13,384 results on '"Ascending aorta"'
Search Results
202. Role of autophagy in aneurysm and dissection of the ascending aorta.
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Lusini, Mario, Nenna, Antonio, Chello, Camilla, Greco, Salvatore Matteo, Gagliardi, Ilaria, Nappi, Francesco, and Chello, Massimo
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ASCENDING aorta dissection ,AUTOPHAGY ,HUMAN dissection ,TRANSFERASES ,ESTERASES ,AORTA ,VETERINARY dissection - Abstract
Maintenance of physiologically balanced levels of autophagy is crucial for cellular homeostasis and in the normal vessel wall, balanced autophagy can be considered a cytoprotective mechanism that preserves endothelial function and prevents cardiovascular disease. Recent studies pointed out the importance of the modulation of the autophagic flux in the pathogenesis of aortic dissection and aneurysms of the ascending aorta. Notably, shear stress (and its receptor p62), IL-6, Rab7 and Atg5/IRE1α pathways of autophagy may be considered the novel super-selective therapeutic target for the preventive and postoperative treatment of aortic aneurysm and aortic dissection. This review intends to summarize current evidences in this field trying to enlighten new avenues for future researches. [ABSTRACT FROM AUTHOR]
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- 2020
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203. Discrepancies in Measurement of the Thoracic Aorta: JACC Review Topic of the Week.
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Elefteriades, John A, Mukherjee, Sandip K, and Mojibian, Hamid
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Clinicians often encounter discrepant measurements of the ascending aorta that impede, complicate, and impair appropriate clinical assessment-including key issues of presence or absence of aortic growth, rate of growth, and need for surgical intervention. These discrepancies may arise within a single modality (computed tomography scan, magnetic resonance imaging, or echocardiography) or between modalities. The authors explore the origins and significance of these discrepancies, revealing that some "truth" usually underlies all the discrepant measurements, which individually look at the ascending aorta with different perspectives and dimensional definitions. The authors conclude with a practical "question and answer" section that addresses common specific issues in interpretation and management of patients in the real-world setting. [ABSTRACT FROM AUTHOR]
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- 2020
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204. Hemodynamics and tissue biomechanics of the thoracic aorta with a trileaflet aortic valve at different phases of valve opening.
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Sundström, Elias, Jonnagiri, Raghuvir, Gutmark‐Little, Iris, Gutmark, Ephraim, Critser, Paul, Taylor, Michael D., and Tretter, Justin T.
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THORACIC aorta , *AORTIC valve , *TISSUE mechanics , *HEMODYNAMICS , *HEART beat , *FLUID-structure interaction - Abstract
In a normal cardiac cycle, the trileaflet aortic valve opening is progressive, which correlates with the phasic blood flow. Therefore, we aimed to determine the impact of including an anatomically accurate reconstructed trileaflet aortic valve within a fluid‐structure interaction (FSI) simulation model and determine the cyclical hemodynamic forces imposed on the thoracic aortic walls from aortic valve opening to closure. A pediatric patient with a normal trileaflet valve was recruited. Using the Cardiac Magnetic Resonance Data (CMR), a 3D model of the aortic valve and thoracic aorta was reconstructed. FSI simulations were employed to assess the tissue stress during a cardiac cycle as the result of changes in the valve opening. The blood flow was simulated as a mixture of blood plasma and red blood cells to account for non‐Newtonian effects. The computation was validated with phase‐contrast CMR. Windkessel boundary conditions were employed to ensure physiological pressures during the cardiac cycle. The leaflets' dynamic motion during the cardiac cycle was defined with an analytic grid velocity function. At the beginning of the valve opening a thin jet is developing. From mid‐open towards full opening the stress level increases where the jet impinges the convex wall. At peak systole two counter‐rotating Dean‐like vortex cores manifest in the ascending aorta, which correlates with increased integrated mean stress levels. An accurate trileaflet aortic valve is needed for capturing of both primary and secondary flow features that impact the forces on the thoracic aorta wall. Omitting the aortic valve underestimates the biomechanical response. [ABSTRACT FROM AUTHOR]
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- 2020
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205. Evaluation of the Effect of Essential Hypertension on Elasticity of Ascending Aorta in Type 2 Diabetic Mellitus Patients by Echocardiography.
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Song, Xiang-Ting, Fan, Li, Yan, Zi-Ning, and Rui, Yi-Fei
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TYPE 2 diabetes complications , *AORTA , *ARTERIAL diseases , *BLOOD pressure measurement , *COMPARATIVE studies , *ECHOCARDIOGRAPHY , *ELASTICITY , *ESSENTIAL hypertension , *LONGITUDINAL method , *DISEASE complications - Abstract
Both essential hypertension (EH) and type 2 diabetes mellitus (T2DM) can impair the elasticity of the ascending aorta. We prospectively enrolled 42 patients with T2DM, 44 patients with EH, 45 patients with T2DM and EH (T2DM + EH), and 41 healthy subjects (HS). They all underwent transthoracic echocardiography to measure ascending aorta inner diameters and a brachial blood pressure measurement to calculate aortic elastic parameters (ie, compliance, distensibility, strain, stiffness index, and Peterson elastic modulus). We found that there were no significant differences as regard with age, sex, body mass index, blood lipids and glucose, carotid atherosclerosis, and ascending aorta inner diameters among the 4 groups. The aortic elastic properties were significantly impaired in T2DM, EH, and T2DM + EH patients compared with the HS, and more impaired in EH and T2DM + EH patients than T2DM patients; there were no significant differences between EH and T2DM + EH patients. Our findings suggest that both T2DM and EH can impair aortic elastic properties. Essential hypertension may play a more important role in the process of ascending aorta sclerosis in patients with T2DM + EH. [ABSTRACT FROM AUTHOR]
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- 2020
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206. Selecting The Arterial Cannulation Site In Acute Type A Aortic Dissection: Axillary Artery Or Femoral Artery?
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Şahinalp, Şahin and Gür, Ali Kemal
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FEMORAL artery , *AORTIC dissection , *AXILLARY artery , *CATHETERIZATION , *OPERATIVE surgery - Abstract
The aim of this study was to investigate the effects of cannulation site (either the right axillary artery or the right/left main femoral artery) on the mortality and morbidity of postoperative acute type A aortic dissection (ATAAD) patients. A total of 41 ATAAD patients (male:female = 29:12), of whom 15 underwent cannulation of the right axillary and 26 of the common femoral artery, were retrospectively evaluated. Post -operative mortality and morbidity were assessed and statistically analyzed. Of the participants, 34 (82.9%) were type I and 7 (17.0%) were type II according to the DeBakey classification. Cerebral protection was achieved using deep hypothermia in 14 patients, and by antegrade cerebral perfusion in addition to deep hypothermia in 9 patients. Early postoperative mortality was 17% (n= 7) . There were no significant differences between the axillary artery and femoral artery cannulation groups in terms of postoperative mortality and morbidity. However, a greater number of arcus aortic interventions was performed in the group undergoing axill ary artery cannulation (Group II). In this group, the rate of antegrade cerebral perfusion was also higher. Although the cannulation site in patients with ATAAD was not determined to affect mortality and morbidity, both options present advantages and disadvantages. We believe that all relevant factors pertaining to the patient as well as the surgical procedure to be employed should be evaluated in tandem in selecting the optimal cannulation site. [ABSTRACT FROM AUTHOR]
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- 2020
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207. Effect of moderate hypothermic circulatory arrest on neurological outcomes in elderly patients undergoing replacement of the thoracic aorta.
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Salem, Mohamed, Friedrich, Christine, Thiem, Alexander, Salem, Mostafa Ahmed, Puehler, Thomas, Rusch, Rene, Berndt, Rouven, Cremer, Jochen, and Haneya, Assad
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Background: Various studies evaluated the relationship between hypothermic circulatory arrest and neurological outcome in patients undergoing replacement of ascending aorta. The current analysis focuses on the effect of moderate hypothermic circulatory arrest (MHCA) on elderly patients. The aim of our study was to evaluate the impact of MHCA on neurological outcomes in elderly patients undergoing replacement of the ascending aorta. Results: We retrospectively analyzed 905 consecutive patients, who underwent elective replacement of ascending aorta in MHCA (24 ± 2 °C, nasopharyngeal) between 2001 and 2015. Patients with acute aortic dissection were excluded from this study. Patients were divided into two groups: those aged 75 years and older (elderly group 22.4%, n = 203) and those younger than 75 years (younger group 77.6%, n = 702). The average age was 63.2 ± 10.2 in the young group vs. 78.7 ± 3.0 years in elderly group (p < 0.001). The elderly group had a significantly higher EuroSCORE II [26.7% (18.1, 36.3) vs. 11.6% (7.4, 19.9); p < 0.001)]. The incidence of coronary heart disease (49.8% vs. 35.6%, p < 0.001) and chronic renal failure (17.2% vs. 9.1%, p = 0.001) was significantly higher in the elderly group. Intraoperatively, the time of MHCA [14 min (12, 17) vs. 15 min (12, 18); p = 0.42], cardiopulmonary bypass [139 min (110, 183) vs. 144 min (113, 189); p = 0.225], and cross-clamping [91 min (63, 116) vs. 92 min (65, 127); p = 0.348] was similar in both groups. Postoperatively, a higher incidence of delirium was significantly reported in the elderly group (24.1% vs. 9.0%, p < 0.001). However, there was no significant difference regarding neurological complications between both groups. A 30-day mortality was acceptable for the elderly group, but significantly higher compared with the younger group (7.1% vs. 3.5%, p = 0.031). Conclusions: Our study suggests that surgical replacement of the ascending aorta in MHCA can also be applied safely in elderly patients without increasing the risk of severe neurological complications. [ABSTRACT FROM AUTHOR]
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- 2020
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208. Detailed Echocardiographic Measurements of Individual Chamber in a Chinese Cohort of Hypoplastic Left Heart Syndrome and Comparison with Normal Fetuses via Z-score Modeling.
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Wu, Peng-Fei, Li, Rui-Zhuo, Zhang, Rongsen, Zhang, Wan, Li, Xinyan, Zeng, Shi, Liu, Minghui, Zhou, Qichang, Su, Zhongzhen, and Lin, Yu-hong
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HYPOPLASTIC left heart syndrome , *FETUS , *CONGENITAL heart disease , *LEFT heart atrium , *LEFT heart ventricle - Abstract
Hypoplastic left heart syndrome (HLHS) is a rare, but exceptionally serious, congenital heart defect. We aimed to explore the best-fitted Z-score models for individual chamber dimension and to draw a comparison between fetuses with HLHS and the normal Chinese cohort. We made measurements of 1674 healthy fetuses and 79 fetuses with HLHS, undertaking echocardiography. Normal fetal cardiovascular Z-score formulae were established by curve-fitting with 5 algorithmic functions and weighted regression of absolute residuals. Classic linear models were fitted for left ventricular diameter against gestational age, and log-transformed linear-power models-were statistically better for left ventricular length, diameter of left atrium and ascending aorta. Fetuses with HLHS manifested significantly lower Z-score means (≤3.5) for these 4 parameters and the vast majority (∼90%) lay beyond -2. Overall, cardiovascular Z-score equations were reliably constructed in a larger Chinese cohort, and their application should benefit evaluation and diagnosis of HLHS. [ABSTRACT FROM AUTHOR]
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- 2020
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209. Aortic root and ascending aorta dimensions in acute aortic dissection.
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Koechlin, Luca, Macius, Evelina, Kaufmann, Josefin, Gahl, Brigitta, Reuthebuch, Oliver, Eckstein, Friedrich, and Berdajs, Denis A
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ANTHROPOMETRY , *AORTA , *COMPARATIVE studies , *COMPUTED tomography , *CONFIDENCE intervals , *AORTIC dissection , *FISHER exact test , *MULTIVARIATE analysis , *REGRESSION analysis , *SEX distribution , *STROKE , *PREOPERATIVE period , *DESCRIPTIVE statistics , *KRUSKAL-Wallis Test , *DISEASE risk factors - Abstract
Objectives: Aim of this study was to evaluate ascending aorta and aortic root dimension at acute type A dissection (acute aortic dissection) and to identify demographics elements being allied to the acute event. Methods: In a period between 2009 and 2017, 225 (n = 71, 32% female, mean age = 63 ± 12 years) patients eligible for analysis of ascending aorta and 223 (n = 70, 31% female, mean age = 63 ± 13 years) of aortic root were included in this study. Aortic diameter was assessed in preoperative computed tomography scan. The predissection diameters were modeled from the diameters obtained at diagnosis, assuming 30% augmentation of the diameter at acute event. Results: The mean diameter of the ascending aorta at dissection was 46 ± 8 mm and the modeled diameter was 32.3 ± 5.7 mm. The diameter of the aortic root at dissection was 42 ± 8 mm and modeled diameter was 29.5 ± 5.6 mm. In multivariate analysis, female gender (p = 0.026) and history of cerebrovascular event (p = 0.001) were associated with acute aortic dissection in small aortic root. Patient age (p < 0.001) and history of inguinal hernia (p = 0.001) in ascending aorta <55 mm correlated with acute aortic dissection. Conclusion: Modeling indicates that more than 90% of patients had aortic root and ascending aorta diameter <45 mm. It seems that the aortic diameter expansion over the 55 mm in development of acute aortic dissection is overestimated. Parameters other than aortic size were identified, which may be considered when patients at high risk for dissection were identified. [ABSTRACT FROM AUTHOR]
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- 2020
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210. Epiaortic Ultrasound for Assessment of Intraluminal Atheroma; Insights from the REGROUP Trial.
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Shapeton, Alexander D., Leissner, Kay B., Zorca, Suzana M., Amirfarzan, Houman, Stock, Eileen M., Biswas, Kousick, Haime, Miguel, Srinivasa, Venkatesh, Quin, Jacquelyn A., and Zenati, Marco A.
- Abstract
To assess the use of epiaortic ultrasound in contemporary cardiac surgery, as well as its impact on surgical cannulation strategy and cerebrovascular events. Epiaortic ultrasound data was prospectively collected in the Randomized Endovein Graft Prospective (REGROUP) trial (VA Cooperative Studies Program #588, ClinicalTrials.gov, NCT01850082), which randomized 1,150 coronary artery bypass graft patients between 2014 and 2017 to endoscopic or open-vein graft harvest. Sixteen cardiac surgery programs within the Veterans Affairs Healthcare System with expertise at performing endoscopic vein-graft harvesting. Veterans Affairs patients, greater than 18 years of age, undergoing elective or urgent coronary artery bypass grafting with cardiopulmonary bypass and cardioplegic arrest with at least one planned saphenous vein graft were eligible for enrollment. Epiaortic ultrasound was performed by the surgeon using a high frequency (>7 MHz) ultrasound transducer. Two-dimensional images of the ascending aorta in multiple planes were acquired before aortic cannulation and cross-clamping. Epiaortic ultrasound was performed in 34.1% (269 of 790) of patients in REGROUP. Among these patients, simple intraluminal atheroma was observed in 21.9% (59 269), and complex intraluminal atheroma comprised 2.2% (6 of 269). The aortic cannulation or cross-clamp strategy was modified based on these findings in 7.1% of cases (19 of 269). There was no difference in stroke between patients who underwent epiaortic ultrasound and those who did not (1.9% v 1.2% p = 0.523). Despite current guidelines recommending routine use of epiaortic ultrasound (IIa/B) to reduce the risk of stroke in cardiac surgery, in this contemporary trial, use remains infrequent, with significant site-to-site variability. [ABSTRACT FROM AUTHOR]
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- 2020
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211. Acute type A aortic dissection - a review.
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Gudbjartsson, Tomas, Ahlsson, Anders, Geirsson, Arnar, Gunn, Jarmo, Hjortdal, Vibeke, Jeppsson, Anders, Mennander, Ari, Zindovic, Igor, and Olsson, Christian
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AORTIC dissection , *OPERATIVE surgery , *SURGEONS , *PERFUSION - Abstract
Acute type A aortic dissection (ATAAD) is still one of the most challenging diseases that cardiac surgeons encounter. This review is based on the current literature and includes the results from the Nordic Consortium for Acute Type-A Aortic Dissection (NORCAAD) database. It covers different aspects of ATAAD and concentrates on the outcome of surgical repair. The diagnosis is occasionally delayed, and ATAAD is usually lethal if prompt repair is not performed. The dynamic nature of the disease, the variation in presentation and clinical course, and the urgency of treatment require significant attentiveness. Many surgical techniques and perfusion strategies of varying complexity have been described, ranging from simple interposition graft to total arch replacement with frozen elephant trunk and valve-sparing root reconstruction. Although more complex techniques may provide long-term benefit in selected patients, they require significant surgical expertise and experience. Short-term survival is first priority so an expedited operation that fits in with the surgeon's level of expertise is in most cases appropriate. [ABSTRACT FROM AUTHOR]
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- 2020
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212. High prevalence of ascending aortic dilatation in a consecutive coronary CT angiography patient population.
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Kauhanen, S. Petteri, Saari, Petri, Jaakkola, Pekka, Korhonen, Miika, Parkkonen, Johannes, Vienonen, Juska, Vanninen, Ritva, Liimatainen, Timo, and Hedman, Marja
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CORONARY angiography , *SINUS of valsalva , *BODY surface area , *BODY size , *CORONARY disease , *AORTIC diseases , *PATHOLOGICAL anatomy , *RETROSPECTIVE studies , *DISEASE prevalence , *AORTA - Abstract
Objectives: To clarify the prevalence and risk factors of ascending aortic (AA) dilatation according to ESC 2014 guidelines.Methods: This study included 1000 consecutive patients scheduled for diagnostic coronary artery computed tomographic angiography. AA diameter was retrospectively measured in 3 planes: sinus valsalva, sinotubular junction, and tubular part. The threshold for AA dilatation was set to > 40 mm which has been suggested as an upper normal limit for AA diameter in ESC 2014 guidelines on aortic diseases. Aortic size index (ASI) using the ratio between aortic diameter and body surface area (BSA) was applied as a comparative measurement. The threshold for AA dilatation was set to the upper limit of normal distribution exceeding two standard deviations (95%). Risk factors for AA dilatation were collected from medical records.Results: The patients' mean age was 52.9 ± 9.8 years (66.5% women). The prevalence of AA dilatation was 23.0% in the overall study population (52.5% males) and 15.1% in the subgroup of patients with no coronary artery disease or bicuspid (BAV)/mechanical aortic valve (n = 365). According to the normal-distributed ASI values, the threshold for sinus valsalva was defined as 23.2 mm/m2 and for tubular part 22.2 mm/m2 in the subgroup. Higher BSA was associated with larger AA dimensions (r = 0.407, p < 0.001). Male gender (p < 0.001), BAV (p < 0.001), hypertension (p = 0.009) in males, and smoking (p < 0.001) appeared as risk factors for AA dilatation.Conclusions: The prevalence of AA dilatation is high with current ESC guidelines for normal AA dimension, especially in males. Body size is strongly associated with AA dimensions; it would be more reliable to use BSA-adjusted AA diameters for the definition of AA dilatation.Key Points: • The prevalence of AA dilatation is high in patients who are candidates for coronary CT angiography. • Body size is strongly associated with AA dimensions. [ABSTRACT FROM AUTHOR]- Published
- 2020
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213. NUMERICAL SIMULATION OF DILATION PATTERNS OF THE ASCENDING AORTA IN AORTOPATHIES.
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OLIVEIRA, DIANA C., LARANJO, SÉRGIO, TIAGO, JORGE, PINTO, FÁTIMA F., and SEQUEIRA, ADÉLIA
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AORTA , *FLUID-structure interaction , *MITRAL valve , *AORTIC valve insufficiency , *AORTIC valve , *COMPUTER simulation , *THORACIC aorta - Abstract
Aortic dilation is associated with congenital bicuspid aortic valve (BAV) disease, and its etiology is still not completely understood. The aim of this study is to provide further insight into aortic hemodynamics in a BAV population with different degrees of aortic dilation and regurgitation in comparison with a patient without pathology. A fluid–structure interaction (FSI) numerical approach is implemented regarding patient-specific geometries, where the aortic valves are defined by analytical orifices. Results show that, while the patient without pathology displays a typical hemodynamic behavior of flows in bends, BAV-related aortas present an accelerated flow along the outer aortic wall. Wall shear stress (WSS) overload in the outer curvature is observed, more marked in more dilated aortas. Moreover, helices in the ascending aorta are present in these patients, enhanced with greater dilation. These findings support the fact that hemodynamic factors play an important role in aortic dilation onset and development in BAV patients, caused by a prolonged exposure of the outer ascending aortic curvature to altered WSS. Besides, our results suggest that greater aortic regurgitation may be associated with abnormal WSS distributions in the ascending aorta during diastole, which can facilitate aortic root dilation. [ABSTRACT FROM AUTHOR]
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- 2020
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214. Effects of Normal Variation in the Rotational Position of the Aortic Root on Hemodynamics and Tissue Biomechanics of the Thoracic Aorta.
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Sundström, Elias, Jonnagiri, Raghuvir, Gutmark-Little, Iris, Gutmark, Ephraim, Critser, Paul, Taylor, Michael D., and Tretter, Justin T.
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Purpose: Variation in the rotational position of the aortic root relative to the left ventricle is present in normal trileaflet aortic valves. Its impact on the resulting fluid mechanics of blood flow in the thoracic aorta and structural mechanics in the aortic wall are unknown. We aimed to determine the regional hemodynamic and biomechanical differences in different rotational positions of the normal aortic root (clockwise, central, and counterclockwise positions). Method: Cardiac magnetic resonance imaging (CMR) data was acquired from a normal pediatric patient. These were used for reconstruction of the aortic valve and thoracic aorta 3D model. Fluid–structure interaction (FSI) simulations were employed to study the influence of the root rotation with a central position as compared to observed extreme variations. Patient-specific phase-encoding CMR data were used to assess the validity of computed blood flow. The 3D FSI model was coupled with Windkessel boundary conditions that were tuned for physiological pressures. A grid velocity function was adopted for the valve motion during the systolic period. Results: The largest wall shear stress level is detected in the clockwise positioned aortic root at the sinutubular junction. Two counter-rotating vortex cores are formed within the aortic root of both the central and extreme root configurations, however, in the clockwise root the vortex system becomes more symmetric. This also coincides with more entrainment of the valve jet and more turbulence production along the shear layer. Conclusion: A clockwise rotational position of the aortic root imparts an increased wall shear stress at the sinutubular junction and proximal ascending aorta in comparison to other root rotation positions. This may pose increased risk for dilation of the sinutubular junction and ascending aorta in the patient with a clockwise positioned aortic root compared to other normal positional configurations. [ABSTRACT FROM AUTHOR]
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- 2020
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215. Pulmonary trunk to ascending aorta ratio and reference values for diameters of pulmonary arteries and main bronchi in healthy adults.
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Pirinç, Büşra, Fazlıoğulları, Zeliha, Koplay, Mustafa, and Karabulut, Ahmet Kağan
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PULMONARY artery , *REFERENCE values , *AORTA , *BRONCHI , *DIAMETER - Abstract
Objectives: The ratio of the diameter of pulmonary trunk (PT) to the diameter of the ascending aorta (AA) is used to evaluate cardiopulmonary diseases. Different values have been reported for the normal value of PT:AA ratio (to be less than 0.9, 1 or 1.4). In this study, we aimed to investigate the diameters of the PT, right (RPA) and left pulmonary artery (LPA), AA, right (RMB) and left main bronchus LMB) using multidetector computed tomography (MDCT) and to determine reference values for PT:AA according to age and sex in normal healthy adults. Methods: Thoracic CT images of 200 individuals, (103 males, 97 females; age 18-89 years), without cardiopulmonary pathology and surgery, were retrospectively evaluated using MDCT. Diameters of PT, RPA, LPA, AA were measured at the level of the pulmonary artery bifurcationand PT:AA ratio was calculated. Results: The mean diameters of PT, AA, RPA, LPA, RMB, LMB were found as 2.7±0.51 cm, 3.25±0.63 cm, 1.98±0.46 cm, 1.81±0.43 cm, 1.73±0.35 cm, and 1.66±0.55 cm, respectively. The mean value of PT:AA ratio was 0.84±0.18 cm in males and 0.86±0.13 cm in females. . Conclusion: Determining the normal values of related measurements will contribute to diagnosis and treatment of cardiopulmonary diseases. [ABSTRACT FROM AUTHOR]
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- 2020
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216. Off-Pump Plicating Ascending Aortoplasty With External Wrapping: Magnum in Parvo.
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Kocica, Mladen J., Karadzic, Milica M., Cvetkovic, Dragan D., Grujic, Milos B., and Soskic, Ljiljana
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PATIENT selection , *OPERATIVE surgery , *MULTIDETECTOR computed tomography , *AORTA ,STERNUM surgery - Abstract
Background: Isolated, fusiform aneurysms, exclusively affecting the tubular portion of the ascending aorta, are rare. Surgical treatment aims to change their natural course, reducing individual and cumulative risks of rupture, dissection and death. Open tubular graft replacement still remains the procedure of choice, despite significant risks. In permanent pursuit for optimal, alternative surgical strategy in high-risk patients, less invasive and off-pump plicating ascending aortoplasty with modified external Dacron graft wrapping seems to be a reliable choice.Methods: Two (2) consecutive patients were operated on. The same preoperative calculations and slightly different operative techniques were applied regarding surgical exposure and wrapping graft orientation. Immediate and late follow-up (5 years) results were compared.Results: Absolute and indexed target ascending aortic diameters remained acceptable (<2.1cm/m2 considered the upper normal range for adults). There were no significant changes in proximal and distal aortic diameters. Ascending aortic silhouette on contrast enhanced multi-detector CT was better with Dacron wrapping graft tailored to have its grooves in the longitudinal direction. Upper mini-sternotomy was quite appropriate for this procedure, from a surgical point of view, and was safe for the patient.Conclusions: Careful patient selection and using the current model of preoperative calculations and surgical technique resulted in acceptable and stable ascending aortoplasty in high-risk patients 5 years after surgery. [ABSTRACT FROM AUTHOR]- Published
- 2019
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217. Transcription Factor TBX18 Reprograms Vascular Smooth Muscle Cells of Ascending Aorta to Pacemaker-Like Cells.
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Wang, Fengyuan, Zhao, Hongyi, Yin, Lin, Tang, Yanhong, Wang, Xi, Zhao, Qingyan, Wang, Teng, and Huang, Congxin
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HYPERPOLARIZATION (Cytology) , *VASCULAR smooth muscle , *MUSCLE cells , *TRANSCRIPTION factors , *AORTA , *CONNEXIN 43 , *GENE enhancers , *VOLTAGE-gated ion channels - Abstract
Vascular smooth muscle cells (VSMCs) of ascending aorta and TBX18+ sinus node both originated from the second heart field. The study explored whether ascending aortic smooth muscle cells in vitro could be reprogrammed into pacemaker-like cells with human TBX18. In the study, VSMCs were infected with TBX18, and then cocultured with neonatal rat ventricular cardiomyocytes (NRVMs) in vitro. By overexpressing TBX18, the transfected VSMCs expressed high levels of hyperpolarization-activated cyclic nucleotide-gated channel 4 (HCN4), insulin gene enhancer binding protein 1, and human dwarf homeobox gene SHOX2, cardiac troponin I, and low level of connexin 43. In addition, funny current (If) was recorded by patch clamp appeared the time and voltage dependence in TBX18 group, which the amplitude of If density was from −5.164 ± 0.662 pA/pF to −0.765 ± 0.358 pA/pF (n = 14). Furthermore, TBX18-transfected VSMCs coupled with NRVMs showed typical action potential of pacemaker-like cells and the beating rate was faster (178.00 ± 7.55 bpm, p < 0.05) compared with other groups. In conclusion, our study indicated that transcription factor TBX18 could reprogram VSMCs into pacemaker-like cells in vitro. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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218. Endovascular Treatment of the Ascending Aorta: is this the Last Frontier in Aortic Surgery?
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Saadi, Eduardo Keller, Tagliari, Ana Paula, and Almeida, Rui M. S.
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AORTA ,THORACIC aorta ,PATIENT selection ,GEOGRAPHIC boundaries ,SURGERY ,BLOOD vessel prosthesis - Abstract
Regardless the successful treatment of the descending aorta with endovascular prosthesis, for the ascending aorta segment, because of several anatomic and physiologic issues, this technique has been considered an alternative only for high-risk or inoperable patients. Despite restricted indications, hundreds of treatments have been performed worldwide, demonstrating its safety and reproducibility if it is done in high-quality centers. Therefore, understanding patients' selection criteria and technique limitations are critical to its application. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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219. Endovascular Hybrid Repair of True Ascending Aortic Aneurysms Using Double Graft Wrapping to Prepare a Landing Zone for Ascending Aortic Stent-Graft Placement: A Cohort Study.
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Kolvenbach, Ralf, Karmeli, Ron, Rabin, Assaf, and Lica, Raluca
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Purpose: To describe a hybrid procedure that avoids cardiopulmonary bypass to treat patients with true ascending aortic aneurysms without a suitable proximal landing zone for endovascular repair. Material and Methods: Thirteen consecutive patients (mean age 75.9±6.5 years; 8 women) with true ascending aortic aneurysms were treated with the endovascular hybrid repair of true aortic aneurysms (EHTA) approach, which consists of a conventional sternotomy with double wrapping of the ascending aorta followed by staged stent-graft placement. Via sternotomy, a polypropylene mesh trimmed to downsize the aneurysm is placed around the dilated ascending aorta and sutured to the adventitia. A similarly trimmed polytetrafluoroethylene graft is placed loosely around the first wrap to avoid adhesions and secure the proximal landing zone. There is no need for cardiopulmonary bypass. A few days later, a standard thoracic stent-graft is deployed via either a transaxillary or transfemoral access; chimney or bypass grafts are used as needed to revascularize the supra-aortic vessels. Results: The ascending aortic diameter was reduced from a mean 5.7 cm (range 4.8-6.5) to 3.9 cm (range 3.2-4.3) after wrapping. The mean interval between surgery and stent-graft placement was 5 days. In this interval, 2 patients with significant reduction in the diameter of the ascending aorta elected to forego placement of a stent-graft. Of the 11 patients who underwent the full hybrid EHTA procedure, the ascending aortic stent-graft was combined with a chimney graft in the innominate artery in 4 cases. In 1 patient, a supra-aortic debranching procedure using a bifurcated Dacron graft to the innominate and left common carotid arteries was performed after wrapping with the polypropylene mesh. There was no mortality or neurological complication. A sternal wound infection required a prolonged hospital stay. At a mean follow-up of 13.8 months (range 3-24), there has been no death, type I endoleak, or sign of aneurysm enlargement on imaging. Conclusion: This technique permits complete endovascular exclusion of an ascending aortic aneurysm in a less invasive approach than standard open repair. Although this is only a small cohort of patients without long-term follow-up, it seems that this hybrid procedure is associated with low morbidity and mortality. It offers a beating-heart approach to treat true ascending aortic aneurysms in selected high-risk patients. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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220. Molecular Pathways and Animal Models of Tetralogy of Fallot and Double Outlet Right Ventricle
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Kelly, Robert G., Rickert-Sperling, Silke, editor, Kelly, Robert G., editor, and Driscoll, David J., editor
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- 2016
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221. Thoracic Aortic Surgery in Marfan Syndrome
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Youssefi, Pouya, Jahangiri, Marjan, and Child, Anne H., editor
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- 2016
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222. Echocardiography in Diagnosis and Management of Patients with Marfan Syndrome
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Marciniak, Anna, Sharma, Rajan, and Child, Anne H., editor
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- 2016
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223. Aortic Dissection and Injury
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Kushwaha, Virag, Blackman, Daniel, Lindsay, Alistair, editor, Chitkara, Kamal, editor, and Di Mario, Carlo, editor
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- 2016
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224. Aortic regurgitation provokes phenotypic modulation of smooth muscle cells in the normal ascending aorta.
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Balint, Brittany, Bernstorff, Inés García Lascurain, Schwab, Tanja, and Schäfers, Hans-Joachim
- Abstract
Aortic complications are more likely to occur in patients with ascending aortic aneurysms and concomitant aortic regurgitation (AR). AR may have a negative influence on the aortic wall structure even in patients with tricuspid aortic valves and absence of aortic dilatation. It is unknown whether smooth muscle cell (SMC) changes are a feature of AR-associated aortic remodeling. Nondilated aortic samples were harvested intraoperatively from individuals with normal aortic valves (n = 10) or those with either predominant aortic stenosis (AS) (n = 20) or AR (n = 35). Tissue from each patient was processed for immunohistochemistry or used for the extraction of medial SMCs. Tissue and cells were stained for markers of SMC contraction (alpha-smooth muscle actin), synthesis (vimentin) and senescence (p16
INK4A and p21Cip1 [p16/p21]). Replicative capacity was analyzed in cultured SMCs from AS- and AR-associated aortas. A subanalysis compared SMCs from individuals with either tricuspid aortic valves or bicuspid aortic valves to evaluate the effect of aortic valve morphology. In aortic tissue samples, AR was associated with decreased alpha-smooth muscle actin and increased vimentin, p16 and p21 compared with normal aortic valves and AS. In cell culture, SMCs from AR-aortas had decreased alpha-smooth muscle actin and increased vimentin compared with SMCs from AS-aortas. AR-associated SMCs had increased p16 and p21 expression, and they reached senescence earlier than SMCs from AS-aortas. In AR, SMC changes were more pronounced with the presence of a bicuspid aortic valve. AR itself negatively influences SMC phenotype in the ascending aortic wall. This AR-specific effect is independent of aortic diameter and aortic valve morphology, although it is more pronounced with bicuspid aortic valves. These findings provide insight into the mechanisms of AR-related aortic remodeling, and they provide a model for studying SMC-specific therapies in culture. [ABSTRACT FROM AUTHOR]- Published
- 2023
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225. Aortic area/height ratio, peak wall stresses, and outcomes in veterans with tricuspid versus bicuspid aortic valve–associated ascending thoracic aortic aneurysms.
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Zamirpour, Siavash, Xuan, Yue, Wang, Zhongjie, Gomez, Axel, Leach, Joseph, Mitsouras, Dimitrios, Saloner, David A., Guccione, Julius M., Ge, Liang, and Tseng, Elaine E.
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In ascending thoracic aortic aneurysm risk stratification, aortic area/height ratio is a reasonable alternative to maximum diameter. Biomechanically, aortic dissection may be initiated by wall stress exceeding wall strength. Our objective was to evaluate the association between aortic area/height and peak aneurysm wall stresses in relation to valve morphology and 3-year all-cause mortality. Finite element analysis was performed on 270 ascending thoracic aortic aneurysms (46 associated with bicuspid and 224 with tricuspid aortic valves) in veterans. Three-dimensional aneurysm geometries were reconstructed from computed tomography and models developed accounting for prestress geometries. Fiber-embedded hyperelastic material model was applied to obtain aneurysm wall stresses during systole. Correlations of aortic area/height ratio and peak wall stresses were compared across valve types. Area/height ratio was evaluated across peak wall stress thresholds obtained from proportional hazards models of 3-year all-cause mortality, with aortic repair treated as a competing risk. Aortic area/height 10 cm
2 /m or greater coincided with 23/34 (68%) 5.0 to 5.4 cm and 20/24 (83%) 5.5 cm or greater aneurysms. Area/height correlated weakly with peak aneurysm stresses: for tricuspid valves, r = 0.22 circumferentially and r = 0.24 longitudinally; and for bicuspid valves, r = 0.42 circumferentially and r = 0.14 longitudinally. Age and peak longitudinal stress, but not area/height, were independent predictors of all-cause mortality (age: hazard ratio, 2.20 per 9-year increase, P =.013; peak longitudinal stress: hazard ratio, 1.78 per 73-kPa increase, P =.035). Area/height was more predictive of high circumferential stresses in bicuspid than tricuspid valve aneurysms, but similarly less predictive of high longitudinal stresses in both valve types. Peak longitudinal stress, not area/height, independently predicted all-cause mortality. [Display omitted] Aortic area/height ratio, peak wall stresses, and outcomes in veterans with TAV versus BAV-associated aTAAs. [Display omitted] [ABSTRACT FROM AUTHOR]- Published
- 2023
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226. Thoracic aorta diameters in Marfan patients: Intraindividual comparison of 3D modified relaxation-enhanced angiography without contrast and triggering (REACT) with transthoracic echocardiography.
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Gietzen, Carsten, Pennig, Lenhard, von Stein, Jennifer, Guthoff, Henning, Weiss, Kilian, Gertz, Roman, Thürbach, Iris, Bunck, Alexander C., Maintz, David, Baldus, Stephan, Ten Freyhaus, Henrik, Hohmann, Christopher, and von Stein, Philipp
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- *
THORACIC aorta , *TRANSESOPHAGEAL echocardiography , *PEARSON correlation (Statistics) , *SINUS of valsalva , *ECHOCARDIOGRAPHY , *ANGIOGRAPHY - Abstract
To compare the measurement of aortic diameters using a novel flow-independent MR-Angiography (3D modified Relaxation-Enhanced Angiography without Contrast and Triggering (modified REACT)) and transthoracic echocardiography (TTE) in Marfan syndrome (MFS) patients. This retrospective, single-center analysis included 46 examinations of 32 MFS patients (mean age 37.5 ± 11.3 years, 17 women, no prior aortic surgery) who received TTE and 3D modified REACT (ECG- and respiratory-triggering, Compressed SENSE factor 9 for acceleration of image acquisition) of the thoracic aorta. Aortic diameters (sinus of Valsalva (SV), sinotubular junction (STJ), and ascending aorta (AoA)) were independently measured by two cardiologists in TTE (leading-edge) and two radiologists in modified REACT (inner-edge, using multiplanar reconstruction). Intraclass correlation coefficient, Bland-Altman analyses, and Pearson's correlation (r) were used to assess agreement between observers and methods. Interobserver correlation at the SV, STJ, and AoA were excellent for both, TTE (ICC = 0.95–0.98) and modified REACT (ICC = 0.99–1.00). There was no significant difference between TTE and modified REACT for diameters measured at the SV (39.24 ± 3.24 mm vs. 39.63 ± 3.76 mm; p = 0.26; r = 0.78) and the STJ (35.16 ± 4.47 mm vs. 35.37 ± 4.74 mm; p = 0.552; r = 0.87). AoA diameters determined by TTE were larger than in modified REACT (34.29 ± 5.31 mm vs. 30.65 ± 5.64 mm; p < 0.01; r = 0.74). The mean scan time of modified REACT was 05:06 min ± 02:47 min, depending on the patient's breathing frequency and heart rate. Both TTE and modified REACT showed a strong correlation for all aortic levels; however, at the AoA, diameters were larger using TTE, mostly due to the limited field of view of the latter with measurements being closer to the aortic valve. Given the excellent interobserver correlation and the strong agreement with TTE, modified REACT represents an attractive method to depict the thoracic aorta in MFS patients. • TTE and modified REACT showed excellent interobserver reliability for measurements of the proximal thoracic aorta. • There was a strong correlation for all levels of measurement between TTE and modified REACT. At the SV and STJ there was no significant difference of measured diameters between both techniques whereas at the AoA, diameters were significantly larger using TTE. • Given the high agreement between both techniques, TTE and modified REACT can be used for surveillance of aortic diameters in MFS. [ABSTRACT FROM AUTHOR]
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- 2023
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227. Cardiac Anatomy
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Pelberg, Robert and Pelberg, Robert
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- 2015
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228. Effect of injection duration on contrast enhancement during cardiac computed tomography angiography in newborns and infants
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M. Tahara, T. Yoshiura, Takeshi Nakaura, S. Arao, H. Imaizumi, T. Masuda, R. Gotanda, Tomokazu Sato, Yoshinori Funama, Kazuo Awai, K. Arao, S. Masuda, and J. Hiratsuka
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Vena Cava, Superior ,Heart disease ,Computed Tomography Angiography ,business.industry ,Infant, Newborn ,Contrast Media ,Infant ,Pulmonary Artery ,medicine.disease ,Contrast medium ,Contrast-to-noise ratio ,Superior vena cava ,medicine.artery ,Hounsfield scale ,Ascending aorta ,Pulmonary artery ,Propensity score matching ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Podiatry ,Tomography, X-Ray Computed ,Nuclear medicine ,business - Abstract
To investigate how changing the injection duration at cardiac computed tomography angiography (CCTA) affects contrast enhancement in newborns and infants.Included were 142 newborns and infants with confirmed congenital heart disease who underwent CCTA between January 2015 and December 2018. In group 1 (n = 71 patients), the injection duration was 8 s; in group 2 (n = 71) it was 16 s. Our findings were assessed by one-to-one matching analysis to estimate the propensity score of each patient. We compare the CT number for the pulmonary artery (PA), ascending aorta (AAO), left superior vena cava (SVC), AAO and PA enhancement ratio, and the scores for visualization between the two groups.In group 1, median CT number and ranges was 345 (211-591) HU in the AAO, 324 (213-567) HU in the PA, and 62 (1-70) HU in the SVC. These values were 465 (308-669) HU, 467 (295-638) HU, and 234 (67-443) HU, respectively, in group 2 (p 0.05). The median score for volume-rendering visualization on 3D images of the CCTA was 2 in group 1 and 3 in group 2; the score for visualization of the left SVC of the maximum intensity projection images was 2 in group 1 and 3 in group 2 (p 0.05). The CT number for the AAO and PA enhancement ratio was 15.2 in group 1 and 9.2 in group 2 (p 0.05).The 16-sec injection protocol yielded significantly higher CT numbers for the AAO, PA, and the SVC than the 8-sec injection protocol; the visualization scores were also significantly higher in group 2.In newborns and infants, the longer injection time for CCTA yields stable and higher contrast enhancement at identical CM concentrations.
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- 2022
229. Efficacy of the spiral flow generating extended tube during paediatric CCTA
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S. Arao, S. Masuda, J. Hiratsuka, R. Gotanda, Kazuo Awai, M. Tahara, K. Arao, T. Yoshiura, H. Imaizumi, Tomokazu Sato, Yoshinori Funama, T. Masuda, Takeshi Nakaura, and Y. Yamashita
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medicine.diagnostic_test ,Heart disease ,Computed Tomography Angiography ,business.industry ,Heart ,Computed tomography ,Internal thoracic artery ,Coronary Angiography ,Radiation Dosage ,medicine.disease ,Cannula ,Spiral flow ,medicine.artery ,Pulmonary artery ,Ascending aorta ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Podiatry ,Child ,Tomography, X-Ray Computed ,business ,Nuclear medicine ,Spiral - Abstract
To compare the computed tomography (CT) number for paediatric cardiac computed tomography angiography (CCTA) and visualisation score of the three-dimensional (3D) images using the conventional T-shaped extended tube (T-tube) and spiral flow-generating extended tube (spiral-tube) connected between the contrast injector and cannula.In total, 108 patients suspected to have congenital heart disease (CHD) were considered for inclusion. We utilised the T-tube for intravenous contrast and spiral-tube in 54 patients each. Observers individually inspected randomized volume rendering images of the internal thoracic artery, each acquired from the with or without spiral-tube groups, using a four-point scale. We compared the mean CT number of the ascending aorta (AAO) and pulmonary artery (PA), contrast noise ratio (CNR), CT number for the AAO and PA enhancement ratio, and the visualisation scores between the groups.There were no significant differences in patient characteristics between the with or without spiral-tube groups (p 0.05). The mean CT number ±standard deviation for the AAO and PA, and the CNR without or with spiral-tube groups were 441.2 ± 89.2 and 489.8 ± 86.1 HU for the AAO, 436.3 ± 100.6 and 475.3 ± 85.2 HU for the PA, and 9.5 ± 2.2 and 10.8 ± 2.4 for the CNR, respectively (p 0.05). In the spiral-tube group, the CT number, CNR, and visualisations score of the 3D images were significantly higher for the AAO and PA than those in the T-tube group (p 0.05).The spiral-tube proved to be beneficial in improving the CT number for the AAO and PA, CNR, and visualisation score compared with the conventional T-tube during paediatric CCTA.The spiral-tube may allow the visualisation of smaller blood vessels than those visualised by the conventional T-tube for paediatric patients in CCTA.
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- 2022
230. Outcomes of Bicuspid Aortic Valve Thoracic Aorta (4.0-4.5 cm) After Aortic Valve Replacement
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Bo Yang, Faraz Longi, Xiaoting Wu, Aroma Naeem, Felix Orelaru, and Jeffrey Clemence
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Heart Valve Diseases ,Aorta, Thoracic ,Article ,Aortic aneurysm ,Bicuspid aortic valve ,Bicuspid Aortic Valve Disease ,Aortic valve replacement ,medicine.artery ,Internal medicine ,Ascending aorta ,medicine ,Humans ,Thoracic aorta ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,Body surface area ,Aorta ,business.industry ,medicine.disease ,Treatment Outcome ,Aortic Valve ,cardiovascular system ,Cardiology ,Dilation (morphology) ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Dilatation, Pathologic - Abstract
BACKGROUND: There is little evidence on managing the proximal aorta of 4.0-4.5 cm during aortic valve replacement (AVR) in bicuspid aortic valve (BAV) patients. METHODS: A total of 431 patients between 1993-2019 underwent either an isolated AVR, AVR + concomitant ascending aorta replacement, or aortic root replacement. We divided patients into native root dilation [4.0-4.5 cm, n=121] vs. root control groups [
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- 2022
231. A 23-year experience with the reversed elephant trunk technique for staged repair of extensive thoracic aortic aneurysm
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Matt D. Price, Ourania Preventza, Qianzi Zhang, Heidi M. Krause, Susan Y. Green, Joseph S. Coselli, Hiruni S. Amarasekara, and Scott A. LeMaire
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Male ,Pulmonary and Respiratory Medicine ,Aortic arch ,medicine.medical_specialty ,Elephant trunks ,030204 cardiovascular system & hematology ,Thoracic aortic aneurysm ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Aneurysm ,Postoperative Cognitive Complications ,medicine.artery ,Ascending aorta ,medicine ,Humans ,Prospective Studies ,Aged ,Retrospective Studies ,Aortic dissection ,Aorta ,Aortic Aneurysm, Thoracic ,business.industry ,Middle Aged ,Thoracic Surgical Procedures ,medicine.disease ,Surgery ,Aortic Dissection ,030228 respiratory system ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective The reversed elephant trunk technique permits staged repair of extensive thoracic aortic aneurysm in patients whose distal (ie, descending thoracic and thoracoabdominal) aorta is symptomatic or disproportionately large compared with their proximal aorta (ie, ascending aorta and transverse aortic arch). We present our 23-year experience with the reversed elephant trunk approach. Methods Between 1994 and 2017, 94 patients (median age 62 [46-69] years) underwent stage 1 reversed elephant trunk repair of the distal aorta. Fifty-three patients (56%) had aortic dissection, and 31 patients (33%) had heritable thoracic aortic disease. Eighty-eight operations (94%) were Crawford extent I or II thoracoabdominal aortic repairs. Twenty-seven patients (29%) underwent subsequent stage 2 repair of the proximal aorta; 14 patients (52%) required redo median sternotomy. The median time between the stage 1 and 2 operations was 18.8 (4.8-69.3) months. Results The operative mortality was 10% (9/94) for stage 1 repairs and 4% (1/27) for stage 2 repairs; 1 patient with heritable thoracic aortic disease died after stage 1 repair (1/31, 3%), and 1 patient died after stage 2 repair (1/13, 8%). Two patients (2%) had ruptures after stage 1 repair; 1 resulted in death, and 1 precipitated emergency stage 2 repair. In total, 36 patients (38%) who survived stage 1 repair died before stage 2 reversed elephant trunk completion repair could be performed. Conclusions Managing extensive aortic aneurysm with the 2-stage reversed elephant trunk technique yields acceptable short-term outcomes. This technique is useful for the reversed elephant trunk in patients who require distal aortic repair before proximal repair and is particularly effective in patients with heritable thoracic aortic disease. The low number of patients returning for completion repair is concerning. Rigorous surveillance is needed.
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- 2022
232. Occurrence of Intimal Thickening in Aging Ascending Aorta as a Most Initial Marker of Atherosclerotic Changes in Cardiovascular Diseases
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Amardeep Shivkishan Bissa and Achleshwar R Gandotra
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Atherosclerotic Changes ,Intimal Thickening ,Ascending Aorta ,Smooth Muscle Cells ,Aging ,Public aspects of medicine ,RA1-1270 - Abstract
Introduction: Atherosclerotic Changes are the most common causes of cardiovascular diseases. So it’s always been a matter of discussion that whether Intimal Thickening (ITN) has its relation to age or preexisting lipid mass or it’s biased to any specific part of ascending aorta. Methods: We used 120 autopsied Ascending Aorta and instrumented histological procedure followed by H&E staining. Results & Discussion: Accumulation of SMCs in Intima of Ascending Aorta (AA) increase with advancing Age and it happens equally in all segments of AA. This is in coinciding with previous workers. Conclusion: Though ITN is the most initial stage of Atherosclerotic change but it’s a very important indicator for the same. It increases uniformly with Age.
- Published
- 2019
233. What determines outcomes in multivalve reoperations? Effect of patient and surgical complexity.
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Insler JE, Tipton AE, Bakaeen FG, Bakhos JJ, Houghtaling PL, Blackstone EH, Roselli EE, Soltesz EG, Tong MZ, Unai S, McCurry K, Vargo P, Hodges K, Smedira NG, Pettersson GB, Weiss A, Koprivanac M, Elgharably H, Gillinov AM, and Svensson LG
- Abstract
Objective: Patient characteristics, risks, and outcomes associated with reoperative multivalve cardiac surgery are poorly characterized. Effect of patient variables and surgical components of each reoperation were evaluated with regard to operative mortality., Methods: From January 2008 to January 2022, 2324 patients with previous cardiac surgery underwent 2352 reoperations involving repair or replacement of multiple cardiac valves at Cleveland Clinic. Mean age was 66 ± 14 years. Number of surgical components representing surgical complexity (valve procedures, aortic surgery, coronary artery bypass grafting, and atrial fibrillation procedures) ranged from 2 to 6. Random forest for imbalanced data was used to identify risk factors for operative mortality., Results: Surgery was elective in 1327 (56%), urgent in 1006 (43%), and emergency in 19 (0.8%). First-time reoperations were performed in 1796 (76%) and 556 (24%) had 2 or more previous operations. Isolated multivalve operations comprised 54% (1265) of cases; 1087 incorporated additional surgical components. Two valves were operated on in 80% (1889) of cases, 3 in 20% (461), and 4 in 0.09% (2). Operative mortality was 4.2% (98 out of 2352), with 1.7% (12 out of 704) for elective, isolated multivalve reoperations. For each added surgical component, operative mortality incrementally increased, from 2.4% for 2 components (24 out of 1009) to 17% for ≥5 (5 out of 30). Predictors of operative mortality included coronary artery bypass grafting, surgical urgency, cardiac, renal dysfunction, peripheral artery disease, New York Heart Association functional class, and anemia., Conclusions: Elective, isolated reoperative multivalve surgery can be performed with low mortality. Surgical complexity coupled with key physiologic factors can be used to inform surgical risk and decision making., Competing Interests: Conflict of Interest Statement The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)
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- 2023
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234. Effect of turbulence and viscosity models on wall shear stress derived biomarkers for aorta simulations.
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Martínez A, Hoeijmakers M, Geronzi L, Morgenthaler V, Tomasi J, Rochette M, and Biancolini ME
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- Humans, Viscosity, Computer Simulation, Stress, Mechanical, Blood Flow Velocity, Aorta, Models, Cardiovascular
- Abstract
Ascending aorta simulations provide insight into patient-specific hemodynamic conditions. Numerous studies have assessed fluid biomarkers which show a potential to aid clinicians in the diagnosis process. Unfortunately, there exists a large disparity in the computational methodology used to model turbulence and viscosity. Recognizing this disparity, some authors focused on analysing the influence of either the turbulence or viscosity models on the biomarkers in order to quantify the importance of these model choices. However, no analysis has yet been done on their combined effect. In order to fully understand and quantify the effect of the computational methodology, an assessment of the combined effect of turbulence and viscosity model choice was performed. Our results show that (1) non-Newtonian viscosity has greater impact (2.9-5.0%) on wall shear stress than Large Eddy Simulation turbulence modelling (0.1-1.4%), (2) the contribution of non-Newtonian viscosity is amplified when combined with a subgrid-scale turbulence model, (3) wall shear stress is underestimated when considering Newtonian viscosity by 2.9-5.0% and (4) cycle-to-cycle variability can impact the results as much as the numerical model if insufficient cycles are performed. These results demonstrate that, when assessing the effect of computational methodologies, the resultant combined effect of the different modelling assumptions differs from the aggregated effect of the isolated modifications. Accurate aortic flow modelling requires non-Newtonian viscosity and Large Eddy Simulation turbulence modelling., Competing Interests: Declaration of competing interest Authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)
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- 2023
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235. Aorta Dilatation in Unrepaired Tetralogy of Fallot.
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Lu L, Guo Q, and Cui Z
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Background Aortic root dilation is an increasingly recognized feature in repaired tetralogy of Fallot (TOF) patients. However, the dilation at the aortic root and ascending aorta in unrepaired TOF is rarely studied. This study aims to confirm whether aortic dilation is a common feature in unrepaired TOF and investigate the factors attributed to aortic dilation. Methodology Patients with an echocardiographic diagnosis of TOF undergoing computed tomography angiography were retrospectively studied. Diameters and z scores of aortic annular (Ao1), aortic sinotubular junction (Ao2), ascending aorta (Ao3), and distal transverse aortic arch (Ao4) were measured. Preoperative body surface area (BSA), hemoglobin (Hb), hematocrit (HCT), arterial oxygen saturation (SaO
2 ), and platelet (PLT) count were recorded. Results A total of 101 TOF patients aged 6.8 ± 9.5 years were included in this study, whose mean BSA (m2 ), Hb (g/L), HCT, SaO2 (%), and PLT (109 /L) were 0.7 ± 0.4, 162.1 ± 3.8, 0.5 ± 0.1, 85.1 ± 9.3, and 238.1 ± 101.1, respectively. The mean z score of Ao1, Ao2, Ao3, and Ao4 were 10.3 ± 3.5, 4.7 ± 2.9, 4.0 ± 2.7, and 4.1 ± 2.4, respectively. Age and BSA were positively correlated with the z scores of Ao1 and Ao2. Preoperative Hb and HCT were positively correlated with the z scores of Ao1, Ao2, Ao3, and Ao4. Preoperative SaO2 and PLT were negatively correlated with the z scores of Ao1, Ao2, Ao3, and Ao4. Conclusions Aortic dilation is common in unrepaired TOF patients. The dilation of different levels of the aorta was correlated with age, BSA, preoperative Hb, HCT, SaO2 , and PLT., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Lu et al.)- Published
- 2023
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236. Case Report: Successful endovascular treatment of acute type A aortic dissection.
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Pitts L, Heck R, Montagner M, Penkalla A, Kofler M, Falk V, Kempfert J, and Buz S
- Abstract
Introduction: Open surgical repair remains the current gold standard for the treatment of acute type A aortic dissection. However, especially elderly patients with relevant comorbidities who are deemed unfit for open surgery may benefit from a minimally invasive endovascular approach., Methods: We report a case of an 80-year-old male with retrograde acute type A aortic dissection and peripheral malperfusion after receiving thoracic endovascular aortic repair due to thoracic aortic aneurysm. Our individualized endovascular approach consisted of left carotid-subclavian bypass, proximal extension of thoracic endovascular aortic repair using a covered stent graft and a single covered stent graft for the ascending aorta in combination with an uncovered stent for the aortic arch., Results: Postoperative computed tomographic angiography demonstrated excellent outcome with no signs of endoleak or patent false lumen. Follow-up after 3.5 years showed a stable result with no signs of stent failure or dissection progress. No aortic re-interventions were needed in the further course., Discussion: An individualized endovascular approach may be justified for acute type A aortic dissection in elderly patients with high surgical risk if performed in specialized aortic centers. Additional short-length stent graft devices are needed to address the anatomical challenges of the ascending aorta. For enhanced remodeling of the dissected aorta, the use of an additional uncovered stent may be advisable., Competing Interests: MM has received speaker fees and travel grants from Artivion® (Hechingen, Germany). VF has received educational grants, including travel support, fees for lectures and speeches, as well as for professional consultation and research, along with study funds from Medtronic® GmbH (Dublin, Ireland) and Artivion® (Hechingen, Germany). JK is a proctor for and has received travel support and speaker fees from Artivion® (Hechingen, Germany), Medtronic® GmbH (Dublin, Ireland), JOTEC GmbH (now Artivion®, Hechingen, Germany), and Vascutek/Terumo® (Inchinnan, UK). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Pitts, Heck, Montagner, Penkalla, Kofler, Falk, Kempfert and Buz.)
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- 2023
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237. Sex-Specific Morphometric Analysis of Ascending Aorta and Aortic Arch for Planning Thoracic Endovascular Aortic Repair: A Retrospective Cohort Study.
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Katsarou M, Mandigers TJ, Berczeli M, Mujeeb Zubair M, Belvroy VM, Bissacco D, van Herwaarden JA, Trimarchi S, and Bismuth J
- Abstract
Objective: In many studies on aortic disease, women are underrepresented. The present study aims to assess sex-specific morphometric differences and gain more insight into endovascular treatment of the ascending aorta (AA) and arch., Methods: Electrocardiogram-gated cardiac computed tomography scans of 116 consecutive patients who were evaluated for transcatheter aortic valve replacement were retrospectively reviewed. Measurements of the AA and aortic arch were made in multiplanar views, perpendicular to the semi-automatic centerline. Multiple linear regression analysis was performed to identify predictors affecting AA and aortic arch diameter in men and women. Propensity score matching was used to investigate whether sex influences aortic morphology., Results: In both sexes, body surface area (BSA) was identified as a positive predictor and diabetes as a negative predictor for aortic diameters. In men, age was identified as a positive predictor and smoking as a negative predictor for aortic diameters. Propensity score matching identified 40 pairs. Systolic and diastolic mean diameters and AA length were significantly wider in men. On average, male aortas were 7.4% wider than female aortas, both in systole and diastole., Conclusions: The present analysis demonstrates that, in women, increased BSA is associated with increased aortic arch diameters, while diabetes is associated with decreased AA and arch diameters. In men, increased BSA and age are associated with increased AA and arch diameters, while smoking and diabetes are associated with decreased AA and arch diameters. Men were confirmed to have 7.4% greater AA and arch diameters than women., Clinical Impact: Men had 7.4% greater ascending aorta and arch diameters than women in a retrospective cohort, gated computed tomography-based study of 116 patients. Sex-specific differences in ascending aortic and arch size should be considered by aortic endovascular device manufacturers and physicians when developing ascending and arch endografts and planning aortic interventions., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2023
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238. Emergency and Compassionate Use of a Novel Ascending Endograft for Ascending and Arch Aortic Pathology.
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Patel HJ, Preventza O, Roselli EE, Atkins MD, Brinkman W, Coselli J, Desai N, Estrera A, Fleischman F, Taylor BS, and Reardon MJ
- Abstract
Purpose: Patients with complicated ascending aortic pathology, including patients with acute type A aortic dissection may be at extreme risk for open repair. Thoracic endovascular aortic repair (TEVAR), infrequently used for the ascending aorta, may be considered an alternative in this setting. We describe early results for emergency and compassionate (E&C) use of a novel endograft, specifically designed for use to treat pathology of the ascending aorta., Materials and Methods: This case series evaluated 19 patients (mean age, 68.84±13.12 years; 57.9% female) treated with ascending TEVAR for acute and chronic acute (4), subacute (1), or chronic (1) aortic dissection or pseudoaneurysm (13). Six of the 19 patients (31.5%) were treated under compassionate use and 13 patients (68.4%) were treated under the emergency use exemption. Ten patients (52.6%) received additional devices to extend treatment into the arch and descending aorta., Results: Device delivery was achieved in all patients (100%). Thirty-day mortality and stroke occurred in 3 patients (15.8%) and in 1 patient (5.3%), respectively. In 1 patient (5.3%), with an Unanticipated Adverse Device Event, the aorta ruptured when the endograft eroded into the adventitial portion of dissection site at the posterior aspect of the ascending wall. Devices were explanted in 2 patients (10.5%), 353 and 610 days after the index procedure, respectively. Six patients had endoleaks (31.6%), including type I (n=2, 10.5%), type II endoleaks (n=3, 15.8%), and indeterminate endoleak (n=1, 5.3%)., Conclusions: Delivery and deployment of a novel ascending thoracic stent graft with or without an additional branched arch extension is feasible in patients with complex anatomy and pathology, including acute aortic dissection and pseudoaneurysm. Additional experience with this novel device will further refine the patient population most suitable for endovascular ascending aortic repair for these pathologies., Clinical Impact: This study describes a novel stent graft specifically designed for treatment of ascending aortic pathology, including acute type A dissection. The patients described in this series constituted a group outside the formal US FDA sponsored clinical trial, and were those accepted as part of an emergency and compassionate use basis., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: W.L. Gore is the co-patent holder for different device and consultant.
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- 2023
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239. Cocaine-Induced Ascending Aortic Thrombus.
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Vu PQ, Patel S, Pathak PR, and Basu AK
- Abstract
Aortic thrombosis without coexisting atherosclerosis is uncommon. Sometimes, aneurysms or dissections can predispose to thrombus in the abdominal or thoracic aorta. However, ascending aortic thrombus in a non-aneurysmal, non-atherosclerotic aorta is a rare occurrence. Although arterial thrombosis has been linked with its use, cocaine-associated thrombus of the ascending aorta has been rarely described. We report a young man with regular use of cocaine presenting with constant, burning, left-sided chest pain. He was found to have a large thrombus in a structurally normal ascending aorta. Medical management with therapeutic anticoagulation was started. Despite an interruption of anticoagulation treatment for two months due to non-compliance, the man survived. This unique case highlights the importance of various vascular complications associated with cocaine use, their early recognition, and their treatment., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Vu et al.)
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- 2023
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240. 心房細動患者における上行大動脈の機械的圧迫による左房前壁の低電位領域形成についての検討
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心房細動 ,ascending aorta ,low-voltage zones in left atrium ,左房内低電位領域 ,atrial fibrillation ,心外構造物 ,extracardiac structures ,上行大動脈 ,Thesis or Dissertation - Published
- 2023
241. Guía anestésico-quirúrgica en el tratamiento de la cirugía de la aorta ascendente y del arco aórtico
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Del Rey de Cabo, Carla, Cocho Crespo, Sara, López Herrero, Rocío, and Rubio Babiano, Pilar
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arco aórtico ,tratamiento ,aneurysms ,treatment ,aorta ascendente ,aortic arch ,ascending aorta ,aortic dissection ,aneurisma ,disección aorta - Abstract
The pathology of the aorta is a challenge for medicine. Diagnostic and therapeutica move a huge volumen of variables. Diagnostic and therapeutica move a huge volumen of variables. This has let this pathology to be addressed by a big number of specialists. In this document, agreed between the Aorta working groups of the Spanish societies of Anesthesiology (SEDAR) and Thoracic-Cardiovascular Surgery (SECCE), it is sought to disseminate the most agreed working modes among the centers of greatest activity in the country by both specialties, as far as surgical treatment is concerned with ascending aortic and aortic arch pathology, as well as the treatment of acute aortic dissection., La patología de la aorta supone un reto para la medicina. Tanto a nivel diagnóstico, como terapéutico, el volumen de variables implicado ha hecho que dicha patología sea abordada por una ingente cantidad de especialistas. En este documento, consensuado entre los grupos de trabajo de Aorta de las sociedades españolas de Anestesiología (SEDAR) y Cirugía Torácica-cardiovascular (SECTCV) se busca difundir los modos de trabajo más consensuados entre los centros de mayor actividad del país por parte de ambas especialidades, en lo que al tratamiento quirúrgico se refiere de la patología de aorta ascendente y arco aórtico se refiere, así como del tratamiento de la disección aguda de aorta. 
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- 2023
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242. Vascular Deformation Mapping for CT Surveillance of Thoracic Aortic Aneurysm Growth
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Jianyang Zhong, Gary E. Christensen, Nicholas S. Burris, Zhangxing Bian, Theodorus M. J. van Bakel, Brian D. Ross, Charles R. Hatt, Jeffrey Dominic, Himanshu J. Patel, and Ignas B Houben
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Male ,Computed Tomography Angiography ,Aorta, Thoracic ,Thoracic aortic aneurysm ,Imaging, Three-Dimensional ,Dilated segment ,Interquartile range ,medicine.artery ,Ascending aorta ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Retrospective Studies ,Reproducibility ,medicine.diagnostic_test ,Aortic Aneurysm, Thoracic ,business.industry ,Reproducibility of Results ,medicine.disease ,Descending aorta ,Angiography ,Area ratio ,Female ,Nuclear medicine ,business - Abstract
Background Aortic diameter measurements in patients with a thoracic aortic aneurysm (TAA) show wide variation. There is no technique to quantify aortic growth in a three-dimensional (3D) manner. Purpose To validate a CT-based technique for quantification of 3D growth based on deformable registration in patients with TAA. Materials and Methods Patients with ascending and descending TAA with two or more CT angiography studies between 2006 and 2020 were retrospectively identified. The 3D aortic growth was quantified using vascular deformation mapping (VDM), a technique that uses deformable registration to warp a mesh constructed from baseline aortic anatomy. Growth assessments between VDM and clinical CT diameter measurements were compared. Aortic growth was quantified as the ratio of change in surface area at each mesh element (area ratio). Manual segmentations were performed by independent raters to assess interrater reproducibility. Registration error was assessed using manually placed landmarks. Agreement between VDM and clinical diameter measurements was assessed using Pearson correlation and Cohen κ coefficients. Results A total of 38 patients (68 surveillance intervals) were evaluated (mean age, 69 years ± 9 [standard deviation]; 21 women), with TAA involving the ascending aorta (n = 26), descending aorta (n = 10), or both (n = 2). VDM was technically successful in 35 of 38 (92%) patients and 58 of 68 intervals (85%). Median registration error was 0.77 mm (interquartile range, 0.54-1.10 mm). Interrater agreement was high for aortic segmentation (Dice similarity coefficient = 0.97 ± 0.02) and VDM-derived area ratio (bias = 0.0, limits of agreement: -0.03 to 0.03). There was strong agreement (r = 0.85, P < .001) between peak area ratio values and diameter change. VDM detected growth in 14 of 58 (24%) intervals. VDM revealed growth outside the maximally dilated segment in six of 14 (36%) growth intervals, none of which were detected with diameter measurements. Conclusion Vascular deformation mapping provided reliable and comprehensive quantitative assessment of three-dimensional aortic growth and growth patterns in patients with thoracic aortic aneurysms undergoing CT surveillance. Published under a CC BY 4.0 license Online supplemental material is available for this article. See also the editorial by Wieben in this issue.
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- 2023
243. Προστασία του Εγκεφάλου κατά τη Χειρουργική της Ανιούσας Αορτής και του Αορτικού Τόξου
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Παλίνδρομη εγκεφαλική άρδευση ,Ανιούσας αορτή ,Μέθοδος pH-stat ,Brain function ,Alpha-stat method ,Μέθοδος α-stat ,Retrograde cerebral perfusion ,Aortic arch ,Εγκεφαλικής προστασίας ,pH-stat method ,Antegrade cerebral perfusion ,Ορθόδρομη εγκεφαλική άρδευση ,Ascending aorta ,Αορτικό τόξο - Abstract
Παρά την πρόοδο της καρδιοχειρουργικής και της καρδιοαναισθησιολογίας, τα ποσοστά εγκεφαλικής βλάβης και η θνησιμότητα παραμένουν υψηλά στις χειρουργικές επεμβάσεις ανιούσας αορτής και αορτικού τόξου που απαιτούν κυκλοφορική παύση. Οι μηχανισμοί της εγκεφαλικής βλάβης, συμπεριλαμβανομένου της μόνιμης διεγχειρητικής ισχαιμίας του εγκεφάλου και η προσωρινή ή μόνιμη νευρολογική δυσλειτουργία, είναι πολυπαραγοντική. Οι διάφορες μέθοδοι παρακολούθησης του εγκεφάλου παρέχουν διαφορετικές πληροφορίες αναφορικά με τη φυσιολογία της εγκεφαλικής λειτουργίας, με σκοπό τη βελτιστοποίηση της εγκεφαλικής προστασίας κατά τη διάρκεια της καρδιοχειρουργικής επέμβασης. Το Ηλεκτροεγκεφαλογράφημα παρέχει κρίσιμα δεδομένα για την εξασφάλιση ελάχιστου εγκεφαλικού μεταβολισμού κατά τη βαθιά υποθερμική κυκλοφορική παύση. Το διακρανιακό Doppler, μετρά άμεσα την εγκεφαλική αρτηριακή αιματική ροή και η μαγνητική φασματοσκοπία παρακολουθεί τον περιφερειακό κορεσμό οξυγόνου του εγκεφάλου. Διάφορες τεχνικές προστασίας του εγκεφάλου, συμπεριλαμβανομένης της υποθερμίας, της ορθόδρομης εγκεφαλικής άρδευσης ή παλίνδρομης εγκεφαλικής άρδευσης, της φαρμακολογικής προστασίας και τέλος της διαχείρισης αερίων του αίματος με την μέθοδο α-stat ή την μέθοδο pH-stat, έχουν χρησιμοποιηθεί κατά τη διάρκεια παύσης της συστηματικής κυκλοφορίας, αλλά η βέλτιστη στρατηγική παραμένει αδιευκρίνιστη., Despite advances in cardiac surgery and cardiac anesthesia, rates of brain injury and mortality remain high in ascending aorta and aortic arch surgeries that require circulatory arrest. The mechanisms of brain injury, including permanent intraoperative cerebral ischemia and temporary or permanent neurological dysfunction, are multifactorial. The various brain monitoring methods provide different information regarding the physiology of brain function, with the aim of optimizing brain protection during cardiac surgery. The electroencephalogram provides critical data to ensure minimal cerebral metabolism during deep hypothermic circulatory arrest. Transcranial Doppler directly measures cerebral arterial blood flow and magnetic spectroscopy monitors regional brain oxygen saturation. Various brain protection techniques, including hypothermia, antegrade cerebral perfusion or retrograde cerebral perfusion, and pharmacological protection. Finally, blood gas management with the alpha-stat method or the pH-stat method have been used during circulatory arrest, but the optimal strategy remains unclear.
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- 2023
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244. A Rare Catastrophe: Three Cases of Aortic Root Dehiscence after Surgery
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Taner İyigün, Barış Timur, and Timuçin Aksu
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Rupture ,Dehiscence ,Cardiac Surgery ,RD1-811 ,Spontaneous ,RC666-701 ,Ascending Aorta ,Aortic Diseases ,Diseases of the circulatory (Cardiovascular) system ,Medicine (miscellaneous) ,Surgery ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Ascending aortic pathologies may be life-threatening. Postoperative aortic root dehiscence is a very rare but extremely dangerous complication with a high mortality rate, and redo surgery is mandatory due to high risk of spontaneous rupture. We present three cases that had undergone Bentall procedure and had postoperative aortic root dehiscence. One of the patients presented with hemiplegia caused by septic embolus while the others had mild symptoms. Dr. Yakut’s modified Bentall procedure, the flanged technique, was performed for each patient in redo surgery. Two patients were successfully discharged from the hospital, but one died due to intracranial hemorrhage and multiple organ failure.
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- 2023
245. Histomorphometric analysis of cell and matrix components of ascending thoracic aortic aneurysm.
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Ganizada, Berta, Parikh, Shaiv, Ramaekers, Mitch, Jaminon, Armand, Akbulut, Asim Cengiz, Natour, Ehsan, Accord, Ryan, Wildberger, Joachim Ernst, Schalla, Simon, Maessen, Jos, Reesink, Bidar, Elham, and Schurgers, Leon
- Subjects
HISTOMORPHOMETRY ,THORACIC aneurysms ,EXTRACELLULAR matrix - Abstract
Background: Current indication for ascending thoracic aortic aneurysm (aTAA) surgery is based on aortic diameter of 5-5.5 cm or a growth rate of > 0.5 cm/year [1]. However, current screening surveillance and risk estimation simplifies the complexity of aTAA disease, which might lead to a high-risk open-chest cardiac surgery [2]. Our aim was to examine ex vivo histological features of aTAA specimens, to assess changes in extracellular matrix (ECM) content and vascular smooth muscle cell (VSMC) properties. Methods: Surgical samples of the ventral aspect of the ascending aorta were collected from patients suffering from aTAA (n = 20) and patients with non-aneurysmal coronary bypass or stenotic valve surgery which served as controls (n = 10). Medial cross-sectional thickness, collagen/elastin content, and VSMC number were determined by quantitative histomorphometry. In addition, immunohistochemical markers of VSMC phenotype, a-smooth muscle actin (a-SMA), calponin-1 (CNN1), and S100 calcium binding protein A4 (S100A4) were assessed. Image quantification analysis was performed using QuPath. Results: Aneurysmal aortas showed increased elastin fragmentation and regionally more dense collagen I/III confirming medial degeneration. This resulted in a marked rise in collagen-to-elastin ratio (Table 1). Medial cross-sectional thickness and number of VSMCs were increased in aneurysmal aortas (Table 1). Expression of a-SMA and CNN1 decreased significantly, whilst S100A4 expression was not different between the groups (Table 1). Conclusions: Our preliminary results support the notion of an imbalanced interaction between ECM-VSMCs that may play a crucial role in arterial remodeling cascade, leading to aTAA formation. Further research is needed with the ultimate aim to guide clinical management. Age and weight are represented as mean ± SD and other values as median with IQR [Q1-Q3]. [ABSTRACT FROM AUTHOR]
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- 2023
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246. An In Vitro Analysis of the Influence of the Arterial Stiffness on the Aortic Flow Using Three-Dimensional Particle Tracking Velocimetry
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Gülan, U., Lüthi, B., Holzner, M., Liberzon, A., Tsinober, A., Kinzelbach, W., Magjarevic, Ratko, Editor-in-chief, Ładyzynsk, Piotr, Series editor, Ibrahim, Fatimah, Series editor, Lacković, Igor, Series editor, Rock, Emilio Sacristan, Series editor, and Roa Romero, Laura M., editor
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- 2014
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247. Thoracic Angiography
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Miclaus, Gratian Dragoslav, Ples, Horia, Miclaus, Gratian Dragoslav, and Ples, Horia
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- 2014
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248. The Prospects for Total Endovascular Repair of Acute Type A Aortic Dissection
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Nordon, Ian M., Thompson, Matt M., Bonser, Robert S., editor, Pagano, Domenico, editor, Haverich, Axel, editor, and Mascaro, Jorge, editor
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- 2014
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249. A new vessel segmentation algorithm for robust blood flow quantification from two‐dimensional phase‐contrast magnetic resonance images.
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Bidhult, Sebastian, Hedström, Erik, Carlsson, Marcus, Töger, Johannes, Steding‐Ehrenborg, Katarina, Arheden, Håkan, Aletras, Anthony H., and Heiberg, Einar
- Subjects
- *
BLOOD flow , *MAGNETIC resonance imaging - Abstract
Summary: Blood flow measurements in the ascending aorta and pulmonary artery from phase‐contrast magnetic resonance images require accurate time‐resolved vessel segmentation over the cardiac cycle. Current semi‐automatic segmentation methods often involve time‐consuming manual correction, relying on user experience for accurate results. The purpose of this study was to develop a semi‐automatic vessel segmentation algorithm with shape constraints based on manual vessel delineations for robust segmentation of the ascending aorta and pulmonary artery, to evaluate the proposed method in healthy volunteers and patients with heart failure and congenital heart disease, to validate the method in a pulsatile flow phantom experiment, and to make the method freely available for research purposes. Algorithm shape constraints were extracted from manual reference delineations of the ascending aorta (n = 20) and pulmonary artery (n = 20) and were included in a semi‐automatic segmentation method only requiring manual delineation in one image. Bias and variability (bias ± SD) for flow volume of the proposed algorithm versus manual reference delineations were 0·0 ± 1·9 ml in the ascending aorta (n = 151; seven healthy volunteers; 144 heart failure patients) and −1·7 ± 2·9 ml in the pulmonary artery (n = 40; 25 healthy volunteers; 15 patients with atrial septal defect). Interobserver bias and variability were lower (P = 0·008) for the proposed semi‐automatic method (−0·1 ± 0·9 ml) compared to manual reference delineations (1·5 ± 5·1 ml). Phantom validation showed good agreement between the proposed method and timer‐and‐beaker flow volumes (0·4 ± 2·7 ml). In conclusion, the proposed semi‐automatic vessel segmentation algorithm can be used for efficient analysis of flow and shunt volumes in the aorta and pulmonary artery. [ABSTRACT FROM AUTHOR]
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- 2019
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250. Independent origin of anterior interventricular and left marginal arteries from the left posterior aortic sinus.
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Shetty, Prakash and Nayak, Satheesha B.
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- *
SINUS of valsalva , *ARTERIES , *MEDICAL students , *HEART - Abstract
We present a unique, unreported variation of the left coronary artery. During dissection classes for first-year medical students, we observed the absence of left coronary artery in an adult male cadaver aged approximately 78 years. The left aortic sinus was dilated and it gave origin to anterior interventricular and left marginal arteries independently. Left marginal artery was large and the circumflex artery arose from it. There were two independent opening for anterior interventricular and left marginal arteries in the left posterior aortic sinus. No variations were found in the origin and branching pattern of right coronary artery and the walls and chambers of the heart. [ABSTRACT FROM AUTHOR]
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- 2019
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