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1.
J Cardiothorac Surg ; 18(1): 51, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36726170

RESUMO

BACKGROUND: We compare the early and late outcomes of a modified aortic root remodelling (ARR) technique for aortic root replacement without mobilisation or reimplantation of the coronary ostia, with those of the modified Bentall-de Bono procedure. METHODS: A retrospective observational study was performed comprising 181 consecutive patients who underwent aortic root replacement with a modified Bentall-de Bono procedure (104 patients) or ARR (77 patients) between January 2013 and December 2019. Primary endpoints included hospital mortality and late survival. Secondary endpoints included incidence of post-operative complications and freedom from late re-operation. RESULTS: ARR procedures were performed with shorter cross-clamp times and comparable cardiopulmonary bypass times to modified Bentall-de Bono procedures. The incidence of early post-complications was comparable between groups. 30-day mortality was numerically lower with ARR than the modified Bentall-de Bono procedure. Over 7-year follow-up, 4 patients (3.8%) required repeat aortic surgery after a modified Bentall-de Bono procedure, and none after ARR. Long-term mortality after ARR and after modified Bentall-de Bono procedures was 17.1% and 22.7%, respectively. The cumulative incidence of reintervention on the aortic root/valve was 3.2% after a modified Bentall-de Bono procedure and 0% after ARR. When adjusted for other independent risk factors, late mortality was not influenced by the procedure performed, although competing risk adjusted for age showed that the modified Bentall-de Bono procedure was associated with an increased risk of aortic root/aortic valve re-operation. CONCLUSIONS: The modified ARR technique is associated with reduced myocardial ischaemia time, lower post-operative mortality and aortic re-intervention rates compared to a modified Bentall-de Bono procedure. It may be considered a safe and feasible procedure for aortic root/ascending aortic replacement offering good long-term outcomes.


Assuntos
Valva Aórtica , Implante de Prótese de Valva Cardíaca , Humanos , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Resultado do Tratamento , Aorta/cirurgia , Reimplante , Estudos Retrospectivos
2.
Ann Card Anaesth ; 26(1): 97-101, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36722597

RESUMO

The use of ECPELLA in patients with severe lung disease may result in an unfavorable phenomenon of differential hypoxia. The simultaneous evaluation of three arterial blood samples from different arterial line (right radial artery, left radial artery, ECMO arterial line) in patients at risk of Harlequin syndrome (also called differential hypoxemia (DH)) can localize the "mixing cloud" along the aorta. Focusing the attention on the "mixing cloud" position instead of on isolated flows of Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) and Impella CP makes the decision making easier about how to modify MCSs flows according to the clinical context. Herein, we present two cases in which ECPELLA configuration was used to treat a cardiogenic shock condition and how the ECPELLA-induced hypoxia was managed.


Assuntos
Doenças do Sistema Nervoso Autônomo , Hipo-Hidrose , Humanos , Hipo-Hidrose/complicações , Hipo-Hidrose/terapia , Aorta , Hipóxia
3.
Int J Clin Pract ; 2023: 4191277, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36713953

RESUMO

Objective: To summarize the experience of the postoperative intensive care treatment of Stanford type A aortic dissection (STAAD) following Sun's procedure. Methods: A total of 124 patients with STAAD who underwent Sun's procedure from January 2014 to December 2021 at the General Hospital of Ningxia Medical University were retrospectively analyzed. All patients were admitted to the cardiac surgery intensive care unit (ICU) after surgery. According to the perioperative characteristics of the patients with STAAD, intensive care treatment was given to actively prevent the occurrence of postoperative complications. Results: In all the cases enrolled in this study, the causes of aortic dissection comprised hypertension (105 cases), trauma (six cases), Marfan's syndrome (six cases), and aorto-arteritis (seven cases). The history of past illnesses comprised hypertension (105 cases), coronary disease (25 cases), diabetes mellitus (16 cases), and chronic obstructive pulmonary disease (six cases). There were some preoperative complications, such as cardiac insufficiency, acute liver insufficiency, acute renal insufficiency, pleural effusion, pericardial effusion, pulmonary infection, lower limb ischemia, mesenteric arterial embolism, and digestive tract hemorrhage. The average cardiopulmonary bypass time was 186 ± 32.1 min, the aortic clamp time was 74 ± 12.8 min, the deep hypothermic circulatory arrest time was 21 ± 2.6 min, and the mechanical ventilation time was 34 ± 2.8 h. The average ICU and hospital residence times were 7 ± 1.6 days and 12 ± 3.6 days, respectively. Postoperative complications comprised hypoxemia (34 cases), pulmonary infections (22 cases), tracheostomy (four cases), cerebral hemorrhage (four cases), cerebral infarction (four cases), transient delirium (eight cases), secondary thoracotomies due to bleeding (two cases), alimentary tract hemorrhage (eight cases), and acute renal insufficiency (38 cases). There was no occurrence of hoarseness or chylothorax. There were 15 cases of death, and the total mortality rate was 12.1%. In four cases, the cause of death was one postoperative complication (3.2%), and in 11 cases, the cause of death was multiple postoperative complications (8.9%). The other patients were discharged from the hospital with a good prognosis for full recovery. Conclusion: Postoperative intensive care treatment was an important part of the successful surgical treatment of STAAD.


Assuntos
Humanos , Estudos Retrospectivos , Aorta/cirurgia , Complicações Pós-Operatórias/etiologia , Cuidados Críticos
4.
In Vivo ; 37(1): 88-98, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36593031

RESUMO

AIM: To compare 4D flow magnetic resonance imaging (MRI) and 2D phase contrast (PC) MRI when evaluating bicuspid (BAV) and tricuspid (TAV) aortic valves. MATERIALS AND METHODS: A total of 83 subjects (35 BAV, 48 TAV) were explored with 4D flow and 2D PC MRI. Systolic peak velocity, peak flow and regurgitation fraction were analysed at two pre-defined aortic levels (aortic root, mid-tubular). Furthermore, the two methods of 4D flow analysis (Heart and Artery) were compared. RESULTS: Correlation between the 2D PC MRI and 4D flow MRI derived parameters ranged from moderate (R=0.58) to high (R=0.90). 4D flow MRI yielded significantly higher peak velocities in the tubular aorta in both groups. Regarding the aortic root, peak velocities were significantly higher in the TAV group with 4D flow MRI, but in the BAV group 4D flow MRI yielded non-significantly lower values. Findings on peak flow differences between the two modalities followed the same pattern as the differences in peak velocities. 4D flow MRI derived regurgitation fraction values were lower in both locations in both groups. Interobserver agreement for different 4D flow MRI acquired parameters varied from poor (ICC=0.07) to excellent (ICC=1.0) in the aortic root, and it was excellent in the tubular aorta (ICC=0.8-1.0). CONCLUSION: 4D flow MRI seems to be accurate in comparison to 2D PC MRI in normal aortic valves and in BAV with mild to moderate stenosis. However, the varying interobserver reproducibility and impaired accuracy at higher flow velocities should be taken into account in clinical practice when using the 4D flow method.


Assuntos
Doença da Válvula Aórtica Bicúspide , Doenças das Valvas Cardíacas , Humanos , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/patologia , Doença da Válvula Aórtica Bicúspide/patologia , Reprodutibilidade dos Testes , Aorta/diagnóstico por imagem , Imageamento por Ressonância Magnética , Velocidade do Fluxo Sanguíneo , Hemodinâmica
5.
Artigo em Inglês | MEDLINE | ID: mdl-36598345

RESUMO

Surgically explanting a failed transcatheter aortic valve can be challenging due to substantial neoendothelialization and may require concomitant and often unanticipated repairs of the aortic root and ascending aorta. We describe the explant of a failed transcatheter aortic valve-in-transcatheter aortic valve with surgical aortic valve replacement and pericardial patch repair of the aortic root. This case report illustrates that appropriate patient selection is essential for transcatheter aortic valve replacement, especially as transcatheter technology expands to lower-risk and younger patients.


Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Humanos , Estenose da Valva Aórtica/cirurgia , Aorta Torácica/cirurgia , Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Aorta/cirurgia , Resultado do Tratamento
6.
Development ; 150(1)2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36602140

RESUMO

Recent studies have highlighted the crucial role of the aorta microenvironment in the generation of the first haematopoietic stem cells (HSCs) from specialized haemogenic endothelial cells (HECs). Despite more than two decades of investigations, we require a better understanding of the cellular and molecular events driving aorta formation and polarization, which will be pivotal to establish the mechanisms that operate during HEC specification and HSC competency. Here, we outline the early mechanisms involved in vertebrate aorta formation by comparing four different species: zebrafish, chicken, mouse and human. We highlight how this process, which is tightly controlled in time and space, requires a coordinated specification of several cell types, in particular endothelial cells originating from distinct mesodermal tissues. We also discuss how molecular signals originating from the aorta environment result in its polarization, creating a unique entity for HSC generation.


Assuntos
Hemangioblastos , Peixe-Zebra , Animais , Humanos , Camundongos , Peixe-Zebra/metabolismo , Células-Tronco Hematopoéticas/metabolismo , Hemangioblastos/metabolismo , Proteínas de Peixe-Zebra/metabolismo , Aorta , Diferenciação Celular , Hematopoese
9.
Turk Kardiyol Dern Ars ; 51(1): 69-71, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36689286

RESUMO

A bicuspid aortic valve (BAV) is one of the most congenital anomalies of the heart in adults. It is also associated with a higher-than-expected incidence of coronary artery anomalies. We present a rare case of congenital BAV associated with anomalous origin of the left main coronary artery (LMCA) from the posterior left coronary sinus of Valsalva in young symptomatic athlete.


Assuntos
Doença da Válvula Aórtica Bicúspide , Anomalias dos Vasos Coronários , Seio Aórtico , Adulto , Humanos , Valva Aórtica/anormalidades , Anomalias dos Vasos Coronários/complicações , Aorta , Doença da Válvula Aórtica Bicúspide/complicações
10.
Curr Opin Cardiol ; 38(2): 75-81, 2023 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-36718617

RESUMO

PURPOSE OF REVIEW: Acute aortic syndromes include acute aortic dissection, intramural hematoma, and penetrating aortic ulcer, and are associated with high mortality and morbidity. This review focuses on recent findings and current understanding of gender-related and sex-related differences in acute aortic syndromes. RECENT FINDINGS: Large international and national registries, population studies, and multicentre national prospective cohort studies show evidence of sex differences in acute aortic syndromes. Recent studies of risk factors, aorta remodelling, and genetics provide possible biological basis for sex differences. The 2022 American College of Cardiology/American Heart Association Guidelines for the Diagnosis and Management of Aortic Disease revise recommendations for surgical management for aortic root and ascending aorta dilatation, which could impact outcome differences between the sexes. SUMMARY: Acute aortic syndromes affect men more frequently than women. The prevalence of acute aortic syndromes and prevalence of many risk factors rise sharply with age in women leading to higher age at presentation for women. Times from symptom onset to presentation and presentation to diagnosis are delayed in female patients. Females with type A dissection are also more commonly treated conservatively than male counterparts. These factors likely contribute to higher early mortality and complications in women.


Assuntos
Doenças da Aorta , Humanos , Feminino , Masculino , Caracteres Sexuais , Fatores Sexuais , Estudos Prospectivos , Doenças da Aorta/diagnóstico , Doenças da Aorta/terapia , Aorta , Doença Aguda , Hematoma/terapia
11.
Curr Opin Cardiol ; 38(2): 61-67, 2023 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-36718616

RESUMO

PURPOSE OF REVIEW: Bicuspid aortic valve (BAV) disease is observed in 1-2% of the general population. In addition to valve-related complications (such as aortic stenosis and aortic regurgitation), individuals with BAV often develop dilatation of the proximal aorta (aortic root and ascending aorta), a condition termed BAV aortopathy. The development of BAV aortopathy can occur independent of valvular alterations and can lead to aneurysm formation, aortic dissection or aortic rupture. This review aims to update the clinician with an approach to BAV aortopathy decision making in keeping with the 2022 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline recommendations. RECENT FINDINGS: The ACC/AHA 2022 guidelines provide a contemporary and comprehensive approach to the diagnosis and treatment of aortic pathologies. We review the thresholds for replacement of the aortic root and/or ascending aorta along with the strength and level of evidence recommendations. We also review the various Class 2A and 2B recommendations for earlier intervention, which emphasize the importance of experienced surgeons, and multidisciplinary aortic teams (MATs). SUMMARY: BAV aortopathy is a common and heterogenous clinical problem. The decision making around timing of intervention requires a personalized approach that is based on the aortic dimensions, valve function, rate of growth, family history, patient factors, and surgical experience within MATs.


Assuntos
Estenose da Valva Aórtica , Doença da Válvula Aórtica Bicúspide , Doenças das Valvas Cardíacas , Humanos , Doença da Válvula Aórtica Bicúspide/complicações , Doença da Válvula Aórtica Bicúspide/patologia , Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Fatores de Risco , Aorta/patologia , Aorta/cirurgia , Estenose da Valva Aórtica/cirurgia
12.
BMC Cardiovasc Disord ; 23(1): 36, 2023 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-36670346

RESUMO

BACKGROUND: Abdominal aortic aneurysm (AAA) is an aortic enlargement in which the transverse diameter reaches at least 30 mm. Certain risk factors, such as age, male gender, and smoking, are well known; however, less is known about the genetic factors involved. Fibrillin-1 (FBN1) is a protein that coordinates the deposition of elastin fibres in the extracellular matrix and is therefore likely to affect the elastic properties in the aortic wall. Previously studies have found associations between the FBN1-2/3 genotype and arterial stiffness, but how different FBN1 genotypes, AAA, and arterial stiffness are related has been less frequently investigated. AIM: This study aimed to investigate whether there is a difference in FBN1 genotype between men with and without AAA. A further aim was to study whether the FBN1 genotype affects arterial wall stiffness differently in men with and without AAA. METHODS: Pulse wave velocity and FBN1 genotyping were performed in 229 men (159 with AAA, 70 without AAA). Participants were recruited from ultrasound AAA surveillance programs or ongoing ultrasound screening programs from 2011 to 2016. RESULTS: The distribution of the FBN1 genotype in the AAA and control groups were as follows: FBN1-2/2: 62% vs. 64%; FBN1-2/3: 8% vs. 14%; and FBN1-2/4: 30% vs. 21%, respectively. Men with AAA and FBN1-2/2 had increased central pulse wave velocity (p < 0.005) compared to the control group (those without AAA) with the FBN1-2/2 genotype. CONCLUSION: No differences were found with respect to FBN1 genotypes between men with and without AAA. The development of AAA in men does not appear to be linked to a specific FBN1 genotype. Nevertheless, men with FBN1-2/2 and AAA have increased central arterial stiffness compared to men with the same FBN1 genotype but without AAA.


Assuntos
Aneurisma da Aorta Abdominal , Análise de Onda de Pulso , Humanos , Masculino , Fibrilina-1/genética , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/genética , Genótipo , Aorta , Fatores de Risco
13.
Shock ; 59(1): 74-81, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36703278

RESUMO

ABSTRACT: Kawasaki disease (KD) is a systemic vasculitis of childhood characterized by vascular damage in the acute stage, which can persist into the late stage. The vascular mechanisms in the cardiovascular risk of KD are not fully studied. We investigated the vascular function and blood pressure in a murine model of KD. We used the Candida albicans water-soluble (CAWS) fraction model. Mice were injected with 4 mg CAWS for 5 consecutive days and separated into three groups. Control, CAWS 7 days (C7), and CAWS 28 days (C28). Hearts and arteries were harvested for vascular characterization. Rat aortic smooth muscle cells were used to studies in vitro. C7 presented elevated inflammatory markers in the coronary area and abdominal aortas, whereas C28 showed severe vasculitis. No difference was found in blood pressure parameters. Vascular dysfunction characterized by higher contractility to norepinephrine in C7 and C28 in aortic rings was abolished by blocking nitric oxide (NO), reactive oxygen species, and cyclooxygenase (COX)-derived products. The CAWS complex increased COX2 expression in rat aortic smooth muscle cells, which was prevented by Toll-like receptor 4 antagonist. Our data indicate that the murine model of KD is associated with vascular dysfunction likely dependent on COX-derived products, oxidant properties, and NO bioavailability. Furthermore, vascular smooth muscle cell may present an important role in the genesis of vascular dysfunction and vasculitis via the Toll-like receptor 4 pathway. Finally, the CAWS model seems not to be appropriate to study KD-associated shock. More studies are necessary to understand whether vascular dysfunction and COXs are triggers for vasculitis.


Assuntos
Síndrome de Linfonodos Mucocutâneos , Vasculite , Camundongos , Animais , Ratos , Síndrome de Linfonodos Mucocutâneos/metabolismo , Receptor 4 Toll-Like , Pressão Sanguínea , Modelos Animais de Doenças , Aorta , Candida albicans
14.
J Biomech ; 147: 111432, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36634401

RESUMO

The stress distribution in ascending thoracic aortic aneurysms is determined by the mechanical properties, geometry, loading conditions, and zero-stress state of the aneurysmal aorta. Our objective was to fully characterize the zero-stress state of the aneurysmal aorta in twelve tricuspid aortic valve patients and eight (age/aortic diameter-matched) bicuspid aortic valve patients, for which little data are available. Opening angles and residual stretches were measured for the intact wall and individual layers according to quadrant and were similar in the two patient groups. The intact-wall and medial opening angles were comparable; their circumferential but not their axial ones peaked in the left lateral quadrant, with non-significant regional differences in the other layers. The intima's circumferential opening angles were the highest of all layers (∼300 deg) and the adventitia's the lowest (∼165 deg), with lesser layer differences in the axial opening angles. Upon radially cutting aortic rings, the released circumferential residual stretches were tensile (of large magnitude) externally and compressive (of small magnitude) internally, unlike the axial residual stretches released when cutting intact-wall strips, whose magnitude was small externally and large internally. Nevertheless, large circumferential compressive residual stretches were released in the adventitia upon layer dissection, counteracting the large circumferential tensile stretches of the intact wall externally. Moreover, the large axial tensile residual stretches of the intima counteracted the large axial compressive stretches of the intact wall internally. These layer-specific residual stretches may moderate the in-vivo stress gradients across wall thickness, serving as a protective mechanism against aortic dissection or rupture.


Assuntos
Aneurisma da Aorta Torácica , Humanos , Fenômenos Biomecânicos , Estresse Mecânico , Aorta , Valva Aórtica
15.
J Biomech ; 147: 111457, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36701962

RESUMO

Chronic hypoxia during gestation and postnatal period induces pulmonary hypertension, aorta stiffening and vascular remodeling. In this study, we hypothesized that a postnatal treatment with Cinaciguat, a guanylate cyclase activator, may improve the vascular function by enhancing NO-sGC pathways that induce vasodilation. To assess this, we collected aortas from six lambs gestated, born and raised at 3600 masl. Half of these lambs received a Cinaciguat postnatal treatment, while the other half was used as control (vehicle). Uniaxial tension was applied on samples of each group of aortas (control and Cinaciguat-treated) through cyclic loading. The obtained stress-stretch curves were used to identify constitutive parameters of a hyperelastic damage model. These material constants allowed us to assess the softening/dissipation behavior and to characterize the treatment effects. Results showed that Cinaciguat has an effect on the damage behavior at large strains, altering the damage onset under uniaxial tension. We conclude that Cinaciguat, as a vasodilator, can prevent the very early effects of vascular remodeling caused by perinatal hypoxia, and improve the aortic-tissue damage properties of hypoxic lambs.


Assuntos
Guanilato Ciclase , Remodelação Vascular , Gravidez , Feminino , Animais , Ovinos , Guanilil Ciclase Solúvel/metabolismo , Guanilato Ciclase/metabolismo , Aorta/metabolismo
16.
J Biomech ; 146: 111422, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36610388

RESUMO

Transvalvular pressure gradient (ΔP) after aortic valve replacement is an important surrogate of aortic bioprostheses performance. Invasive ΔP is often measured after transcatheter aortic valve replacement to exclude patient-prosthetic mismatch. However, invasive aortic pressures are usually recorded in the pressure recovery (PR) zone downstream of the valve, potentially resulting in ΔP underestimation compared to noninvasive measurements. PR was extensively studied in straight ascending aortas. However, the impact of various aortic arch configurations on ΔP has not been explored. PR was assessed in a pulse duplicating simulator at various cardiac conditions of cardiac output, heart rates and pressures. Three different aortic geometries with identical root dimensions but with different aortic arches were used: (1) curvature 1, (2) curvature 2, and (3) straight aortic models. Instantaneous pressure and peak ΔP measurements were recorded incrementally along the models for each cardiac condition. The models with aortic arches produced two distinct PR zones (after the valve and after the aortic arch), whereas the model without an aortic arch produced only one PR zone (after the valve). The trend of the pressure and ΔP curves for each model was independent of the cardiac condition used, but the individually measured pressure magnitudes did change with different conditions. In this study, we illustrated the differences in PR between distinct aortic curvatures and straight aorta. PR affects pressure and ΔP measurements. These effects are clear when recording aortic pressures by catheterization and echocardiography.


Assuntos
Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Humanos , Valva Aórtica/fisiologia , Débito Cardíaco , Estenose da Valva Aórtica/cirurgia , Aorta , Desenho de Prótese
17.
Life Sci Alliance ; 6(3)2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36625204

RESUMO

Baroreceptors are nerve endings located in the adventitia of the carotid sinus and aortic arch. They act as a mechanoelectrical transducer that can sense the tension stimulation exerted on the blood vessel wall by the rise in blood pressure and transduce the mechanical force into discharge of the nerve endings. However, the molecular identity of mechanical signal transduction from the vessel wall to the baroreceptor is not clear. We discovered that exogenous integrin ligands, such as RGD, IKVAV, YIGSR, PHSRN, and KNEED, could restrain pressure-dependent discharge of the aortic nerve in a dose-dependent and reversible manner. Perfusion of RGD at the baroreceptor site in vivo can block the baroreceptor reflex. An immunohistochemistry study showed the binding of exogenous RGD to the nerve endings under the adventitia of the rat aortic arch, which may competitively block the binding of integrins to ligand motifs in extracellular matrix. These findings suggest that connection of integrins with extracellular matrix plays an important role in the mechanical coupling process between vessel walls and arterial baroreceptors.


Assuntos
Mecanotransdução Celular , Pressorreceptores , Ratos , Animais , Pressorreceptores/fisiologia , Aorta/inervação , Artérias
18.
J Cardiothorac Surg ; 18(1): 22, 2023 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-36635783

RESUMO

BACKGROUND: Behcet's disease is a multi-system inflammatory disorder. A small subset of patients with Behcet's develop relapsing polychondritis which is classified as a separate disease known as Mouth and Genital ulcers with inflamed cartilage (MAGIC syndrome). It has previously been observed that this condition can also affect the cartilaginous tissue in the tracheobronchial tree. CASE PRESENTATION: We present the case of a 44-year-old lady with Behcet's Disease, Mouth and Genital ulcers with inflamed cartilage (MAGIC) syndrome and an aortic Frozen Elephant Trunk (FET) who presented to hospital with recurrent episodes of left lobar collapse of the lung. During bronchoscopy, we found the presence of multiple inflammatory endobronchial webs occluding segments of the left bronchial tree. Repeated examinations showed evidence that these inflammatory webs were progressing in size, density and location. Furthermore, we noticed herniation of her descending aortic FET into her left bronchial tree forming an aorto-bronchial fistula which was complicated by a graft infection. Her descending aortic FET section was surgically replaced with an open procedure and bronchoscopic interventions attempted to remove the occlusions in her bronchial tree. Despite optimisation of medical management and surgical correction, this patient continued to develop progressive occlusion of her left bronchial tree, resulting in a chronically collapsed left lung. CONCLUSIONS: A multi-disciplinary team approach is of paramount importance in order to optimally manage patients with Behcet's disease, balancing immunosuppressive regimens that need close monitoring and titration in the context of potential surgical intervention and the risk for intercurrent infection.


Assuntos
Síndrome de Behçet , Fístula Brônquica , Humanos , Feminino , Adulto , Síndrome de Behçet/complicações , Úlcera/complicações , Fístula Brônquica/cirurgia , Fístula Brônquica/complicações , Aorta , Complicações Pós-Operatórias
19.
J Mech Behav Biomed Mater ; 138: 105647, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36610281

RESUMO

The authors have observed that a stress-strain curve for uniaxial tension of an aortic intact wall cannot be simply obtained by combining the strain energy functions of the three individual aortic layers - intima, media and adventitia - even taking into account the interaction among the three layers; the strain energy functions of the three layers are obtained fitting tensile tests on strips from the individual layers. Due to the layer separation, the residual stresses are released and thus they do not affect the stress-strain curves of the individual layers. The present study shows that it is instead possible to fit the intact wall experimental curves with the combination of the strain energy functions of the three individual layers if residual strains are added. The residual strains are used as optimization parameters with specific constraints and allowing for the buckling (wrinkling) of the intima under unpressurized condition of the aortic wall, as experimentally observed. By varying these parameters in the experimentally observed range of values, it is possible to find a solution with the combined responses of the individual layers matching the experimental stress-strain curves of the intact wall.


Assuntos
Aorta , Túnica Íntima , Estresse Mecânico , Fenômenos Biomecânicos , Aorta/fisiologia , Túnica Média
20.
J Cardiothorac Surg ; 18(1): 19, 2023 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-36631825

RESUMO

BACKGROUND: Traumatic aortic pseudoaneurysms (PSAs) classified as grade III aortic injuries are conventionally repaired as procedural emergencies, generally within 24 h of arrival. These patients typically require adequate resuscitation and treatment of multiple traumatic injuries, which complicate optimal management strategies of aortic PSAs. This study reviews the experience of an Asian single center to evaluate the efficacy and safety of delayed (> 24 h) endovascular repair for PSAs. METHODS: Twenty-seven patients with blunt aortic injury (BTAI) were brought to our institution between February 2014 and May 2020. Patients with other grades of aortic injuries (grade I, II, or IV) were excluded from the study, and the remaining patients with grade III aortic injuries were placed into the early (< 24 h) and delayed (> 24 h) groups according to the timing of repair. Medical records and follow-up computed tomography (CT) scans were reviewed to document the outcomes of the procedures. Primary outcomes included mortality and complications. RESULTS: During this period, there were 14 patients (13 males and 1 females) with aortic PSAs, and each patient received thoracic endovascular aortic repair (TEVAR). Of these 14 patients, 1 underwent emergent TEVAR, and 13 underwent delayed repair (median 7 days, range, 3-14 days). Over a period of 8 years, the overall survival of our series was 100%. No paraplegia, stroke, ischemia of limb or other serious procedural complications were observed during the duration of follow-up. CONCLUSION: The experience of our center indicates that delayed repair for selected PSAs could be permissible, which enables a repair in more controlled circumstances.


Assuntos
Falso Aneurisma , Procedimentos Endovasculares , Feminino , Humanos , Masculino , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Aorta/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aorta Torácica/lesões , Implante de Prótese Vascular , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Estudos Retrospectivos , Traumatismos Torácicos/cirurgia , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/cirurgia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/cirurgia
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