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1.
Cardiol Clin ; 41(1): 51-69, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36368811

RESUMO

Congenital coronary anomalies are not an infrequent occurrence and their clinical presentation typically occurs during early years, though may be manifested only in adulthood. In the setting of anomalous aortic origin of a coronary artery, this is particularly concerning as it inflicts sudden loss of healthy young lives. Risk stratification remains a challenge and so does the best management decision-making in these patients, particularly if asymptomatic. Standardized approach to evaluation and management, with careful data collection and collaboration among centers, will likely impact future outcomes in this patient population, thus allowing for exercise participation and healthier lives.


Assuntos
Anomalias dos Vasos Coronários , Humanos , Adulto , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/terapia , Anomalias dos Vasos Coronários/epidemiologia , Vasos Coronários/diagnóstico por imagem , Aorta/anormalidades
2.
Zhonghua Wai Ke Za Zhi ; 60(11): 987-991, 2022 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-36323580

RESUMO

In recent years, great progress has been made in the treatment of Stanford type B aortic dissection, especially endovascular repair technology has become the main treatment. However, it is only used to repair the primary tear, the residual tears and false lumen are often left at the distal end, which causes adverse events such as distal aortic dilatation or even rupture. At present, there are many studies on the influencing factors of aortic remodeling, which provide some references for the prognosis of patients.The aorta carries the transportation of blood flow, and various factors affecting hemodynamics also affect the remodeling of aorta. Some researchers reported several factors related to negative remodeling and added auxiliary techniques, and achieved gratifying results. However, because of the different conditions of each patient, the specific treatment method is still unclear, the factors affecting the aortic remodeling effect also have not been thoroughly studied. Clarifying the influencing factors of negative remodeling is helpful to screen high-risk patients, optimize the treatment plan and improve the prognosis.


Assuntos
Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Humanos , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/métodos , Resultado do Tratamento , Aorta , Fatores de Risco , Estudos Retrospectivos
3.
Heart Surg Forum ; 25(5): E750-E752, 2022 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-36317901

RESUMO

Internal jugular vein placement is frequently utilized in clinical practice for rapid infusion, intraoperative monitoring, peritoneal dialysis, and access for interventions. Additionally, the process may lead to complications like hematoma, infection, misdirection of the artery, pneumothorax, and arteriovenous fistula. In the case described in this report, all vascular ruptures effectively were repaired because when internal jugular vein placement was adopted, a dialysis catheter would go through the right internal jugular vein into the subclavian artery, then the ascending aorta via the cephalic trunk, and finally the ectopic catheter would be surgically removed. The patient was released from the hospital on the seventh postoperative day after maintaining stable vital signs throughout the procedure.


Assuntos
Fístula Arteriovenosa , Cateterismo Venoso Central , Humanos , Veias Jugulares/cirurgia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Fístula Arteriovenosa/etiologia , Veias Braquiocefálicas , Aorta
4.
Heart Surg Forum ; 25(5): E645-E648, 2022 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-36317913

RESUMO

Patients with organ malperfusion from acute aortic dissection (AAD) have poor outcomes, and the surgical indications for patients with AAD complicated by extensive cerebral infarction have not been established. Here, we report a successfully treated surgical case of a patient with cerebral infarction and Stanford type A, AAD. A 77-year-old man was admitted to the hospital with a chief complaint of left paresis. After confirming that there was no cerebral hemorrhage with a head computed tomography and an incision in the right neck, and the right internal carotid artery was ligated and closed, emergency surgery was performed with a 24 mm Triplex® raft. The ascending aorta was replaced, and a bypass was performed with a prosthetic graft from the right axillary artery. No cerebral hemorrhage or neurological issues were observed postoperatively, which indicates the possibility of surgical intervention as a treatment strategy for this disease.


Assuntos
Aneurisma Dissecante , Implante de Prótese Vascular , Masculino , Humanos , Idoso , Aneurisma Dissecante/cirurgia , Implante de Prótese Vascular/métodos , Infarto Cerebral , Aorta/cirurgia , Hemorragia
6.
J Am Heart Assoc ; 11(22): e025772, 2022 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-36346062

RESUMO

Background Aortic intima-media thickness (aIMT) measurement is an established indicator of preclinical atherosclerosis. We aimed to describe the aIMT in infants with congenital heart disease undergoing cardiac surgery over the first year of life and explore its association with cardiopulmonary bypass, growth velocity, and a diagnosis of left heart obstruction. Methods and Results A prospective cohort study measuring mean and maximum aIMT preoperatively, at 3 months, and 1 year of age in neonates with congenital heart disease undergoing cardiac surgery. Twenty-four infants with a median gestation of 39 weeks and a median birth weight of 3184 g were included. Sixteen (67%) infants had left outflow tract obstruction. Gestation correlated inversely with baseline mean aIMT (ß=-0.027, P=0.018) and positively with the percentage of increase in mean and maximum aIMT between baseline and 3 months (ß=17%, P=0.027 and ß=15%, P=0.023). The presence of left outflow obstruction was significantly associated with increasing mean and maximum aIMT between baseline and 1 year (mean aIMT change: ß=34%, P=0.017 and maximum aIMT change ß=43%, P=0.001). Both subgroups of left heart obstruction and non-left heart obstruction significantly changed over time (P=0.001 and P<0.001) but trends were not statistically different between both subgroups (P=0.21). Growth velocity and cardiopulmonary bypass were not associated with baseline or change in aIMT over the first year of life. Conclusions AIMT significantly increased over the first 3 months in our cohort of infants with repaired congenital heart disease. Increasing gestation was associated with decreasing aIMT at 3 months. Growth velocity and cardiopulmonary bypass were not associated with aIMT changes over the first year. Left heart obstruction was associated with a trend toward increased aIMT.


Assuntos
Aterosclerose , Cardiopatias Congênitas , Humanos , Lactente , Recém-Nascido , Espessura Intima-Media Carotídea , Estudos Prospectivos , Aterosclerose/complicações , Aterosclerose/diagnóstico , Aterosclerose/epidemiologia , Aorta , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/cirurgia
7.
PLoS One ; 17(11): e0277111, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36355794

RESUMO

BACKGROUND: CT contrast media improves vessel visualization but can also confound calcification measurements. We evaluated variance in aorta attenuation from varied contrast-enhancement scans, and quantified expected plaque detection errors when thresholding for calcification. METHODS: We measured aorta attenuation (AoHU) in central vessel regions from 10K abdominal CT scans and report AoHU relationships to contrast phase (non-contrast, arterial, venous, delayed), demographic variables (age, sex, weight), body location, and scan slice thickness. We also report expected plaque segmentation false-negative errors (plaque pixels misidentified as non-plaque pixels) and false-positive errors (vessel pixels falsely identified as plaque), comparing a uniform thresholding approach and a dynamic approach based on local mean/SD aorta attenuation. RESULTS: Females had higher AoHU than males in contrast-enhanced scans by 65/22/20 HU for arterial/venous/delayed phases (p < 0.001) but not in non-contrast scans (p > 0.05). Weight was negatively correlated with AoHU by 2.3HU/10kg but other predictors explained only small portions of intra-cohort variance (R2 < 0.1 in contrast-enhanced scans). Average AoHU differed by contrast phase, but considerable overlap was seen between distributions. Increasing uniform plaque thresholds from 130HU to 200HU/300HU/400HU produces respective false-negative plaque content losses of 35%/60%/75% from all scans with corresponding false-positive errors in arterial-phase scans of 95%/60%/15%. Dynamic segmentation at 3SD above mean AoHU reduces false-positive errors to 0.13% and false-negative errors to 8%, 25%, and 70% in delayed, venous, and arterial scans, respectively. CONCLUSION: CT contrast produces heterogeneous aortic enhancements not readily determined by demographic or scan protocol factors. Uniform CT thresholds for calcified plaques incur high rates of pixel classification errors in contrast-enhanced scans which can be minimized using dynamic thresholds based on local aorta attenuation. Care should be taken to address these errors and sex-based biases in baseline attenuation when designing automatic calcification detection algorithms intended for broad use in contrast-enhanced CTs.


Assuntos
Calcinose , Placa Aterosclerótica , Masculino , Feminino , Humanos , Placa Aterosclerótica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Aorta , Algoritmos , Meios de Contraste
8.
J Cardiovasc Magn Reson ; 24(1): 57, 2022 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-36336682

RESUMO

BACKGROUND: Computational fluid dynamics (CFD) is increasingly used for the assessment of blood flow conditions in patients with congenital heart disease (CHD). This requires patient-specific anatomy, typically obtained from segmented 3D cardiovascular magnetic resonance (CMR) images. However, segmentation is time-consuming and requires expert input. This study aims to develop and validate a machine learning (ML) method for segmentation of the aorta and pulmonary arteries for CFD studies. METHODS: 90 CHD patients were retrospectively selected for this study. 3D CMR images were manually segmented to obtain ground-truth (GT) background, aorta and pulmonary artery labels. These were used to train and optimize a U-Net model, using a 70-10-10 train-validation-test split. Segmentation performance was primarily evaluated using Dice score. CFD simulations were set up from GT and ML segmentations using a semi-automatic meshing and simulation pipeline. Mean pressure and velocity fields across 99 planes along the vessel centrelines were extracted, and a mean average percentage error (MAPE) was calculated for each vessel pair (ML vs GT). A second observer (SO) segmented the test dataset for assessment of inter-observer variability. Friedman tests were used to compare ML vs GT, SO vs GT and ML vs SO metrics, and pressure/velocity field errors. RESULTS: The network's Dice score (ML vs GT) was 0.945 (interquartile range: 0.929-0.955) for the aorta and 0.885 (0.851-0.899) for the pulmonary arteries. Differences with the inter-observer Dice score (SO vs GT) and ML vs SO Dice scores were not statistically significant for either aorta or pulmonary arteries (p = 0.741, p = 0.061). The ML vs GT MAPEs for pressure and velocity in the aorta were 10.1% (8.5-15.7%) and 4.1% (3.1-6.9%), respectively, and for the pulmonary arteries 14.6% (11.5-23.2%) and 6.3% (4.3-7.9%), respectively. Inter-observer (SO vs GT) and ML vs SO pressure and velocity MAPEs were of a similar magnitude to ML vs GT (p > 0.2). CONCLUSIONS: ML can successfully segment the great vessels for CFD, with errors similar to inter-observer variability. This fast, automatic method reduces the time and effort needed for CFD analysis, making it more attractive for routine clinical use.


Assuntos
Hemodinâmica , Imageamento por Ressonância Magnética , Humanos , Estudos Retrospectivos , Valor Preditivo dos Testes , Aorta/diagnóstico por imagem
9.
Sci Rep ; 12(1): 19163, 2022 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-36357433

RESUMO

Functional implications of left ventricular (LV) morphological characterization in congenital heart disease are not widely explored. This study qualitatively and quantitatively assessed LV shape associations with a) LV function and b) thoracic aortic morphology in patients with aortic coarctation (CoA) with/without bicuspid aortic valve (BAV), and healthy controls. A statistical shape modelling framework was employed to analyse three-dimensional (3D) LV shapes from cardiac magnetic resonance (CMR) data in isolated CoA (n = 25), CoA + BAV (n = 30), isolated BAV (n = 30), and healthy controls (n = 25). Average 3D templates and deformations were computed. Correlations between shape data and CMR-derived morphometric parameters (i.e., sphericity, conicity) or global and apical strain values were assessed to elucidate possible functional implications. The relationship between LV shape features and arch architecture was also explored. The LV template was shorter and more spherical in CoA patients. Sphericity was overall associated with global and apical radial (p = 0.001, R2 = 0.09; p < 0.0001, R2 = 0.17) and circumferential strain (p = 0.001, R2 = 0.10; p = 0.04, R2 = 0.04), irrespective of the presence of aortic stenosis and/or regurgitation and controlling for age and hypertension status. LV strain was not associated with arch architecture. Differences in LV morphology were observed between CoA and BAV patients. Increasing LV sphericity was associated with reduced strain, independent of aortic arch architecture and functional aortic valve disease.


Assuntos
Coartação Aórtica , Doença da Válvula Aórtica Bicúspide , Humanos , Valva Aórtica/patologia , Aorta/patologia , Ventrículos do Coração/diagnóstico por imagem , Função Ventricular Esquerda , Coenzima A
10.
J Pharmacol Sci ; 150(4): 223-232, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36344044

RESUMO

Oroxylin-A (OroA), a flavonoid isolated from Scutellariae baicalensis, alleviates cardiovascular dysfunction. Several procedures for synthesizing OroA have been developed but show low production yield and regioselectivity. We synthesized OroA from baicalin using a one-pot reaction to increase its overall yield. We also determined the chemical properties and mechanism of action of the synthesized OroA and OroA phosphate diethyl ester (OroA-OET) in vascular function. The induction of vascular reactivity by OroA and OroA-OET was evaluated using blood vessel myography and biochemical analysis to assess nitric oxide synthase-mediated nitric oxide production in mouse aortic arteries. OroA and OroA-OET (0.1-30 µM) induced sustained vasorelaxation, which was partly mediated by the endothelium in isolated normal arteries pre-contracted with phenylephrine. OroA and OroA-OET significantly attenuated vasoconstrictors-induced contractile responses. Dilation effects were blocked by the non-selective nitric oxide synthase inhibitor N (omega)-nitro-l-arginine methyl ester but not by tetraethylammonium or 1H-(1,2,4)oxadiazolo [4,3-a]quinoxalin-1-one. Notably, preincubation with OroA and OroA-OET potentiated acetylcholine-induced relaxation and endothelial nitric oxide production in the arteries with the endothelium. OroA and OroA-OET protected against cardiovascular dysfunction. The synthesis and lead compounds used not only improved the yield of OroA from natural sources but also potentially regulated vascular tone.


Assuntos
Organofosfonatos , Vasoconstritores , Camundongos , Animais , Vasoconstritores/farmacologia , Óxido Nítrico/farmacologia , Organofosfonatos/farmacologia , Óxido Nítrico Sintase Tipo III , Aorta , Flavonoides/farmacologia , Óxido Nítrico Sintase , Vasodilatação , Endotélio Vascular , NG-Nitroarginina Metil Éster/farmacologia
11.
Biomolecules ; 12(11)2022 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-36358914

RESUMO

Vascular smooth muscle cells (VSMCs) are the main stromal cells in the medial layer of the vascular wall. These cells produce the extracellular matrix (ECM) and are involved in many pathological changes in the vascular wall. Semicarbazide-sensitive amine oxidase (SSAO) and lysyl oxidase (LOX) are vascular enzymes associated with the development of atherosclerosis. In the vascular smooth muscle cells, increased SSAO activity elevates reactive oxygen species (ROS) and induces VSMCs death; increased LOX induces chemotaxis through hydrogen peroxide dependent mechanisms; and decreased LOX contributes to endothelial dysfunction. This study investigates the relationship between SSAO and LOX in VSMCs by studying their activity, protein, and mRNA levels during VSMCs passaging and after silencing the LOX gene, while using their respective substrates and inhibitors. At the basal level, LOX activity decreased with passage and its protein expression was maintained between passages. ßAPN abolished LOX activity (** p < 0.01 for 8 vs. 3 and * p < 0.05 for 5 vs. 8) and had no effect on LOX protein and mRNA levels. MDL72527 reduced LOX activity at passage 3 and 5 (##&nbsp;p < 0.01) and had no effect on LOX protein, and mRNA expression. At the basal level, SSAO activity also decreased with passage, and its protein expression was maintained between passages. MDL72527 abolished SSAO activity (****&nbsp;p < 0.0001 for 8 vs. 3 and * p < 0.05 for 5 vs. 8), VAP-1 expression at passage 5 (** p < 0.01) and 8 (**** p < 0.0001), and Aoc3 mRNA levels at passage 8 (* p < 0.05). ßAPN inhibited SSAO activity (**** p < 0.0001 for 5 vs. 3 and 8 vs. 3 and * p < 0.05 for 5 vs. 8), VAP-1 expression at passage 3 (* p < 0.05), and Aoc3 mRNA levels at passage 3 (* p < 0.05). Knockdown of the LOX gene (**** p < 0.0001 for Si6 vs. Sictrl and *** p < 0.001 for Si8 vs. Sictrl) and LOX protein (** p < 0.01 for Si6 and Si8 vs. Sictrl) in VSMCs at passage 3 resulted in a reduction in Aoc3 mRNA (####&nbsp;p < 0.0001 for Si6 vs. Sictrl and ###&nbsp;p < 0.001 for Si8 vs. Sictrl) and VAP-1 protein (#&nbsp;p < 0.05 for Si8 vs. Sictrl). These novel findings demonstrate a passage dependent decrease in LOX activity and increase in SSAO activity in rat aortic VSMCs and show an association between both enzymes in early passage rat aortic VSMCs, where LOX was identified as a regulator of SSAO activity, protein, and mRNA expression.


Assuntos
Amina Oxidase (contendo Cobre) , Ratos , Animais , Amina Oxidase (contendo Cobre)/genética , Amina Oxidase (contendo Cobre)/metabolismo , Músculo Liso Vascular/metabolismo , Proteína-Lisina 6-Oxidase/genética , Proteína-Lisina 6-Oxidase/metabolismo , Aorta/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo
12.
Turk J Med Sci ; 52(3): 848-857, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36326331

RESUMO

BACKGROUND: Hydroxychloroquine (HCQ) is an antimalarial that is widely used in the management of rheumatoid arthritis and other autoimmune diseases. In this study, we aimed to examine the vascular effects of HCQ on rat aorta (RA). METHODS: The RA rings were suspended in isolated organ baths and tension was recorded isometrically. HCQ-induced relaxations were tested in the presence of the nitric oxide synthase inhibitor, nitro-L-arginine methyl ester (L-NAME, 100 mM); the cyclooxygenase enzyme inhibitor, indomethacin (10 mM); the calcium (Ca2+) ion channel blocker, nilvadipine (10 µM); and the K+ ion channel inhibitors, tetraethylammonium (1 mM), glibenclamide (10 mM), 4-aminopyridine (1 mM), and barium chloride (30 mM). The effect of HCQ on Ca2+ channels was examined using Ca2+-free Krebs solution, and adding calcium chloride (CaCl2 , 10-5- 10-2 M) cumulatively to baths incubated with HCQ. RESULTS: Removing the endothelium resulted in less relaxation of RA rings compared to endothelium-intact rings (p < 0.05). The effect of endothelium was supported by using L-NAME where HCQ produced-vasorelaxation was decreased (p < 0.05). The contraction of vascular rings was inhibited to a significant degree following the addition of CaCl2 , PE, or KCl on HCQ-incubated RA rings (p < 0.05). The incubation of the RA rings with the Ca2+ channel blocker, the K+ channel blockers, and the COX inhibitor, indomethacin did not significantly affect vascular relaxation induced by HCQ. DISCUSSION: HCQ produced relaxation of RA rings. The relaxation mechanism differs according to the concentration of HCQ. At con-centrations of 10-6 and 10-5 M, the relaxation is endothelium-dependent and mediated by NO. We strongly suggest that Ca2+ channel inhibition is involved at concentrations of 10-5 and 10-4 M, as well as NO.


Assuntos
Hidroxicloroquina , Indometacina , Ratos , Animais , NG-Nitroarginina Metil Éster/farmacologia , Cloreto de Cálcio/farmacologia , Endotélio , Indometacina/farmacologia , Aorta , Endotélio Vascular , Vasodilatadores/farmacologia , Relação Dose-Resposta a Droga
13.
Arch Biochem Biophys ; 731: 109430, 2022 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-36326546

RESUMO

Diabetic cardiovascular complication is a common systemic disease with high morbidity and mortality worldwide. We hypothesise that exosomes derived from human umbilical cord mesenchymal stem cells (hUCMSCs-exos) can rescue these disorders and alleviate vascular remodeling in diabetes. Morphological, non-targeted metabolomics and 4D label-free proteomics techniques were used to analyze the aortas of db/m mice as normal control group (NCA), saline treated db/db mice (DMA), and hUCMSCs-exos treated db/db mice (DMTA), and to clarify the molecular mechanism of the protection of hUCMSCs-exos in vascular remodeling from a new point of view. The results showed that 74 metabolites were changed significantly in diabetic aortas, of which 15 were almost restored by hUCMSCs-exos. In proteomics, 30 potential targets such as Stromal cell-derived factor 2-like protein 1, Leukemia inhibitory factor receptor, Peroxisomal membrane protein and E3 ubiquitin-protein ligase MYCBP2 were detected. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway-based analysis showed that Central carbon metabolism in cancer and Galactose metabolism pathway were up-regulated to near normal by hUCMSCs-exos in metabolomics, with janus associated kinase-signal transducer and activator of transcription (JAK-STAT) pathway displayed in proteomics. According to bioinformatics and integrated analysis, these targeted molecules of hUCMSCs-exos to attenuate the vascular remodeling were mainly associated with regulation of energy metabolism, oxidative stress, inflammation, and cellular communications. This study provided a reference for the therapy of diabetes-induced cardiovascular complications.


Assuntos
Exossomos , Células-Tronco Mesenquimais , Humanos , Camundongos , Animais , Exossomos/metabolismo , Cordão Umbilical , Proteômica , Remodelação Vascular , Células-Tronco Mesenquimais/metabolismo , Aorta
14.
BMJ Case Rep ; 15(11)2022 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-36328361

RESUMO

A man in his 50s with sudden-onset left-sided subcostal pain was diagnosed with splenic infarction by thoracoabdominal CT with contrast enhancement, which also revealed a mural thrombus in the thoracoabdominal aorta, raising the possibility of aortic dissection. The electrocardiographic findings were normal and transthoracic echocardiography did not detect thrombus in the heart. Antihypertensive medication was administered on admission, and anticoagulation therapy was started after he developed left renal infarction and occlusion of the superior mesenteric artery. Nevertheless, he subsequently sustained an acute cerebral infarction. Transoesophageal echocardiography revealed an abnormal floating structure in the ascending aorta, which was surgically removed and finally diagnosed as an organising thrombus. Although most of the causes of multiorgan infarction are cardiogenic, floating mural thrombus can also be a cause. Anticoagulation therapy may be necessary for patients with recurring severe embolisms even when aortic dissection has not been completely ruled out.


Assuntos
Aneurisma Dissecante , Doenças da Aorta , Cardiopatias , Infarto do Miocárdio , Tromboembolia , Trombose , Masculino , Humanos , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico por imagem , Trombose/complicações , Trombose/diagnóstico por imagem , Aorta/diagnóstico por imagem , Tromboembolia/complicações , Infarto do Miocárdio/diagnóstico , Cardiopatias/complicações , Anticoagulantes/uso terapêutico , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem
15.
JAMA ; 328(19): 1935-1944, 2022 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-36378208

RESUMO

Importance: Ascending thoracic aortic disease is an important cause of sudden death in the US, yet most aortic aneurysms are identified incidentally. Objective: To develop and validate a clinical score to estimate ascending aortic diameter. Design, Setting, and Participants: Using an ongoing magnetic resonance imaging substudy of the UK Biobank cohort study, which had enrolled participants from 2006 through 2010, score derivation was performed in 30 018 participants and internal validation in an additional 6681. External validation was performed in 1367 participants from the Framingham Heart Study (FHS) offspring cohort who had undergone computed tomography from 2002 through 2005, and in 50 768 individuals who had undergone transthoracic echocardiography in the Community Care Cohort Project, a retrospective hospital-based cohort of longitudinal primary care patients in the Mass General Brigham (MGB) network between 2001-2018. Exposures: Demographic and clinical variables (11 covariates that would not independently prompt thoracic imaging). Main Outcomes and Measures: Ascending aortic diameter was modeled with hierarchical group least absolute shrinkage and selection operator (LASSO) regression. Correlation between estimated and measured diameter and performance for identifying diameter 4.0 cm or greater were assessed. Results: The 30 018-participant training cohort (52% women), were a median age of 65.1 years (IQR, 58.6-70.6 years). The mean (SD) ascending aortic diameter was 3.04 (0.31) cm for women and 3.32 (0.34) cm for men. A score to estimate ascending aortic diameter explained 28.2% of the variance in aortic diameter in the UK Biobank validation cohort (95% CI, 26.4%-30.0%), 30.8% in the FHS cohort (95% CI, 26.8%-34.9%), and 32.6% in the MGB cohort (95% CI, 31.9%-33.2%). For detecting individuals with an ascending aortic diameter of 4 cm or greater, the score had an area under the receiver operator characteristic curve of 0.770 (95% CI, 0.737-0.803) in the UK Biobank, 0.813 (95% CI, 0.772-0.854) in the FHS, and 0.766 (95% CI, 0.757-0.774) in the MGB cohorts, although the model significantly overestimated or underestimated aortic diameter in external validation. Using a fixed-score threshold of 3.537, 9.7 people in UK Biobank, 1.8 in the FHS, and 4.6 in the MGB cohorts would need imaging to confirm 1 individual with an ascending aortic diameter of 4 cm or greater. The sensitivity at that threshold was 8.9% in the UK Biobank, 11.3% in the FHS, and 18.8% in the MGB cohorts, with specificities of 98.1%, 99.2%, and 96.2%, respectively. Conclusions and Relevance: A prediction model based on common clinically available data was derived and validated to predict ascending aortic diameter. Further research is needed to optimize the prediction model and to determine whether its use is associated with improved outcomes.


Assuntos
Aneurisma Aórtico , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Estudos de Coortes , Aneurisma Aórtico/diagnóstico por imagem , Aorta/diagnóstico por imagem , Ecocardiografia
16.
Eur J Cardiothorac Surg ; 62(6)2022 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-36367298

RESUMO

A 69-year-old woman underwent aortic root reimplantation and graft replacement of the ascending aorta 12 years ago. A pseudoaneurysm (2.5 cm × 3 cm) arising from the side branch of the ascending aortic prosthetic graft was incidentally detected on contrast-enhanced computed tomography. After endovascular balloon occlusion of the side branch through the left subclavian artery, the side branch was exposed via right mini-thoracotomy in the third intercostal space. After circumferential dissection, the side branch was ligated uneventfully. The patient was discharged home on postoperative day 7 without any complications.


Assuntos
Falso Aneurisma , Oclusão com Balão , Humanos , Feminino , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Toracotomia , Aorta/cirurgia , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgia
17.
PLoS One ; 17(11): e0265854, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36395179

RESUMO

BACKGROUND: Diabetes mellitus is a chronic metabolic disorder which induces endothelial dysfunction and platelet activation. Eicosanoids produced from arachidonic acid regulate cellular and vascular functions. Sigma-1 receptors (S1R) are expressed in platelets and endothelial cells and S1R expression is protective in diabetes. OBJECTIVES: Our aim was to examine the influence of sub-chronic, in vivo administered S1R ligands PRE-084, (S)-L1 (a new compound) and NE-100 on the ex vivo arachidonic acid metabolism of platelets and aorta in streptozotocin-induced diabetic rats. METHODS: The serum level of the S1R ligands was detected by LC-MS/MS before the ex vivo analysis. Sigma-1 receptor and cyclooxygenase gene expression in platelets were determined by RT-qPCR. The eicosanoid synthesis was examined with a radiolabelled arachidonic acid substrate and ELISA. RESULTS: One month after the onset of STZ-induced diabetes, in vehicle-treated, diabetic rat platelet TxB2 and aortic 6-k-PGF1α production dropped. Sub-chronic in vivo treatment of STZ-induced diabetes in rats for one week with PRE-084 enhanced vasoconstrictor and platelet aggregator and reduced vasodilator and anti-aggregator cyclooxygenase product formation. (S)-L1 reduced the synthesis of vasodilator and anti-aggregator cyclooxygenase metabolites and promoted the recovery of physiological platelet function in diabetic rats. The S1R antagonist NE-100 produced no significant changes in platelet arachidonic acid metabolism. (S)-L1 decreased the synthesis of vasoconstrictor and platelet aggregator cyclooxygenase metabolites, whereas NE-100 increased the quantity of aortic vasodilator and anti-aggregator cyclooxygenase products and promoted the recovery of diabetic endothelial dysfunction in the aorta. The novel S1R ligand, (S)-L1 had similar effects on eicosanoid synthesis in platelets as the agonist PRE-084 and in aortas as the antagonist NE-100. CONCLUSIONS: S1R ligands regulate cellular functions and local blood circulation by influencing arachidonic acid metabolism. In diabetes mellitus, the cell-specific effects of S1R ligands have a compensatory role and aid in restoring physiological balance between the platelet and vessel.


Assuntos
Diabetes Mellitus Experimental , Animais , Ratos , Estreptozocina , Ácido Araquidônico/farmacologia , Diabetes Mellitus Experimental/metabolismo , Ligantes , Células Endoteliais/metabolismo , Cromatografia Líquida , Espectrometria de Massas em Tandem , Ácidos Araquidônicos/metabolismo , Aorta/metabolismo , Eicosanoides , Ciclo-Oxigenase 2 , Vasodilatadores , Vasoconstritores
18.
Card Electrophysiol Clin ; 14(4): 621-631, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36396181

RESUMO

Idiopathic ventricular arrhythmias (VAs) most commonly originate from the ventricular outflow tracts. Because the anatomy of this region is complex and some of those VA origins are intramural and epicardial, it may sometimes be difficult to locate the site of the VA origin. Meticulous mapping in multiple different locations such as the right and left ventricular outflow tracts, endocardial and epicardial sites, and above and below the aortic and pulmonic valves may be required to achieve successful catheter ablation of those VAs. Special ablation techniques may be considered to improve the outcome of catheter ablation of intramural and epicardial VAs.


Assuntos
Ablação por Cateter , Humanos , Ablação por Cateter/métodos , Ventrículos do Coração/cirurgia , Arritmias Cardíacas , Endocárdio/cirurgia , Aorta
19.
ASAIO J ; 68(11): e179-e187, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-36326700

RESUMO

Institution of extracorporeal membrane oxygenation (ECMO) results in unique blood flow characteristics to the end-organ vascular beds. We studied the interplay between cardiac-driven and extracorporeal membrane oxygenation (ECMO)-driven flow to vascular beds in different ECMO configurations using a patient-specific computational fluid dynamics (CFD) analysis. A computational ECMO model (femoral artery cannulation [FAC]) was constructed using patient-specific imaging and hemodynamic data. Following model calibration, we augmented the 3D geometrical model to represent alternative ECMO configurations (ascending aorta cannulation [AAC] and subclavian artery cannulation [SAC]). We performed CFD analyses, including a novel virtual color-dye analysis to compare global and regional blood flow and pressure characteristics as well as contributions of cardiac and ECMO-derived flow to the various vascular beds. Flow waveforms at all the aortic branch vessels were pulsatile, despite low cardiac output and predominant nonpulsatile ECMO-driven hemodynamics. Virtual color-dye analysis revealed differential contribution of cardiac and ECMO-derived flow to the end-organ vascular beds in the FAC model, while this was more evenly distributed in the AAC and SAC models. While global hemodynamics were relatively similar between various ECMO configurations, several distinct hemodynamic indices, in particular wall shear stress and oscillatory shear patterns, as well as differential contribution of ECMO-derived flow to various vascular beds, showed remarkable differences. The clinical impact of this study highlighting the relevance of CFD modeling in assessment of complex hemodynamics in ECMO warrants further evaluation.


Assuntos
Oxigenação por Membrana Extracorpórea , Humanos , Oxigenação por Membrana Extracorpórea/métodos , Modelagem Computacional Específica para o Paciente , Hemodinâmica/fisiologia , Cateterismo , Aorta
20.
PLoS One ; 17(11): e0267765, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36331977

RESUMO

In-vitro models of the systemic circulation have gained a lot of interest for fundamental understanding of cardiovascular dynamics and for applied hemodynamic research. In this study, we introduce a physiologically accurate in-vitro hydraulic setup that models the hemodynamics of the coupled atrioventricular-aortic system. This unique experimental simulator has three major components: 1) an arterial system consisting of a human-scale artificial aorta along with the main branches, 2) an artificial left ventricle (LV) sac connected to a programmable piston-in-cylinder pump for simulating cardiac contraction and relaxation, and 3) an artificial left atrium (LA). The setup is designed in such a way that the basal LV is directly connected to the aortic root via an aortic valve, and to the LA via an artificial mitral valve. As a result, two-way hemodynamic couplings can be achieved for studying the effects that the LV, aorta, and LA have on each other. The collected pressure and flow measurements from this setup demonstrate a remarkable correspondence to clinical hemodynamics. We also investigate the physiological relevancies of isolated effects on cardiovascular hemodynamics of various major global parameters found in the circulatory system, including LV contractility, LV preload, heart rate, aortic compliance, and peripheral resistance. Subsequent control over such parameters ultimately captures physiological hemodynamic effects of LV systolic dysfunction, preload (cardiac) diseases, and afterload (arterial) diseases. The detailed design and fabrication of the proposed setup is also provided.


Assuntos
Hemodinâmica , Disfunção Ventricular Esquerda , Humanos , Hemodinâmica/fisiologia , Aorta/fisiologia , Contração Miocárdica , Valva Aórtica , Função Ventricular Esquerda
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