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1.
Undersea Hyperb Med ; 46(5): 635-646, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31683362

RESUMO

We aimed to assess the effects of intermittent hyperbaric oxygenation (HBO2 at 2 bars for 120 minutes a day for four successive days) on acetylcholine-induced vasorelaxation (AChIR) in female Sprague-Dawley (SD) rats (N=80) that were randomized into four groups: healthy controls (CTR); diabetic rats (DM); and control and diabetic rats that underwent hyperbaric oxygenation (CTR+HBO and DM+HBO), respectively. AChIR was measured in vitro in aortic rings, with/without L-NAME, MS-PPOH, HET0016 or indomethacin. mRNA expression of eNOS, iNOS, COX-1, COX-2, thromboxane A synthase 1 (TBXAS1), CYP4A1, CYP4A3 and CYP2J3 was assessed by qPCR. Systemic oxidative stress and plasma antioxidative capacity were determined with the thiobarbituric acid-reactive substances (TBARS) and the ferric reducing ability of plasma (FRAP) assays, respectively. There was no significant difference in AChIR among experimental groups of rats. In CTR and DM group of rats, AChIR was mediated by NO and EETs pathway, while in the CTR+HBO and DM+HBO groups, NO-pathway prevailed. iNOS expression was upregulated in the DM group compared to CTR, while HBO2 upregulated eNOS in CTR group and TBXAS1 in DM group of rats. In both, CTR and DM group of rats, the sensitivity to ACh in the presence of L-NAME or in the presence of MSPPOH was significantly decreased compared to the response to ACh in the absence or presence of indomethacin or HET0016. DM and DM+HBO rats had increased TBARS compared to their respective controls. In conclusion, HBO2 presumably alters vasorelaxation in response to ACh from NO-EETs mediated pathways to solely NO-pathway, without affecting oxidative status of DM rats.


Assuntos
Acetilcolina/farmacologia , Inibidores das Enzimas do Citocromo P-450/farmacologia , Diabetes Mellitus Experimental/fisiopatologia , Oxigenação Hiperbárica , Vasodilatação/efeitos dos fármacos , Vasodilatadores/farmacologia , Análise de Variância , Animais , Aorta/efeitos dos fármacos , Aorta/fisiopatologia , Glicemia/análise , Peso Corporal , Sistema Enzimático do Citocromo P-450/fisiologia , Primers do DNA , Diabetes Mellitus Experimental/induzido quimicamente , Diabetes Mellitus Tipo 1/induzido quimicamente , Diabetes Mellitus Tipo 1/fisiopatologia , Feminino , Oxigenação Hiperbárica/métodos , Estresse Oxidativo , RNA Mensageiro/metabolismo , Ratos , Ratos Sprague-Dawley , Estreptozocina , Fatores de Tempo , Vasodilatação/fisiologia
3.
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
4.
Braz J Cardiovasc Surg ; 34(4): 451-457, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454199

RESUMO

OBJECTIVE: To evaluate the aortic wall elasticity using the maximal rate of systolic distension (MRSD) and maximal rate of diastolic recoil (MRDR) and their correlation with the aortic size index (ASI). METHODS: Forty-eight patients with thoracic aortic aneurysm were enrolled in this study. A standard magnetic resonance imaging (MRI) protocol was used to calculate MRSD and MRDR. Both MRSD and MRDR were expressed as percentile of maximal area/10-3 sec. ASI (maximal aortic diameter/body surface area) was calculated. A correlation between MRSD, MRDR, ASI, and the patient's age was performed using regression plot. RESULTS: A significant correlation between MRSD (t=-4,36; r2=0.29; P≤0.0001), MRDR (t=3.92; r2=0.25; P=0.0003), and ASI (25±4.33 mm/m2; range 15,48-35,14 mm/m2) is observed. As ASI increases, aortic MRSD and MRDR decrease. Such inverse correlation between MRSD, MRDR, and ASI indicates increased stiffness of the ascending aorta. A significant correlation between the patient's age and the decrease in MRSD and MRDR is observed. CONCLUSION: MRSD and MRDR are significantly correlated with ASI and the patient's age. They seem to describe properly the increasing stiffness of aortas. These two new indexes provide a promising, accessible, and reproducible approach to evaluate the biomechanical property of the aorta.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Aorta/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Imagem por Ressonância Magnética , Adulto , Idoso , Diástole/fisiologia , Dilatação Patológica , Elasticidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sístole/fisiologia
5.
Medicine (Baltimore) ; 98(33): e16802, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415390

RESUMO

Impact of arterial stiffness on aortic morphology has not been well evaluated. We sought to investigate the association of brachial-ankle pulse wave velocity (baPWV) with aortic calcification and tortuosity.A total of 181 patients (65.4 ±â€Š10.4 years, males 59.7%) who underwent computed tomographic angiography and baPWV measurement within 1 month of study entry were retrospectively reviewed. Aortic calcification was quantified by the calcium scoring software system. Aortic tortuosity was defined as the length of the midline in the aorta divided by the length of linear line from the aortic root to the distal end of the thoraco-abdominal aorta. In simple correlation analyses, baPWV was correlated with aortic calcification (r = 0.36, P < .001) and tortuosity (r = 0.16, P = .030). However, these significances disappeared after controlling for confounders in multivariate analyses. Factors showing an independent association with aortic calcification were age (ß = 0.37, P < .001), hypertension (ß = 0.19, P = .003), diabetes mellitus (ß = 0.12, P = .045), smoking (ß = 0.17, P = .016), and estimated glomerular filtration rate (ß = -0.25, P = .002). Factors showing an independent association with aortic tortuosity were age (ß = 0.34, P < .001), body mass index (ß = -0.19, P = .018), and diabetes mellitus (ß = -0.21, P = .003).In conclusion, baPWV reflecting arterial stiffness was not associated with aortic calcification and tortuosity. Traditional cardiovascular risk factors were more influential to aortic geometry. Further studies with a larger sample size are needed to confirm our results.


Assuntos
Aorta/patologia , Artérias/anormalidades , Instabilidade Articular/fisiopatologia , Dermatopatias Genéticas/fisiopatologia , Calcificação Vascular/fisiopatologia , Malformações Vasculares/fisiopatologia , Rigidez Vascular/fisiologia , Idoso , Índice Tornozelo-Braço , Aorta/fisiopatologia , Artérias/patologia , Artérias/fisiopatologia , Índice de Massa Corporal , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Instabilidade Articular/patologia , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Estudos Retrospectivos , Dermatopatias Genéticas/patologia , Calcificação Vascular/patologia , Malformações Vasculares/patologia
6.
Int J Cardiovasc Imaging ; 35(10): 1903-1911, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31209684

RESUMO

Familial hypercholesterolemia (FH) is an autosomal dominant disorder that affects 1 in 250 people. Aortic stiffness, measured by pulse wave velocity (PWV), is an independent predictor for cardiovascular events. Young FH patients are a unique group with early vessel wall disease that may serve to elucidate the determinants of aortic stiffness. We hypothesized that young FH patients would have early changes in aortic stiffness compared to healthy, age- and sex-matched reference values. Thirty-three FH patients ( ≥ 7 years age; mean age 14.6 ± 3.3 years; 26/33 on statin therapy) underwent cardiac MRI. PWV was determined using propagation of flow waveform from aortic arch phase contrast images. Distensibility and aortic wall thickness (AWT) were measured at the ascending, proximal descending, and diaphragmatic aorta. Ventricular volumes and left ventricular (LV) myocardial mass were measured from 2D cine images. These parameters were compared to age- and sex-matched reference values. FH patients had significantly higher PWV (4.5 ± 0.8 vs. 3.5 ± 0.3 m/s; p < 0.001), aortic distensibility, and ascending aortic wall thickness (1.37 ± 0.18 vs. 1.30 ± 0.02 mm; p < 0.05) compared to reference. There was no difference in aortic area or descending aortic wall thickness between groups. Young FH patients had aortic changes with increased aortic pulse wave velocity in the setting of increased aortic distensibility, accompanied by increased thickness of the ascending aortic wall. Presence of these early findings in young patients despite the majority being on statin therapy support enhanced screening and aggressive treatment of familial hypercholesterolemia to prevent potential future cardiovascular events.


Assuntos
Aorta/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Aterosclerose/diagnóstico por imagem , Hiperlipoproteinemia Tipo II/complicações , Imagem Cinética por Ressonância Magnética , Análise de Onda de Pulso , Rigidez Vascular , Adolescente , Fatores Etários , Aorta/fisiopatologia , Doenças da Aorta/etiologia , Doenças da Aorta/fisiopatologia , Doenças da Aorta/prevenção & controle , Aterosclerose/etiologia , Aterosclerose/fisiopatologia , Aterosclerose/prevenção & controle , Estudos de Casos e Controles , Criança , Estudos Transversais , Progressão da Doença , Feminino , Predisposição Genética para Doença , Heterozigoto , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hiperlipoproteinemia Tipo II/diagnóstico , Hiperlipoproteinemia Tipo II/tratamento farmacológico , Hiperlipoproteinemia Tipo II/genética , Masculino , Fenótipo , Placa Aterosclerótica , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Remodelação Vascular
7.
Angiology ; 70(10): 929-937, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31234636

RESUMO

The morphology and function of the arteries can be directly measured using different established methods. This prospective cohort study aimed to translate 2 of these, aortic pulse wave velocity (aPWV) and carotid intima-media thickness (cIMT), into a combined Vascular Aging Index (VAI) and then evaluate the predictive power of aPWV, cIMT, and VAI. Patients (n = 2718) were included from the cardiovascular arm of the Malmö Diet and Cancer Study (median age 71.9 years, 62.2% females). Total follow-up time was 16 448 person-years and a composite cardiovascular disease (CVD) end point was used. Cox regressions yielded adjusted hazard ratios (95% confidence interval) per 1 standard deviation increment of loge aPWV, loge cIMT, and loge VAI of 1.25 (1.08-1.45, P = .003), 1.27 (1.13-1.44, P < .001), and 1.45 (1.26-1.68, P < .001), respectively. The C-statistics increased from 0.714 to 0.734 when adding aPWV and cIMT to a model of conventional risk factors. Net Reclassification Index also showed a significant (P < .001) improvement for the classification of event-free patients and no change for patients with events. A VAI based on aPWV and cIMT had a good predictive performance. Used together, aPWV and cIMT incrementally and significantly improve the prediction of CVD events by correctly down-adjusting the predicted risk for noncases.


Assuntos
Envelhecimento , Aorta/fisiopatologia , Doenças Cardiovasculares/mortalidade , Espessura Intima-Media Carotídea/mortalidade , Idoso , Doenças Cardiovasculares/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Análise de Onda de Pulso/métodos , Fatores de Risco , População Urbana/estatística & dados numéricos
8.
Dtsch Med Wochenschr ; 144(11): 734-738, 2019 06.
Artigo em Alemão | MEDLINE | ID: mdl-31163471

RESUMO

There is growing understanding to recognize the aorta as complex system and treat aortic diseases in an integrated fashion.The indication for interventional aortic valve replacement (TAVR) comprises patients with moderate and high perioperative risk and symptomatic, high grade aortic valve stenosis. In contrast "low risk" patients receive conventional therapy. Ongoing randomised trials analyse the expansion of indication towards low risk patients for interventional approaches. A final rating is owing, but first data support the assumption that both therapeutic options may be equivalent. Moreover, the interventional therapy of low flow, low gradient aortic valve stenosis has been revalued and interventional valve-in-valve therapy has been integrated into clinical routine as invidualised decision of the heart team.Aortic diseases include several entities which require specialised diagnostic and therapeutic tools. Studies to evaluate evidence of follow up options need to be performed in future to enable for surveillance tailored to suit medical need.


Assuntos
Doenças da Aorta , Estenose da Valva Aórtica , Aorta/fisiopatologia , Doenças da Aorta/diagnóstico , Doenças da Aorta/fisiopatologia , Doenças da Aorta/terapia , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/terapia , Humanos
9.
Zhonghua Wai Ke Za Zhi ; 57(6): 471-475, 2019 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-31142073

RESUMO

Aortic dissection is a urgent and dangerous disease, and the endovascular treatments can cure it in an effective and efficient way. As an important indicator of aorta remodeling, false lumen thrombosis is related to the prognosis of aortic dissection after endovascular treatment. The relationships among false lumen thrombosis after endovascular treatment and prognosis of aortic dissection, and the clinical techniques that can promote the false lumen thrombosis are reviewed in this paper. The aim is to promote a comprehensive evaluation of aorta remodeling.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Trombose/fisiopatologia , Remodelação Vascular/fisiologia , Aneurisma Dissecante/fisiopatologia , Aorta/fisiopatologia , Aneurisma Aórtico/fisiopatologia , Humanos , Estudos Retrospectivos , Trombose/etiologia , Resultado do Tratamento
10.
Int J Cardiovasc Imaging ; 35(10): 1925-1934, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31144256

RESUMO

Bicuspid aortic valve (BAV) is associated with abnormal valve-mediated hemodynamics including high velocity jets and elevated wall shear stress (WSS). This study investigated interval changes in flow and WSS in a multi-year follow-up study. This cross-sectional study included n = 44 patients with BAV (age = 44.9 ± 12 years), n = 17 patients with tricuspid aortic valve and thoracic aortic dilatation (TAV with dilation, age = 54.6 ± 16.5 years), and n = 9 healthy controls (age = 49.3 ± 14.7 years) underwent baseline and serial aortic 4D flow MRI (follow-up duration: BAV: 2.6 ± 0.7 years, TAV with dilation: 2.7 ± 0.5 years, controls: 1.1 ± 0.5 years). Data analysis included quantification of aortic dimensions, peak systolic velocities, as well as regional 3D WSS in the ascending aorta. At baseline, BAV patients demonstrated uniformly elevated peak velocity and WSS compared to TAV with dilation and control groups (peak velocity 2.2 m/s vs. 1.6 m/s vs. 1.5 m/s, p < 0.004; WSS: 0.74 Pa vs. 0.45 Pa vs. 0.55 Pa, p < 0.001). For BAV, peak velocity increased from baseline to follow up (2.2 ± 0.8 to 2.3 ± 0.9 m/s, p < 0.001) while WSS decreased (0.74 ± 0.22 to 0.65 ± 0.21 Pa, p < 0.001). Aortic growth was minimal for both BAV (0.05 cm/year) and TAV with dilation (0.03-0.04 cm/year) patients. For BAV patients, increase of ascending aorta peak velocities indicated worsening of valve function at follow-up. Compared to TAV with dilation patients, BAV patients demonstrated a reduction in WSS which may indicate a compensatory mechanism to reduce elevated WSS forces by aortic remodeling.


Assuntos
Aorta/diagnóstico por imagem , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/diagnóstico por imagem , Hemodinâmica , Angiografia por Ressonância Magnética , Imagem Cinética por Ressonância Magnética , Adulto , Idoso , Aorta/fisiopatologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Velocidade do Fluxo Sanguíneo , Estudos Transversais , Dilatação Patológica , Progressão da Doença , Feminino , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Estresse Mecânico , Fatores de Tempo , Remodelação Vascular
11.
J Card Surg ; 34(5): 337-347, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30932260

RESUMO

OBJECTIVES: It is difficult to predict the evolution of uncomplicated type B intramural hematoma (IMHB) with a focal intimal disruption (FID) in the acute phase. The aims of this study were to investigate the predictors of FIDs and summarize the risk factors for the evolution of uncomplicated IMHB in the acute phase. METHODS: Eighty-six patients with uncomplicated IMHB were included and were divided according to the development of an FID during the acute phase: the FID group (n = 32) and the no-FID group (n = 54). Geometric measurements and computed fluid dynamic calculations were based on a computed tomography scan performed on admission. Multivariate logistic regression analysis was used to estimate the predictors of FID development. RESULTS: Thirty-two (37%) patients developed an FID. Patients with an FID had higher C-reactive protein levels (18.6 ± 2.3 vs 8.1 ± 0.2 mg/dL, P < 0.001) and white blood cell counts (10.3 ± 2.1 vs 7.5 ± 1.7 109 /L, P < 0.001). The no-FID group had lower occurrences of disease progression (15% vs 64%, P < 0.001) and aorta-related mortality (6% vs 25%, P = 0.016). Multivariate logistic regression analysis indicated a significant risk for the occurrence of an FID with a larger maximum aortic diameter (OR, 1.35; 95% CI, 1.05-1.73, P = 0.020), thicker hematoma (OR, 2.20; 95% CI, 1.40-3.48, P = 0.001), and higher oscillatory shear index (per 0.01 unit, OR, 1.74; 95% CI, 1.21-2.49, P = 0.003). The aorta-related mortality during the acute phase was 25% (n = 8). CONCLUSIONS: Certain aortic conditions, including ta larger aortic diameter, thicker hematoma and higher oscillatory shear stress, are associated with the FID development and result in worse clinical outcomes.


Assuntos
Reação de Fase Aguda , Aorta/patologia , Aorta/fisiopatologia , Hematoma/patologia , Hematoma/fisiopatologia , Hemodinâmica , Idoso , Aorta Torácica , Feminino , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
12.
Oxid Med Cell Longev ; 2019: 4628962, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30944692

RESUMO

Oxidative stress plays a crucial role in the pathogenesis of diabetic vascular complications. It is known that the accumulation of advanced glycation end products (AGEs) and the activation of the receptor of AGEs (RAGE) induce sustained oxidative stress in the vascular tissue. Growing evidence indicates that glycine, the simplest amino acid, exerts antioxidant and antiglycation effects and also improves vascular function. However, the mechanism whereby glycine protects vascular tissue against oxidative stress in models with diabetes has not been investigated. In the present study, we evaluated whether glycine can attenuate oxidative stress by suppressing the AGE/RAGE signaling pathway in the aorta of streptozotocin-induced diabetic rats and in human umbilical vascular endothelial cells (HUVECs). Our results showed that oral glycine administration increased NO content and ameliorated oxidative stress in the serum and aorta of diabetic rats. The AGE/RAGE signaling pathway in the aorta of diabetic rats was significantly attenuated by glycine treatment as manifested by decreases in levels of AGEs, RAGE, Nox4, and NF-κB p65. The suppressive effect of glycine on the formation of AGEs was associated with increased activity and expression of aortic glyoxalase-1 (Glo1), a crucial enzyme that degrades methylglyoxal (MG), the major precursor of AGEs. In MG-treated HUVECs, glycine restored the function of Glo1, suppressed the AGE/RAGE signaling pathway, and inhibited the generation of reactive oxygen species. In addition, the reduction in the formation of AGEs in HUVECs caused by glycine treatment was inhibited by Glo1 inhibition. Taken together, our study provides evidence that glycine might inhibit the AGE/RAGE pathway and subsequent oxidative stress by improving Glo1 function, thus protecting against diabetic macrovascular complications.


Assuntos
Aorta/fisiopatologia , Produtos Finais de Glicação Avançada/metabolismo , Glicina/uso terapêutico , Lactoilglutationa Liase/genética , Animais , Glicina/farmacologia , Humanos , Masculino , Estresse Oxidativo , Ratos , Transdução de Sinais
13.
Cardiovasc Pathol ; 41: 29-37, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31029755

RESUMO

BACKGROUND: A bicuspid aortic valve (BAV) is the most common congenital cardiac malformation and is associated with ascending aortic dilation in 60%-80% of patients. In this study, we aimed to address the role of hemodynamic influences on the development of aortopathy in BAV patients. PATIENT AND METHODS: BAV (n=36) and tricuspid aortic valve (TAV) patients (n=17) undergoing aortic valve replacement underwent preoperative flow magnetic resonance imaging (MRI) assessment to detect the area of maximal flow-induced stress in the proximal aorta. Based on these MRI data, paired ascending aortic wall samples [i.e., area of maximal jet impact (jet sample) and the opposite aortic wall (nonjet sample)] were collected during surgery. To study and describe the effects of jet stream on the complete vascular wall, a pathology score was developed based on the recently published aortic consensus paper statement on surgical pathology of the aorta using routine histologic stainings (resorcin fuchsin, hematoxylin-eosin, and Movat) and immunohistochemistry (alpha smooth muscle actin, smooth muscle 22 alpha, platelet endothelial cell adhesion molecule). RESULTS: Comparing the jet and nonjet samples in both BAV and TAV, regions of maximal jet impact did not show any difference in the pathology score in the adventitia and the middle and outer media. In the jet samples, the inner media however showed loss of actin expression in both BAV (P<.0001) and the TAV (P=.0074), and the intimal thickness was significantly enlarged in both patient groups (BAV P=.0005, TAV P=.0041), which was not accompanied by loss of elastic lamellae or vascular smooth muscle cell nuclei. CONCLUSIONS: In our study population, we could not demonstrate a potential distinct role for hemodynamics in the development of aortopathy in BAV patients even if corrected for aortic diameter, raphe position, or whether the valve is stenotic or regurgitant. The intimal layer and inner media however showed alterations in all jet specimens.


Assuntos
Aorta/fisiopatologia , Aneurisma Aórtico/fisiopatologia , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/fisiopatologia , Hemodinâmica , Actinas/análise , Idoso , Aorta/química , Aorta/diagnóstico por imagem , Aorta/patologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/etiologia , Aneurisma Aórtico/metabolismo , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/etiologia , Estenose da Valva Aórtica/fisiopatologia , Dilatação Patológica , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Imuno-Histoquímica , Imagem por Ressonância Magnética , Masculino , Proteínas dos Microfilamentos/análise , Pessoa de Meia-Idade , Proteínas Musculares/análise , Molécula-1 de Adesão Celular Endotelial a Plaquetas/análise
14.
J Vasc Surg ; 69(5): 1538-1544, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31010518

RESUMO

OBJECTIVE: This study aimed to examine the relationship between dynamic changes in aortic diameter and corresponding measurement methods. METHODS: Consecutive adult (nonaneurysmal) patients being surgically treated for heart disease (mean age, 51 ± 11 years; range, 29-76 years; N = 25) were included in this study. All patients underwent transthoracic echocardiography (TTE), computed tomography angiography (CTA), and intraoperative ultrasound (IOUS). Anteroposterior diameters were measured at 1 cm above the junction of the aortic sinus, the proximal 1 cm of the innominate artery, and the midpoint of the two. RESULTS: The average diameter of the proximal ascending aorta in systole/diastole measured by IOUS was 32.07 ± 2.03/30.27 ± 2.05 mm (paired t-test: difference, 1.80 ± 0.46 mm; P < .001). The average diameters of the proximal ascending aorta measured by nonelectrocardiography-gated CTA and TTE were 31.45 ± 1.97 mm and 29.7 ± 1.84 mm, respectively. The average diameter of the mid and distal ascending aorta in systole/diastole measured by IOUS was 32.35 ± 1.95/30.57 ± 1.94 mm (paired t-test: difference, 1.78 ± 0.44 mm; P < .001) and 32.32 ± 1.92/30.67 ± 1.90 mm (paired t-test: difference, 1.65 ± 0.42 mm; P < .001), respectively. The average diameter of the mid and distal ascending aorta measured by CTA was 31.74 ± 1.92 mm and 31.59 ± 1.96 mm, respectively. At each location, the difference in the aortic diameter between systole and diastole was statistically significant (all P values <.001; paired t-test). The minimum and maximum changes in the diameter between systole and diastole were 0.90 mm and 2.70 mm. In all, 96% (24/25) of the average diameters derived from IOUS and CTA at the three locations were within the concordance limit in systole, and 92% to 100% (23/25 to 25/25) were within the concordance limit in diastole. The average diameters derived from IOUS and TTE images of the proximal ascending aorta were within the bounds of the concordance limit 92% (23/25) of the time in systole and 100% (25/25) of the time in diastole. The average diameters derived from CTA and TTE images of the proximal ascending aorta were within the bounds of the concordance limit 88% (22/25) of the time. Pearson correlation coefficients between these groups ranged from 0.905 to 0.982 (all P values <.01). CONCLUSIONS: The ascending aorta diameters measured by nonelectrocardiography-gated CTA and TTE were consistent with the IOUS measurements.


Assuntos
Aorta/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Ecocardiografia , Cardiopatias/diagnóstico por imagem , Hemodinâmica , Tomografia Computadorizada Multidetectores , Ultrassonografia de Intervenção , Adulto , Idoso , Pontos de Referência Anatômicos , Aorta/fisiopatologia , Técnicas de Imagem de Sincronização Cardíaca , Feminino , Cardiopatias/fisiopatologia , Cardiopatias/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo
15.
Biomed Mater Eng ; 30(3): 255-266, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30988235

RESUMO

BACKGROUND: Marfan syndrome (MFS) is a genetic disorder of the connective tissue. It most prominently influences the skeletal, cardiovascular, and ocular systems, but all fibrous connective tissue throughout the body can be affected as well. OBJECTIVE: This study aims to investigate a realistic three-dimensional model of an aorta of a specific patient suffering from MFS by considering elastic and hyperelastic materials for the tissue using fluid-structure interaction (FSI). METHODS: Isotropic linear elastic and Mooney-Rivlin hyperelastic assumptions are implemented. Linear and nonlinear mechanical properties of the aneurysmal MFS aortic tissue are derived from an uniaxial experimental test. RESULTS: Vortex generation in the vicinity of the aneurysm region in both elastic and hyperelastic models and the maximum blood velocity at peak flow time is calculated as 0.517 and 0.533 m/s for the two materials, respectively. The blood pressure is not significantly different between the two models (±8 Pa) and the blood pressure difference between the points in the horizontal plane of the aneurysm region is obtained as ±10 Pa for both models. The maximum von Mises stress for the hyperelastic model (2.19 MPa) is 27% more than the elastic one (1.72 MPa) and takes place at the inner curvature and upper part of the aorta and somehow far from the aneurysm region. The wall shear stress (WSS) is also considered for the elastic and hyperelastic assumptions, which is 36.7 Pa for both elastic and hyperelastic models. CONCLUSION: The aneurysm region in the MFS affects the blood flow and causes the vortex to be generated which consequently affects the blood flow in the downstream by adding some perturbations to the blood flow. The WSS is obtained to be lower in the aneurysm region compared to other regions which indicated vascular remodeling.


Assuntos
Aorta/fisiopatologia , Síndrome de Marfan/fisiopatologia , Aorta/patologia , Velocidade do Fluxo Sanguíneo , Pressão Sanguínea , Simulação por Computador , Elasticidade , Hemodinâmica , Humanos , Síndrome de Marfan/patologia , Modelos Anatômicos , Modelos Cardiovasculares
16.
Transfusion ; 59(S2): 1568-1577, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30980740

RESUMO

BACKGROUND: We set out to define the impact of collection, processing, and storage on plasma product microparticle (MP) abundance, potential for nitric oxide (NO) scavenging, and vasoactivity. STUDY DESIGN AND METHODS: Three currently US licensed products were tested: liquid plasma (LP), fresh frozen plasma (FFP), and solvent detergent plasma (SDP), along with a product under development, spray-dried solvent detergent plasma (SD-SDP) with/without beads. Vasoactivity was assessed in vitro using rabbit aortic vascular rings; MP abundance was determined by flow cytometry; and NO scavenging capacity/rate was determined using a biochemical NO consumption assay. All samples were analyzed unprocessed and following centrifugation at two speeds (2,500× g to remove platelets, and 25,000× g to remove microparticles). RESULTS: Significant differences in vasoactivity were observed, with SD-SDP minus beads demonstrating the greatest constriction and FFP the lowest constriction response. All products exhibited the same total NO scavenging capacity; however, significant differences were observed in the maximal rate of scavenging, with SD-SDP minus beads and FFP reacting fastest and SDP the slowest. Across all products, platelet and microparticle depletion had no effect on vasoactivity or NO scavenging (total or rate). Microparticles (RBC derived) were found only in FFP and LP, with relative abundance (LP > FFP). Additionally, storage had no effect on total or RBC-derived MP abundance, NO scavenging, or vasoactivity. CONCLUSION: Although vasoactivity differed between plasma products, we did not find similar differences in either total or RBC-derived MP abundance or NO scavenging capacity/rate.


Assuntos
Aorta/metabolismo , Preservação de Sangue , Micropartículas Derivadas de Células/química , Eritrócitos/química , Depuradores de Radicais Livres , Plasma/química , Vasoconstritores , Animais , Aorta/fisiopatologia , Depuradores de Radicais Livres/química , Depuradores de Radicais Livres/farmacologia , Humanos , Óxido Nítrico/metabolismo , Coelhos , Vasoconstritores/química , Vasoconstritores/farmacologia
18.
Dtsch Med Wochenschr ; 144(7): 484-488, 2019 04.
Artigo em Alemão | MEDLINE | ID: mdl-30925605

RESUMO

HISTORY AND CLINICAL FINDINGS: A 75-year-old woman was admitted to our institution for acute abdominal pain. She had a history of atrial fibrillation, pacemaker implantation and diastolic heart failure. At time of admission, she was under oral anticoagulation therapy with apixaban. EXAMINATIONS AND DIAGNOSIS: The X-ray of the chest showed a reduction in transparency surrounding the calcification of the aortic arch. CT angiography revealed evidence of an intramural hematoma of the aorta ranging from the left subclavian artery to the inferior mesenteric artery with presence of localized ulcer-like projections. THERAPY AND COURSE: Since the IMH was limited to the descending aorta, we first chose a conservative strategy with tight blood pressure control. Unfortunately, the patients' clinical symptoms did not improve. Her pain persisted despite medical treatment. After joint discussion with surgery and radiology, an endovascular aortic repair was successfully performed. The patient recovered well and could be discharged from the hospital. CONCLUSIONS: Acute aortic syndrome describes a life-threatening condition, including acute aortic dissection, intramural hematoma, and penetrating atherosclerotic aortic ulcer. Rapid and correct diagnosis is imperative for adequate management. Once the definitive diagnosis of an aortic syndrome is made, prompt and appropriate therapeutic interventions should be undertaken. Urgent surgery for acute aortic syndromes involving the ascending aorta (Stanford Type A) and medical therapy alone for uncomplicated cases involving the descending aorta (Stanford Type B) are typically recommended. In complicated Stanford Type B situations, endovascular aortic repair (TEVAR) should be considered.


Assuntos
Aorta , Doenças da Aorta , Hematoma , Idoso , Aorta/diagnóstico por imagem , Aorta/fisiopatologia , Aorta/cirurgia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Doenças da Aorta/cirurgia , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares , Feminino , Hematoma/diagnóstico por imagem , Hematoma/fisiopatologia , Hematoma/cirurgia , Humanos
20.
Biomed Pharmacother ; 113: 108667, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30852419

RESUMO

OBJECTIVE: Glucagon-like peptide-1 (GLP-1) showed protective effects on endothelium-dependent dilatation. Since endothelial barrier dysfunction also plays a pivotal role in atherosclerosis, this study was designed to investigate the effects of GLP-1 on endothelial barrier function in diabetic aortic endothelium and explore the underlying mechanism. METHODS: For in vivo studies, diabetic rats were established and subjected to 12- and 24-week treatment of exenatide. The morphological changes of aortic endothelium were observed with transmission electron microscope. A permeability assay of aortic endothelium was performed using the surface biotinylation technique. Protein expression was detected by immunohistochemical analysis and Western blots. For in vitro studies, human umbilical vein endothelial cells (HUVECs) were cultured in medium enriched with advanced glycation end products (AGEs) or AGEs plus GLP-1 and other reagents. The integrity of endothelium was evaluated by endothelial monolayer permeability assay and transendothelial resistance. The in vitro expressions of relevant proteins in signaling pathways were also detected by immunofluorescence and Western blots. RESULTS: In vivo, the enhanced aortic endothelial permeability in diabetic aortas were attenuated by exenatide treatment. Additionally, myosin light chain (MLC) phosphorylation, related to actomyosin contractility, and activation of its upstream targets in diabetic aorta were inhibited after administration of exenatide. In vitro, the endothelial monolayer permeability and the assembly of stress fibers were reduced by GLP-1 intervention under diabetic condition. Meanwhile, AGE-induced MLC phosphorylation mediating ECs contractility was inhibited by GLP-1. Furthermore, GLP-1 down-regulated the upstream targets of MLC phosphorylation, including RAGE, Rho/ROCK and MAPK signaling pathways. Intriguingly, the effects of GLP-1 elicited on ECs contractility and barrier function in diabetes were blunted by inhibition of GLP-1R, cAMP or PKA and stimulation of Rho/ROCK and MAPK signaling pathways. CONCLUSION: The findings of this study suggest that the stabilizing effect of GLP-1 on the endothelial barrier and contraction of AGE-treated ECs is caused by GLP-1R/cAMP/PKA activation and the subsequent inactivation of RAGE/Rho/ROCK as well as MAPK signaling pathways.


Assuntos
Proteínas Quinases Dependentes de AMP Cíclico/metabolismo , AMP Cíclico/metabolismo , Diabetes Mellitus Experimental/fisiopatologia , Endotélio Vascular/fisiopatologia , Peptídeo 1 Semelhante ao Glucagon/metabolismo , Animais , Aorta/efeitos dos fármacos , Aorta/fisiopatologia , Células Cultivadas , Diabetes Mellitus Experimental/tratamento farmacológico , Diabetes Mellitus Experimental/metabolismo , Regulação para Baixo , Endotélio Vascular/efeitos dos fármacos , Exenatida/farmacologia , Células Endoteliais da Veia Umbilical Humana/efeitos dos fármacos , Células Endoteliais da Veia Umbilical Humana/metabolismo , Humanos , Hipoglicemiantes/farmacologia , Masculino , Cadeias Leves de Miosina/metabolismo , Permeabilidade , Fosforilação , Ratos Sprague-Dawley
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