies. A random-effects metaregression was performed across study arms with logit-transformed proportions weighted by the study size for each of these outcomes. The results are presented as odds ratios with the RAV procedure as compared to the CVG procedure, including 95% confidence intervals (CIs) and P-values. Further outcomes are summarized with medians, interquartile ranges and the range and number of patients at risk. A total of 27 retrospective studies that included a combined 3058 patients were analysed. In-hospital mortality was in favour of the RAV procedure, which was 2% vs 8% for the CVG procedure. Survival rate at midterm was 98.8% (95% CI 91.7-100%) for RAV and 81.3% (CI 78.5-83.9%) for CVG. Freedom from valve-related reintervention was 100% (CI 93.7-100%) for RAV and 94.6% (CI 86.7-99.1%) for CVG. For an acute type A aortic dissection in the mid-term period, RAV provides a superior outcome over CVG, both in terms of aortic-valve-related reintervention and survival rate.


Assuntos
Aneurisma Dissecante , Aneurisma Aórtico , Implante de Prótese de Valva Cardíaca , Adulto , Aneurisma Dissecante/epidemiologia , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/epidemiologia , Aneurisma Aórtico/cirurgia , Valva Aórtica/cirurgia , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/métodos , Implante de Prótese de Valva Cardíaca/mortalidade , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação/estatística & dados numéricos
15.
J Stroke Cerebrovasc Dis ; 28(2): 288-294, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30391330

RESUMO

BACKGROUND: Previous studies have described ischemic stroke temporally related to specific triggers, but only 1 series collected patients with acute ischemic stroke (AIS) following downhill skiing and all caused by cervical artery dissections. Here we describe our series of AIS temporally associated to ski practice, focusing on the frequency, pathogenesis, clinical presentation, and prognosis. METHODS: We maintained a prospective list of Skiing Associated Strokes (SASs) from 2003 to 2017. From all AIS patients included in our stroke registry Acute Stroke Registry and Analysis of Lausanne (ASTRAL) over the same period, we identified a comparison group of non-SAS patients, matched for age and gender. RESULTS: In the 12-year observation period, we identified 17 SASs (4 females, median age 51 years) and 51 matched control patients with nonski-associated strokes. Vascular risk factors, stroke features, and outcome were similar between the 2 groups. Stroke mechanism was arterial dissection in 11 of 17 SASs (65%) and in 7 of 51 control patients (14%, chi-square test: P < .05). In the other 6 cases of ski-associated stroke, etiology was cardiac embolism from atrial fibrillation in 2 patients, large vessel atherosclerosis with stenosis >50% in 1 patient, and undetermined in 3. Among the 11 patients with SAS caused by dissection, 8 reported minor falls while skiing, 1 had a major head trauma without loss of consciousness, and 2 had no traumatism (compared to preceding trauma in 29 of 147 [20%] of all other AIS caused by arterial dissection in ASTRAL, P < .01). CONCLUSIONS: Arterial dissection was a significantly more frequent stroke mechanism in SAS compared to matched controls, but other mechanisms occurred as well. Minor or moderate skiing-related trauma preceded most SAS with dissections.


Assuntos
Ataque Isquêmico Transitório/epidemiologia , Ataque Isquêmico Transitório/terapia , Esqui/lesões , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Acidentes por Quedas , Aneurisma Dissecante/epidemiologia , Aneurisma Dissecante/terapia , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/terapia , Estudos de Casos e Controles , Feminino , Humanos , Embolia Intracraniana/epidemiologia , Embolia Intracraniana/terapia , Ataque Isquêmico Transitório/diagnóstico , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Suíça/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/epidemiologia , Lesões do Sistema Vascular/terapia
16.
Z Rheumatol ; 78(3): 287-294, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30324280

RESUMO

Aortic aneurysm and dissection are rare complications of systemic lupus erythematosus (SLE). The incidence, etiology, risk factors, and outcomes of this entity were largely unknown.The study materials were based on the publications of aortic aneurysm or dissection due to SLE published between 2000 and 2017.A total of 36 articles reporting a single case or case series involving 40 patients were collected. The patients showed an absolute female dominance at a mean aneurysm age of 44.6 years. Steroid use was 13.3 ± 9.4 years prior to admission for management of aortic aneurysm or dissection. Aortic aneurysm occurred more commonly in abdominal than other segments of the aorta, whereas aortic dissection did not show any location predilection. Patients with open aortic operations showed a higher mortality rate than other groups; however, no statistical significance was reached. Interventional therapy was minimally invasive, but postinterventional endoleaks were a concerning problem.SLE patients had significant risks for developing aortic aneurysm and dissection. Hypertension, long-term steroid use, and aortic pathological changes related to SLE seemed to be predominant risk factors for the occurrence of aortic aneurysm and dissection. Upon diagnosis, a surgical, interventional, or hybrid treatment should be performed to prevent severe sequelae and sudden deaths.


Assuntos
Aneurisma Dissecante , Aneurisma Aórtico , Lúpus Eritematoso Sistêmico , Aneurisma Dissecante/epidemiologia , Aneurisma Aórtico/epidemiologia , Comorbidade , Feminino , Humanos , Hipertensão/complicações , Incidência , Lúpus Eritematoso Sistêmico/epidemiologia
17.
J Neuroradiol ; 46(1): 15-24, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29733918

RESUMO

BACKGROUND AND PURPOSE: Delayed cerebral ischemia (DCI) is a complication of aneurysmal subarachnoid hemorrhage (SAH). Arterial cerebral vasospasm (CVS) is discussed as the main pathomechanism for DCI. Due to positive effects of per os nimodipine, intraarterial nimodipine application is used in patients with DCI. Further, percutaneous transluminal balloon angioplasty (PTA) is applied in focal high-grade spasm of intracranial arteries. However, clinical benefits of those techniques are unconfirmed in randomized trials so far, and complications might occur. We analyzed the occurrence of new infarcts in patients with severe CVS treated intra-arterially to assess benefits and risks of those techniques in a large single-center collective. MATERIALS AND METHODS: All imaging and clinical data of 88 patients with CVS after SAH and 188 procedures of intraarterial nimodipine infusion and additional PTA in selected cases (18 patients, 20 PTA procedures) treated at our institution were reviewed. In the event of new infarcts after endovascular treatment of CVS, infarct patterns were analyzed to determine the most probable etiology. RESULTS: Fifty-three percent of patients developed new cerebral infarction after intraarterial nimodipine and additional PTA in selected cases. Hereunder 47% were caused by persisting CVS. In 6% of patients, 3% of procedures respectively, new infarcts occurred due to complications of the intraarterial treatment including thromboembolism and arterial dissection. Of those, 3% of patients, 2% of procedures respectively, were assigned to thrombembolic complications of digital substraction angiography for intraarterial nimodipine. 17% of all patients treated with PTA (3/18=17%) showed infarction as a complication of PTA (15% of all PTA procedures). In 1% of patients, etiology of new infarction remained unclear. CONCLUSION: Ischemic complications occur in about 6% of patients treated intraarterially for CVS, 3% of procedures respectively. Further, to date a benefit for patients treated with this therapy could not be proven. Therefore, intraarterial treatment of CVS should be performed only in carefully selected cases.


Assuntos
Angioplastia , Nimodipina/uso terapêutico , Complicações Pós-Operatórias/epidemiologia , Hemorragia Subaracnóidea/complicações , Vasodilatadores/uso terapêutico , Vasoespasmo Intracraniano/terapia , Adulto , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/epidemiologia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/epidemiologia , Terapia Combinada , Feminino , Humanos , Infusões Intra-Arteriais , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/epidemiologia , Masculino , Pessoa de Meia-Idade , Nimodipina/administração & dosagem , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Hemorragia Subaracnóidea/diagnóstico por imagem , Tromboembolia/diagnóstico por imagem , Tromboembolia/epidemiologia , Resultado do Tratamento , Vasodilatadores/administração & dosagem , Vasoespasmo Intracraniano/diagnóstico por imagem , Vasoespasmo Intracraniano/etiologia
19.
Circ Cardiovasc Imaging ; 11(12): e007611, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30562107

RESUMO

BACKGROUND: The study objective was to assess the severity, progression rate, and risk factors for aortic root dilatation (ARD) in pediatric tetralogy of Fallot (TOF) and to study its relationship to complications including aortic regurgitation. METHODS AND RESULTS: Seven hundred sixty-eight TOF patients were studied with echocardiography (median age at repair 6.1 months; interquartile range, 4.5-11.3 months) and compared with 304 controls. Five hundred ninety-two (77%) had usual TOF, 41 (5.3%) TOF-type double outlet right ventricle, and 135 (17.6%) TOF with pulmonary atresia. Median follow-up was 3.7 years (interquartile range, 0.5-6.9 years, total follow-up 3002 patients-years). Aortic root dimensions were enlarged at TOF diagnosis and during follow-up. Mean aortic valve annulus Z score at first postoperative echo was 3.3±2.7, associated with TOF type (TOF1 Z score unit per year) was observed in <1% of patients. Of the 768 patients, only 3 (0.39%) developed moderate/severe aortic regurgitation and 2 required aortic surgery for subvalvar aortic stenosis and aortic dissection, respectively. CONCLUSIONS: ARD is common before and after TOF repair, but our data suggest that aortic root dimensions remain stable in the majority of pediatric TOF patients. Progressive ARD and aortic-related complications are distinctly uncommon during childhood.


Assuntos
Aneurisma Dissecante/epidemiologia , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/epidemiologia , Ecocardiografia/métodos , Complicações Pós-Operatórias/epidemiologia , Tetralogia de Fallot/cirurgia , Adolescente , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/etiologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/etiologia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Incidência , Masculino , Ontário/epidemiologia , Complicações Pós-Operatórias/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Tetralogia de Fallot/diagnóstico , Fatores de Tempo
20.
J Cardiothorac Surg ; 13(1): 129, 2018 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-30563552

RESUMO

BACKGROUND: In recent years, surgical outcomes have improved, and positive reports on surgery for type A aortic dissection (AAD) in the elderly are increasing. However, the difference between surgical and conservative treatments in the elderly remains unclear. Therefore, we conducted this study to determine whether surgery should be performed for Stanford (AAD) in elderly patients. METHODS: Data of patients aged 80 years or older who were hospitalized for AAD from April 2014 to March 2016 were extracted from the Japanese national inpatient database. Outcome measures were all-cause in-hospital death, stroke, acute kidney injury and tracheotomy, and composite adverse events (consisting of all-cause in-hospital death, stroke, acute kidney injury, and tracheotomy), and we compared them between surgical and conservative treatments using propensity score matching. RESULTS: The study cohort included 3258 patients, with 845 matched pairs (1690 patients) in the propensity score matching. All-cause in-hospital death was significantly lower in the surgical treatment group than in the conservative treatment group before and after matching (15.6% vs. 51.1%, p < 0.001; 16.7% vs. 31.6%, p < 0.001, respectively); however, there was no significant difference in composite adverse events after matching (36.0%, conservative vs. 37.2%, surgical; p = 0.65), and adjusted odds ratio was 1.06 and 95% confidence interval was 0.86-1.29 (p = 0.61) with reference to conservative treatment. CONCLUSIONS: All-cause in-hospital death among elderly patients with AAD was significantly lower in patients treated surgically than in those undergoing conservative treatment. However, there was no significant difference between the two groups in the event-free survival, which is important for the elderly. These findings may be used in the consideration of treatment course for elderly patients with AAD.


Assuntos
Aneurisma Dissecante/terapia , Implante de Prótese Vascular/estatística & dados numéricos , Tratamento Conservador/estatística & dados numéricos , Idoso de 80 Anos ou mais , Aneurisma Dissecante/epidemiologia , Aneurisma Dissecante/cirurgia , Implante de Prótese Vascular/efeitos adversos , Tratamento Conservador/efeitos adversos , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Japão/epidemiologia , Masculino , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
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