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1.
N Engl J Med ; 382(2): 130-139, 2020 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-31733182

RESUMO

BACKGROUND: Subclinical leaflet thickening and reduced leaflet motion of bioprosthetic aortic valves have been documented by four-dimensional computed tomography (CT). Whether anticoagulation can reduce these phenomena after transcatheter aortic-valve replacement (TAVR) is not known. METHODS: In a substudy of a large randomized trial, we randomly assigned patients who had undergone successful TAVR and who did not have an indication for long-term anticoagulation to a rivaroxaban-based antithrombotic strategy (rivaroxaban [10 mg] plus aspirin [75 to 100 mg] once daily) or an antiplatelet-based strategy (clopidogrel [75 mg] plus aspirin [75 to 100 mg] once daily). Patients underwent evaluation by four-dimensional CT at a mean (±SD) of 90±15 days after randomization. The primary end point was the percentage of patients with at least one prosthetic valve leaflet with grade 3 or higher motion reduction (i.e., involving >50% of the leaflet). Leaflet thickening was also assessed. RESULTS: A total of 231 patients were enrolled. At least one prosthetic valve leaflet with grade 3 or higher motion reduction was found in 2 of 97 patients (2.1%) who had scans that could be evaluated in the rivaroxaban group, as compared with 11 of 101 (10.9%) in the antiplatelet group (difference, -8.8 percentage points; 95% confidence interval [CI], -16.5 to -1.9; P = 0.01). Thickening of at least one leaflet was observed in 12 of 97 patients (12.4%) in the rivaroxaban group and in 33 of 102 (32.4%) in the antiplatelet group (difference, -20.0 percentage points; 95% CI, -30.9 to -8.5). In the main trial, the risk of death or thromboembolic events and the risk of life-threatening, disabling, or major bleeding were higher with rivaroxaban (hazard ratios of 1.35 and 1.50, respectively). CONCLUSIONS: In a substudy of a trial involving patients without an indication for long-term anticoagulation who had undergone successful TAVR, a rivaroxaban-based antithrombotic strategy was more effective than an antiplatelet-based strategy in preventing subclinical leaflet-motion abnormalities. However, in the main trial, the rivaroxaban-based strategy was associated with a higher risk of death or thromboembolic complications and a higher risk of bleeding than the antiplatelet-based strategy. (Funded by Bayer; GALILEO-4D ClinicalTrials.gov number, NCT02833948.).


Assuntos
Valva Aórtica/fisiopatologia , Aspirina/farmacologia , Clopidogrel/farmacologia , Inibidores do Fator Xa/farmacologia , Próteses Valvulares Cardíacas , Inibidores da Agregação de Plaquetas/farmacologia , Rivaroxabana/farmacologia , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/efeitos dos fármacos , Valva Aórtica/patologia , Aspirina/efeitos adversos , Aspirina/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Doenças Cardiovasculares/mortalidade , Clopidogrel/efeitos adversos , Clopidogrel/uso terapêutico , Quimioterapia Combinada , Inibidores do Fator Xa/efeitos adversos , Inibidores do Fator Xa/uso terapêutico , Feminino , Tomografia Computadorizada Quadridimensional , Hemorragia/induzido quimicamente , Humanos , Análise de Intenção de Tratamento , Masculino , Inibidores da Agregação de Plaquetas/efeitos adversos , Inibidores da Agregação de Plaquetas/uso terapêutico , Rivaroxabana/efeitos adversos , Rivaroxabana/uso terapêutico , Tromboembolia/etiologia , Tromboembolia/mortalidade
2.
BMC Infect Dis ; 19(1): 957, 2019 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-31707976

RESUMO

BACKGROUND: Patients with multiple myeloma (MM) are known to be immune incompetent and experience higher incidences of infectious diseases. However, infective endocarditis (IE) is rarely observed in patients with MM and Morganella morganii (M. morganii) has rarely been associated with IE. CASE PRESENTATION: A 72-year-old female receiving 4th line treatment for MM presented with fever and concomitant confusion. Urinary culture revealed growth of Escherichia coli, wherefore broadspectrum penicillin and high-dose corticosteroids were initiated. However, blood cultures showed growth of M. morganii. Fluoroquinolone was added due to penicillin-resistance of the Morganella species. Two days after admission, the patient acutely deteriorated with hemodynamic instability. Gentamicin and high dose corticosteroids were added. Echocardiography showed marked aortic valve vegetation with severe aortic valve regurgitation, leading to the diagnosis of bacterial endocarditis of the native aortic valve. Shortly after diagnosis, the patient died. At autopsy, vegetation with gram-negative rods in the native aortic valve was observed, confirming the diagnosis of M. morganii-endocarditis. Additional staining for amyloid confirmed advanced light-chain (AL) amyloidosis with extensive amyloid depositions of the aortic valve and valvular damage as complications of her MM. CONCLUSIONS: Our case suggests that IE with M. morganii was facilitated by the combination of the cardiac amyloidosis with valvular impairment and the profound immune deficiency caused by the several chemo-immunomodulatory treatment lines and the MM itself. This case further illustrates that awareness for rare opportunistic infections in an era with growing potential of combined chemoimmunotherapy is warranted.


Assuntos
Endocardite Bacteriana/diagnóstico , Morganella morganii/isolamento & purificação , Mieloma Múltiplo/patologia , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Ecocardiografia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/microbiologia , Feminino , Humanos , Mieloma Múltiplo/complicações
3.
Braz J Cardiovasc Surg ; 34(5): 637-639, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719017

RESUMO

Quadricuspid aortic valve (QAV) is a rare cardiac malformation. Many cases are incidentally diagnosed in aortic surgeries or autopsies and it usually appears as an isolated anomaly. The most widely classification used is the one by Hurwitz and Roberts[], which divides 7 alphabetical subtypes based on the cusps size. The aim of this report is to describe three different anatomic presentations of this rare aortic valve anomaly.


Assuntos
Valva Aórtica/anormalidades , Valva Aórtica/patologia , Cardiopatias Congênitas/patologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Ecocardiografia , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
4.
Rev Port Cir Cardiotorac Vasc ; 26(3): 225-227, 2019.
Artigo em Português | MEDLINE | ID: mdl-31734977

RESUMO

Alkaptonuria is a rare genetic disorder related to tyrosine metabolism. The cardiovascular manifestations are rare being the aortic stenosis the most commonly reported. We present a case of 72-year-old women who underwent aortic valve replacement with intraoperative findings in the aortic valve and the aortic wall suggestive of Cardiac Ochronosis. Once it is a rare disease there are issues related to the natural history of the disorder that still unknown, namely the type of aortic prothesis in use. For this reason, we find essential the documentation and follow-up of all these rare cases.


Assuntos
Alcaptonúria/complicações , Estenose da Valva Aórtica/cirurgia , Ocronose/patologia , Idoso , Valva Aórtica/patologia , Estenose da Valva Aórtica/patologia , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Ocronose/etiologia
6.
APMIS ; 127(11): 727-730, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31418929

RESUMO

Aortic valve tissue excised during stenotic valve replacement surgery commonly exhibits histopathologic changes including prominent calcification of variable severity. We present briefly a case of a 78-year-old man with aortic valve stenosis and coronary artery disease undergoing aortic valve replacement and coronary artery bypass grafting. After pathologic examination of excised tissue, the aortic valve was determined to have nodular calcification and myxoid degeneration, as well as evidence of prominent, contiguous fatty infiltration of the valve's spongiosa layer. Although osseous and chondroid metaplasia have been described within excised cardiac valves, a significant constituent of adipose tissue contiguous through the length of a valve and not representing a discrete mass-forming, neoplastic lesion has been only described in isolated case reports.


Assuntos
Tecido Adiposo/patologia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/patologia , Idoso , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/patologia , Ponte de Artéria Coronária , Próteses Valvulares Cardíacas , Histologia , Humanos , Masculino
7.
S D Med ; 72(6): 272-273, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31461233

RESUMO

Quadricuspid aortic valve is a rare cause of symptomatic aortic regurgitation. It tends to present earlier than degenerative native valve aortic regurgitation but with similar symptoms. The condition can occur in isolation or in association with other congenital cardiac abnormalities. Surgical intervention before the development of left ventricular failure is critical to improve long term survival. We describe a case of severe aortic regurgitation due to isolated quadricuspid valve morphology that was treated surgically.


Assuntos
Insuficiência da Valva Aórtica , Valva Aórtica/patologia , Cardiopatias Congênitas , Insuficiência Cardíaca , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/diagnóstico , Humanos
8.
Medicina (Kaunas) ; 55(8)2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31362438

RESUMO

Background and objectives: Mechanical stress is currently considered as the main factor promoting calcific aortic valve stenosis (AS) onset. It causes endothelial damage and dysfunction. The chronic inflammatory process causes oxidative stress. Oxidative stress-induced high-density lipoprotein cholesterol (HDL-C) dysfunction is an important component of the development of AS. The aim of the study was to evaluate the role of HDL-C in AS patients in three severity grades and in relation to the biomarkers of oxidative stress, thioredoxin reductase 1 (TrxR1) and myeloperoxidase (MPO). Materials and Methods: 18 patients with mild, 19 with moderate. and 15 with severe AS were included in the study, and 50 individuals were enrolled in the control group. Stenosis severity was determined by echocardiography. The TrxR1 and MPO were analyzed by ELISA, and HDL-C by commercially available tests. Data were analyzed using GraphPad Prism 8. Results: HDL-C in AS patients vs. control substantially decreases and this decline was observed in all three AS severity groups: mild (p = 0.018), moderate (p = 0.0002), and severe (p = 0.004). In both the control and the stenosis group, the HDL-C was higher in women than in men. In comparison to control, the HDL-C level was lower in the AS group, and more pronounced in women (p = 0.0001) than in men (p = 0.049). A higher TrxR1 level was observed in patients with mild (p = 0.0001) and severe AS (p = 0.047). However, a clear correlation between TrxR1 and HDL-C was not obtained. Analysis of MPO showed differences in all severity grades vs. control (p = 0.024 mild stenosis; p = 0.002 moderate stenosis; p = 0.0015 severe stenosis). A negative correlation (p = 0.047; rp = -0.28) was found between MPO and HDL-C, which confirms the adverse effects of MPO resulting in HDL-C dysfunction. Conclusions: In this study, we justified HDL-C level association with AS development process. The results unequivocally substantiated the association between HDL-C and AS in all severity grades in women, but only in moderate AS for men, which we explained by the small number of men in the groups. The obtained correlation between the HDL-C and MPO levels, as well as the concurrent decrease in the HDL-C level and increase in the TrxR1 level, indicate in general an HDL-C association with oxidative stress in AS patients.


Assuntos
Estenose da Valva Aórtica/sangue , HDL-Colesterol/análise , Estresse Oxidativo/fisiologia , Idoso , Valva Aórtica/patologia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/fisiopatologia , Biomarcadores/análise , Biomarcadores/sangue , Calcinose/sangue , Calcinose/complicações , HDL-Colesterol/sangue , Ecocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença
9.
Pan Afr Med J ; 32: 157, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31303927

RESUMO

Infectious endocarditis is regarded as a potentially serious pathology despite the advances in diagnostic and treatment options. Valves on the left side of the heart are most affected and embolic events, mycotic aneurysms, abscesses as well as valve perforations are life-threatening consequences of this disease. We here report a case of endocarditis with aortic and mitral valve involvement complicated by splenic and renal infarction, cerebral mycotic aneurysm and mitral valve perforation. The interest in the subject of this case study is the positive medico-surgical treatment outcome obtained despite a multitude of complications.


Assuntos
Valva Aórtica/microbiologia , Endocardite Bacteriana/diagnóstico , Aneurisma Cardíaco/diagnóstico , Valva Mitral/microbiologia , Idoso , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiologia , Valva Aórtica/patologia , Endocardite Bacteriana/microbiologia , Aneurisma Cardíaco/microbiologia , Humanos , Masculino , Valva Mitral/patologia , Infarto do Baço/diagnóstico
10.
Nat Commun ; 10(1): 3111, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31308376

RESUMO

Biomedical repositories such as the UK Biobank provide increasing access to prospectively collected cardiac imaging, however these data are unlabeled, which creates barriers to their use in supervised machine learning. We develop a weakly supervised deep learning model for classification of aortic valve malformations using up to 4,000 unlabeled cardiac MRI sequences. Instead of requiring highly curated training data, weak supervision relies on noisy heuristics defined by domain experts to programmatically generate large-scale, imperfect training labels. For aortic valve classification, models trained with imperfect labels substantially outperform a supervised model trained on hand-labeled MRIs. In an orthogonal validation experiment using health outcomes data, our model identifies individuals with a 1.8-fold increase in risk of a major adverse cardiac event. This work formalizes a deep learning baseline for aortic valve classification and outlines a general strategy for using weak supervision to train machine learning models using unlabeled medical images at scale.


Assuntos
Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/patologia , Aprendizado de Máquina , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Cardiopatias/patologia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Aprendizado de Máquina Supervisionado
11.
Heart Lung Circ ; 28(9): 1310-1319, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31266725

RESUMO

Degenerative or fibrocalcific aortic stenosis (AS) is now the most common native valvular heart disease assessed and managed by cardiologists in developed countries. Transthoracic echocardiography remains the quintessential imaging modality for the non-invasive characterisation of AS due to its widespread availability, superior assessment of flow haemodynamics, and a wealth of prognostic data accumulated over decades of clinical utility and research applications. With expanding technologies and increasing availability of treatment options such as transcatheter aortic valve replacements, in addition to conventional surgical approaches, accurate and precise assessment of AS severity is critical to guide decisions for and timing of interventions. Despite clear guideline echocardiographic parameters demarcating severe AS, discrepancies between transvalvular velocities, gradients, and calculated valve areas are commonly encountered in clinical practice. This often results in diagnostically challenging cases with significant implications. Greater emphasis must be placed on the quality of performance of basic two dimensional (2D) and Doppler measurements (attention to detail ensuring accuracy and precision), incorporating ancillary haemodynamic surrogates, understanding study- or patient-specific confounders, and recognising the role and limitations of stress echocardiography in the subgroups of low-flow low-gradient AS. A multiparametric approach, along with the incorporation of multimodality imaging (cardiac computed tomography or magnetic resonance imaging) in certain scenarios, is now mandatory to avoid incorrect misclassification of severe AS. This is essential to ensure appropriate selection of patients who would most benefit from interventions on the aortic valve to relieve the afterload mismatch resulting from truly severe valvular stenosis.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Valva Aórtica/patologia , Calcinose/diagnóstico por imagem , Calcinose/fisiopatologia , Ecocardiografia sob Estresse , Ecocardiografia , Hemodinâmica , Imagem Multimodal , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/prevenção & controle , Estenose da Valva Aórtica/terapia , Calcinose/prevenção & controle , Calcinose/terapia , Humanos , Substituição da Valva Aórtica Transcateter
12.
Mayo Clin Proc ; 94(7): 1158-1170, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31272566

RESUMO

OBJECTIVE: To study contemporary etiologies, mechanisms, and corresponding surgical approaches in isolated aortic regurgitation (AR). PATIENTS AND METHODS: Consecutive patients undergoing surgery for moderately severe and severe AR were retrospectively identified from January 1, 2006, through October 20, 2017. Intraoperative echocardiograms, surgical reports, and pathology reports were reviewed. RESULTS: Of 382 patients (54±16 years, 82% men), there were 207 (54%) tricuspid (TAV), 167 (44%) bicuspid (BAV), 5 quadricuspid, and 3 unicuspid aortic valves. Isolated AR mechanisms (n=116, 30%) included cusp prolapse (n=44, 11%), restriction/retraction (n=33, 9%), aortic root dilatation (n=33, 9%), perforation (n=5, 1%), and fenestration (<1%); mixed mechanisms were present in 266 (70%). The most common mixed mechanism was root dilatation and prolapse (27% BAV vs 16% TAV, P=.01). Valve repair (AVr) was performed in 31% BAV and 23% TAV (P=.06). Aortic surgery was more common in BAV (37% vs 27%, P<.001). Overall, root dilatation was associated with AVr. In TAV, cusp prolapse and restriction/retraction were associated with replacement; in BAV, prolapse was associated with AVr. AR etiology was idiopathic in 43% TAV patients, 47% of whom had root dilatation. CONCLUSIONS: BAV accounted for 44% of surgical referrals for AR and, compared with TAV, was more often associated with prolapse, root dilatation, and mixed mechanisms of AR. Because mechanisms affected the choice of AVr differently in BAV and TAV, comprehensive mechanistic description of surgical AR is critical.


Assuntos
Aorta/fisiopatologia , Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/etiologia , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/etiologia , Doenças das Valvas Cardíacas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/patologia
13.
Int J Mol Sci ; 20(13)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31269711

RESUMO

Bicuspid aortic valve (BAV), the most common congenital heart defect, is associated with an increased prevalence of aortic dilation, aortic rupture and aortic valve calcification. Endothelial cells (ECs) play a major role in vessel wall integrity. Little is known regarding EC function in BAV patients due to lack of patient derived primary ECs. Endothelial colony forming cells (ECFCs) have been reported to be a valid surrogate model for several cardiovascular pathologies, thereby facilitating an in vitro system to assess patient-specific endothelial dysfunction. Therefore, the aim of this study was to investigate cellular functions in ECFCs isolated from BAV patients. Outgrowth and proliferation of ECFCs from patients with BAV (n = 34) and controls with a tricuspid aortic valve (TAV, n = 10) were determined and related to patient characteristics. Interestingly, we were only able to generate ECFCs from TAV and BAV patients without aortic dilation, and failed to isolate ECFC colonies from patients with a dilated aorta. Analyzing EC function showed that while proliferation, cell size and endothelial-to-mesenchymal transition were similar in TAV and BAV ECFCs, migration and the wound healing capacity of BAV ECFCs is significantly higher compared to TAV ECFCs. Furthermore, calcification is blunted in BAV compared to TAV ECFCs. Our results reveal ECs dysfunction in BAV patients and future research is required to unravel the underlying mechanisms and to further validate ECFCs as a patient-specific in vitro model for BAV.


Assuntos
Valva Aórtica/anormalidades , Células Endoteliais/patologia , Doenças das Valvas Cardíacas/patologia , Adulto , Aorta/patologia , Valva Aórtica/patologia , Movimento Celular , Tamanho Celular , Células Cultivadas , Dilatação Patológica/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
14.
Georgian Med News ; (290): 63-68, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31322517

RESUMO

Little is known about the gender differences of left ventricular (LV) remodeling in patients with aortic valve calcification (AVC). The aim was to assess gender differences of structure functional changes and LV myocardial remodeling in patients with AVC depending on the type of valve lesion. 293 patients (131 men) with revealed AVC by transthoracic echocardioscopy without aortic stenosis and 76 patients (50 men) without AVC were examined. Men had normal geometry of LV more often than women (15.7% vs. 4.4 % in isolated AVC and 11.9% vs. 2.8 % in combined lesion of aortic valve (AV) and mitral valves ring (MVR), р<0.052), and eccentric hypertrophy was registered more often in man with combined AV and MVR lesion (38.1% vs. 15.5 % in women with combined AV and MVR lesion and vs. 20.2 % in men with isolated AVC, р<0.029). LV systolic function was worse in men with combined valves lesion (ejection fraction was 54.0 (48.0; 65.0) vs. 66.0 (60.0; 71.0) % in women with combined valves lesion and vs. 63.0 (55.0; 70.0) % in men with isolated AVC, р<0.022). Men with combined valves lesion also had a larger right ventricle (RV) size (RV index was 1.3 (1.2; 1.5) vs. 1.2 (1.1; 1.4) cm/m2 in women with combined valves lesion and vs. 1.2 (1.1; 1.4) cm/m2 in men with isolated AVC, р<0.036) and had tricuspid regurgitation more often (76.2% vs. 56.3 % in women with combined valves lesion and vs. 58.4 % in men with isolated AVC, р<0.029). Women had higher peak aortic jet velocity (1.5 (1.4; 1.7) vs. 1.4 (1.2; 1.6) m/s in man, р<0.0001). Dominating models of LV remodeling in women were concentric, mainly concentric hypertrophy (61.5% vs. 31.5 % in men in groups with isolated AVC and 64.8% vs. 31.0 % in combined valves lesion groups, р<0.001). Also women had a higher left auricle index than men (2.3 (2.0; 2.5) vs. 2.1 (1.9; 2.4) cm/m2, р<0.015). There were revealed differences in distribution of LV remodeling types depending on the gender and the type of valve lesion.


Assuntos
Estenose da Valva Aórtica/patologia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/patologia , Calcinose/sangue , Função Ventricular Esquerda/fisiologia , Remodelação Ventricular , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/fisiologia , Valva Aórtica/cirurgia , Biomarcadores/sangue , Calcinose/complicações , Calcinose/patologia , Calcinose/fisiopatologia , Calcinose/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
15.
Monaldi Arch Chest Dis ; 89(2)2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31315350

RESUMO

Calcific aortic stenosis is the most common lesion requiring valve replacement. Transcutaneous procedures (TAVR) are rapidly increasing yet detailed information on aortic valve and root anatomy are sparse.  This study examined gated cardiac CT scans to make observations regarding the size and proportions of the valve leaflets, sinuses of Valsalva, and sinotubular junction. One hundred and fifty gated cardiac CT scans were performed for a variety of clinical indications. Area of each cusp (short axis plane) was measured along with sinus height (from leaflet base to sinotubular junction), sinus width (from central coaptation point to outer sinus edge), annular perimeter, perimeter at mid-sinus level, and perimeter at the sinotubular junction. The right coronary cusp was largest, the left cusp smallest, and the non-coronary cusp intermediate in size. Each cusp was larger in men than women, even after indexing for body surface area.  By contrast, indexed sinus width and height did not differ between genders. No significant differences were noted between races. Annular perimeter did not vary by age while the mid-sinus perimeter and sinotubular junction perimeter increased with age (p=0.01, r2 =0.05 and p=0.002, r2 =0.07).  Interestingly, the ratio of sinus height (average): annular radius was 1.69±0.18, very close to the "golden ratio" of 1.62 found throughout the natural world.  This might be important for proper vortex formation in the sinuses.


Assuntos
Aorta/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Calcinose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Tomografia Computadorizada por Raios X/métodos
16.
Angiol Sosud Khir ; 25(2): 171-174, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31150005

RESUMO

Aneurysmatic dilatation of the aortic root and ascending portion of the aorta is one of the most complicated pathologies of the cardiovascular system. The 5-year survival rate does not exceed 13%. Especially difficult from the point of view of surgical reconstruction are variants of massive calcification of the aortic root. This article describes a case report concerning the Florida sleeve technique in a patient with diffuse calcification of the aortic root, involving the ostia of the coronary arteries. An important advantage of this type of intervention is technical simplicity consisting in no need for reimplantation of coronary artery ostia, thus decreasing the number of surgical manipulations and sutures on the aortic root, as well as reducing the risk of haemorrhage.


Assuntos
Insuficiência da Valva Aórtica , Valva Aórtica , Aorta , Aorta Torácica , Valva Aórtica/patologia , Insuficiência da Valva Aórtica/cirurgia , Calcinose/cirurgia , Humanos
19.
Innovations (Phila) ; 14(2): 159-167, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31039682

RESUMO

OBJECTIVE: Aortic root enlargement may be necessary to implant adequately sized valves to avoid patient-prosthetic mismatch. Our objective was to assess the feasibility of annular enlargement during aortic valve replacement via a right anterior minithoracotomy. METHODS: Twelve consecutive patients undergoing elective minimally invasive aortic valve replacement requiring annular enlargement over a 2-year period were retrospectively reviewed. A right anterior minithoracotomy was performed in all patients. Cardiopulmonary bypass and aortic crossclamp times, hospital length of stay, postoperative complications, rate of reoperation, echocardiographic data, and mortality were analyzed. RESULTS: Mean age was 66 years ± 14. Mean body mass index was 34 ± 7.8 kg/m2. All patients had normal preoperative ejection fractions. Indications for aortic valve replacement were severe (3/12, 25%) or critical (9/12, 75%) aortic stenosis due to degenerative aortic valve disease (10/12, 83%) and congenitally bicuspid aortic valve (2/12, 17%). Cardiopulmonary bypass and aortic crossclamp times were 144.7 ± 14.7 minutes and 111.7 ± 10.6 minutes, respectively. The median postoperative length of stay was 4 days. Peak and mean aortic valve gradients on postreplacement intraoperative transesophageal echocardiography were 14.5 ± 9.4 mmHg and 7.2 ± 4.2 mmHg, respectively, with no perivalvular leak on intraoperative or follow-up transthoracic echocardiogram. Postoperative transthoracic echocardiography had peak and mean aortic valve gradients of 12.1 ± 6.9 mmHg and 6.3 ± 3.7 mmHg, respectively. There were no postoperative mortalities. Freedom from reoperation was 100%. CONCLUSIONS: Annular enlargement performed during minimally invasive aortic valve replacement is feasible. Basic minimally invasive skills are recommended prior to instituting these more advanced techniques.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Anuloplastia da Valva Cardíaca/métodos , Implante de Prótese de Valva Cardíaca/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/anormalidades , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Estenose da Valva Aórtica/etnologia , Anuloplastia da Valva Cardíaca/mortalidade , Ponte Cardiopulmonar/normas , Ecocardiografia/métodos , Estudos de Viabilidade , Feminino , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos , Toracotomia/métodos , Toracotomia/tendências
20.
EBioMedicine ; 43: 54-66, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31078518

RESUMO

BACKGROUND: Ascending aortic aneurysms constitute an important hazard for individuals with a bicuspid aortic valve (BAV). However, the processes that degrade the aortic wall in BAV disease remain poorly understood. METHODS: We undertook in situ analysis of ascending aortas from 68 patients, seeking potentially damaging cellular senescence cascades. Aortas were assessed for senescence-associated-ß-galactosidase activity, p16Ink4a and p21 expression, and double-strand DNA breaks. The senescence-associated secretory phenotype (SASP) of cultured-aged BAV aortic smooth muscle cells (SMCs) was evaluated by transcript profiling and consequences probed by combined immunofluorescence and circular polarization microscopy. The contribution of p38 MAPK signaling was assessed by immunostaining and blocking strategies. FINDINGS: We uncovered SMCs at varying depths of cellular senescence within BAV- and tricuspid aortic valve (TAV)-associated aortic aneurysms. Senescent SMCs were also abundant in non-aneurysmal BAV aortas but not in non-aneurysmal TAV aortas. Multivariable analysis revealed that BAV disease independently associated with SMC senescence. Furthermore, SMC senescence was heightened at the convexity of aortas associated with right-left coronary cusp fusion. Aged BAV SMCs had a pronounced collagenolytic SASP. Moreover, senescent SMCs in the aortic wall were enriched with surface-localized MMP1 and surrounded by weakly birefringent collagen fibrils. The senescent-collagenolytic SMC phenotype depended on p38 MAPK signaling, which was chronically activated in BAV aortas. INTERPRETATION: We have identified a cellular senescence-collagen destruction axis in at-risk ascending aortas. This novel "seno-destructive" SMC phenotype could open new opportunities for managing BAV aortopathy. FUND: Canadian Institutes of Health Research, Lawson Health Research Institute, Heart and Stroke Foundation of Ontario/Barnett-Ivey Chair.


Assuntos
Aorta/metabolismo , Aorta/patologia , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/patologia , Miócitos de Músculo Liso/metabolismo , Idoso , Idoso de 80 Anos ou mais , Aneurisma Aórtico/etiologia , Aneurisma Aórtico/metabolismo , Aneurisma Aórtico/patologia , Valva Aórtica/patologia , Biomarcadores , Células Cultivadas , Senescência Celular , Colágeno/metabolismo , Quebras de DNA de Cadeia Dupla , Feminino , Doenças das Valvas Cardíacas/complicações , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/patologia , Miócitos de Músculo Liso/patologia , Proteólise , Fatores de Risco
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