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Al-Mudhaffar SS, Alwan A, Ouj R, Mowaffaq A, Kakamad FH, Ahmad OF, Mohammed-Saeed DH, Ali RK, Abdalla BA, Mohammed SH, Salih AM. Bentall procedure as a lifesaving surgery: A single center experience. MEDICINE INTERNATIONAL 2023; 3:8. [PMID: 36733412 PMCID: PMC9887084 DOI: 10.3892/mi.2023.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/09/2023] [Indexed: 01/11/2023]
Abstract
The Bentall procedure is a surgical technique used in the management of aortic root abnormalities with ascending aorta and aortic valve issues. The present study aimed to evaluate the outcomes of 18 patients treated with the Bentall procedure in a single center. The present study was a single-center retrospective case series conducted over a period of 3 years. The patients had either acute ascending dissection and/or dilated ascending aorta with aortic valve dysfunction. The Bentall procedure was performed via standard median sternotomy. St. Jude Medical composite grafts with a valve were applied in all cases. A total number of 18 patients with either acute ascending dissection and/or dilated ascending aorta with aortic valve dysfunction were included in the study. The age of the participants ranged from 27-60 years. The ratio of males to females was 16:2 (males, 88.8%). The symptoms developed 3-4 days prior to hospital admission. Chest pain was the most common presenting symptom (n=10, 55.5%). Hypertension was the most common risk factor (n=12, 66.6%). In total, 14 cases underwent emergency surgery (77.7%). The emergency surgery was performed in 9 patients within 24 h of arrival owing to the association of aortic root dissection with tamponade. For the other cases, the surgery was performed within 2 and 7 days (n=5, 27.7% and n=4, 22.2%) respectively. Early post-operative complications occurred in 5 patients (27.7%). On the whole, as demonstrated herein, the modifications of the Bentall procedure have a notable impact on decreasing the overall mortality rates. Raising the awareness of clinicians and the general population as regards aortic dissection may aid in the early referral of patients to specialized centers and may thus decrease the overall mortality rate.
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Affiliation(s)
- Saif S. Al-Mudhaffar
- Department of Cardiac Surgery, Ibn Al-Bitar Specialized Center for Cardiac Surgery, Baghdad 10011, Iraq
| | - Ala Alwan
- Department of Cardiac Surgery, Ibn Al-Bitar Specialized Center for Cardiac Surgery, Baghdad 10011, Iraq
| | - Rafid Ouj
- Department of Cardiac Surgery, Ibn Al-Bitar Specialized Center for Cardiac Surgery, Baghdad 10011, Iraq
| | - Abdullah Mowaffaq
- Department of Cardiac Surgery, Ibn Al-Bitar Specialized Center for Cardiac Surgery, Baghdad 10011, Iraq
| | - Fahmi H. Kakamad
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq,Smart Research Center, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq,Kscien Organization, Sulaimani, Kurdistan 46000, Iraq,Correspondence to: Dr Fahmi H. Kakamad, College of Medicine, University of Sulaimani, 31 Madam Mitterrand Street, Sulaimani, Kurdistan 46000, Iraq
| | - Okba F. Ahmad
- Department of Surgery, Mosul Cardiac Center, Mosul 41001, Iraq
| | - Dana H. Mohammed-Saeed
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq,Smart Research Center, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq,Sulaimani Center for Heart Disease, Sulaimani, Kurdistan 46000, Iraq
| | - Razhan K. Ali
- Department of Surgery, Shar Hospital, Sulaimani, Kurdistan 46000, Iraq
| | - Berun A. Abdalla
- Smart Research Center, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq,Kscien Organization, Sulaimani, Kurdistan 46000, Iraq
| | | | - Abdulwahid M. Salih
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq,Smart Research Center, Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
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Stengl R, Ágg B, Pólos M, Mátyás G, Szabó G, Merkely B, Radovits T, Szabolcs Z, Benke K. Potential predictors of severe cardiovascular involvement in Marfan syndrome: the emphasized role of genotype-phenotype correlations in improving risk stratification-a literature review. Orphanet J Rare Dis 2021; 16:245. [PMID: 34059089 PMCID: PMC8165977 DOI: 10.1186/s13023-021-01882-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/21/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Marfan syndrome (MFS) is a genetically determined systemic connective tissue disorder, caused by a mutation in the FBN1 gene. In MFS mainly the cardiovascular, musculoskeletal and ocular systems are affected. The most dangerous manifestation of MFS is aortic dissection, which needs to be prevented by a prophylactic aortic root replacement. MAIN BODY The indication criteria for the prophylactic procedure is currently based on aortic diameter, however aortic dissections below the threshold defined in the guidelines have been reported, highlighting the need for a more accurate risk stratification system to predict the occurrence of aortic complications. The aim of this review is to present the current knowledge on the possible predictors of severe cardiovascular manifestations in MFS patients, demonstrating the wide range of molecular and radiological differences between people with MFS and healthy individuals, and more importantly between MFS patients with and without advanced aortic manifestations. These differences originating from the underlying common molecular pathological processes can be assessed by laboratory (e.g. genetic testing) and imaging techniques to serve as biomarkers of severe aortic involvement. In this review we paid special attention to the rapidly expanding field of genotype-phenotype correlations for aortic features as by collecting and presenting the ever growing number of correlations, future perspectives for risk stratification can be outlined. CONCLUSIONS Data on promising biomarkers of severe aortic complications of MFS have been accumulating steadily. However, more unifying studies are required to further evaluate the applicability of the discussed predictors with the aim of improving the risk stratification and therefore the life expectancy and quality of life of MFS patients.
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Affiliation(s)
- Roland Stengl
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary.
- Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary.
| | - Bence Ágg
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
- Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - Miklós Pólos
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
- Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary
| | - Gábor Mátyás
- Center for Cardiovascular Genetics and Gene Diagnostics, Foundation for People With Rare Diseases, Wagistrasse 25, 8952, CH-Schlieren-Zurich, Switzerland
| | - Gábor Szabó
- Department of Cardiac Surgery, University of Halle, Halle, Germany
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
| | - Zoltán Szabolcs
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
- Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary
| | - Kálmán Benke
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, 1122, Hungary
- Hungarian Marfan Foundation, Városmajor u. 68, Budapest, 1122, Hungary
- Department of Cardiac Surgery, University of Halle, Halle, Germany
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3
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Ágg B, Szilveszter B, Daradics N, Benke K, Stengl R, Kolossváry M, Pólos M, Radovits T, Ferdinandy P, Merkely B, Maurovich-Horvat P, Szabolcs Z. Increased visceral arterial tortuosity in Marfan syndrome. Orphanet J Rare Dis 2020; 15:91. [PMID: 32293489 PMCID: PMC7160945 DOI: 10.1186/s13023-020-01369-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/31/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Clinical evidence suggests that the currently recommended approach to estimate the risk of aortic dissection in Marfan syndrome (MFS) is not reliable enough. Therefore, we investigated the possible role of visceral arterial tortuosity in the risk stratification. METHODS AND RESULTS Splenic and renal arteries of 37 MFS patients and 74 age and gender matched control subjects were segmented using CT angiography imaging. To measure tortuosity, distance metric (DM), sum of angles metric (SOAM), inflection count metric (ICM), and the ratio of ICM and SOAM (ICM/SOAM) were calculated. DM of the splenic, right and left renal artery was significantly higher in MFS patients than in controls (2.44 [1.92-2.80] vs. 1.75 [1.57-2.18] p < 0.001; 1.16 [1.10-1.28] vs. 1.11 [1.07-1.15] p = 0.011; 1.40 [1.29-1.70] vs. 1.13 [1.09-1.23] p < 0.001, respectively). A similar tendency for ICM and an opposite tendency for SOAM were observed. ICM/SOAM was significantly higher in the MFS group compared to controls in case of all three arteries (73.35 [62.26-93.63] vs. 50.91 [43.19-65.62] p < 0.001; 26.52 [20.69-30.24] vs. 19.95 [16.47-22.95] p < 0.001; 22.81 [18.64-30.96] vs. 18.38 [15.29-21.46] p < 0.001, respectively). MFS patients who underwent aortic root replacement had increased right and left renal DM and ICM/SOAM compared to MFS patients without surgery. CONCLUSION To our knowledge this is the first demonstration of increased arterial tortuosity in MFS on visceral arteries. Visceral arterial tortuosity, dominated by curves of lower frequency but higher amplitude according to the observed opposite tendency between the DM and SOAM metrics, could be a possible new predictor of serious manifestations of MFS.
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Affiliation(s)
- Bence Ágg
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, H-1122, Hungary. .,Hungarian Marfan Foundation, Városmajor u. 68, Budapest, H-1122, Hungary. .,Department of Pharmacology and Pharmacotherapy, Semmelweis University, Üllői út 26, Budapest, H-1085, Hungary.
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, H-1122, Hungary
| | - Noémi Daradics
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, H-1122, Hungary.,Hungarian Marfan Foundation, Városmajor u. 68, Budapest, H-1122, Hungary
| | - Kálmán Benke
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, H-1122, Hungary.,Hungarian Marfan Foundation, Városmajor u. 68, Budapest, H-1122, Hungary
| | - Roland Stengl
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, H-1122, Hungary.,Hungarian Marfan Foundation, Városmajor u. 68, Budapest, H-1122, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, H-1122, Hungary
| | - Miklós Pólos
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, H-1122, Hungary.,Hungarian Marfan Foundation, Városmajor u. 68, Budapest, H-1122, Hungary
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, H-1122, Hungary
| | - Péter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Üllői út 26, Budapest, H-1085, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, H-1122, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, H-1122, Hungary
| | - Zoltán Szabolcs
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, Budapest, H-1122, Hungary.,Hungarian Marfan Foundation, Városmajor u. 68, Budapest, H-1122, Hungary
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Pólos M, Șulea CM, Benke K, Ágg B, Kovács A, Hartyánszky I, Merkely B, Schäfers HJ, Szabolcs Z. Giant unruptured sinus of Valsalva aneurysm successfully managed with valve-sparing procedure - a case report. J Cardiothorac Surg 2020; 15:6. [PMID: 31915041 PMCID: PMC6950913 DOI: 10.1186/s13019-020-1061-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/03/2020] [Indexed: 11/22/2022] Open
Abstract
Background Sinus of Valsalva aneurysm (SVA) is an uncommon cardiac anomaly, with an incidence of less than 1% of open heart surgery cases. Its evolution is most frequently silent, being found incidentally or discovered in the event of its acute rupture. Non-ruptured giant SVAs may cause unusual clinical manifestations, as a consequence of their protrusion into the heart chambers or compression of the coronary vessels and are frequently associated with aortic insufficiency of various degrees of severity. The gold standard treatment for SVAs consists of complete replacement of the aortic root and valve. However, in certain cases, valve-sparing procedures may prove to be a more suitable alternative. Case presentation A 68-year-old male patient presented with dyspnea as symptom caused by a large (> 5 cm) right sinus of Valsalva aneurysm. The aneurysm was occupying most of the right ventricle and was associated with severe aortic regurgitation. The surgical treatment of the condition involved valve-sparing root reconstruction procedure (remodeling technique), completed with external stabilization of the aortic valve annulus via running suture annuloplasty. Following the uneventful intervention, the patient did well and his status improved. The follow-up transthoracic echocardiography obtained 1 month after surgery showed a fully competent aortic valve with no regurgitation. Conclusions Despite complete aortic root and valve replacement being considered the safest approach to large SVAs complicated with aortic insufficiency, valve-sparing procedures should not be overlooked in case of a dilated aortic root with uncalcified aortic valve. Performing valve-sparing by applying a remodeling technique operation completed with annuloplasty reduces aortic valve insufficiency, avoiding side-effects related to implanted valves.
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Affiliation(s)
- Miklós Pólos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
| | - Cristina-Maria Șulea
- George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
| | - Kálmán Benke
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bence Ágg
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University, Medical Center and Saarland University Faculty of Medicine, Saarbrücken, Germany
| | - Zoltán Szabolcs
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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5
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Lung Function Changes are More Common in Marfan Patients Who Need Major Thoracic Surgery. Lung 2019; 197:465-472. [PMID: 31089858 PMCID: PMC6647216 DOI: 10.1007/s00408-019-00236-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/02/2019] [Indexed: 11/24/2022]
Abstract
Introduction Marfan syndrome is a genetic disorder affecting the connective tissue. Changes in lung tissue might influence respiratory function; however, a detailed respiratory functional assessment according to the need for major thoracic surgery is missing. Methods Comprehensive pulmonary examinations were performed in 55 Marfan patients including respiratory symptoms, lung function (LF) testing using European Coal and Steel Community (ECSC) reference values, TLCO and quality of life measurements. Groups included patients who did not need surgery (Mf, n = 32) and those who underwent major thoracic surgery (Mfop, n = 23). Results Respiratory symptoms affected 20% of patients. Scoliosis was significantly more frequent in the Mfop group. LF demonstrated in all Marfan patients a tendency towards airway obstruction (FEV1/FVC = 0.77 ± 0.10), more prominent in Mfop patients (0.74 ± 0.08 vs. Mf: 0.80 ± 0.11; p = 0.03). Correction of LF values using a standing height modification by arm span (Hcorrected) revealed additional changes in FVC and FEV1. TLCO and quality of life did not differ between groups. Conclusions Marfan syndrome is associated with airway obstruction, especially in patients who have undergone major thoracic surgery, indicative of more severe connective tissue malfunction. The use of arm span for height correction is suitable to evaluate LF changes in this special patient group including patients with significant scoliosis.
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6
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Karangelis D, Tzertzemelis D, Demis AA, Economidou S, Panagiotou M. Eighteen years of clinical experience with a modification of the Bentall button technique for total root replacement. J Thorac Dis 2018; 10:6733-6741. [PMID: 30746218 DOI: 10.21037/jtd.2018.11.61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We retrospectively reviewed our experience with the modified Bentall procedure and evaluated the short- and long-term results over a period of 18 years. Methods Between 1999 and 2017, 89 patients with a mean age of 57.3±13.9 years underwent the modified Bentall operation with a slight modification for the correction of aortic root disease. Results The operative mortality was 1.1% while the overall early mortality rate, defined as death within 30 days of initial hospitalization, was 2.2% (2/89). Logistic regression analysis revealed that increased Euroscore and aortic cross-clamp times were associated with greater likelihood for complications. The overall survival rates for the 89 patients (including deaths occurred at the initial hospitalization) were 93.0% (SE =3.0%) at 6 months, 93.0% (SE =3.0%) at 1 year, 89% (SE =5.0%) at 5 years and 73.0% (SE =5.0%) at 10, 15 and 18 years. Multiple Cox regression analysis for survival identified that increased aortic cross-clamp time, increased age, having a concomitant cardiac procedure and increased NYHA Class were associated with greater hazard. Left ventricular remodeling was assessed by means of echocardiography preoperatively and 1, 3, 6 and 12 months postoperatively. Conclusions According to our experience, the Bentall procedure is a safe procedure, provides optimal long-term survival and can still be regarded as the gold standard procedure for aortic root replacement.
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Affiliation(s)
- Dimos Karangelis
- Cardiac Surgery Department, Athens Medical Center, Distomou 5, Amaroussio 151 25, Greece
| | - Dimitrios Tzertzemelis
- Cardiac Surgery Department, Athens Medical Center, Distomou 5, Amaroussio 151 25, Greece
| | - Alexandros A Demis
- Cardiac Surgery Department, Athens Medical Center, Distomou 5, Amaroussio 151 25, Greece
| | - Stella Economidou
- Cardiac Surgery Department, Athens Medical Center, Distomou 5, Amaroussio 151 25, Greece
| | - Matthew Panagiotou
- Cardiac Surgery Department, Athens Medical Center, Distomou 5, Amaroussio 151 25, Greece
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7
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Benke K, Ágg B, Meienberg J, Kopps AM, Fattorini N, Stengl R, Daradics N, Pólos M, Bors A, Radovits T, Merkely B, De Backer J, Szabolcs Z, Mátyás G. Hungarian Marfan family with large FBN1 deletion calls attention to copy number variation detection in the current NGS era. J Thorac Dis 2018; 10:2456-2460. [PMID: 29850152 DOI: 10.21037/jtd.2018.04.40] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Copy number variations (CNVs) comprise about 10% of reported disease-causing mutations in Mendelian disorders. Nevertheless, pathogenic CNVs may have been under-detected due to the lack or insufficient use of appropriate detection methods. In this report, on the example of the diagnostic odyssey of a patient with Marfan syndrome (MFS) harboring a hitherto unreported 32-kb FBN1 deletion, we highlight the need for and the feasibility of testing for CNVs (>1 kb) in Mendelian disorders in the current next-generation sequencing (NGS) era.
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Affiliation(s)
- Kálmán Benke
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Hungarian Marfan Foundation, Budapest, Hungary
| | - Bence Ágg
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Hungarian Marfan Foundation, Budapest, Hungary.,Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
| | - Janine Meienberg
- Center for Cardiovascular Genetics and Gene Diagnostics, Foundation for People with Rare Diseases, Schlieren-Zurich, Switzerland
| | - Anna M Kopps
- Center for Cardiovascular Genetics and Gene Diagnostics, Foundation for People with Rare Diseases, Schlieren-Zurich, Switzerland
| | - Nathalie Fattorini
- Center for Cardiovascular Genetics and Gene Diagnostics, Foundation for People with Rare Diseases, Schlieren-Zurich, Switzerland
| | - Roland Stengl
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Hungarian Marfan Foundation, Budapest, Hungary
| | - Noémi Daradics
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Hungarian Marfan Foundation, Budapest, Hungary
| | - Miklós Pólos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Hungarian Marfan Foundation, Budapest, Hungary
| | - András Bors
- Laboratory of Molecular Diagnostics, Hungarian National Blood Transfusion Service, Budapest, Hungary
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Julie De Backer
- Center for Medical Genetics Ghent, Ghent University, Ghent, Belgium
| | - Zoltán Szabolcs
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Hungarian Marfan Foundation, Budapest, Hungary
| | - Gábor Mátyás
- Center for Cardiovascular Genetics and Gene Diagnostics, Foundation for People with Rare Diseases, Schlieren-Zurich, Switzerland.,Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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8
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Benke K, Ágg B, Pólos M, Sayour AA, Radovits T, Bartha E, Nagy P, Rákóczi B, Koller Á, Szokolai V, Hedberg J, Merkely B, Nagy ZB, Szabolcs Z. The effects of acute and elective cardiac surgery on the anxiety traits of patients with Marfan syndrome. BMC Psychiatry 2017; 17:253. [PMID: 28716062 PMCID: PMC5512884 DOI: 10.1186/s12888-017-1417-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/04/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Marfan syndrome is a genetic disease, presenting with dysfunction of connective tissues leading to lesions in the cardiovascular and skeletal muscle system. Within these symptoms, the most typical is weakness of the connective tissue in the aorta, manifesting as aortic dilatation (aneurysm). This could, in turn, become annuloaortic ectasia, or life-threatening dissection. As a result, life-saving and preventative cardiac surgical interventions are frequent among Marfan syndrome patients. Aortic aneurysm could turn into annuloaortic ectasia or life-threatening dissection, thus life-saving and preventive cardiac surgical interventions are frequent among patients with Marfan syndrome. We hypothesized that patients with Marfan syndrome have different level of anxiety, depression and satisfaction with life compared to that of the non-clinical patient population. METHODS Patients diagnosed with Marfan syndrome were divided into 3 groups: those scheduled for prophylactic surgery, those needing acute surgery, and those without need for surgery (n = 9, 19, 17, respectively). To examine the psychological features of the patients, Spielberger's anxiety (STAI) test, Beck's Depression questionnaire (BDI), the Berne Questionnaire of Subjective Well-being, and the Satisfaction with Life scale were applied. RESULTS A significant difference was found in trait anxiety between healthy individuals and patients with Marfan syndrome after acute life-saving surgery (p < 0.01). The mean score of Marfan syndrome patients was 48.56 (standard deviation (SD): 5.8) as compared to the STAI population mean score of 43.72 (SD: 8.53). No difference was found between groups on the BDI (p > 0.1). Finally, a significant, medium size effect was found between patient groups on the Joy in Living scale (F (2.39) = 3.51, p = 0.040, η2 = 0.15). CONCLUSIONS Involving psychiatric and mental-health care, in addition to existing surgical treatment interventions, is essential for more successful recovery of patients with Marfan syndrome.
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Affiliation(s)
- Kálmán Benke
- Heart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122, Hungary. .,Hungarian Marfan Foundation, Városmajor Street 68, Budapest, 1122, Hungary.
| | - Bence Ágg
- 0000 0001 0942 9821grid.11804.3cHeart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122 Hungary ,Hungarian Marfan Foundation, Városmajor Street 68, Budapest, 1122 Hungary ,0000 0001 0942 9821grid.11804.3cDepartment of Pharmacology and Pharmacotherapy, Semmelweis University, 1089 Nagyvárad tér 4, Budapest, Hungary
| | - Miklós Pólos
- 0000 0001 0942 9821grid.11804.3cHeart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122 Hungary
| | - Alex Ali Sayour
- 0000 0001 0942 9821grid.11804.3cHeart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122 Hungary
| | - Tamás Radovits
- 0000 0001 0942 9821grid.11804.3cHeart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122 Hungary
| | - Elektra Bartha
- 0000 0001 0942 9821grid.11804.3cHeart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122 Hungary ,Hungarian Marfan Foundation, Városmajor Street 68, Budapest, 1122 Hungary
| | - Péter Nagy
- GenePointPlus Hungary Ltd., János Zsigmond Street 7B, Budapest, 1121 Hungary
| | - Balázs Rákóczi
- 0000 0001 2149 6445grid.5146.6Central European University, Nádor Street 9, Budapest, 1051 Hungary
| | - Ákos Koller
- 0000 0000 9243 1481grid.472475.7Institute of Natural Sciences, University of Physical Education, Alkotás Street 44, Budapest, 1123 Hungary
| | - Viola Szokolai
- GenePointPlus Hungary Ltd., János Zsigmond Street 7B, Budapest, 1121 Hungary
| | - Julianna Hedberg
- Hungarian Marfan Foundation, Városmajor Street 68, Budapest, 1122 Hungary
| | - Béla Merkely
- 0000 0001 0942 9821grid.11804.3cHeart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122 Hungary
| | - Zsolt B. Nagy
- GenePointPlus Hungary Ltd., János Zsigmond Street 7B, Budapest, 1121 Hungary
| | - Zoltán Szabolcs
- 0000 0001 0942 9821grid.11804.3cHeart and Vascular Center, Semmelweis University, Városmajor Street 68, Budapest, 1122 Hungary ,Hungarian Marfan Foundation, Városmajor Street 68, Budapest, 1122 Hungary
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