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Mayer C, Pepe A, Hossain S, Karner B, Arnreiter M, Kleesiek J, Schmid J, Janisch M, Hannes D, Fuchsjäger M, Zimpfer D, Egger J, Mächler H. Type B Aortic Dissection CTA Collection with True and False Lumen Expert Annotations for the Development of AI-based Algorithms. Sci Data 2024; 11:596. [PMID: 38844767 PMCID: PMC11156948 DOI: 10.1038/s41597-024-03284-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 04/22/2024] [Indexed: 06/09/2024] Open
Abstract
Aortic dissections (ADs) are serious conditions of the main artery of the human body, where a tear in the inner layer of the aortic wall leads to the formation of a new blood flow channel, named false lumen. ADs affecting the aorta distally to the left subclavian artery are classified as a Stanford type B aortic dissection (type B AD). This is linked to substantial morbidity and mortality, however, the course of the disease for the individual case is often unpredictable. Computed tomography angiography (CTA) is the gold standard for the diagnosis of type B AD. To advance the tools available for the analysis of CTA scans, we provide a CTA collection of 40 type B AD cases from clinical routine with corresponding expert segmentations of the true and false lumina. Segmented CTA scans might aid clinicians in decision making, especially if it is possible to fully automate the process. Therefore, the data collection is meant to be used to develop, train and test algorithms.
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Affiliation(s)
- Christian Mayer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Antonio Pepe
- Institute of Computer Graphics and Vision (ICG), Graz University of Technology, Inffeldgasse 16/II, 8010, Graz, Austria
| | - Sophie Hossain
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Barbara Karner
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Melanie Arnreiter
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Jens Kleesiek
- Institute for Artificial Intelligence in Medicine (IKIM), AI-guided Therapies (AIT), Essen University Hospital (AöR), Girardetstraße 2, 45131, Essen, Germany
| | - Johannes Schmid
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Michael Janisch
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Deutschmann Hannes
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, 8036, Graz, Austria
| | - Daniel Zimpfer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Jan Egger
- Institute of Computer Graphics and Vision (ICG), Graz University of Technology, Inffeldgasse 16/II, 8010, Graz, Austria.
- Institute for Artificial Intelligence in Medicine (IKIM), AI-guided Therapies (AIT), Essen University Hospital (AöR), Girardetstraße 2, 45131, Essen, Germany.
| | - Heinrich Mächler
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria.
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Fujita Y, Tanabe R. Diagnostic Ultrasound: On-Site Diagnosis of Type B Aortic Dissection During Cataract Surgery. A A Pract 2024; 18:e01745. [PMID: 38381459 PMCID: PMC10885863 DOI: 10.1213/xaa.0000000000001745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
We report a case of aortic dissection occurring during cataract surgery under local anesthesia, which was diagnosed on-site by point-of-care ultrasound. Intimal flaps were detected in the abdominal aorta, whereas the parasternal view showed no abnormalities in the aortic root or left ventricular function. According to these ultrasound findings, a Stanford type B aortic dissection was more likely than a type A aortic dissection, and imminent death was unlikely. Therefore, we decided to resume and complete the surgery. Subsequent computed tomography (CT) confirmed the point-of-care diagnosis. The patient was transferred to a tertiary hospital for medical treatment.
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Affiliation(s)
| | - Ryo Tanabe
- Emergency Medicine, Kasaoka Daiichi Hospital, Kasaoka, Japan
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Wong YM, Ong CC, Liang CR, Tan CA, Teo LLS. Image quality, contrast enhancement and radiation dose of electrocardiograph- versus non-electrocardiograph-triggered computed tomography angiography of the aorta. Singapore Med J 2024; 65:84-90. [PMID: 34688230 PMCID: PMC10942131 DOI: 10.11622/smedj.2021166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 09/28/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Computed tomography angiography of the aorta (CTAA) is the modality of choice for investigating aortic disease. Our aim was to evaluate the image quality, contrast enhancement and radiation dose of electrocardiograph (ECG)-triggered and non-ECG-triggered CTAA on a 256-slice single-source CT scanner. This allows the requesting clinician and the radiologist to balance radiation risk and image quality. METHODS We retrospectively assessed the data of 126 patients who had undergone CTAA on a single-source CT scanner using ECG-triggered (group 1, n = 77) or non-ECG-triggered (group 2, n = 49) protocols. Radiation doses were compared. Qualitative (4-point scale) and quantitative image quality assessments were performed. RESULTS The mean volume CT dose index, dose length product and effective dose in group 1 were 12.4 ± 1.9 mGy, 765.8 ± 112.4 mGy cm and 13.0 ± 1.9 mSv, respectively. These were significantly higher compared to group 2 values (9.1 ± 2.6 mGy, 624.1 ± 174.8 mGy cm and 10.6 ± 3.0 mSv, respectively) ( P < 0.001). Qualitative assessment showed the image quality at the aortic root-proximal ascending aorta was significantly higher in group 1 (median 3) than in group 2 (median 2, P < 0.001). Quantitative assessment showed significantly better mean arterial attenuation, signal-to-noise ratio and contrast-to-noise ratio in ECG-triggered CTAA compared to non-ECG-triggered CTAA. CONCLUSION ECG-triggered CTAA in a single-source scanner has superior image quality and vessel attenuation of aortic root/ascending aorta, but a higher radiation dose of approximately 23%. Its use should be considered specifically when assessing aortic root/ascending aorta pathology.
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Affiliation(s)
- Ying Mei Wong
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Ching Ching Ong
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Chong Ri Liang
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Choon Ann Tan
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Lynette Li San Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore
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Zaki HA, Albaroudi B, Shaban EE, Alkahlout BH, Yigit Y, Elnabawy W, Basharat K, Almarri ND, Azad AM. Comparison between transthoracic echocardiography and transoesophageal echocardiography in the diagnosis of acute aortic dissection from an emergency perspective. A systematic review and meta-analysis. Front Cardiovasc Med 2024; 10:1283703. [PMID: 38268852 PMCID: PMC10806094 DOI: 10.3389/fcvm.2023.1283703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Abstract
Background Acute aortic dissection (AAD) is a life-threatening medical condition with high early fatality. Therefore, a prompt and precise diagnosis, which can be achieved through invasive and non-invasive techniques is vital. Echocardiography, unlike MRI and CT, is accessible in emergency units and bedside-compatible. The recommended echocardiographic techniques for AAD are transthoracic and transoesophageal echocardiography (TTE and TOE). Therefore, our review compares their diagnostic roles in AAD. Methods Studies relevant to our topic were attained through a database search and manual scrutiny of references lists of articles obtained from the electronic databases. The Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) has been used for quality assessment. All quantitative analyses were performed using either STATA 16 or Comprehensive Meta-Analyst software. Results The search strategy yielded 1,798 articles, of which only 11 were eligible for inclusion. Our subgroup analysis showed that conventional TTE had a sensitivity and specificity of 85.35% and 84.51% for the diagnosis of Stanford type A AAD and was 45.89% sensitive and 87.05% specific for the diagnosis of type B AAD. However, the subgroup analysis shows that contrast-enhancement of TTE results in a sensitivity and specificity of 93.30% and 97.60% for diagnosis of type A AAD, and 83.60% and 94.50% for diagnosis of type B AAD, respectively. On the other hand, conventional TOE was 93.64% sensitive and 95.50% specific for the diagnosis of type A AAD, 99.80% sensitive and 99.87% specific for the diagnosis of type B AAD. Moreover, our analyses show that TTE has pooled false negative and positive rates of 28.6% and 18.6%, while TOE has shown false negative and positive rates of 2.4% and 4.3%, respectively. Conclusion TOE is the more favorable diagnostic tool for AAD diagnosis than TTE. However, it cannot be used as a stand-alone diagnostic tool since misdiagnosis cases are being reported. Contrast-enhanced TTE can also diagnose AAD since it provides similar results to conventional TOE.
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Affiliation(s)
- Hany A. Zaki
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Bilal Albaroudi
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Eman E. Shaban
- Department of Cardiology, Al Jufairi Diagnosis and Treatment, MOH, Doha, Qatar
| | | | - Yavuz Yigit
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
- Centre for Neuroscience, Blizard Institute, Queen Mary University, London, UK
| | - Wael Elnabawy
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Kaleem Basharat
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Nood Dhafi Almarri
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Aftab Mohammad Azad
- Hamad Medical Corporation, Collège of Medicine QU and Weil Cornell Medical College, Doha, Qatar
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Sturla F, Caimi A, Romarowski RM, Nano G, Glauber M, Redaelli A, Votta E, Marrocco-Trischitta MM. Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant. J Endovasc Ther 2023; 30:756-768. [PMID: 35588222 PMCID: PMC10503258 DOI: 10.1177/15266028221095403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Displacement forces (DFs) identify hostile landing zones for stent graft deployment in thoracic endovascular aortic repair (TEVAR). However, their use in TEVAR planning is hampered by the need for time-expensive computational fluid dynamics (CFD). We propose a novel fast-approximate computation of DFs merely exploiting aortic arch anatomy, as derived from the computed tomography (CT) and a measure of central aortic pressure. MATERIALS AND METHODS We tested the fast-approximate approach against CFD gold-standard in 34 subjects with the "bovine" aortic arch variant. For each dataset, a 3-dimensional (3D) model of the aortic arch lumen was reconstructed from computed tomography angiography and CFD then employed to compute DFs within the aortic proximal landing zones. To quantify fast-approximate DFs, the wall shear stress contribution to the DF was neglected and blood pressure space-distribution was averaged on the entire aortic wall to reliably approximate the patient-specific central blood pressure. Also, DF values were normalized on the corresponding proximal landing zone area to obtain the equivalent surface traction (EST). RESULTS Fast-approximate approach consistently reflected (r2=0.99, p<0.0001) the DF pattern obtained by CFD, with a -1.1% and 0.7° bias in DFs magnitude and orientation, respectively. The normalized EST progressively increased (p<0.0001) from zone 0 to zone 3 regardless of the type of arch, with proximal landing zone 3 showing significantly greater forces than zone 2 (p<0.0001). Upon DF normalization to the corresponding aortic surface, fast-approximate EST was decoupled in blood pressure and a dimensionless shape vector (S) reflecting aortic arch morphology. S showed a zone-specific pattern of orientation and proved a valid biomechanical blueprint of DF impact on the thoracic aortic wall. CONCLUSION Requiring only a few seconds and quantifying clinically relevant biomechanical parameters of proximal landing zones for arch TEVAR, our method suits the real preoperative decision-making process. It paves the way toward analyzing large population of patients and hence to define threshold values for a future patient-specific preoperative TEVAR planning.
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Affiliation(s)
- Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Alessandro Caimi
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Rodrigo M. Romarowski
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giovanni Nano
- Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery Unit, Istituto Clinico Sant’Ambrogio, Milano, Italy
| | - Alberto Redaelli
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Emiliano Votta
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Massimiliano M. Marrocco-Trischitta
- Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Clinical Research Unit, Cardiovascular Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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Mahabir S, Okumus N, Samra G, Mohammed A, Gupta M, Naser A, Puttur A, Bihler E, DuMont T, Nauer K, Khalif A, Ivanova V. Common Cardiovascular Diseases in Women. Crit Care Nurs Q 2023; 46:362-376. [PMID: 37684732 DOI: 10.1097/cnq.0000000000000473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Cardiovascular disease is a leading cause of death for women in the United States. This article encompasses the epidemiology/etiology, clinical presentation, diagnostic assessment, management, and prognosis of some common cardiovascular disorders seen in women with a special focus on pregnancy.
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Affiliation(s)
- Sunita Mahabir
- Division of Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania (Ms Mahabir and Drs Okumus, Samra, Mohammed, and Gupta); Division of Medicine (Drs Naser and Puttur), Division of Pulmonary and Critical Care Medicine (Drs Bihler and DuMont and Mr Nauer), Division of Cardiovascular Disease and Critical Care (Dr Khalif), and Division of Cardiovascular Medicine (Dr Ivanova), Allegheny Health Network Medicine Institute, Pittsburgh, Pennsylvania; and Drexel University College of Medicine, Philadelphia, Pennsylvania (Dr Ivanova)
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Janus SE, Chami T, Arora S, Goessl M, Sorajja P, Filby SJ, Kleiman NS, Shishehbor MH, Saxon JT, Brilakis ES, Al-Kindi SG. Reconstructing Interventional Cardiology Fellowships to Include Cardiac Computed Tomography Training. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101057. [PMID: 39132410 PMCID: PMC11307885 DOI: 10.1016/j.jscai.2023.101057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 08/13/2024]
Affiliation(s)
- Scott E. Janus
- St Luke’s Mid America Heart Institute, Kansas City, Missouri
- University of Missouri-Kansas City, Kansas City, Missouri
| | - Tarek Chami
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Shilpkumar Arora
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Mario Goessl
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Steven J. Filby
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Neal S. Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Mehdi H. Shishehbor
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - John T. Saxon
- St Luke’s Mid America Heart Institute, Kansas City, Missouri
- University of Missouri-Kansas City, Kansas City, Missouri
| | | | - Sadeer G. Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Mahdi A, Akkawi AR, Mahdi M, Farhoud H. The Silent Threat: A Case of Iatrogenic Asymptomatic Aortic Dissection Post Coronary Artery Bypass Grafting. Cureus 2023; 15:e41035. [PMID: 37519582 PMCID: PMC10374978 DOI: 10.7759/cureus.41035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Asymptomatic aortic dissection (AD) is a rare but potentially life-threatening complication that can occur following coronary artery bypass graft (CABG) surgery. While CABG is a well-established surgical procedure for managing multivessel coronary artery disease, it can inadvertently predispose patients to the development of AD, especially in those with pre-existing aortic pathology. The pathophysiology underlying AD after CABG is multifactorial, with factors, such as atherosclerosis, manipulation of the aorta during surgery, and hemodynamic stress, playing significant roles. Notably, the absence of symptoms poses a diagnostic challenge, as patients may remain unaware of the underlying condition until a catastrophic event occurs. Therefore, a high index of suspicion and vigilant postoperative monitoring are crucial in identifying asymptomatic AD. Diagnostic modalities including imaging techniques, such as computed tomography angiography (CTA), magnetic resonance imaging (MRI), and echocardiography, play pivotal roles in confirming the diagnosis and determining the extent of the dissection. Prompt surgical intervention is generally recommended in symptomatic patients or those with evidence of impending complications. We hereby present a case report of a patient who presented with asymptomatic AD post CABG surgery and discuss the pathophysiology, presentation, diagnostic workup, and treatment options.
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Affiliation(s)
- Ahmad Mahdi
- Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, USA
| | - Abdul Rahman Akkawi
- Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, USA
| | - Mahmoud Mahdi
- Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, USA
| | - Hussam Farhoud
- Cardiology, University of Kansas School of Medicine-Wichita, Wichita, USA
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Zhang Y, Yang Y, Guo J, Zhang X, Cheng Y, Sun T, Lin L. Risk factors for early death after surgery in patients with acute Stanford type A aortic dissection: A systematic review and meta-analysis. Int J Cardiol 2023; 377:33-41. [PMID: 36513283 DOI: 10.1016/j.ijcard.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are many risk factors related to early death after surgery among patients with acute Stanford type A aortic dissection (ATAAD) that have been analyzed in previous studies, but no evidence-based study has been conducted to confirm these risk factors. AIMS The aims of this study were to investigate risk factors for early death after surgery in patients with ATAAD via systematic review and meta-analysis and assess evidence-based strategies for preventing adverse events. METHODS The protocol for this study was prospectively registered with PROSPERO (CRD 42022332772). The authors systematically searched PubMed, Ovid, Scopus, Web of Science and Cochrane Library following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines from database construction to May 2021. Studies that met the selection criteria were determined by two independent researchers, and the odds ratios (ORs) and 95% confidence intervals (95% CIs) were reported for the risk factors and were pooled using Stata 15.0. RESULTS A total of 23 studies including 5510 patients met the inclusion criteria, and 10 risk factors were analyzed in this meta-analysis. The preoperative risk factors for early death after surgery in patients with ATAAD were age [(OR: 1.03, 95% CI (1.01, 1.06)], male sex [(OR: 1.43, 95% CI (1.06, 1.92)], shock [(OR: 1.91, 95% CI (1.06, 3.45)], malperfusion [(OR: 3.45, 95% CI (2.24, 5.31)] and cardiac tamponade [(OR: 3.89, 95% CI (1.17, 12.98)]. CONCLUSION Patients with ATAAD who have an older age, male sex, shock, malperfusion and cardiac tamponade have a higher risk for early death after surgery. However, more highly homogenous studies are needed to demonstrate these results. Clinical staff should pay more attention to these factors and take individual actions to reduce mortality after surgery in patients with ATAAD.
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Affiliation(s)
- Yi Zhang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, Guangdong Province, China
| | - Yuanyuan Yang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, Guangdong Province, China
| | - Jinhua Guo
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, Guangdong Province, China
| | - Xiaotian Zhang
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, Guangdong Province, China
| | - Yunqing Cheng
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, Guangdong Province, China
| | - Tucheng Sun
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, Guangdong Province, China
| | - Lixia Lin
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, Guangdong Province, China.
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Gong Z, Huang J, Wang D, Yang S, Ma Z, Fu Y, Ma Q, Kong W. ADAMTS-7 deficiency attenuates thoracic aortic aneurysm and dissection in mice. J Mol Med (Berl) 2023; 101:237-248. [PMID: 36662289 DOI: 10.1007/s00109-023-02284-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/18/2022] [Accepted: 01/10/2023] [Indexed: 01/21/2023]
Abstract
Thoracic aortic aneurysm and dissection (TAAD) is a life-threatening cardiovascular disease with severe extracellular matrix (ECM) remodeling that lacks efficient early stage diagnosis and nonsurgical therapy. A disintegrin and metalloproteinase with thrombospondin motif 7 (ADAMTS-7) is recognized as a novel locus for human coronary artery atherosclerosis. Previous work by us and others showed that ADAMTS-7 promoted atherosclerosis, postinjury neointima formation, and vascular calcification. However, whether ADAMTS-7 is involved in TAAD pathogenesis is unknown. We aimed to explore the alterations in ADAMTS-7 expression in human and mouse TAAD, and investigate the role of ADAMTS-7 in TAAD formation. A case-control study of TAAD patients (N = 86) and healthy participants (N = 88) was performed. The plasma ADAMTS-7 levels were markedly increased in TAAD patients within 24 h and peaked in 7 days. A TAAD mouse model was induced with 0.5% β-aminopropionitrile (BAPN) in drinking water. ELISA analysis of mouse plasma, Western blotting, and immunohistochemical staining of aorta showed an increase in ADAMTS-7 in the early stage of TAAD. Moreover, ADAMTS-7-deficient mice exhibited significantly attenuated TAAD formation and TAAD rupture-related mortality in both male and female mice, which was accompanied by reduced artery dilation and inhibited elastin degradation. ADAMTS-7 deficiency caused repressed inflammatory response and complement system activation during TAAD formation. An increase in plasma ADAMTS-7 is a novel biomarker for human TAAD. ADAMTS-7 deficiency attenuates BAPN-induced murine TAAD. ADAMTS-7 is a potential novel target for TAAD diagnosis and therapy. KEY MESSAGES: A case-control study revealed increased plasma ADAMTS-7 is a risk factor for TAAD. ADAMTS-7 was elevated in plasma and aorta at early stage of mouse TAAD. ADAMTS-7 knockout attenuated mouse TAAD formation and mortality in both sexes.
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Affiliation(s)
- Ze Gong
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, People's Republic of China
| | - Jiaqi Huang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, People's Republic of China
| | - Daidai Wang
- Department of Emergency Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Shiyu Yang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, People's Republic of China
| | - Zihan Ma
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, People's Republic of China
| | - Yi Fu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, People's Republic of China
| | - Qingbian Ma
- Department of Emergency Medicine, Peking University Third Hospital, Beijing, 100191, People's Republic of China.
| | - Wei Kong
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing, 100191, People's Republic of China.
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12
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Perone F, Guglielmo M, Coceani M, La Mura L, Dentamaro I, Sabatino J, Gimelli A. The Role of Multimodality Imaging Approach in Acute Aortic Syndromes: Diagnosis, Complications, and Clinical Management. Diagnostics (Basel) 2023; 13:diagnostics13040650. [PMID: 36832136 PMCID: PMC9954850 DOI: 10.3390/diagnostics13040650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023] Open
Abstract
Acute aortic syndromes are life-threatening conditions with high morbidity and mortality. The principal pathological feature is acute wall damage with possible evolution towards aortic rupture. Accurate and timely diagnosis is mandatory to avoid catastrophic consequences. Indeed, misdiagnosis with other conditions mimicking acute aortic syndromes is associated with premature death. In this view, cardiovascular imaging is necessary for the correct diagnosis and management. Echocardiography, computed tomography, magnetic resonance imaging, and aortography allow for diagnosis, guarantee immediate treatment, and detect associated complications. Multimodality imaging is essential in the diagnostic work-up to confirm or rule out acute aortic syndromes. The aim of this review is to highlight the contemporary evidence on the role of single cardiovascular imaging techniques and multimodality imaging in the diagnosis and management of acute aortic syndromes.
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Affiliation(s)
- Francesco Perone
- Cardiac Rehabilitation Unit, Rehabilitation Clinic “Villa delle Magnolie”, Castel Morrone, 81020 Caserta, Italy
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University Medical Center, 3584 CX Utrecht, The Netherlands
| | - Michele Coceani
- Diagnostic and Interventional Cardiology Unit, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Lucia La Mura
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80133 Naples, Italy
| | - Ilaria Dentamaro
- Cardiology Department and Cardiovascular Imaging Laboratory, Hospital Miulli, 70124 Bari, Italy
| | - Jolanda Sabatino
- Pediatric and Congenital Cardiology Unit, Department for Women’s and Children’s Health, University Hospital of Padova, 35128 Padova, Italy
| | - Alessia Gimelli
- Imaging Department, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
- Correspondence:
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13
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Yang X, Xu C, Yao F, Ding Q, Liu H, Luo C, Wang D, Huang J, Li Z, Shen Y, Yang W, Li Z, Yu F, Fu Y, Wang L, Ma Q, Zhu J, Xu F, Cong X, Kong W. Targeting endothelial tight junctions to predict and protect thoracic aortic aneurysm and dissection. Eur Heart J 2023; 44:1248-1261. [PMID: 36638776 DOI: 10.1093/eurheartj/ehac823] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 11/16/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023] Open
Abstract
AIMS Whether changes in endothelial tight junctions (TJs) lead to the formation of thoracic aortic aneurysm and dissection (TAAD) and serve as an early indicator and therapeutic target remains elusive. METHODS AND RESULTS Single-cell RNA sequencing analysis showed aberrant endothelial TJ expressions in the thoracic aortas of patients with TAAD. In a β-aminopropionitrile (BAPN)-induced TAAD mouse model, endothelial TJ function was disrupted in the thoracic aortas at an early stage (5 and 10 days) as observed by a vascular permeability assay, while the intercellular distribution of crucial TJ components was significantly decreased by en face staining. For the non-invasive detection of endothelial TJ function, two dextrans of molecular weights 4 and 70 kDa were conjugated with the magnetic resonance imaging (MRI) contrast agent Gd-DOTA to synthesize FITC-dextran-DOTA-Gd and rhodamine B-dextran-DOTA-Gd. MRI images showed that both probes accumulated in the thoracic aortas of the BAPN-fed mice. Particularly, the mice with increased accumulated signals from 5 to 10 days developed TAAD at 14 days, whereas the mice with similar signals between the two time points did not. Furthermore, the protease-activated receptor 2 inhibitor AT-1001, which seals TJs, alleviated the BAPN-induced impairment of endothelial TJ function and expression and subsequently reduced TAAD incidence. Notably, endothelial-targeted ZO-1 conditional knockout increased TAAD incidence. Mechanistically, vascular inflammation and edema were observed in the thoracic aortas of the BAPN-fed mice, whereas these phenomena were attenuated by AT-1001. CONCLUSION The disruption of endothelial TJ function is an early event prior to TAAD formation, herein serving as a potential indicator and a promising target for TAAD.
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Affiliation(s)
- Xueyuan Yang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Chen Xu
- Key Lab of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology, Ministry of Education), Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, China
| | - Fang Yao
- Shenzhen Key Laboratory of Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen 518057, China.,State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.,Key Laboratory of Pluripotent Stem Cells in Cardiac Repair and Regeneration, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Qianhui Ding
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Hao Liu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Congcong Luo
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Daidai Wang
- Department of Emergency, Peking University Third Hospital, Beijing 100191, China
| | - Jiaqi Huang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Zhiqing Li
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Yicong Shen
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Weijie Yang
- Key Lab of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology, Ministry of Education), Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, China
| | - Zhuofan Li
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Fang Yu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Yi Fu
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Li Wang
- Shenzhen Key Laboratory of Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen 518057, China.,State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.,Key Laboratory of Pluripotent Stem Cells in Cardiac Repair and Regeneration, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Qingbian Ma
- Department of Emergency, Peking University Third Hospital, Beijing 100191, China
| | - Junming Zhu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing 100029, China
| | - Fujian Xu
- Key Lab of Biomedical Materials of Natural Macromolecules (Beijing University of Chemical Technology, Ministry of Education), Beijing Laboratory of Biomedical Materials, Beijing University of Chemical Technology, Beijing 100029, China
| | - Xin Cong
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
| | - Wei Kong
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Peking University, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing 100191, China
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14
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Jia Y, Li D, Yu J, Jiang W, Liu Y, Li F, Li W, Zeng R, Liao X, Wan Z. Prognostic value of interleukin-33, sST2, myeloperoxidase, and matrix metalloproteinase-9 in acute aortic dissection. Front Cardiovasc Med 2023; 9:1084321. [PMID: 36684579 PMCID: PMC9853981 DOI: 10.3389/fcvm.2022.1084321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/30/2022] [Indexed: 01/07/2023] Open
Abstract
Background and purpose Acute aortic dissection (AAD) is a life-threatening cardiovascular emergency. Both neutrophil granzyme and interleukin (IL)-33/ST2 systems have proven to be effective diagnostic markers for AAD. This study aimed to investigate the relationship between plasma IL-33, soluble suppression of tumorigenesis-2 (sST2), myeloperoxidase (MPO), and matrix metalloproteinase (MMP)-9 levels at admission and all-cause mortality in patients with AAD. Methods A total of 155 patients with AAD were enrolled from the Prospective Evaluation of Acute Chest Pain (PEACP) study. Plasma concentrations of IL-33, sST2, and MMP-9 were measured using an enzyme-linked immunosorbent assay, and MPO was detected using a chemiluminescence immunoassay. Aortic anatomical parameters were measured using CT radiography. The primary endpoint was all-cause mortality rate. Results The median age of the patients was 55 years, and 96 (61.9%) were diagnosed with type A-AAD. After adjusting for confounding factors, the highest tertiles of IL-33, sST2, MPO, and MMP-9 had hazard risks of 0.870 (95% CI: 0.412-1.836, P = 0.714), 3.769 (95% CI: 1.504-9.446, P = 0.005), 4.689 (95% CI: 1.985-11.076, P < 0.001), and 4.748 (95% CI: 1.763-12.784, P = 0.002), respectively, compared to the lowest tertile. Pearson's correlation analysis revealed a significant correlation between these markers (P < 0.001). Moreover, sST2, MPO, and MMP-9 levels had a significant positive correlation with aortic diameter and pseudolumen area (P < 0.001). Conclusion The biomarkers sST2, MPO, and MMP-9 were independently associated with mortality in patients with AAD. The significant correlation between these biomarkers suggests a pathogenic role for the IL-33/ST2/neutrophil granzyme system in patients with AAD.
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Affiliation(s)
- Yu Jia
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Dongze Li
- Department of Emergency Medicine and National Clinical Research Center for Geriatrics, Disaster Medicine Center, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Jing Yu
- Department of Emergency Medicine and National Clinical Research Center for Geriatrics, Disaster Medicine Center, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Wenli Jiang
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Yi Liu
- Department of Emergency Medicine and National Clinical Research Center for Geriatrics, Disaster Medicine Center, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Fanghui Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Wentao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Rui Zeng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyang Liao
- Institute of Biomedical Engineering, West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu, China
| | - Zhi Wan
- Department of Emergency Medicine and National Clinical Research Center for Geriatrics, Disaster Medicine Center, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Zhi Wan,
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15
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The Echocardiographic Evaluation of Aortic Aneurysm. Curr Cardiol Rep 2022; 24:1893-1900. [PMID: 36242729 DOI: 10.1007/s11886-022-01791-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Aortic aneurysm is the second most common aortic disease associated with significant morbidity and mortality. We summarize the role of echocardiography in the evaluation of aortic aneurysms in assessing the different etiologies, associated complications, and the role in serial follow-up. In addition, we discuss the limitations of echocardiographic evaluation and the role of multimodality imaging. RECENT FINDINGS Echocardiographic tools such as 2D/3D and Doppler imaging have helped improve the quality of aortic evaluation in acute and long-term follow-up. Moreover, multimodality imaging (CT and MR angiography) has advanced the field of aortic imaging. Echocardiography is an essential and critical tool for the evaluation of normal aorta and various aortic pathologies. It provides valuable information with its diverse modalities such as TTE and TEE. Echocardiography along with complimentary multimodality imaging is critical to identify the acute aortic syndromes and other associated complications of aortic aneurysms, and in long-term follow-up.
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16
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Bhat S, Bir S, Schreve F, Bergin CJ, Jones PG, Waqanivavalagi SWFR. Ethnic Disparities in CT Aortography Use for Diagnosing Acute Aortic Syndrome. Radiol Cardiothorac Imaging 2022; 4:e220018. [PMID: 36601460 PMCID: PMC9806728 DOI: 10.1148/ryct.220018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/31/2022] [Accepted: 10/13/2022] [Indexed: 11/19/2022]
Abstract
Purpose To determine whether CT aortography was performed in proportion to patient risk for acute aortic syndrome (AAS) and incidence of AAS for different ethnic groups. Materials and Methods All atraumatic thoracic aorta CT aortographic examinations performed in adults (age > 15 years) suspected of having AAS between January 2009 and December 2019 at Auckland City Hospital (New Zealand) were included. Patients were risk stratified using the aortic dissection detection risk score (ADD-RS). The primary outcomes were the ratio of CT aortography rates to rates of positive CT aortographic examinations and the incidence of AAS. Population census data were used to determine age-standardized incidence of AAS in the emergency department (ED). Results In total, 1646 CT aortographic examinations were performed in 1543 patients (mean age, 62 years ± 16 [SD]; 877 male patients). Māori (34% [68 of 203]) and Pacific Islanders (35% [80 of 229]) were more likely to be at high risk of AAS (ADD-RS > 1) compared with patients from other ethnic groups (25% [308 of 1214]); in the ED catchment population, age-standardized AAS incidence was significantly higher in Māori (6.9 per 100 000 person-years [95% CI: 4.3, 10.4]) and Pacific Islanders (5.3 [95% CI: 3.4, 7.8]) than in other ethnic groups (2.3 [95% CI: 1.8, 2.8]). Despite this higher incidence, disproportionately fewer CT aortographic examinations were requested in the ED for Māori (9.2 CT aortographic examinations per AAS diagnosis) and Pacific Islanders (9.2 CT aortographic examinations per AAS diagnosis) compared with other ethnic groups (13.8 CT aortographic examinations per AAS diagnosis). Conclusion Māori and Pacific Islanders were at disproportionately higher risk of AAS but had fewer requested CT aortographic examinations compared with other ethnic groups. This increased risk of AAS in Pacific Islander and indigenous Māori patients should be considered by clinicians when investigating AAS.Keywords: Ethnicity, Māori, Pacific Islander, Aortic Dissection Detection Risk Score, Acute Aortic Syndrome, Aortic Dissection, CT Angiography Supplemental material is available for this article. © RSNA, 2022.
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17
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Aziz J, Aziz S. Putative computed tomography scan-negative type A dissection. JTCVS OPEN 2022; 12:30-36. [PMID: 36590711 PMCID: PMC9801335 DOI: 10.1016/j.xjon.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/29/2022] [Accepted: 10/12/2022] [Indexed: 11/12/2022]
Abstract
Objectives Computed tomography angiography (CTA) is the imaging modality most frequently used to diagnosis type A aortic dissection for chest pain with a high degree of sensitivity and specificity. False negative and positive errors in diagnosis are infrequent. Despite initial negative imaging studies for dissection, surgeons must consider early operation in patients with recent onset chest pain in the presence of an ascending aortic aneurysm. Methods We report 4 cases (2004-2021) of patients with a mean age of 51.25 years (male:female = 3:1) who presented with chest pain. Two had a history of syncope. On computed tomography angiography, all had an ascending aortic aneurysm and no dissection flap. Three had thickening of the ascending aorta and 1 had a chronic type B dissection. On echocardiography, aortic regurgitation was moderate-severe in 2 patients, 2 had a pericardial effusion, and none had a definitive dissection flap. All were operated on because of the surgeon's concern for the association of chest pain and an ascending aortic aneurysm. The Institutional Review Board at George Washington University Committee on Human Research has determined that the research is exempt from review under Department of Health and Human Services regulatory category 4 (#FWA00005945). The project as described in the application may proceed without further oversight by the Office of Human Resources on September 9, 2022. Results The diagnosis of type A aortic dissection was made at operation (3 on median sternotomy and 1 after aortotomy). All patients did well. One patient who had peripheral cannulation (no malperfusion) and severe coagulopathy developed a compartment syndrome and postoperatively required a below-knee amputation. Conclusions Surgeons must maintain a high index of suspicion for aortic dissection when patients present with chest pain and are found to have an ascending aortic aneurysm even in the absence of initial, classic features of dissection on computed tomography angiography. Improvements in imaging techniques and analysis are required.
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Affiliation(s)
- Jenna Aziz
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio,Address for reprints: Jenna Aziz, MD, Division of Cardiothoracic Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210.
| | - Salim Aziz
- Division of Cardiac Surgery, George Washington University Hospital, Washington, DC
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18
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Use of Point-of-Care Ultrasound for Early Identification of Acute Aortic Root Dissection. Case Rep Crit Care 2022; 2022:7166230. [PMID: 36299499 PMCID: PMC9592206 DOI: 10.1155/2022/7166230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/11/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Point-of-care ultrasound (POCUS) is becoming a frequently utilized imaging tool in the emergency department (ED) as it can aid in early diagnosis of many pathologies. This is a case report of a 55-year-old male who presented to the emergency department by ambulance for sudden onset chest pain followed by a syncopal episode. Point-of-care echocardiogram revealed a large pericardial effusion with a significantly dilated aortic root, concerning for aortic dissection. Patient was emergently taken for a computed tomography (CT) scan, which was only remarkable for an ascending thoracic aortic aneurysm but failed to show an aortic dissection flap. On repeat POCUS, a dissection intimal flap, large pericardial effusion with tamponade physiology, and aortic regurgitation were identified and later confirmed on transesophageal echocardiogram. This case report details a rare pathology that was correctly identified on initial POCUS before it was seen on CT scan.
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19
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Yuan X, Mitsis A, Nienaber CA. Current Understanding of Aortic Dissection. Life (Basel) 2022; 12:1606. [PMID: 36295040 PMCID: PMC9605578 DOI: 10.3390/life12101606] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/24/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023] Open
Abstract
The aorta is the largest artery in the body, delivering oxygenated blood from the left ventricle to all organs. Dissection of the aorta is a lethal condition caused by a tear in the intimal layer of the aorta, followed by blood loss within the aortic wall and separation of the layers to full dissection. The aorta can be affected by a wide range of causes including acute conditions such as trauma and mechanical damage; and genetic conditions such as arterial hypertension, dyslipidaemia, and connective tissue disorders; all increasing the risk of dissection. Both rapid diagnostic recognition and advanced multidisciplinary treatment are critical in managing aortic dissection patients. The treatment depends on the severity and location of the dissection. Open surgical repair is the gold standard of treatment for dissections located to the proximal part of the aorta and the arch, while endovascular interventions are recommended for most distal or type B aortic dissections. In this review article, we examine the epidemiology, pathophysiology, contemporary diagnoses, and management of aortic dissection.
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Affiliation(s)
- Xun Yuan
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
| | - Andreas Mitsis
- Cardiology Department, Nicosia General Hospital, Strovolos 2029, Cyprus
| | - Christoph A. Nienaber
- Cardiology and Aortic Centre, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London SW7 2BX, UK
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20
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Waqanivavalagi SWFR, Bhat S, Schreve F, Milsom P, Bergin CJ, Jones PG. Trends in computed tomography aortography and acute aortic syndrome in an emergency department within Aotearoa New Zealand. Emerg Med Australas 2022; 34:769-778. [PMID: 35415971 PMCID: PMC9790442 DOI: 10.1111/1742-6723.13974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/12/2022] [Accepted: 03/17/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Acute aortic syndrome (AAS) comprises a triad of life-threatening aortic conditions that are difficult to diagnose because of their non-specific clinical presentations. Contrast-enhanced computed tomography aortography (CTA) has a high sensitivity and specificity for these conditions. However, under- and over-investigation of patients with suspected AAS using CTA carries significant risk. The aim of the present study was to evaluate the diagnostic imaging practices of CTA use for patients presenting to an ED with suspected AAS. METHODS All atraumatic thoracic CTAs performed on patients aged ≥15 years old with suspected AAS who presented to Auckland City Hospital between 2009 and 2019 were included. Outcomes of interest were the annual ED and population incidences of AAS, and the rate of CTAs performed. RESULTS A total of 1646 CTAs were included. There were 135 (8.2%) cases of at least one AAS diagnosis and 220 (13.4%) cases where an alternative diagnosis was made. The population-adjusted number of AAS diagnoses remained relatively stable over the study period, with a mean annual AAS incidence of 19.6 (95% confidence interval 9.9-33.7) per 100 000 patients, and 3.2 (95% confidence interval 1.6-5.4) per 100 000 population. The number of ED presentations increased during the study period, along with the population-adjusted rate of CTAs performed, from approximately 150 per 100 000 patients (2009) to 350 per 100 000 patients (2019). CONCLUSIONS Thoracic CTA use for investigating suspected AAS in our ED has recently increased. However, the annual incidence of AAS did not increase over the same period, but was higher than reported in overseas institutions.
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Affiliation(s)
- Steve WFR Waqanivavalagi
- Adult Emergency DepartmentAuckland City Hospital, Auckland District Health BoardAucklandNew Zealand,Department of MedicineThe University of AucklandAucklandNew Zealand,Green Lane Cardiothoracic Surgical UnitAuckland City Hospital, Auckland District Health BoardAucklandNew Zealand
| | - Sameer Bhat
- Department of SurgeryThe University of AucklandAucklandNew Zealand
| | - Franco Schreve
- Adult Emergency DepartmentAuckland City Hospital, Auckland District Health BoardAucklandNew Zealand
| | - Paget Milsom
- Green Lane Cardiothoracic Surgical UnitAuckland City Hospital, Auckland District Health BoardAucklandNew Zealand
| | - Colleen J Bergin
- Department of RadiologyAuckland City Hospital, Auckland District Health BoardAucklandNew Zealand
| | - Peter G Jones
- Adult Emergency DepartmentAuckland City Hospital, Auckland District Health BoardAucklandNew Zealand,Department of SurgeryThe University of AucklandAucklandNew Zealand
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21
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Endovascular Repair of the Thoracic Aorta Combined with Drug Therapy in Acute Uncomplicated Type B Aortic Dissection. DISEASE MARKERS 2022; 2022:3021599. [PMID: 36193494 PMCID: PMC9526592 DOI: 10.1155/2022/3021599] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022]
Abstract
Objective This study was to evaluate the clinical efficacy of thoracic endovascular aortic repair (TEVAR) combined with Best Medical Therapy (BMT) in acute uncomplicated type B aortic dissection (TBAD). Methods Using the random method, 90 patients admitted to our hospital between January 2018 and January 2020 with acute uncomplicated TBAD were randomly divided into a control group and a study group, with 45 cases in each of the groups. The effectiveness of BMT combined with TEVAR treatment was compared. Results The incidence of recent adverse reactions did not differ significantly between the two groups. Compared to the control group, the 1-year survival rate and 2-year survival rate of patients in the study group were considerably higher. In order to examine the relationship between survival and time, the Kaplan-Meier curve was used. Both groups reached the median survival time after 24 months of follow-up. The expected survival time of the study group was longer than that of the control group. False lumen thrombosis or absence of thrombus was significantly more prevalent in the study group than in the control group. Conclusion For patients with acute uncomplicated TBAD, BMT combined with TEVAR can significantly improve the long-term survival rate and increase the expected survival time.
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Trends in mortality from aortic dissection analyzed from the World Health Organization Mortality Database from 2000 to 2017. Int J Cardiol 2022; 360:83-90. [PMID: 35609714 DOI: 10.1016/j.ijcard.2022.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/29/2022] [Accepted: 05/18/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND We assessed trends in aortic dissection (AD) death rates in 23 countries from 2000 to 2017. METHODS We extracted AD mortality data for countries with high usability data from the World Health Organization (WHO) Mortality Database and from the Center for Disease Control (CDC) WONDER Database for the United States of America (USA). Age Standardized Death Rates (ASDRs) per 100,000 population were computed. Trends were assessed by locally weighted scatter plot smoother (LOWESS) regression. RESULTS Between 2000 and 2017, ASDRs from AD decreased in Australia, Belgium, Croatia, Denmark, France, Italy, New Zealand, Norway, Sweden, the United Kingdom, and the USA for both sexes. Increasing AD mortality was observed in Austria, Czech Republic, Germany, Hungary, Israel, and Japan for both sexes. The largest absolute increases in ASDR were in Japan for men (+1.59) and women (+1.11). The largest percentage decreases were in Norway for men (-0.91) and in New Zealand (-0.6) for women. In 2017, the highest mortality rates were in Japan for both sexes (3.22 and 2.09, respectively). The lowest ASDR was in Kyrgyzstan for both sexes (0.16 and 0.10, respectively). ASDRs for AD in 2017 were higher for men than women in all countries included. Spain had the greatest difference between the gender's mortality rates with a 2.71-fold higher mortality average rate in men. CONCLUSION We identified an overall decrease in AD mortality in most included countries, while an increase was noted in other countries including Israel and Japan.
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Wu MY, Bang TJ, Restauri N, Chawla A, Khawaja RDA, Vargas D. Imaging Acute Aortic Syndromes. Semin Roentgenol 2022; 57:335-344. [DOI: 10.1053/j.ro.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/11/2022]
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24
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Tan M, Xu Y, Gao Z, Yuan T, Liu Q, Yang R, Zhang B, Peng L. Recent Advances in Intelligent Wearable Medical Devices Integrating Biosensing and Drug Delivery. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2108491. [PMID: 35008128 DOI: 10.1002/adma.202108491] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/28/2021] [Indexed: 05/27/2023]
Abstract
The primary roles of precision medicine are to perform real-time examination, administer on-demand medication, and apply instruments continuously. However, most current therapeutic systems implement these processes separately, leading to treatment interruption and limited recovery in patients. Personalized healthcare and smart medical treatment have greatly promoted research on and development of biosensing and drug-delivery integrated systems, with intelligent wearable medical devices (IWMDs) as typical systems, which have received increasing attention because of their non-invasive and customizable nature. Here, the latest progress in research on IWMDs is reviewed, including their mechanisms of integrating biosensing and on-demand drug delivery. The current challenges and future development directions of IWMDs are also discussed.
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Affiliation(s)
- Minhong Tan
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, P. R. China
- School of Materials Science and Engineering, Zhejiang University, Hangzhou, 310027, P. R. China
| | - Yang Xu
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, P. R. China
| | - Ziqi Gao
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, P. R. China
| | - Tiejun Yuan
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, P. R. China
| | - Qingjun Liu
- College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310027, P. R. China
| | - Rusen Yang
- School of Advanced Materials and Nanotechnology, Xidian University, Xian, 710126, P. R. China
| | - Bin Zhang
- School of Mechanical Engineering, Zhejiang University, Hangzhou, 310027, P. R. China
| | - Lihua Peng
- College of Pharmaceutical Sciences, Zhejiang University, Hangzhou, 310058, P. R. China
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, P. R. China
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25
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Beckerman WE, Lajos PS. Management of Acute Aortic Syndromes. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Voit J, Otto CM, Burke CR. Acute native aortic regurgitation: clinical presentation, diagnosis and management. BRITISH HEART JOURNAL 2022; 108:1651-1660. [PMID: 35641177 DOI: 10.1136/heartjnl-2021-320157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jay Voit
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Christopher R Burke
- Department of Cardiac Surgery, University of Washington, Seattle, Washington, USA
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Umaña JP, Camacho J. Disección aórtica aguda: diagnóstico y manejo inicial. REVISTA MÉDICA CLÍNICA LAS CONDES 2022. [DOI: 10.1016/j.rmclc.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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28
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Messina F, Turano L, Calabrese G, Tebala C, Arcadi N. Acute aortic dissection in a young man with bilateral Covid-19 pneumonia: A suggestive case report at Computed Tomography Angiography. Radiol Case Rep 2022; 17:1276-1279. [PMID: 35186176 PMCID: PMC8842582 DOI: 10.1016/j.radcr.2022.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 11/22/2022] Open
Abstract
Acute Aortic Dissection (AAD) is one of the most common lifethreatening diseases that affects the aortic vessel. An its immediate and accurate diagnosis is crucial to initiate the appropriate treatment. The Covid-19 Coronavirus infectious pandemic started since December 2019 and was declared a pandemic by the World Health Organization in March 2020. It caused mainly bilateral interstitial pneumonia, up to causing a severe respiratory failure for the patients, and other complications. Now, we describe the case of a young man that was admitted to our hospital and was found positive for the Coronavirus disease 2019 (Covid-19). While we were performing Computed Tomography (CT) scan of the chest, we had suspected the concomitant presence of an aortic dissection, which was then immediately confirmed by Computed Tomography Angiography (CTA) study, that we had performed to complete the baseline CT scan.
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Lescan M, Mustafi M, Wilhelm V, Keller M, Schlensak C, Rosenberger P, Magunia H. The impact of dissection membrane motility on mid-term aortic remodelling after thoracic endovascular repair. Eur J Cardiothorac Surg 2022; 61:869-876. [PMID: 34747437 DOI: 10.1093/ejcts/ezab444] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess preoperative dissection flap motility and to evaluate its impact on the aortic remodelling and the development of distal stent-induced new entry after thoracic endovascular aneurysm repair (TEVAR)/frozen elephant trunk (FET). METHODS Patients with primary or residual type B dissections were included in a retrospective study with transoesophageal echocardiography analysis of the preoperative dissection flap motility assessed by the true lumen (TL) strain. Three-dimensional computing tomography centreline reconstructions before TEVAR/FET and during the follow-up were conducted to measure aortic remodelling: false lumen thrombosis, TL expansion and aortic diameters at 10 and 20 cm downstream the left subclavian artery, at the coeliac trunk and in the infrarenal aorta. All continuous variables are reported as median with first and third quartiles. RESULTS Fifty-six consecutive patients were treated with TEVAR (n = 45) or FET (n = 11) in the acute (n = 16), subacute (n = 16) and chronic (n = 24) dissection phase. At a median follow-up of 6 (3-12) months, they showed a favourable TL expansion in the descending aorta, significantly higher in the acute [+9 mm (5-12); P < 0.001] and subacute groups [+5 mm (3-8); P = 0.039] than in the chronic group [+2 mm (0-5)]. The dissection flap motility parameter TL strain was superior in the acute (P = 0.006) and subacute (P = 0.035) groups in comparison to the chronic group. The motile flap [TL strain >22.5% (median)] was associated with a higher TL expansion rate in the thoracic aorta (P = 0.009) and a comparable distal stent-induced new entry incidence (overall: 16%) in comparison to the immobile flap (P = 0.89). CONCLUSIONS The intraoperative assessment and the inclusion of the dissection flap motility parameters in the decision-making during TEVAR/FET may refine the distal endograft sizing for an improved remodelling of the TL.
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Affiliation(s)
- Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Migdat Mustafi
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Viktoria Wilhelm
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Marius Keller
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Harry Magunia
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
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Lee JR, Segal C, Howitt J, Lawrence SO, Grima J, Eagle K, Woo K, Byers P, Klein-Rogers E, Milewicz D, Mussa F, Soderlund T, Cotter N, Case M, Trotter D, Shalhub S. A mixed method approach to understanding the impact of COVID-19 on patients with or at risk for aortic dissection. Semin Vasc Surg 2022; 35:100-109. [PMID: 35501037 PMCID: PMC8864810 DOI: 10.1053/j.semvascsurg.2022.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 01/18/2023]
Abstract
Aortic dissection (AD) is a life-threatening rare disease that occurs as a spontaneous tear in the wall of the aorta. Survivors of AD go on to have a chronic disease process that requires lifelong follow-up and management. Although the COVID-19 pandemic has strained health systems and impacted practice in the United States, the effects of these impacts on people living with or at risk for AD is not well understood. This mixed methods project examined the experiences of people in the AD community during the COVID-19 pandemic between March and October 2020. Results reveal that the AD community lacked clear guidance on the role aortic health status plays in COVID-19 risk and experienced significant disruptions in aortic healthcare. At the same time, the new expansion in access to medical care with telehealth conferred unforeseen benefits in the form of reduced barriers for access to specialized aortic health care.
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Affiliation(s)
- Jenney R. Lee
- Department of Urology, University of Washington, Seattle, WA,Corresponding author: Department of Urology, University of Washington School of Medicine, 1959 N.E. Pacific Street, Box 356510, Seattle, WA 98195, United States
| | - Courtney Segal
- Department of Health Services, University of Washington, Seattle, WA
| | - Jake Howitt
- Aortic Dissection Collaborative Advisory Group, Seattle, WA
| | - Sarah O. Lawrence
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine; 1959 N.E. Pacific Street, Box 356410, Seattle, WA 98195
| | | | - Kim Eagle
- University of Michigan, Ann Arbor, MI,International Registry of Acute Aortic Dissections
| | - Karen Woo
- University of California Los Angeles, Los Angeles, CA
| | - Peter Byers
- Department of Pathology, University of Washington, Seattle, WA
| | | | - Dianna Milewicz
- Department of Internal Medicine McGovern Medical School, The University of Texas Health Science Center, Houston, TX
| | - Firas Mussa
- Imperial College, Imperial NHS Healthcare, London, UK
| | - Timo Soderlund
- Aortic Dissection Collaborative Advisory Group, Seattle, WA
| | | | - Melanie Case
- Aortic Dissection Collaborative Advisory Group, Seattle, WA
| | - Debra Trotter
- Aortic Dissection Collaborative Advisory Group, Seattle, WA
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine; 1959 N.E. Pacific Street, Box 356410, Seattle, WA 98195
| | - Aortic Dissection Collaborative#CaseMelanie1CotterNovelett E.BA1DavidCarmen C.1FasanoMark1GoldenbergRichardMD, PhD1HowittJake1SöderlundTimo T.1TrotterDebra1RabinAsafMD2Boehler-TatmanMattieBA3RussoMelissa L.MD3DrudiLaura MarieMD, CM, MSc, FRCSC4MarksLaura L.5YousifMaisoon D.MSc6HoffstaetterTabea7TaubenfeldElla7VemulapalliSreekanthMD8CamposChrisanne S.PhD9RuscheLindsey9PenaRobert C.F.MD, MEng.10MussaFiras F.MD, MS, FACS11MacCarrickGretchenMS, CGC12GoldsboroughEarlIIIBS12SamuelChristeen12XuLillian12MouawadNicolas J.MD, MPH, MBA13YassaEanas S.MD, FACS, FSVS14TengXiaoyiMD15PolitanoAmaniMD, MS16TeindlJesse17BloomLara18GluckRebeccaMS, PA-C18O'NealMeredith Ford19GrimaJosephinePhD20MascialeEileenMA20OtaTakeyoshiMD, PhD21WrightKatelyn22HakimAlan J.MB, BChir, MA, FRCP(UK)23OwensGarethMSc (Oxon)24ArnaoutakisGeorge J.MD25JudelsonDejahMD26D'OriaMarioMD27del Rio-SolaLurdesMD, PhD27AjalatMark28ChauMarvin28TalutisStephanie D.MD, MPH28WooKarenMD, PhD28WohlauerMax V.MD29YiJeniann A.MD, MS29EagleKim A.MD30BowmanMarion A. HofmannMD, PhD30Kline-RogersEvaMS, NP30KimHyeinMD31HenoudClaudineHBSc32DamrauerScottMD33KrolEmiliaMD, FACS34AfifiRana O.MD35CecchiAlana C.MS35DrakeMadeline35EstreraAnthonyMD35HebertAvery MBSA35MilewiczDianna M.MD, PhD35PrakashSiddharth K.MD, PhD35RobertsAaron W.MD, MS35SandhuHarleenMD, MPH35Smith-WashingtonAkili35TanakaAkikoMD, PhD35WatsonJacobBS35AhmadMyraBA36AlbrightCatherine M.MD, MS36BurkeChristopher R.MD36ByersPeter H.MD36KennedyL'OrealDNP, NM, ARNP36LawrenceSarah O.MA36LeeJenney R.MA36MedinaJonathanDNP, ARNP36NishathThamannaMSPH36PhamJulieBS36SegalCourtney36ShalhubShereneMD, MPH36SotoMichaelMPH36CatalanLinellRN, BSN37PattersonMegan37IlonzoNicoleMD38Aortic Dissection Collaborative Patient and Family AdvisorsBaruch Padeh Medical Center, IsraelBrown UniversityCentre Hospitalier de l'Université de MontréalCook Medical, Inc.Dalhousie Medical SchoolDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellDuke UniversityGenetic Aortic Disorders Association Canada (GADA Canada)George Washington UniversityImperial College-LondonJohns Hopkins UniversityMcLaren Health SystemMichigan State University/Spectrum Health Heart and Vascular InstituteMinneapolis Heart InstituteOregon Health & Sciences UniversitySkinny Genes FoundationThe Ehlers-Danlos SocietyThe John Ritter Foundation for Aortic HealthThe Marfan FoundationThe University of ChicagoThe VEDS MovementThe Wellington Hospital (UK)THINK AORTAUF HealthUmass Memorial HealthUniversity Hospital of Trieste ASUGI (Italy)University Hospital of Valladolid (Spain)University of California, Los AngelesUniversity of ColoradoUniversity of MichiganUniversity of OklahomaUniversity of OttawaUniversity of PennsylvaniaUniversity of South CarolinaUniversity of Texas Health Science Center at HoustonUniversity of WashingtonVascular CuresWeill Cornell Medicine
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Li L, Lin LY, Lu YQ. Analysis of imaging characteristics of blunt traumatic aortic dissection: an 8-year experience. World J Emerg Med 2022; 13:361-366. [PMID: 36119775 PMCID: PMC9420656 DOI: 10.5847/wjem.j.1920-8642.2022.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 07/22/2022] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Traumatic aortic dissection (TAD) has a low incidence but extremely high mortality. It always presents atypical clinical manifestations that are easily missed or misdiagnosed. This study mainly aims to describe the imaging characteristics and management of TAD patients. METHODS A retrospective analysis of 27 blunt TAD patients was performed between 2013 and 2020. Demographic features, imaging characteristics, and management were analyzed. RESULTS Twenty-seven patients with type B aortic dissection (age 56.04±16.07 years, 20 men) were included. Aortic intimal tears were mostly initiated from the aortic isthmus. The sizes of the proximal intimal tears in the greater curvature were larger than those in the lesser curvature (1.78±0.56 cm vs. 1.24±0.52 cm, P=0.031). Compared with those in the control group, the maximum diameters of the aortic arch, thoracic aorta, and abdominal aorta in the TAD patients were all significantly widened (all P<0.050). Multivariate logistic regression analysis showed that the maximum diameter of the thoracic aorta was an independent risk factor for TAD, with a predictive value with an area under the receiver operating characteristic curve (AUC) of 0.673. Finally, 26 patients successfully underwent delayed thoracic endovascular aortic repair (TEVAR), and the remaining one patient was treated conservatively. No progression of aortic dissection or death occurred during the six-month follow-up period. CONCLUSIONS In blunt trauma, the aortic isthmus is the most common site of proximal intimal tears. An accurate diagnosis of TAD requires an overall consideration of medical history and imaging characteristics. Delayed TEVAR might be an effective therapeutic option for TAD.
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Affiliation(s)
- Li Li
- Department of Emergency Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
- The Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province, Hangzhou 310003, China
| | - Li-ying Lin
- Department of Emergency Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
- The Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province, Hangzhou 310003, China
| | - Yuan-qiang Lu
- Department of Emergency Medicine, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
- The Key Laboratory for Diagnosis and Treatment of Aging and Physic-chemical Injury Diseases of Zhejiang Province, Hangzhou 310003, China
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Spindelböck T, Ranftl S, von der Linden W. Cross-Entropy Learning for Aortic Pathology Classification of Artificial Multi-Sensor Impedance Cardiography Signals. ENTROPY 2021; 23:e23121661. [PMID: 34945967 PMCID: PMC8700029 DOI: 10.3390/e23121661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/20/2022]
Abstract
An aortic dissection, a particular aortic pathology, occurs when blood pushes through a tear between the layers of the aorta and forms a so-called false lumen. Aortic dissection has a low incidence compared to other diseases, but a relatively high mortality that increases with disease progression. An early identification and treatment increases patients’ chances of survival. State-of-the-art medical imaging techniques have several disadvantages; therefore, we propose the detection of aortic dissections through their signatures in impedance cardiography signals. These signatures arise due to pathological blood flow characteristics and a blood conductivity that strongly depends on the flow field, i.e., the proposed method is, in principle, applicable to any aortic pathology that changes the blood flow characteristics. For the signal classification, we trained a convolutional neural network (CNN) with artificial impedance cardiography data based on a simulation model for a healthy virtual patient and a virtual patient with an aortic dissection. The network architecture was tailored to a multi-sensor, multi-channel time-series classification with a categorical cross-entropy loss function as the training objective. The trained network typically yielded a specificity of (93.9±0.1)% and a sensitivity of (97.5±0.1)%. A study of the accuracy as a function of the size of an aortic dissection yielded better results for a small false lumen with larger noise, which emphasizes the question of the feasibility of detecting aortic dissections in an early state.
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Affiliation(s)
- Tobias Spindelböck
- Institute of Theoretical and Computational Physics, Graz University of Technology, Petersgasse 16, 8010 Graz, Austria; (T.S.); (W.v.d.L.)
| | - Sascha Ranftl
- Institute of Theoretical and Computational Physics, Graz University of Technology, Petersgasse 16, 8010 Graz, Austria; (T.S.); (W.v.d.L.)
- Graz Center of Computational Engineering, Graz University of Technology, Krenngasse 37, 8010 Graz, Austria
- Correspondence:
| | - Wolfgang von der Linden
- Institute of Theoretical and Computational Physics, Graz University of Technology, Petersgasse 16, 8010 Graz, Austria; (T.S.); (W.v.d.L.)
- Graz Center of Computational Engineering, Graz University of Technology, Krenngasse 37, 8010 Graz, Austria
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Huang F, Wu H, Lai QQ, Ke XT. Application value of preoperative dual-source computed tomography in assessing the rupture site of thoracic aortic dissection. J Cardiothorac Surg 2021; 16:346. [PMID: 34872588 PMCID: PMC8647340 DOI: 10.1186/s13019-021-01729-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the application value of dual-source computed tomography (DSCT) in preoperative assessment the rupture site of an thoracic aortic dissection (TAD). Methods A retrospective analysis of preoperative DSCT, multislice computed tomography (MSCT), and transthoracic echocardiography (TTE) results of 150 patients with suspected TAD in our hospital was conducted, and the intraoperative findings or interventional treatment results were used as the diagnostic gold standard. Results Of all 150 suspected TAD patients, 123 patients were confirmed to have TAD. The rupture site of TAD was in the ascending aorta in 46 patients, in the aortic arch in 13 patients, and in the descending aorta in 64 patients. The sensitivity of DSCT, MSCT, and TTE for locating the rupture site of the TAD was 100%, 93.5%, and 89.5%, respectively, and the specificity was 100%, 88.9%, and 81.5%. The differences were statistically significant. The distance between the actual rupture site and the one diagnosed by DSCT, MSCT, and TTE was 1.9 ± 1.2 mm, 5.1 ± 2.7 mm, and 7.8 ± 3.5 mm, respectively; the latter two were significantly worse than DSCT. The size of the rupture site diagnosed by DSCT, MSCT, and TTE was 1.5 ± 0.8 cm, 1.7 ± 0.9 cm, and 1.9 ± 1.0 cm, respectively. The size of the rupture site diagnosed by DSCT was not significantly different from the actual size of 1.4 ± 0.7 cm, while those by MSCT and TTE were. Conclusion DSCT has high sensitivity and specificity in diagnosing the rupture site of TAD and can clearly locate the rupture site. It can be a preferred imaging method for TAD.
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Affiliation(s)
- Fang Huang
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China.
| | - Hong Wu
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Qing-Quan Lai
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Xiao-Ting Ke
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
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Soliman-Aboumarie H, Pastore MC, Galiatsou E, Gargani L, Pugliese NR, Mandoli GE, Valente S, Hurtado-Doce A, Lees N, Cameli M. Echocardiography in the intensive care unit: An essential tool for diagnosis, monitoring and guiding clinical decision-making. Physiol Int 2021. [PMID: 34825894 DOI: 10.1556/1647.2021.00055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022]
Abstract
In the last years, new trends on patient diagnosis for admission in cardiac intensive care unit (CICU) have been observed, shifting from acute myocardial infarction or acute heart failure to non-cardiac diseases such as sepsis, acute respiratory failure or acute kidney injury. Moreover, thanks to the advances in scientific knowledge and higher availability, there has been increasing use of positive pressure mechanical ventilation which has its implications on the heart. Therefore, there is a growing need for Cardiac intensivists to quickly, noninvasively and repeatedly evaluate various hemodynamic conditions and the response to therapy. Transthoracic critical care echocardiography (CCE) currently represents an essential tool in CICU, as it is used to evaluate biventricular function and complications following acute coronary syndromes, identify the mechanisms of circulatory failure, acute valvular pathologies, tailoring and titrating intravenous treatment or mechanical circulatory support. This could be completed with trans-esophageal echocardiography (TOE), advanced echocardiography and lung ultrasound to provide a thorough evaluation and monitoring of CICU patients. However, CCE could sometimes be challenging as the acquisition of good-quality images is limited by mechanical ventilation, suboptimal patient position or recent surgery with drains on the chest. Moreover, there are some technical caveats that one should bear in mind while performing CCE in order to optimize its use and avoid misleading findings. The aim of this review is to highlight the key role of CCE, providing an updated overview of its main applications and possible pitfalls in order to facilitate its use in CICU for clinical decision-making.
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Affiliation(s)
- Hatem Soliman-Aboumarie
- 1 Department of Anesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London , United Kingdom
- 4 School of Cardiovascular Sciences and Medicine, King's College, London , United Kingdom
| | - Maria Concetta Pastore
- 2 Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Eftychia Galiatsou
- 1 Department of Anesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London , United Kingdom
| | - Luna Gargani
- 3 Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | - Giulia Elena Mandoli
- 2 Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- 2 Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Ana Hurtado-Doce
- 1 Department of Anesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London , United Kingdom
| | - Nicholas Lees
- 1 Department of Anesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London , United Kingdom
| | - Matteo Cameli
- 2 Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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Abstract
Acute aortic syndromes, classified into aortic dissection, intramural hematoma, and penetrating aortic ulcer, are associated with high early mortality for which early diagnosis and management are crucial to optimize outcomes. Patients often present with nonspecific clinical symptoms and signs; therefore, it is important for providers to maintain a high index of suspicion for acute aortic syndromes. Electrocardiogram-gated computed tomographic angiography of the chest, abdomen, and pelvis is currently the most practical imaging modality for diagnosis and identification of complications. Evolution in surgical techniques and the development of aortic endografts have improved patient outcomes, but randomized trials are still needed.
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Affiliation(s)
- R Kevin Rogers
- Division of Cardiology, University of Colorado, School of Medicine, Section of Vascular Medicine, Mail Stop B132, Leprino Building, 12401 East 17th Avenue, Room 560, Aurora, CO 80045, USA.
| | - T Brett Reece
- Division of Cardiovascular Surgery, University of Colorado, School of Medicine, 12631 East 17th Avenue, Room 6111, Aurora, CO 80045, USA
| | - Marc P Bonaca
- Division of Cardiology, University of Colorado, School of Medicine, Section of Vascular Medicine, Mail Stop B132, Leprino Building, 12401 East 17th Avenue, Room 560, Aurora, CO 80045, USA; CPC Clinical Research, 2115 North Scranton Street Suite 2040, Aurora, CO 80045, USA
| | - Connie N Hess
- Division of Cardiology, University of Colorado, School of Medicine, Section of Vascular Medicine, Mail Stop B132, Leprino Building, 12401 East 17th Avenue, Room 560, Aurora, CO 80045, USA; CPC Clinical Research, 2115 North Scranton Street Suite 2040, Aurora, CO 80045, USA
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Mehta CK, Son AY, Chia MC, Budd AN, Allen BD, Vassallo P, Hoel AW, Brady WJ, Nable JV. Management of acute aortic syndromes from initial presentation to definitive treatment. Am J Emerg Med 2021; 51:108-113. [PMID: 34735967 DOI: 10.1016/j.ajem.2021.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acute aortic syndromes comprise a spectrum of diseases including aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcers. Early diagnosis, rapid intervention, and multidisciplinary team care are vital to efficiently manage time-sensitive aortic emergencies, mobilize appropriate resources, and optimize clinical outcomes. OBJECTIVE This comprehensive review outlines the multidisciplinary team approach from initial presentation to definitive interventional treatment and post-operative care. DISCUSSION Acute aortic syndromes can be life-threatening and require prompt diagnosis and aggressive initiation of blood pressure and pain control to prevent subsequent complications. Early time to diagnosis and intervention are associated with improved outcomes. CONCLUSIONS A multidisciplinary team can help promptly diagnose and manage aortic syndromes.
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Affiliation(s)
- Christopher K Mehta
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, United States of America.
| | - Andre Y Son
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, United States of America
| | - Matthew C Chia
- Division of Vascular Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, United States of America
| | - Ashley N Budd
- Department of Anesthesiology, Northwestern Medicine, Chicago, IL, United States of America
| | - Bradley D Allen
- Department of Radiology, Northwestern Medicine, Chicago, IL, United States of America
| | - Patricia Vassallo
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, United States of America
| | - Andrew W Hoel
- Division of Vascular Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, IL, United States of America
| | - William J Brady
- Departments of Emergency Medicine and Internal Medicine, University of Virginia, Charlottesville, VA, United States of America
| | - Jose V Nable
- Department of Emergency Medicine, MedStar Georgetown University Hospital, Washington D.C., United States of America
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CHAVES VM, PEREIRA CG, RESENDE CX, TAVARES SF, GOMES CF, RODRIGUES PS, PINHEIRO TORRES JL, VON HAFE P. A successful case of aortic intramural hematoma with type-A aortic dissection: symptoms first. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2021. [DOI: 10.23736/s0393-3660.19.04256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Aldalati A, Bellamkonda VR, Moore GP, Finch AS. Three Cases of Emergency Department Medical Malpractice Involving "Consultations": How Is Liability Legally Determined? Clin Pract Cases Emerg Med 2021; 5:283-288. [PMID: 34437032 PMCID: PMC8373181 DOI: 10.5811/cpcem.2021.7.52680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/02/2021] [Indexed: 11/18/2022] Open
Abstract
This article presents three successfully litigated medical malpractice cases involving emergency physicians and consultants. We discuss the respective case medical diagnoses, as well as established legal principles that determine in a court proceeding which provider will be liable. Specifically, we explain the legal principles of “patient physician relationship” and “affirmative act.”
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Affiliation(s)
- Alaa Aldalati
- Mayo Clinic College of Medicine and Science, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota
| | - Venkatesh R Bellamkonda
- Mayo Clinic College of Medicine and Science, Department of Emergency Medicine, Rochester, Minnesota
| | - Gregory P Moore
- Mayo Clinic College of Medicine and Science, Department of Emergency Medicine, Rochester, Minnesota
| | - Alexander S Finch
- Mayo Clinic College of Medicine and Science, Department of Emergency Medicine, Rochester, Minnesota
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Kobayashi K, Kuroda Y, Hayashi J, Mizumoto M, Yamashita A, Ohba E, Nakai S, Ochiai T, Uchida T. Step-by-step aortic clamping technique for safe retrieval of the elephant trunk. J Card Surg 2021; 36:3854-3856. [PMID: 34338372 DOI: 10.1111/jocs.15879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022]
Abstract
Staged repair of the aortic arch and downstream aorta using the elephant trunk technique is widely accepted for extensive aortic disease. However, elephant trunk retrieval is challenging in patients with unclampable descending aorta caused by extreme aneurysmal dilation or surrounding tissue adhesion. Here, we introduce a new elephant trunk retrieval technique using the step-by-step aortic clamping in descending aortic replacement of dissecting aortic aneurysm. This technique is a safe and feasible method of elephant trunk retrieval that consists of staged clamping and intraoperative ultrasound assessment of blood flow in the aorta.
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Affiliation(s)
- Kimihiro Kobayashi
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yoshinori Kuroda
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Jun Hayashi
- Department of Cardiovascular Surgery, Sendai City Hospital, Sendai, Japan
| | - Masahiro Mizumoto
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Atsushi Yamashita
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Eiichi Ohba
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Shingo Nakai
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Tomonori Ochiai
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Tetsuro Uchida
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
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Grant MD, Mann RD, Kristenson SD, Buck RM, Mendoza JD, Reese JM, Grant DW, Roberge EA. Transthoracic Echocardiography: Beginner's Guide with Emphasis on Blind Spots as Identified with CT and MRI. Radiographics 2021; 41:1022-1042. [PMID: 34115535 DOI: 10.1148/rg.2021200142] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Transthoracic echocardiography (TTE) is the primary initial imaging modality in cardiac imaging. Advantages include portability, safety, availability, and ability to assess the morphology and physiology of the heart in a noninvasive manner. Because of this, many patients who undergo advanced imaging with CT or MRI will have undergone prior TTE, particularly when cardiac CT angiography or cardiac MRI is performed. In the modern era, the increasing interconnectivity of picture archiving and communication systems (PACS) has made these images more available for comparison. Therefore, radiologists who interpret chest imaging studies should have a basic understanding of TTE, including its strengths and limitations, to make accurate comparisons and assist in rendering a diagnosis or avoiding a misdiagnosis. The authors present the standard TTE views along with multiplanar reformatted CT images for correlation. This is followed by examples of limitations of TTE, focusing on potential blind spots, which have been placed in seven categories on the basis of the structures involved: (a) pericardium (thickening, calcification, effusions, cysts, masses), (b) aorta (dissection, intramural hematoma, penetrating atherosclerotic ulcer), (c) left ventricular apex (infarcts, aneurysms, thrombus, apical hypertrophic cardiomyopathy), (d) cardiac valves (complications of native and prosthetic valves), (e) left atrial appendage (thrombus), (f) coronary arteries (origins, calcifications, fistulas, aneurysms), and (g) extracardiac structures (primary and metastatic masses). Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article . ©RSNA, 2021.
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Affiliation(s)
- Matthew D Grant
- From the Departments of Radiology (M.D.G., R.D.M., S.D.K., R.M.B., J.D.M., D.W.G., E.A.R.) and Cardiology (J.M.R.), Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431; and the Uniformed Services University of the Health Sciences, Bethesda, Md (M.D.G., J.M.R., D.W.G., E.A.R.)
| | - Ryan D Mann
- From the Departments of Radiology (M.D.G., R.D.M., S.D.K., R.M.B., J.D.M., D.W.G., E.A.R.) and Cardiology (J.M.R.), Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431; and the Uniformed Services University of the Health Sciences, Bethesda, Md (M.D.G., J.M.R., D.W.G., E.A.R.)
| | - Scott D Kristenson
- From the Departments of Radiology (M.D.G., R.D.M., S.D.K., R.M.B., J.D.M., D.W.G., E.A.R.) and Cardiology (J.M.R.), Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431; and the Uniformed Services University of the Health Sciences, Bethesda, Md (M.D.G., J.M.R., D.W.G., E.A.R.)
| | - Richard M Buck
- From the Departments of Radiology (M.D.G., R.D.M., S.D.K., R.M.B., J.D.M., D.W.G., E.A.R.) and Cardiology (J.M.R.), Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431; and the Uniformed Services University of the Health Sciences, Bethesda, Md (M.D.G., J.M.R., D.W.G., E.A.R.)
| | - Juan D Mendoza
- From the Departments of Radiology (M.D.G., R.D.M., S.D.K., R.M.B., J.D.M., D.W.G., E.A.R.) and Cardiology (J.M.R.), Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431; and the Uniformed Services University of the Health Sciences, Bethesda, Md (M.D.G., J.M.R., D.W.G., E.A.R.)
| | - Jason M Reese
- From the Departments of Radiology (M.D.G., R.D.M., S.D.K., R.M.B., J.D.M., D.W.G., E.A.R.) and Cardiology (J.M.R.), Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431; and the Uniformed Services University of the Health Sciences, Bethesda, Md (M.D.G., J.M.R., D.W.G., E.A.R.)
| | - David W Grant
- From the Departments of Radiology (M.D.G., R.D.M., S.D.K., R.M.B., J.D.M., D.W.G., E.A.R.) and Cardiology (J.M.R.), Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431; and the Uniformed Services University of the Health Sciences, Bethesda, Md (M.D.G., J.M.R., D.W.G., E.A.R.)
| | - Eric A Roberge
- From the Departments of Radiology (M.D.G., R.D.M., S.D.K., R.M.B., J.D.M., D.W.G., E.A.R.) and Cardiology (J.M.R.), Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431; and the Uniformed Services University of the Health Sciences, Bethesda, Md (M.D.G., J.M.R., D.W.G., E.A.R.)
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Modares M, Hanneman K, Ouzounian M, Chung J, Nguyen ET. Computed Tomography Angiography Assessment of Acute Aortic Syndromes: Classification, Differentiating Imaging Features, and Imaging Interpretation Pitfalls. Can Assoc Radiol J 2021; 73:228-239. [PMID: 33874779 DOI: 10.1177/08465371211001525] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
An acute aortic syndrome (AAS) is an important life-threatening condition that requires early detection and management. Acute intramural hematoma (IMH), aortic dissection (AD) and penetrating atherosclerotic ulcer (PAU) are included in AAS. ADs can be classified using the well-known Stanford or DeBakey classification systems. However, these classification systems omit description of arch dissections, anatomic variants, and morphologic features that impact outcome. The Society for Vascular Surgery and Society of Thoracic Surgeons (SVS-STS) have recently introduced a classification system that classifies ADs according to the location of the entry tear (primary intimomedial tear, PIT) and the proximal and distal extent of involvement, but does not include description of all morphologic features that may have diagnostic and prognostic significance. This review describes these classification systems for ADs and other AAS entities as well as their limitations. Typical computed tomography angiography (CTA) imaging appearance and differentiating features of ADs, limited intimal tears (LITs), IMHs, intramural blood pools (IBPs), ulcer-like projections (ULPs), and PAUs will be discussed. Furthermore, this review highlights common imaging interpretation pitfalls, what should be included in a comprehensive CTA report, and provides a brief overview of current management options.
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Affiliation(s)
- Mana Modares
- Faculty of Medicine, 1 King's College Circle, Medical Sciences Building, 7938University of Toronto, Toronto, Ontario, Canada
| | - Kate Hanneman
- Department of Medical Imaging, Joint Department of Medical Imaging, Peter Munk Cardiac Center, Toronto General Hospital, University Avenue, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Cardiovascular Division, Department of Surgery, Peter Munk Cardiac Center, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jennifer Chung
- Cardiovascular Division, Department of Surgery, Peter Munk Cardiac Center, Toronto General Hospital, Toronto, Ontario, Canada
| | - Elsie T Nguyen
- Department of Medical Imaging, Joint Department of Medical Imaging, Peter Munk Cardiac Center, Toronto General Hospital, University Avenue, Toronto, Ontario, Canada
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Aortic Intimo-intimal Intussusception: A Pooled Analysis of Published Reports. Ann Vasc Surg 2021; 75:471-478. [PMID: 33831523 DOI: 10.1016/j.avsg.2021.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 11/20/2022]
Abstract
AIM Aortic intimo-intimal intussusception (AoII) is a rare manifestation of aortic dissection with high mortality. This study aimed to obtain a comprehensive understanding of AoII. METHODS Three databases (PubMed, Scopus, Embase) were searched with predefined search terms ["intimal intussusception", "aortic intussusception", "(circumferential) AND (intimal dissection)" and "(circumferential) AND (aortic dissection)"]. Demographics, clinical manifestations, imaging methods, therapies, and follow-up data were recorded and analyzed. RESULTS The literature search finally identified 81 papers comprising 87 patients (Mean age: 53.7 ± 14.9 years old; male: n = 63). According to morphologic criteria (orientation of AoII intimal flap), patients were divided into three groups: antegrade (n = 37), retrograde (n = 49) and bidirectional (n = 1) orientation. The most frequent symptoms in antegrade group were chest pain (62.2%), syncope (27%), and unconsciousness (21.6%), while in retrograde group, they were chest pain (71.4%), dyspnea (20.4%), and back pain (16.3%). Regarding applied imaging modalities, 67.5% of patients in antegrade group were diagnosed with≥2 methods, comparing with 87.7% in retrograde group. A total of 21 patients (24.1%) with AoII finally died, among which 13.8% (12/87) died before surgery. CONCLUSION AoII is a rare form of aortic dissection with high mortality. Antegrade orientation of the intima flap was more accompanied with neurological disorders and asymmetric blood pressure, while retrograde orientation mostly manifested with aortic regurgitation. Application of multiple imaging examinations may detect this rare entity in time.
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Ghaghada KB, Ren P, Devkota L, Starosolski Z, Zhang C, Vela D, Stupin IV, Tanifum EA, Annapragada AV, Shen YH, LeMaire SA. Early Detection of Aortic Degeneration in a Mouse Model of Sporadic Aortic Aneurysm and Dissection Using Nanoparticle Contrast-Enhanced Computed Tomography. Arterioscler Thromb Vasc Biol 2021; 41:1534-1548. [PMID: 33535789 PMCID: PMC7990703 DOI: 10.1161/atvbaha.120.315210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Ketan B Ghaghada
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston (K.B.G., L.D., Z.S., I.V.S., E.A.T., A.V.A.)
- Department of Radiology (K.B.G., Z.S., E.A.T., A.V.A.), Baylor College of Medicine, Houston, TX
- Cardiovascular Research Institute (K.B.G., A.V.A., Y.H.S., S.A.L.), Baylor College of Medicine, Houston, TX
| | - Pingping Ren
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (P.R., C.Z., Y.H.S., S.A.L.), Baylor College of Medicine, Houston, TX
| | - Laxman Devkota
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston (K.B.G., L.D., Z.S., I.V.S., E.A.T., A.V.A.)
- Department of Pediatrics, Section of Hematology-Oncology (L.D.), Baylor College of Medicine, Houston, TX
| | - Zbigniew Starosolski
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston (K.B.G., L.D., Z.S., I.V.S., E.A.T., A.V.A.)
- Department of Radiology (K.B.G., Z.S., E.A.T., A.V.A.), Baylor College of Medicine, Houston, TX
| | - Chen Zhang
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (P.R., C.Z., Y.H.S., S.A.L.), Baylor College of Medicine, Houston, TX
| | - Deborah Vela
- Department of Cardiovascular Pathology Research (D.V.), Texas Heart Institute, Houston
| | - Igor V Stupin
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston (K.B.G., L.D., Z.S., I.V.S., E.A.T., A.V.A.)
| | - Eric A Tanifum
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston (K.B.G., L.D., Z.S., I.V.S., E.A.T., A.V.A.)
- Department of Radiology (K.B.G., Z.S., E.A.T., A.V.A.), Baylor College of Medicine, Houston, TX
| | - Ananth V Annapragada
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston (K.B.G., L.D., Z.S., I.V.S., E.A.T., A.V.A.)
- Department of Radiology (K.B.G., Z.S., E.A.T., A.V.A.), Baylor College of Medicine, Houston, TX
- Cardiovascular Research Institute (K.B.G., A.V.A., Y.H.S., S.A.L.), Baylor College of Medicine, Houston, TX
| | - Ying H Shen
- Cardiovascular Research Institute (K.B.G., A.V.A., Y.H.S., S.A.L.), Baylor College of Medicine, Houston, TX
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (P.R., C.Z., Y.H.S., S.A.L.), Baylor College of Medicine, Houston, TX
- Department of Cardiovascular Surgery (Y.H.S., S.A.L.), Texas Heart Institute, Houston
| | - Scott A LeMaire
- Cardiovascular Research Institute (K.B.G., A.V.A., Y.H.S., S.A.L.), Baylor College of Medicine, Houston, TX
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery (P.R., C.Z., Y.H.S., S.A.L.), Baylor College of Medicine, Houston, TX
- Department of Cardiovascular Surgery (Y.H.S., S.A.L.), Texas Heart Institute, Houston
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Murillo H, Molvin L, Chin AS, Fleischmann D. Aortic Dissection and Other Acute Aortic Syndromes: Diagnostic Imaging Findings from Acute to Chronic Longitudinal Progression. Radiographics 2021; 41:425-446. [PMID: 33646901 DOI: 10.1148/rg.2021200138] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Acute aortic dissection is the prototype of acute aortic syndromes (AASs), which include intramural hematoma, limited intimal tear, penetrating atherosclerotic ulcer, traumatic or iatrogenic aortic dissection, and leaking or ruptured aortic aneurysm. The manifestation is usually sudden and catastrophic with acutely severe tearing chest or back pain. However, clinical symptoms do not allow distinction between AAS types and other acute pathologic conditions. Diagnostic imaging is essential to rapidly confirm and accurately diagnose the type, magnitude, and complications of AASs. CT fast acquisition of volumetric datasets has become instrumental in diagnosis, surveillance, and intervention planning. Most critical findings affecting initial intervention and prognosis are obtained at CT, including involvement of the ascending aorta, primary intimal tear location, rupture, malperfusion, size and patency of the false lumen, complexity and extent of the dissection, maximum caliber of the aorta, and progression or postintervention complications. Involvement of the ascending aorta-Stanford type A-has the most rapid lethal complications and requires surgical intervention to affect its morbidity and mortality. Lesions not involving the ascending aorta-Stanford type B-have a lesser rate of complications in the acute phase. During the acute to longitudinal progression, various specific and nonspecific imaging findings are encountered, including pleural and pericardial effusions, fluid collections, progression including aortic enlargement, and postoperative changes that can be discerned at CT. A systematic analysis algorithm is proposed for CT of the entire aorta throughout the continuum of AASs into the chronic and posttreated disease state, which synthesizes and communicates salient findings to all care providers. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Horacio Murillo
- From the Department of Radiology, Enloe Medical Center, 1531 Esplanade, Chico, CA 95926 (H.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (L.M., D.F.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada (A.S.C.)
| | - Lior Molvin
- From the Department of Radiology, Enloe Medical Center, 1531 Esplanade, Chico, CA 95926 (H.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (L.M., D.F.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada (A.S.C.)
| | - Anne S Chin
- From the Department of Radiology, Enloe Medical Center, 1531 Esplanade, Chico, CA 95926 (H.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (L.M., D.F.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada (A.S.C.)
| | - Dominik Fleischmann
- From the Department of Radiology, Enloe Medical Center, 1531 Esplanade, Chico, CA 95926 (H.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (L.M., D.F.); and Department of Radiology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada (A.S.C.)
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Volvovitch D, Ram E, Cohen H, Kogan A, Sternik L, Raanani E. Acute pulmonary embolism following acute type A aortic dissection in a patient with COVID-19. J Card Surg 2021; 36:1566-1568. [PMID: 33533105 PMCID: PMC8013687 DOI: 10.1111/jocs.15389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 01/25/2023]
Abstract
Acute aortic dissection and acute pulmonary embolism (PE) are life-threatening emergencies that can mimic each other at presentation. Immediate and accurate diagnosis of these scenarios is crucial to initiate the appropriate interventions. In this case report we present a 73-year-old patient, who was admitted to our Medical Center with acute type A aortic dissection. She was tested for coronavirus disease 2019 (COVID-19) infection and was found to be positive. During her admission in the COVID-19 designated intensive care unit, she diagnosed with acute PE in the main right and left pulmonary arteries. She underwent surgery that included bilateral pulmonary embolectomy and aortic dissection repair. The patient was discharged from our hospital on the ninth postoperative day without any complications. Frequency of simultaneous presentation of acute aortic dissection and acute PE is increased with a history of coagulation abnormalities as seen in patients with COVID-19.
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Affiliation(s)
- David Volvovitch
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Tel Aviv University, Tel Aviv, Israel.,Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eilon Ram
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Tel Aviv University, Tel Aviv, Israel.,Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hillit Cohen
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Tel Aviv University, Tel Aviv, Israel.,Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Kogan
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Tel Aviv University, Tel Aviv, Israel.,Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonid Sternik
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Tel Aviv University, Tel Aviv, Israel.,Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ehud Raanani
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Tel Aviv University, Tel Aviv, Israel.,Sheba Medical Center, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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46
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Roccuzzo S, Mondello C, Salamone I, Gualniera P, Sapienza D, Scurria S, Asmundo A. Acute aortic syndrome and radiology liability in Italy: Case reports and medico-legal considerations. MEDICINE, SCIENCE, AND THE LAW 2021; 61:141-145. [PMID: 33591862 DOI: 10.1177/0025802420977977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The trend for medical malpractice claims has increased in recent years, both in the USA and in Europe. Although diagnostic radiology is not considered a high-risk field, malpractice claims in this area follow this general trend. The most common legal action taken against radiologists includes failure to diagnose, poor communication between physicians, failure to supervise technologists properly and improper procedures. Recently, the Italian Civil Supreme Court delivered a judgment (Cass. Civ., N.10158-18) regarding the liability of radiologists, stating that in radiological practice, a correct and timely execution of the diagnostic investigation is required. By contrast, the same judgment states that requesting further clinical consultations and/or the execution of in-depth diagnostic examinations are not within their duties. Considering this judgment, we report two cases of radiologist malpractice and related responsibility for negligent conduct regarding the diagnosis of thoracic aortic dissection and the prevention and management of acute aortic syndrome.
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Affiliation(s)
- Salvatore Roccuzzo
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Cristina Mondello
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Ignazio Salamone
- Departmental Section of Radiology, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Patrizia Gualniera
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Daniela Sapienza
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Serena Scurria
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Alessio Asmundo
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
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47
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Cioni G. Usefulness of point-of-care ultrasound in the atypical presentation of aortic dissection: a case series and brief review of literature. ITALIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4081/itjm.2020.1379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Acute aortic dissection represents a surgical emergency that, in most cases, may present an atypical and non-specific clinic, making the diagnosis difficult and late. Computed tomography angiography represents the gold standard for diagnosis, but different ultrasound techniques are able to provide valuable additional information related to diagnosis, and optimize therapy and prognostic assessment. In this case series, we describe different atypical patterns of aortic dissection, associated to non-diagnostic D-Dimer levels. These atypical conditions escape recognized diagnostic algorithms for the diagnosis of aortic dissection, although the incidence of such events is far from negligible. A clinical approach in the emergency setting that provides for a systematic and standardized use of bedside ultrasound could help reduce the incidence of errors and diagnostic delay, addressing the gold standard instrumental diagnostics for the reference pathology.
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48
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Luke P, Booth K, Kindawi A, Eggett C. Type A aortic dissection: Why there is still a role for echocardiography when every second counts. SAGE Open Med Case Rep 2020; 8:2050313X20973086. [PMID: 33414921 PMCID: PMC7750756 DOI: 10.1177/2050313x20973086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 10/22/2020] [Indexed: 01/16/2023] Open
Abstract
Aortic dissection is often regarded as a catastrophic aortic syndrome with high rates of
mortality. The sensitivity and specificity of transthoracic echocardiography when
diagnosing acute type A aortic dissection has been reported as high as 97% and 100%,
respectively, in patients with optimal imaging quality when compared to computed
tomography. In this article, we discuss the benefit of transthoracic echocardiography in a
patient with type A aortic dissection extending from ascending aorta to iliac
arteries.
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Affiliation(s)
- Peter Luke
- Echocardiography Department, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Karen Booth
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Ali Kindawi
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Christopher Eggett
- School of Biomedical Sciences, Newcastle University, Newcastle Upon Tyne, UK
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49
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Ahmed R. Extrinsic tricuspid valve compression due to an aortic aneurysm causing significant right to left shunt via a patent foramen ovale: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 33447706 PMCID: PMC7793208 DOI: 10.1093/ehjcr/ytaa453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/21/2020] [Accepted: 10/24/2020] [Indexed: 11/14/2022]
Abstract
Background Aortic aneurysms are known to cause compression of adjacent structures including the tracheobronchial tree, oesophagus, and recurrent laryngeal nerve. Extremely rarely, they can lead to compression of the tricuspid valve (TV) annulus. We describe a case where aortic aneurysm caused TV annulus compression and persistent right-to-left shunt through a patent foramen ovale (PFO). Case summary A 75-year-old female was admitted with headache and dizziness. On examination, she had persistent arterial desaturation with oxygen levels reduced to 69% at rest whilst breathing ambient air. Complete blood count demonstrated polycythaemia (Hb 174 g/L). Right to left cardiac shunt was suspected after significant lung and haematologic pathology was excluded. Transoesophageal echocardiography demonstrated a trileaflet aortic valve with an ascending aorta aneurysm and a stretched PFO with persistent right to left shunt across it. The ascending aortic aneurysm was observed coursing superior to and compressing the TV annulus. Invasive haemodynamic data demonstrated prominent 'a' waves in the right atrium, low RV (12/1 mmHg), and pulmonary artery pressures (14/6 mmHg), reduced cardiac output and significant right to left shunt with Qp:Qs 0.6. Computed tomography (CT) angiogram demonstrated a 5 cm fusiform ascending aorta aneurysm that coursed anteriorly causing TV annulus compression. Discussion Tricuspid valve inflow obstruction associated with a right to left shunt across PFO can be an extremely rare complication of aortic aneurysm. This may result in persistent arterial hypoxaemia and secondary polycythaemia.
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Affiliation(s)
- Rizwan Ahmed
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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50
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Du X, Zhang S, Xu J, Xiang Q, Tian F, Li X, Guo L, Zhu L, Qu P, Fu Y, Tan Y, Gui Y, Wen T, Godinez B, Liu L. Diagnostic value of monocyte to high-density lipoprotein ratio in acute aortic dissection in a Chinese han population. Expert Rev Mol Diagn 2020; 20:1243-1252. [PMID: 33176510 DOI: 10.1080/14737159.2020.1847647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Recently, considerable evidence pointed out monocyte to high-density lipoprotein ratio (MHR) is highly related to inflammatory related diseases. We aim to explore the level of MHR in acute aortic dissection (AAD) patients and determine whether MHR can be a novel diagnostic marker of AAD. Research design and methods: A total of 228 subjects including 128 AAD patients and 110 healthy control were enrolled. MHR levels and other serum samples were obtained at admission. Results: The baseline MHR levels were significantly higher in patients with AAD (p < 0.0001). A cutoff value of MHR >0.37 was associated with a sensitivity of 86.70% and a specificity of 93.60% for AAD. MHR levels were positively correlated with the time from symptom onset (R2 = 0.0318, p = 0.0003). Additionally, the area under the curve (AUC) was increased to 0.979 in patients whose time from onset of symptoms >24 h, with a sensitivity of 98.04% and a specificity of 93.64%. Multivariate logistic regression demonstrated that MHR levels, history of hypertension, and coronary artery disease (CHD) emerged as independent predictors of AAD. Expert Opinion: MHR has a high diagnostic value in AAD patients, especially in those whose time from onset of symptoms >24 h.
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Affiliation(s)
- Xiao Du
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University , PR China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University , PR China
| | - Shilan Zhang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University , PR China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University , PR China
| | - Jin Xu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University , PR China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University , PR China
| | - Qunyan Xiang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University , PR China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University , PR China
| | - Feng Tian
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University , PR China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University , PR China
| | - Xin Li
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University , PR China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University , PR China
| | - Liling Guo
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University , PR China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University , PR China
| | - Liyuan Zhu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University , PR China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University , PR China
| | - Peiliu Qu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University , PR China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University , PR China
| | - Yan Fu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University , PR China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University , PR China
| | - Yangrong Tan
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University , PR China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University , PR China
| | - Yajun Gui
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University , PR China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University , PR China
| | - Tie Wen
- Department of Emergency, The Second Xiangya Hospital, Central South University , PR China
| | - Brianna Godinez
- Center for Genomic and Precision Medicine, Texas A&M University College of Medicine, Institute of Biosciences and Technology , Houston, TX, USA
| | - Ling Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University , PR China.,Research Institute of Blood Lipid and Atherosclerosis, Central South University , PR China
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