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1.
Int J Cardiovasc Imaging ; 36(2): 357-366, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31686278

RESUMO

The purpose of this study was to assess by multislice computed tomography (MSCT) imaging geometry of the ascending aorta, the aortic root, the aortic annulus and the left ventricle outflow tract (LVOT) in aortic stenosis (AS) patients, to compare aortic root morphology in patients with AS with healthy controls and to evaluate sex differences. Fifty patients with severe AS and 50 age- and gender-matched controls who underwent MSCT were included in the study. The dimensions of the LVOT, the aortic annulus, the aortic root, the ascending aorta, and the volume of the aortic root were retrospectively assessed and a comparison was made between patients with severe tricuspid AS and controls. Patients with tricuspid AS in comparison with controls had smaller dimensions of the sinus of Valsalva resulting in reduction of the aortic root volume, whereas the dimensions of the other structures were comparable. MSCT revealed larger annular, LVOT and the sinus of Valsalva dimensions and the aortic root volume in men than women. Men with AS differed from healthy men only in regard to the dimensions of the sinus of Valsalva, while women showed significant differences also in the LVOT, and the aortic annulus. MSCT showed accurately aortic root remodeling in tricuspid AS patients and indentified sex-dependent differences. Women with tricuspid AS differ from healthy women more than men did. A high degree of the variability in the aortic root dimensions requires further careful research.


Assuntos
Aorta/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Cardiopatias Congênitas/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Idoso , Idoso de 80 Anos ou mais , Aorta/fisiopatologia , Valva Aórtica/anormalidades , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/etiologia , Estenose da Valva Aórtica/fisiopatologia , Feminino , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/fisiopatologia , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/fisiopatologia
2.
Medicine (Baltimore) ; 98(48): e18169, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770266

RESUMO

INTRODUCTION: Sinus of Valsalva aneurysm (SVA) protruding into the mitral anterior leaflet is an extremely rare clinical condition; herein, we present a case of unruptured noncoronary SVA protruding into the mitral anterior leaflet. PATIENT'S CONCERNS: A 46-year-old male was referred to hospital for exertional dyspnea. DIAGNOSIS: Transthoracic echocardiography (TTE) and coronary computed tomography angiography (CTA) suggested a noncoronary SVA protruding into the mitral anterior leaflet, causing mitral regurgitation and aortic insufficiency. INTERVENTIONS: The aneurysm was resected and the aortic and mitral valves were replaced with mechanical valves via a transaortic approach. OUTCOMES: Postoperative recovery was uneventful. CONCLUSIONS: A rare noncoronary SVA protruding into the mitral anterior leaflet can be diagnosed via TTE and CTA. Transaortic mitral surgery is feasible in patients with a dilated aortic annulus ring and mitral valve diseases.


Assuntos
Aneurisma Aórtico , Insuficiência da Valva Aórtica , Dispneia , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral , Valva Mitral , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/fisiopatologia , Aneurisma Aórtico/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Dispneia/diagnóstico , Dispneia/etiologia , Dispneia/fisiopatologia , Ecocardiografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/fisiopatologia , Resultado do Tratamento
3.
Arch Cardiovasc Dis ; 112(5): 305-313, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30772270

RESUMO

BACKGROUND: Aortopathy is common in patients with bicuspid aortic valve (BAV). AIM: To evaluate the fate of unreplaced Valsalva sinuses in patients with BAV, 10 years after aortic valve replacement (AVR) with or without replacement of the ascending aorta (RAA). METHODS: We retrospectively reviewed all surgical patients with BAV who were operated on between January 2005 and December 2007. Patients who underwent AVR with or without RAA were included. Surgical data were entered prospectively. Ten-year clinical and echocardiographic follow-up data as well as survival data were collected by contacting the patients and their personal cardiologists, and by consulting the French national mortality registry. Overall, 25% of the patients had computed tomography angiographic assessment of the aortic root at follow-up. RESULTS: A total of 133 patients with BAV were operated on within the selected period. Thirty-two patients did not meet the inclusion criteria, and had primary Valsalva sinus surgery. Twenty-four patients underwent AVR with RAA and 77 patients had isolated AVR; all of these 101 patients were included in the study. The median follow-up was 9 years (up to 12 years). During follow-up, eight patients (7.9%) underwent late reoperation; two of them (2.0%) required root surgery. Ten-year freedom from reoperation was 86.2±4.7%. Ten-year freedom from dilatation of the Valsalva sinuses (>45mm) was 86.6±5.2%. Ten-year cumulative survival was 83.5±4%. CONCLUSIONS: Ascending aorta and Valsalva sinuses seem to have different fates after AVR in BAV disease. When the Valsalva sinuses are not dilated at the initial surgery, the risk of secondary dilatation at 10 years is low. Preservation of the sinuses is therefore justified in patients with BAV with a non-dilated root. In BAV with isolated aortic insufficiency, a more aggressive approach may be justified, especially in young patients.


Assuntos
Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Seio Aórtico , Adulto , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Dilatação Patológica , Feminino , Seguimentos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Reoperação , Estudos Retrospectivos , Fatores de Risco , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/fisiopatologia , Seio Aórtico/cirurgia , Fatores de Tempo , Remodelação Vascular
4.
Ann Biomed Eng ; 47(4): 1116-1128, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30710186

RESUMO

Several studies have shown the variation of aortic sinus structures' hemodynamics with different flow and geometric characteristics. They have also correlated aortic sinus hemodynamics with the progression and evolution of calcific aortic valve disease (CAVD). This study aims at visualizing aortic sinus fluid structure variations as functions of different leaflet calcification degrees and assessing their potential relationship with CAVD. A degenerated 23 mm Carpentier-Edwards Perimount Magna valve extracted from a redo-surgery patient was implanted in an aortic root model and tested in a pulse duplicator left heart simulator. The valve has 3 leaflets with 3 different levels of calcium distribution: mild, moderate and severe. High-speed imaging and particle image velocimetry were performed to assess sinus vortices, leaflet tip position and velocity along with shear stress. Results have shown that (a) aortic sinus vortices initiation, entrapment and evolution varied with different calcified leaflet exposure; (b) higher velocities in the sinus were calculated with the mildly calcified leaflet compared to the moderately and severely calcified ones; (c) during systole, the mildly calcified leaflet sinus case shows the most spread-out and higher ranges of shear stress probabilities and highest magnitudes going from (- 1.5 to + 1.8 Pa) compared with (- 1.0 to + 1.0 Pa) for moderately and severely calcified leaflets. The higher the calcification degree the lower the shear stress range and likelihoods of having higher shear stress. This holds in diastole as well. This study shows the impact of calcification on the aortic sinus flow structures.


Assuntos
Estenose da Valva Aórtica/fisiopatologia , Valva Aórtica/patologia , Calcinose/fisiopatologia , Simulação por Computador , Modelos Cardiovasculares , Seio Aórtico/fisiopatologia , Estresse Mecânico , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Humanos , Seio Aórtico/diagnóstico por imagem
5.
J Thorac Cardiovasc Surg ; 158(2): 392-403, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30745047

RESUMO

OBJECTIVE: The optimal conduit for valve-sparing aortic root replacement is still debated, with several conduit variations available, ranging from straight tubular grafts to Valsalva grafts. Benefits of neosinus reconstruction include enhanced flow profiles and improved hemodynamics. Curiously, however, some clinical data suggest that straight grafts may have greater long-term durability. In this study, we hypothesized that straight tubular grafts may help maintain the native cylindrical position of the aortic valve commissures radially, resulting in preserved leaflet coaptation, reduced stresses, and potentially improved valve performance. METHODS: Using 3D printing, a left heart simulator with a valve-sparing root replacement model and a physiologic coronary circulation was constructed. Aortic valves were dissected from fresh porcine hearts and reimplanted into either straight tubular grafts (n = 6) or Valsalva grafts (n = 6). Conduits were mounted into the heart simulator and hemodynamic, echocardiographic, and high-speed videometric data were collected. RESULTS: Hemodynamic parameters and coronary blood flow were similar between straight and Valsalva grafts, although the former were associated with lower regurgitant fractions, less peak intercommissural radial separation, preserved leaflet coaptation, decreased leaflet velocities, and lower relative leaflet forces compared with Valsalva grafts. CONCLUSIONS: Valsalva grafts and straight grafts perform equally well in terms of gross hemodyanics and coronary blood flow. Interestingly, however, the biomechanics of these 2 conduits differ considerably, with straight grafts providing increased radial commissural stability and leaflet coaptation. Further investigation into how these parameters influence clinical outcomes is warranted.


Assuntos
Aorta/cirurgia , Valva Aórtica/cirurgia , Impressão Tridimensional , Animais , Aorta/patologia , Aorta/fisiopatologia , Valva Aórtica/patologia , Valva Aórtica/fisiopatologia , Fenômenos Biomecânicos , Circulação Coronária , Ecocardiografia Transesofagiana , Hemodinâmica , Modelos Anatômicos , Seio Aórtico/patologia , Seio Aórtico/fisiopatologia , Seio Aórtico/cirurgia , Suínos , Enxerto Vascular/métodos
6.
J Cardiovasc Surg (Torino) ; 60(2): 259-267, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30465417

RESUMO

BACKGROUND: Valve sparing root replacement differs in specific points. The main target remains to achieve a perfect intraoperative result and long-term stability. We aimed in this study to present our modified sizing technique for valve-sparing "David" procedure and its mid-term results. METHODS: We present a retrospective single-center study. A newly designed sizing ring in addition to triple-armed forceps (Trifeet®) was used to measure the proper size of the Valsalva® prosthesis for patients undergoing David-procedure. Primary endpoints are intraoperative aortic regurgitation (AR) and early postoperative outcomes. Secondary endpoints included freedom from aortic regurgitation or reoperation and overall mortality. RESULTS: A total of 63 consecutive patients who underwent David procedure between 09/2012 and 12/2016 were evaluated. Mean age was 52±15 years and 76.2% were male. Moderate to severe aortic regurgitation was reported in 60 (95.2%) patients. Four (6.3%) patients presented with type-A aortic dissection, 20 (31.7%) patients had bicuspid and 3 (4.8%) had a unicuspid aortic valve, 2 (3.2%) patients had a prior aortic valve repair. Intraoperative echocardiography revealed no 34 (54%), trace 26 (41.2%) or moderate 3 (4.8%) AR. Stroke, myocardial infarction, and 30-day mortality occurred in 1 patient (1.6%). During follow-up 5 (7.9%) patients needed reoperation due to recurrent AR within a mean of 35±18 months. One could be re-repaired, and the other four underwent aortic valve replacement. A second patient died in the late follow-up. CONCLUSIONS: Our modified sizing technique simplifies the "David-procedure" and allows to achieve a good intraoperative and mid-term results. However, these results have to be confirmed in a larger cohort with a long-term follow-up.


Assuntos
Aneurisma Aórtico/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Desenho de Prótese , Reimplante , Seio Aórtico/cirurgia , Adulto , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/mortalidade , Aneurisma Aórtico/fisiopatologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/mortalidade , Insuficiência da Valva Aórtica/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Reimplante/efeitos adversos , Reimplante/mortalidade , Fatores de Risco , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
7.
Ann Biomed Eng ; 47(1): 75-84, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30151733

RESUMO

Leaflet thrombosis is a complication associated with transcatheter aortic valve (TAV) replacement (TAVR) correlated with sinus flow stasis. Sinus hemodynamics are important because they dictate shear stress and washout necessary to avoid stasis on TAV leaflets. Sinus flow is controlled by TAV axial deployment position but little is known regarding TAV axis misalignment effect. This study aims to elucidate TAV angular misalignment with respect to aortic root axis effect on sinus flow stasis potentially leading to leaflet thrombosis. Sinus hemodynamics were assessed in vitro using particle-image velocimetry in three different angular misalignments with respect to aorta axis: untilted, tilted away from the sinus and tilted towards sinus. A 26 mm Edwards SAPIEN3 was implanted in a 3D printed model of an anatomically realistic aortic root. TAV hemodynamics, sinus vortex tracking, leaflet shear stress probability density functions, and sinus blood time to washout were calculated. While pressure gradients differed insignificantly, blood velocity and vorticity decreased significantly in both tilted cases sinuses. Shear stress probability near the leaflet decreases with tilt indicating stasis. TAV tilted away from the sinus is the most unfavorable scenario with poor washout. TAV axial misalignment adds to factors list that could influence leaflet thrombosis risk through modifying sinus hemodynamics and washout.


Assuntos
Hemodinâmica , Modelos Cardiovasculares , Impressão Tridimensional , Seio Aórtico , Substituição da Valva Aórtica Transcateter , Feminino , Humanos , Masculino , Seio Aórtico/fisiopatologia
8.
J Emerg Med ; 55(4): e93-e96, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30166075

RESUMO

BACKGROUND: Anomalous coronary artery origins appear in roughly 1% of coronary angiograms, and up to 15% of syncope and sudden cardiac death events can be attributed to anomalous coronaries. Patients with an anomalous coronary artery arising from the opposite sinus may initially present with syncope and electrocardiographic findings of ischemia. CASE REPORT: We describe a case in which an adolescent male presented with exercise-induced angina and syncope, and his initial electrocardiogram (ECG) showed diffuse ST-segment depression with ST-segment elevation in lead aVR. Cardiac catheterization revealed there was no coronary ostium in the left coronary cusp, and the left coronary artery had an anomalous origin from the right cusp. The patient received urgent left internal mammary artery-to-left anterior descending artery coronary bypass and a saphenous vein graft to the ramus intermedius. After he underwent 6 months of medical therapy with ß-blockade and angiotensin-receptor blockade, his left ventricular systolic function improved to low-normal level (left ventricular ejection fraction, approximately 50%). WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ST-segment elevation in lead aVR is strongly prognostic for left main or triple-vessel coronary artery disease. However, in patients who present with syncope and few other coronary artery disease risk factors, this ECG finding should be suggestive of an ischemic event caused by an anomalous left coronary artery. Early recognition of this pattern of clinical signs and ECG findings by an emergency physician could be critical for making the correct diagnosis and risk stratifying the patient for early coronary angiography and urgent surgical revascularization.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/anatomia & histologia , Exercício Físico/fisiologia , Seio Aórtico/anormalidades , Adolescente , Traumatismos em Atletas/complicações , Anomalias dos Vasos Coronários/fisiopatologia , Vasos Coronários/patologia , Morte Súbita Cardíaca/prevenção & controle , Eletrocardiografia/métodos , Serviço Hospitalar de Emergência/organização & administração , Humanos , Masculino , Seio Aórtico/anatomia & histologia , Seio Aórtico/fisiopatologia , Síncope/etiologia , Síncope/fisiopatologia
9.
Ann Afr Med ; 17(3): 133-139, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30185682

RESUMO

Background: The aortic root is an aggregate of various components that connects the left ventricle to the aorta. The most predominant pathologies have been associated with the dilation of the aortic root leading to aneurysms. Aim: This study is designed to measure the role of systemic morbidities such as hypertension, diabetes, and body mass index (BMI) on the dimension of the aortic root. Materials and Methods: Participants were volunteers of African descent who were recruited during and after an organized health fair by the medical students' body from All Saints University, School of Medicine. 169 participants consisting of 62 males and 107 females with ages ranging from 9 to 84 years agreed to volunteer by signing the consent after which a questionnaire was administered and a preliminary clinical procedure was used to check for blood pressure (BP), blood glucose (BG), and BMI. The measurement of the aortic root was carried out by an experienced single investigator who was not aware of the purpose of measurements, using a DUS-5000 ultrasound machine (Miami, Florida, USA) at a low-frequency micro-convex transducer preset to "adult cardiac" with a default frequency of 4 MHz. Results: Among the participants, 35.03%, 47.80%, and 29.11% had normal BP, BG, and BMI readings, respectively. The Chi-squared analysis identified a significant correlation between the diameter of the aortic annulus (AA) and BMI. Diastolic BP is also correlated with the diameter of the AA. Sinus of Valsalva (SV) showed an unusual correlation with BG as opposed to BP and BMI. Conclusion: The disparity in how a systemic factor individually correlates with the AA and the SV is not clear. The study targets to provide educational concept in this regard.


Assuntos
Aorta/anatomia & histologia , Diabetes Mellitus/diagnóstico por imagem , Hipertensão/diagnóstico por imagem , Seio Aórtico/diagnóstico por imagem , Ultrassonografia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aorta/diagnóstico por imagem , Pressão Sanguínea , Índice de Massa Corporal , Criança , Diabetes Mellitus/fisiopatologia , Feminino , Humanos , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Seio Aórtico/fisiopatologia , Inquéritos e Questionários , Adulto Jovem
12.
Gen Thorac Cardiovasc Surg ; 66(9): 523-528, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29956049

RESUMO

OBJECTIVES: Stentless bioprosthetic valves provide hemodynamic advantages over stented valves as well as excellent durability. However, some primary tissue failures in bioprostheses have been reported. This study was conducted to evaluate the morphometrical and biomechanical properties of the stentless Medtronic Freestyle™ aortic root bioprosthesis, to identify any arising problem areas, and to speculate on a potential solution. METHODS: The three-dimensional heterogeneity of the stentless bioprosthesis wall was investigated using computed tomography. The ascending aorta and the right, left, and non-coronary sinuses of Valsalva were resected and examined by an indentation test to evaluate their biomechanical properties. RESULTS: The non-coronary sinus of Valsalva was significantly thinner than the right sinus of Valsalva (p < 0.01). Young's modulus, calculated as an indicator of elasticity, was significantly greater at the non-coronary sinus of Valsalva (430.7 ± 374.2 kPa) than at either the left (190.6 ± 70.6 kPa, p < 0.01) or right sinuses of Valsalva (240.0 ± 56.5 kPa, p < 0.05). CONCLUSIONS: Based on the morphometrical and biomechanical analyses of the stentless bioprosthesis, we demonstrated that there are differences in wall thickness and elasticity between each sinus of Valsalva. These differences suggest that the non-coronary sinus of Valsalva is the most vulnerable and at greater risk of tissue failure. The exclusion of the non-coronary sinus of Valsalva may be beneficial to mitigate the long-term risks of tissue failure in the stentless bioprosthesis.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Bioprótese , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Seio Aórtico/diagnóstico por imagem , Idoso , Aorta , Estenose da Valva Aórtica/cirurgia , Fenômenos Biomecânicos , Módulo de Elasticidade , Feminino , Hemodinâmica , Humanos , Masculino , Desenho de Prótese , Seio Aórtico/fisiopatologia , Stents , Tomografia Computadorizada por Raios X
14.
Catheter Cardiovasc Interv ; 92(1): 68-75, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29521471

RESUMO

OBJECTIVES: To describe the use of fractional flow reserve (FFR) and intravascular ultrasound (IVUS) in the evaluation of patients with anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS). BACKGROUND: ACAOS of the right and left coronary are rare, but may lead to symptoms and impose a risk for sudden cardiac death, depending on several anatomical features. Assessment and risk estimation is challenging in (nonathlete) adults, especially if they present without symptoms or with atypical complaints. METHODS: The team retrospectively studied 30 consecutive patients with ACAOS with interarterial course, who received IVUS- and FFR-guided treatment at our institution between October 2010 and September 2017. RESULTS: FFR was abnormal in only seven patients. IVUS showed the typical slit-like anatomy of the orifice in 23 patients. Based on FFR and/or IVUS results, in conjunction with the clinical presentation, clinical decision was made. A decision for intervention was made if at least two out of three entities were abnormal. Intervention implied unroofing of the coronary artery (n = 10) or coronary artery bypass grafting (n = 1). In all other patients a conservative strategy was followed. No adverse events occurred in the total population after a median of 37 (0-62) months of follow-up. CONCLUSIONS: Conservative treatment may be justifiable in adult patients with ACAOS in the presence of normal FFR and nonsuspicious symptoms, despite the presence of an interarterial course and/or slitlike orifice on IVUS. We recommend the use of FFR and IVUS in the standard work-up for adult patients with ACAOS and propose the use of a flowchart to aid in decision-making.


Assuntos
Cateterismo Cardíaco , Anomalias dos Vasos Coronários/diagnóstico por imagem , Reserva Fracionada de Fluxo Miocárdico , Seio Aórtico/diagnóstico por imagem , Ultrassonografia de Intervenção , Adulto , Tomada de Decisão Clínica , Angiografia Coronária , Anomalias dos Vasos Coronários/fisiopatologia , Anomalias dos Vasos Coronários/terapia , Técnicas de Apoio para a Decisão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Estudos Retrospectivos , Seio Aórtico/fisiopatologia , Resultado do Tratamento
15.
J Cardiovasc Electrophysiol ; 29(4): 591-599, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29446182

RESUMO

BACKGROUND: There is a close anatomical relationship between aortic sinus cusp (ASC) and the left pulmonary sinus cusp (LPSC). PURPOSE: The study was to investigate the significance of mapping and ablation of LPSC for ventricular arrhythmias (VAs) with QRS morphology resembling that of ASC arrhythmias. METHODS: In 33 consecutive patients undergoing successful catheter ablation of idiopathic VAs with ASC arrhythmia-like QRS morphology, LPSC was mapped carefully. RESULTS: Among the 33 patients studied, QRS morphology resembled that of arrhythmias of either right or left coronary cusp (LCC or RCC) origin in 17 and 16 patients, respectively. Out of 12 arrhythmias with the earliest potential in LCC during left-sided mapping, an earlier potential in LPSC than in LCC was recorded in 2 arrhythmias, the same earliest potential in LPSC as in LCC was recorded in 6 arrhythmias, and 5 (42%) were finally ablated successfully in LPSC using the reversed U curve. Out of 16 arrhythmias with the earliest potential in the RCC during left-sided mapping, an earlier potential in LPSC than in RCC was recorded in 4 arrhythmias, the same earliest potential in LPSC as in RCC was recorded in 3 arrhythmias, and 4 (25%) were finally ablated successfully in LPSC using the reversed U curve. CONCLUSIONS: For VAs with ASC arrhythmia-like QRS morphology, mapping in LPSC could have unique electrophysiologic characteristics, and some of them could be eliminated in LPSC using reversed U curve.


Assuntos
Potenciais de Ação , Arritmias Cardíacas/cirurgia , Ablação por Cateter , Técnicas Eletrofisiológicas Cardíacas , Ventrículos do Coração/cirurgia , Veias Pulmonares/fisiopatologia , Adulto , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Eletrocardiografia , Feminino , Frequência Cardíaca , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Seio Aórtico/fisiopatologia , Resultado do Tratamento
16.
Interact Cardiovasc Thorac Surg ; 27(1): 108-115, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29481667

RESUMO

OBJECTIVES: Bioprosthetic valve thrombosis has been considered uncommon, but recent studies have shown that it is more frequent than previously thought. Insufficient washout of the aortic sinus is believed to be a risk factor for bioprosthetic valve thrombosis. The objective of this in vitro experiment was to investigate the impact of aortic root morphology on blood flow in the aortic sinus and to relate these results to in vivo data obtained in patients with a transcatheter aortic valve implant. METHODS: Two compliant aortic root phantoms with different morphologies (symmetrical and patient-specific) were fabricated with silicone. A bioprosthetic aortic valve was inserted in both phantoms. Haemodynamic measurements were performed in a pulsatile flow-loop replicating physiological flow and pressure conditions. The flow in the aortic root was visualized by injecting contrast agent (CA). The distribution of the CA was captured by a high-speed camera, and image post-processing was performed to quantify CA distribution in the aortic sinus. The results were compared with angiographic images after a transcatheter aortic valve implant. RESULTS: Blood flow in the aortic root and the washout of the sinus portion are significantly affected by aortic root morphology. CA arrives at the aortic sinus of the 2 phantoms at 0.09 s and 0.16 s after the valve opens in the symmetrical and the patient-specific phantoms, respectively. Delayed CA arrival was also observed in the patients with a transcatheter aortic valve implant. CONCLUSIONS: Aortic root morphology affects the blood flow in the aortic sinus and may be a factor in bioprosthetic valve thrombosis. Therefore, patient-specific aortic root morphology should be considered when selecting and positioning a prosthesis.


Assuntos
Valva Aórtica/patologia , Bioprótese , Próteses Valvulares Cardíacas , Trombose/etiologia , Substituição da Valva Aórtica Transcateter/instrumentação , Hemodinâmica , Humanos , Modelos Cardiovasculares , Seio Aórtico/fisiopatologia , Trombose/patologia , Trombose/fisiopatologia , Substituição da Valva Aórtica Transcateter/efeitos adversos
17.
Ann Thorac Cardiovasc Surg ; 24(6): 320-323, 2018 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-29386473

RESUMO

BACKGROUND: Localized aortic dissection on the left coronary cusp with critical malperfusion of the left main trunk (LMT) is rare and carries a high risk of death. CASE PRESENTATION: We report a case of a 48-year-old patient who developed localized aortic dissection of the left coronary cusp complicated by critical malperfusion of the LMT of the coronary artery. After percutaneous coronary intervention (PCI) for the LMT, a Koster-Collins-like direct repair of the localized aortic dissection was carried out by closure of the false channel using BioGlue (CyroLife, Inc., Kennesaw, GA, USA) with the reinforcement of double Teflon felt strips. CONCLUSION: The aortic repair using a modified Koster-Collins technique was successful.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Estenose Coronária/cirurgia , Intervenção Coronária Percutânea , Seio Aórtico/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/fisiopatologia , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Circulação Coronária , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/etiologia , Estenose Coronária/fisiopatologia , Stents Farmacológicos , Ecocardiografia Transesofagiana , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Intervenção Coronária Percutânea/instrumentação , Proteínas/uso terapêutico , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/fisiopatologia , Técnicas de Sutura , Resultado do Tratamento , Ultrassonografia de Intervenção
19.
Europace ; 20(1): 124-133, 2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-28011797

RESUMO

Aims: The clinical characteristics of atrial tachycardias (AT) ablated from the non-coronary aortic sinus (NCS) are thus far described only in small series. We aimed to outline, in a large cohort of patients, the clinical, electrocardiographic, electrophysiological characteristics of this tachycardia. Methods and results: We analysed data pertaining to clinical, electrocardiographic, and electrophysiological characteristics of 43 consecutive patients from an overall cohort of 441 with AT who were successfully ablated from the NCS. The tachycardias ablated from the NCS were paroxysmal (98%) and adenosine sensitive (35/35). The patients were aged 54.6 ± 12.4 years, showing female preponderance (74%). No P wave pattern was predictive of the location of ablation. Electrophysiological findings suggested a possible micro-reentrant mechanism. During tachycardia, atrial electrograms recorded in the NCS preceded the A in the His region by 10.9 ± 7.4 ms. Fractionated atrial electrograms were noted at the site of ablation in 42 patients during the tachycardia. Radiofrequency ablation terminated the tachycardia within 5 s in 88%, with thermal automaticity seen only in 3 patients. The site of ablation at the base of the NCS was adjacent to the presumed site of the retroaortic node, a remnant of the initial atrio-ventricular canal musculature. Conclusions: AT ablated from the NCS is a paroxysmal arrhythmia in middle-aged women, with distinct electrocardiographic and electrophysiological characteristics. We suspect the retroaortic node to be involved in the tachycardia circuit.


Assuntos
Ablação por Cateter/métodos , Seio Aórtico/cirurgia , Taquicardia Supraventricular/cirurgia , Potenciais de Ação , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Ablação por Cateter/efeitos adversos , Intervalo Livre de Doença , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Europa (Continente) , Feminino , Frequência Cardíaca , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Seio Aórtico/fisiopatologia , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
20.
J Thorac Cardiovasc Surg ; 155(2): 461-469.e4, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29042101

RESUMO

BACKGROUND: Bicuspid aortic valves (BAV) are associated with incompletely characterized aortopathy. Our objectives were to identify distinct patterns of aortopathy using machine-learning methods and characterize their association with valve morphology and patient characteristics. METHODS: We analyzed preoperative 3-dimensional computed tomography reconstructions for 656 patients with BAV undergoing ascending aorta surgery between January 2002 and January 2014. Unsupervised partitioning around medoids was used to cluster aortic dimensions. Group differences were identified using polytomous random forest analysis. RESULTS: Three distinct aneurysm phenotypes were identified: root (n = 83; 13%), with predominant dilatation at sinuses of Valsalva; ascending (n = 364; 55%), with supracoronary enlargement rarely extending past the brachiocephalic artery; and arch (n = 209; 32%), with aortic arch dilatation. The arch phenotype had the greatest association with right-noncoronary cusp fusion: 29%, versus 13% for ascending and 15% for root phenotypes (P < .0001). Severe valve regurgitation was most prevalent in root phenotype (57%), followed by ascending (34%) and arch phenotypes (25%; P < .0001). Aortic stenosis was most prevalent in arch phenotype (62%), followed by ascending (50%) and root phenotypes (28%; P < .0001). Patient age increased as the extent of aneurysm became more distal (root, 49 years; ascending, 53 years; arch, 57 years; P < .0001), and root phenotype was associated with greater male predominance compared with ascending and arch phenotypes (94%, 76%, and 70%, respectively; P < .0001). Phenotypes were visually recognizable with 94% accuracy. CONCLUSIONS: Three distinct phenotypes of bicuspid valve-associated aortopathy were identified using machine-learning methodology. Patient characteristics and valvular dysfunction vary by phenotype, suggesting that the location of aortic pathology may be related to the underlying pathophysiology of this disease.


Assuntos
Aorta Torácica/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Valva Aórtica/anormalidades , Aortografia/métodos , Angiografia por Tomografia Computadorizada/métodos , Diagnóstico por Computador/métodos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Aprendizado de Máquina , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Seio Aórtico/diagnóstico por imagem , Adulto , Idoso , Aorta Torácica/fisiopatologia , Aneurisma Aórtico/classificação , Aneurisma Aórtico/etiologia , Aneurisma Aórtico/fisiopatologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/etiologia , Estenose da Valva Aórtica/fisiopatologia , Estudos Transversais , Feminino , Doenças das Valvas Cardíacas/classificação , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Reconhecimento Automatizado de Padrão , Fenótipo , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Seio Aórtico/fisiopatologia
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