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Yamauchi MSW, Puchalski MD, Weng HY, Pinto NM, Etheridge SP, Presson AP, Minich LL, Williams RV. Variation in provider compliance with sports restriction guidelines in children with an isolated bicuspid aortic valve. Cardiol Young 2023; 33:1813-1818. [PMID: 36200342 DOI: 10.1017/s1047951122003110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Published guidelines for sports restriction for children with a bicuspid aortic valve remain controversial. We sought to describe practice variation and factors influencing sports restrictions in these children. METHODS This retrospective single-centre study included children (7-18 years old) with an isolated bicuspid aortic valve at baseline from 1 January, 2005 to 31 December, 2014. Sports restrictions, factors potentially influencing decision-making, and outcomes were collected. Descriptive statistics and multivariable mixed-effects logistic regression models were performed with providers and patients as random effects. Provider variation was estimated using intraclass correlation coefficients. Odds ratios, 95% confidence intervals, and p-values were reported from the models. RESULTS In 565 encounters (253 children; 34 providers), 41% recommended no sports restrictions, 40% recommended high-static and high-dynamic restrictions, and 19% had no documented recommendations. Based on published guidelines, 22% of children were inappropriately restricted while 30% were not appropriately restricted. The paediatric cardiology provider contributed to 37% of observed practice variation (p < 0.001). Sports restriction was associated with older age, males, greater ascending aorta z-score, and shorter follow-up interval. There were no aortic dissections or deaths and one cardiac intervention. CONCLUSION Physicians frequently fail to document sports restrictions for children with a bicuspid aortic valve, and documented recommendations often conflict with published guidelines. Despite this, no adverse outcomes occurred. Providers accounted for a significant proportion of the variation in sports restrictions. Further research to provide evidence-based guidelines may improve provider compliance with activity recommendations in this population.
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Affiliation(s)
| | - Michael D Puchalski
- Department of Pediatrics, Division of Pediatric Cardiology, All Children's Hospital, St Petersburg, FL, USA
| | - Hsin-Yi Weng
- Division of Epidemiology Biostatistics, University of Utah, Salt Lake City, UT, USA
| | - Nelangi M Pinto
- Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA
- Division of Pediatric Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA
| | - Susan P Etheridge
- Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA
- Division of Pediatric Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA
| | - Angela P Presson
- Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA
| | - L LuAnn Minich
- Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA
- Division of Pediatric Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA
| | - Richard V Williams
- Department of Pediatrics, University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA
- Division of Pediatric Cardiology, University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA
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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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Qin J, Mazomba M, Huang R, Zhao J, Wang F, He G, Wang J, Du W, Mo Y. Study on the relationship among typhoon, climate change, and acute Stanford type A aortic dissection in southern of Zhejiang in China. Gen Thorac Cardiovasc Surg 2023; 71:113-120. [PMID: 35723828 DOI: 10.1007/s11748-022-01837-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/22/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to investigate the relationship between typhoon, climate change, and acute Stanford type A aortic dissection (TAAD) in southern of Zhejiang Province in China. METHOD 371 patients with TAAD were admitted to three hospitals (the aortic dissection center) in southern of Zhejiang Province, China from January 2015 to December 2020, and data were retrospectively collected, the data included (1) the number of patients admitted in different months and seasons, (2) daily meteorological data in southern of Zhejiang Province, and (3) typhoon information were retrospectively analyzed. RESULTS The number of TAAD occurred in winter was the highest and in summer was the lowest. The incidence of TAAD was correlated with minimum temperature, maximum wind speed, mean wind speed, and water vapor pressure (P < 0.05). Maximum wind speed (RR 0.37; 95% CI 0.17 to 0.80, P = 0.01) and water vapor pressure (RR 0.96; 95% CI 0.92 to 1, P = 0.03) were the protective factor. The occurrence incidence of TAAD under the influence of typhoon climate was less than that during the period not affected by typhoon (P < 0.05). CONCLUSION There was a correlation between typhoon, climate change, and the occurrence of TAAD in southern Zhejiang Province. Wind speed, vapor pressure, and typhoon may be protective factors.
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Affiliation(s)
- Jiazhu Qin
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, Zhejiang, China
| | - Manala Mazomba
- Wenzhou Medical University, Ouhai District, Wenzhou, Zhejiang, China
| | - Renwei Huang
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, Zhejiang, China
| | - Jiating Zhao
- Department of Anesthesiology, Dongyang People's Hospital Affiliated to Wenzhou Medical University, Zhejiang, China
| | - Faxing Wang
- Department of Anesthesiology, Wenzhou Medical University, The Sixth Affiliated Hospital, Zhejiang, China
| | - Gangjian He
- Wenzhou Meteorological Bureau, Zhejiang, China
| | - Jue Wang
- Department of Cardiac Surgery, The First Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Wenwen Du
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, Zhejiang, China.
| | - Yunchang Mo
- Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai District, Wenzhou, Zhejiang, China.
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Condemi F, Campisi S, Viallon M, Croisille P, Avril S. Relationship Between Ascending Thoracic Aortic Aneurysms Hemodynamics and Biomechanical Properties. IEEE Trans Biomed Eng 2020; 67:949-956. [DOI: 10.1109/tbme.2019.2924955] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Thijssen CGE, Bons LR, Gökalp AL, Van Kimmenade RRJ, Mokhles MM, Pelliccia A, Takkenberg JJM, Roos-Hesselink JW. Exercise and sports participation in patients with thoracic aortic disease: a review. Expert Rev Cardiovasc Ther 2019; 17:251-266. [DOI: 10.1080/14779072.2019.1585807] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Carlijn G. E. Thijssen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lidia R. Bons
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arjen L. Gökalp
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Mostafa M. Mokhles
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Antonio Pelliccia
- Department of Cardiology, Institute of Sports Medicine & Science, Rome, Italy
| | - Johanna J. M. Takkenberg
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jolien W. Roos-Hesselink
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Abstract
Spontaneous coronary artery dissection (SCAD) is a non-inflammatory, non-atherosclerotic cause of acute myocardial infarction (AMI) that, by definition, is not iatrogenic or due to trauma. It is a condition that predominantly affects pre- or perimenopausal women without the traditional risk factors for cardiovascular disease. PURPOSE OF REVIEW: In this review, we will discuss the epidemiology, diagnosis, and management of this condition, with an emphasis on the ongoing research needed to better understand how to care for patients with SCAD. RECENT FINDINGS: There is a paucity of data related to this condition. However, an American Heart Association consensus statement has recently been released that provides helpful insight. There has also been better characterization of pregnancy-associated SCAD. We have learned much about SCAD over the last decade and greatly increased the identification of this condition by first responders and physicians through research and patient advocacy. However, there is much we still do not know about this condition, and further research, using larger numbers of patients, is greatly needed to better understand this condition.
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Affiliation(s)
- Sahar Naderi
- Division of Cardiology, Kaiser Northern California, 2238 Geary Boulevard, 8th Floor, San Francisco, CA, USA.
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7
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Acute type a aortic dissection associated with a sporting activity. Surg Today 2017; 47:1163-1171. [DOI: 10.1007/s00595-017-1492-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 01/23/2017] [Indexed: 11/26/2022]
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Chaddha A, Kline-Rogers E, Braverman AC, Erickson SR, Jackson EA, Franklin BA, Woznicki EM, Jabara JT, Montgomery DG, Eagle KA. Survivors of Aortic Dissection: Activity, Mental Health, and Sexual Function. Clin Cardiol 2016; 38:652-9. [PMID: 26769699 DOI: 10.1002/clc.22418] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 03/28/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Currently no research exists assessing lifestyle modifications and emotional state of acute aortic dissection (AAD) survivors. We sought to assess activity, mental health, and sexual function in AAD survivors. HYPOTHESIS Physical and sexual activity will decrease in AAD survivors compared to pre-dissection. Incidence of anxiety and depression will be significant after AAD. METHODS A cross sectional survey was mailed to 197 subjects from a single academic medical center (part of larger IRAD database). Subjects were ≥18 years of age surviving a type A or B AAD between 1996 and 2011. 82 surveys were returned (overall response rate 42%). RESULTS Mean age ± SD was 59.5 ± 13.7 years, with 54.9% type A and 43.9% type B patients. Walking remained the most prevalent form of physical activity (49 (60%) pre-dissection and 47 (57%) post-dissection). Physical inactivity increased from 14 (17%) before AAD to 20 (24%) after AAD; sexual activity decreased from 31 (38%) to 9 (11%) mostly due to fear. Most patients (66.7%) were not exerting themselves physically or emotionally at AAD onset. Systolic blood pressure (SBP) at 36 months post-discharge for patients engaging in ≥2 sessions of aerobic activity/week was 126.67 ± 10.30 vs. 141.10 ± 11.87 (p-value 0.012) in those who did not. Self-reported new-onset depression after AAD was 32% and also 32% for new-onset anxiety. CONCLUSIONS Alterations in lifestyle and emotional state are frequent in AAD survivors. Clinicians should screen for unfounded fears or beliefs after dissection that may reduce function and/or quality of life for AAD survivors.
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Affiliation(s)
- Ashish Chaddha
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Eva Kline-Rogers
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Alan C Braverman
- Cardiovascular Division, Washington University, St. Louis, Missouri
| | | | | | - Barry A Franklin
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Elise M Woznicki
- Preventive Cardiology and Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Royal Oak, Michigan
| | - Justin T Jabara
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | | | - Kim A Eagle
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
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Chaddha A, Eagle KA, Braverman AC, Kline-Rogers E, Hirsch AT, Brook R, Jackson EA, Woznicki EM, Housholder-Hughes S, Pitler L, Franklin BA. Exercise and Physical Activity for the Post-Aortic Dissection Patient: The Clinician's Conundrum. Clin Cardiol 2016; 38:647-51. [PMID: 26769698 DOI: 10.1002/clc.22481] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/10/2015] [Indexed: 11/10/2022] Open
Abstract
Despite the paucity of evidence, it is often presumed, and is physiologically plausible, that sudden, acute elevations in blood pressure may transiently increase the risk of recurrent aortic dissection (AD) or rupture in patients with a prior AD, because a post-dissection aorta is almost invariably dilated and may thus experience greater associated wall stress as compared with a nondilated aorta. Few data are available regarding the specific types and intensities of exercise that may be both safe and beneficial for this escalating patient population. The purpose of this editorial/commentary is to further explore this conundrum for clinicians caring for and counseling AD survivors. Moderate-intensity cardiovascular activity may be cardioprotective in this patient cohort. It is likely that severe physical activity restrictions may reduce functional capacity and quality of life in post-AD patients and thus be harmful, underscoring the importance of further exploring the role of physical activity and/or structured exercise in this at-risk patient population.
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Affiliation(s)
- Ashish Chaddha
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Kim A Eagle
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Alan C Braverman
- Cardiovascular Division, Washington University, St. Louis, Missouri
| | - Eva Kline-Rogers
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Alan T Hirsch
- Cardiovascular Division, University of Minnesota Physicians Heart Practice, Minneapolis, Minnesota
| | - Robert Brook
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | | | - Elise M Woznicki
- Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | | | - Linda Pitler
- Thoracic Aortic Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Barry A Franklin
- Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Beaumont Health Center, Royal Oak, Michigan
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Singh B, Treece JM, Murtaza G, Bhatheja S, Lavine SJ, Paul TK. Aortic Dissection in a Healthy Male Athlete: A Unique Case with Comprehensive Literature Review. Case Rep Cardiol 2016; 2016:6460386. [PMID: 27738530 PMCID: PMC5050354 DOI: 10.1155/2016/6460386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 08/29/2016] [Indexed: 12/18/2022] Open
Abstract
A young otherwise healthy 27-year-old male who has been using anabolic steroids for a long time developed Type I aortic dissection associated with heavy weightlifting. The patient did not have a recent history of trauma to the chest, no history of hypertension, and no illicit drug use. He presented with severe chest pain radiating to back and syncopal event with exertion. Initial vitals were significant for blood pressure of 80/50 mmHg, pulse of 80 beats per minute, respirations of 24 per minute, and oxygen saturation of 92% on room air. Physical exam was significant for elevated jugular venous pressure, muffled heart sounds, and cold extremities with diminished pulses in upper and absent pulses in lower extremities. Bedside echocardiogram showed aortic root dilatation and cardiac tamponade. STAT computed tomography (CT) scan of chest revealed dissection of ascending aorta. Cardiothoracic surgery was consulted and patient underwent successful repair of ascending aorta. Hemodynamic stress of weightlifting can predispose to aortic dissection. Aortic dissection is a rare but often catastrophic condition if not diagnosed and managed acutely. Although rare, aortic dissection needs to be in the differential when a young weightlifter presents with chest pain as a delay in diagnosis may be fatal.
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Affiliation(s)
- Balraj Singh
- Department of Internal Medicine, Division of Cardiology, East Tennessee State University, Johnson City, TN, USA
| | - Jennifer M. Treece
- Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Ghulam Murtaza
- Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Samit Bhatheja
- Department of Internal Medicine, Division of Cardiology, East Tennessee State University, Johnson City, TN, USA
| | - Steven J. Lavine
- Department of Internal Medicine, Division of Cardiology, East Tennessee State University, Johnson City, TN, USA
| | - Timir K. Paul
- Department of Internal Medicine, Division of Cardiology, East Tennessee State University, Johnson City, TN, USA
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Biaxial rupture properties of ascending thoracic aortic aneurysms. Acta Biomater 2016; 42:273-285. [PMID: 27345137 DOI: 10.1016/j.actbio.2016.06.028] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/11/2016] [Accepted: 06/22/2016] [Indexed: 12/22/2022]
Abstract
UNLABELLED Although hundreds of samples obtained from ascending thoracic aortic aneurysms (ATAA) of patients undergoing elective surgical repair have already been characterized biomechanically, their rupture properties were always derived from uniaxial tensile tests. Due to their bulge shape, ATAAs are stretched biaxially in vivo. In order to understand the biaxial rupture of ATAAs, our group developed a novel methodology based on bulge inflation and full-field optical measurements. The objective of the current paper is threefold. Firstly, we will review the failure properties (maximum stress, maximum stretch) obtained by bulge inflation testing on a cohort of 31 patients and compare them with failure properties obtained by uniaxial tension in a previously published study. Secondly, we will investigate the relationship between the failure properties and the age of patients, showing that patients below 55years of age display significantly higher strength. Thirdly, we will define a rupture risk based on the extensibility of the tissue and we will show that this rupture risk is strongly correlated with the physiological elastic modulus of the tissue independently of the age, ATAA diameter or the aortic valve phenotype of the patient. STATEMENT OF SIGNIFICANCE Despite their medical importance, rupture properties of ascending thoracic aortic aneurysms (ATAA) subjected to biaxial tension were inexistent in the literature. In order to address this lack, our group developed a novel methodology based on bulge inflation and full-field optical measurements. Here we report rupture properties obtained with this methodology on 31 patients. It is shown for the first time that rupture occurs when the stretch applied to ATAAs reaches the maximum extensibility of the tissue and that this maximum extensibility correlates strongly with the elastic properties. The outcome is a better detection of at-risk individuals for elective surgical repair.
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12
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Franklin BA. Invited Commentary: Simulated performance testing to determine the aortic dissection patient's potential for vigorous physical activity. Proc AMIA Symp 2016; 29:154-6. [PMID: 27034551 DOI: 10.1080/08998280.2016.11929396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Barry A Franklin
- Department of Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Royal Oak, Michigan Oakland University William Beaumont School of Medicine, Rochester, Michigan
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Efird JT, O'Neal WT, Davies SW, O'Neal JB, Kypson AP. Seasonal incidence of hospital admissions for Stanford type A aortic dissection. Chronobiol Int 2014; 31:954-8. [PMID: 25003650 DOI: 10.3109/07420528.2014.933842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The objective of this study was to test the hypothesis that there is seasonal variation in the incidence of Stanford type A aortic dissection (SA-AoD) among patients admitted to our cardiovascular surgical service. A sinusoidal logistic regression model was used to analyze event data for 6081 calendar days. A cyclic peak risk for SA-AoD was observed for calendar day 304 (p=0.019). The odds ratios for the 3- and 6-month window surrounding this peak were 1.6 (p=0.054) and 1.7 (p=0.0040), respectively. Our results suggest than a seasonal variation exists in the incidence of SA-AoD.
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Affiliation(s)
- Jimmy T Efird
- Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University , Greenville, NC , USA
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14
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Riles TS, Lin JC. Celiac artery dissection from heavy weight lifting. J Vasc Surg 2011; 53:1714-5. [DOI: 10.1016/j.jvs.2011.01.075] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 01/27/2011] [Accepted: 01/28/2011] [Indexed: 10/18/2022]
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Tsai SH, Lin YY, Hsu CW, Chen YL, Liao MT, Chu SJ. The characteristics of acute aortic dissection among young Chinese patients: a comparison between Marfan syndrome and non-Marfan syndrome patients. Yonsei Med J 2009; 50:239-44. [PMID: 19430557 PMCID: PMC2678699 DOI: 10.3349/ymj.2009.50.2.239] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Revised: 03/26/2008] [Accepted: 03/26/2008] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Aortic dissection (AoD) is one of the most common catastrophes involving the aorta. Nevertheless, early diagnosis remains to be a challenge in the Emergency Department (ED), particularly in young individuals. In this study, we attempted to identify the characteristics of acute AoD among young individuals, particular in patients with Marfan syndrome. MATERIALS AND METHODS This was an retrospective chart-review study conducted in a tertiary referring hospital. The hospital database was queried for the combination of AoD and patients under age of 40 years. The medical charts were reviewed to obtain demographic data, clinical data and laboratory characteristics by using a standardized data collection sheet. A comparison between Marfan syndrome and non-Marfan syndrome patients was performed. RESULTS During the 10-years period, 18 of 344 patients with acute AoD were younger than 40 years-old. Patients with Marfan syndrome developed acute AoD at a younger age than patients without Marfan syndrome. The mean diastolic blood pressure was significantly lower in patients with Marfan syndrome upon presenting to the ED than those without. Patients with Marfan syndrome had trends toward higher risk of development of type A AoD, increased recurrence rate and higher mortality rate than those without. However, statistical significance was not present. CONCLUSION ED physicians should have high alert to acute AoD in young patients presenting with severe unexplained chest and back pain, particularly in those patients with a history of heart diseases, hypertension, and Marfan syndrome or featuring Marfanoid habitus. Acute coronary syndrome, unexplained abdominal symptoms, and sudden cardiac arrest could be the initial manifestation of AoD in young patients. A low threshold to perform enhanced computed tomography may facilitate early diagnosis and timely treatment in this patient population.
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Affiliation(s)
- Shih-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Ahmadi H, Shirani S, Yazdanifard P. Aortic dissection type I in a weightlifter with hypertension: A case report. CASES JOURNAL 2008; 1:99. [PMID: 18706125 PMCID: PMC2533001 DOI: 10.1186/1757-1626-1-99] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Accepted: 08/18/2008] [Indexed: 05/25/2023]
Abstract
Acute aortic dissection can occur at the time of intense physical exertion in strength-trained athletes like weightlifters, bodybuilders, throwers, and wrestlers. Rapid rise in blood pressure and history of hypertension are the most common causes of aortic dissection in athletes. It is a very tragic event because of its high mortality rate of about 32% in young patients. We report a case of aortic dissection in a young weightlifter with an extensive intimal tear of the aorta, from the sinus of Valsalva to the abdominal aorta.
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Affiliation(s)
- Hossein Ahmadi
- Associate Professor of cardiovascular and thoracic surgery, Tehran Heart Center, North Kargar Street, Tehran, Iran.
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17
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Sakata N, Hamasaki M, Iwasaki H, Shigekawa S, Arai S. Dissecting aneurysms involving both anterior cerebral artery and aorta. Pathol Int 2007; 57:224-8. [PMID: 17316419 DOI: 10.1111/j.1440-1827.2007.02085.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Non-traumatic intracranial dissecting aneurysm (IDA) has been recently reported with increasing frequency and is recognized as a possible cause of subarachnoid hemorrhage. However, the pathogenesis of this disease is still unclear. Cystic medial necrosis (CMN) is known to be a cause of aortic dissection, especially in Marfan's syndrome. Presented herein is the case of a 49-year-old man who had IDA of the right anterior cerebral artery and abdominal aortic dissection without Marfan's syndrome. Histological examination showed medial degenerative changes with the accumulation of acid mucopolysaccharides in various intra- and extracranial arteries. Coexistence of dissecting aneurysms in the anterior cerebral artery and aorta suggests the presence of underlying pathogenesis that is common to these two dissection processes.
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Affiliation(s)
- Noriyuki Sakata
- Department of Pathology, School of Medicine, Fukuoka University, Fukuoka, Japan.
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18
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Hatzaras I, Tranquilli M, Coady M, Barrett PM, Bible J, Elefteriades JA. Weight Lifting and Aortic Dissection: More Evidence for a Connection. Cardiology 2006; 107:103-6. [PMID: 16847387 DOI: 10.1159/000094530] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Accepted: 05/08/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS In 2003, we reported on a small number of patients in whom acute aortic dissection appeared to be causally related to intense weight lifting. If additional cases could be identified, the phenomenon of weight lifting induced aortic dissection would be further substantiated. We now report a substantially larger number of cases in which aortic dissection is associated with intense physical exertion. METHODS Additional cases of acute aortic dissection occurring at the time of intense physical exertion were accumulated and analyzed. Cases were culled from retrospective review of a large university data base and from reports forwarded to our attention from around the country. We determined type of activity bringing on symptoms, age and sex of the patients, location of the dissection (ascending or descending aorta), aortic size, therapy, and survival. RESULTS We identified 31 patients in whom acute aortic dissection occurred in the context of severe physical exertion, predominantly weight lifting or similar activities. All patients except one were males. Mean age was 47.3 (range = 19-76). All except four dissections were in the ascending aorta. Only three patients (9.7%) had a family history of aortic disease. Mean aortic diameter on the initial imaging study was 4.63 cm. Twenty-six of the 31 cases were diagnosed ante-mortem and 5 post-mortem. Overall, 10 of the 31 patients (32.2%) died. Of 24 patients reaching surgical therapy, 20 (83.3%) survived. CONCLUSION Weight lifting related acute aortic dissection appears to be a real phenomenon, with increasing evidence for the association of extreme exertion with this catastrophic aortic event. Moderate aortic dilatation confers vulnerability to exertion-related aortic dissection. Individuals with known aortic dilatation should be cautioned to refrain from weight lifting or strenuous exertion. Routine echocardiographic screening of individuals engaging in heavy strength training should be considered, in order to prevent this tragic loss of life.
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Affiliation(s)
- I Hatzaras
- Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, CT 06510, USA
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19
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Cooper D, Magilner D, Call J. Spinal cord infarction after weight lifting. Am J Emerg Med 2006; 24:352-5. [PMID: 16635712 DOI: 10.1016/j.ajem.2005.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2005] [Accepted: 10/01/2005] [Indexed: 10/24/2022] Open
Affiliation(s)
- Debra Cooper
- Department of Emergency Medicine, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157-1089, USA
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20
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Abstract
Acute aortic dissection is an uncommon but lethal cause of acute chest, back, and abdominal pain. Establishing a timely diagnosis is paramount, as mortality from acute aortic dissection rises by the hour. Physical findings are protean and may include acute aortic valve insufficiency, peripheral pulse deficits, a variety of neurologic deficits, or end-organ ischemia. The keys to establishing a timely diagnosis are maintaining a high index of suspicion and quickly obtaining a diagnostic study. CT angiography, magnetic resonance imaging, transesophageal echocardiography, and, to a lesser extent, aortography are all highly accurate imaging modalities. The choice of study should be driven by the clinical stability of the patient, the information required and the resources available at presentation. Proximal dissections are surgical emergencies, but distal dissections are generally treated medically. Endovascular stents are gaining favor for use in the repair of both acute and chronic distal dissections. Long-term outcome data for endovascular stenting are still limited, and it remains unclear when stenting should be favored over surgery or medical therapy.
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Affiliation(s)
- Eric M Siegal
- University of Wisconsin School of Medicine and Public Health, Section of General Internal Medicine, Madison, Wisconsin 53792, USA.
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21
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Raymond LW, Barringer TA, Konen JC. Stress testing in the medical evaluation for hazardous materials duty: results and consequences in three groups of candidates. J Occup Environ Med 2005; 47:493-502. [PMID: 15891528 DOI: 10.1097/01.jom.0000161733.30550.e9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine the yield of exercise stress testing (GXT) and other methods for evaluating candidates for HAZMAT duty. METHODS The authors conducted an analysis of prior and current records of GXTs, medical examinations, blood tests, chest radiographs, spirometry, and audiometry in 190 candidates. The authors also conducted scrutiny of GXT results, using Duke Treadmill Score (DTS), Chronotropic Index (CI), and Heart Rate Recovery (HRR). RESULTS Seven candidates were disapproved by history and/or physical examination. Twenty-one others were deferred for GXT-induced, marked hypertension, and/or ST depression >/=2 mm. The latter appeared to be false-positive indications of ischemia, low risks confirmed by DTS, CI, and HRR. Heat stress was not induced in 26 subjects so evaluated. CONCLUSIONS GXT identified marked hypertension in 12 HAZMAT candidates and ischemic ST changes in 10, the latter appearing to be false-positives. Other testing yielded useful baselines, rarely disqualifying.
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Affiliation(s)
- Lawrence W Raymond
- Department of Family Medicine and Carolinas Poison Center, Carolinas Healthcare System, Charlotte, North Carolina, USA.
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22
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Maron BJ, Ackerman MJ, Nishimura RA, Pyeritz RE, Towbin JA, Udelson JE. Task Force 4: HCM and other cardiomyopathies, mitral valve prolapse, myocarditis, and Marfan syndrome. J Am Coll Cardiol 2005; 45:1340-5. [PMID: 15837284 DOI: 10.1016/j.jacc.2005.02.011] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Farrokh D. A rare sign of intracranial internal carotid artery dissection causing cerebral infarction: a case report and review of the literature. J Comput Assist Tomogr 2002; 26:944-7. [PMID: 12488740 DOI: 10.1097/00004728-200211000-00015] [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: 11/26/2022]
Abstract
We describe a patient with CT-proven ischemic infarction of the left middle cerebral artery (MCA) territory. The emergency CT, on admission, was suggestive of intracranial internal carotid artery dissection by demonstrating gaseous gap defects in the arterial wall and a subsequent thromboembolic process in the MCA. To our knowledge, there is no previous report regarding radiologically detected gas within the vessel wall or lumen secondary to dissection. We discuss this uncommon radiologic sign and its possible pathogenesis with a review of the literature.
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Affiliation(s)
- Dordaneh Farrokh
- Department of Radiology, University Hospital Saint-Pierre, Avenue de Broqueville, 157/1 1200 Brussels, Belgium.
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24
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Gwan-Nulla DN, Davidson WR, Grenko RT, Damiano RJ. Aortic dissection in a weight lifter with nodular fasciitis of the aorta. Ann Thorac Surg 2000; 69:1931-2. [PMID: 10892951 DOI: 10.1016/s0003-4975(00)01210-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We report a case of spontaneous aortic dissection in a young weight lifter without aortic medial disease but with a myofibroblastic proliferation of the aortic adventitia consistent with nodular fasciitis. Successful treatment included ascending aorta replacement with Dacron graft and aortic valve resuspension. We believe that the underlying aortic pathology most likely contributed to the development of the aortic dissection.
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Affiliation(s)
- D N Gwan-Nulla
- Division of Surgery, Penn State Geisinger Health System, Pennsylvania State University, Hershey, USA
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Abstract
Current concepts in the pathophysiology and predisposing conditions of acute aortic dissection in children, adolescents, and young adults are presented. Timely diagnosis is required for this life-threatening condition. Most children and adolescents with aortic dissection have congenital cardiovascular anomalies. Certain heritable disorders involving connective tissue also predispose to this disorder. Newer associations include cocaine abuse and weight lifting. To facilitate early diagnosis, the salient physical findings of the known predisposing conditions are reviewed. Clinical presentation and diagnostic imaging of aortic dissection are briefly summarized. Physicians working in an acute care setting, particularly in the emergency room, should be aware of disorders predisposing to acute aortic dissection in the pediatric and young adult population. Practitioners conducting school or college preparticipation sports evaluations can make use of such information in their assessment of risk for sudden death.
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Affiliation(s)
- C R Fikar
- New York College of Podiatric Medicine, NY 10035, USA
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26
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Abstract
The presentation of aortic dissection in the emergency department may be more subtle than the classic description of a shocked patient with "ripping" chest pain. The epidemiology, variation in presentation, investigation, and management of aortic dissection are reviewed.
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Affiliation(s)
- A T Dmowski
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock 72205, USA
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27
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Dickerman RD, Schaller F, McConathy WJ. Aortic valve thickening associated with power training: is it pressure overload? Am J Cardiol 1998; 82:996. [PMID: 9794363 DOI: 10.1016/s0002-9149(98)00524-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This is a first report of aortic valve thickening secondary to intermittent hypertensive episodes experienced with weight lifting.
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Affiliation(s)
- R D Dickerman
- Department of Surgery, University of North Texas Health Science Center, Fort Worth 76107-2699, USA
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28
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Reeves RK, Laskowski ER, Smith J. Weight training injuries: part 1: diagnosing and managing acute conditions. PHYSICIAN SPORTSMED 1998; 26:67-96. [PMID: 20086781 DOI: 10.3810/psm.1998.02.939] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
When patients present with acute weight training injuries, familiarity with the demands of the activity can help physicians get the most out of the patient history. Probable risk factors for injury include errors in technique (described in a sidebar), skeletal immaturity, and anabolic steroid abuse. Common acute injuries in weight training include sprains, strains, tendon avulsions, and compartment syndrome. Possible nonmusculoskeletal problems include retinal hemorrhage, radiculopathy, and various cardiovascular complications. Treatment of acute musculoskeletal injuries varies, but usually includes sports medicine mainstays such as prompt RICE. Chronic weight training injuries will be described in part 2 of this series.
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Affiliation(s)
- R K Reeves
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, 55905, USA
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29
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de Virgilio C, Cherry KJ, Schaff HV. Multiple aneurysms and aortic dissection: an unusual manifestation of Marfan's syndrome. Ann Vasc Surg 1994; 8:383-6. [PMID: 7947066 DOI: 10.1007/bf02133002] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Annuloaortic ectasia and dissection of the ascending aorta are common cardiovascular complications of Marfan's syndrome. True aneurysms of the subclavian arteries in these patients are rare. We present an unusual case of a 37-year-old woman who over the span of 10 years sequentially developed an aneurysm of the ascending aorta (annuloaortic ectasia), a right subclavian artery aneurysm, a left axillary-subclavian artery aneurysm, and a dissection of the aortic arch. Aside from the aortic dissection, the aneurysms produced no symptoms. All vascular complications were detected with computed tomography and managed successfully. This case emphasizes the need for close postoperative surveillance in patients with Marfan's syndrome who have had one cardiovascular complication of the disease.
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Affiliation(s)
- C de Virgilio
- Department of Surgery, Mayo Clinic, Rochester, MN 55920
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30
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Schor JS, Horowitz MD, Livingstone AS. Recreational weight lifting and aortic dissection: Case report. J Vasc Surg 1993. [DOI: 10.1016/0741-5214(93)90125-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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