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False lumen stent graft implantation is an infrequent but intractable complication of surgery for dissection. Surgery has a high rate of morbidity and mortality. We report the case of a 28-year-old patient with complicated type A aortic dissection (TAAD) who developed acute visceral malperfusion after implantation of a stent graft into the false lumen. The patient underwent urgent endovascular revision involving septal fenestration and distal extension of the stent graft into the true lumen. Clinical Impact: This technology is a good supplement to the clinical practice, providing a new solution to the problem of stent placement in the prosthetic cavity, avoiding the patient to have another surgical operation, which is good for both medicine and patients. [ABSTRACT FROM AUTHOR]

Background: Computational fluid dynamics (CFD) is a new medical method combining medicine and science. The aim of this study is to summarize and analyze the application of CFD in adult aortic diseases. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search in the PubMed, Cochrane Library and Chinese databases identified 47 highly relevant articles. Studies were included if they assessed biomechanical markers and their potential association with progression or rupture of aortic aneurysms or dissections. Results: There are no randomized controlled trials to examine the direct relationship between all biomechanical parameters and aortic disease progression or rupture. Wall stress and peak wall rupture risk can predict the risk of aortic aneurysm rupture using biomechanics, which is more accurate than the prediction based on "diameter" alone. Areas with lower time averaged wall shear stress (TAWSS) and higher oscillatory shear index (OSI) are at risk for further aortic expansion or dissection. Higher relative residence time (RRT) area can predict platelet activation and thrombosis. In addition, pressure, flow field and other indicators can also roughly predict the risk of aortic disease progression. Conclusions: Contemporary evidence suggests that CFD can provide additional hemodynamic parameters, which have the potential to predict the progression of aortic lesions, the effect of surgical intervention, and prognosis. [ABSTRACT FROM AUTHOR]

Marfan syndrome (MFS) is a systemic connective tissue disease that commonly and most severely affects the ocular, skeletal, and cardiovascular systems. The aim of the manuscript is to review the aortic involvement and complications in MFS, including aortal dissection, thoracic aortic aneurysm, abdominal aortic aneurysm, and acute aortic syndrome. Dissecting thoracic aortic aneurysm and progressing aortic root enlargement are the major causes of MFS morbidity and mortality. Guidelines on aortic disease endorsed by the American College of Cardiology, and the American Heart Association recommend the measurement of the external and internal aortic diameters perpendicular to the axis of blood flow when Computed Tomography, or Magnetic Resonance Imaging, or Cardiac Echography are performed. The pathophysiology, diagnosis, prevention, and medical and surgical treatments of MFS associated with aortic complications are reported in this narrative review. Development and strengthening of centers specialized in cardiovascular diseases and MFS, together with an improvement in the knowledge of its pathogenesis through genetics and proteomics investigations, can ameliorate the prognosis of this disease. [ABSTRACT FROM AUTHOR]

Abstract Background The incidence and mortality of aortic dissection (AD) are increasing. In pathological studies, macrophages, T lymphocytes and dendritic cells were found in the tunica media of the aorta. Acetaldehyde dehydrogenase 2 (ALDH2) gene polymorphisms are associated with a high incidence of hypertension in Asian populations. However, there is no clear evidence of the relationship between ALDH2 and aortic dissection in Asians. The aim of this study was to investigate the incidence of aortic dissection in different ALDH2 genotypes and explore changes in the vasculature. Materials and methods Three-week-old male mice were administered freshly prepared β-aminopropionitrile solution dissolved in drinking water (1 g/kg/d) for 28 days to induce TAD. An animal ultrasound imaging system was used to observe the formation of arterial dissection and changes in cardiac function. Subsequently, mice were euthanized by cervical dislocation. The aortas were fixed for HE staining and EVG staining to observe aortic elastic fiber tears and pseudoluma formation under a microscope. Results Knockout of ALDH2 mitigated β-aminopropionitrile-induced TAD formation in animal studies. Ultrasound results showed that ALDH2 knockout reduced the degree of ascending aortic widening and the incidence of aortic dissection rupture. Pathological sections of multiple aortic segments showed that the protective effect of ALDH2 knockout was observed in not only the ascending aorta but also the aortic arch and descending aorta. The expression levels of genes related to NK CD56bright cells, Th17 cells, T cells and T helper cells were decreased in ALDH2 knockout mice treated with β-aminopropionitrile for 28 days. Conclusion ALDH2 knockout protects against aortic dissection by altering the inflammatory response and immune response and protecting elastic fibers.

Background: We present an analysis that compares aortic morphological and clinical outcomes of 36 patients, all treated with endovascular uncovered stents implantation preceded or not by stent-graft implantation, or surgical treatment in the context of complex treatment of type A or type B aortic dissection. Methods: Between 2014 and 05/2018 our team treated 36 patients with acute aortic dissection and end-organ ischemia due to true lumen compression. All clinical and periprocedural data were obtained prospectively, followed by a retrospective analysis. The case series aim is to show induction of aortic remodeling by depressurization of the false lumen and increasing the size of the true lumen by non-covered stents implantation in the aorta and its affected side branches. Secondary endpoints were survival, branch patency, true lumen and false lumen size evolution. Results: Results from the diameter of both lumens measured by computed tomography angiography (CTA) before and at least 1 year after the treatment showed statistically significant differences, patent stents, as well as symptomatic improvement in all patients. Both aorta-related and general mortality in this complex group of patients was 0%. Conclusions: The concept of redirection of flow in aortic dissection with non-covered stents was safe, led to positive aorta remodeling and resulted in excellent survival rate. [ABSTRACT FROM AUTHOR]

Background: Developmental lead (Pb2+) exposure has been historically shown to alter the pathological functions of the cardiovascular system at high blood lead levels (i.e.,>15 μg/dL). However, given the time that has elapsed in the field (i.e., some 30 years), there is a great need for less clinical and more basic research on the cardiopathology of low blood lead levels (lBLLs; i.e.,3.33 μg/dL). Materials and Methods: Rats were then subjected to cardiovascular measures of systolic and diastolic blood pressures (SBP and DBP) and heart rates. Rats were sacrificed and their hearts were weighed; their thoracic aortas were collected and examined for microstructural and morphological changes through a scanning electron micrograph. Results: The data showed that compared to age matched control rats, the Pb2+ exposed rats have increased SBP, DBP, and heart rate with no differences in heart weight. These data show that early developmental Pb2+ exposure comprising lBLLs can cause significant cardiovascular pathological changes in rats. Conclusion: The present model of developmental Pb2+-exposure occurring early in life caused Pb2+-induced cardiopathology later in life through increased hypertension and reduced elasticity of the aorta media. These cardiovascular pathologies could further increase the likelihood of accelerated fronto executive dysfunctions due to the direct action of Pb2+ on neurons through inhibition of calcium dependent processes and might also contribute to vascular dementias.

Background: The incidence and mortality of aortic dissection (AD) are increasing. In pathological studies, macrophages, T lymphocytes and dendritic cells were found in the tunica media of the aorta. Acetaldehyde dehydrogenase 2 (ALDH2) gene polymorphisms are associated with a high incidence of hypertension in Asian populations. However, there is no clear evidence of the relationship between ALDH2 and aortic dissection in Asians. The aim of this study was to investigate the incidence of aortic dissection in different ALDH2 genotypes and explore changes in the vasculature.Materials and Methods: Three-week-old male mice were administered freshly prepared β-aminopropionitrile solution dissolved in drinking water (1 g/kg/d) for 28 days to induce TAD. An animal ultrasound imaging system was used to observe the formation of arterial dissection and changes in cardiac function. Subsequently, mice were euthanized by cervical dislocation. The aortas were fixed for HE staining and EVG staining to observe aortic elastic fiber tears and pseudoluma formation under a microscope.Results: Knockout of ALDH2 mitigated β-aminopropionitrile-induced TAD formation in animal studies. Ultrasound results showed that ALDH2 knockout reduced the degree of ascending aortic widening and the incidence of aortic dissection rupture. Pathological sections of multiple aortic segments showed that the protective effect of ALDH2 knockout was observed in not only the ascending aorta but also the aortic arch and descending aorta. The expression levels of genes related to NK CD56bright cells, Th17 cells, T cells and T helper cells were decreased in ALDH2 knockout mice treated with β-aminopropionitrile for 28 days.Conclusion: ALDH2 knockout protects against aortic dissection by altering the inflammatory response and immune response and protecting elastic fibers. [ABSTRACT FROM AUTHOR]

COVID-19 had a significant impact on public health, including respiratory and cardiovascular complications. Because of COVID-19 hypercoaglupathy effect, it can lead to cardiovascular complications. A 68-year-old Iranian male admitted to the infectious diseases department with the diagnosis of COVID-19 infection. Despite initially stable vital signs and mild symptoms, the patient's condition rapidly deteriorated over the course of several days, with severe respiratory distress and other concerning symptoms. Further investigations revealed evidence of aortic aneurysm or dissection, which was confirmed to be a Stanford type A aortic dissection extending from the aortic root to the abdominal aorta. The available evidence points to a potential association between COVID-19 infection and aortic dissection, and the need for continue investigations about the pathophysiological mechanisms underlying this relationship., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Background: We present an analysis that compares aortic morphological and clinical outcomes of 36 patients, all treated with endovascular uncovered stents implantation preceded or not by stent-graft implantation, or surgical treatment in the context of complex treatment of type A or type B aortic dissection. Methods: Between 2014 and 05/2018 our team treated 36 patients with acute aortic dissection and end-organ ischemia due to true lumen compression. All clinical and periprocedural data were obtained prospectively, followed by a retrospective analysis. The case series aim is to show induction of aortic remodeling by depressurization of the false lumen and increasing the size of the true lumen by non-covered stents implantation in the aorta and its affected side branches. Secondary endpoints were survival, branch patency, true lumen and false lumen size evolution. Results: Results from the diameter of both lumens measured by computed tomography angiography (CTA) before and at least 1 year after the treatment showed statistically significant differences, patent stents, as well as symptomatic improvement in all patients. Both aorta-related and general mortality in this complex group of patients was 0%. Conclusions: The concept of redirection of flow in aortic dissection with non-covered stents was safe, led to positive aorta remodeling and resulted in excellent survival rate.

Background: Developmental lead (Pb2+) exposure has been historically shown to alter the pathological functions of the cardiovascular system at high blood lead levels (i.e.,>15 µg/dL). However, given the time that has elapsed in the field (i.e., some 30 years), there is a great need for less clinical and more basic research on the cardiopathology of low blood lead levels (lBLLs; i.e.,<10 µg/dL). Further, most of the prior literature had focused solely on males as they had been reported to be more vulnerable to Pb2+ induced cardiovascular pathology. Aims and Objectives: To generate a model system of Pb2+-induced cardiovascular pathology that would be consistent with past reports, the present study examined male Long-Evans Hooded rats that were perinatally Pb2+ exposed (i.e., via their food with 996 ppm lead acetate in the rat chow) up until weaning (i.e., postnatal day 22; blood lead levels [BLLs]: 10-15 µg/dL) and were then removed from Pb2+ exposure for nearly 1.5 months (i.e., BLLs >3.33 µg/dL). Materials and Methods: Rats were then subjected to cardiovascular measures of systolic and diastolic blood pressures (SBP and DBP) and heart rates. Rats were sacrificed and their hearts were weighed; their thoracic aortas were collected and examined for microstructural and morphological changes through a scanning electron micrograph. Results: The data showed that compared to age matched control rats, the Pb2+ exposed rats have increased SBP, DBP, and heart rate with no differences in heart weight. These data show that early developmental Pb2+ exposure comprising lBLLs can cause significant cardiovascular pathological changes in rats. Conclusion: The present model of developmental Pb2+-exposure occurring early in life caused Pb2+-induced cardiopathology later in life through increased hypertension and reduced elasticity of the aorta media. These cardiovascular pathologies could further increase the likelihood of accelerated fronto executive dysfunctions due to the direct action of Pb2+ on neurons through inhibition of calcium dependent processes and might also contribute to vascular dementias. [ABSTRACT FROM AUTHOR]

Background and Aims: The contradiction of management modality between acute myocardial infarction(AMI) and aortic dissection(AD) may result in clinical catastrophe. Data on risk factors, incidence, and outcome of AD and AMI are limited, and there have been no studies on the long-term outcomes of AMI in patients with AD. So we aimed to investigate long-term outcomes after AMI in patients with AD, and propose a useful diagnostic paradigm.Methods: Consecutively enrolled patients with AD and AMI who were referred to our center from 2010 to 2017. Baseline patient characteristics, risk factors, all medical treatments, echocardiographic parameters, laboratory data, and treatment were recorded. All patients were followed up from the first hospitalization until a first heart event, death, or 17 March, 2018.Results: 0.13% in AMI and 7.49% in AD patients had a concomitant diagnosis of AD and AMI. The average patient age was 53.3 ± 12.1 years and 84.6% were male. The most prevalent vascular risk factors were hypertension (69.2%) and current smoker (64.1%). Of all the 39 patients, 66.7% were managed surgically. Overall in-hospital mortality was 10.3%. The 30-day and 5-year fatality rates were 23.1% and 35.9%, but were higher for female than for male (66.7 vs. 30.3%, log-rank P = 0.045) on 5-year mortality. The overall survival of females was inferior to the males (log-rank P = 0.045).Conclusions: Patients with AMI and AD exhibit high 5-year fatality rates. For these patients, surgical management tends to have lower mortality. Improved management of hypertension and smoking, may reduce future incidence rates.

Loeys–Dietz syndrome (LDS) is a rare connective tissue genetic disorder that is caused by a pathogenic variant in genes of transforming growth factor (TGF) beta receptor 1 (TGFBR1), TGFBR2, mothers against decapentaplegic homolog 2 (SMAD2), SMAD3, TGFB2, or TGFB3. It is characterized by aggressive vascular pathology, aneurysms, arterial tortuosity, bifid uvula, hypertelorism, and cleft palate. Here we present a 42-year-old female patient with LDS. The patient underwent rapidly progressing artery aneurysms and life-threatening aortic dissection. Spontaneous fracture of the first metatarsal bone was noted in her medical record. Physical examination revealed a delayed wound healing on her left abdomen. Considering these clinical manifestations, we speculated that there was a genetic defect in the connective tissue, which provides strength and flexibility to structures such as bones, skins, ligaments, and blood vessels. Thus, whole exome sequencing (WES) was performed on the proband and revealed a heterozygous missense pathogenic variant (c.1613T > C/p.Val538Ala) in TGFBR2, which was a de novo variant in the proband as confirmed by the segregation analysis in parental samples. Although this variant was discovered and associated with the phenotype of LDS previously, the pathogenicity of the variant had not been confirmed by cellular functional assay yet. To further validate the effects of the variant in vitro, we assessed the canonical TGF-β signaling pathway in mutant cells. Our results showed that the p.Val538Ala variant significantly decreased TGF-β-induced gene transcription and the phosphorylation of Smad2, which were consistent with other pathogenic variants of TGFBR2. In conclusion, this study demonstrates that the p.Val538Ala pathogenic variant in TGFBR2 leads to aberrant TGF-β signaling and LDS in this patient.

In the article, a brief review provided of various perspectives on the tactics of surgery in thoracic aorta dissection in pregnant and parturient women. Clinical case presented of successful surgery of dissection type A (Stanford) in the puerperant, with good short and middle term results. The aim of clinical case demonstration is to rise awareness on the risks of aorta dissection in pregnant and puerperant women. It also witness for radicality of the “frozen elephant trunk” technology.

Loeys–Dietz syndrome (LDS) is a rare connective tissue genetic disorder that is caused by a pathogenic variant in genes of transforming growth factor (TGF) beta receptor 1 (TGFBR1), TGFBR2 , mothers against decapentaplegic homolog 2 (SMAD2), SMAD3 , TGFB2 , or TGFB3. It is characterized by aggressive vascular pathology, aneurysms, arterial tortuosity, bifid uvula, hypertelorism, and cleft palate. Here we present a 42-year-old female patient with LDS. The patient underwent rapidly progressing artery aneurysms and life-threatening aortic dissection. Spontaneous fracture of the first metatarsal bone was noted in her medical record. Physical examination revealed a delayed wound healing on her left abdomen. Considering these clinical manifestations, we speculated that there was a genetic defect in the connective tissue, which provides strength and flexibility to structures such as bones, skins, ligaments, and blood vessels. Thus, whole exome sequencing (WES) was performed on the proband and revealed a heterozygous missense pathogenic variant (c.1613T > C/p.Val538Ala) in TGFBR2 , which was a de novo variant in the proband as confirmed by the segregation analysis in parental samples. Although this variant was discovered and associated with the phenotype of LDS previously, the pathogenicity of the variant had not been confirmed by cellular functional assay yet. To further validate the effects of the variant in vitro , we assessed the canonical TGF-β signaling pathway in mutant cells. Our results showed that the p.Val538Ala variant significantly decreased TGF-β-induced gene transcription and the phosphorylation of Smad2, which were consistent with other pathogenic variants of TGFBR2. In conclusion, this study demonstrates that the p.Val538Ala pathogenic variant in TGFBR2 leads to aberrant TGF-β signaling and LDS in this patient. [ABSTRACT FROM AUTHOR]

Introduction: Both acute aorta dissection and ruptured aorta aneurism are prominent causes of death in cardiovascular diseases. The frequency of developing neurological complications in aortic dissections is reported to be between 2 to 8%. Stroke is more common in dissections involving the proximal aorta, but paraparesis is more common in distal aortic dissections due to circulatory impairment in the spinal arteries. Case: The 70-year-old male patient was referred to our emergency service from an external center with diagnosis of acute ischemic stroke. The patient had experienced loss of strength on his left side and had syncope one hour before. After his physical examination, the patient received computerized brain tomography and diffusion MR imaging with the pre-diagnosis of acute stroke. For the patient who had an appearance of acute diffusion restriction in the right parietal region in the diffusion MRI and had a chance of thrombolytic treatment, thrombolytic treatment was planned. However, the general status of the patient was worsened in this checkup examination, and his GCS score regressed down to 7. The poor current condition of the patient could not be explained by the acute ischemic stroke in the right parietal region. Aorta dissection, which may progress with clinical signs of stroke, was considered for the patient, and as an advanced test, dynamic thorax CT angiography was taken. In the dynamic thorax CT angiography of the patient, aneurism in the ascending aorta, dissection and fluid around the pericardium and left lung (hemorrhage?) were observed. The echocardiography of the patient revealed that the fluid around the pericardium caused tamponade. Discussion: Cardiovascular system diseases are the most common cause of natural sudden deaths and are mostly seen in middle and older ages. Acute myocardial infarction and coronary artery disease are the most common cardiovascular diseases, however, sudden deaths due to aortic dissection and rupture have been reported less frequently. The most typical symptom is the sudden start of severe chest or back pain. Patients typically visit with complaints of tearing chest and back pain, while they may visit with atypical clinical pictures wementioned in our cases such as abdominal pain, syncope, stroke. Sensory loss may also be seen in patients, and this is a neurological symptom which may extend from falling as leep to deep coma. Conclusion: Patients who visit emergency services with symptoms that are not expected for aorta dissection such as syncope, altered consciousness, hypotension, atypical abdominal pain and loss of strength in the extremities. [ABSTRACT FROM AUTHOR]

The article provides data on the patient with chronic dissecting aorta of type III under DeBakey, who was operated on once in the Filatov municipal clinical hospital No. 16 of the Moscow Healthcare Department and data of his subsequent outpatient follow-up.he article provides data on the patient with chronic dissecting aorta of type III under DeBakey, who was operated on once in the Filatov municipal clinical hospital No. 16 of the Moscow Healthcare Department and data of his subsequent outpatient follow-up

Marfan syndrome is a disease associated with high prevalence of aorta-related morbidity and mortality. Dissections and ruptures of thoracal aorta (ThAo) lead to decreased life duration in persons with Marfan syndrome with mediana at 30 year-old.Aim. To study the changes of distal aorta and clinical outcomes after surgical treatment for proximal aorta dissection in Marfan syndrome.Material and methods. In the SRICP, among patients operated for proximal aorta dissection, 14 were selected, who had histologically proven Marfan syndrome. They were followed-up.Results. In the long-term follow-up after the intervention on thoracoabdominal aorta (TAAo) was required in 2 patients. Reasons for transforming of the distal aorta were the age of the disease onset (p=0,04), acute stage of dissection (p=0,02). Changes in TAAo developed during first months after primary intervention, as inseveral years.Conclusion. Surgery for proximal dissections in Marfan syndrome patients is related to acceptable levels of morbidity and mortality in early and post-operation periods. Regular follow-up is required of such patients in post-operation period for on-time diagnostics and performing of secondary interventions.

Background: Computational fluid dynamics (CFD) is a new medical method combining medicine and science. The aim of this study is to summarize and analyze the application of CFD in adult aortic diseases., Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search in the PubMed, Cochrane Library and Chinese databases identified 47 highly relevant articles. Studies were included if they assessed biomechanical markers and their potential association with progression or rupture of aortic aneurysms or dissections., Results: There are no randomized controlled trials to examine the direct relationship between all biomechanical parameters and aortic disease progression or rupture. Wall stress and peak wall rupture risk can predict the risk of aortic aneurysm rupture using biomechanics, which is more accurate than the prediction based on "diameter" alone. Areas with lower time averaged wall shear stress (TAWSS) and higher oscillatory shear index (OSI) are at risk for further aortic expansion or dissection. Higher relative residence time (RRT) area can predict platelet activation and thrombosis. In addition, pressure, flow field and other indicators can also roughly predict the risk of aortic disease progression., Conclusions: Contemporary evidence suggests that CFD can provide additional hemodynamic parameters, which have the potential to predict the progression of aortic lesions, the effect of surgical intervention, and prognosis., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 The Author(s). Published by IMR Press.)

Introduction: In acute type B aortic dissection (TBAD) patients, thoracic endovascular aorta repair (TEVAR) and best medical treatment (BMT) have both been employed for the clinical management of this condition. The relative efficacy of TEVAR and BMT when used to manage cases of acute uncomplicated TBAD, however, remains to be clarified., Aim: To conduct a pooled meta-analysis comparing acute uncomplicated TBAD patient outcomes associated with primary TEVAR or BMT treatment., Material and Methods: Relevant articles published up to July 2023 were identified by searching the Web of Science, PubMed, and Wanfang databases. Pooled analyses of endpoints from these studies were then conducted., Results: Six relevant studies were included in this meta-analysis, involving 522 and 535 patients who underwent TEVAR and BMT treatment, respectively. No significant differences were observed between these two groups with respect to pooled hospitalization duration, re-intervention rates, early mortality, organ failure incidence, stroke incidence, or the incidence of retrograde type A dissection ( p = 0.89, 0.12, 0.09, 0.36, 0.09, and 0.95, respectively). TEVAR, however, was associated with significantly better pooled thrombosed/obliterated false lumen, late mortality, aorta-related mortality, and rupture rates relative to BMT ( p = 0.00001, 0.002, 0.0001, and 0.04, respectively). TEVAR was associated with a 7% pooled type I endoleak incidence rate. Endpoints exhibiting significant heterogeneity included hospitalization duration, thrombosed/obliterated false lumen rates, and rupture rates ( I 2 = 96%, 73%, and 61%, respectively)., Conclusions: While TEVAR and BMT yield similar short-term outcomes for acute uncomplicated TBAD patients, TEVAR may be associated with a better long-term patient prognosis., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2023 Termedia Sp. z o. o.)

Objectives: To determine the impact of a non-restrictive clinical decision rule on CT utilization for Emergency Department patients suspected of having an acute aortic syndrome (AAS).Methods: We prospectively assessed the performance of a previously described, collaboratively designed, non-restrictive clinical decision rule for AAS. Emergency Department patients with suspected AAS were stratified into low and high-risk groups based on decision rule results, from July 2013-August 2014. Patients with acute trauma, prior AAS or aortic surgery were excluded. CT dose reduction protocols were concurrently implemented as a quality improvement measure. Bivariate analysis was performed to compare the prospective cohort with the historical derivation cohort for CT utilization rates, results of CT, AAS incidence and radiation exposure. The performance of the clinical decision rule was evaluated.Results: Compared with the historic cohort, the study cohort demonstrated a lower CT utilization rate [0.344% (427/124,093) versus 0.477% (1465/306,961), (p<0.001)], a trend toward higher CT diagnostic yield [4.4% (19/427) versus 2.7% (40/1465), (p=0.08)]. AAS incidence was similar [0.015% (19/124,093) versus 0.013% (40/306,961), (p=0.57)]. The mean effective radiation dose was markedly lower [12±5.5mSv versus 43±20mSv, (p<0.0001)]. The clinical decision rule correctly stratified only 56% (10/18) of patients with AAS as high-risk.Conclusions: A non-restrictive, collaboratively designed, clinical decision rule for Emergency Department patients with suspected AAS performed poorly in risk-stratifying patients for AAS. However, its implementation was associated with a significant and safe decrease in CT utilization. [ABSTRACT FROM AUTHOR]

Purpose: Whether to proceed left subclavian artery (LSA) revascularization in patients with LSA coverage due to insufficient proximal landing zone (PLZ) during thoracic endovascular aortic repair (TEVAR) remains controversial., Methods: A total of 903 patients who received TEVAR were retrospectively analyzed. LSA could be covered if the PLZ was less than 15 mm accompanied with 1) a dominant or balanced right vertebral artery, 2) a complete circle of Willis, and 3) a left vertebral artery with a diameter ≥3 mm and without severe stenosis., Results: LSA selective coverage was necessary for 35.0% (316/903) of the patients to extend the PLZ. Patients presented with weakness, pain, cooling and discoloration of the left upper extremity (LUE), and pulselessness of the left brachial artery were more in the LSA-covered group. The ischemia of LUE occurred more often in patients with LSA covered completely than in those with LSA covered partially. Functional arm status showed no significant difference in the arm, shoulder, and hand questionnaire scores at 12 months postoperative between the LSA-covered group and LSA-uncovered group, or between the LSA-covered completely group and LSA-covered partially group., Conclusion: It was safe to cover the LSA origin without revascularization if the PLZ was less than 15 mm accompanied with careful evaluation (description in method).

The aim of the study is to analyze predictors of lethality, false lumen thrombosis, enlargement of aortic diameter, and frequency of aorta-related events in the early and remote postoperative periods for various types of proximal aortic dissection surgery using the logistic regression method., Materials and Methods: A retrospective observational comparison of the results of surgical treatment of 213 patients with the diagnosis of "DeBakey type I aortic dissection" has been carried out. The participants were divided into three groups: group 1 underwent classic aortic arch reconstruction using hemiarch technique or total reconstruction of the aortic arch with a multiple-branch prosthesis (n=121); group 2 was subjected to the hemiarch technique and implantation of bare-metal (uncoated) stents (n=55); in group 3, the "frozen elephant trunk" correction technique was used (n=37). The diagnosis of all patients included into the study was preoperatively confirmed by ultrasound and tomographic examination. Predictors of negative events have been identified by building the models of logistic regressions., Results: The multivariate model of logistic regression has revealed multiplicative significant predictors of lethality: postoperative neurological complications increased the probability of lethality by 3.39 (1.24-9.18) times and presence of a patent false lumen by 4.17 (1.49-13.68) times.Among the predictors of aorta-related events, the most important were connective tissue diseases (the probability increased by 6.68 (2.98-15.62) times), presence of partial thrombosis of the false lumen (the probability of event development increased by 2.39 (1.07-5.44) times), and aortic valve repair (the probability aorta-event occurrence increased by 2.84 (1.13-7.17) times).Hybrid prosthesis implantation appeared to be the most significant predictor of false lumen thrombosis increasing its probability by 4.19 (1.90-9.44) times among aortic repair methods, while a bare-metal stent implantation in contrast reduced the likelihood of false lumen thrombosis by 0.17 (0.03-0.62) times. Eventually, the type of repair had not any significant impact on the aorta-related events and lethality in the long-term period., Competing Interests: Conflicts of interest. The authors have no conflicts of interest to declare.

Purpose: To present a case of penetrating aortic ulcer with extraordinary etiology. Case Report: A 57-year-old man was admitted with acute retrosternal and interscapular pain. He was a demolition worker and often used a pneumatic drill to which he pressed his chest as he drilled. Clinical examination showed previously undiagnosed hypertension. Computed tomographic angiography disclosed a penetrating aortic ulcer in the descending thoracic aorta without any sign of atherosclerosis. Initial treatment consisted of blood pressure control. However, due to progression of the lesion, endovascular treatment was performed to implant a covered endoprosthesis. Conclusion: We hypothesize that the etiology of the ulcer was the shear forces developed by incorrect, repetitive use of the pneumatic hammer in combination with the untreated hypertension. This is analogous to the hypothenar hammer syndrome, and we propose naming this the 'aortic hammer syndrome.' [ABSTRACT FROM AUTHOR]

Aorta, aorta dissection, outcomes, root repair, root replacement Keywords: aorta; aorta dissection; outcomes; root repair; root replacement EN aorta aorta dissection outcomes root repair root replacement 270 270 1 12/03/21 20220101 NES 220101 RESPONSE We would like to thank Dr. Vendramin and colleagues from Udine, Italy for their letter to the editor1 which discusses the management of the aortic root (AR) in acute type A aortic dissection (A-AAD). Outcomes of aortic root replacement after previous aortic root replacement: the "true redo root". [Extracted from the article]

Purpose: To assess prospectively the accuracy of phase-contrast cine MR angiography in the detection of thoracic aortic dissection with operative correlation. Materials and methods: One hundred and ninety-seven symptomatic patients suspected of having thoracic aortic dissection or aneurysm as well as 13 patients suspected of having thoracic aortic coarctation and 20 asymptomatic normals (as controls) were examined prospectively with phase-contrast cine MR angiography on a 1.5-T MR imager. Seventy-eight of these patients had operative correlation, and only these 78 patients were included in the statistical analysis. Results: There were 51 true positive and 27 true negative findings of thoracic aortic dissection in this study for an accuracy of 100%. Conclusion: Phase-contrast cine MR angiography is an accurate non-invasive imaging technique for evaluating patients suspected of having thoracic aortic dissection. [ABSTRACT FROM AUTHOR]

Purpose: To verify the diagnostic potentialities of conventional magnetic resonance imaging (MRI), breath-hold 3D contrast enhanced MR angiography (C3D MRA) and transesophageal echocardiography (TEE) in patients surgically treated for type A aortic dissection. Materials and methods: Twenty-nine patients (21 males and 8 females), surgically treated for type A aortic dissection, were evaluated with MRI using a 1.5 T (GE Horizon Echospeed 8.2) with standard gated SE sequences and breath-hold 3D fast SPGR after intravenous Gd injection (0.2 mmol/kg). 3D MIP reconstruction was obtained. TEE evaluation was performed with a HP 2000 system and a biplane 5 MHz probe. The sizes of aortic root, distal anastomosis, descending aorta and periprosthetic thickening were measured. Regional false lumen and aortic branch involvement were also evaluated. Results: Concordance among TEE, conventional MRI and C3D MRA was observed in the evaluation of aortic root (MRI vs. C3D MRA r = 0.93; MRI vs. TEE r = 0.84; C3D MRA vs. TEE r = 0.84) and descending aorta ( r = 0.94, 0.91 and 0.92, respectively). The interobserver variability was also very low. Inadequate agreement was observed for distal anastomosis. C3D MRA was inadequate in the evaluation of periprosthetic thickening; r = 0.73 was obtained between MRI and TEE. For qualitative data: TEE was inadequate in the evaluation of the abdominal aorta and branches. C3D MRA depicted supra-aortic vessel involvement in more cases than the other techniques. Conclusion: C3D MRA is a fast and accurate technique in the evaluation of the endoluminal alterations and involvement of the aortic branches. Conventional MRI allows a direct evaluation of the aortic wall and periaortic tissue. TEE is less accurate in the evaluation of aortic branches and abdominal aorta. [ABSTRACT FROM AUTHOR]

• An algorithm for dissected aorta segmentation based on 3-D and 2-D convolutional neural networks. • A 3-D CNN model identifies the proximal and distal regions of the dissected aorta data. • A 2-D CNN model for aorta segmentation which incorporates boundary information. Aortic dissection is a severe cardiovascular pathology in which an injury of the intimal layer of the aorta allows blood flowing into the aortic wall, forcing the wall layers apart. Such situation presents a high mortality rate and requires an in-depth understanding of the 3-D morphology of the dissected aorta to plan the right treatment. An accurate automatic segmentation algorithm is therefore needed. In this paper, we propose a deep-learning-based algorithm to segment dissected aorta on computed tomography angiography (CTA) images. The algorithm consists of two steps. Firstly, a 3-D convolutional neural network (CNN) is applied to divide the 3-D volume into two anatomical portions. Secondly, two 2-D CNNs based on pyramid scene parsing network (PSPnet) segment each specific portion separately. An edge extraction branch was added to the 2-D model to get higher segmentation accuracy on intimal flap area. The experiments conducted and the comparisons made show that the proposed solution performs well with an average dice index over 92%. The combination of 3-D and 2-D models improves the aorta segmentation accuracy compared to 3-D only models and the segmentation robustness compared to 2-D only models. The edge extraction branch improves the DICE index near aorta boundaries from 73.41% to 81.39%. The proposed algorithm has satisfying performance for capturing the aorta structure while avoiding false positives on the intimal flaps. [ABSTRACT FROM AUTHOR]

Background and Aims: The contradiction of management modality between acute myocardial infarction(AMI) and aortic dissection(AD) may result in clinical catastrophe. Data on risk factors, incidence, and outcome of AD and AMI are limited, and there have been no studies on the long-term outcomes of AMI in patients with AD. So we aimed to investigate long-term outcomes after AMI in patients with AD, and propose a useful diagnostic paradigm. Methods: Consecutively enrolled patients with AD and AMI who were referred to our center from 2010 to 2017. Baseline patient characteristics, risk factors, all medical treatments, echocardiographic parameters, laboratory data, and treatment were recorded. All patients were followed up from the first hospitalization until a first heart event, death, or 17 March, 2018. Results: 0.13% in AMI and 7.49% in AD patients had a concomitant diagnosis of AD and AMI. The average patient age was 53.3 ± 12.1 years and 84.6% were male. The most prevalent vascular risk factors were hypertension (69.2%) and current smoker (64.1%). Of all the 39 patients, 66.7% were managed surgically. Overall in-hospital mortality was 10.3%. The 30-day and 5-year fatality rates were 23.1% and 35.9%, but were higher for female than for male (66.7 vs. 30.3%, log-rank P = 0.045) on 5-year mortality. The overall survival of females was inferior to the males (log-rank P = 0.045). Conclusions: Patients with AMI and AD exhibit high 5-year fatality rates. For these patients, surgical management tends to have lower mortality. Improved management of hypertension and smoking, may reduce future incidence rates., 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. The reviewer ZWZ declared a shared affiliation with one of the authors, FL, to the handling editor., (Copyright © 2021 Liu, Qian, Jing, Wang, Yang and Chen.)

Obesity is a common public health problem and cause adverse effects on children's cardiovascular system. Aortic dissection, a rare clinical manifestation of hypertension in a fat 18-year-old girl who was diagnosed to have hypertension, was presented in this report. [ABSTRACT FROM AUTHOR]

Introducción: La disección aórtica es una causa importante de muerte dentro de los síndromes aórticos agudos. De hecho, la mortalidad se estima en 3,2/100000 habitantes al año, y la muerte súbita en pacientes no hospitalizados es de un 1,5%. Sin embargo, no es inusual el diagnóstico desacertado in vivo. Se presenta una serie de muertes repentinas e inesperadas debido a disección aórtica. Método: Se realizó un estudio retrospectivo en 5394 exámenes forenses post mortem de los casos con diagnóstico anatomopatológico de disección aórtica (intervalo de tiempo de 5 años y 6 meses, área territorial de 29206 km2, y 2595540 habitantes). Los datos relevantes evaluados fueron demográficos, clínicos, circunstanciales y morfológicos. Resultados: Se encontró disección aórtica en 48 fallecidos (0,89%), 28 hombres con edad media de 58,8 años (rango de 32-84) y 20 mujeres con edad media de 70,6 años (rango de 47-86). Todas fueron agudas, tipo A según la clasificación de Standford. Un caso también presentó disección crónica y en 10 (20,8%) la disección se encontraba en segmentos aneurismáticos de la aorta. Hubo extensión de la disección a otros territorios arteriales. En la mayoría de los casos (n=28; 58,3%) se desconocían los síntomas. La mayoría de las muertes ocurrieron fuera del hospital, a pesar de las maniobras de reanimación y sin sospecha premortem del diagnóstico. La mayoría tenía factores de riesgo subyacentes. El examen microscópico demostró enfermedades inflamatorias aórticas en 2 casos, y no inflamatorias, degenerativas o ateroscleróticas en 46. Discusión y Conclusiones: Este estudio dirigió nuestra atención a que: 1) en los países industrializados, el aumento de la esperanza de vida con el envejecimiento de la población aumenta el riesgo de disección aórtica; 2) puede permanecer asintomática hasta el exitus letalis; 3) la evaluación histopatológica de la aorta es fundamental. En los pacientes más jóvenes, puede apuntar a un trastorno genético, por lo que es necesario un asesoramiento familiar. En los fallecidos de mayor edad, los datos recopilados pueden ayudar a tomar medidas de salud pública para reducir los factores de riesgo regionales y nacionales. [ABSTRACT FROM AUTHOR]