40,356 results on '"Aorta, Thoracic"'
Search Results
2. Brain protection in perioperative period of aortic arch surgery
- Author
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TANG Yi⁃peng, BAI Yun⁃peng, and CHEN Qing⁃liang
- Subjects
aorta, thoracic ,extracorporeal circulation ,cardiovascular surgical procedures ,perioperative period ,review ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Maintaining optimal cerebral perfusion during cardiopulmonary bypass and circulatory arrest is basis of intraoperative management of aortic arch surgery. Various cerebral protection techniques including hypothermia, cerebral perfusion, drug protection and blood gas management have been used in the clinic, but the optimal strategy remains difficult to determine. The clinical outcome of cerebral protection in aortic arch surgery largely depends on brain temperature, circulatory arrest time and cerebral perfusion at the time of circulatory arrest. The optimal brain protection strategy should be individualized treatment on the basis of comprehensive brain monitoring, so as to effectively reduce the occurrence of brain injury. This article summarizes the means or indicators of brain monitoring and management during cardiopulmonary bypass in aortic arch surgery, as well as perioperative brain protection strategies, in order to guide the clinical practice of intraoperative brain protection in aortic arch surgery.
- Published
- 2024
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3. Longitudinal follow-up by MR angiography reveals progressive dilatation of the distal aorta after aortic root replacement in Marfan syndrome.
- Author
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Lenz, Alexander, Warncke, Malte, Wright, Felicia, Weinrich, Julius Matthias, Schoennagel, Bjoern P., Henes, Frank Oliver, Adam, Gerhard, von Kodolitsch, Yskert, Schoen, Gerhard, and Bannas, Peter
- Subjects
- *
MARFAN syndrome , *AORTA , *THORACIC aorta , *ANGIOGRAPHY , *MAGNETIC resonance angiography - Abstract
Objectives : To define and compare growth rates of the distal aorta in Marfan patients with and without aortic root replacement using serial MR angiography (MRA). Methods: We retrospectively included 136 Marfan patients with a total of 645 MRAs who underwent a median of five MRAs (range: 2–13) at 1.5 T and 3 T in annual intervals. Of these, 41 patients (34.8 ± 12 years) had undergone aortic root replacement. The remaining 95 patients (29.0 ± 17 years) still had a native aorta and served as the control group. Thoracic aortic diameters were independently measured at eleven predefined levels. Estimated growth rates were calculated using a mixed effects model adjusted for sex, age, BMI, and medication. Results: Marfan patients with aortic root replacement revealed the highest mean estimated growth rate in the proximal descending aorta (0.77 mm/year, CI: 0.31–1.21). Mean growth rates at all levels of the distal thoracic aorta were significantly higher in patients with aortic root replacement (0.28–0.77 mm/year) when compared to patients without aortic root replacement (0.03–0.07 mm/year) (all p < 0.001). Antihypertensive medication, gender, and BMI had no significant impact on the distal aortic growth rates. Conclusion: Distal thoracic aortic diameters increase at a significantly higher rate in Marfan patients with aortic root replacement compared to Marfan patients without aortic root replacement. Further studies are warranted to investigate if the increased growth rate of the distal thoracic aorta after aortic root replacement is caused by altered hemodynamics due to the rigid aortic root graft or due to the general genetic disposition of post-operative Marfan patients. Clinical relevance statement: High growth rates of the distal aorta after aortic root replacement underline the need for careful life-long aortic imaging of Marfan patients after aortic root replacement. Key Points: • Aortic growth rates in Marfan patients with aortic root replacement are highest in the mid-aortic arch, the proximal- and mid-descending aorta. • Growth rates of the distal thoracic aorta are significantly higher in Marfan patients with aortic root replacement compared to Marfan patients without aortic root replacement. • Antihypertensive medication, gender, and BMI have no significant impact on distal aortic growth rates in Marfan patients. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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4. Rare association between giant-cell aortitis and giant-cell aortic valvulitis
- Author
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Georgina del Cisne Jadán Luzuriaga, Ricardo Ribeiro Dias, José Augusto Duncan Santiago, Vagner Madrini Junior, Walther Yoshiharu Ishikawa, Fabio Fernandes, and Vera Demarchi Aiello
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Aorta, Thoracic ,Aortic Diseases ,Aortic Aneurysm ,Aortic Valve ,Aortic Valve Insufficiency ,Medicine ,Internal medicine ,RC31-1245 - Abstract
Giant cell arteritis (GCA) is a type of chronic vasculitis that affects medium and large-caliber arteries, frequently related to aortic involvement and, consequently, to aneurysm formation. However, associated valvulitis with giant cells is uncommon. We describe the case of a 50-year-old female patient with aortic aneurysm and valvular insufficiency, whose anatomopathological examination revealed giant-cell aortic valvulitis associated with giant cell aortitis.
- Published
- 2023
5. Subarachnoid haemorrhage in a patient with undiagnosed aortic coarctation
- Author
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Anders Peder Højer Karlsen, Michael Rahbek Schmidt, Trine Stavnsgaard, and Martin Kryspin Sørensen
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Male ,Hypertension ,Humans ,Aorta, Thoracic ,Stents ,General Medicine ,Aneurysm, Ruptured ,Subarachnoid Hemorrhage ,Aortic Coarctation - Abstract
A man in his mid-30s was admitted with a thunderclap headache. He was conscious and hypertensive. A decade earlier, severe hypertension had been diagnosed and extensively investigated without revealing an underlying cause. Brain imaging showed subarachnoid haemorrhage caused by a ruptured pericallosal aneurysm. Endovascular occlusion was attempted, but as the sheath could not pass the aortic arch, it was converted to surgical aneurismal clipping. Intraoperative blood pressure measurement revealed a peak-to-peak gradient of 100 mm Hg across the aortic arch and an ankle/brachial index of 0.46 (normal range 0.9–1.2). Aortic coarctation was suspected, and angiographic imaging and echocardiography confirmed the diagnosis. Subacute direct stenting was performed, which normalised the peak-to-peak gradient and ankle/brachial index. To minimise the risk of severe complications, early diagnosis of aortic coarctation is important and can be facilitated by ankle/brachial index and echocardiography in the suprasternal view.
- Published
- 2024
6. β-Aminopropionitrile Induces Distinct Pathologies in the Ascending and Descending Thoracic Aortic Regions of Mice.
- Author
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Franklin MK, Sawada H, Ito S, Howatt DA, Amioka N, Liang CL, Zhang N, Graf DB, Moorleghen JJ, Katsumata Y, Lu HS, and Daugherty A
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- Animals, Female, Male, Mice, Vascular Remodeling drug effects, Dilatation, Pathologic, Muscle, Smooth, Vascular pathology, Muscle, Smooth, Vascular drug effects, Muscle, Smooth, Vascular metabolism, Age Factors, Time Factors, Sex Factors, Cell Proliferation drug effects, Protein-Lysine 6-Oxidase metabolism, Aminopropionitrile toxicity, Aminopropionitrile pharmacology, Aorta, Thoracic pathology, Aorta, Thoracic drug effects, Aorta, Thoracic metabolism, Mice, Inbred C57BL, Disease Models, Animal, Aortic Rupture chemically induced, Aortic Rupture pathology, Aortic Rupture metabolism, Aortic Rupture prevention & control
- Abstract
Background: β-aminopropionitrile (BAPN) is a pharmacological inhibitor of LOX (lysyl oxidase) and LOXLs (LOX-like proteins). Administration of BAPN promotes aortopathies, although there is a paucity of data on experimental conditions to generate pathology. The objective of this study was to define experimental parameters and determine whether equivalent or variable aortopathies were generated throughout the aortic tree during BAPN administration in mice., Methods: BAPN was administered in drinking water for a period ranging from 1 to 12 weeks. The impacts of BAPN were first assessed with regard to BAPN dose, and mouse strain, age, and sex. BAPN-induced aortic pathological characterization was conducted using histology and immunostaining. To investigate the mechanistic basis of regional heterogeneity, the ascending and descending thoracic aortas were harvested after 1 week of BAPN administration before the appearance of overt pathology., Results: BAPN-induced aortic rupture predominantly occurred or originated in the descending thoracic aorta in young C57BL/6J or N mice. No apparent differences were found between male and female mice. For mice surviving 12 weeks of BAPN administration, profound dilatation was consistently observed in the ascending region, while there were more heterogeneous changes in the descending thoracic region. Pathological features were distinct between the ascending and descending thoracic regions. Aortic pathology in the ascending region was characterized by luminal dilatation and elastic fiber disruption throughout the media. The descending thoracic region frequently had dissections with false lumen formation, collagen deposition, and remodeling of the wall surrounding the false lumen. Cells surrounding the false lumen were predominantly positive for α-SMA (α-smooth muscle actin). One week of BAPN administration compromised contractile properties in both regions equivalently, and RNA sequencing did not show obvious differences between the 2 aortic regions in smooth muscle cell markers, cell proliferation markers, and extracellular components., Conclusions: BAPN-induced pathologies show distinct, heterogeneous features within and between ascending and descending aortic regions in mice., Competing Interests: Disclosures None.
- Published
- 2024
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7. Vascular Remodeling During Late-Gestation Pregnancy: An In-Vitro Assessment of the Murine Ascending Thoracic Aorta.
- Author
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Vargas AI, Tarraf SA, Jennings T, Bellini C, and Amini R
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- Female, Humans, Animals, Mice, Pregnancy, Aorta, Stress, Mechanical, Aorta, Thoracic, Vascular Remodeling
- Abstract
Maternal mortality due to cardiovascular disease is a rising concern in the U.S. Pregnancy triggers changes in the circulatory system, potentially influencing the structure of the central vasculature. Evidence suggests a link between a woman's pregnancy history and future cardiovascular health, but our understanding remains limited. To fill this gap, we examined the passive mechanics of the murine ascending thoracic aorta during late gestation. By performing biaxial mechanical testing on the ascending aorta, we were able to characterize the mechanical properties of both control and late-gestation tissues. By examining mechanical, structural, and geometric properties, we confirmed that remodeling of the aortic wall occurred. Morphological and mechanical properties of the tissue indicated an outward expansion of the tissue, as reflected in changes in wall thickness (∼12% increase) and luminal diameter (∼6% increase) at its physiologically loaded state in the pregnant group. With these geometric adaptations and despite increased hemodynamic loads, pregnancy did not induce significant changes in the tensile wall stress at the similar physiological pressure levels of the pregnant and control tissues. The alterations also included reduced intrinsic stiffness in the circumferential direction (∼18%) and reduced structural stiffness (∼26%) in the pregnant group. The observed vascular remodeling maintained the elastic stored energy of the aortic wall under systolic loads, indicating preservation of vascular function. Data from our study of pregnancy-related vascular remodeling will provide valuable insights for future investigations of maternal cardiovascular health., (Copyright © 2024 by ASME; reuse license CC-BY 4.0.)
- Published
- 2024
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8. Ministernotomy in Aortic Root and Arch Surgery: Early Outcomes
- Author
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Ulku Kafa Kulacoglu and Mehmet Kaya
- Subjects
Sternotomy ,Thoracic Surgery ,Aorta, Thoracic ,Erythrocytes ,Morbidity ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
ABSTRACT Introduction: Minimally invasive methods have become more preferred in cardiac surgery today. In this study, the comparative results of patients who underwent an aortic root, arch or hemiarch replacement by ministernotomy and full sternotomy in our clinic are presented. Methods: Between January 2017 and October 2019, a series of operations including aortic root, ascending aorta, and aortic arch replacements were performed on 278 patients. The ministernotomy technique was used in 25 of them. Twenty patients who underwent full sternotomy were selected and matched to this group for comparison. Results: The ministernotomy group had a longer cross-clamping time (128.3±30.8 vs. 104.7±23.4 min, P=0.007) but the total operating time was similar in the two groups (249.76±28.56 vs. 248.25±37.53 min, P=0.879). The number of red blood cell (RBC) transfusions per patient was higher in the full sternotomy group (4.65±3.74 vs. 2.44±1.85 unit, P=0.020). The ministernotomy group had shorter ventilation times (7.60±4.88 vs. 32.30±32.25 h, P
- Published
- 2022
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9. Percutaneous Aortic Stent Implantation in an Adult Patient with Interrupted Aortic Arch.
- Author
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DEMİR, Mustafa, KESKİN, Ömer Faruk, İYİSOY, Atila, and ÖZ, Bilgehan Savaş
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THORACIC aorta , *AORTA , *ADULTS , *TREATMENT effectiveness , *HUMAN abnormalities , *AORTIC dissection - Abstract
An interrupted aortic arch (IAA) is an infrequent congenital or acquired malformation defined as a complete absence or discontinuation of a portion of the aortic arch. In most cases especially in neonates, IAA is accompanied by a cardiac malformation or genetic syndromes. IAA has a very poor prognosis in patients without surgical treatment, so it is rarely detected in adulthood. Nowadays the definitive treatment option is still surgery. However, percutaneous aortic stent implantation may be a life-saving alternative treatment method, especially in patients with high surgical risk. Herein we present a very rare case of Type A IAA in a 55-year-old female patient which was successfully treated with percutaneous aortic stent implantation. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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10. Anomalous right subclavian artery as cause of dysphagia
- Author
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Basel Abdelazeem, Mehak Qureshi, Saed Alnaimat, and Rudin Gjeka
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Subclavian Artery ,Humans ,Aorta, Thoracic ,General Medicine ,Deglutition Disorders ,Brachiocephalic Trunk - Published
- 2024
11. Exploration of Simplified Intraluminal TEVAR Technique for the Treatment of Aortic Arch Disease
- Author
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Bailang Chen and Minxin Wei
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Aorta, Thoracic ,Computed Tomography Angiography ,Aorta ,Stents ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Objective: The positional relationship between the three branches of the aortic arch was determined in normal people. This study provides data to support the customization of aortic arch stents and simplifies intraluminal treatment. Methods: From January 2019 to August 2019, 120 patients who met the inclusion criteria were examined by CT angiography. The ratio of the distance from the midpoint of the three-branch opening onto the anterior wall to the cross-sectional diameter of the aortic arch was calculated. The positional relationship among the three-branch openings was obtained and the data were analyzed statistically. Results: The three-branch openings were not in a straight line. The positional relationship among the three-branch openings was divided into four types, which were not statistically different between sex and age (P>0.05). Conclusion: By measuring the opening position of the three aortic branches, the positional relationship among the three branches was defined to provide a theoretical basis for the design of intraluminal stents and simplified intracavity thoracic endovascular aortic repair (TEVAR) technology.
- Published
- 2020
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12. Curative effect of angioplasty and stenting on proximal arcus aortae stenosis
- Author
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Rong-ju ZHANG, Xiang-yu CAO, Zhi-hua DU, Xin-feng LIU, Bin Lü, and Jun WANG
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aorta, thoracic ,angioplasty ,stents ,angiography, digital subtraction ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Objective To investigate the application of angioplasty and stenting in the treatment of proximal arcus aortae stenosis. Methods and Results From January 2015 to June 2018, 13 patients with proximal stenosis of superior aortic arch including 5 patients with anonymous stenosis, 5 patients with right common carotid artery (CCA) stenosis and 3 patients with left CCA stenosis were treated by stenting. Eleven Express LD balloon-expanding stents and 2 Wallstent self-expanding stents were implanted. No thrombus protective umbrella was used during stent release in 4 patients (one case of anonymous artery stenosis and 3 cases of left CCA stenosis). One case of anonymous artery stenosis showed small cortical infarction 3 d after operation. Six months after operation, CTA showed restenosis in stent in one case with anonymous artery stenosis. The restenosis rate was more than 50%. Conclusions Stenosis of anonymous artery and CCA can be treated by angioplasty and stenting. The stability of the guide catheter and the recovery of the filter devices should be considered during the operation. The perioperative and long-term results are satisfactory. DOI:10.3969/j.issn.1672-6731.2019.10.010
- Published
- 2019
13. Protein malnutrition during lactation affects thoracic aortic tunica media thickness in Wistar rat pups
- Author
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Ronaldo Miguel Carvalho, Isabeliza Maria do Espírito Santo Rangel Ferreira, and Fausto Miranda Jr
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Protein Deficiency ,Aorta, Thoracic ,Malnutrition ,Rats ,Surgery ,RD1-811 - Abstract
ABSTRACT Purpose: To evaluate the morphological effects of a low-protein diet during maternal lactation on the offspring’s thoracic aorta. Methods: Two female Wistar rats were mated with male of the same species at 4 months of age. Until the birth of the pups, all animals received commercial rat chow. After giving birth, the puerperal females were divided into two groups and adjusted the litter to five puppies per group: a control group that received commercial feed, and an experimental group whose diet included the same amount of calories, but 8% lower protein content. All animals’ masses were measured throughout the lactation period, and the pups were euthanized after weaning at 21 days of age. The thoracic aorta was removed, histologically processed and stained with Weigert’s resorcin-fuchsin for histomorphometric analysis of tunica media thickness. Results: Although both groups were born with similar body mass, during the 21 days of lactation the restricted protein group gained only 39% of the body mass of the control group. Histomorphometric analysis revealed that the restricted protein group had a significantly lower mean tunica media thickness than the control group. Conclusions: A low-protein diet for nursing mothers influences mass gain and aortic tunica media thickness in their offspring.
- Published
- 2021
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14. Akkermansia muciniphila extracellular vesicles have a protective effect against hypertension.
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Kim JY, Kim CW, Oh SY, Jang S, Yetunde OZ, Kim BA, Hong SH, and Kim I
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- Animals, Male, Rats, Aorta, Thoracic, Leukocytes, Mononuclear, Blood Pressure, Vasodilation, Spleen, Rats, Inbred SHR, Rats, Inbred WKY, Extracellular Vesicles, Hypertension, Akkermansia, Probiotics
- Abstract
Akkermansia muciniphila (Am) shows a beneficial role as a probiotic in the treatment of metabolic syndrome. However, the mechanism remains to be elucidated. We tested the hypothesis that Am extracellular vesicles (AmEVs) have a protective effect against hypertension. Extracellular vesicles purified from anaerobically cultured Am were characterized by nanoparticle tracking analysis, transmission electron microscopy, and silver stain after sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). AmEVs (1.0 × 10
10 log particles/L) or vehicles were added into organ baths to induce vasorelaxation. In addition, AmEVs (1.0 × 108 or 1.0 × 109 particles/kg) or vehicles were injected into the tail veins of Wistar-Kyoto rats (WKYs) and spontaneously hypertensive rats (SHRs) weekly for 4 weeks. Peripheral blood mononuclear cells (PBMCs) and splenocytes isolated from both rat strains were analyzed by flow cytometry, RT-qPCR, and western blot. AmEVs affected neither vascular contraction nor endothelial relaxation in thoracic aortas. Moreover, AmEVs protected against the development of hypertension in SHRs without a serious adverse reaction. Additionally, AmEVs increased the population of T regulatory (Treg) cells and tended to reduce proinflammatory cytokines. These results indicate that AmEVs have a protective effect against hypertension without a serious adverse reaction. Therefore, it is foreseen that AmEVs may be utilized as a novel therapeutic for the treatment of hypertension., (© 2024. The Author(s), under exclusive licence to The Japanese Society of Hypertension.)- Published
- 2024
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15. Atherosclerotic Calcifications Have a Local Effect on the Peel Behavior of Human Aortic Media.
- Author
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Donahue CL, Badal RM, Younger TS, Guan W, Tolkacheva EG, and Barocas VH
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- Humans, X-Ray Microtomography, Aorta diagnostic imaging, Aorta, Thoracic, Atherosclerosis diagnostic imaging, Aortic Dissection, Calcinosis
- Abstract
Aortic dissections, characterized by the propagation of a tear through the layers of the vessel wall, are critical, life-threatening events. Aortic calcifications are a common comorbidity in both acute and chronic dissections, yet their impact on dissection mechanics remains unclear. Using micro-computed tomography (CT) imaging, peel testing, and finite element modeling, this study examines the interplay between atherosclerotic calcifications and dissection mechanics. Samples cut from cadaveric human thoracic aortas were micro-CT imaged and subsequently peel-tested to map peel tension curves to the location of aortic calcifications. Empirical mode decomposition separated peel tension curves into high and low-frequency components, with high-frequency effects corresponding to interlamellar bonding mechanics and low-frequency effects to peel tension fluctuations. Finally, we used an idealized finite element model to examine how stiff calcifications affect aortic failure mechanics. Results showed that atherosclerosis influences dissection behavior on multiple length scales. Experimentally, atherosclerotic samples exhibited higher peel tensions and greater variance in the axial direction. The variation was driven by increased amplitudes of low-frequency tension fluctuations in diseased samples, indicating that more catastrophic propagations occur near calcifications. The simulations corroborated this finding, suggesting that the low-frequency changes resulted from the presence of a stiff calcification in the vessel wall. There were also modifications to the high-frequency peel mechanics, a response likely attributable to alterations in the microstructure and interlamellar bonding within the media. Considered collectively, these findings demonstrate that dissection mechanics are modified in aortic media nearby and adjacent to aortic calcifications., (Copyright © 2024 by ASME.)
- Published
- 2024
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16. Buffering Mechanism in Aortic Arch Artery Formation and Congenital Heart Disease.
- Author
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Ramirez A, Vyzas CA, Zhao H, Eng K, Degenhardt K, and Astrof S
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- Animals, Mice, Gene Expression Regulation, Developmental, Cell Differentiation, Mice, Inbred C57BL, Vascular Endothelial Growth Factor Receptor-2 metabolism, Vascular Endothelial Growth Factor Receptor-2 genetics, Aorta, Thoracic embryology, Aorta, Thoracic metabolism, Heart Defects, Congenital genetics, Heart Defects, Congenital metabolism, Heart Defects, Congenital pathology, Heart Defects, Congenital embryology, T-Box Domain Proteins metabolism, T-Box Domain Proteins genetics, Endothelial Cells metabolism
- Abstract
Background: The resiliency of embryonic development to genetic and environmental perturbations has been long appreciated; however, little is known about the mechanisms underlying the robustness of developmental processes. Aberrations resulting in neonatal lethality are exemplified by congenital heart disease arising from defective morphogenesis of pharyngeal arch arteries (PAAs) and their derivatives., Methods: Mouse genetics, lineage tracing, confocal microscopy, and quantitative image analyses were used to investigate mechanisms of PAA formation and repair., Results: The second heart field (SHF) gives rise to the PAA endothelium. Here, we show that the number of SHF-derived endothelial cells (ECs) is regulated by VEGFR2 (vascular endothelial growth factor receptor 2) and Tbx1 . Remarkably, when the SHF-derived EC number is decreased, PAA development can be rescued by the compensatory endothelium. Blocking such compensatory response leads to embryonic demise. To determine the source of compensating ECs and mechanisms regulating their recruitment, we investigated 3-dimensional EC connectivity, EC fate, and gene expression. Our studies demonstrate that the expression of VEGFR2 by the SHF is required for the differentiation of SHF-derived cells into PAA ECs. The deletion of 1 VEGFR2 allele ( VEGFR2
SHF-HET ) reduces SHF contribution to the PAA endothelium, while the deletion of both alleles ( VEGFR2SHF-KO ) abolishes it. The decrease in SHF-derived ECs in VEGFR2SHF-HET and VEGFR2SHF-KO embryos is complemented by the recruitment of ECs from the nearby veins. Compensatory ECs contribute to PAA derivatives, giving rise to the endothelium of the aortic arch and the ductus in VEGFR2SHF-KO mutants. Blocking the compensatory response in VEGFR2SHF-KO mutants results in embryonic lethality shortly after mid-gestation. The compensatory ECs are absent in Tbx1+/- embryos, a model for 22q11 deletion syndrome, leading to unpredictable arch artery morphogenesis and congenital heart disease. Tbx1 regulates the recruitment of the compensatory endothelium in an SHF-non-cell-autonomous manner., Conclusions: Our studies uncover a novel buffering mechanism underlying the resiliency of PAA development and remodeling., Competing Interests: Disclosures None.- Published
- 2024
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17. Experimental characterization of residual deformations in human descending thoracic aortas.
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Amabili M, Franchini G, and Garziera R
- Subjects
- Humans, Stress, Mechanical, Pressure, Biomechanical Phenomena, Aorta, Thoracic, Aorta
- Abstract
The effect of residual stresses on the deformation of human aortas under pulsatile pressure is relevant. Experimental measurements of residual deformations are necessary to characterize residual stresses in human aortas. For this reason, an experimental study is carried out. In the present study, longitudinal and circumferential strips from descending thoracic aortas obtained from 21 donors, harvested during organ donation explant, underwent residual deformation measurements. The intact wall and the three separated layers were tested in both directions, resulting in 8 tests per donor, which gives a relevant set of experimental data for further studies. Results show significant residual deformations both in circumferential and longitudinal directions, which are compatible with a significantly compressed intima in the unloaded aorta. In particular, the measured mean effective curvature was -0.193 ± 0.064 (1/mm) for the circumferential strips and -0.076 ± 0.030 (1/mm) for longitudinal strips of the full wall. The effects of age and gender were also investigated., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)
- Published
- 2024
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18. Ultrasound images of the ascending aorta of anesthetized northern fur seals and Steller sea lions confirm that the aortic bulb maintains continuous blood flow.
- Author
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Storlund RL, Rosen DAS, Haulena M, Sanatani S, Vander Zaag J, and Trites AW
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- Animals, Aorta, Thoracic, Body Size, Fur Seals, Sea Lions, Caniformia
- Abstract
The increased size and enhanced compliance of the aortic bulb-the enlargement of the ascending aorta-are believed to maintain blood flow in pinnipeds during extended periods of diastole induced by diving bradycardia. The aortic bulb has been described ex vivo in several species of pinnipeds, but in vivo measurements are needed to investigate the relationship between structure and function. We obtained ultrasound images using electrocardiogram-gated transesophageal echocardiography during anesthesia and after atropine administration to assess the relationship between aortic bulb anatomy and cardiac function (heart rate, stroke volume, cardiac output) in northern fur seals (Callorhinus ursinus) and Steller sea lions (Eumetopias jubatus). We observed that the aortic bulb in northern fur seals and Steller sea lions expands during systole and recoils over the entire diastolic period indicating that blood flow is maintained throughout the entire cardiac cycle as expected. The stroke volumes we measured in the fur seals and sea lions fit the values predicted based on body size in mammals and did not change with increased heart rates, suggesting that greater stroke volumes are not needed for aortic bulb function. Overall, our results suggest that peripheral vasoconstriction during diving is sufficient to modulate the volume of blood in the aortic bulb to ensure that flow lasts over the entire diastolic period. These results indicate that the shift of blood into the aortic bulb of pinnipeds is a fundamental mechanism caused by vasoconstriction while diving, highlighting the importance of this unique anatomical adaptation., (© 2024 The Authors. Journal of Experimental Zoology Part A: Ecological and Integrative Physiology published by Wiley Periodicals LLC.)
- Published
- 2024
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19. Acute Large Vessel Occlusion Caused by Giant Floating Aortic Thrombus.
- Author
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Johno T, Kawano H, Nagahama K, Kubota H, and Hirano T
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- Humans, Aorta, Thoracic diagnostic imaging, Stroke etiology, Stroke complications, Thrombosis complications, Thrombosis diagnostic imaging, Aortic Diseases complications, Aortic Diseases diagnostic imaging
- Abstract
Competing Interests: Disclosures None.
- Published
- 2024
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20. Late Migration of Fully Deployed Left Main Coronary Stent into Aortic Root: A Late Complication and Its Surgical Management.
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Ahmad T, Alafifi AA, Aldossari M, Tasca G, and Aljerayed N
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- Humans, Aorta, Thoracic, Aorta diagnostic imaging, Aorta surgery, Stents, Percutaneous Coronary Intervention adverse effects, Embolization, Therapeutic
- Abstract
Abstract: Migration and embolization of a deployed stent is a rare complication of percutaneous coronary interventions (PCI) and can result in serious and potentially life-threatening complications. There are many reports of intracoronary stent entrapment, stripping, and dislodgement during PCI, however, only a few reports about migration. We report a rare case of migration of the left main coronary stent into the aortic root, which happened 5 months after the procedure and was treated by its partial removal through aortotomy along with surgical revascularization. The patient was discharged 5 days later, after an uneventful hospital stay., (Copyright © 2024 Copyright: © 2024 Annals of Cardiac Anaesthesia.)
- Published
- 2024
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21. Growth and remodeling of the dissected membrane in an idealized dissected aorta model.
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Gheysen L, Maes L, Famaey N, and Segers P
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- Humans, Aorta, Thoracic, Aorta, Inflammation, Elastin, Collagen, Aortic Dissection, Aortic Aneurysm, Thoracic
- Abstract
While transitioning from the acute to chronic phase, the wall of a dissected aorta often expands in diameter and adaptations in thickness and microstructure take place in the dissected membrane. Including the mechanisms, leading to these changes, in a computational model is expected to improve the accuracy of predictions of the long-term complications and optimal treatment timing of dissection patients. An idealized dissected wall was modeled to represent the elastin and collagen production and/or degradation imposed by stress- and inflammation-mediated growth and remodeling, using the homogenized constrained mixture theory. As no optimal growth and remodeling parameters have been defined for aortic dissections, a Latin hypercube sampling with 1000 parameter combinations was assessed for four inflammation patterns, with a varying spatial extent (full/local) and temporal evolution (permanent/transient). The dissected membrane thickening and microstructure was considered together with the diameter expansion over a period of 90 days. The highest success rate was found for the transient inflammation patterns, with about 15% of the samples leading to converged solutions after 90 days. Clinically observed thickening rates were found for 2-4% of the transient inflammation samples, which represented median total diameter expansion rates of about 5 mm/year. The dissected membrane microstructure showed an elastin decrease and, in most cases, a collagen increase. In conclusion, the model with the transient inflammation pattern allowed the reproduction of clinically observed dissected membrane thickening rates, diameter expansion rates and adaptations in microstructure, thus providing guidance in reducing the parameter space in growth and remodeling models of aortic dissections., (© 2023. The Author(s).)
- Published
- 2024
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22. Aberrant right subclavian artery: will it need surgery?
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Zidere V and Vigneswaran TV
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- Humans, Subclavian Artery diagnostic imaging, Subclavian Artery surgery, Aorta, Thoracic, Cardiovascular Abnormalities diagnostic imaging, Cardiovascular Abnormalities surgery, Subclavian Artery abnormalities
- Published
- 2024
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23. Prognostic impact of main pulmonary artery to ascending aorta diameter ratio in patients with severe aortic stenosis underwent transcatheter aortic valve implantation.
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Hakgor A, Dursun A, Kahraman BC, Yazar A, Savur U, Akhundova A, Olgun FE, Arman ME, and Boztosun B
- Subjects
- Female, Humans, Aged, Aged, 80 and over, Male, Prognosis, Pulmonary Artery diagnostic imaging, Treatment Outcome, Retrospective Studies, Aorta, Thoracic, Aortic Valve diagnostic imaging, Aortic Valve surgery, Transcatheter Aortic Valve Replacement adverse effects, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Hypertension, Pulmonary
- Abstract
Background: Pulmonary hypertension (PH) and right ventricular dysfunction are poor prognostic predictors in patients underwent transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS)., Aims: The prognostic impact of the main pulmonary artery/ascending aorta diameter ratio (MPA/AOr), measured simply by computed-tomographic angiography (CTA), was investigated in this patient group., Methods: A total of 374 retrospectively evaluated patients (mean age 78.1 ± 8.4 years, 192 [51.3%] females) who underwent TAVI for severe AS were included. MPA/AOr was measured on preprocedural CTA in all patients and the effect of this measurement on the presence of PH, in-hospital and 2-year-overall long-term mortality was investigated., Results: The presence of PH was defined as a systolic pulmonary artery pressure (sPAP) >42 mmHg measured by echocardiography. According to multivariate-logistic-regression analysis, MPA/AOr (adjusted [Adj] odds ratio [OR]: 1.188, confidence interval [CI] 95% [1.002-1.410], p = 0.048), tricuspid annular plane systolic excursion (TAPSE) (adj OR:0.736, CI 95% [0.663-0.816], p < 0.001) and left atrial diameter (adj OR:1.051, CI 95% [1.007-1.098], p = 0.024) were identified as independent predictors of PH. In addition, a statistically significant correlation was found between MPA/AOr and TAPSE (r: -0.283, p < 0.001). Furthermore, MPA/AOr was found to be an independent predictor of both in-hospital (adj OR:1.434, CI 95% [1.093-1.881], p = 0.009) and 2-year long-term (adj OR:1.518, CI 95% [1.243-1.853], p < 0.001) mortality in multivariate analysis including TAPSE, STS score and sPAP. In the 2-year Kaplan-Meier survival probability analysis, an MPA/AOr >0.86 was found to have a hazard ratio of 3.697 (95% CI: 2.341-5.840), with a log-rank p < 0.001., Conclusion: MPA/AOr, which can be measured simply by CTA, may be useful as an indicator of the presence of PH and poor prognosis in patients planned for TAVI for severe AS., (© 2024 Wiley Periodicals LLC.)
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- 2024
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24. Ruptured cerebral aneurysm in isolated type A interrupted aortic arch managed by transradial endovascular route: A case report with literature review
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Chirag K Ahuja, Manisha Joshi, Sunil K Gupta, and N Khandelwal
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Adult ,Adolescent ,Computed Tomography Angiography ,Endovascular Procedures ,Infant, Newborn ,Intracranial Aneurysm ,Aorta, Thoracic ,General Medicine ,Aneurysm, Ruptured ,cardiovascular system ,Humans ,Radiology, Nuclear Medicine and imaging ,Female ,Neurology (clinical) ,Tomography, X-Ray Computed - Abstract
Background and Introduction Interrupted aortic arch (IAA) is a very rare congenital anomaly carrying high neonatal mortality rate if left untreated. Rarer still, is its presentation in teenage or adulthood. This condition has been found to be complicated with cerebral aneurysms, which is a consequence of hemodynamic stress and hypertension secondary to arch interruption. Cerebral aneurysms can further complicate the clinical course and lead to poor clinical outcomes, especially if ruptured. Clinical Presentation A 17-year-old female presented with ruptured basilar top aneurysm and was considered for endovascular coiling. Transfemoral access was chosen but the catheter could not be negotiated beyond proximal thoracic aorta. A computed tomographic angiography (CTA) of thorax and abdomen was performed, which showed isolated interruption of aortic arch. Subsequently, transradial route was used for coiling of the aneurysm. Conclusion To the best of our knowledge, the index case is one of the only seven cases of IAA with cerebral aneurysm that have been reported till date in medical literature. It also holds the unique distinction of being the first case of IAA with cerebral aneurysm treated by endovascular approach. Our case highlights the importance of transradial access in such pathological conditions.
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- 2023
25. Exploration of Simplified Intraluminal TEVAR Technique for the Treatment of Aortic Arch Disease.
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Bailang Chen and Minxin Wei
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THORACIC aorta ,AORTA ,ANGIOGRAPHY - Abstract
Objective: The positional relationship between the three branches of the aortic arch was determined in normal people. This study provides data to support the customization of aortic arch stents and simplifies intraluminal treatment. Methods: From January 2019 to August 2019, 120 patients who met the inclusion criteria were examined by CT angiography. The ratio of the distance from the midpoint of the three-branch opening onto the anterior wall to the cross-sectional diameter of the aortic arch was calculated. The positional relationship among the three-branch openings was obtained and the data were analyzed statistically. Results: The three-branch openings were not in a straight line. The positional relationship among the three-branch openings was divided into four types, which were not statistically different between sex and age (P>0.05). Conclusion: By measuring the opening position of the three aortic branches, the positional relationship among the three branches was defined to provide a theoretical basis for the design of intraluminal stents and simplified intracavity thoracic endovascular aortic repair (TEVAR) technology. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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26. Conservative Treatment of Unicuspid Aortic Valve with Newly Diagnosed Type A Aortic Dissection
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Vera Graup, Lukas Meier, Francesco Maisano, and Ahmed Ouda
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Aortic Valve Disease 1 ,Aortic Valve ,Aorta, Thoracic ,Dilatation ,Heart Valve Diseases ,Aortic Diseases ,Heart Defects, Congenital ,Surgery ,RD1-811 ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract We present a case of a 36-year-old male patient with known arthrogryposis multiplex congenita and an associated unicuspid aortic valve. The patient later developed a significant aneurysm of the ascending aorta, however refused surgical intervention and missed follow-up appointments for 5 years. During an urgent, general practitioner-initiated transthoracic echocardiography follow-up, a chronic type A aortic dissection was diagnosed as a result of progressive aortic dilatation. Due to the stationary pressure gradients and non-progressive leaflet fibrosis, a conservative approach for to the unicuspid aortic valve was chosen, combined with replacement of the ascending aorta and partial replacement of the aortic arch.
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- 2020
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27. Acute Infarcts on Brain MRI Following Aortic Arch Repair With Circulatory Arrest: Insights From the ACE CardioLink-3 Randomized Trial
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Chih-Hao Chen, Mark D. Peterson, C. David Mazer, Makoto Hibino, Andrew E. Beaudin, Michael W.A. Chu, François Dagenais, Hwee Teoh, Adrian Quan, Jeffrey Dickson, Subodh Verma, and Eric E. Smith
- Subjects
Advanced and Specialized Nursing ,Diffusion Magnetic Resonance Imaging ,Infarction ,Humans ,Brain ,Aorta, Thoracic ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,Magnetic Resonance Imaging - Abstract
Background: to investigate the frequency and distribution of new ischemic brain lesions detected by diffusion-weighted imaging on brain magnetic resonance imaging after aortic arch surgery. Methods: This preplanned secondary analysis of the randomized, controlled ACE (Aortic Surgery Cerebral Protection Evaluation) CardioLink-3 trial compared the safety and efficacy of innominate versus axillary artery cannulation during elective proximal aortic arch surgery. Participants underwent pre and postoperative magnetic resonance imaging. New ischemic lesions were defined as lesions visible on postoperative, but not preoperative diffusion weighted imaging. Results: Of the 111 trial participants, 102 had complete magnetic resonance imaging data. A total of 391 new ischemic lesions were observed on diffusion-weighted imaging in 71 (70%) patients. The average number of lesions in patients with ischemic lesion were 5.5±4.9 with comparable numbers in the right (2.9±2.0) and left (3.0±2.3) hemispheres ( P =0.49). Half the new lesions were in the middle cerebral artery territory; 63% of the cohort had ischemic lesions in the anterior circulation, 49% in the posterior circulation, 42% in both, and 20% in watershed areas. A probability mask of all diffusion-weighted imaging lesions revealed that the cerebellum was commonly involved. More severe white matter hyperintensity on preoperative magnetic resonance imaging (odds ratio, 1.80 [95% CI, 1.10–2.95]; P =0.02) and lower nadir nasopharyngeal temperature during surgery (odds ratio per 1°C decrease, 1.15 [95% CI, 1.00–1.32]; P =0.05) were associated with the presentation of new ischemic lesion; older age (risk ratio per 1-year increase, 1.02 [95% CI, 1.00–1.04]; P =0.03) and lower nadir temperature (risk ratio per 1°C decrease, 1.06 [95% CI, 1.00–1.14]; P =0.06) were associated with greater number of lesions. Conclusions: In patients who underwent elective proximal aortic arch surgery, new ischemic brain lesions were common, and predominantly involved the middle cerebral artery territory or cerebellum. Underlying small vessel disease, lower temperature nadir during surgery, and advanced age were risk factors for perioperative ischemic lesions. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02554032.
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- 2023
28. A Systematic Review of Total Endovascular Aortic Arch Repair: A Promising Technology
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Ameen M. Basha, Randy D. Moore, Kenton L. Rommens, Eric J. Herget, and R. Scott McClure
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Blood Vessel Prosthesis Implantation ,Aortic Dissection ,Treatment Outcome ,Aortic Aneurysm, Thoracic ,Endovascular Procedures ,Humans ,Aorta, Thoracic ,Stents ,Cardiology and Cardiovascular Medicine ,Blood Vessel Prosthesis ,Retrospective Studies - Abstract
Total endovascular aortic arch repair (TEAAR) represents an emerging alternative for the treatment of aortic arch disease in patients at prohibitive risk for open surgery. A systematic review of TEAAR was performed to delineate early outcomes with this new technology.All studies (excluding single-patient case reports) of CE-certified "custom made" or "off-the-shelf" zone 0 stent graft deployments were included. The primary search of Medline, Embase, CINAHL, and the Cochrane CENTRAL registry was supplemented with searches of Web of Science, ClinicalTrials.gov, and conference abstracts (within last 3 years), and a hand search of citations within relevant articles. Articles underwent 2-stage screening by 2 independent reviewers before inclusion.Fifteen relevant investigations were identified. Indications for TEAAR were chronic arch dissection with degenerative aneurysmal disease (54%, 148/273), pure arch aneurysm (41%, 112/273), penetrating atherosclerotic ulcer (2%, 5/273), and type IA endoleak from a zone 2 thoracic endograft (1%, 3/273). Double-branch (70%, 192/273), triple-branch (19%, 53/273), and single-branch (into innominate artery; 10%, 28/273) devices were used. Adjunct left carotid-subclavian bypass occurred in 90% of double- and single-branch procedures. Procedural success with TEAAR was 93% (95% CI 85.8%-96.3%). The proportion of all-cause mortality was 16% (95% CI 8%-26%), stroke 14% (8%-24%), peripheral vascular events 7% (1%-33%), and myocardial infarction 4% (2%-7%). Endoleaks were identified in 13% (7%-25%) of the study population.TEAAR represents an emerging option for the management of aortic arch disease wth high procedural success rates and acceptable early outcomes in a high-risk patient population.
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- 2023
29. Female sex is independently associated with reduced inpatient mortality after endovascular repair of blunt thoracic aortic injury
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Vy Thuy Ho, Sabina Sorondo, Joseph D. Forrester, Elizabeth L. George, Kenneth Tran, Jason T. Lee, Manuel Garcia-Toca, and Jordan R. Stern
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Male ,Inpatients ,Thoracic Injuries ,Endovascular Procedures ,Aftercare ,Aorta, Thoracic ,Vascular System Injuries ,Wounds, Nonpenetrating ,Patient Discharge ,Treatment Outcome ,Postoperative Complications ,Humans ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,Retrospective Studies - Abstract
Female sex has been associated with decreased mortality after blunt trauma, but whether sex influences the outcomes of thoracic endovascular aortic repair (TEVAR) for traumatic blunt thoracic aortic injury (BTAI) is unknown.In this retrospective study of a prospectively maintained database, the Vascular Quality Initiative registry was queried from 2013 to 2020 for patients undergoing TEVAR for BTAI. Univariate Student's t-tests and χOf 806 eligible patients, 211 (26.2%) were female. Female patients were older (47.9 vs 41.8 years, P .0001) and less likely to smoke (38.3% vs 48.2%, P = .044). Most patients presented with grade III BTAI (54.5% female, 53.6% male), followed by grade IV (19.0% female, 19.5% male). Mean Injury Severity Scores (30.9 + 20.3 female, 30.5 + 18.8 male) and regional Abbreviated Injury Score did not vary by sex. Postoperatively, female patients were less likely to die as inpatients (3.8% vs 7.9%, P = .042) and to be discharged home (41.4% vs 52.2%, P = .008). On multivariate logistic regression, female sex (odds ratio [OR]: 0.05, P = .002) was associated with reduced inpatient mortality. Advanced age (OR: 1.06, P .001), postoperative transfusion (OR: 1.05, P = .043), increased Injury Severity Score (OR: 1.03, P = .039), postoperative stroke (OR: 9.09, P = .016), postoperative myocardial infarction (OR: 9.9, P = .017), and left subclavian coverage (OR: 2.7, P = .029) were associated with inpatient death.Female sex is associated with lower odds of inpatient mortality after TEVAR for BTAI, independent of age, injury severity, BTAI grade, and postoperative complications. Further study of the influence of sex on postdischarge outcomes is needed.
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- 2023
30. Contemporary Multicenter Outcomes for Truncus Arteriosus With Interrupted Aortic Arch
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Jason R. Buckley, John M. Costello, Arthur J. Smerling, Peter Sassalos, Venu Amula, Katherine Cashen, Christine M. Riley, Adnan M. Bakar, Ilias Iliopoulos, Aimee Jennings, Sukumar Suguna Narasimhulu, and Christopher W. Mastropietro
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Pulmonary and Respiratory Medicine ,Truncus Arteriosus ,Infant ,Aorta, Thoracic ,Truncus Arteriosus, Persistent ,Aortic Coarctation ,Treatment Outcome ,Child, Preschool ,Humans ,Multicenter Studies as Topic ,Surgery ,Child ,Cardiology and Cardiovascular Medicine ,Retrospective Studies - Abstract
Truncus arteriosus with interrupted aortic arch (TA-IAA) is a rare congenital heart defect with historically poor outcomes. Contemporary multicenter data are limited.A retrospective cohort study of children who underwent repair of TA-IAA between 2009 and 2016 at 12 tertiary care referral centers within the United States was performed. Major adverse cardiac events (MACE) were defined as postoperative extracorporeal membrane oxygenation, cardiopulmonary resuscitation, or operative mortality. TA-IAA patients were compared with TA patients who underwent repair during the study period from the same institutions.We reviewed 35 patients with TA-IAA. MACE occurred in 12 patients (34%). Improvement over time was observed during the study period with 11 events (92%) occurring in the first half of the study period (P = .03). Factors associated with MACE included moderate or severe truncal valve insufficiency (P.01), concomitant truncal valve repair (P = .04), and longer cardiopulmonary bypass duration (P = .02). In comparison with 216 patients who underwent TA repair, patients with TA-IAA had a higher rate of MACE, but this finding was not statistically significant (34% vs 20%, respectively; P = .07). Additionally no differences between TA-IAA and TA groups were observed for unplanned reoperations (14% vs 22%, respectively; P = .3), hospital length of stay (24 vs 23 days, P = .65), or late deaths (7% vs 7%, P = 1.00).In this contemporary, multicenter cohort the rate of MACE after repair of TA-IAA was high but improved during the study period. Early childhood outcomes of patients with TA-IAA were similar to those with TA.
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- 2023
31. New Findings on Ascending Aortic Dilation in Coarctation of the Aorta: Expanding Perspectives.
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Rinnström D and Johansson B
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- Humans, Dilatation, Aorta diagnostic imaging, Aortic Valve, Aorta, Thoracic, Aortic Coarctation complications, Aortic Coarctation diagnostic imaging
- Abstract
Competing Interests: Funding Support and Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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- 2024
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32. Development of hypertension models for lung cancer screening cohorts using clinical and thoracic aorta imaging factors.
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Yang J, Yu J, Wang Y, Liao M, Ji Y, Li X, Wang X, Chen J, Qi B, and Yang F
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- Humans, Aorta, Thoracic, Calibration, Early Detection of Cancer, Nomograms, Hypertension diagnostic imaging, Lung Neoplasms diagnostic imaging
- Abstract
This study aims to develop and validate nomogram models utilizing clinical and thoracic aorta imaging factors to assess the risk of hypertension for lung cancer screening cohorts. We included 804 patients and collected baseline clinical data, biochemical indicators, coexisting conditions, and thoracic aorta factors. Patients were randomly divided into a training set (70%) and a validation set (30%). In the training set, variance, t-test/Mann-Whitney U-test and standard least absolute shrinkage and selection operator were used to select thoracic aorta imaging features for constructing the AIScore. Multivariate logistic backward stepwise regression was utilized to analyze the influencing factors of hypertension. Five prediction models (named AIMeasure model, BasicClinical model, TotalClinical model, AIBasicClinical model, AITotalClinical model) were constructed for practical clinical use, tailored to different data scenarios. Additionally, the performance of the models was evaluated using receiver operating characteristic (ROC) curves, calibration curves and decision curve analyses (DCA). The areas under the ROC curve for the five models were 0.73, 0.77, 0.83, 0.78, 0.84 in the training set, and 0.77, 0.78, 0.81, 0.78, 0.82 in the validation set, respectively. Furthermore, the calibration curves and DCAs of both sets performed well on accuracy and clinical practicality. The nomogram models for hypertension risk prediction demonstrate good predictive capability and clinical utility. These models can serve as effective tools for assessing hypertension risk, enabling timely non-pharmacological interventions to preempt or delay the future onset of hypertension., (© 2024. The Author(s).)
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- 2024
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33. Distal Extent of Resection in Type A Dissection: Keeping It Simple.
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Moon MR and Kachroo P
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- Humans, Aorta, Thoracic surgery, Dissection, Treatment Outcome, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation, Endovascular Procedures
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- 2024
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34. [Effect of asiaticoside on systolic blood pressure and relaxation of isolated thoracic aorta of rats].
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Lu G, Sun H, Sun Z, Liu L, Wang L, Zhang N, Wang Y, He Y, Ji J, Li X, Kang P, and Tang B
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- Rats, Animals, Blood Pressure, Endothelial Cells, Calcium, Calcium Chloride pharmacology, Nitroarginine pharmacology, Rats, Sprague-Dawley, 4-Aminopyridine pharmacology, Indomethacin pharmacology, Esters pharmacology, Endothelium, Vascular, Dose-Response Relationship, Drug, Aorta, Thoracic, Vasodilation, Chlorides, Triterpenes, Barium Compounds
- Abstract
Objective: To investigate the effect of asiaticoside on blood pressure and relaxation of thoracic aorta in rats and explore the underlying mechanism., Methods: SD rats treated with 50 and 100 mg/kg asiaticoside by daily gavage for 2 weeks were monitored for systolic blood pressure changes, and histological changes of the thoracic aorta were evaluated using HE staining. In isolated rat endothelium-intact and endothelium-denuded thoracic aorta rings, the effects of asiaticoside on relaxation of the aortic rings were tested at baseline and following norepinephrine (NE)- and KCl-induced constriction. The vascular relaxation effect of asiaticoside was further observed in NE-stimulated endothelium-intact rat aortic rings pretreated with L-nitroarginine methyl ester, indomethacin, zinc protoporphyrin Ⅸ, tetraethyl ammonium chloride, glibenclamide, barium chloride, Iberiotoxin, 4-aminopyridine, or TASK-1-IN-1. The aortic rings were treated with KCl and NE followed by increasing concentrations of CaCl
2 to investigate the effect of asiaticoside on vasoconstriction induced by external calcium influx and internal calcium release., Results: Asiaticoside at 50 and 100 mg/kg significantly lowered systolic blood pressure in rats without affecting the thoracic aorta histomorphology. While not obviously affecting resting aortic rings with intact endothelium, asiaticoside at 100 mg/kg induced significant relaxation of the rings constricted by KCl and NE, but its effects differed between endothelium-intact and endothelium-denuded rings. In endothelium-intact aortic rings pretreated with indomethacin, ZnPP Ⅸ, barium chloride, glyburide, TASK-1-IN-1 and 4-aminopyridine, asiaticoside did not produce significant effect on NE-induced vasoconstriction, and tetraethylammonium, Iberiotoxin and L-nitroarginine methyl ester all inhibited the relaxation effect of asiaticoside. In KCland NE-treated rings, asiaticoside obviously inhibited CaCl2 -induced vascular contraction., Conclusion: Asiaticoside induces thoracic aorta relaxation by mediating high-conductance calcium-activated potassium channel opening, promoting nitric oxide release from endothelial cells and regulating Ca2+ influx and outflow, thereby reducing systolic blood pressure in rats.- Published
- 2024
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35. Association Between Aortic Wall Parameters on Multidetector Computed Tomography and Ruptured Plaques By Nonobstructive General Angioscopy.
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Miyagawa M, Kojima K, Takahashi K, Nakajima Y, Migita S, Mizobuchi S, Tanaka Y, Fukumoto K, Arai R, Morikawa T, Mineki T, Murata N, Sudo M, Fukamachi D, and Okumura Y
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- Humans, Female, Angioscopy methods, Aorta, Thoracic, Aorta, Multidetector Computed Tomography, Plaque, Atherosclerotic
- Abstract
Background: Nonobstructive general angioscopy (NOGA) can identify vulnerable plaques in the aortic lumen that serve as potential risk factors for cardiovascular events such as embolism. However, the association between computed tomography (CT) images and vulnerable plaques detected on NOGA remains unknown., Methods and Results: We investigated 101 patients (67±11 years; women, 13.8%) who underwent NOGA and contrast-enhanced CT before or after 90 days in our hospital. On CT images, the aortic wall thickness, aortic wall area (AWA), and AWA in the vascular area were measured at the thickest point from the 6th to the 12th thoracic vertebral levels. Furthermore, the association between these measurements and the presence or absence of NOGA-derived aortic plaque ruptures (PRs) at the same vertebral level was assessed. NOGA detected aortic PRs in the aortic lumens at 145 (22.1%) of the 656 vertebral levels. The presence of PRs was significantly associated with greater aortic wall thickness (3.3±1.7 mm versus 2.1±1.2 mm), AWA (1.33±0.68 cm
2 versus 0.89±0.49 cm2 ), and AWA in the vascular area (23.2%±9.3% versus 17.2%±7.6%) ( P <0.001 for all) on the CT scans compared with the absence of PRs. The frequency of PRs significantly increased as the aortic wall thickness increased. Notably, a few NOGA-derived PRs were detected on CT in near-normal intima., Conclusions: The presence of NOGA-derived PRs was strongly associated with increased aortic wall thickness, AWA, and AWA in the vascular area, measured using CT. NOGA can detect PRs in the intima that appear almost normal on CT scans.- Published
- 2024
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36. Epidermal growth factor receptor phosphorylation contributes to levobupivacaine-induced contraction in isolated rat aorta.
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Lee SH, Ok SH, Park KE, Bae SI, Hwang Y, Ahn SH, Sim G, Bae M, and Sohn JT
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- Animals, Rats, Aorta, Thoracic, Epidermal Growth Factor metabolism, Levobupivacaine pharmacology, Phosphorylation, RNA, Small Interfering metabolism, src-Family Kinases metabolism, Calcium metabolism, ErbB Receptors metabolism, Quinazolines, Tyrphostins
- Abstract
Vasoconstriction induced by levobupivacaine, a local anesthetic, is mediated by increased levels of calcium, tyrosine kinase, c-Jun NH
2 -terminal kinase (JNK), and phospholipase D, which are associated with prolonged local anesthesia. Epidermal growth factor receptor (EGFR) phosphorylation is associated with vasoconstriction. However, its role in levobupivacaine-induced contractions remains unknown. We determined whether EGFR phosphorylation is associated with levobupivacaine-induced contractions in isolated rat thoracic aortas and identified the underlying cellular signaling pathways. The effects of various inhibitors and a calcium-free solution alone or in combination on levobupivacaine-induced contractions were then assessed. Furthermore, we examined the effects of various inhibitors on levobupivacaine-induced EGFR and JNK phosphorylation and calcium levels in vascular smooth muscle cells (VSMCs) of rat aortas. The EGFR tyrosine kinase inhibitor AG1478, matrix metalloproteinase (MMP) inhibitor GM6001, Src kinase inhibitors PP1 and PP2, and JNK inhibitor SP600125 attenuated levobupivacaine-induced contractions. Moreover, although the calcium-free solution abolished levobupivacaine-induced contractions, calcium reversed this inhibitory effect. The magnitude of the calcium-mediated reversal of abolished levobupivacaine-induced contractions was lower in the combination treatment with calcium-free solution and AG1478 than in the treatment with calcium-free solution alone. Levobupivacaine induced EGFR and JNK phosphorylation. However, AG1478, GM6001, and PP2 attenuated levobupivacaine-induced EGFR and JNK phosphorylation. Moreover, although levobupivacaine induced JNK phosphorylation in control siRNA-transfected VSMCs, EGFR siRNA inhibited levobupivacaine-induced JNK phosphorylation. Furthermore, AG1478 inhibited levobupivacaine-induced calcium increases in VSMCs. Collectively, these findings suggest that levobupivacaine-induced EGFR phosphorylation, which may occur via the Src kinase-MMP pathway, contributes to vasoconstriction via JNK phosphorylation and increased calcium levels., Competing Interests: Declaration of competing interest There are no conflicts of interest to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)- Published
- 2024
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37. Automatic thoracic aorta calcium quantification using deep learning in non-contrast ECG-gated CT images.
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Guilenea FN, Casciaro ME, Soulat G, Mousseaux E, and Craiem D
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- Male, Humans, Middle Aged, Aged, Female, Calcium, Tomography, X-Ray Computed methods, Electrocardiography, Aorta, Thoracic, Deep Learning
- Abstract
Thoracic aorta calcium (TAC) can be assessed from cardiac computed tomography (CT) studies to improve cardiovascular risk prediction. The aim of this study was to develop a fully automatic system to detect TAC and to evaluate its performance for classifying the patients into four TAC risk categories. The method started by segmenting the thoracic aorta, combining three UNets trained with axial, sagittal and coronal CT images. Afterwards, the surrounding lesion candidates were classified using three combined convolutional neural networks (CNNs) trained with orthogonal patches. Image datasets included 1190 non-enhanced ECG-gated cardiac CT studies from a cohort of cardiovascular patients (age 57 ± 9 years, 80% men, 65% TAC > 0). In the test set (N = 119), the combination of UNets was able to successfully segment the thoracic aorta with a mean volume difference of 0.3 ± 11.7 ml (<6%) and a median Dice coefficient of 0.947. The combined CNNs accurately classified the lesion candidates and 87% of the patients (N = 104) were accurately placed in their corresponding risk categories (Kappa = 0.826, ICC = 0.9915). TAC measurement can be estimated automatically from cardiac CT images using UNets to isolate the thoracic aorta and CNNs to classify calcified lesions., (© 2024 IOP Publishing Ltd.)
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- 2024
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38. Selective sinus replacement for aortic root repair in bicuspid aortopathy.
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Urbanski PP, Atieh A, Lehmkuhl L, Irimie V, Zhan X, Thamm T, Ahmidou A, Nasra W, and Diegeler A
- Subjects
- Humans, Aortic Valve diagnostic imaging, Aortic Valve surgery, Aorta, Thoracic, Aorta diagnostic imaging, Aorta surgery, Reoperation, Retrospective Studies, Treatment Outcome, Heart Valve Diseases complications, Heart Valve Diseases diagnostic imaging, Heart Valve Diseases surgery, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency etiology, Aortic Valve Insufficiency surgery, Aortic Dissection diagnostic imaging, Aortic Dissection etiology, Aortic Dissection surgery
- Abstract
Objectives: To evaluate the results after selective sinus replacement (SSR) for aortic root remodeling in bicuspid aortopathy., Methods: Among 662 patients who underwent root repair using SSR between 2005 and 2020, there were 114 with bicuspid aortopathy. SSR was performed either as an isolated procedure (31) or as an adjunct to aortic valve repair (83) and was adjusted to the existing aortic annulus diameter rather than a downsized diameter. In valves with asymmetrical commissural orientation, the repair aimed for the achievement of a 180°-commissural orientation., Results: Abolishment of aortic insufficiency (AI) ≥2+ using root repair alone was only possible in 2 patients with acute-dissection-related AI, yet isolated root repair was also performed in 29 further patients with no/mild AI. All remaining patients with AI ≥2+ presented cusp-related regurgitation and necessitated an additional valve repair. During the mean follow-up of 91 months (range, 13-196), a relevant valve defect (AI ≥3+ in 8, stenosis in 2) occurred in 10 patients (all after combined repair) resulting in an estimated freedom from a relevant aortic valve defect and/or reoperation of 96 ± 2%, 89 ± 4%, and 82 ± 6% at 5, 10, and 12 years, respectively. Echocardiographically, no patient revealed a considerable change of form or size of the repaired root nor was any root reintervention necessary., Conclusions: Patient-tailored root repair using SSR is a very effective and durable valve-sparing approach for bicuspid aortopathy. Aortic cusp repair is decisive for both abolishment of AI in bicuspid aortopathy and for the functional durability of the repaired aortic valve., (Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
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- 2024
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39. Aortic root rotation: morphological analysis of the aortic root with three-dimensional computed tomography.
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Miazza J, Winkel D, Thieringer F, Reuthebuch O, Eckstein F, Gahl B, and Berdajs D
- Subjects
- Humans, Aortic Valve surgery, Tricuspid Valve, Multidetector Computed Tomography, Aorta, Thoracic, Aorta surgery
- Abstract
Objectives: The aortic root (AoR) rotation and its spatial morphology at the base of the heart were postulated but not described in every detail. AoR rotation modalities may play an important role in decision-making during AoR surgery and its outcome. The aim was to provide a detailed spatial anatomy of the AoR rotation and its relation to the vital surrounding structure., Methods: The AoR rotation and its relation to the surrounding structure were assessed in 104 patients with tricuspid aortic valve. The interatrial septum was chosen as a reference to describe AoR rotation that marked the midline of the heart base as a landmark for the AoR rotation direction. Intermediate, clockwise and counterclockwise AoR rotations were defined based on the mentioned reference structures., Results: The AoR rotation was successfully assessed in 104 patients undergoing ascending aorta and or AoR intervention by multidetector row computed tomography. AoR was positioned normally in 53.8% of cases (n = 56) and rotated counterclockwise in 5.8% (n = 6) and clockwise in 40.4% (n = 42) of cases. In clockwise AoR rotation, the right coronary sinus was positioned in proximity to the right atrium and of the tricuspid valve, whereas in a counterclockwise rotation, the noncoronary sinus was placed over the tricuspid valve just over the membranous septum., Conclusions: The AoR's rotation can be diagnosed using multidetector row computed tomography. Understanding the anatomy of the aortic valve related to rotational position helps guide surgical decision-making in performing AoR reconstruction., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)
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- 2024
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40. The difference in endothelium-dependent relaxation components in proximal and distal thoracic aorta regions of male rats.
- Author
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Mezhenskyi OR and Philyppov IB
- Subjects
- Rats, Male, Animals, Rats, Wistar, Endothelium, Vascular, Vasodilation, Aorta, Abdominal, Potassium Channels, Calcium Channels, Aorta, Thoracic, Acetylcholine pharmacology
- Abstract
Aorta, the largest vessel in the body, is generally considered anatomically homogeneous, yet spatial functional differences exist. In our study, we conducted a comprehensive analysis by reexamining public RNA-SEQ data, comparing expression patterns between thoracic and abdominal aorta. Additionally, we measured acetylcholine-induced relaxations of the different regions of thoracic aorta in Wistar Rats. Our results revealed a distinct percentage difference in acetylcholine-induced relaxation in the proximal and distal segments of the thoracic aorta (p = 1.14e-4). To explain this variation, we performed differential expression analysis of previously published RNA-sequencing data between thoracic and abdominal aorta, which showed 497 differentially expressed genes between these locations. From results of RNA-Seq analysis, we draw a hypothesis that differential expressions of the potassium inward rectifying channels (K
IR ) and voltage gated calcium channels (VGCC) presumably located on SMC, with higher expression in the distal thoracic segments in comparison with the proximal thoracic segments of aorta, can explain differences in acetylcholine-induced relaxation. Notably, specific blockade of KIR eliminated differences between the proximal and distal regions of thoracic aorta, underscoring their significance in understanding the spatial nuances in aortic behavior, also blockade of VGCC, shows a higher effect on basal tone, in distal region of thoracic aorta in comparison with proximal., (© 2024 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)- Published
- 2024
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41. Reply from authors: Prospective trials are required to determine the optimal arch strategy for acute type A dissection.
- Author
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Elbatarny M, Boodhwani M, Chu MWA, Appoo JJ, and Ouzounian M
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- Humans, Prospective Studies, Aorta, Thoracic, Aortic Aneurysm, Thoracic
- Abstract
Competing Interests: Conflict of Interest Statement M.W.A.C. and M.O. have received Speakers’ honoraria from Medtronic, Edwards Lifesciences, Terumo Aortic, and Artivion. M.B. has received honoraria from Terumo Aortic and serves as a proctor for Edwards Lifesciences. J.J.A. has consultancy agreements with Artivion and Gore Medical. The other author reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.
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- 2024
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42. Editorial: Cardiometabolic diseases and inflammatory responses.
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Suffee N, Le Goff W, and Chen J
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- Humans, Risk Factors, Aorta, Thoracic, Cardiovascular Diseases therapy
- Abstract
Competing Interests: The 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.
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- 2024
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43. Perfusion During Aortic Arch Surgery-Keep it Physiologic!
- Author
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Grieshaber P, Farag M, Fonseca-Escalante E, and Loukanov T
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- Humans, Aorta, Thoracic, Perfusion, Cerebrovascular Circulation, Treatment Outcome, Aortic Dissection, Aortic Aneurysm, Thoracic, Hypothermia, Induced
- Published
- 2024
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44. Anomalous origin of the right subclavian artery in a Neotropical otter (Lontra longicaudis, Olfers-1818).
- Author
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Vélez García JF
- Subjects
- Animals, Aorta, Thoracic, Subclavian Artery, Otters
- Abstract
The Neotropical otter (Lontra longicaudis) is a mustelid distributed geographically from Mexico to Argentina. Anomalous origins of the aortic arch branches are rarely reported in wild carnivorans. Therefore, this study aimed to report the anomalous branching of the aortic arch in one formaldehyde-fixed specimen of L. longicaudis. The aortic arch provided three branches: the bicarotid trunk and the left and right subclavian arteries. The latter passed dorsally to the esophagus toward the right side without a mark of compression at the esophagus. This is the first report of an anomalous origin of the right subclavian artery in L. longicaudis., (© 2024 Wiley-VCH GmbH. Published by John Wiley & Sons Ltd.)
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- 2024
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45. Tailoring left ventricular assist device cannula implantation using coupled multi-scale multi-objective optimization.
- Author
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Dankano A, Prather R, Lozinski B, Divo E, Kassab A, and DeCampli W
- Subjects
- Humans, Cannula, Aorta, Aorta, Thoracic, Hemodynamics, Models, Cardiovascular, Heart-Assist Devices, Thrombosis
- Abstract
Background: The frequent occurrence of thromboembolic cerebral events continues to limit the widespread implementation of Ventricular Assist Devices (VAD) despite continued advancements in VAD design and anti-coagulation treatments. Recent studies point to the optimal positioning of the outflow graft (OG) as a potential mitigator of post implantation thromboembolism., Objective: This study aims to examine the tailoring of the OG implantation orientation with the goal of minimizing the number of thrombi reaching the cerebral vessels by means of a formal shape optimization scheme incorporated into a multi-scale hemodynamics analysis., Methods: A 3-D patient-specific computational fluid dynamics model is loosely coupled in a two-way manner to a 0-D lumped parameter model of the peripheral circulation. A Lagrangian particle-tracking scheme models and tracks thrombi as non-interacting solid spheres. The loose coupling between CFD and LPM is integrated into a geometric shape optimization scheme which aims to optimize an objective function that targets a drop in cerebral embolization, and an overall reduction in particle residence times., Results: The results elucidate the importance of OG anastomosis orientation and placement particularly in the case that studied particle release from the OG, as a fivefold decrease in cerebral embolization was observed between the optimal and non-optimal implantations. Another case considered particle release from the ventricle and aortic root walls, in which optimal implantation was achieved with a shallow insertion angle. Particle release from all three origins was investigated in the third case, demonstrating that the optimal configurations were generally characterized by VAD flow directed along the central lumen of the aortic arch. Because optimal configurations depended on the anatomic origin of the thrombus, it is important to determine, in clinical studies, the most likely sites of thrombus formation in VAD patients., Competing Interests: Declaration of Competing Interest Abubakar Dankano, Ray Prather, Blake Lozinski, Eduardo Divo: none declared. Alain Kassab has received research Grant number 18TPA34230091 from the American Heart Association as PI. William DeCampli has received research Grant number 18TPA34230091 from the American Heart Association as CoPI., (Copyright © 2024. Published by Elsevier Ltd.)
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- 2024
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46. Evaluating a Phase-Specific Approach to Aortic Flow: A 4D Flow MRI Study.
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Ramaekers MJFG, Westenberg JJM, Venner MFGHM, Juffermans JF, van Assen HC, Te Kiefte BJC, Adriaans BP, Lamb HJ, Wildberger JE, and Schalla S
- Subjects
- Humans, Male, Female, Prospective Studies, Aorta, Thoracic, Magnetic Resonance Imaging methods, Blood Flow Velocity, Hemodynamics, Aorta
- Abstract
Background: Aortic flow parameters can be quantified using 4D flow MRI. However, data are sparse on how different methods of analysis influence these parameters and how these parameters evolve during systole., Purpose: To assess multiphase segmentations and multiphase quantification of flow-related parameters in aortic 4D flow MRI., Study Type: Prospective., Population: 40 healthy volunteers (50% male, 28.9 ± 5.0 years) and 10 patients with thoracic aortic aneurysm (80% male, 54 ± 8 years)., Field Strength/sequence: 4D flow MRI with a velocity encoded turbo field echo sequence at 3 T., Assessment: Phase-specific segmentations were obtained for the aortic root and the ascending aorta. The whole aorta was segmented in peak systole. In all aortic segments, time to peak (TTP; for flow velocity, vorticity, helicity, kinetic energy, and viscous energy loss) and peak and time-averaged values (for velocity and vorticity) were calculated., Statistical Tests: Static vs. phase-specific models were assessed using Bland-Altman plots. Other analyses were performed using phase-specific segmentations for aortic root and ascending aorta. TTP for all parameters was compared to TTP of flow rate using paired t-tests. Time-averaged and peak values were assessed using Pearson correlation coefficient. P < 0.05 was considered statistically significant., Results: In the combined group, velocity in static vs. phase-specific segmentations differed by 0.8 cm/sec for the aortic root, and 0.1 cm/sec (P = 0.214) for the ascending aorta. Vorticity differed by 167 sec
-1 mL-1 (P = 0.468) for the aortic root, and by 59 sec-1 mL-1 (P = 0.481) for the ascending aorta. Vorticity, helicity, and energy loss in the ascending aorta, aortic arch, and descending aorta peaked significantly later than flow rate. Time-averaged velocity and vorticity values correlated significantly in all segments., Data Conclusion: Static 4D flow MRI segmentation yields comparable results as multiphase segmentation for flow-related parameters, eliminating the need for time-consuming multiple segmentations. However, multiphase quantification is necessary for assessing peak values of aortic flow-related parameters., Level of Evidence: 2 TECHNICAL EFFICACY STAGE: 3., (© 2023 The Authors. Journal of Magnetic Resonance Imaging published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)- Published
- 2024
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47. Regional and Global Aortic Pulse Wave Velocity in Patients with Abdominal Aortic Aneurysm.
- Author
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Lindenberger M, Ziegler M, Bjarnegård N, Ebbers T, and Dyverfeldt P
- Subjects
- Humans, Male, Aged, Female, Pulse Wave Analysis, Aorta, Abdominal, Aorta, Thoracic, Magnetic Resonance Imaging, Aortic Aneurysm, Abdominal surgery, Vascular Stiffness
- Abstract
Objective: Abdominal aortic aneurysm (AAA) is commonly defined as localised aortic dilatation with a diameter > 30 mm. The pathophysiology of AAA includes chronic inflammation and enzymatic degradation of elastin, possibly increasing aortic wall stiffness and pulse wave velocity (PWV). Whether aortic stiffness is more prominent in the abdominal aorta at the aneurysm site is not elucidated. The aim of this study was to evaluate global and regional aortic PWV in patients with AAA., Methods: Experimental study of local PWV in the thoracic descending and abdominal aorta in patients with AAA and matched controls. The study cohort comprised 25 patients with an AAA > 30 mm (range 36 - 70 mm, all male, age range 65 - 76 years) and 27 age and sex matched controls free of AAA. PWV was measured with applanation tonometry (carotid-femoral PWV, cfPWV) as well as a 4D flow MRI technique, assessing regional aortic PWV. Blood pressure and anthropometrics were measured., Results: Global aortic PWV was greater in men with an AAA than controls, both by MRI (AAA 8.9 ± 2.4 m/s vs. controls 7.1 ± 1.5 m/s; p = .007) and cfPWV (AAA 11.0 ± 2.1 m/s vs. controls 9.3 ± 2.3 m/s; p = .007). Regionally, PWV was greater in the abdominal aorta in the AAA group (AAA 7.0 ± 1.8 m/s vs. controls 5.8 ± 1.0 m/s; p = .022), but similar in the thoracic descending aorta (AAA 8.7 ± 3.2 m/s vs. controls 8.2 ± 2.4 m/s; p = .59). Furthermore, PWV was positively associated with indices of central adiposity both in men with AAA and controls., Conclusion: PWV is higher in men with AAA compared with matched controls in the abdominal but not the thoracic descending aorta. Furthermore, aortic stiffness was linked with central fat deposition. It remains to be seen whether there is a causal link between AAA and increased regional aortic stiffness., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2024
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48. Effect of Sinotubular Junction Size on TAVR Leaflet Thrombosis: A Fluid-Structure Interaction Analysis.
- Author
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Oks D, Reza S, Vázquez M, Houzeaux G, Kovarovic B, Samaniego C, and Bluestein D
- Subjects
- Humans, Aortic Valve surgery, Aorta, Thoracic, Hemodynamics, Treatment Outcome, Transcatheter Aortic Valve Replacement adverse effects, Thrombosis etiology, Aortic Valve Stenosis surgery, Heart Valve Prosthesis adverse effects
- Abstract
TAVR has emerged as a standard approach for treating severe aortic stenosis patients. However, it is associated with several clinical complications, including subclinical leaflet thrombosis characterized by Hypoattenuated Leaflet Thickening (HALT). A rigorous analysis of TAVR device thrombogenicity considering anatomical variations is essential for estimating this risk. Clinicians use the Sinotubular Junction (STJ) diameter for TAVR sizing, but there is a paucity of research on its influence on TAVR devices thrombogenicity. A Medtronic Evolut® TAVR device was deployed in three patient models with varying STJ diameters (26, 30, and 34 mm) to evaluate its impact on post-deployment hemodynamics and thrombogenicity, employing a novel computational framework combining prosthesis deployment and fluid-structure interaction analysis. The 30 mm STJ patient case exhibited the best hemodynamic performance: 5.94 mmHg mean transvalvular pressure gradient (TPG), 2.64 cm
2 mean geometric orifice area (GOA), and the lowest mean residence time (TR )-indicating a reduced thrombogenic risk; 26 mm STJ exhibited a 10 % reduction in GOA and a 35% increase in mean TPG compared to the 30 mm STJ; 34 mm STJ depicted hemodynamics comparable to the 30 mm STJ, but with a 6% increase in TR and elevated platelet stress accumulation. A smaller STJ size impairs adequate expansion of the TAVR stent, which may lead to suboptimal hemodynamic performance. Conversely, a larger STJ size marginally enhances the hemodynamic performance but increases the risk of TAVR leaflet thrombosis. Such analysis can aid pre-procedural planning and minimize the risk of TAVR leaflet thrombosis., (© 2023. The Author(s) under exclusive licence to Biomedical Engineering Society.)- Published
- 2024
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49. Outcomes of emergency surgery for acute type A aortic dissection complicated by malperfusion syndrome.
- Author
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Brown JA, Aranda-Michel E, Navid F, Serna-Gallegos D, Thoma F, and Sultan I
- Subjects
- Humans, Treatment Outcome, Postoperative Complications etiology, Syndrome, Aorta, Thoracic, Acute Disease, Retrospective Studies, Risk Factors, Aortic Dissection complications, Aortic Dissection surgery, Aortic Aneurysm, Thoracic complications, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic surgery
- Abstract
Objective: The study objective was to determine the impact of malperfusion syndrome on in-hospital mortality and midterm survival after emergency aortic arch reconstruction for acute type A aortic dissection., Methods: This was an observational study of aortic surgeries from 2010 to 2018. All patients with acute type A aortic dissection undergoing open aortic arch reconstruction were included. Patients were dichotomized by the presence or absence of malperfusion syndrome and were analyzed for differences in short-term postoperative outcomes, including morbidity and in-hospital mortality. Kaplan-Meier survival estimation and multivariable Cox analysis were performed to identify variables associated with survival., Results: A total of 467 patients undergoing aortic arch reconstruction for acute type A aortic dissection were identified, of whom 332 (71.1%) presented without malperfusion syndrome and 135 (28.9%) presented with malperfusion syndrome. Patients with malperfusion syndrome had higher in-hospital mortality (21.5% vs 5.7%) than patients without malperfusion syndrome. After multivariable adjustment, malperfusion syndrome was associated with worse survival (hazard ratio, 2.43, 95% confidence interval, 1.61-3.66, P < .001) compared with patients without malperfusion syndrome. The predicted risk of mortality increased as the number of malperfused vascular beds increased. Patients with coronary malperfusion syndrome and neuro-malperfusion syndrome had reduced survival compared with the rest of the cohort (P < .05)., Conclusions: Malperfusion syndrome is associated with higher in-hospital mortality and reduced survival for patients with acute type A aortic dissection, with the risk of mortality increasing as the number of malperfused vascular beds increases. Coronary malperfusion syndrome and neuro-malperfusion syndrome may represent a high-risk subgroup of patients presenting with acute type A aortic dissection complicated by malperfusion syndrome. Finally, malperfusion syndrome may benefit from immediate surgical intervention to restore true lumen perfusion, as opposed to operative delay., (Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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50. Spatial Metabolomics Identifies LPC(18:0) and LPA(18:1) in Advanced Atheroma With Translation to Plasma for Cardiovascular Risk Estimation.
- Author
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Cao J, Martin-Lorenzo M, van Kuijk K, Wieland EB, Gijbels MJ, Claes BSR, Heredero A, Aldamiz-Echevarria G, Heeren RMA, Goossens P, Sluimer JC, Balluff B, and Alvarez-Llamas G
- Subjects
- Humans, Animals, Mice, Risk Factors, Aorta diagnostic imaging, Aorta metabolism, Glycerophospholipids metabolism, Heart Disease Risk Factors, Plaque, Atherosclerotic metabolism, Cardiovascular Diseases diagnosis, Cardiovascular Diseases metabolism, Atherosclerosis diagnosis, Atherosclerosis metabolism, Aortic Diseases genetics, Aortic Diseases metabolism
- Abstract
Background: The metabolic alterations occurring within the arterial architecture during atherosclerosis development remain poorly understood, let alone those particular to each arterial tunica. We aimed first to identify, in a spatially resolved manner, the specific metabolic changes in plaque, media, adventitia, and cardiac tissue between control and atherosclerotic murine aortas. Second, we assessed their translatability to human tissue and plasma for cardiovascular risk estimation., Methods: In this observational study, mass spectrometry imaging (MSI) was applied to identify region-specific metabolic differences between atherosclerotic (n=11) and control (n=11) aortas from low-density lipoprotein receptor-deficient mice, via histology-guided virtual microdissection. Early and advanced plaques were compared within the same atherosclerotic animals. Progression metabolites were further analyzed by MSI in 9 human atherosclerotic carotids and by targeted mass spectrometry in human plasma from subjects with elective coronary artery bypass grafting (cardiovascular risk group, n=27) and a control group (n=27)., Results: MSI identified 362 local metabolic alterations in atherosclerotic mice (log2 fold-change ≥1.5; P ≤0.05). The lipid composition of cardiac tissue is altered during atherosclerosis development and presents a generalized accumulation of glycerophospholipids, except for lysolipids. Lysolipids (among other glycerophospholipids) were found at elevated levels in all 3 arterial layers of atherosclerotic aortas. LPC(18:0) (lysophosphatidylcholine; P =0.024) and LPA(18:1) (lysophosphatidic acid; P =0.025) were found to be significantly elevated in advanced plaques as compared with mouse-matched early plaques. Higher levels of both lipid species were also observed in fibrosis-rich areas of advanced- versus early-stage human samples. They were found to be significantly reduced in human plasma from subjects with elective coronary artery bypass grafting ( P <0.001 and P =0.031, respectively), with LPC(18:0) showing significant association with cardiovascular risk (odds ratio, 0.479 [95% CI, 0.225-0.883]; P =0.032) and diagnostic potential (area under the curve, 0.778 [95% CI, 0.638-0.917])., Conclusions: An altered phospholipid metabolism occurs in atherosclerosis, affecting both the aorta and the adjacent heart tissue. Plaque-progression lipids LPC(18:0) and LPA(18:1), as identified by MSI on tissue, reflect cardiovascular risk in human plasma., Competing Interests: Disclosures None.
- Published
- 2024
- Full Text
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