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Thoracic aortic aneurysm

Jessica E Wagenseil
Most thoracic aortic aneurysms (TAAs) occur in the ascending aorta. This review focuses on the unique bio-chemo-mechanical environment that makes the ascending aorta susceptible to TAA. The environment includes solid mechanics, fluid mechanics, cell phenotype, and extracellular matrix composition. Advances in solid mechanics include quantification of biaxial deformation and complex failure behavior of the TAA wall. Advances in fluid mechanics include imaging and modeling of hemodynamics that may lead to TAA formation...
March 2018: Current Opinion in Biomedical Engineering
Rodolfo Citro, Moreno Cecconi, Salvatore La Carrubba, Eduardo Bossone, Francesco Antonini-Canterin, Stefano Nistri, Fabio Chirillo, Ilaria Dentamaro, Michele Bellino, Alfredo Posteraro, Mauro Giorgi, Licia Petrella, Ines Monte, Vincenzo Manuppelli, Antonio Mantero, Scipione Carerj, Frank Benedetto, Paolo Colonna
Background: Bicuspid aortic valve (BAV) is the most common congenital heart disease, affecting 0.5%-2% of the general population. It is associated not only with notable valvular risk (aortic stenosis and/or regurgitation, endocarditis) but also with aortopathy with a wide spectrum of unpredictable clinical presentations, including aneurysmal dilation of the aortic root and/or ascending thoracic aorta, isthmic coarctation, aortic dissection, or wall rupture. Methods: The REgistro della Valvola Aortica Bicuspide della Società Italiana di ECocardiografia e CArdiovascular Imaging is a retrospective (from January 1, 2010)/prospective, multicenter, observational registry, expected to enroll 3000 patients with definitive diagnosis of BAV made by transthoracic and/or transesophageal echocardiography, computed tomography, cardiovascular magnetic resonance, or at surgery...
April 2018: Journal of Cardiovascular Echography
Anne S Chin, Martin J Willemink, Aya Kino, Virginia Hinostroza, Anna M Sailer, Michael P Fischbein, R Scott Mitchell, Gerald J Berry, D Craig Miller, Dominik Fleischmann
BACKGROUND: Limited intimal tears (LITs) of the aorta (Class 3 dissection variant) are the least common form of aortic pathology in patients presenting with acute aortic syndrome (AAS). LITs are difficult to detect on imaging and may be underappreciated. OBJECTIVES: This study sought to describe the frequency, pathology, treatment, and outcome of LITs compared with other AAS, and to demonstrate that LITs can be detected pre-operatively by contemporary imaging. METHODS: The authors retrospectively reviewed 497 patients admitted for 513 AAS events at a single academic aortic center between 2003 and 2012...
June 19, 2018: Journal of the American College of Cardiology
Ekamjeet Randhawa, John Woytanowski, Kedesha Sibliss, Ian Sheffer
Streptococcus pyogenes is a Gram-positive beta-hemolytic bacteria, also known as group A streptococci, that causes a range of infections. The most common presentation is acute pharyngitis; however, it is also implicated in skin and soft tissue infections, and less commonly bacteremia, osteomyelitis, pneumonia, otitis media and sinusitis. Group A streptococci infections of the central nervous system are exceedingly rare in the antibiotic era. The mechanism of infection is typically contiguous spread from existing infection or via direct inoculation...
2018: SAGE Open Medical Case Reports
Vicente Orozco-Sevilla, Richard Whitlock, Ourania Preventza, Kim I de la Cruz, Joseph S Coselli
Aortic root aneurysm is the most common cardiovascular manifestation requiring surgical intervention in patients with Marfan syndrome (MFS), a heritable thoracic aortic disease. Elective replacement of the aortic root is the treatment of choice for patients with aneurysmal complications of the aortic root and ascending aorta. There are two basic approaches to aortic root replacement: valve-sparing (VS) and valve-replacing (VR) techniques. After successful aortic root replacement surgery, several patients with MFS may develop a late complication related to their aortic disease process, such as developing a pseudoaneurysm of the coronary artery reattachment buttons, aneurysmal expansion, or aortic dissection in the remaining native aorta...
June 2018: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Koji Maeda, Takao Ohki, Yuji Kanaoka
The technologies and innovations applicable to endovascular treatment for complex aortic pathologies have progressed rapidly over the last two decades. Although the initial outcomes of an endovascular aortic repair have been excellent, as long-term data became available, complications including endoleaks, endograft migration, and endograft infection have become apparent and are of concern. Previously, the indication for endovascular therapy was restricted to descending thoracic aortic aneurysms and abdominal aortic aneurysms...
June 2018: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Konstantinos G Moulakakis, Vangelis G Alexiou, Georgios Karaolanis, George S Sfyroeras, George Theoharopoulos, Andreas Lazaris, John Kakisis, George Geroulakos
AIM: Spinal cord ischemia (SCI) following endovascular abdominal aortic aneurysm (AAA) repair (EVAR) is a rare but devastating complication. The mechanism underlying the occurrence of SCI following EVAR seems to be multifactorial and is underreported and not fully elucidated. The aim of the study was to investigate the clinical outcomes in patients with this serious complication. MATERIAL-METHODS: A systematic review of the current literature, as per PRISMA statement guidelines, to evaluate the incidence of SCI following elective EVAR was performed...
June 6, 2018: Annals of Vascular Surgery
Frank Cikach, Milind Y Desai, Eric E Roselli, Vidyasagar Kalahasti
Thoracic aortic aneurysm (TAA) is usually clinically silent and progresses slowly until a tipping point is reached, after which the aortic diameter can expand more rapidly and the condition can potentially end in aortic dissection or rupture. Causes include bicuspid aortic valve and genetic syndromes (Marfan, Loeys-Dietz, and Ehlers-Danlos syndromes) and familial associations, but many cases are idiopathic. Clinicians should therefore be alert for clues on chest imaging, and consider screening in first-degree relatives of patients known to have aortic disease...
June 2018: Cleveland Clinic Journal of Medicine
Nicole M Bhave, Christoph A Nienaber, Rachel E Clough, Kim A Eagle
In diagnosing and following patients with acute aortic syndromes and thoracic aortic aneurysms, high-quality imaging of the thoracic aorta is indispensable. Mainstay modalities for thoracic aortic imaging are echocardiography, computed tomographic angiography, and magnetic resonance angiography. For any given clinical scenario, the imaging modality and protocol chosen will have a significant impact on sensitivity and specificity for the aortic diagnosis of concern. Imaging can also provide important ancillary information regarding myocardial performance, aortic valve morphology and function, and end-organ perfusion...
June 2018: JACC. Cardiovascular Imaging
Yuichi Baba, Toru Kubo, Naohito Yamasaki, Hiroaki Kitaoka
No abstract text is available yet for this article.
June 6, 2018: Internal Medicine
Christopher Yu, Richmond W Jeremy
Marfan syndrome is consequent upon mutations in FBN1 , which encodes the extracellular matrix microfibrillar protein fibrillin-1. The phenotype is characterised by development of thoracic aortic aneurysm. Current understanding of the pathogenesis of aneurysms in Marfan syndrome focuses upon abnormal vascular smooth muscle cell signalling through the transforming growth factor beta (TGFβ) pathway. Angiotensin II (Ang II) can directly induce aortic dilatation and also influence TGFβ synthesis and signalling...
March 2018: IJC Heart & Vasculature
Kenneth J Taubenslag, Hannah L Scanga, Jennifer Huey, Jennifer Lee, Anagha Medsinge, Christin L Sylvester, Kenneth P Cheng, Ken K Nischal
BACKGROUND: Central cysts of the iris pigment epithelium, or iris flocculi, are frequently reported in the literature in association with thoracic aortic aneurysm and dissection due to smooth muscle alpha-actin 2 ( ACTA2 ) mutations. Children with ACTA2 mutations may also present with congenital mydriasis. We report our experience regarding the frequency of ACTA2 mutation in children with the above iris anomalies. METHODS: This is a retrospective, consecutive case series of all children presenting for iris flocculi or congenital mydriasis at a single tertiary centre from October 2012 to December 2016...
June 6, 2018: British Journal of Ophthalmology
Şükrü Oğuz, Süleyman Bekirçavuşoğlu, Zerrin Pulathan
Purpose: To describe two patients presenting life-threatening hemoptysis with saccular thoracic aortic aneurysm penetrating lung parenchyma and its endovascular treatment. Case Report: We present two cases of 73- and 74-year-old men with massive hemoptysis secondary to saccular thoracic aortic aneurysm ruptured lung parenchyma who were successfully treated with endovascular approach with 3rd month's imaging follow-up. Conclusion: Thoracic aortic aneurysm is one of the rarest causes of hemoptysis and thoracic endovascular aortic repair (TEVAR) and can be used for an effective and problem-solving treatment approach...
2018: Case Reports in Vascular Medicine
Dania Daye, T Gregory Walker
In recent decades, endovascular aneurysm repair or endovascular aortic repair (EVAR) has become an acceptable alternative to open surgery for the treatment of thoracic and abdominal aortic aneurysms and other aortic pathologies such as the acute aortic syndromes (e.g., penetrating aortic ulcer, intramural hematoma, dissection). Available data suggest that endovascular repair is associated with lower perioperative 30-day all-cause mortality as well as a significant reduction in perioperative morbidity when compared to open surgery...
April 2018: Cardiovascular Diagnosis and Therapy
Jun Bai, Yandong Liu, Jie Jin, Jun Li, Xiangguo Ji, Lefeng Qu
To present a case with aorta coarctation complicated by aortic arch aneurysm which is clinical rare and entails a high risk of rupture. Here we reported a 46-year-old female patient diagnosed with aortic arch aneurysm combined with coarctation. The computed tomography angiography shows that an irregular aneurysm was located at the aortic arch site with its maximal diameter 86.55 mm and the right end of aneurysm was located 10 mm away from the ostium of left common carotid artery (LCCA). The aneurysm body invaded the left subclavian artery, and at the distal end of aneurysm a coarctation had been observed with a minimum diameter reaching 2...
April 2018: Journal of Thoracic Disease
Ateeque Ahmed Khan, Mahnoor Hafeez
We report a case of 65-year male patient, a known hypertensive and a chronic smoker, who presented to the Civil Hospital, Karachi with complaints of cough, hemoptysis and shortness of breath for three weeks. The chest radiograph showed left apical solitary pulmonary nodule (SPN) and aneurysmal dilatation of the descending thoracic aorta. He was further investigated with contrast enhanced computed tomography (CECT) scan of chest, which apart from demonstrating malignant pulmonary lesion, surprisingly revealed Stanford type B descending thoracic aortic dissecting aneurysm with intramural hematoma, jeopardising renal and splanchnic circulation...
June 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Prity Gupta, Amer Harky, Saleem Jahangeer, Benjamin Adams, Mohamad Bashir
Cardiovascular surgeons have long debated the safe duration of deep hypothermic circulatory arrest during thoracic aortic aneurysm surgery. The rationale for using adjunctive cerebral perfusion (or not) is to achieve the best technical aortic repair with the lowest risk of morbidity and death. In this literature review, we highlight the debates surrounding these issues, evaluate the disparate findings on deep hypothermic circulatory arrest durations and temperatures, and consider the usefulness of adjunctive perfusion...
April 2018: Texas Heart Institute Journal
Konstantinos Tsagakis, Daniel Wendt, Alexandros M Dimitriou, Matthias Thielmann, Shehada Sharaf-Eldin, Mohamed El Gabry, Heinz G Jakob
BACKGROUND: Frozen elephant trunk (FET) is considered to be the treatment of choice in complex multi-segmental thoracic aortic disease involving the distal arch. Institutional results of FET technique are presented. METHODS: From 01.2005 to 10,2017 2018 286 patients underwent FET surgery in our department. Patients (age mean±SD 59±11 years) were operated for acute type I (55%) aortic dissection (AD), chronic AD (23%) and aneurysm (22%). Arch repair was performed with the E- vita open prosthesis under with selective cerebral perfusion and hypothermic circulatory arrest...
May 25, 2018: Journal of Cardiovascular Surgery
Enrico Gallitto, Gianluca Faggioli, Chiara Mascoli, Rodolfo Pini, Stefano Ancetti, Andrea Vacirca, Andrea Stella, Mauro Gargiulo
BACKGROUND: Thoracoabdominal aortic aneurysms (TAAAs) after previous aortic open surgical repair (OSR) are challenging clinical scenarios. Redo-OSR is technically demanding, and standard endovascular repair is unavailable due to visceral vessel involvement. Fenestrated and branched endografts (FB-EVAR) are effective options to treat TAAAs in high surgical risk patients but dedicated studies on the FB-EVAR outcomes in patients with TAAAs with previous OSR are not available. The aim of the study was to evaluate the impact of previous OSR on TAAAs FB-EVAR outcomes...
May 24, 2018: Journal of Vascular Surgery
Charles Briggs, Trissa Babrowski, Christopher Skelly, Ross Milner
OBJECTIVE: The purpose of this analysis was to compare 1-year clinical outcomes after endovascular repair of abdominal aortic aneurysms with the EXCLUDER device in patients with standard and narrow aortic bifurcations (AOBs). METHODS: Data were prospectively collected from a 1055-participant subset of the multicenter Global Registry for Endovascular Aortic Treatment (GREAT) treated for abdominal aortic aneurysm repair between August 2010 and September 2015. There were 117 patients with a narrow AOB (NB; defined as <16 mm) and 938 patients with a standard bifurcation (SB)...
May 22, 2018: Journal of Vascular Surgery
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