Descending Aorta Diameters as Predictor of Late Adverse Outcomes in Patients with Uncomplicated Type B Aortic Dissection: A Systematic Review and Meta-Analysis

Comparing pharmacotherapy and transcranial magnetic stimulation for the treatment of anxiety and depression after aortic dissection surgery

BACKGROUND

Aortic coarctation is a potentially fatal condition that is primarily treated surgically. Despite successful procedures, patients frequently experience postoperative anxiety and depression, which can hinder recovery and worsen outcomes. Pharmacological interventions, such as 5-hydroxytryptamine (5-HT) and norepinephrine reuptake inhibitors, are commonly prescribed; however, their efficacy alone or in combination with non-invasive brain stimulation techniques, such as repetitive transcranial magnetic stimulation (TMS), remains unclear.

AIM

To assess the effect of medications and TMS on post-aortic surgery anxiety and depression.

METHODS

We analyzed the outcomes of 151 patients with anxiety and depression who were hospitalized for aortic dissection between January 2020 and September 2022. Using the random number table method, 75 and 76 patients were allocated to the normal control and study groups, respectively. All the patients were treated using routine procedures. The control group was administered anti-anxiety and anti-depression drugs, whereas the study group was treated with TMS in addition to these medications. The patients in both groups showed improvement after two courses of treatment. The Hamilton Anxiety Scale (HAMA) and the Hamilton Depression Scale (HAMD) were used to assess anxiety and depression, respectively. The serum levels of brain-derived neurotrophic factor (BDNF) and 5-HT were determined using enzyme-linked immunosorbent assay. The Pittsburgh Sleep Quality Index (PSQI) was used to estimate sleep quality, and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to assess cognitive function.

RESULTS

The HAMD and HAMA scores reduced in 2 groups, with the study group achieving a lower level than control (P < 0.05). In the control group, 43 patients recovered, 17 showed improvement, and 15 were deemed invalid. In the study group, 52 recovered, 20 improved, and four were invalid. The efficacy rate in study group was 94.74% compared to 80.00% in control (P < 0.05). The BDNF and 5-HT levels increased in both groups, with higher levels observed in the experimental group (P < 0.05). Moreover, the PSQI scores decreased in 2 groups, but were lower in the intervention group than control (P < 0.05). The scores of the RBANS items increased, with the study group scoring higher than control (P < 0.05).

CONCLUSION

Combining anti-anxiety and anti-depressive drugs with repetitive TMS after aortic surgery may enhance mood and treatment outcomes, offering a promising clinical approach.

Aortic dissection in Indonesia male: 3 case report

Background

Aortic dissection (AD) is a life-threatening rare condition caused by a tear in the aortic wall which requires urgent surgery.

Case presentation

3 Indonesian males obtained a CT angiography (CTA) showing a picture of AD which was confirmed using the Stanford and De Bakey classification. The patient was successful in undergoing TEVAR and open-heart surgery which 2 patients survived and 1 patient died.

Discussion

The speed of handling in AD is the key to successful management of AD supported by an understanding of the signs and symptoms and results of thoracoabdominal CTA.

Conclusion

The ability to interpret CTA results and understand AD sign symptoms is very helpful in minimizing mortality.