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Aironi B, Shetty T, Kulkarni D, Patil P. Management of compromised bilateral carotid artery flow in acute type A aortic dissection, in a neurologically intact patient. Indian J Thorac Cardiovasc Surg 2024; 40:484-488. [PMID: 38919179 PMCID: PMC11194247 DOI: 10.1007/s12055-023-01679-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/25/2023] [Accepted: 12/27/2023] [Indexed: 06/27/2024] Open
Abstract
Type A aortic dissection (TAAD) is a disease that can have a cataclysmic impact on a patient's life, and early surgical intervention is crucial for survival. Cerebral malperfusion occurs in 6-14% of TAAD patients, primarily from partial or complete blockage of the arch vessels by the dissection flap, and hypoxic brain injury secondary to tamponade or shock and/or brain embolism from thrombosis of the false lumen. Management protocols for concomitant carotid arterial dissection in TAAD patients are inconsistent in the current literature. Through this case report, we have tried to describe our easily replicable strategies to manage bilateral carotid artery involvement in TAAD, avoiding total circulatory arrest (TCA), in a neurologically intact patient with good neurological outcome.
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Affiliation(s)
- Balaji Aironi
- Department of Cardiovascular & Thoracic Surgery, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra India
| | - Tarun Shetty
- Department of Cardiovascular & Thoracic Surgery, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra India
| | - Dwarkanath Kulkarni
- Department of Cardiovascular & Thoracic Surgery, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra India
| | - Prashant Patil
- Department of Cardiovascular & Thoracic Surgery, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra India
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Qiu S, Liu Z, Jiang WD, Sun JH, Liu ZQ, Sun XD, Wang CT, Liu W. Diabetes and aortic dissection: unraveling the role of 3-hydroxybutyrate through mendelian randomization. Cardiovasc Diabetol 2024; 23:159. [PMID: 38715052 PMCID: PMC11077732 DOI: 10.1186/s12933-024-02266-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/04/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND In observational and experimental studies, diabetes has been reported as a protective factor for aortic dissection. 3-Hydroxybutyrate, a key constituent of ketone bodies, has been found to favor improvements in cardiovascular disease. However, whether the protective effect of diabetes on aortic dissection is mediated by 3-hydroxybutyrate is unclear. We aimed to investigate the causal effects of diabetes on the risk of aortic dissection and the mediating role of 3-hydroxybutyrate in them through two-step Mendelian randomization. MATERIALS AND METHODS We performed a two-step Mendelian randomization to investigate the causal connections between diabetes, 3-hydroxybutyrate, and aortic dissection and calculate the mediating effect of 3-hydroxybutyrate. Publicly accessible data for Type 1 diabetes, Type 2 diabetes, dissection of aorta and 3-hydroxybutyrate were obtained from genome-wide association studies. The association between Type 1 diabetes and dissection of aorta, the association between Type 2 diabetes and dissection of aorta, and mediation effect of 3-hydroxybutyrate were carried out separately. RESULTS The IVW method showed that Type 1 diabetes was negatively associated with the risk of aortic dissection (OR 0.912, 95% CI 0.836-0.995), The weighted median, simple mode and weighted mode method showed consistent results. The mediated proportion of 3-hydroxybutyrate on the relationship between Type 1 diabetes and dissection of aorta was 24.80% (95% CI 5.12-44.47%). The IVW method showed that Type 2 diabetes was negatively associated with the risk of aortic dissection (OR 0.763, 95% CI 0.607-0.960), The weighted median, simple mode and weighted mode method showed consistent results. 3-Hydroxybutyrate does not have causal mediation effect on the relationship between Type 2 diabetes and dissection of aorta. CONCLUSION Mendelian randomization study revealed diabetes as a protective factor for dissection of aorta. The protective effect of type 1 diabetes on aortic dissection was partially mediated by 3-hydroxybutyrate, but type 2 diabetes was not 3-hydroxybutyrate mediated.
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Affiliation(s)
- Shi Qiu
- Department of Cardiac Surgery, The Second Hospital of Shandong University, 250033, Jinan, Shandong, China
| | - Zhen Liu
- Department of Cadre Health Care, The Second Hospital of Shandong University, 247 Beiyuan Street, 250033, Jinan, Shangdong, People's Republic of China
| | - Wei-Dong Jiang
- Department of Cadre Health Care, The Second Hospital of Shandong University, 247 Beiyuan Street, 250033, Jinan, Shangdong, People's Republic of China
| | - Jin-Hui Sun
- Department of Cardiac Surgery, The Second Hospital of Shandong University, 250033, Jinan, Shandong, China
| | - Zeng-Qiang Liu
- Department of Cadre Health Care, The Second Hospital of Shandong University, 247 Beiyuan Street, 250033, Jinan, Shangdong, People's Republic of China
| | - Xiao-Di Sun
- Department of Cadre Health Care, The Second Hospital of Shandong University, 247 Beiyuan Street, 250033, Jinan, Shangdong, People's Republic of China
| | - Chun-Ting Wang
- Department of Cardiac Surgery, The Second Hospital of Shandong University, 250033, Jinan, Shandong, China
| | - Wen Liu
- Department of Cadre Health Care, The Second Hospital of Shandong University, 247 Beiyuan Street, 250033, Jinan, Shangdong, People's Republic of China.
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Liu F, Li X, Zhang T, Gao Z, Zhang S, Qian Y. Occult aortic dissection. Quant Imaging Med Surg 2024; 14:3751-3754. [PMID: 38720831 PMCID: PMC11074724 DOI: 10.21037/qims-23-1636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/29/2024] [Indexed: 05/12/2024]
Affiliation(s)
- Fujun Liu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaoshu Li
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tingting Zhang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhao Gao
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shuhai Zhang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yinfeng Qian
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Mahlmann A, Rodionov RN, Behrendt CA, Leip JL, Lackner HK, Eraqi M, Elzanaty N, Ghazy T. Evaluation of the Value of Histological Examination for the Prediction of Genetic Thoracic Proximal Aortopathies. J Clin Med 2024; 13:1838. [PMID: 38610603 PMCID: PMC11012398 DOI: 10.3390/jcm13071838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Heritable connective tissue disorders are often accompanied by an increased risk for thoracic aortic aneurysm and dissection (TAAD). Profound knowledge of the underlying pathology may have an impact on individual treatment, systematic follow-up, and early detection by the screening of offspring. The aim of this study, based in a single high-volume tertiary center, was an analysis of the diagnostic validity of histopathologic findings in patients with TAAD due to these findings' accuracy in diagnosing heritable connective tissue disorders. Methods: Therefore, genetic testing by next-generation sequencing (NGS) was performed to evaluate the correlations. In total, 65 patients with TAAD undergoing surgical treatment before the age of 60 years or with age up to 80 years if they had offspring at the time of the procedure were included in the analysis. Results: In our cohort, no certain correlation of histological findings to the results of genetic diagnostics in patients with clinically relevant aortic pathology could be shown. Patients with histopathologic findings for heritable connective tissue disorder and a positive gene variant were 11.6 years younger than patients without mutation and without histological evidence for connective tissue disorder. Conclusions: Genetic clarification is useful to define the specific genotype of the disease of the aortic wall in the case of non-specific histological characteristics.
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Affiliation(s)
- Adrian Mahlmann
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at Technische Universität, 01307 Dresden, Germany; (A.M.); (R.N.R.)
- Centre for Vascular Medicine, Clinic of Angiology, St.-Josefs-Hospital, Katholische Krankenhaus Hagen gem. GmbH, 58097 Hagen, Germany
| | - Roman N. Rodionov
- Department of Internal Medicine III, University Hospital Carl Gustav Carus at Technische Universität, 01307 Dresden, Germany; (A.M.); (R.N.R.)
- University Center for Vascular Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Christian-Alexander Behrendt
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, 20099 Hamburg, Germany;
- Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | | | - Helmut Karl Lackner
- Division of Physiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, 8010 Graz, Austria;
| | - Mohamed Eraqi
- Department of Cardiac Surgery, Klinikum Bayreuth GmbH, 95445 Bayreuth, Germany;
| | - Nesma Elzanaty
- Department of Medical Physiology, Tanta Faculty of Medicine, Tanta University, Tanta 31527, Egypt;
| | - Tamer Ghazy
- Department of Cardiac Surgery, Marburg University Hospital, Philipps University of Marburg, 35037 Marburg, Germany
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Lai X, Wan Q, Jiao SF, Sun XC, Hu JF, Peng HW. Cardiovascular toxicities following the use of tyrosine kinase inhibitors in hepatocellular cancer patients: a retrospective, pharmacovigilance study. Expert Opin Drug Saf 2024; 23:287-296. [PMID: 37608525 DOI: 10.1080/14740338.2023.2251398] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/29/2023] [Accepted: 08/09/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Cardiac adverse events (AEs) are common in tyrosine kinase inhibitors(TKIs). This study explored the cardiac AEs of TKIs through the Food and Drug Administration's Adverse Event Reporting System (FAERS). METHODS Disproportionality analysis and Bayesian analysis were utilized for data mining of the suspected cardiac AEs of TKIs, based on FAERS data from January 2004 to December 2021. RESULTS A total of 4708 cardiac AEs reports of sorafenib, regorafenib, lenvatinib, and cabozantinib were identified. Hypertension accounts for the most reported cardiac AE. Lenvatinib appears to induce cardiac failure with the highest signals strength [ROR = 7.7 (3.46,17.17)]. Acute myocardial infarction was detected in lenvatinib [ROR = 7.91 (5.64,11.09)] and sorafenib [ROR = 2.22 (1.74, 2.84)]. Acute coronary syndrome was detected in lenvatinib [ROR = 11.57 (6.84, 19.58)] and sorafenib [ROR = 2.81 (1.87,4.24)]. Atrial fibrillation was detected in sorafenib [ROR = 1.82 (1.55,2.14)] and regorafenib [ROR = 1.36 (1.03,1.81)]. Meanwhile, aortic dissections were detected in sorafenib [ROR = 5.08 (3.31,7.8)] and regorafenib [ROR = 3.39 (1.52,7.56)]. Most patients developed hypertension and cardiac failure within 30 days of initiating TKI treatments. Patients taking lenvatinib had an increased incidence of developing acute coronary syndrome after 180 days of treatment. CONCLUSION Analysis of FAERS data provides a precise profile on the characteristics of cardiac AEs associated with different TKI regimens. Distinct monitoring and appropriate management are needed in the care of TKI recipients.
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Affiliation(s)
- Xin Lai
- Department of Pharmacy, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qing Wan
- Department of Pharmacy, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shou-Feng Jiao
- Department of Pharmacy, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiao-Chun Sun
- Department of Pharmacy, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jin-Fang Hu
- Department of Pharmacy, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hong-Wei Peng
- Department of Pharmacy, First Affiliated Hospital of Nanchang University, Nanchang, China
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Peng H, Wang X, Zhang L, Su Y, Yan J, Wu X. Correlation of the serum cell division cycle 42 with CD4 + T cell subsets and in-hospital mortality in Stanford type B aortic dissection patients. Front Cardiovasc Med 2024; 11:1324345. [PMID: 38476381 PMCID: PMC10927740 DOI: 10.3389/fcvm.2024.1324345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/22/2024] [Indexed: 03/14/2024] Open
Abstract
Objective Cell division cycle 42 (CDC42) regulates CD4+ T-cell differentiation and participates in vascular stiffness and atherosclerosis and is involved in the progression of Stanford type B aortic dissection (TBAD). This study aimed to explore the correlation between serum CDC42 level and CD4+ T cell subsets and in-hospital mortality in TBAD patients. Methods Serum CDC42 and peripheral blood T-helper (Th) 1, Th2, and Th17 cells were detected in 127 TBAD patients by enzyme-linked immunosorbent assay and flow cytometry, respectively. Serum CDC42 was also quantified in 30 healthy controls. Results Serum CDC42 was decreased in TBAD patients vs. healthy controls (median [interquartile range (IQR)]: 418.0 (228.0-761.0) pg/ml vs. 992.0 (716.3-1,445.8) pg/ml, P < 0.001). In TBAD patients, serum CDC42 was negatively correlated with Th17 cells (P = 0.001), but not Th1 (P = 0.130) or Th2 cells (P = 0.098). Seven (5.5%) patients experienced in-hospital mortality. Serum CDC42 was reduced in patients who experienced in-hospital mortality vs. those who did not (median (IQR): 191.0 (145.0-345.0) pg/ml vs. 451.5 (298.3-766.8) pg/ml, P = 0.006). By receiver operating characteristic analysis, serum CDC42 showed a good ability for estimating in-hospital mortality [area under curve = 0.809, 95% confidence interval (CI) = 0.662-0.956]. By the multivariate logistic regression analysis, elevated serum CDC42 [odd ratio (OR) = 0.994, 95% CI = 0.998-1.000, P = 0.043] was independently correlated with lower risk of in-hospital mortality, while higher age (OR = 1.157, 95% CI = 1.017-1.316, P = 0.027) was an independent factor for increased risk of in-hospital mortality. Conclusion Serum CDC42 negatively associates with Th17 cells and is independently correlated with decreased in-hospital mortality risk in TBAD patients.
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Affiliation(s)
- Hui Peng
- Department of Cardiac Surgery, Xingtai People’s Hospital, Xingtai, Hebei, China
| | - Xugang Wang
- Department of Cardiovascular Surgery, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Longfei Zhang
- Department of Cardiac Surgery, Xingtai People’s Hospital, Xingtai, Hebei, China
| | - Yang Su
- Department of Cerebrovascular Neurosurgery, Xingtai People’s Hospital, Xingtai, Hebei, China
| | - Jieli Yan
- Department of Cardiac Surgery, Xingtai People’s Hospital, Xingtai, Hebei, China
| | - Xin Wu
- Department of Cardiac Surgery, Xingtai People’s Hospital, Xingtai, Hebei, China
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Zhao J, Yoshizumi M. A Comprehensive Retrospective Study on the Mechanisms of Cyclic Mechanical Stretch-Induced Vascular Smooth Muscle Cell Death Underlying Aortic Dissection and Potential Therapeutics for Preventing Acute Aortic Aneurysm and Associated Ruptures. Int J Mol Sci 2024; 25:2544. [PMID: 38473793 DOI: 10.3390/ijms25052544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Acute aortic dissection (AAD) and associated ruptures are the leading causes of death in cardiovascular diseases (CVDs). Hypertension is a prime risk factor for AAD. However, the molecular mechanisms underlying AAD remain poorly understood. We previously reported that cyclic mechanical stretch (CMS) leads to the death of rat aortic smooth muscle cells (RASMCs). This review focuses on the mechanisms of CMS-induced vascular smooth muscle cell (VSMC) death. Moreover, we have also discussed the potential therapeutics for preventing AAD and aneurysm ruptures.
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Affiliation(s)
- Jing Zhao
- Department of Pharmacology, Nara Medical University School of Medicine, 840 Shijo-Cho, Kashihara 634-8521, Japan
| | - Masanori Yoshizumi
- Department of Pharmacology, Nara Medical University School of Medicine, 840 Shijo-Cho, Kashihara 634-8521, Japan
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Mahlmann A, Elzanaty N, Saleh M, Irqsusi M, Rastan A, Leip JL, Behrendt CA, Ghazy T. Prevalence of Genetic Variants and Deep Phenotyping in Patients with Thoracic Aortic Aneurysm and Dissection: A Cross-Sectional Single-Centre Cohort Study. J Clin Med 2024; 13:461. [PMID: 38256594 PMCID: PMC10816602 DOI: 10.3390/jcm13020461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND There is a paucity of evidence on people with thoracic aortic aneurysm and dissection. We aimed to determine the prevalence of genetic variants and their associations with phenotypes. METHODS In this cross-sectional single-centre cohort study of consecutive patients who underwent endovascular or open-surgical repair of thoracic aortic aneurysm and dissection, genetic analysis was performed using four-stage Next Generation Sequencing, and findings were confirmed with Sanger sequencing. We collected personal and family history on comorbidities, clinical examination, anthropometrics, skeletal deformities, joint function, and ophthalmological measures. Cardiovascular risk and phenotype scores were calculated. RESULTS Ninety-five patients were eligible (mean age 54 ± 9 years, 70% males, 56% aortic dissection). One-fifth had a family history of aortic disease. Furthermore, 95% and 54% had a phenotype score of ≤5 and ≤2, respectively. There were no significant differences in the distribution of phenotype characteristics according to age, sex, aortic pathology, or performed invasive procedures. Genetic variants of uncertain significance were detected in 40% of patients, with classic mutations comprising 18% of all variants. We observed no significant association with cardiovascular and phenotype scores but with higher joint function scores (p = 0.015). CONCLUSION Genetic variants are highly present in clinically relevant aortic pathologies. Variants appear to play a larger role than previously described. The different variants do not correlate with specific phenotypes, age, pathology, sex, or family history.
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Affiliation(s)
- Adrian Mahlmann
- Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany;
- Centre for Vascular Medicine, Clinic of Angiology, St.-Josefs-Hospital, Katholische Krankenhaus Hagen gem. GmbH, 58097 Hagen, Germany
| | - Nesma Elzanaty
- Department of Medical Physiology, Tanta Faculty of Medicine, Tanta University, Tanta 31527, Egypt;
| | - Mai Saleh
- Department of Chest Diseases, Tanta Faculty of Medicine, Tanta University, Tanta 31527, Egypt;
| | - Marc Irqsusi
- Department of Cardiac Surgery, Marburg University Hospital, Philipps University of Marburg, 35043 Marburg, Germany; (M.I.); (A.R.)
| | - Ardawan Rastan
- Department of Cardiac Surgery, Marburg University Hospital, Philipps University of Marburg, 35043 Marburg, Germany; (M.I.); (A.R.)
| | | | - Christian-Alexander Behrendt
- Department of Vascular and Endovascular Surgery, Asklepios Clinic Wandsbek, Asklepios Medical School, 20099 Hamburg, Germany;
- Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
| | - Tamer Ghazy
- Department of Cardiac Surgery, Marburg University Hospital, Philipps University of Marburg, 35043 Marburg, Germany; (M.I.); (A.R.)
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Cavanaugh S, Amirjamshidi H, Hisamoto K. Navigating the Unexpected: Iatrogenic Aortic Injuries during Transcatheter Aortic Valve Replacement (TAVR). J Clin Med 2023; 12:7630. [PMID: 38137699 PMCID: PMC10744134 DOI: 10.3390/jcm12247630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/27/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
The introduction of transcatheter aortic valve replacement (TAVR) has undeniably changed the landscape of valvular heart disease management over the last two decades. A reduction in complications through improvements in techniques, experience, and technology has established TAVR as a safe and effective alternative to surgical aortic valve replacement. However, it is important to consider the potential risks associated with TAVR and ways in which life-threatening complications can be identified and managed in a timely fashion. In this article, we review some catastrophic iatrogenic aortic injuries that are described in the literature and present a case of an acute iatrogenic type A aortic dissection that occurred during a transcatheter aortic valve replacement (TAVR). After valve deployment, a routine neurologic examination noted the new onset of a left-sided facial droop and upper extremity weakness. Urgent imaging revealed an extensive type A aortic dissection, and the patient was taken to the operating room for surgical repair. The coordination of our multidisciplinary team allowed for prompt recognition of her neurologic symptoms, urgent imaging, and timely transport to the operating room, all of which contributed to the successful management of this life-threatening procedural complication.
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Affiliation(s)
| | | | - Kazuhiro Hisamoto
- Division of Cardiac Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA; (S.C.)
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