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Du Y, Ding S, Li C, Bai Y, Wang X, Li D, Xie Y, Fan G, Wu LM, Wang G. Coronary artery wall contrast enhancement imaging impact on disease activity assessment in IgG4-RD: a direct marker of coronary involvement. J Cardiovasc Magn Reson 2024; 26:101047. [PMID: 38825155 PMCID: PMC11268104 DOI: 10.1016/j.jocmr.2024.101047] [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: 01/10/2024] [Revised: 04/23/2024] [Accepted: 05/25/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Coronary artery wall contrast enhancement (CE) has been applied to non-invasive visualization of changes to the coronary artery wall in systemic lupus erythematosus (SLE). This study investigated the feasibility of quantifying CE to detect coronary involvement in IgG4-related disease (IgG4-RD), as well as the influence on disease activity assessment. METHODS A total of 93 subjects (31 IgG4-RD; 29 SLE; 33 controls) were recruited in the study. Coronary artery wall imaging was performed in a 3.0 T MRI scanner. Serological markers and IgG4-RD Responder Index (IgG4-RD-RI) scores were collected for correlation analysis. RESULTS Coronary wall CE was observed in 29 (94 %) IgG4-RD patients and 22 (76 %) SLE patients. Contrast-to-noise ratio (CNR) and total CE area were significantly higher in patient groups compared to controls (CNR: 6.1 ± 2.7 [IgG4-RD] v. 4.2 ± 2.3 [SLE] v. 1.9 ± 1.5 [control], P < 0.001; Total CE area: 3.0 [3.0-6.6] v. 1.7 [1.5-2.6] v. 0.3 [0.3-0.9], P < 0.001). In the IgG4-RD group, CNR and total CE area were correlated with the RI (CNR: r = 0.55, P = 0.002; total CE area: r = 0.39, P = 0.031). RI´ scored considering coronary involvement by CE, differed significantly from RI scored without consideration of CE (RI v. RI´: 15 ± 6 v. 16 ± 6, P < 0.001). CONCLUSIONS Visualization and quantification of CMR coronary CE by CNR and total CE area could be utilized to detect subclinical and clinical coronary wall involvement, which is prevalent in IgG4-RD. The potential inclusion of small and medium-sized vessel involvements in the assessment of disease activity in IgG4-RD is worthy of further investigation.
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Affiliation(s)
- Yaqi Du
- Department of Radiology, the First Hospital of China Medical University, Shenyang, China
| | - Shuang Ding
- Department of rheumatology and immunology, the First Hospital of China Medical University, Shenyang, China
| | - Ce Li
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang, China
| | - Yun Bai
- Department of Radiology, the First Hospital of China Medical University, Shenyang, China
| | - Xinrui Wang
- Department of Radiology, the First Hospital of China Medical University, Shenyang, China
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Yibin Xie
- Biomedical Imaging Research Institute, Cedars Sinai Medical Center, Los Angeles, California
| | - Guoguang Fan
- Department of Radiology, the First Hospital of China Medical University, Shenyang, China.
| | - Lian-Ming Wu
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Guan Wang
- Department of Radiology, the First Hospital of China Medical University, Shenyang, China.
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2
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Son J, Lee SH. IgG4-related pericarditis. QJM 2024; 117:300-301. [PMID: 38113430 DOI: 10.1093/qjmed/hcad284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Indexed: 12/21/2023] Open
Affiliation(s)
- J Son
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - S H Lee
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Medical School, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
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3
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Houshmand G, Moosavi NS, Shahbazkhani A, Pouraliakbar H. IgG4-Related disease with diffuse myopericardial involvement- value of CMR: a case report and literature review of cardiac involvement. BMC Cardiovasc Disord 2024; 24:200. [PMID: 38582827 PMCID: PMC10998427 DOI: 10.1186/s12872-024-03874-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/02/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND IgG4-related disease is a fibro-inflammatory disorder with an unknown etiology, which can affect multiple organ systems, including the cardiovascular system. While most reported cases of cardiovascular involvement are primarily associated with the aorta, there have been sporadic reports of isolated cardiac involvement. CASE PRESENTATION This paper presents a documented case of IgG4-related systemic disease with symptoms indicative of restrictive cardiomyopathy. Subsequent Cardiac Magnetic Resonance imaging revealed diffuse myopericardial involvement, characterized by pericardial thickening and enhancement, accompanied by subepicardial and myocardial infiltration. Considering the rarity of cardiac involvement in our case, we conducted a thorough review of the existing literature pertaining to various patterns of cardiac involvement in IgG4-related disease, as well as the diagnostic modalities that can be employed for accurate identification and assessment. CONCLUSIONS This case report sheds light on the importance of recognizing and evaluating cardiac manifestations in IgG4-related systemic disease to facilitate timely diagnosis and appropriate management.
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Affiliation(s)
- Golnaz Houshmand
- Rajaie Cardiovascular Medical and Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Hamidreza Pouraliakbar
- Rajaie Cardiovascular Medical and Research Centre, Iran University of Medical Sciences, Tehran, Iran
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4
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Yağcı AF, Asil S, Kaya C, Dinç C, Bozlar U, Barçın C. IGG4-related giant lymphoproliferative-inflammatory left atrial mass. Echocardiography 2023; 40:996-1000. [PMID: 37382184 DOI: 10.1111/echo.15645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023] Open
Abstract
Cardiac masses are rare entities that can be challenging in clinical diagnosis and management. Cardiac masses can be detected incidentally in patients with an asymptomatic course or may cause systemic inflammation findings due to inflammatory cytokine release or symptoms such as shortness of breath, chest pain, syncope, sudden cardiac death, and mortality due to the location of the mass. Cardiac masses associated with systemic inflammatory disorders are uncommon in this disease group. This case report will present a case with an asymptomatic IgG4-related left atrial mass detected in routine echocardiographic control imaging due to rheumatic valve disease.
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Affiliation(s)
- Ahmet Faruk Yağcı
- Department of Cardiology, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Serkan Asil
- Department of Cardiology, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Cihad Kaya
- Department of Cardiology, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Cemal Dinç
- Department of Cardiology, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Uğur Bozlar
- Department of Radiology, Gülhane Education and Research Hospital, Ankara, Turkey
| | - Cem Barçın
- Department of Cardiology, Gülhane Education and Research Hospital, Ankara, Turkey
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5
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Rahmouni K, Nguyen ET, Seidman MA, Cusimano RJ. Aortic and Cardiac IgG4-Related Tumor: Case Report With Radiologic and Histopathologic Features. Can J Cardiol 2023; 39:1014-1017. [PMID: 37003417 DOI: 10.1016/j.cjca.2023.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Affiliation(s)
- Kenza Rahmouni
- Division of Cardiac Surgery, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada.
| | - Elsie T Nguyen
- Joint Department of Medical Imaging-Cardiothoracic Division, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Michael A Seidman
- Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Robert J Cusimano
- Division of Cardiac Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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6
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Falk GE, Cornell LD, Brake M, Ford R, Todd K, Fox C. Unique Challenges in Diagnosing IgG4-Related Tubulointerstitial Nephritis with Arteritis. Kans J Med 2022; 15:443-445. [PMID: 36578454 PMCID: PMC9778723 DOI: 10.17161/kjm.vol15.18510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/14/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Grace E. Falk
- Department of Laboratory Medicine and Pathology, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Lynn D. Cornell
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Mona Brake
- Robert J. Dole Veterans Affairs Medical Center, Wichita, KS,Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Ryan Ford
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Kaleb Todd
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Christopher Fox
- Robert J. Dole Veterans Affairs Medical Center, Wichita, KS,Department of Pathology, University of Kansas School of Medicine-Wichita, Wichita, KS
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Pota P, Suwannasom P, Woragidpoonpol S, Srisuwan T. Coil embolization to giant left anterior descending artery and left circumflex artery coronary artery aneurysm after failed coronary aneurysmal repair in IgG4-related disease: a case report. Eur Heart J Case Rep 2021; 5:ytab452. [PMID: 34859189 PMCID: PMC8633654 DOI: 10.1093/ehjcr/ytab452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/15/2021] [Accepted: 11/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND IgG4-related disease (IgG4-RD) is a chronic fibroinflammatory condition with multiple-organ involvement. Rupture of coronary artery aneurysms (CAAs) in IgG4-RD is rare. CASE SUMMARY A 65-year-old man with IgG4-RD has suffered from recurrent episodes of arterial aneurysms since 2003. He presented with chest pain and hypotension caused by localized cardiac tamponade at right ventricle free wall due to the rupture of coronary artery aneurysm (CAA) of left anterior descending artery (LAD). An urgent LAD aneurysm repaired with bovine pericardium and obliterated aneurysmal sac with cryo-acrylate glue was done together with coronary artery bypass grafting (CABG) using saphenous vein graft (SVG) to LAD and SVG to posterior descending artery. Three-month after surgery, the follow-up coronary computed tomography angiography (CCTA) revealed a growing in size of LAD and the second obtuse marginal (OM) branch aneurysm. Heart team discussion agreed to schedule the patient for double coil embolization to LAD and second OM aneurysm under intravascular ultrasound guidance. Both aneurysms were successfully obliterated with vascular coils. Two-week follow-up coronary angiogram showed complete occlusion of LAD aneurysm and near occlusion of the second OM branch aneurysm. DISCUSSION Coronary artery aneurysm rupture is a life-threatening condition that required prompt detection and treatments. In IgG4-RD patients, acute cardiac tamponade suggesting the rupture of CAA. Coil embolization is an alternative treatment in patients who suffered from recurrent CAA after surgical repair. Serial CCTA is important for early detection of aneurysm in IgG4-RD patients who had vascular involvement.
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Affiliation(s)
- Panupong Pota
- Division of Cardiology, Department of Internal Medicine, Faculty of Internal Medicine, Chiang Mai University, 110 Intavaroros Road, Sripoom District, Muang, Chiang Mai 50200, Thailand
| | - Pannipa Suwannasom
- Division of Cardiology, Department of Internal Medicine, Faculty of Internal Medicine, Chiang Mai University, 110 Intavaroros Road, Sripoom District, Muang, Chiang Mai 50200, Thailand
| | - Surin Woragidpoonpol
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tanop Srisuwan
- Division of Interventional Radiology, Department of Radiology, Faculty of Internal Medicine, Chiang Mai University, Chiang Mai, Thailand
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8
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Lee NJ, Glockner JF. Multisystem IgG4-related disease involving the abdomen and coronary arteries and causing chronic abdominal pain. Acta Radiol Open 2021; 10:20584601211044989. [PMID: 34603747 PMCID: PMC8485284 DOI: 10.1177/20584601211044989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022] Open
Abstract
IgG4-related disease was originally discovered in patients with autoimmune pancreatitis accompanied by elevated serum IgG4 levels and has subsequently been described in almost every organ system. IgG4-related disease presents with a variety of symptoms according to the organ affected and may be accompanied by serious complications such as organ dysfunction associated with IgG4-positive cell proliferation. We report a case of IgG4-related abdominal disease in a patient who also had involvement of the coronary artery.
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9
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Vasudevan AK, Kumar GA, Rajesh S, Ahamed MZ. IgG4-Related Coronary Aneurysm in a Child. Indian J Pediatr 2021; 88:593. [PMID: 33864603 DOI: 10.1007/s12098-021-03743-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/16/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Anu K Vasudevan
- Department of Pediatrics, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, 695029, India.
| | - G Asok Kumar
- Department of Pediatrics, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, 695029, India
| | - S Rajesh
- Department of Rheumatology, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India
| | - M Zulfikar Ahamed
- Department of Pediatric Cardiology, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India
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10
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Diamond JE, Marboe C, Palmeri N, Cook JR, Bijou R, Restaino S, Lin E. Isolated Immunoglobulin G4-Related Disease Myocarditis Treated With Heart Transplantation. Circ Heart Fail 2020; 13:e007204. [PMID: 32894982 DOI: 10.1161/circheartfailure.120.007204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Jamie E Diamond
- Beth Israel Deaconess Medical Center, Boston, MA (J.E.D., N.P.).,NewYork Presbyterian Hospital/Columbia University Medical Center, New York, NY (C.M., J.R.C., R.B., S.R., E.L.)
| | - Charles Marboe
- Beth Israel Deaconess Medical Center, Boston, MA (J.E.D., N.P.).,NewYork Presbyterian Hospital/Columbia University Medical Center, New York, NY (C.M., J.R.C., R.B., S.R., E.L.)
| | - Nicholas Palmeri
- Beth Israel Deaconess Medical Center, Boston, MA (J.E.D., N.P.).,NewYork Presbyterian Hospital/Columbia University Medical Center, New York, NY (C.M., J.R.C., R.B., S.R., E.L.)
| | - Joshua R Cook
- Beth Israel Deaconess Medical Center, Boston, MA (J.E.D., N.P.).,NewYork Presbyterian Hospital/Columbia University Medical Center, New York, NY (C.M., J.R.C., R.B., S.R., E.L.)
| | - Rachel Bijou
- Beth Israel Deaconess Medical Center, Boston, MA (J.E.D., N.P.).,NewYork Presbyterian Hospital/Columbia University Medical Center, New York, NY (C.M., J.R.C., R.B., S.R., E.L.)
| | - Susan Restaino
- Beth Israel Deaconess Medical Center, Boston, MA (J.E.D., N.P.).,NewYork Presbyterian Hospital/Columbia University Medical Center, New York, NY (C.M., J.R.C., R.B., S.R., E.L.)
| | - Edward Lin
- Beth Israel Deaconess Medical Center, Boston, MA (J.E.D., N.P.).,NewYork Presbyterian Hospital/Columbia University Medical Center, New York, NY (C.M., J.R.C., R.B., S.R., E.L.)
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11
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Hou X, Gao B, Han Q, Wang Q, Liang H, Huo Q. Acetyl-11-keto-β-boswellic acid alleviates myocardial fibrosis injury by inhibiting the TGF-β1/Smads pathway and activating the Nrf2/HO-1 pathway. Minerva Med 2019; 111:285-288. [PMID: 31345015 DOI: 10.23736/s0026-4806.19.06185-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Xiyan Hou
- Clinical Medicine of Emergency Internal Medicine and Critical Care, Affiliated Hospital of Jining Medical University, Jining, China
| | - Bingfeng Gao
- Department of Cardiovascular Medicine, the Third People's Hospital of Linyi, Linyi, China
| | - Qingtao Han
- Department of Vascular Intervention, the People's Hospital of Zhangqiu Area, Jinan, China
| | - Qing Wang
- Department of Emergency Internal Medicine, the People's Hospital of Zhangqiu Area, Jinan, China
| | - Haiyang Liang
- Department of Pharmacy, the People's Hospital of Zhangqiu Area, Jinan, China
| | - Qianqian Huo
- Department of Cardiology, Jining No.1 People's Hospital, Jining, China -
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12
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Fathala A. Multimodalities Imaging of Immunoglobulin 4-related Cardiovascular Disorders. Curr Cardiol Rev 2019; 15:224-229. [PMID: 30652646 PMCID: PMC6719394 DOI: 10.2174/1573403x15666190117101607] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 01/27/2023] Open
Abstract
Immunoglobulin 4 (IgG4)-related systemic disease (IgG4-RSD) is a systemic inflammatory disease characterized by elevation of serum IgG4. IgG4-RSD can affect any organ in the body, and the list of organs associated with this condition is growing steadily. IgG4-related cardiovascular disease affects the coronary arteries, heart valves, myocardium, pericardium, aorta, pulmonary and peripheral vessels. Echocardiography is the most commonly used non-invasive imaging method. Computed tomography angiography (CTA) can assess aortitis, periarteritis and coronary aneurysms. Coronary CTA is fast, offers high spatial resolution and a wide coverage field of view. Cardiac magnetic resonance imaging (CMR) offers a comprehensive evaluation of the cardiovascular system including cardiac function, extent of myocardial fibrosis, characterise cardiac masses with different pulse sequences and guide to further treatment. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) can provide important information about the extent of disease, the presence of active inflammation and the optimum biopsy site. In general, the role of diagnostic imaging includes establishing the diagnosis, detecting complications, guiding biopsy and documenting response to therapy.
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Affiliation(s)
- Ahmed Fathala
- Department of Radiology, King Fasial Hospital, Riyadh, Saudi Arabia
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13
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Misawa Y, Ohki SI, Sugaya A, Uesugi S. Immunoglobulin G4-Related Aortic Disease. Ann Thorac Cardiovasc Surg 2018; 24:211-212. [PMID: 29780068 PMCID: PMC6102608 DOI: 10.5761/atcs.lte.18-00056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Yoshio Misawa
- Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Shin-Ichi Ohki
- Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Akira Sugaya
- Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Satoshi Uesugi
- Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
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