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1.
Int Heart J ; 62(1): 104-111, 2021 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-33455986

RESUMO

There is scant information about the incidence, risk factors, and outcomes of coronary obstruction (CO) following valve-in-valve transcatheter aortic valve replacement (VIV-TAVR). A meta-analysis of the published studies from January 2000 to April 2020 was conducted, and the endpoint was CO. A total of 2858 patients were enrolled in this study. The mean age was 77.7 ± 9.8, and 39.9% of them were female. The Society of Thoracic Surgeons (STS) score, European System for Cardiac Operative Risk Evaluation (EuroSCORE), and Logistic EuroSCORE were 8.9 ± 7.8, 16.0 ± 10.9, and 26.3 ± 16.3, respectively. The overall incidence of CO was 2.58%. CO incidence between patients with prior stented and stentless valves were significantly different (1.67% versus 7.17%), with an odds ratio (OR) of 0.25 and a 95% confidence interval (CI) of 0.14-0.44 (P < 0.00001). The first-generation valves were significantly associated with higher CO incidence compared with the second-generation valves (7.09% versus 2.03%; OR, 2.44; 95%CI, 1.06-5.62; P = 0.04), while no statistical difference was found between self-expandable valves and balloon-expandable valves (2.45% versus 2.60%; OR, 0.99; 95%CI, 0.55-1.79; P = 0.98). Virtual transcatheter to coronary ostia (VTC) distance (3.3 ± 2.1 mm, n = 29 versus 5.8 ± 2.4 mm, n = 169; mean difference, -2.70; 95%CI, -3.46 to -1.95; P < 0.00001) and the sinus of Valsalva (SOV) diameter (27.5 ± 3.8 mm, n = 23 versus 32.3 ± 4.0 mm, n = 101; mean difference, -3.80; 95%CI, -6.55 to -1.05; P = 0.007) were enormously shorter in patients with CO. The 24-hour, in-hospital, and 30-day mortality of patients with CO were 10.5%, 30.8%, and 37.1%, respectively. In conclusion, device selections, VTC distances, and SOV diameters may be important factors in assessing the CO risk in VIV-TAVR.


Assuntos
Estenose da Valva Aórtica/cirurgia , Oclusão Coronária/epidemiologia , Oclusão Coronária/cirurgia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Bioprótese/efeitos adversos , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/estatística & dados numéricos , Oclusão Coronária/mortalidade , Feminino , Próteses Valvulares Cardíacas/tendências , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Intervenção Coronária Percutânea/métodos , Intervenção Coronária Percutânea/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Desenho de Prótese , Fatores de Risco , Seio Aórtico/diagnóstico por imagem , Stents , Tomografia Computadorizada por Raios X/métodos , Substituição da Valva Aórtica Transcateter/instrumentação
3.
Methodist Debakey Cardiovasc J ; 16(3): e8-e10, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33133369

RESUMO

Sinus of Valsalva aneurysm (SOVA) is an unusual cardiac anomaly that is potentially fatal with rupture. It is often asymptomatic but has various presentations. We describe a case of a 67-year-old male who presented with atypical chest pain. Transthoracic echocardiogram and cardiac computed tomography scan confirmed a large SOVA complicated by thrombus formation and compression of the left atrium and left ventricular outflow tract. The patient successfully underwent a Bentall procedure-surgical aortic aneurysm repair with mechanical aortic valve conduit. We discuss several clinical decision-making branch points to highlight the complexity of managing this condition. Even in asymptomatic or minimally symptomatic patients with SOVA, surgery may be indicated if the aneurysm meets the criteria for size or has thrombus formation or compressive effects.


Assuntos
Aneurisma Aórtico/complicações , Seio Aórtico , Trombose/etiologia , Idoso , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Humanos , Masculino , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/cirurgia , Trombose/diagnóstico por imagem , Trombose/cirurgia , Resultado do Tratamento
4.
Pediatr Cardiol ; 41(6): 1199-1205, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32474735

RESUMO

The aim of this study was to compare the size and geometry of the aorta in patients with 7q11.23 duplication (Dup7) to healthy controls. We retrospectively reviewed all echocardiograms in all patients with Dup7 evaluated at our institutions from June 2017 through September 2019. All standard aortic diameter measurements were made and recorded. Z-scores for the measurements were calculated. For comparison, a set of control echocardiograms was developed by randomly selecting 24 normal echocardiograms in age-matched patients who had undergone echocardiograms for an indication of either chest pain or syncope. In 58 echocardiograms from 21 Dup7 patients, all aortic measurements were increased compared to controls (p < 0.0001). Effacement of the sinotubular junction (STJ) of the aorta was present in all Dup7 patients. Our novel STJ-to-aortic annulus ratio of ≥ 1.15 had a 98.28% sensitivity (95% CI 90.76-99.96) and 100% specificity (95% CI 85.75-100) for distinguishing Dup7 from controls with a positive predictive value of 100% and a negative predictive value of 96.00% (95% CI 77.47-99.41). All patients in our study with Dup7 had echocardiographic evidence of aortopathy. Effacement of the STJ was present in all Dup7 patients. The STJ-to-annulus ratio is a better indicator of aortopathy in Dup7 than the aortic Z-score.


Assuntos
Aorta/patologia , Síndrome de Williams/patologia , Adolescente , Aorta/diagnóstico por imagem , Criança , Pré-Escolar , Ecocardiografia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/patologia , Síndrome de Williams/diagnóstico por imagem
6.
Int J Cardiovasc Imaging ; 36(8): 1533-1542, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32314122

RESUMO

Aortic diameter measurements play a crucial role for the indication of aortic root surgery in Marfan patients. However, for magnetic resonance angiography (MRA)-derived measurements, there is no consensus on whether the aortic wall should be included or excluded in the aortic diameter. The purpose of this retrospective study was to compare the reliability of non-contrast bright blood MRA aortic inner-to-inner and outer-to-outer edge measurements in patients with Marfan syndrome. Forty Marfan patients underwent ECG-gated balanced steady-state free-precession MRA of the aorta at 1.5 T. Two readers independently performed inner and outer measurements at different aortic levels. They rated the image quality of the delineation of both inner and outer vessel wall edges on a four-point scale. MRA-derived diameters of the sinuses of Valsalva were compared with echocardiography-derived diameters. Aortic vessel wall delineation score was rated higher at all levels for inner than for outer vessel walls (p < 0.001). Inter- and intraobserver variances of aortic measurements were smaller for inner-to-inner measurements at the sinuses of Valsalva, sinotubular junction and ascending aorta (p < 0.03). There was a difference of 1.1 ± 2.3 mm for inner MRA measurements (p = 0.014) and 6.9 ± 3.1 mm for outer MRA measurements (p < 0.001) when compared to echocardiographic leading-edge measurements. Inner-to-inner vessel wall diameter measurements in non-contrast bright blood MRA provide more reliable diameters when compared to outer-to-outer vessel wall measurements of the aortic root. Therefore, we propose to rely on inner rather than outer aortic wall measurements in non-contrast-MRA when monitoring aortic diameters in patients with Marfan syndrome.


Assuntos
Aorta/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Angiografia por Ressonância Magnética , Síndrome de Marfan/complicações , Seio Aórtico/diagnóstico por imagem , Adolescente , Adulto , Aorta/fisiopatologia , Aneurisma Aórtico/etiologia , Aneurisma Aórtico/fisiopatologia , Técnicas de Imagem de Sincronização Cardíaca , Dilatação Patológica , Eletrocardiografia , Feminino , Humanos , Masculino , Síndrome de Marfan/diagnóstico , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Seio Aórtico/fisiopatologia , Remodelação Vascular , Adulto Jovem
8.
BMC Cardiovasc Disord ; 20(1): 84, 2020 02 18.
Artigo em Inglês | MEDLINE | ID: mdl-32070284

RESUMO

BACKGROUND: Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly which has potential for spontaneous rupture into other cardiac chambers or the pericardial space (depending on its location). A ruptured SVA has a very poor prognosis with high morbidity and mortality. The development of a shunt between the sinus of Valsalva and right-sided cardiac chambers results in a continuous murmur on examination. Our case report is a case of SVA rupture into the right atrium. CASE PRESENTATION: In this case report, we describe a 23-year-old patient with an acute onset of chest pain, shortness of breath, palpitations and dizziness starting 2 days prior to presentation to the emergency department. The patient was initially treated for presumed pulmonary embolism overnight while awaiting CTPA the next morning. However, further examination by the inpatient medical team demonstrated a continuous machinery cardiac murmur. Subsequent echocardiography demonstrated an acutely ruptured SVA with shunting to the right atrium. Emergency surgical repair resulted in an excellent outcome for the patient. CONCLUSION: A thorough clinical history and physical examination is the cornerstone of all medical encounters. An SVA could be asymptomatic until acute rupture. Echocardiography is the preferred initial diagnostic tool. Additional imaging techniques can be used to confirm the diagnosis. In cases of rupture, prognosis is poor and surgical repair is always required.


Assuntos
Aneurisma Aórtico , Ruptura Aórtica , Átrios do Coração , Seio Aórtico , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/fisiopatologia , Aneurisma Aórtico/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/fisiopatologia , Ruptura Aórtica/cirurgia , Ecocardiografia Doppler em Cores , Ecocardiografia Doppler de Pulso , Ecocardiografia Transesofagiana , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Átrios do Coração/cirurgia , Humanos , Pericárdio/transplante , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/fisiopatologia , Seio Aórtico/cirurgia , Resultado do Tratamento , Adulto Jovem
9.
Intern Med ; 59(4): 533-539, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32062625

RESUMO

An 82-year-old woman was admitted to our hospital with heart failure. Coronary angiography revealed one anatomically normal right coronary artery and three left coronary arteries (LCA-1, LSA-2, and LSA-3) separately originating from the right sinus of Valsalva, comprising multiple atherosclerotic lesions. LCA-1 became the obtuse marginal branch after branching off into the septal branches. LCA-2 was the main circumflex artery with an obstructive lesion. LCA-3 corresponded to the distal part of the anterior descending branch. The patient died 14 days after hospitalization. We describe the rarity of quadriostial origin, the unusual course, and the unusual branching of the coronary arteries.


Assuntos
Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/etiologia , Anomalias dos Vasos Coronários/fisiopatologia , Seio Aórtico/anormalidades , Seio Aórtico/anatomia & histologia , Idoso de 80 Anos ou mais , Anomalias dos Vasos Coronários/mortalidade , Evolução Fatal , Feminino , Humanos , Seio Aórtico/diagnóstico por imagem
11.
Semin Thorac Cardiovasc Surg ; 32(2): 230-241, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31954834

RESUMO

The aortic valvar sinuses are supported, in part, by ventricular myocardium, so-called myocardial crescents. We elucidated individual variation in the extent of the myocardial support. We assessed the extent of the crescents in 84 patients who underwent cardiac computed tomography. We measured their maximal width, their extent within the circumference of the aortic root, and the influence of rotation of the root itself within the ventricular base. The maximal widths, and rotational locations, of the crescents supporting the base of the left coronary aortic sinus were significantly smaller than those supporting the right coronary aortic sinus (2.9 ± 0.8 mm vs 6.4 ± 1.2 mm, P < 0.001; 54.2 ± 12.0° vs 70.4 ± 13.5°, P < 0.001, respectively). Overall, 42.7 ± 4.3% of the circumference of the virtual basal ring was supported by myocardium as opposed to fibrous tissue. Clockwise rotation of the aortic root was correlated with a decrease in the extent of myocardial crescent supporting the left coronary aortic sinus, but an increase in the myocardial support of the right coronary aortic sinus (R2 = 0.3899 and R2 = 0.2752, P < 0.001). Clockwise rotation of the root was correlated in negative fashion with the ratio of its myocardial as opposed to fibrous support (R2 = 0.0527, P = 0.0356). The extent of myocardial support of the left coronary aortic sinus, on average, is less than that of the right coronary aortic sinus. This difference becomes greater when the aortic root is rotated in clockwise fashion.


Assuntos
Valva Aórtica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Cardiopatias/diagnóstico por imagem , Miocárdio/patologia , Seio Aórtico/diagnóstico por imagem , Idoso , Feminino , Cardiopatias/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente , Valor Preditivo dos Testes
12.
World Neurosurg ; 138: 706-713, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31917307

RESUMO

In this paper, 64-slice spiral computed tomography (CT) retrospective electrocardiographic (ECG) gating technology was used to perform coronary CT angiography scans. The aorta and aortic pulmonary artery diameter were measured quantitatively in healthy people and patients with hypertension and cerebrovascular disease. Corresponding aortic pulmonary artery ratios were obtained through calculation, and the changes of aortic diameter, aortic pulmonary artery ratio, and aortic diameter difference between different cardiac phases, ages, sexes, and levels of hypertension were discussed. Through research, it can be concluded that 64-row spiral CT scan combined with ECG gating technology can accurately measure the dynamic changes of the aortic diameter with the cardiac cycle. At the same time, the aortic diameter measured by multidetector CT scan combined with ECG gating technology and the phase difference between different phases can objectively reflect the degree of arterial damage in patients with hypertension; therefore, early screening of aortic diseases in patients with hypertension can be performed. Diagnosis to detect abnormalities as early as possible and start treatment as early as possible to prevent the disease from progressing and even affecting other tissues and organs can also be obtained.


Assuntos
Aorta/diagnóstico por imagem , Técnicas de Imagem de Sincronização Cardíaca/métodos , Angiografia por Tomografia Computadorizada/métodos , Hipertensão/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Tomografia Computadorizada Espiral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta/patologia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Estudos de Casos e Controles , Angiografia Coronária/métodos , Diástole , Eletrocardiografia , Feminino , Humanos , Hipertensão/patologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Tamanho do Órgão , Artéria Pulmonar/patologia , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/patologia , Sístole , Tomografia Computadorizada por Raios X
15.
Clin Anat ; 33(1): 117-123, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31576608

RESUMO

Current knowledge of the aortic root geometric anatomy and its surgical implications remain limited. We analyzed multiple predefined parameters of the aortic root to increase our understanding of the geometric changes that occur in normal and aneurysmal transformations. Between November 2003 and September 2015, the aortic roots of 107 healthy subjects (control group) and 105 annuloaortic ectasia (AAE) patients (AAE group) were analyzed using multiplanar reformatted computed tomographic images. The intercommissural distance (ICD), sinus width (SW), and sinus volume (SV) of the left (LCS), right (RCS), and noncoronary sinuses (NCS) of Valsalva were adopted as study parameters. In the control group, all study parameters of the LCS were smaller than those of the RCS and the NCS. In the AAE group, all parameters of the LCS were significantly smaller than those of the RCS or NCS, but the RCS and NCS parameters were similar. Proportionately less LCS enlargement relative to either the RCS or NCS was observed in root aneurysm(AAE group) than in the control group. We observed a distinct aortic root geometric pattern which was characterized by the LCS being smaller than either the RCS or NCS, while the latter were similar. This geometric configuration was significantly accentuated in AAE patients due to the greater disproportionate disparity in the LCS relative to either the RCS or NCS than in the roots of normal control subjects. Clin. Anat. 32:117-123, 2019. © 2019 Wiley Periodicals, Inc.


Assuntos
Aneurisma da Aorta Torácica/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Seio Aórtico/diagnóstico por imagem , Adulto , Idoso , Valva Aórtica/anatomia & histologia , Estudos de Casos e Controles , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador , Seio Aórtico/anatomia & histologia , Tomografia Computadorizada por Raios X
17.
Pediatr Cardiol ; 41(1): 31-37, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31654096

RESUMO

Neoaortic regurgitation and root dilatation are common findings in patients with transposition after an arterial switch operation. The aim of this study was to describe the relation between neoaortic regurgitation long term after an arterial switch procedure, aortic root diameters, and surgical technique used. We also assessed the agreement of the neoaortic regurgitation grade and root diameters in different imaging modalities. For this retrospective study, we qualified 56 consecutive patients who, according to our institutional protocol, had a routine postoperative evaluation of more than 16 years with multimodality imaging studies. Neoaortic regurgitation was assessed by both transthoracic echocardiography and magnetic resonance imaging, and the root diameters obtained by echocardiography and tomography were compared to the reference values and associated with the presence of neoaortic insufficiency. Neoaortic insufficiency was present in 75% of examined patients; the vast majority of them had trace or mild regurgitation, and its qualitative evaluation was significantly different between echocardiography and magnetic resonance imaging. In our study group, the neoaortic valve and aortic sinus were larger in relation to the normal values, and they were significantly correlated with the presence of neoaortic insufficiency, but not with the surgical technique used. Values obtained by echocardiography and tomography correlated well but were significantly different. Transthoracic echocardiography has a tendency to overestimate the severity of regurgitation compared to magnetic resonance imaging. Neoaortic valve and sinus dilatation are significantly correlated with valve insufficiency, but in most cases of root dilatation, the valve remains competent.


Assuntos
Insuficiência da Valva Aórtica/etiologia , Transposição das Grandes Artérias/efeitos adversos , Transposição dos Grandes Vasos/cirurgia , Adolescente , Adulto , Insuficiência da Valva Aórtica/diagnóstico por imagem , Ecocardiografia , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Período Pós-Operatório , Valores de Referência , Estudos Retrospectivos , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/patologia , Adulto Jovem
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