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1.
Zhonghua Nei Ke Za Zhi ; 58(11): 808-813, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31665855

RESUMO

Objective: Positron emission tomography-computed tomography (PET-CT) has been used to quantify inflammatory response in the body. The aim of the present study was to explore the possibility of using this method to evaluate the stability of atherosclerotic plaques and the efficacy of atorvastatin in stabilizing atherosclerotic plaques. Methods: Twenty New Zealand male white rabbits were included and divided into the atorvastatin intervention group and the control group, with 10 rabbits in each group. Rabbits in both groups were fed with a high fat diet for 20 weeks, and treated with thoracoabdominal aortic balloon-pulling to establish atherosclerosis model at the end of the 2nd week. Rabbits in atorvastatin intervention group was given atorvastatin intragastrically once a day. At the 8th week, thoracoabdominal aortic ultrasound was used to detect plaques in all rabbits. Blood was drawn at the 3rd and the 20th week, respectively, to measure blood lipids, high-sensitive C-reactive protein (hs-CRP) and matrix metalloproteinase-9 (MMP-9). At the end of experiment, survival animals were scanned by (18)F-FDG PET-CT, and the average and maximum standard uptake values (SUVmean, SUVmax) of aortic segments were measured. Thereafter, the animals were sacrificed and aortic specimens of rabbits were taken and examined by immunohistochemistry. The pathological indexes were measured and compared. Results: At the end of experiment, the total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), hs-CRP [ (4.58±0.51) ng/ml vs.(5.87±0.66) ng/ml, P<0.01], MMP-9[ (43.93±2.16) ng/ml vs. (50.77±2.32) ng/ml, P<0.01], SUVmean (0.59±0.15 vs. 0.68±0.20, P<0.05) , SUVmax (0.68±0.20 vs. 0.81±0.27, P<0.05) , plaque area [ (0.36±0.24) mm(2) vs. (0.50±0.34) mm(2), P<0.05) ] and density of macrophage[ (4.34±1.54) % vs. (5.65±1.89) %, P<0.01] in the atorvastatin intervention group were significantly lower than those in the control group. In contrast, fiber cap thickness of the plaque[ (4.12±0.66) µm vs. (2.96±0.37) µm, P<0.01] in the atorvastatin intervention group was higher than that of the control group, and the difference was statistically significant. The arterial plaque areas were positively correlated with SUVmean (r=0.27, P<0.05) and SUVmax (r=0.43, P<0.01) . Fiber cap thickness was negatively correlated with SUVmean (r=-0.38, P<0.05) and SUVmax (r=-0.47, P<0.01) . The density of macrophage were positively correlated with SUVmean (r=0.52, P<0.01) and SUVmax (r=0.51, P<0.01) . Conclusion: (18)F-FDG PET/CT can be used to evaluate the efficacy of atorvastatin by the stability of atherosclerotic plaques.


Assuntos
Aorta/diagnóstico por imagem , Fluordesoxiglucose F18/administração & dosagem , Placa Aterosclerótica/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Animais , Aorta/patologia , Masculino , Placa Aterosclerótica/patologia , Coelhos , Compostos Radiofarmacêuticos
2.
Zhonghua Fu Chan Ke Za Zhi ; 54(10): 660-665, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31648441

RESUMO

Objective: To analyze the pregnancy outcomes of fetal tetralogy of Fallot and to explore its prenatal diagnosis and treatment procedures. Methods: The clinical data of 63 cases of fetal tetralogy of Fallot (62 cases were singleton and 1 case was one of twin) were collected retrospectively from November, 2013 to November, 2017 in Beijing Obstetrics and Gynecology Hospital. Results: (1) Totally, 63 cases out of 46 352 pregnancies were diagnosed fetal tetralogy of Fallot by fetal ultrasonic cardiogram with about 0.136%(63/46 352) occurrence rate, and the mean gestational age was (23±3) weeks. And 50 cases (79%, 50/63) terminated pregnancy by induced labour. (2) Totally, 57 cases (90%,57/63) accepted genetic diagnosis.Eight cases (13%, 8/63) existed chromosome abnormality including 21-trimosy in 6 cases, 18-trisomy in 1 case and 22q11.2 microdeletion syndrome in 1 case; and these 8 cases were determined before 28 gestational weeks. (3) And 13 cases (21%, 13/63) of no fetal genetic abnormality selected to continue pregnancy. Twelve cases underwent full term delivery (5 cases were cesarean section delivery and 7 cases were vaginal delivery). Twelve newborns underwent surgical radical operation on heart malformation and got recovery. One case underwent preterm cesarean section at 35 gestational weeks for one of twin, and the newborn with tetralogy of Fallot was dead. The other the newborns survived and were followed up for tetralogy of Fallot surgery from 1 month to 3 years old after birth and recovered. Conclusions: Fetal tetralogy of Fallot mainly is diagnosed by ultrasonic cardiogram in the second trimester. The gestational age of diagnosis may be as early as 15 gestational weeks. Fetal tetralogy of Fallot with no genetic abnormality could underwent radical heart malformation operation after birth. It is necessary to undergo genetic testing on fetal tetralogy of Fallot and prenatal multidisciplinary counseling as well.


Assuntos
Resultado da Gravidez , Diagnóstico Pré-Natal/métodos , Tetralogia de Fallot/diagnóstico por imagem , Ultrassonografia Pré-Natal , Aorta/diagnóstico por imagem , Aorta/patologia , Cesárea , Feminino , Feto , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Gravidez , Artéria Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Tetralogia de Fallot/diagnóstico
4.
Presse Med ; 48(9): 931-940, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31471096

RESUMO

Since 2000, imaging is frequently used for the diagnosis and follow-up of giant cell arteritis (GCA). At diagnosis, the demonstration on imaging of an involvement of the temporal arteries is useful to guide the temporal artery biopsy, or, sometimes, to replace it. Large-vessel imaging is nowadays currently performed as some studies indicate that 30 to 80% of patients might demonstrate involvement of the aorta and its branches, often silently. Aorta CT angiography, positron emission tomography or magnetic resonance angiography show a high sensibility to detect large-vessel inflammation, and have become in current practice and recent studies a supplementary criteria to classify or diagnose GCA. Many studies indicate a different prognosis in patients with large-vessel inflammation, highlighting the need to diagnose such involvement. Large-vessel imaging is important in the patients' follow-up to analyze how large-vessel inflammation evolves under treatment and to detect morphologic changes (dilations, dissections, or stenoses) that are more frequent in these patients. Recent European recommendations analyze the different imaging procedures available for diagnosis and follow-up of patients with GCA.


Assuntos
Aorta/diagnóstico por imagem , Aortite/diagnóstico por imagem , Arterite de Células Gigantes/diagnóstico por imagem , Artérias Temporais/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Europa (Continente) , Seguimentos , Humanos , Angiografia por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Guias de Prática Clínica como Assunto , Prognóstico , Sensibilidade e Especificidade
5.
Semin Vasc Surg ; 32(1-2): 73-80, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540660

RESUMO

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


Assuntos
Aneurisma Infectado/cirurgia , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Veia Femoral/transplante , Infecções Relacionadas à Prótese/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aorta/diagnóstico por imagem , Aorta/microbiologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/microbiologia , Implante de Prótese Vascular/instrumentação , Tomada de Decisão Clínica , Remoção de Dispositivo , Humanos , Seleção de Pacientes , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Reoperação , Fatores de Risco , Resultado do Tratamento
6.
Semin Vasc Surg ; 32(1-2): 81-87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540661

RESUMO

Aortic graft infection remains one of the most complex clinical challenges faced by vascular specialists, and is often associated with significant patient morbidity and mortality regardless of the approach used for management. The cryopreserved aortic allograft is now a commonly used in situ aortic replacement in the management of graft infection, and is preferred over rifampin-soaked prosthetic grafts. In the review, we summarize the indications for cryopreserved aortic allograft usage, as well as operative technique, clinical results, and alternative treatments. We propose the use of a novel term tertiary aortic fistula, to distinguish aortic fistulae in the setting of aortic endograft infection, a clinical entity whose natural history and best management are currently being characterized.


Assuntos
Aorta/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Vasos Sanguíneos/transplante , Criopreservação , Infecções Relacionadas à Prótese/cirurgia , Aloenxertos , Aorta/diagnóstico por imagem , Aorta/microbiologia , Implante de Prótese Vascular/instrumentação , Remoção de Dispositivo , Humanos , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Reoperação , Fatores de Risco , Resultado do Tratamento
8.
Methodist Debakey Cardiovasc J ; 15(2): 152-155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384380

RESUMO

Iatrogenic aortocaval fistula is an extremely rare pathologic condition that often results in clinically significant left-to-right extracardiac shunt. In slow-progressing cases, chronic right-sided heart failure can occur and, in some patients, may persist for years. We present a patient with a long-standing aortocaval fistula that was causing high-flow left-to-right shunting, tricuspid regurgitation, severe pulmonary hypertension, and right-side heart failure. After undergoing complete endoscopic isolation of the aortocaval fistula, the patient experienced dramatic clinical improvement and continued to have excellent imaging and clinical resolution after 2 years of follow-up.


Assuntos
Aorta/fisiopatologia , Fístula Arteriovenosa/terapia , Embolização Terapêutica , Procedimentos Endovasculares , Insuficiência Cardíaca/etiologia , Hipertensão Pulmonar/etiologia , Doença Iatrogênica , Veia Cava Inferior/fisiopatologia , Aorta/diagnóstico por imagem , Aortografia/métodos , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/fisiopatologia , Angiografia por Tomografia Computadorizada , Ecocardiografia Doppler em Cores , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Desenho de Prótese , Fluxo Sanguíneo Regional , Dispositivo para Oclusão Septal , Fatores de Tempo , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem
9.
Am J Vet Res ; 80(8): 764-770, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31339766

RESUMO

OBJECTIVE: To determine whether previously described cutoffs for ultrasonographically determined kidney length-to-aorta diameter ratio (KL:Ao) for evaluation of kidney size in adult dogs are applicable to healthy dogs 1 to 18 months of age and to assess interobserver and intraobserver variability for ultrasonographic kidney and aorta measurements in these dogs grouped according to age. ANIMALS: 82 dogs. PROCEDURES: 41 university-owned dogs and 41 client- or staff-owned dogs of 3 age groups (approx 1, 6, and 12 to 18 months of age) underwent ultrasonographic examination by 3 observers. Kidney length, kidney width, and diameter of the aorta were measured by each observer 3 times, and KL:Ao and kidney length-to-body weight ratio were calculated for each dog. Measurements and calculated ratios for the 3 age groups were compared by statistical methods; interobserver and intraobserver variability were calculated. RESULTS: Mean kidney length, kidney width, and aorta diameter were smaller, and calculated KL:Ao and kidney length-to-body weight ratio were larger, for dogs of the 1-month age group than for dogs of the 6-month and 12 to 18-month age groups. There were significant interobserver differences for ultrasonographic measurements in all age groups; these were most frequent in the youngest group of dogs and affected KL:Ao for that group only. CONCLUSIONS AND CLINICAL RELEVANCE: Results revealed that 1-month-old dogs have larger kidneys relative to body weight and aorta diameter than do older dogs. Interobserver variability for the youngest group of dogs indicated limited usefulness of these measurements and related ratios for neonatal dogs in clinical practice. The KL:Ao values for dogs ≥ 6 months of age in this study were similar to values previously described for dogs > 12 months of age.


Assuntos
Aorta/diagnóstico por imagem , Cães/anatomia & histologia , Rim/diagnóstico por imagem , Ultrassonografia/veterinária , Animais , Aorta/anatomia & histologia , Rim/anatomia & histologia , Variações Dependentes do Observador , Tamanho do Órgão
10.
Niger J Clin Pract ; 22(7): 950-956, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31293260

RESUMO

Background: Accurate assessment of the degree of dehydration is essential in the management and fluid therapy of dehydrated children. The invasiveness of central venous pressure limits its routine clinical use. Fortunately, some studies have suggested that ultrasonographic measurement of inferior vena cava (IVC) diameter: aorta diameter ratio (IADR) is an objective method of assessing intravascular volume. Objectives: To determine the clinical usefulness of ultrasound measurement of IADR in assessment of children with dehydration. Methodology: This was a cross-sectional study which compared dehydrated children to age- and sex-matched euvolemic healthy children as controls. The maximum anteroposterior diameter of the abdominal aorta (at peak systole) and maximum IVC diameter (in expiration) were measured. Results: A total of 120 subjects and 120 controls were evaluated. The mean age was 21.73 ± 20.89 months for subjects and 21.19 ± 22.13 months for control. The mean IADR for children with mild, moderate, and severe dehydration was 0.75 ± 0.07, 0.55 ± 0.07, and 0.33 ± 0.05, respectively. The mean IADR for controls was 0.99 ± 0.06. IADR had an inverse relationship with the degree of dehydration in the subjects. A cut-off point of 0.86, with a sensitivity and specificity of 96.7% in predicting dehydration, was derived, with the sensitivity and specificity increasing with increasing level of dehydration. Conclusion: IADR is sensitive and specific for assessing moderate and severe dehydration in Nigerian children.


Assuntos
Aorta/diagnóstico por imagem , Desidratação , Ultrassonografia , Veia Cava Inferior/diagnóstico por imagem , Aorta/anatomia & histologia , Estudos de Casos e Controles , Pressão Venosa Central , Criança , Pré-Escolar , Estudos Transversais , Desidratação/diagnóstico , Desidratação/etiologia , Feminino , Gastroenteropatias/complicações , Humanos , Lactente , Recém-Nascido , Masculino , Nigéria , Estudos Prospectivos , Sensibilidade e Especificidade , Índice de Gravidade de Doença
11.
EuroIntervention ; 15(9): e749-e756, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31334701

RESUMO

AIMS: The aim of this study was to evaluate the impact of a horizontal aorta (HA) on device success and short-term clinical outcomes of transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: We retrospectively assessed 547 consecutive patients treated with transfemoral second-generation non-balloon-expandable (NBE) (n=447) and balloon-expandable (BE) (n=100) TAVI for symptomatic severe aortic stenosis. Aortic angulation (AA) was evaluated with preprocedural computed tomography. Patients were dichotomised according to a previously established AA cut-point: HA group (AA ≥48°, n=230) and normal aorta (NA) group (AA <48°, n=317). Endpoints were considered according to the Valve Academic Research Consortium-2 definitions. Fluoroscopy time (32.8±16.4 vs 30.3±13.9 minutes, p=0.060) and radiation dose (kerma area product 120.8±99.7 vs 103.7±81.1 Gy·cm2, p=0.033) were higher in the HA group as compared to the NA group. No difference in device success was observed between patients with and without an HA (88.3% vs 88.0%, p=0.929). No differences in device success and 30-day outcomes were observed when comparing HA and NA patients, according to BE and NBE prostheses. CONCLUSIONS: The presence of an HA has no impact on device success and short-term clinical outcomes of TAVI with either second-generation NBE or BE devices.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/instrumentação , Aorta/diagnóstico por imagem , Valvuloplastia com Balão/efeitos adversos , Cateterismo Periférico/efeitos adversos , Fluoroscopia , Humanos , Desenho de Prótese , Estudos Retrospectivos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
12.
J Comput Assist Tomogr ; 43(4): 612-618, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31268876

RESUMO

OBJECTIVE: The aim of this study was to determine if computed tomography (CT) angiography using an individualized transition delay (CTA-ID) would facilitate reductions in injection rate and iodine dose. METHODS: The CTA-ID was performed in 20 patients with routine injection rate and iodine dose; 20 patients with injection rate lowered by 1 mL/s; and 40 patients with injection rate lowered by 1 mL/s with 29% less iodine. Routine CTAs in the same or size-matched patients served as controls. Diagnostic image quality and intra-arterial CT numbers were assessed. RESULTS: The median transition delay between aortic threshold and CTA-ID image acquisition was significantly longer than with conventional bolus tracking (mean increase, 13.3 seconds; P < 0.0001), with image quality being the same or better. Intra-arterial CT numbers were 200 Hounsfield units or greater for 80 of 80 CTA-ID, but not for 6 of 49 (12%) internal control or for 11 of 80 (14%) size-matched control patients. CONCLUSION: The CTA-ID bolus-tracking software alters transition delays to permit diagnostic CTA examinations despite slower injection rate and less iodine.


Assuntos
Abdome , Aorta/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Meios de Contraste , Iodo , Abdome/irrigação sanguínea , Abdome/diagnóstico por imagem , Idoso , Angiografia por Tomografia Computadorizada/métodos , Angiografia por Tomografia Computadorizada/estatística & dados numéricos , Meios de Contraste/administração & dosagem , Meios de Contraste/uso terapêutico , Humanos , Iodo/administração & dosagem , Iodo/uso terapêutico , Masculino , Radiografia Abdominal , Estudos Retrospectivos , Fatores de Tempo
13.
J Pediatr Endocrinol Metab ; 32(5): 489-498, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31042642

RESUMO

Background Females with Turner syndrome (TS) carry an elevated risk of aortic dissection. The objective of the study was to assess the biophysical properties of the aorta and ambulatory blood pressure (BP) in females with TS and compare these findings to those in healthy female age-matched controls. Methods This was a prospective cohort study including subjects aged 8-25 years. Utilizing two-dimensional (2D) echocardiography and Doppler, proximal aortic dimensions were measured and biophysical properties of the aorta were calculated including pulse wave velocity (PWV), arterial pressure-strain elastic modulus and stiffness index. Resting BP was measured and ambulatory blood pressure monitoring (ABPM) was performed. Results Of 23 TS patients and 46 controls (median age 16.3 years), aortic annulus, sinus of Valsalva and sinotubular (ST) junction diameters, as well as left ventricular (LV) mass, were significantly greater in TS patients compared with controls when scaled for height2.7, but not for body surface area (BSA), although ascending aorta diameter was greater when scaled for both. Median PWV was faster in TS patients compared to controls (451 vs. 360 cm/s) while arterial pressure-strain elastic modulus and stiffness index were similar. Resting BP was abnormal in seven out of 22 patients and ABPM was abnormal in 16 out of 21 patients. Conclusions Young patients with TS had dilated proximal aortas when scaled for height2.7 and stiffer aortas when compared with healthy female age-matched controls. Moreover, resting BP underdiagnosed pre-hypertension and hypertension compared to ABPM. These findings are consistent with the presence of a primary aortopathy in TS.


Assuntos
Aorta/patologia , Monitorização Ambulatorial da Pressão Arterial/métodos , Pressão Sanguínea , Medição de Risco/métodos , Síndrome de Turner/fisiopatologia , Rigidez Vascular , Adolescente , Adulto , Aorta/diagnóstico por imagem , Estudos de Casos e Controles , Criança , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Estudos Prospectivos , Adulto Jovem
14.
Pediatr Cardiol ; 40(6): 1134-1143, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31087143

RESUMO

The effect of pregnancy on aortic root in women with repaired conotruncal anomalies (CTA) has not been clarified. This study examined aortic diameters during and after pregnancy in women with repaired CTA. A retrospective review of consecutive pregnant women with repaired CTA was performed for results of echocardiography from 1 year before pregnancy to 3 years after delivery and compared with findings from healthy pregnant volunteers. Participants comprised 42 subjects and 49 deliveries with repaired CTA (CTA group), and 47 healthy pregnant women (control group). Although no maternal aortic events were encountered, aortic diameters during pregnancy increased by 1.0 ± 2.2 mm (maximum, 7.0 mm) in the CTA group and 0.6 ± 1.3 mm (maximum, 3.4 mm) in the control group (p = 0.13). The CTA subgroup with increase in aortic diameter ≥ 3.5 mm during pregnancy showed no reversion to baseline diameter at follow-up > 6 months after delivery. Significant risk factors for increased aortic diameter and no reversal included pulmonary atresia, history of aortopulmonary shunt, older age at repair, and smaller left ventricular end-diastolic diameter pre-pregnancy. Women with repaired CTA tolerated pregnancy and delivery well. However, the aortic root progressively dilated during pregnancy and 1/4 of them, especially those with longstanding high aortic blood flow before repair, showed an increase of aortic root size of ≥ 3.5 mm during the peripartum period; this dilatation tended not to revert to the pre-pregnancy diameter. Therefore, serial measurement of the aortic root during pregnancy and after delivery is recommended in these women.


Assuntos
Aorta/patologia , Valva Aórtica/patologia , Seio Aórtico/patologia , Adulto , Fatores Etários , Aorta/anormalidades , Aorta/diagnóstico por imagem , Valva Aórtica/anormalidades , Valva Aórtica/diagnóstico por imagem , Estudos de Casos e Controles , Angiografia por Tomografia Computadorizada , Parto Obstétrico/efeitos adversos , Dilatação Patológica/etiologia , Ecocardiografia , Feminino , Cardiopatias Congênitas/cirurgia , Humanos , Imagem Tridimensional , Imagem por Ressonância Magnética , Masculino , Gravidez , Atresia Pulmonar/etiologia , Estudos Retrospectivos , Fatores de Risco , Seio Aórtico/diagnóstico por imagem , Fatores de Tempo
15.
Rev Port Cir Cardiotorac Vasc ; 26(1): 19-26, 2019.
Artigo em Português | MEDLINE | ID: mdl-31104372

RESUMO

Aortic mural thrombus is a rare clinical finding in the absence of aneurysm or atherosclerosis but an important source of noncardiogenic emboli with a difficult diagnosis and a high rate of complications, including high mortality. It appears to occur more frequently in young adults usually with underlying pro-thrombotic disorder. With the increasing use of high resolution imaging, the asymptomatic mural thrombus became an increasingly frequent finding, but its potential for embolization or the best treatment are still a matter of debate. The management of mural thrombus in non-atherosclerotic aorta represents a challenge because no guidelines are available, and should be individualized. The therapeutic approach should include the triple aspects of aortic mural thrombus: primary disease anticoagulation treatment, surgical thrombectomy to solve embolic complications and endovascular/classical surgery to exclude the thrombus from the aorta. Historically therapeutic anticoagulation was proposed as first-line therapy and surgical intervention was reserved for mobile thrombus, recurrent embolism and contraindication for anticoagulation. However, it is associated with a 25-50% embolic recurrence rate, thrombus persistence in 35% and secondary aortic surgery in up to 31% of the cases. Recent data suggest that endovascular coverage of the aortic thrombus, when feasible, appears to be an effective and safe procedure with a low recurrence and re-embolization rates. In this article we review the published literature concerning this topic.


Assuntos
Doenças da Aorta/terapia , Trombose/terapia , Anticoagulantes/uso terapêutico , Aorta/diagnóstico por imagem , Aorta/cirurgia , Doenças da Aorta/diagnóstico por imagem , Procedimentos Endovasculares , Humanos , Fatores de Risco , Trombectomia , Trombose/diagnóstico por imagem , Resultado do Tratamento
16.
J Cardiothorac Surg ; 14(1): 87, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046784

RESUMO

BACKGROUND: Iatrogenic aortic dissection is a rare and fatal complication. Its treatment was challenging and controversial especially in patients with previous cardiac procedure. This study aimed to present the case of a patient with aortic dissection after previous open cardiac surgery who was successfully treated by in situ laser fenestration for revascularization of aortic arch. CASE PRESENTATION: A 65-year-old man suffered severe aortic and mitral valve regurgitation was treated by open cardiac aortic valve replacement (biological valve, Edwards) and mitral valve repair. During the sixth-month follow-up, computed tomography angiography (CTA) scan revealed an aortic dissection that extended from the ascending aorta to both femoral arteries. After stabilized by medical treatment, the patient was treated by endovascular stent-graft implantation and in situ laser (holmium laser, energy: 0 5 J, frequency: 5 Hz.) fenestration for revascularization of aortic arch in our one-stop hybrid operating room. The patient recovered without any clinical complication and was discharged 5 days after the procedure. CONCLUSIONS: Our work suggested that in situ laser fenestration for revascularization of aortic arch is a feasible, effective, and safe treatment in patients with iatrogenic aortic dissection.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Doenças das Valvas Cardíacas/cirurgia , Terapia a Laser/métodos , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/etiologia , Aorta/diagnóstico por imagem , Aorta/cirurgia , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/métodos , Humanos , Doença Iatrogênica , Masculino , Resultado do Tratamento
17.
Radiol Clin North Am ; 57(4): 787-794, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31076032

RESUMO

Cardiovascular injuries represent the second most common cause of death among trauma victims in the United States. Motor vehicle collisions account for more than 80% of all blunt thoracic trauma. Given the nonspecific nature and variable severity of presenting symptoms, such as chest pain and shortness of breath, as well as confounding and overlapping clinical presentations in the setting of additional injuries, diagnosis of cardiovascular injuries can be challenging. This article reviews the clinical entities of acute aortic syndrome and pulmonary embolism, their imaging findings, and diagnostic challenges.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Úlcera/diagnóstico por imagem , Ferimentos não Penetrantes/diagnóstico por imagem , Aneurisma Dissecante/complicações , Aorta/diagnóstico por imagem , Aorta/lesões , Angiografia por Tomografia Computadorizada/métodos , Emergências , Hematoma/complicações , Humanos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/lesões , Embolia Pulmonar/complicações , Síndrome , Úlcera/complicações
18.
Int Heart J ; 60(3): 688-694, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31105154

RESUMO

The prevalence and extent of immunoglobulin G4 (IgG4)-positive cell infiltration were investigated in 282 surgical samples of aortic wall and aortic valve. Tissue infiltration of IgG4-positive cells was observed in 24 (17.3%) of 139 aortic valve samples and 46 (32%) of 143 aortic wall samples, and the condition of IgG4-positive cell infiltration > 30/hpf together with IgG4/CD138 ratio > 40% was observed in 2 (1.4%) of aortic valve samples and 14 (9.8%) of aortic wall samples. Among 275 patients, preoperative serum IgG4 level was available in 48 patients (50 samples), and it was > 135 mg/dL in only one patient. Of these 48 patients with serum IgG4 measurement, 29 patients had aortic valve stenosis and 12 had aortic aneurysm. Compared with 23 aortic stenosis patients without tissue infiltration of IgG4-positive cells in the aortic valve, six patients with IgG4-positive cell infiltration had a more prevalent smoking history (26% versus 83%) and borderline significantly higher serum IgG4 (median, 24.5 mg/dL versus 55.5 mg/dL), although either preoperative peak pressure gradient between left ventriculum and aorta or aortic valve area did not differ significantly between groups. Compared with six aortic aneurysm patients without tissue infiltration of IgG4-positive cells in the aortic wall, six patients with IgG4-positive cell infiltration had borderline significantly higher serum IgG4 (median, 28.9 mg/dL versus 68.2 mg/dL). The current study showed that tissue IgG4-positive infiltration is not a rare occurrence in the aortic stenosis and aortic aneurysm. Clinical significance of tissue IgG4-postive cell infiltration in these patients requires further investigation.


Assuntos
Aneurisma Aórtico/imunologia , Estenose da Valva Aórtica/imunologia , Doença Relacionada a Imunoglobulina G4/sangue , Imunoglobulina G/sangue , Plasmócitos/patologia , Idoso , Idoso de 80 Anos ou mais , Aorta/anatomia & histologia , Aorta/citologia , Aorta/diagnóstico por imagem , Aorta/cirurgia , Aneurisma Aórtico/sangue , Aneurisma Aórtico/patologia , Valva Aórtica/citologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/sangue , Estenose da Valva Aórtica/patologia , Ecocardiografia/métodos , Feminino , Humanos , Doença Relacionada a Imunoglobulina G4/imunologia , Doença Relacionada a Imunoglobulina G4/patologia , Masculino , Pessoa de Meia-Idade , Plasmócitos/imunologia , Período Pré-Operatório , Estudos Retrospectivos
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