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Salmasi MY, Pirola S, Mahuttanatan S, Fisichella SM, Sengupta S, Jarral OA, Oo A, O'Regan D, Xu XY, Athanasiou T. Geometry and flow in ascending aortic aneurysms are influenced by left ventricular outflow tract orientation: Detecting increased wall shear stress on the outer curve of proximal aortic aneurysms. J Thorac Cardiovasc Surg 2023; 166:11-21.e1. [PMID: 34217540 DOI: 10.1016/j.jtcvs.2021.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The geometrical characterization of ascending thoracic aortic aneurysms in clinical practice is limited to diameter measurements. Despite growing interest in hemodynamic assessment, its relationship with ascending thoracic aortic aneurysm pathogenesis is poorly understood. This study examines the relationship between geometry of the ventriculo-aortic junction and blood flow patterns in ascending thoracic aortic aneurysm disease. METHODS Thirty-three patients with ascending thoracic aortic aneurysms (exclusions: bicuspid aortic valves, connective tissue disease) underwent 4-dimensional flow magnetic resonance imaging. After image segmentation, geometrical parameters were measured, including aortic curvature, tortuosity, length, and diameter. A unique angular measurement made by the trajectory of the left ventricular outflow tract axis and the proximal aorta was also conducted. Velocity profiles were quantitatively and qualitatively analyzed. In addition, 11 patients (33%) underwent wall shear stress mapping of the ascending thoracic aortic aneurysm region using computational fluid dynamics simulation. RESULTS Greater left ventricular outflow tract aortic angles were associated with larger aortic diameters at the levels of the sinus (coefficient = 0.387, P = .014) and ascending aorta (coefficient = 0.284, P = .031). Patients with left ventricular outflow tract aortic angles greater than 60° had marked asymmetric flow acceleration on the outer curvature in the proximal aorta, ascertained from 4-dimensional flow analysis. For patients undergoing computational fluid dynamics assessment, regression analysis found that higher left ventricular outflow tract aortic angles were associated with significantly higher wall shear stress values in the outer curve of the aorta (coefficient 0.07, 95% confidence interval 0.04-0.11, P = .002): Angles greater than 50° yielded time-averaged wall shear stress values greater than 2.5 Pa, exhibiting a linear relationship. CONCLUSIONS Our findings strengthen the hypothesis of flow-mediated ascending thoracic aortic aneurysm disease progression and that left ventricular outflow tract aortic angle may be a predictor of disease severity.
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Affiliation(s)
- M Yousuf Salmasi
- Department of Surgery, Imperial College London, London, United Kingdom.
| | - Selene Pirola
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Suchaya Mahuttanatan
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Serena M Fisichella
- Department of Chemical Engineering, Imperial College London, London, United Kingdom; Politecnico di Milano, Milan, Italy
| | - Sampad Sengupta
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Omar A Jarral
- Department of Surgery, Imperial College London, London, United Kingdom
| | - Aung Oo
- Barts Heart Centre, London, United Kingdom
| | - Declan O'Regan
- London Institute of Medical Sciences, Imperial College London, London, United Kingdom
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Thanos Athanasiou
- Department of Surgery, Imperial College London, London, United Kingdom
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2
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Pan Y, Wang Y, Li J, Xu P, Zeng M, Shan Y, Lin J. Prognostic role of aortic distensibility in patients with bicuspid aortic valve: a CMR study. Int J Cardiovasc Imaging 2023; 39:161-168. [PMID: 36598697 DOI: 10.1007/s10554-022-02710-z] [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: 04/11/2022] [Accepted: 08/05/2022] [Indexed: 01/11/2023]
Abstract
To evaluate the prognostic value of aortic distensibility measured by cardiovascular magnetic resonance (CMR) as predictors of prophylactic aortic valve or aortic surgery in patients with bicuspid aortic valve (BAV). 110 patients with BAV were included. Distensibility of middle ascending aorta (AscAo) and proximal descending aorta (DescAo) at baseline was determined using CMR. The association between aortic distensibility and primary endpoint of aortic valve and/or aortic surgery was investigated with Cox proportional hazard regression analyses. The receiver operating characteristics curves (ROC) of the area under receiver-operator (AUC) and DeLong test were used to evaluate and compare the performance of different models. During a median follow-up of 66.5 months [IQR 13-75 months], 42 patients experienced surgical treatments. After adjusting for traditional risk factors, aortic distensibility (P = 0.003) and severe valve dysfunction (P < 0.001) were found significantly associated with aortic valve and/or aortic surgery. The model 2 (aortic distensibility and severe valve dysfunction) is slightly better in predicting primary endpoint than the model 1 (aortic diameter and severe valve dysfunction) (AUC: 0.893 vs. 0.842, P = 0.106). In BAV patients, aortic distensibility and severe valve dysfunction are valuable predictors for final aortic valve and/or aortic surgery.
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Affiliation(s)
- Yijun Pan
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yongshi Wang
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jun Li
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Pengju Xu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yan Shan
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
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3
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Fletcher AJ, Nash J, Syed MB, Macaskill MG, Tavares AA, Walker N, Salcudean H, Leipsic JA, Lim KH, Madine J, Wallace W, Field M, Newby DE, Bouchareb R, Seidman MA, Akhtar R, Sellers SL. Microcalcification and Thoracic Aortopathy: A Window Into Disease Severity. Arterioscler Thromb Vasc Biol 2022; 42:1048-1059. [PMID: 35770666 PMCID: PMC9311465 DOI: 10.1161/atvbaha.122.317111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients with thoracic aortopathy are at increased risk of catastrophic aortic dissection, carrying with it substantial mortality and morbidity. Although granular medial calcinosis (medial microcalcification) has been associated with thoracic aortopathy, its relationship to disease severity has yet to be established. METHODS One hundred one thoracic aortic specimens were collected from 57 patients with thoracic aortopathy and 18 control subjects. Standardized histopathologic scores, immunohistochemistry, and nanoindentation (tissue elastic modulus) were compared with the extent of microcalcification on von Kossa histology and 18F-sodium fluoride autoradiography. RESULTS Microcalcification content was higher in thoracic aortopathy samples with mild (n=28; 6.17 [2.71-10.39]; P≤0.00010) or moderate histopathologic degeneration (n=30; 3.74 [0.87-11.80]; P<0.042) compared with control samples (n=18; 0.79 [0.36-1.90]). Alkaline phosphatase (n=26; P=0.0019) and OPN (osteopontin; n=26; P=0.0045) staining were increased in tissue with early aortopathy. Increasingly severe histopathologic degeneration was related to reduced microcalcification (n=82; Spearman ρ, -0.51; P<0.0001)-a process closely linked with elastin loss (n=82; Spearman ρ, -0.43; P<0.0001) and lower tissue elastic modulus (n=28; Spearman ρ, 0.43; P=0.026).18F-sodium fluoride autoradiography demonstrated good correlation with histologically quantified microcalcification (n=66; r=0.76; P<0.001) and identified areas of focal weakness in vivo. CONCLUSIONS Medial microcalcification is a marker of aortopathy, although progression to severe aortopathy is associated with loss of both elastin fibers and microcalcification.18F-sodium fluoride positron emission tomography quantifies medial microcalcification and is a feasible noninvasive imaging modality for identifying aortic wall disruption with major translational promise.
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Affiliation(s)
- Alexander J. Fletcher
- British Heart Foundation Centre for Cardiovascular Science (A.J.F., J.N., M.B.J.S., N.W., D.E.N.), University of Edinburgh, United Kingdom.,Department of Child Health, University of Glasgow, School of Medicine and Dentistry, United Kingdom (A.J.F.)
| | - Jennifer Nash
- British Heart Foundation Centre for Cardiovascular Science (A.J.F., J.N., M.B.J.S., N.W., D.E.N.), University of Edinburgh, United Kingdom
| | - Maaz B.J. Syed
- British Heart Foundation Centre for Cardiovascular Science (A.J.F., J.N., M.B.J.S., N.W., D.E.N.), University of Edinburgh, United Kingdom
| | - Mark G. Macaskill
- Edinburgh Imaging Facility, Queens Medical Research Institute (M.G.M., A.A.S.T.), University of Edinburgh, United Kingdom
| | - Adriana A.S. Tavares
- Edinburgh Imaging Facility, Queens Medical Research Institute (M.G.M., A.A.S.T.), University of Edinburgh, United Kingdom
| | - Niki Walker
- British Heart Foundation Centre for Cardiovascular Science (A.J.F., J.N., M.B.J.S., N.W., D.E.N.), University of Edinburgh, United Kingdom.,Scottish Adult Congenital Cardiology Service, Golden Jubilee National Hospital, Clydebank, Glasgow, United Kingdom (N.W.)
| | - Hannah Salcudean
- Department of Radiology, Division of Cardiology, Cardiovascular Translational Lab at the Centre for Heart Lung Innovation, St. Paul’s Hospital and University of British Columbia, Vancouver, Canada (H.S., J.A.L., S.L.S.)
| | - Jonathon A. Leipsic
- Department of Radiology, Division of Cardiology, Cardiovascular Translational Lab at the Centre for Heart Lung Innovation, St. Paul’s Hospital and University of British Columbia, Vancouver, Canada (H.S., J.A.L., S.L.S.)
| | - Kelvin H.H. Lim
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, United Kingdom (K.H.H.L.)
| | - Jillian Madine
- Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences (J.M., M.F., R.A.), University of Liverpool, United Kingdom.,Liverpool Centre for Cardiovascular Sciences (J.M.), University of Liverpool, United Kingdom
| | - William Wallace
- Division of Pathology (W.W.), University of Edinburgh, United Kingdom
| | - Mark Field
- Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences (J.M., M.F., R.A.), University of Liverpool, United Kingdom.,Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital (LCCS), United Kingdom (M.F.)
| | - David E. Newby
- British Heart Foundation Centre for Cardiovascular Science (A.J.F., J.N., M.B.J.S., N.W., D.E.N.), University of Edinburgh, United Kingdom
| | - Rihab Bouchareb
- Department of Medicine, Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.B.)
| | - Michael A. Seidman
- Department of Laboratory Medicine and Pathobiology, Toronto General Hospital, Canada (M.A.S.)
| | - Riaz Akhtar
- Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences (J.M., M.F., R.A.), University of Liverpool, United Kingdom.,Department of Mechanical, Materials and Aerospace Engineering, School of Engineering, University of Liverpool, United Kingdom (R.A.)
| | - Stephanie L. Sellers
- Department of Radiology, Division of Cardiology, Cardiovascular Translational Lab at the Centre for Heart Lung Innovation, St. Paul’s Hospital and University of British Columbia, Vancouver, Canada (H.S., J.A.L., S.L.S.)
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Hossack M, Fisher R, Torella F, Madine J, Field M, Akhtar R. Micromechanical and Ultrastructural Properties of Abdominal Aortic Aneurysms. Artery Res 2022. [DOI: 10.1007/s44200-022-00011-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AbstractAbdominal aortic aneurysms are a common condition of uncertain pathogenesis that can rupture if left untreated. Current recommended thresholds for planned repair are empirical and based entirely on diameter. It has been observed that some aneurysms rupture before reaching the threshold for repair whilst other larger aneurysms do not rupture. It is likely that geometry is not the only factor influencing rupture risk. Biomechanical indices aiming to improve and personalise rupture risk prediction require, amongst other things, knowledge of the material properties of the tissue and realistic constitutive models. These depend on the composition and organisation of the vessel wall which has been shown to undergo drastic changes with aneurysmal degeneration, with loss of elastin, smooth muscle cells, and an accumulation of isotropically arranged collagen. Most aneurysms are lined with intraluminal thrombus, which has an uncertain effect on the underlying vessel wall, with some authors demonstrating a reduction in wall stress and others a reduction in wall strength. The majority of studies investigating biomechanical properties of ex vivo abdominal aortic aneurysm tissues have used low-resolution techniques, such as tensile testing, able to measure the global material properties at the macroscale. High-resolution engineering techniques such as nanoindentation and atomic force microscopy have been modified for use in soft biological tissues and applied to vascular tissues with promising results. These techniques have the potential to advance the understanding and improve the management of abdominal aortic aneurysmal disease.
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Mid-term follow-up of aortic valve replacement for bicuspid aortic valve. Cardiol Young 2021; 31:1290-1296. [PMID: 33641690 DOI: 10.1017/s1047951121000160] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the mid-term outcome of aortic valve replacement for bicuspid aortic valve and tricuspid aortic valve and the related risk factors. METHODS From January 2014 to June 2019, 177 tricuspid aortic valve patients and 101 bicuspid aortic valve patients who underwent aortic valve replacement in our hospital were collected. 1:1 propensity score matching analysis was used to control the bias in patient selection. The perioperative and follow-up data between the two groups were compared. Independent risk factors which were associated with the continued dilatation of the ascending aorta were identified by univariate or multivariate logistic regression analysis. RESULTS After the matching procedure, 160 patients were included in the analysis (80 in each group). Baseline characteristics, intraoperative, and perioperative outcomes were similar between the two groups (all p > 0.05). Moreover, 67 patients in the tricuspid aortic valve group and 70 in the bicuspid aortic valve group completed the follow-up. The ascending aorta change, annual change rate, and the proportion of continuous dilation of ascending aorta in bicuspid aortic valve group were significantly higher than those in the tricuspid aortic valve group (p < 0.05). Multivariate logistic regression analysis showed that type 1 in bicuspid aortic valve (OR 5.173; 95% CI 1.772, 15.101; p = 0.003), aortic regurgitation (OR 3.673; 95% CI 1.133, 11.908; p = 0.030), and aortic valve stenosis with regurgitation (OR 6.489; 95% CI 1.726, 24.404; p = 0.006) were independent risk factors for the continued dilatation of the ascending aorta in all AV patients. Furthermore, the multivariate logistic regression analysis showed that type 1 in bicuspid aortic valve (OR 5.157; 95% CI 1.053, 25.272; p = 0.043), age ≥ 40 years (OR 6.956; 95% CI 1.228, 39.410; p = 0.028), and aortic regurgitation (OR 4.322; 95% CI 1.174, 15.911; p = 0.028) were independent risk factors for the continued dilatation of the ascending aorta in bicuspid aortic valve patients. CONCLUSION Compared with tricuspid aortic valve patients, the ascending aorta of bicuspid aortic valve patients is more likely to continue to enlarge after aortic valve replacement. Type 1 in bicuspid aortic valve, age ≥ 40 years, and aortic regurgitation were the independent risk factors.
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6
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Davies HA, Caamano-Gutierrez E, Sarsby J, Nawaytou O, Harky A, Akhtar R, Field M, Madine J. Exploring the potential of rapid evaporative ionization mass spectrometry (Intelligent Knife) for point-of-care testing in aortic surgery. Eur J Cardiothorac Surg 2021; 60:562-568. [PMID: 33842942 PMCID: PMC8434870 DOI: 10.1093/ejcts/ezab166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/09/2021] [Accepted: 02/24/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Many intraoperative decisions regarding the extent of thoracic aortic surgery are subjective and are based on the appearance of the aorta, perceived surgical risks and likelihood of early recurrent disease. Our objective in this work was to carry out a cross-sectional study to demonstrate that rapid evaporative ionization mass spectrometry (REIMS) of electrosurgical aerosol is able to empirically discriminate ex vivo aneurysmal human thoracic aorta from normal aorta, thus providing supportive evidence for the development of the technique as a point-of-care test guiding intraoperative surgical decision-making. METHODS Human aortic tissue was obtained from patients undergoing surgery for thoracic aortic aneurysms (n = 44). Normal aorta was obtained from a mixture of post-mortem and punch biopsies from patients undergoing coronary surgery (n = 13). Monopolar electrocautery was applied to samples and surgical aerosol aspirated and analysed by REIMS to produce mass spectral data. RESULTS Models generated from REIMS data can discriminate aneurysmal from normal aorta with accuracy and precision of 88.7% and 85.1%, respectively. In addition, further analysis investigating aneurysmal tissue from patients with bicuspid and tricuspid aortic valves was discriminated from normal tissue and each other with accuracies and precision of 93.5% and 91.4% for control, 83.8% and 76.7% for bicuspid aortic valve and 89.3% and 86.0% for tricuspid aortic valve, respectively. CONCLUSIONS Analysis of electrosurgical aerosol from ex vivo aortic tissue using REIMS allowed us to discriminate aneurysmal from normal aorta, supporting its development as a point-of-care test (Intelligent Knife) for guiding surgical intraoperative decision-making.
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Affiliation(s)
- Hannah A Davies
- Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Eva Caamano-Gutierrez
- Computational Biology Facility, Technology Directorate, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Joscelyn Sarsby
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Centre for Proteomic Research, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Omar Nawaytou
- Liverpool Centre for Cardiovascular Science, Liverpool, UK.,Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Amer Harky
- Liverpool Centre for Cardiovascular Science, Liverpool, UK.,Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Riaz Akhtar
- Liverpool Centre for Cardiovascular Science, Liverpool, UK.,Department of Mechanical, Materials and Aerospace Engineering, School of Engineering, University of Liverpool, UK
| | - Mark Field
- Liverpool Centre for Cardiovascular Science, Liverpool, UK.,Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Jillian Madine
- Liverpool Centre for Cardiovascular Science, Liverpool, UK.,Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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7
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Falasa MP, Arnaoutakis GJ, Beaver TM. Commentary: In the absence of convincing evidence, more is not better. JTCVS OPEN 2021; 5:44-45. [PMID: 36003165 PMCID: PMC9390603 DOI: 10.1016/j.xjon.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Matheus P. Falasa
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Fla
| | - George J. Arnaoutakis
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Fla
| | - Thomas M. Beaver
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Fla
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8
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Anzai I, Kriegel J, Kim I, Pearsall C, Lewis M, Rosenbaum M, Ferrari G, George I, Takayama H. Should all patients with aortic aneurysm and bicuspid aortic valve also undergo hemiarch? JTCVS OPEN 2021; 5:39-43. [PMID: 36003181 PMCID: PMC9390205 DOI: 10.1016/j.xjon.2020.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Isao Anzai
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Irving Medical Center, New York, NY
| | - Jacob Kriegel
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Irving Medical Center, New York, NY
| | - Ilya Kim
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Irving Medical Center, New York, NY
| | - Christian Pearsall
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Irving Medical Center, New York, NY
| | - Matthew Lewis
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY
| | - Marlon Rosenbaum
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY
| | - Giovanni Ferrari
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Irving Medical Center, New York, NY
| | - Isaac George
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Irving Medical Center, New York, NY
| | - Hiroo Takayama
- Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York Presbyterian-Columbia University Irving Medical Center, New York, NY
- Address for reprints: Hiroo Takayama, MD, PhD, 177 Fort Washington Ave, New York, NY 10032.
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9
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Sood V, Si MS. Commentary: Aortic aneurysms are not created equal. J Thorac Cardiovasc Surg 2019; 160:e261-e262. [PMID: 31619330 DOI: 10.1016/j.jtcvs.2019.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 09/13/2019] [Accepted: 09/13/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Vikram Sood
- Section of Pediatric Cardiovascular Surgery, Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Ming-Sing Si
- Section of Pediatric Cardiovascular Surgery, Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
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10
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McKellar SH. Commentary: Can we move beyond aortic size, using real-time analysis of aortic tissue, to more precisely guide therapy for patients with bicuspid aortic valves? J Thorac Cardiovasc Surg 2019; 160:e259. [PMID: 31607498 DOI: 10.1016/j.jtcvs.2019.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 09/12/2019] [Accepted: 09/13/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Stephen H McKellar
- Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
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