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Azogui R, Porto A, Castelli M, Omnes V, De Masi M, Bartoli M, Piquet P, Gariboldi V, Busa T, Jacquier A, Bal L, Gaudry M. In Marfan Syndrome and Related Diseases, STABILISE Technique Should Be Used with Care: Results from a Volumetric Comparative Study of Endovascular Treatment for Aortic Dissection. J Clin Med 2023; 12:4378. [PMID: 37445413 DOI: 10.3390/jcm12134378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
Objectives: Aortic dissection in patients with Marfan and related syndromes (HTAD) is a serious pathology whose treatment by thoracic endovascular repair (TEVAR) is still under debate. The aim of this study was to assess the results of the TEVAR for aortic dissection in patients with HTAD as compared to a young population without HTAD. Methods: The study received the proper ethical oversight. We performed an observational exposed (confirmed HTAD) vs. non-exposed (<65 years old) study of TEVAR-treated patients. The preoperative, 1 year, and last available CT scans were analyzed. The thoracic and abdominal aortic diameters, aortic length, and volumes were measured. The entry tears and false lumen (FL) status were assessed. The demographic, clinical, and anatomic data were collected during the follow-up. Results: Between 2011 and 2021, 17 patients were included in the HTAD group and 22 in the non-HTAD group. At 1 year, the whole aortic volume increased by +21.2% in the HTAD group and by +0.2% the non-HTAD groups, p = 0.005. An increase in the whole aortic volume > 10% was observed in ten cases (58.8%) in the HTAD group and in five cases (22.7%) in the non-HTAD group (p = 0.022). FL thrombosis was achieved in nine cases (52.9%) in the HTAD group vs. twenty (90.9%) cases in the non-HTAD group (p < 0.01). The risk factors for unfavorable anatomical evolution were male gender and the STABILISE technique. With a linear model, we observed a significantly different aortic volume evolution between the two groups (p < 0.01) with the STABILISE technique; this statistical difference was not found in the TEVAR subgroup. In the HTAD patients, there was a significant difference in the total aortic volume evolution progression between the patients treated with the STABILISE technique and the patients treated with TEVAR (+160.1 ± 52.3% vs. +47 ± 22.5%, p < 0.01 and +189.5 ± 92.5% vs. +58.6 ± 34.8%, p < 0.01 at 1 year and at the end of follow-up, respectively). Conclusions: TEVAR in the HTAD patients seemed to be associated with poorer anatomical outcomes at 1 year. This result was strongly related to the STABILISE technique which should be considered with care in these specific patients.
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Affiliation(s)
- Ron Azogui
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Alizee Porto
- Department of Cardiac Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Maxime Castelli
- Department of Radiology, APHM, Timone Hospital, 13005 Marseille, France
| | - Virgile Omnes
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Mariangela De Masi
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Michel Bartoli
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Philippe Piquet
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Tiffany Busa
- Department of Genetic, APHM, Timone Hospital, 13005 Marseille, France
| | - Alexis Jacquier
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
- Department of Radiology, APHM, Timone Hospital, 13005 Marseille, France
| | - Laurence Bal
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
- Timone Aortic Center, APHM, Centre de Référence Marfan et Apparentés, 13005 Marseille, France
| | - Marine Gaudry
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
- Timone Aortic Center, APHM, Centre de Référence Marfan et Apparentés, 13005 Marseille, France
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Porto A, Omnes V, Bartoli MA, Azogui R, Resseguier N, De Masi M, Bal L, Imbert L, Jaussaud N, Morera P, Jacquier A, Barral PA, Gariboldi V, Gaudry M. Reintervention of Residual Aortic Dissection after Type A Aortic Repair: Results of a Prospective Follow-Up at 5 Years. J Clin Med 2023; 12:jcm12062363. [PMID: 36983363 PMCID: PMC10054589 DOI: 10.3390/jcm12062363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
Background After a type A aortic dissection repair, a patent false lumen in the descending aorta is the most common situation encountered, and is a well-known risk factor for aortic growth, reinterventions and mortality. The aim of this study was to analyze the long-term results of residual aortic dissection (RAD) at a high-volume aortic center with prospective follow-up. Methods In this prospective single-center study, all patients operated for type A aortic dissection between January 2017 and December 2022 were included. Patients without postoperative computed tomography scans or during follow-up at our center, and patients without RAD were excluded. The primary endpoint was all-cause mortality during follow-up for patients with RAD. The secondary endpoints were perioperative mortality, rate of distal aneurysmal evolution, location of distal aneurysmal evolution, rate of distal reinterventions, outcomes of distal reinterventions, and aortic-related death during follow-up. Results In total, 200 survivors of RAD comprised the study group. After a mean follow-up of 27.2 months (1-66), eight patients (4.0%) died and 107 (53.5%) had an aneurysmal progression. The rate of distal reintervention was 19.5% (39/200), for malperfusion syndrome in seven cases (3.5%) and aneurysmal evolution in 32 cases (16.0%). Most reinterventions occurred during the first 2 years (82.1%). Twenty-seven patients were treated for an aneurysmal evolution of RAD including aortic arch with hybrid repair in 21 cases and branched aortic arch endoprosthesis in six cases. In the hybrid repair group, there was no death, and the rate of morbidity was 28.6% (6/21) (one minor stroke, one pulmonary complication, one recurrent paralysis with complete recovery and three major bleeding events). In the branched endograft group, there was no death, no stroke, and no paraplegia. There was one case (16.7%) of carotid dissection. Complete aortic remodeling or complete FL thrombosis on the thoracic aorta was found in 18 cases (85.7%) and in five cases (83.3%) in the hybrid and branched endograft groups, respectively. Conclusions: Despite a critical course in most cases of RAD, with a high rate of aneurysmal evolution and reintervention, the long-term mortality rate remains low with a close follow-up and a multidisciplinary management in an expert center.
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Affiliation(s)
- Alizée Porto
- Department of Cardiac Surgery, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Virgile Omnes
- Department of Vascular Surgery, Timone Aortic Center, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Michel A Bartoli
- Department of Vascular Surgery, Timone Aortic Center, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Ron Azogui
- Department of Vascular Surgery, Timone Aortic Center, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Noémie Resseguier
- Department of Epidemiology and Public Health Cost, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Mariangela De Masi
- Department of Vascular Surgery, Timone Aortic Center, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Laurence Bal
- Department of Vascular Surgery, Timone Aortic Center, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Laura Imbert
- Department of Epidemiology and Public Health Cost, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Nicolas Jaussaud
- Department of Cardiac Surgery, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Pierre Morera
- Department of Cardiac Surgery, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Alexis Jacquier
- Department of Radiology, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Pierre-Antoine Barral
- Department of Radiology, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Marine Gaudry
- Department of Vascular Surgery, Timone Aortic Center, Timone Hospital, Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
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Alqahtani M, Claudinot A, Gaudry M, Bartoli A, Barral PA, Vidal V, Boyer L, Busa T, Cadour F, Jacquier A, De Masi M, Bal L. Endovascular Management of Vascular Complications in Ehlers-Danlos Syndrome Type IV. J Clin Med 2022; 11:6344. [PMID: 36362573 PMCID: PMC9658028 DOI: 10.3390/jcm11216344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2023] Open
Abstract
(1) Background: The vascular type of Ehlers-Danlos syndrome (vEDS) is a rare genetic connective tissue disorder caused by pathogenic variants in the COL3A1 gene that result in arterial and organ fragility and premature death. We present five cases of vEDS that highlight the diagnosis and treatment challenges encountered by clinicians with these patients. (2) Case presentations: we present the cases of five patients with vascular complications of vEDS who were successfully managed using endovascular interventions or hybrid techniques at our institution from 2005 to 2022. (3) Conclusions: These data emphasize that a multidisciplinary approach is needed for vEDS patients and that when endovascular or hybrid treatment is performed in a timely manner by a skilled team of interventional radiologists, good results can be achieved. Our report also demonstrates that the prognosis of vEDS patients has improved over the past 20 years with a new prevention program including celiprolol therapy, physical activity adaptation and limitation, and scheduled monitoring by expert clinicians.
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Affiliation(s)
- Mubarak Alqahtani
- Department of Radiology, Hôpital de la Timone, AP-HM, 13005 Marseille, France
| | | | - Marine Gaudry
- Aortic Center, Hopital de la Timone, AP-HM, 13005 Marseille, France
- Department of Vascular Surgery, Hopital de la Timone, AP-HM, 13005 Marseille, France
| | - Axel Bartoli
- Department of Radiology, Hôpital de la Timone, AP-HM, 13005 Marseille, France
- CRMBM-UMR CNRS 7339, Aix-Marseille University, 13007 Marseille, France
| | | | - Vincent Vidal
- Department of Radiology, Hôpital de la Timone, AP-HM, 13005 Marseille, France
| | - Louis Boyer
- Department of Radiology, University Hospital, 63100 Clermont-Ferrand, France
| | - Tiffany Busa
- Department of Medical Genetics, Hopital Enfants de la Timone, AP-HM, 13005 Marseille, France
- Regional Reference Department for Marfan and Related Diseases, AP-HM, 13005 Marseille, France
| | - Farah Cadour
- Department of Radiology, Hôpital de la Timone, AP-HM, 13005 Marseille, France
| | - Alexis Jacquier
- Department of Radiology, Hôpital de la Timone, AP-HM, 13005 Marseille, France
- CRMBM-UMR CNRS 7339, Aix-Marseille University, 13007 Marseille, France
| | - Mariangela De Masi
- Aortic Center, Hopital de la Timone, AP-HM, 13005 Marseille, France
- Department of Vascular Surgery, Hopital de la Timone, AP-HM, 13005 Marseille, France
| | - Laurence Bal
- Aortic Center, Hopital de la Timone, AP-HM, 13005 Marseille, France
- Department of Vascular Surgery, Hopital de la Timone, AP-HM, 13005 Marseille, France
- Regional Reference Department for Marfan and Related Diseases, AP-HM, 13005 Marseille, France
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Gaudry M, Guivier-Curien C, Blanchard A, Porto A, Bal L, Omnes V, De Masi M, Lu C, Jacquier A, Piquet P, Deplano V. Volume Analysis to Predict the Long-Term Evolution of Residual Aortic Dissection after Type A Repair. J Cardiovasc Dev Dis 2022; 9:jcdd9100349. [PMID: 36286301 PMCID: PMC9604488 DOI: 10.3390/jcdd9100349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/26/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022] Open
Abstract
Background: The aim of this study was to evaluate the aortic diameter and volume during the first year after a type A repair to predict the long-term prognosis of a residual aortic dissection (RAD). Methods: All patients treated in our center for an acute type A dissection with a RAD and follow-up > 3 years were included. We defined two groups: group 1 with dissection-related events (defined as an aneurysmal evolution, distal reintervention, or aortic-related death) and group 2 without dissection-related events. The aortic diameters and volume analysis were evaluated on three postoperative CT scans: pre-discharge (T1), 3−6 months (T2) and 1 year (T3). Results: Between 2009 and 2016, 54 patients were included. Following a mean follow-up of 75.4 months (SD 31.5), the rate of dissection-related events was 62.9% (34/54). The total aortic diameters of the descending thoracic aorta were greater in group 1 at T1, T2 and T3, with greater diameters in the FL (p < 0.01). The aortic diameter evolution at 3 months was not predictive of long-term dissection-related events. The total thoracic aortic volume was significantly greater in group 1 at T1 (p < 0.01), T2 (p < 0.01), and T3 (p < 0.01). At 3 months, the increase in the FL volume was significantly greater in group 1 (p < 0.01) and was predictive for long-term dissection-related events. Conclusion: This study shows that an initial CT scan volume analysis coupled with another at 3 months is predictive for the long-term evolution in a RAD. Based on this finding, more aggressive treatment could be given at an earlier stage.
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Affiliation(s)
- Marine Gaudry
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
- Correspondence: ; Tel.: +33-491-388-120
| | | | - Arnaud Blanchard
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Alizée Porto
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
- Department of Cardiac Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Laurence Bal
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Virgile Omnes
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Mariangela De Masi
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Charlotte Lu
- Department of Radiology, APHM, Timone Hospital, 13005 Marseille, France
| | - Alexis Jacquier
- Department of Radiology, APHM, Timone Hospital, 13005 Marseille, France
| | - Philippe Piquet
- Timone Aortic Center, Department of Vascular Surgery, APHM, Timone Hospital, 13005 Marseille, France
| | - Valerie Deplano
- CNRS, Centrale Marseille, IRPHE, Aix Marseille University, 13013 Marseille, France
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Gaudry M, Azogui R, Castelli M, Bartoli M, Omnes V, Demasi M, Jacquier A, Piquet P, Gariboldi V, Busa T, Bal L. Endovascular treatment of aortic dissections in patients presenting a syndrome of Marfan or a related disease: Results of a comparative study. Ann Vasc Surg 2022. [DOI: 10.1016/j.avsg.2022.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Billon C, Adham S, Hernandez Poblete N, Legrand A, Frank M, Chiche L, Zuily S, Benistan K, Savale L, Zaafrane-Khachnaoui K, Brehin AC, Bal L, Busa T, Fradin M, Quelin C, Chesneau B, Wahl D, Fergelot P, Goizet C, Mirault T, Jeunemaitre X, Albuisson J. Cardiovascular and connective tissue disorder features in FLNA-related PVNH patients: progress towards a refined delineation of this syndrome. Orphanet J Rare Dis 2021; 16:504. [PMID: 34863227 PMCID: PMC8642866 DOI: 10.1186/s13023-021-02128-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND FLNA Loss-of-Function (LoF) causes periventricular nodular heterotopia type 1 (PVNH1), an acknowledged cause of seizures of various types. Neurological symptoms are inconstant, and cardiovascular (CV) defects or connective tissue disorders (CTD) have regularly been associated. We aimed at refining the description of CV and CTD features in patients with FLNA LoF and depicting the multisystemic nature of this condition. METHODS We retrospectively evaluated FLNA variants and clinical presentations in FLNA LoF patient with at least one CV or CTD feature, from three cohorts: ten patients from the French Reference Center for Rare Vascular Diseases, 23 patients from the national reference diagnostic lab for filaminopathies-A, and 59 patients from literature review. RESULTS Half of patients did not present neurological symptoms. Most patients presented a syndromic association combining CV and CTD features. CV anomalies, mostly aortic aneurysm and/or dilation were present in 75% of patients. CTD features were present in 75%. Variants analysis demonstrated an enrichment of coding variants in the CH1 domain of FLNA protein. CONCLUSION In FLNA LoF patients, the absence of seizures should not be overlooked. When considering a diagnosis of PVNH1, the assessment for CV and CTD anomalies is of major interest as they represent interlinked features. We recommend systematic study of FLNA within CTD genes panels, regardless of the presence of neurological symptoms.
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Affiliation(s)
- Clarisse Billon
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France. .,INSERM, U970 PARCC, Université de Paris, Paris, France.
| | - Salma Adham
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,Service de Médecine Vasculaire, Hôpital Saint Eloi, CHU Montpellier, Montpellier, France
| | - Natalia Hernandez Poblete
- Département de génétique médicale, Centre national de référence pour les maladies rares Neurogénétiques, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France.,Laboratoire de maladies rares : Génétique et Metabolisme (MRGM), INSERM U1211, Université de Bordeaux, Bordeaux, France
| | - Anne Legrand
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,INSERM, U970 PARCC, Université de Paris, Paris, France
| | - Michael Frank
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,INSERM, U970 PARCC, Université de Paris, Paris, France
| | - Laurent Chiche
- Faculté de médecine, Université de la Sorbonne, Paris, France.,Service de chirurgie vasculaire et endovasculaire, Centre aortique tertiaire, Hôpital universitaire Pitié-Salpêtrière, AP-HP, Paris, France
| | - Stephane Zuily
- Inserm UMRS 1116 DCAC, Université de Lorraine, Nancy, France.,Division de médecine vasculaire et centre de compétence régional pour les maladies vasculaires rares et autoimmunes systémiques, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Karelle Benistan
- Centre de Référence des Syndromes d'Ehlers-Danlos non Vasculaires, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, Garches, France.,UMR U1179 INSERM, Université Versailles Saint-Quentin, Montigny-le-Bretonneux, France
| | - Laurent Savale
- Université Paris-Saclay, Le Kremlin Bicêtre, France.,UMR_S 999, INSERM, Groupe hospitalier Marie-Lannelongue -Saint Joseph, Université Paris-Sud, Le Plessis-Robinson, France.,Service de Pneumologie, Hôpital Bicêtre, APHP, Le Kremlin-Bicêtre, France
| | | | - Anne-Claire Brehin
- INSERM U1245 , Normandy center for Genomic and Personalized Medicine, Normandie Univ, CHU Rouen, 76000, Rouen, France
| | - Laurence Bal
- Centre de référence régional Marfan et apparentés, Centre aortique, Hôpital La Timone, AP-HM, Marseille, France
| | - Tiffany Busa
- Département de Génétique Médicale, Hôpital La Timone, CHU de Marseille, Marseille, France
| | - Mélanie Fradin
- Service de Génétique Clinique, Centre de Référence Maladies Rares CLAD-Ouest, ERN ITHACA, CHU Rennes, Hôpital Sud, Rennes, France
| | - Chloé Quelin
- Service de Génétique Clinique, Centre de Référence Maladies Rares CLAD-Ouest, ERN ITHACA, CHU Rennes, Hôpital Sud, Rennes, France
| | - Bertrand Chesneau
- Service de génétique médicale, Hôpital Purpan, CHU de Toulouse, Toulouse, France.,Centre de Référence du Syndrome de Marfan et des syndromes apparentés, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - Denis Wahl
- Inserm UMRS 1116 DCAC, Université de Lorraine, Nancy, France.,Division de médecine vasculaire et centre de compétence régional pour les maladies vasculaires rares et autoimmunes systémiques, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Patricia Fergelot
- Département de génétique médicale, Centre national de référence pour les maladies rares Neurogénétiques, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France.,Laboratoire de maladies rares : Génétique et Metabolisme (MRGM), INSERM U1211, Université de Bordeaux, Bordeaux, France
| | - Cyril Goizet
- Département de génétique médicale, Centre national de référence pour les maladies rares Neurogénétiques, Hôpital Pellegrin, CHU Bordeaux, Bordeaux, France.,Faculté de médecine, Université de la Sorbonne, Paris, France
| | - Tristan Mirault
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,INSERM, U970 PARCC, Université de Paris, Paris, France
| | - Xavier Jeunemaitre
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,INSERM, U970 PARCC, Université de Paris, Paris, France
| | - Juliette Albuisson
- Département de génétique, Centre national de référence pour les maladies vasculaires rares, centre de référence européen VASCERN MSA, Hôpital Européen Georges Pompidou, AP-HP, 20 rue Leblanc, 75015, Paris, France.,INSERM, U970 PARCC, Université de Paris, Paris, France.,Plateforme de Transfert en Biologie Cancérologique, Centre Georges François Leclerc - UNICANCER- Institut GIMI, Dijon, France
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Gaudry M, Porto A, Guivier-Curien C, Blanchard A, Bal L, Resseguier N, Omnes V, De Masi M, Ejargue M, Jacquier A, Gariboldi V, Deplano V, Piquet P. Results of a prospective follow-up study after type A aortic dissection repair: a high rate of distal aneurysmal evolution and reinterventions. Eur J Cardiothorac Surg 2021; 61:152-159. [PMID: 34355742 DOI: 10.1093/ejcts/ezab317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/08/2021] [Accepted: 06/10/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES We investigated the anatomical evolution of residual aortic dissection after type A repair and factors associated with poor prognosis at a high-volume aortic centre. METHODS Between 2017 and 2019, all type A aortic dissections were included for prospective follow-up. Patients without follow-up computed tomography (CT) scan available for radiological analysis and patients without residual aortic dissection were excluded from this study. The primary end point was a composite end point defined as dissection-related events including aneurysmal evolution (increased diameter > 5 mm/year), aortic reintervention for malperfusion syndrome, aortic diameter >55 mm, rapid aortic growth >10 mm/year or aortic rupture and death. The secondary end points were risk factors for dissection-related events and reintervention analysis. All immediate and last postoperative CT scans were analysed. RESULTS Among 104 patients, after a mean follow-up of 20.4 months (8-41), the risk of dissection-related events was 46.1% (48/104) and the risk of distal reintervention was 17.3% (18/104). Marfan syndrome (P < 0.01), aortic bicuspid valve (P = 0.038), innominate artery debranching (P = 0.025), short aortic cross-clamp time (P = 0.011), initial aortic diameter >40 mm (P < 0.01) and absence of resection of the primary entry tear (P = 0.015) were associated with an increased risk of dissection-related events or reintervention during follow-up. CONCLUSIONS Residual aortic dissection is a serious disease requiring close follow-up at an expert centre. This study shows higher reintervention and aneurysmal development rates than currently published. To improve long-term outcomes, the early demographic and anatomic poor prognostic factors identified may be used for more aggressive treatment at an early phase.
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Affiliation(s)
- Marine Gaudry
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
| | - Alizée Porto
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Carine Guivier-Curien
- Aix-Marseille Université, CNRS, Ecole Centrale Marseille, IRPHE UMR 7342, Marseille, France
| | - Arnaud Blanchard
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
| | - Laurence Bal
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
| | - Noemie Resseguier
- Department of Epidemiology and Public Health Cost, APHM, Marseille, France
| | - Virgile Omnes
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
| | - Mariangela De Masi
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
| | - Meghann Ejargue
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
| | - Alexis Jacquier
- Department of Radiology, APHM, Timone Hospital, Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Valérie Deplano
- Aix-Marseille Université, CNRS, Ecole Centrale Marseille, IRPHE UMR 7342, Marseille, France
| | - Philippe Piquet
- Department of Vascular Surgery, APHM, Timone Hospital, Timone Aortic Center, Marseille, France
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8
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Zieminski P, Risse J, Legrand A, Dufrost V, Bal L, Settembre N, Malikov S, Jeunemaitre X, Wahl D, Zuily S. Vascular manifestations and kyphoscoliosis due to a novel mutation of PLOD1 gene. Acta Cardiol 2021; 76:557-558. [PMID: 32746767 DOI: 10.1080/00015385.2020.1802904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Piotr Zieminski
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
- Inserm, UMR_S 1116, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Jessie Risse
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
- Inserm, UMR_S 1116, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Anne Legrand
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Centre de Référence des Maladies Vasculaires Rares, Paris, France
- Inserm, U970, Paris Cardiovascular Research Centre, Paris, France
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Virginie Dufrost
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
- Inserm, UMR_S 1116, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Laurence Bal
- Timone Aortic Center, Department of Vascular Surgery, La Timone Hospital, Marseille, France
| | - Nicla Settembre
- Inserm, UMR_S 1116, Université de Lorraine, Vandoeuvre-lès-Nancy, France
- Department of Vascular Surgery, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Sergueï Malikov
- Inserm, UMR_S 1116, Université de Lorraine, Vandoeuvre-lès-Nancy, France
- Department of Vascular Surgery, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Xavier Jeunemaitre
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Centre de Référence des Maladies Vasculaires Rares, Paris, France
- Inserm, U970, Paris Cardiovascular Research Centre, Paris, France
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Denis Wahl
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
- Inserm, UMR_S 1116, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Stéphane Zuily
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
- Inserm, UMR_S 1116, Université de Lorraine, Vandoeuvre-lès-Nancy, France
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9
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El Chehadeh S, Legrand A, Stoetzel C, Geoffroy V, Billon C, Adham S, Jeunemaître X, Jaussaud R, Muller J, Schaefer E, Benistan K, Gaertner S, Bloch-Zupan A, Courval A, Manière MC, Petit C, Bursztejn AC, Bal L, Reyre A, Chammas A, Busa T, Dollfus H, Lipsker D. Periodontal (formerly type VIII) Ehlers-Danlos syndrome: Description of 13 novel cases and expansion of the clinical phenotype. Clin Genet 2021; 100:206-212. [PMID: 33890303 DOI: 10.1111/cge.13972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/18/2021] [Indexed: 01/08/2023]
Abstract
Periodontal Ehlers-Danlos syndrome (pEDS) is a rare condition caused by pathogenic variants in the C1R and C1S genes, encoding subunits C1r and C1s of the first component of the classical complement pathway. It is characterized by early-onset periodontitis with premature tooth loss, pretibial hyperpigmentation and skin fragility. Rare arterial complications have been reported, but venous insufficiency is rarely described. Here we report 13 novel patients carrying heterozygous pathogenic variants in C1R and C1S including three novel C1S variants (c.962G > C, c.961 T > G and c.961 T > A). In addition to the pEDS phenotype, three patients and one relative displayed widespread venous insufficiency leading to persistent varicose leg ulcers. One patient suffered an intracranial aneurysm with familial vascular complications including thoracic and abdominal aortic aneurysm and dissection and intracranial aneurysm rupture. This work confirms that vascular complications can occur, although they are not frequent, which leads us to propose to carry out a first complete non-invasive vascular evaluation at the time of the diagnosis in pEDS patients. However, larger case series are needed to improve our understanding of the link between complement pathway activation and connective tissue alterations observed in these patients, and to better assess the frequency, type and consequences of the vascular complications.
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Affiliation(s)
- Salima El Chehadeh
- Service de Génétique Médicale, Institut de Génétique Médicale d'Alsace (IGMA), Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France.,Laboratoire de Génétique Médicale, UMRS_1112, Institut de Génétique Médicale d'Alsace (IGMA), Université de Strasbourg et INSERM, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM U1258, CNRS-UMR7104, Université de Strasbourg, Illkirch-Graffenstaden, France
| | - Anne Legrand
- INSERM, U970, Paris Centre de Recherche Cardiovasculaire, Université de Paris, Paris, France.,Centre de Référence des Maladies Vasculaires Rares, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Corinne Stoetzel
- Laboratoire de Génétique Médicale, UMRS_1112, Institut de Génétique Médicale d'Alsace (IGMA), Université de Strasbourg et INSERM, Strasbourg, France
| | - Véronique Geoffroy
- Laboratoire de Génétique Médicale, UMRS_1112, Institut de Génétique Médicale d'Alsace (IGMA), Université de Strasbourg et INSERM, Strasbourg, France
| | - Clarisse Billon
- INSERM, U970, Paris Centre de Recherche Cardiovasculaire, Université de Paris, Paris, France.,Centre de Référence des Maladies Vasculaires Rares, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Salma Adham
- Centre de Référence des Maladies Vasculaires Rares, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Xavier Jeunemaître
- INSERM, U970, Paris Centre de Recherche Cardiovasculaire, Université de Paris, Paris, France.,Centre de Référence des Maladies Vasculaires Rares, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Roland Jaussaud
- Département de Médecine Interne Immunologie Clinique, CHRU de Nancy et Université de Lorraine, Nancy, France
| | - Jean Muller
- Laboratoire de Génétique Médicale, UMRS_1112, Institut de Génétique Médicale d'Alsace (IGMA), Université de Strasbourg et INSERM, Strasbourg, France.,Laboratoire de Diagnostic Génétique, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Elise Schaefer
- Service de Génétique Médicale, Institut de Génétique Médicale d'Alsace (IGMA), Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | - Karelle Benistan
- Centre de Référence des Syndromes d'Ehlers-Danlos non Vasculaires, Hôpital Raymond Poincaré, Garches, Assistance Publique Hôpitaux de Paris, Garches, France.,UMR U1179 INSERM, Université Versailles Saint-Quentin, Montigny-le-Bretonneux, France
| | - Sébastien Gaertner
- Service des Maladies Vasculaires - Hypertension Artérielle, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France.,Regenerative Nanomedicine, INSERM, UMR 1260, FMTS, Strasbourg, France
| | - Agnès Bloch-Zupan
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM U1258, CNRS-UMR7104, Université de Strasbourg, Illkirch-Graffenstaden, France.,Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France.,Pôle de Médecine et Chirurgie Bucco-Dentaires, Hôpital Civil, Centre de Référence des Maladies Rares Orales et Dentaires, O-Rares, Filière Santé Maladies Rares TETE COU, European Reference Network ERN CRANIO, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Aymeric Courval
- Pôle de Médecine et Chirurgie Bucco-Dentaires, Hôpital Civil, Centre de Référence des Maladies Rares Orales et Dentaires, O-Rares, Filière Santé Maladies Rares TETE COU, European Reference Network ERN CRANIO, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Marie-Cécile Manière
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM U1258, CNRS-UMR7104, Université de Strasbourg, Illkirch-Graffenstaden, France.,Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France.,Pôle de Médecine et Chirurgie Bucco-Dentaires, Hôpital Civil, Centre de Référence des Maladies Rares Orales et Dentaires, O-Rares, Filière Santé Maladies Rares TETE COU, European Reference Network ERN CRANIO, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Catherine Petit
- Faculté de Chirurgie Dentaire, Université de Strasbourg, Strasbourg, France.,Pôle de Médecine et Chirurgie Bucco-Dentaires, Hôpital Civil, Centre de Référence des Maladies Rares Orales et Dentaires, O-Rares, Filière Santé Maladies Rares TETE COU, European Reference Network ERN CRANIO, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,INSERM, UMR 1260 'Osteoarticular and Dental Regenerative Nanomedicine', Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France
| | - Anne-Claire Bursztejn
- Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Service de Dermatologie, Hôpitaux de Brabois, CHU de Nancy, Vandœuvre-lès-Nancy, France
| | - Laurence Bal
- Timone Aortic Center, Department of Vascular Surgery, Timone Hospital, APHM, Marseille, France
| | - Anthony Reyre
- Service de Neuroradiologie Interventionnelle, CHU de Marseille, Hôpital La Timone, Marseille, France
| | - Agathe Chammas
- Service de radiologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | - Tiffany Busa
- Département de Génétique Médicale, CHU de Marseille, Hôpital La Timone, Marseille, France
| | - Hélène Dollfus
- Service de Génétique Médicale, Institut de Génétique Médicale d'Alsace (IGMA), Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France.,Laboratoire de Génétique Médicale, UMRS_1112, Institut de Génétique Médicale d'Alsace (IGMA), Université de Strasbourg et INSERM, Strasbourg, France.,Filière SENSGENE, Centre de Référence Pour les Affections Rares en Génétique Ophtalmologique, CARGO, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Dan Lipsker
- Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Faculté de Médecine, Université de Strasbourg, Strasbourg, France
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10
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Gaudry M, Barral PA, Blanchard A, Palazzolo S, Bolomey S, Omnes V, De Masi M, Carcopino-Tusoli M, Meyrignac O, Rousseau H, Jacquier A, Hassen-Khodja R, Bura-Rivière A, Bartoli JM, Gentile S, Piquet P, Bal L. Prevalence of Thoracic Aortic Aneurysms in Patients with Degenerative Abdominal Aortic Aneurysms: Results from the Prospective ACTA Study. Eur J Vasc Endovasc Surg 2021; 61:930-937. [PMID: 33892987 DOI: 10.1016/j.ejvs.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 02/10/2021] [Accepted: 03/02/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE There are no recommendations for screening for thoracic aortic aneurysms (TAAs), even in patients with infrarenal abdominal aortic aneurysms (AAAs). The aims of this study were to determine the prevalence of TAAs in patients with AAAs and to analyse the risk factors for this association. METHODS This was a multicentre prospective study. The Aortic Concomitant Thoracic and Abdominal Aneurysm (ACTA) study included 331 patients with infrarenal AAAs > 40 mm between September 2012 and May 2016. These patients were prospectively enrolled in three French academic hospitals. RESULTS Patients were classified as having a normal, aneurysmal, or ectatic (non-normal, non-aneurysmal) thoracic aorta according to their maximum aortic diameter indexed by sex, age, and body surface area. Thoracic aortic ectasia (TAE) was defined as above or equal to the 90th percentile of normal aortic diameters according to gender and body surface area. Descending TAA was defined as ≥ 150% of the mean normal value, and ascending TAA as > 47 mm in men and 42 mm in women; 7.6% (n = 25) had either an ascending (seven cases; 2.2%) or descending aortic TAA (18 cases; 5.4%), and 54.6% (n = 181) had a TAE. Among the 25 patients with TAAs, five required surgery; two patients had TAAs related to penetrating aortic ulcers < 60 mm in diameter, and three had a TAA > 60 mm. In the multinomial regression analysis, atrial fibrillation (AF) (odds ratio [OR] 11.36, 95% confidence interval [CI] 2.18 - 59.13; p = .004) and mild aortic valvulopathy (OR 2.89, 1.04-8.05; p = .042) were independent factors associated with TAAs. Age (OR 1.06, CI 1.02 - 1.09; p = .003) and AF (OR 4.36, 1.21 - 15.61; p = .024) were independently associated with ectasia. CONCLUSION This study confirmed that TAAs coexisting with AAAs are not rare, and one fifth of these TAAs are treated surgically. Systematic screening by imaging the whole aorta in patients with AAAs is clinically relevant and should lead to an effective prevention policy.
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Affiliation(s)
- Marine Gaudry
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France.
| | - Pierre-Antoine Barral
- Department of Radiology, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France
| | | | | | - Sonia Bolomey
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France
| | - Virgile Omnes
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France
| | - Mariangela De Masi
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France
| | - Magali Carcopino-Tusoli
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France
| | - Olivier Meyrignac
- Department of Radiology, University Hospital of Toulouse, Toulouse, France
| | - Hervé Rousseau
- Department of Radiology, University Hospital of Toulouse, Toulouse, France
| | - Alexis Jacquier
- Department of Radiology, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France
| | - Reda Hassen-Khodja
- Department of Vascular Surgery, University Hospital of Nice, Hôpital Pasteur, Nice, France
| | | | - Jean-Michel Bartoli
- Department of Radiology, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France
| | - Stéphanie Gentile
- Department of Medical Evaluation, EA 3279 CEReSS, AP-HM, Conception Hospital, Marseille, France
| | - Philippe Piquet
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France
| | - Laurence Bal
- Department of Vascular Surgery, APHM, Timone Hospital, Marseille, France; Aortic Centre, APHM, Timone Hospital, Marseille, France.
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11
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Ghulam Q, Bredahl K, Eiberg J, Bal L, van Sambeek MR, Kirksey L, Kilaru S, Taudorf M, Rouet L, Collet-Billon A, Kawashima T, Entrekin R, Sillesen H. Three-dimensional ultrasound is a reliable alternative in endovascular aortic repair surveillance. J Vasc Surg 2021; 74:979-987. [PMID: 33684470 DOI: 10.1016/j.jvs.2021.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Three-dimensional ultrasound (3D-US) has already demonstrated improved reproducibility with a high degree of agreement (intermodality variability), reproducibility (interoperator variability), and repeatability (intraoperator variability) compared with conventional two-dimensional ultrasound (2D-US) when estimating the maximum diameter of native abdominal aortic aneurysms (AAAs). The aim of the present study was, in a clinical, multicenter setting, to evaluate the accuracy of 3D-US with aneurysm model quantification software (3D-US abdominal aortic aneurysm [AAA] model) for endovascular aortic aneurysm repair (EVAR) sac diameter assessment vs that of computed tomography angiography (CTA) and 2D-US. METHODS A total of 182 patients who had undergone EVAR from April 2016 to December 2017 and were compliant with a standardized EVAR surveillance program were enrolled from five different vascular centers (Rigshospitalet, Copenhagen, Denmark; Catharina Ziekenhuis, Eindhoven, Netherlands; L'hospital de la Timone, Paris, France; Cleveland Clinic, Cleveland, Ohio; and The Christ Hospital, Cincinnati, Ohio) in four countries. All image acquisitions were performed at the local sites (ie, 2D-US, 3D-US, CTA). Only the 2D-US and CTA readings were performed both locally and centrally. All images were read centrally by the US and CTA core laboratory. Anonymized image data were read in a randomized and blinded manner. RESULTS The sample used to estimate the accuracy of the 3D-US AAA model and 2D-US included 164 patients and 177 patients, respectively. The Bland-Altman analysis revealed that the mean difference between CTA and 3D-US was -2.43 mm (95% confidence interval [CI], -5.20 to 0.14; P = .07) with a lower and upper limit of agreement of -8.9 mm (95% CI, -9.3 to -8.4) and 2.7 mm (95% CI, 2.3-3.2), respectively. For 2D-US and CTA, the mean difference was -3.62 mm (95% CI, -6.14 to -1.10; P = .002), with a lower and upper limit of agreement of -10.3 mm (95% CI, -10.8 to -9.8) and 2.5 mm (95% CI, 2-2.9), respectively. CONCLUSIONS The 3D-US AAA model showed no significant difference compared with CTA for measuring the anteroposterior diameter, indicating less bias for 3D-US compared with 2D-US. Thus, 3D-US with AAA model software is a viable modality for anteroposterior diameter assessment for surveillance after EVAR.
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Affiliation(s)
- Qasam Ghulam
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark.
| | - Kim Bredahl
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Eiberg
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Copenhagen Academy of Medical Education and Simulation, Copenhagen, Denmark
| | - Laurence Bal
- Le Centre Aorte Timone, Department of Cardiovascular Surgery, Hospital de la Timone, Marseille, France
| | - Marc R van Sambeek
- Department of Vascular Surgery, Catharina Ziekenhuis, Eindhoven, Netherlands; Department of Cardiovascular Biomechanics, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Lee Kirksey
- Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Sashi Kilaru
- Department of Vascular Surgery, The Christ Hospital, Cincinnati, Ohio
| | | | - Laurence Rouet
- Philips Research Medisys, Suresnes, Philips Ultrasound, Bothell, Wash
| | | | - Toana Kawashima
- Regulatory and Clinical Affairs, Philips Ultrasound, Bothell, Wash
| | - Robert Entrekin
- Ultrasound Clinical Science, Philips Ultrasound, Bothell, Wash
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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12
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Gaudry M, Ejargue M, Porto A, Omnes V, de Masi M, Bolomey S, Gariboldi V, Leveille L, Soler R, Barral PA, Jacquier A, Bal L, Piquet P. Anatomical evolution of residual type B aortic dissections and associated prognostic factors: One year results of the prospective follow-up in an expert center. Ann Vasc Surg 2020. [DOI: 10.1016/j.avsg.2020.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Meyrignac O, Bal L, Zadro C, Vavasseur A, Sewonu A, Gaudry M, Saint-Lebes B, De Masi M, Revel-Mouroz P, Sommet A, Darcourt J, Negre-Salvayre A, Jacquier A, Bartoli JM, Piquet P, Rousseau H, Moreno R. Combining Volumetric and Wall Shear Stress Analysis from CT to Assess Risk of Abdominal Aortic Aneurysm Progression. Radiology 2020; 295:722-729. [PMID: 32228297 DOI: 10.1148/radiol.2020192112] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Despite known limitations, the decision to operate on abdominal aortic aneurysm (AAA) is primarily on the basis of measurement of maximal aneurysm diameter. Purpose To identify volumetric and computational fluid dynamics parameters to predict AAAs that are likely to progress in size. Materials and Methods This study, part of a multicenter prospective registry (NCT01599533), included 126 patients with AAA. Patients were sorted into stable (≤10-mL increase in aneurysm volume) and progression (>10-mL increase in aneurysm volume) groups. Initial AAA characteristics of the derivation cohort were analyzed (maximal diameter and surface, thrombus and lumen volumes, maximal wall pressure, and wall shear stress [WSS]) to identify relevant parameters for a logistic regression model. Model and maximal diameter diagnostic performances were assessed in both cohorts and for AAAs smaller than 50 mm by using area under the receiver operating characteristic curve (AUC). Results Eighty-one patients were included (mean age, 73 years ± 7 years [standard deviation]; 78 men). The derivation and validation cohorts included, respectively, 50 and 31 participants. In the derivation cohort, there was higher mean lumen volume and lower mean WSS in the progression group compared with the stable group (60 mL ± 14 vs 46 mL ± 18 [P = .005] and 66% ± 6 vs 53% ± 9 [P = .02], respectively). Mean lumen volume and mean WSS at baseline were correlated to total volume growth (r = 0.47 [P = .002] and -0.42 [P = .006], respectively). In the derivation cohort, a regression model including lumen volume and WSS to predict aneurysm enlargement was superior to maximal diameter alone (AUC, 0.78 vs 0.52, respectively; P = .003); although no difference was found in the validation cohort (AUC, 0.79 vs 0.71, respectively; P = .51). For AAAs smaller than 50 mm, a regression model that included both baseline WSS and lumen volume performed better than maximal diameter (AUC, 0.79 vs 0.53, respectively; P = .01). Conclusion Combined analysis of lumen volume and wall shear stress was associated with enlargement of abdominal aortic aneurysms at 1 year, particularly in aneurysms smaller than 50 mm in diameter. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Mitsouras and Leach in this issue.
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Affiliation(s)
- Olivier Meyrignac
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Laurence Bal
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Charline Zadro
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Adrien Vavasseur
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Anou Sewonu
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Marine Gaudry
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Bertrand Saint-Lebes
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Mariangela De Masi
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Paul Revel-Mouroz
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Agnès Sommet
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Jean Darcourt
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Anne Negre-Salvayre
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Alexis Jacquier
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Jean-Michel Bartoli
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Philippe Piquet
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Hervé Rousseau
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
| | - Ramiro Moreno
- From the Department of Radiology, Institut Universitaire du Cancer de Toulouse, Avenue Irène Joliot Curie, 31100 Toulouse, France (O.M.); Department of Radiology, CHU Toulouse Rangueil, Toulouse, France (O.M., C.Z., A.V., P.R.M., J.D., H.R.); INSERM, UMR1048, Institut des Maladies Métaboliques et Cardiovasculaire, Toulouse, France (O.M., C.Z., A.V., A. Sewonu, B.S.L., P.R.M., J.D., A.N.S., H.R., R.M.); Department of Vascular Surgery, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (L.B., M.G., M.D.M., P.P.); ALARA Expertise, Strasbourg, France (A. Sewonu, R.M.); Department of Fundamental Pharmaco-Clinical Pharmacology, Université Paul Sabatier, Toulouse, France (A. Sommet); Department of Vascular Surgery, CHU Toulouse Rangueil, Toulouse, France (B.S.L.); and Department of Radiology, Centre Aorte Timone, APHM, CHU de La Timone Adultes, Marseille, France (A.J., J.M.B.)
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Bolomey S, Blanchard A, Barral PA, Mancini J, Lagier D, Bal L, De Masi M, Jacquier A, Piquet P, Gaudry M. Is the Natural Anatomical Evolution of Type B Intramural Hematomas Reliable to Identify the Patients at Risk of Aneurysmal Progression? Ann Vasc Surg 2020; 64:62-70. [PMID: 31904521 DOI: 10.1016/j.avsg.2019.11.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/29/2019] [Accepted: 11/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The natural history of type B intramural hematomas is little-known. Aneurysmal progression or an aortic dissection occurs in 15 to 20% of the cases. The study of the natural anatomical evolution could help identify the patients at risk of unfavorable evolution. METHODS All the patients monitored for a type B intramural hematoma between 2009 and 2018 were included in this monocentric retrospective study. Computed tomography angiography centerline measurement of diameters was obtained in various points of aortic segmentation on day (D) 0 and at one month (M1). Aortic volumes (lumen, intramural hematoma, and total volume) were calculated. The circulating volume was calculated using the volume rendering method. The volume of the intramural hematoma was measured using a manual section-by-section segmentation tool, and the total volume was obtained by summing up the two preceding volumes. Two groups of patients were compared: group 1 (favorable anatomical evolution) and group 2 (unfavorable anatomical evolution). RESULTS Between January 2008 and August 2018, 25 patients were managed for a type B intramural hematoma in our center. After an average follow-up of 15.5 months (1-52), 13 patients (52%) presented a favorable evolution and 12 (48%) an unfavorable evolution. At M1, a significant increase of the luminal diameters (37 mm vs. 32 mm; P < 0.01) and a significant reduction in the longitudinal extension (19 mm vs. 26 mm; P < 0.01) were observed. The maximum aortic diameter evolved significantly between D0 and M1 in the unfavorable evolution group (49 mm vs. 44 mm, respectively; P = 0.038). Such a difference was not found in the favorable evolution group (37.4 vs. 37.1, respectively; P = 0.552). An overall significant reduction in the total aortic volume (166 cm3 vs. 219 cm3; P < 0.01), the circulating volume (124 cm3 vs. 145 cm3; P = 0,026), and the volume of the hematoma (42 cm3 vs. 39 cm3; P < 0.01) was observed. The circulating volume decreased significantly between D0 and M1 in the favorable evolution group (110 cm3 vs. 135 cm3; P = 0.05), whereas no difference was noted in the unfavorable group (142 cm3 vs, 157 cm3; P = 0.24). CONCLUSIONS The progression of the maximum aortic diameter and of the circulating volume after one month of follow-up could be predictive factors of the poor long-term evolution of type B intramural hematomas.
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Affiliation(s)
- Sonia Bolomey
- APHM, Hôpital de La Timone, Department of Vascular Surgery, Marseille, France
| | - Arnaud Blanchard
- APHM, Hôpital de La Timone, Department of Vascular Surgery, Marseille, France
| | | | - Julien Mancini
- Aix-Marseille University, APHM, INSERM, IRD Biostatistics Department, SESSTIM, BIOSTIC, Marseille, France
| | - David Lagier
- APHM, Hôpital de La Timone, Department of Anesthesiology, Marseille, France
| | - Laurence Bal
- APHM, Hôpital de La Timone, Department of Vascular Surgery, Marseille, France
| | - Mariangela De Masi
- APHM, Hôpital de La Timone, Department of Vascular Surgery, Marseille, France
| | - Alexis Jacquier
- APHM, Hôpital de La Timone, Department of Radiology, Marseille, France
| | - Philippe Piquet
- APHM, Hôpital de La Timone, Department of Vascular Surgery, Marseille, France
| | - Marine Gaudry
- APHM, Hôpital de La Timone, Department of Vascular Surgery, Marseille, France.
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De Masi M, Guivier-Curien C, Omnes V, Gaudry M, Bal L, Jacquier A, Deplano V, Piquet P. Correlation Between Unfavorable Tevar Evolution and Morphological Parameters. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hascoet S, Edouard T, Plaisancie J, Arnoult F, Milleron O, Stheneur C, Chevallier B, Zordan C, Odent S, Bal L, Faivre L, Leheup B, Dupuis-Girod S, Ruidavets JB, Acar P, Ferrieres J, Jondeau G, Dulac Y. Incidence of cardiovascular events and risk markers in a prospective study of children diagnosed with Marfan syndrome. Arch Cardiovasc Dis 2019; 113:40-49. [PMID: 31735609 DOI: 10.1016/j.acvd.2019.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 07/21/2019] [Accepted: 09/30/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about the incidence of cardiovascular events (CVEs) and their associated risk markers in children with Marfan syndrome (MFS). AIMS To assess the incidence of CVEs and determine risk markers in a cohort diagnosed with Marfan syndrome during childhood and followed for several years. METHODS From a French multicentre nationwide database, 462 patients with MFS diagnosed during childhood were included prospectively. Patients' files were screened for a period of 20 years (1993-2013). CVEs (e.g. death, aortic dissection, cardiac valve or aortic root surgery) were assessed during the prospective follow-up. RESULTS Median (interquartile range) age at the end of follow-up was 17.2 (11.1-21.3) years. CVEs were reported for 35 participants (7.6%; 95% confidence interval [CI] 5.3-10.4%). First CVEs were prophylactic aortic root surgery (n=29), aortic dissection (n=4; two aged <18 years) and death (n=2). Kaplan-Meier cumulative incidence of CVEs was 5.3% (95% CI 3.3-8.7%) during childhood (aged≤18 years) and 19.4% (95% CI 13.3-27.9%) at 25years of age. The cumulative rate of CVEs was higher in case of Valsalva sinus Z-score increase of≥0.1 per year (P=0.0003), maximal Valsalva sinus diameter growth speed ≥5mm per year (P=0.03), aortic regurgitation≥2 (P=0.0005) and maximal Valsalva sinus Z-score≥3 before 16 years of age (P<0.0001). In a multivariable Cox proportional analysis, the Valsalva sinus Z-score remained significantly related to outcome. Considering aortic root evolution, aortic regurgitation, age at diagnosis and beta-blocker therapy were related to Valsalva sinus Z-score evolution during follow-up. CONCLUSIONS CVEs in children with MFS are mainly related to prophylactic aortic root surgery. Aortic dissections are rarely observed in children. The Valsalva sinus Z-score is a strong indicator of subsequent CVEs in children with MFS. Attention to follow-up and beta-blocker observance may be warranted in high-risk children.
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Affiliation(s)
- Sebastien Hascoet
- Department of Paediatric Cardiology and Paediatric Endocrinology, Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital des Enfants, CHU Toulouse, 31300 Toulouse, France; Department of Congenital Heart Diseases, Centre Constitutif Réseau M3C (Maladies Rares Cardiopathies Congénitales Complexes), Hôpital Marie Lannelongue, Paris-Sud Université, 92350 Plessis-Robinson, France.
| | - Thomas Edouard
- Department of Paediatric Cardiology and Paediatric Endocrinology, Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital des Enfants, CHU Toulouse, 31300 Toulouse, France
| | - Julie Plaisancie
- Department of Paediatric Cardiology and Paediatric Endocrinology, Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital des Enfants, CHU Toulouse, 31300 Toulouse, France
| | - Florence Arnoult
- Department of Cardiology, Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital Bichat, AP-HP, 75018 Paris, France
| | - Olivier Milleron
- Department of Cardiology, Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital Bichat, AP-HP, 75018 Paris, France; Inserm U1148, 75877 Paris, France
| | - Chantal Stheneur
- Department of Cardiology, Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital Bichat, AP-HP, 75018 Paris, France; Inserm U1148, 75877 Paris, France; Department of Paediatrics, Hôpital Ambroise Paré, AP-HP, 92100 Boulogne-Billancourt, France
| | | | - Cécile Zordan
- Department of Clinical Genetics, Centre de Compétence pour le Syndrome de Marfan et Apparentés, CHU Bordeaux, 33000 Bordeaux, France
| | - Sylvie Odent
- Department of Clinical Genetics, Centre de Compétence pour le Syndrome de Marfan et Apparentés, Hôpital Sud CHU, 35200 Rennes, France
| | - Laurence Bal
- Department of Clinical Genetics and Aortic Diseases, Centre de Compétence pour le Syndrome de Marfan et Apparentés, Hôpital de la Timone, AP-HM, 13005 Marseille, France
| | - Laurence Faivre
- Department of Clinical Genetics, Centre de Compétence pour le Syndrome de Marfan et Apparentés, Hôpital d'enfants, CHU, Université de Bourgogne Franche Comté, 21070 Dijon, France
| | - Bruno Leheup
- Department of Clinical Genetics, Centre de Compétence pour le Syndrome de Marfan et Apparentés, Hôpital des Enfants Brabois, CHU Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Sophie Dupuis-Girod
- Department of Clinical Genetics, Hospices Civils de Lyon, Centre de Compétence pour le Syndrome de Marfan et Apparentés, Hôpital Femme-Mère-Enfants, 69677 Bron, France
| | - Jean-Bernard Ruidavets
- Department of Epidemiology, 31073 Toulouse; Inserm/UPS UMR 1048, I2MC, 31432 Toulouse, France; CHU de Toulouse, 31059 Toulouse, France
| | - Philippe Acar
- Department of Paediatric Cardiology and Paediatric Endocrinology, Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital des Enfants, CHU Toulouse, 31300 Toulouse, France
| | - Jean Ferrieres
- Department of Epidemiology, 31073 Toulouse; Inserm/UPS UMR 1048, I2MC, 31432 Toulouse, France; CHU de Toulouse, 31059 Toulouse, France
| | - Guillaume Jondeau
- Department of Cardiology, Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital Bichat, AP-HP, 75018 Paris, France; Inserm U1148, 75877 Paris, France
| | - Yves Dulac
- Department of Paediatric Cardiology and Paediatric Endocrinology, Centre de Référence pour le Syndrome de Marfan et Apparentés, Hôpital des Enfants, CHU Toulouse, 31300 Toulouse, France
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Vaillant M, Barral P, Mancini J, DeMasi M, Bal L, Piquet P. Preoperative Inferior Mesenteric Artery Embolization Is a Cost-effective Technique That May Reduce the Rate of Aneurysm Sac Diameter Enlargement and Reintervention Following EVAR. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bolomey S, Gaudry M, Bal L, de Masi Jacquier M, Barral PA, Piquet P. Does the natural anatomical evolution of the type B intramural hematomas allow identifying the patients at risk of aneurysmal progression? Ann Vasc Surg 2019. [DOI: 10.1016/j.avsg.2019.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cadour F, De Masi-Jacquier M, Barral PA, Cammilleri S, Jacquier A, Bal L. Thoracic Aortic Aneurysms and Erdheim-Chester Disease. J Vasc Interv Radiol 2019; 30:1698-1700. [PMID: 31182275 DOI: 10.1016/j.jvir.2019.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/14/2019] [Accepted: 01/17/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Farah Cadour
- Timone Aortic Center 264, rue Saint-Pierre, Marseille 13005, France; Department of Radiology, La Timone Hospital, Marseille, France
| | - Mariangela De Masi-Jacquier
- Timone Aortic Center 264, rue Saint-Pierre, Marseille 13005, France; Department of Vascular Surgery, La Timone Hospital, Marseille, France
| | - Pierre-Antoine Barral
- Timone Aortic Center 264, rue Saint-Pierre, Marseille 13005, France; Department of Radiology, La Timone Hospital, Marseille, France
| | - Serge Cammilleri
- Timone Aortic Center 264, rue Saint-Pierre, Marseille 13005, France; Department of Nuclear Medicine, La Timone Hospital, Marseille, France
| | - Alexis Jacquier
- Timone Aortic Center 264, rue Saint-Pierre, Marseille 13005, France; Department of Radiology, La Timone Hospital, Marseille, France
| | - Laurence Bal
- Timone Aortic Center 264, rue Saint-Pierre, Marseille 13005, France; Department of Vascular Surgery, La Timone Hospital, Marseille, France
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Habert P, Bentatou Z, Aldebert P, Finas M, Bartoli A, Bal L, Lalande A, Rapacchi S, Guye M, Kober F, Bernard M, Jacquier A. Exercise stress CMR reveals reduced aortic distensibility and impaired right-ventricular adaptation to exercise in patients with repaired tetralogy of Fallot. PLoS One 2018; 13:e0208749. [PMID: 30596647 PMCID: PMC6312273 DOI: 10.1371/journal.pone.0208749] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 11/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of our study was to evaluate the feasibility of exercise cardiac magnetic resonance (CMR) in patients with repaired tetralogy of Fallot (RTOF) and to assess right and left ventricular adaptation and aortic wall response to exercise in comparison with volunteers. METHODS 11 RTOF and 11 volunteers underwent prospective CMR at rest and during exercise. A supine bicycle ergometer was employed to reach twice the resting heart rate during continuous exercise, blood pressure and heart rate were recorded. Bi-ventricular parameters and aortic stiffness were assessed using accelerated cine sequences and flow-encoding CMR. A t-test was used to compare values between groups. A Mann Whitney test was used to compare values within groups. RESULTS In RTOF both ventricles showed an impaired contractile reserve (RVEF rest 36.2±8.3%, +1.3±3.9% increase after exercise; LVEF rest 53.8±6.1%, +5.7±6.4% increase after exercise) compared to volunteers (RVEF rest 50.5±5.0%, +10.4±7.1% increase after exercise, p = 0.039; LVEF rest 61.9±3.1%, +12.2±4.7% increase after exercise, p = 0.014). RTOF showed a reduced distensibility of the ascending aorta during exercise compared to volunteers (RTOF: 3.4±1.9 10-3.mmHg-1 vs volunteers: 5.1±1.4 10-3.mmHg-1; p = 0.027). Ascending aorta distensibility was correlated to cardiac work in the volunteers but not in RTOF. CONCLUSION RTOF showed an impaired contractile reserve for both ventricles. The exercise unmasked a reduced distensibility of the ascending aorta in RTOF, which may be an early sign of increased aortic rigidity.
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Affiliation(s)
- Paul Habert
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
- Department of Radiology and Cardiovascular Imaging, La Timone Hospital, Marseille, France
- * E-mail:
| | | | - Philippe Aldebert
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
- Department of Cardiology and Department of Infectious Diseases, La Timone Hospital, Marseille, France
| | | | - Axel Bartoli
- Department of Radiology and Cardiovascular Imaging, La Timone Hospital, Marseille, France
| | - Laurence Bal
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
- Department of Vascular Surgery and Vascular Medicine, La Timone Hospital, Marseille, France
| | - Alain Lalande
- LE2I, UMR 6306 CNRS, University of Burgundy, Dijon, France
- MRI Department, University Hospital of Dijon, Dijon, France
| | | | - Maxime Guye
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
| | - Frank Kober
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
| | | | - Alexis Jacquier
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
- Department of Radiology and Cardiovascular Imaging, La Timone Hospital, Marseille, France
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Moreno R, Meyrignac O, Zadro C, Sewonu A, Bartoli J, Rousseau H, Piquet P, Bal L. 36 Medical Physicist and Radiologists, a winning team: Definition of a new biomarker for the assessment of small aortic aneurysm rapid growth risk. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.09.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Vaillant M, Gaudry M, Bal L, Jacquier A, Piquet P. The Embolization of the Lower Mesenteric Artery before EVAR Prevents the Risk of Increase in Diameter of the Aneurysmal sac at 2 Years. Ann Vasc Surg 2018. [DOI: 10.1016/j.avsg.2018.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Gaudry M, David B, Omnes V, Bal L, De Masi M, Bartoli JM, Piquet P. [Radiation-induced carotid stenosis: A personnalized approach]. J Med Vasc 2017; 42:263-271. [PMID: 28964385 DOI: 10.1016/j.jdmv.2017.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 05/25/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Surgical treatment of radio-induced carotid stenosis (RICS) is challenging and burdened by an elevated risk of local complications. Carotid artery stenting (CAS) may be a suitable alternative. The best approach is yet to be defined. We reviewed the results of both techniques following selection based on better-suitability characteristics (anatomic and clinical). METHODS We retrospectively reviewed 38 patients treated for 43 RICS from a group of 1230 patients who had carotid interventions between 2008 and 2015 (5 bilateral). Primary endpoints were morbidity and mortality at 30 days (transient ischemic attack, stroke, myocardial infarction, or death). Secondary endpoints were technical success, wound complications, cranial nerve injury (CNI), restenosis (≥50%) and recurrent symptoms. RESULTS RICS was symptomatic in 6 patients in the OR group and 3 in the CAS group. Lesions in the OR group were longer (P=0.02) and more calcified (P=0.08). Technical success rate was 100%. Cranial nerve injury rate was 14.2% (3/21). All injuries were completely resolved within several weeks. In the CAS group, technical success rate was 95% (21/22) with the one failure due to a residual stenosis exceeding 30%. Periprocedural stroke rates were 0% and 4.5% in the OR and CAS groups respectively (0/21 vs 1/22, P=0.32). There were no early deaths. Mean follow-up was 19.1 months (3-75). The restenosis rate was 9.5% (2/21) in the OR group and 9% (2/22) in the CAS group. CONCLUSION Our results do not support a preferred treatment strategy. The choice of treatment should be considered on an individual basis.
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Affiliation(s)
- M Gaudry
- Service de chirurgie vasculaire, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France.
| | - B David
- Service de chirurgie vasculaire, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - V Omnes
- Service de chirurgie vasculaire, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - L Bal
- Service de chirurgie vasculaire, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - M De Masi
- Service de chirurgie vasculaire, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - J M Bartoli
- Service de radiologie, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - P Piquet
- Service de chirurgie vasculaire, hôpital de la Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
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Gaudry M, Bartoli JM, Bal L, Giorgi R, De Masi M, Magnan PE, Piquet P. Anatomical and Technical Factors Influence the Rate of In-Stent Restenosis following Carotid Artery Stenting for the Treatment of Post-Carotid Endarterectomy Stenosis. PLoS One 2016; 11:e0161716. [PMID: 27611997 PMCID: PMC5017627 DOI: 10.1371/journal.pone.0161716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/10/2016] [Indexed: 12/03/2022] Open
Abstract
Background Carotid artery stenting (CAS) has been advocated as an alternative to redo surgery for the treatment of post-carotid endarterectomy (CEA) stenosis. This study analyzed the efficacy of CAS for post-CEA restenosis, focusing on an analysis of technical and anatomical predictive factors for in-stent restenosis. Methods We performed a retrospective monocentric study. We included all patients who underwent CAS for post-CEA restenosis at our institution from July 1997 to November 2013. The primary endpoints were the technical success, the presence of in-stent restenosis >50% or occlusion, either symptomatic or asymptomatic, during the follow-up period, and risk factors for restenosis. The secondary endpoints were early and late morbidity and mortality (TIA, stroke, myocardial infarction, or death). Results A total of 153 CAS procedures were performed for post-CEA restenosis, primarily because of asymptomatic lesions (137/153). The technical success rate was 98%. The 30-day perioperative stroke and death rate was 2.6% (two TIAs and two minor strokes), and rates of 2.2% (3/137) and 6.2% (1/16) were recorded for asymptomatic and symptomatic patients, respectively. The average follow-up time was 36 months (range, 6–171 months). In-stent restenosis or occlusion was observed in 16 patients (10.6%). Symptomatic restenosis was observed in only one patient. We found that young age (P = 0.002), stenosis > 85% (P = 0.018), and a lack of stent coverage of the common carotid artery (P = 0.006) were independent predictors of in-stent restenosis. Conclusion We identified new risk factors for in-stent restenosis that were specific to this population, and we propose a technical approach that may reduce this risk.
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Affiliation(s)
- Marine Gaudry
- APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France
- * E-mail:
| | | | - Laurence Bal
- APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France
| | - Roch Giorgi
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- APHM, Hôpital Timone, Service Biostatistique et Technologies de l’Information et de la Communication, Marseille, France
| | - Mariangela De Masi
- APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France
| | | | - Philippe Piquet
- APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France
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Arnaud P, Hanna N, Aubart M, Leheup B, Dupuis-Girod S, Naudion S, Lacombe D, Milleron O, Odent S, Faivre L, Bal L, Edouard T, Collod-Beroud G, Langeois M, Spentchian M, Gouya L, Jondeau G, Boileau C. Homozygous and compound heterozygous mutations in the FBN1 gene: unexpected findings in molecular diagnosis of Marfan syndrome. J Med Genet 2016; 54:100-103. [PMID: 27582083 DOI: 10.1136/jmedgenet-2016-103996] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/29/2016] [Accepted: 08/03/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Marfan syndrome (MFS) is an autosomal-dominant connective tissue disorder usually associated with heterozygous mutations in the gene encoding fibrillin-1 (FBN1). Homozygous and compound heterozygous cases are rare events and have been associated with a clinical severe presentation. OBJECTIVES Report unexpected findings of homozygosity and compound heterozygosity in the course of molecular diagnosis of heterozygous MFS and compare the findings with published cases. METHODS AND RESULTS In the context of molecular diagnosis of heterozygous MFS, systematic sequencing of the FBN1 gene was performed in 2500 probands referred nationwide. 1400 probands carried a heterozygous mutation in this gene. Unexpectedly, among them four homozygous cases (0.29%) and five compound heterozygous cases (0.36%) were identified (total: 0.64%). Interestingly, none of these cases carried two premature termination codon mutations in the FBN1 gene. Clinical features for these carriers and their families were gathered and compared. There was a large spectrum of severity of the disease in probands carrying two mutated FBN1 alleles, but none of them presented extremely severe manifestations of MFS in any system compared with carriers of only one mutated FBN1 allele. This observation is not in line with the severe clinical features reported in the literature for four homozygous and three compound heterozygous probands. CONCLUSION Homozygotes and compound heterozygotes were unexpectedly identified in the course of molecular diagnosis of MFS. Contrary to previous reports, the presence of two mutated alleles was not associated with severe forms of MFS. Although homozygosity and compound heterozygosity are rarely found in molecular diagnosis, they should not be overlooked, especially among consanguineous families. However, no predictive evaluation of severity should be provided.
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Affiliation(s)
- Pauline Arnaud
- Département de Génétique et Centre de Référence Maladies Rares Syndrome de Marfan et pathologies apparentées, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France.,LVTS, INSERM U1148, Université Paris Diderot, Hôpital Bichat, Paris, France
| | - Nadine Hanna
- Département de Génétique et Centre de Référence Maladies Rares Syndrome de Marfan et pathologies apparentées, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France.,LVTS, INSERM U1148, Hôpital Bichat, Paris, France
| | | | - Bruno Leheup
- Hôpital de Brabois, Service de Génétique Clinique, Centre Hospitalier Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Sophie Dupuis-Girod
- Hôpital Femme-Mère-Enfant, Service de Génétique Clinique, Centre Hospitalier Universitaire de Lyon, Bron, France
| | - Sophie Naudion
- GH Pellegrin, Service de Génétique Médicale, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Didier Lacombe
- GH Pellegrin, Service de Génétique Médicale, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Olivier Milleron
- Hôpital Bichat, Centre de Référence Maladies Rares, Syndrome de Marfan et pathologies apparentéés, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sylvie Odent
- Hôpital Sud, Service de Génétique Clinique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Laurence Faivre
- Hôpital François Mitterrand, Centre de Génétique-Dijon, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - Laurence Bal
- Hôpital Timone Adultes, Service de Chirurgie vasculaire, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Thomas Edouard
- Centre Hospitalier Universitaire de Toulouse, Hôpital des Enfants, Service de Cardiologie, Toulouse, France
| | | | - Maud Langeois
- Hôpital Bichat, Centre de Référence Maladies Rares, Syndrome de Marfan et pathologies apparentéés, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Myrtille Spentchian
- Hôpital Bichat, Centre de Référence Maladies Rares, Syndrome de Marfan et pathologies apparentéés, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Gouya
- Hôpital Bichat, Centre de Référence Maladies Rares, Syndrome de Marfan et pathologies apparentéés, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Jondeau
- LVTS, INSERM U1148, Université Paris Diderot, Hôpital Bichat, Paris, France.,Hôpital Bichat, Centre de Référence Maladies Rares, Syndrome de Marfan et pathologies apparentéés, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Catherine Boileau
- Département de Génétique et Centre de Référence Maladies Rares Syndrome de Marfan et pathologies apparentées, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France.,LVTS, INSERM U1148, Université Paris Diderot, Hôpital Bichat, Paris, France
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De Masi M, Amabile P, Bal L, Piquet P. Management of endograft infection coupled with aortoesophageal fistula: extra-anatomic aortic bypass and endograft explantation. J Thorac Cardiovasc Surg 2013; 146:e11-3. [PMID: 23778082 DOI: 10.1016/j.jtcvs.2013.04.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 04/24/2013] [Indexed: 11/15/2022]
Affiliation(s)
- Mariangela De Masi
- Department of Vascular Surgery, Hôpital de la Timone, Marseille, France.
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Orsini B, Amabile P, Bal L, Piquet P. Management of an aortoesophageal fistula caused by Kirschner wire migration in a patient with arteria lusoria. J Thorac Cardiovasc Surg 2012; 144:e25-7. [DOI: 10.1016/j.jtcvs.2012.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 04/10/2012] [Accepted: 05/09/2012] [Indexed: 11/26/2022]
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Amabile P, Etienne J, De Masi M, Bal L, Cohen S, Bartoli JM, Piquet P. RR1. Selective Cerebrospinal Fluid Drainage Protocole Is Effective to Prevent Spinal Cord Ischemia during Endovascular Repair of Thoracic Aortic Diseases: Results of a Comparative Study. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.03.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bal L, Ederhy S, Di Angelantonio E, Toti F, Zobairi F, Dufaitre G, Meuleman C, Mallat Z, Boccara F, Tedgui A, Freyssinet JM, Cohen A. Circulating procoagulant microparticles in acute pulmonary embolism: a case-control study. Int J Cardiol 2009; 145:321-322. [PMID: 20036020 DOI: 10.1016/j.ijcard.2009.11.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 11/29/2009] [Indexed: 10/20/2022]
Abstract
We investigated whether circulating procoagulant microparticles (CPMPs) contributed to hypercoagulability in 45 patients with acute pulmonary embolism (APE) and in 45 controls with and 45 controls without cardiovascular risk factors. Concentrations of CPMPs and platelet-derived microparticles (PMPs) were statistically significantly higher in patients with APE than in controls without cardiovascular risk factors. PMPs appeared to be the main source of procoagulant microparticle release in APE, but this correlation disappeared when APE patients were compared to controls with cardiovascular risk factors. CPMPs may have a role in venous thrombosis as mediators of cardiovascular risk factors.
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Affiliation(s)
- Laurence Bal
- Cardiology Department, Saint-Antoine University and Medical School, France; Université Pierre et Marie Curie, Paris, France
| | - Stéphane Ederhy
- Cardiology Department, Saint-Antoine University and Medical School, France; Université Pierre et Marie Curie, Paris, France
| | - Emanuele Di Angelantonio
- Cardiology Department, Saint-Antoine University and Medical School, France; Université Pierre et Marie Curie, Paris, France
| | - Florence Toti
- INSERM U.770, Hôpital de Bicêtre, Université Louis Pasteur, Faculté de Médecine, Institut d'Hématologie et Immunologie, Strasbourg, France
| | - Fatiha Zobairi
- INSERM U.770, Hôpital de Bicêtre, Université Louis Pasteur, Faculté de Médecine, Institut d'Hématologie et Immunologie, Strasbourg, France
| | - Ghislaine Dufaitre
- Cardiology Department, Saint-Antoine University and Medical School, France; Université Pierre et Marie Curie, Paris, France
| | - Catherine Meuleman
- Cardiology Department, Saint-Antoine University and Medical School, France; Université Pierre et Marie Curie, Paris, France
| | - Ziad Mallat
- INSERM U970 Paris Cardiovascular Research Center PARCC, Paris, France and Université Paris Descartes UMR-S970, Paris, France
| | - Franck Boccara
- Cardiology Department, Saint-Antoine University and Medical School, France; Université Pierre et Marie Curie, Paris, France
| | - Alain Tedgui
- INSERM U970 Paris Cardiovascular Research Center PARCC, Paris, France and Université Paris Descartes UMR-S970, Paris, France
| | - Jean Marie Freyssinet
- INSERM U.770, Hôpital de Bicêtre, Université Louis Pasteur, Faculté de Médecine, Institut d'Hématologie et Immunologie, Strasbourg, France
| | - Ariel Cohen
- Cardiology Department, Saint-Antoine University and Medical School, France; Université Pierre et Marie Curie, Paris, France.
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Wilhelm C, Bal L, Smirnov P, Galy-Fauroux I, Clément O, Gazeau F, Emmerich J. Magnetic control of vascular network formation with magnetically labeled endothelial progenitor cells. Biomaterials 2007; 28:3797-806. [PMID: 17544118 DOI: 10.1016/j.biomaterials.2007.04.047] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 04/27/2007] [Indexed: 10/23/2022]
Abstract
We describe the applications of new cellular magnetic labeling method to endothelial progenitor cells (EPC), which have therapeutic potential for revascularization. Via their negative surface charges, anionic magnetic nanoparticles adsorb non-specifically to the EPC plasma membrane, thereby triggering efficient spontaneous endocytosis. The label is non-toxic and does not affect the cells' proliferative capacity. The expression of major membrane proteins involved in neovascularisation is preserved. Labeled cells continue to differentiate in vitro and to form tubular structures in Matrigel (an in vitro model of neovascularization). This process was followed in situ by using high-resolution MRI. Finally, we show that magnetic forces can be used to move magnetically labeled EPC in vitro and to modify their organization in Matrigel both in vitro an in vivo. Magnetic cell targeting opens up new possibilities for vascular tissue engineering and for delivering localized cell-based therapies.
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Affiliation(s)
- C Wilhelm
- Laboratoire Matière et Systèmes Complexes, CNRS UMR 7057, Université Paris 7, Paris, France.
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Bal L, Thierry S, Brocas E, Van de Louw A, Pottecher J, Hours S, Moreau MH, Perrin Gachadoat D, Tenaillon A. B-type natriuretic peptide (BNP) and N-terminal-proBNP for heart failure diagnosis in shock or acute respiratory distress. Acta Anaesthesiol Scand 2006; 50:340-7. [PMID: 16480468 DOI: 10.1111/j.1399-6576.2006.00963.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Plasma B-type natriuretic peptide (BNP) assay is recommended as a diagnostic tool in emergency-room patients with acute dyspnea. In the intensive care unit (ICU), the utility of this peptide remains a matter of debate. The objectives of this study were to determine whether cut-off values for BNP and N-terminal-proBNP (NT-proBNP) reliably diagnosed right and/or left ventricular failure in patients with shock or acute respiratory distress, and whether non-cardiac factors led to an increase in these markers. METHODS Plasma BNP and NT-proBNP levels and echocardiographic parameters of cardiac dysfunction were determined in 41 patients within 24 h of the onset of shock or acute respiratory distress. RESULTS BNP and NT-proBNP levels were higher in the 25 patients with heart failure than in the other 16 patients: 491.7 +/- 418 pg/ml vs. 144.3 +/- 128 pg/ml and 2874.4 +/- 2929 pg/ml vs. 762.7 +/- 1128 pg/ml, respectively (P < 0.05). In the diagnosis of cardiac dysfunction, BNP > 221 pg/ml and NT-proBNP > 443 pg/ml had 68% and 84% sensitivity, respectively, and 88% and 75% specificity, respectively, but there was a substantial overlap of BNP and NT-proBNP values between patients with and without heart failure. BNP and NT-proBNP were elevated, but not significantly, in patients with isolated right ventricular dysfunction. Patients with renal dysfunction and normal heart function had significantly higher levels of BNP (258.6 +/- 144 pg/ml vs. 92.4 +/- 84 pg/ml) and NT-proBNP (2049 +/- 1320 pg/ml vs. 118 +/- 104 pg/ml) than patients without renal dysfunction. CONCLUSION Both BNP and NT-proBNP can help in the diagnosis of cardiac dysfunction in ICU patients, but cannot replace echocardiography. An elevated BNP or NT-proBNP level merely indicates the presence of a 'cardiorenal distress' and should prompt further investigation.
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Affiliation(s)
- L Bal
- General Intensive Care Unit, Sud Francilien Hospital Center, Evry, France
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Abstract
Nicardipine is used in the treatment of premature labor. There are no previous reports in the anesthesia literature of serious side effects associated with this drug. We report a case of pulmonary edema induced by nicardipine therapy for tocolysis in a pregnant 27-yr-old patient admitted to our hospital for preterm labor with intact membranes at 27 wk of gestation.
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Affiliation(s)
- Laurence Bal
- Service de Réanimation Polyvalente, Centre Hospitalier Sud Francilien, Evry, France
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Abstract
Pheochromocytoma can induce a adrenergic cardiomyopathy. This one occurs sometimes clinical, biological or and electrocardiographic signs of an acute coronary syndrome. We report two cases of rudimentary necrosis due to a pheochromocytoma: the first one after tumorectomy, the second one has revealed the disease in a patient who was suffering from high blood pressure for many years. The coronarography was in each case normal.
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Affiliation(s)
- F Tournoux
- Service de cardiologie, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France.
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Mouchet B, Bal L, Emmerich J, Fiessinger J, Clément C, Jaussaud R. Les aortites infectieuses de l'aorte abdominale. À propos de 5 cas. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80095-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bal L, Buursink J. An inceptisol formed in calcareous loess on the 'Dast-i-Esan Top' plain in North Afghanistan. Fabric, mineral and trace element analysis. ACTA ACUST UNITED AC 1976. [DOI: 10.18174/njas.v24i1.17163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The calcixerollic xerochrept described has a low bulk density (1.1 g/cm3) which is attributed to faunal activity. The average mineral composition was 25% quartz, 20% CaCO3, 15% feldspars, 15% micas, 15% chlorites, 2-3% other minerals and 10% amorphous material and there was a clear relationship between minerals and particle size fractions. Trace element contents were 0.6, 11.0, 23.2, 49.1; 19.4, 75.9, 18.7 and 525 mg/kg for V, Cr, Co, Ni, Cu, Zn, Sr and Ba, respectively. Sr and Ba contents were related to carbonate redistribution. (Abstract retrieved from CAB Abstracts by CABI’s permission)
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Bal L. Carbonate in soil: a theoretical consideration on, and proposal for its fabric analysis. 2. Crystal tubes, intercalary crystals, K fabric. ACTA ACUST UNITED AC 1975. [DOI: 10.18174/njas.v23i2.17195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The spatial arrangement (fabric) of carbonate in 7 different soils was studied to make a proposal for its fabric analysis. These soils, which have been developed in calcareous loess and marine deposits, are located in Afghanistan, the USSR, Germany and the Netherlands.In the first part of this study (Bal, 1975) the simple plasmic fabrics crystic, calcic and fibrous have been defined. Their distinction is primarly based on theoretical considerations of Brewer's concepts (Brewer, 1964).In this second part the morphology and genesis of carbonate crystal tubes and intercalary carbonate crystals is dealt with.Also K-fabric, the carbonate fabric introduced by Gile et al. (1965) is discussed and redefined. The fabrics crystic, calcic and fibrous are simple fabrics; the K-fabric, on the contrary, is principally a compound fabric. This means that K fabric is composed of one or more of these simple fabrics. (Abstract retrieved from CAB Abstracts by CABI’s permission)
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