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Tamagawa Y, Kawamura M, Shibata K, Asada S, Ryugo M, Tsutsumi YI, Monta O. Risk factor analysis for aortic dissection after aortic valve replacement in patients with tricuspid aortic valve. Gen Thorac Cardiovasc Surg 2024; 72:305-310. [PMID: 37656401 DOI: 10.1007/s11748-023-01970-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/12/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Aortic dilatation concurrent with aortic valve disease is a common condition. However, the incidence of aortic dissection after aortic valve replacement for tricuspid aortic valve has not been fully investigated. Therefore, we performed a risk factor analysis for the incidence of aortic dissection after aortic valve replacement in patients with tricuspid aortic valve. METHODS We retrospectively reviewed 599 patients who underwent aortic valve replacement at our hospital between January 2000 and December 2020. We performed a risk factor analysis for the incidence of aortic dissection after aortic valve replacement in patients with tricuspid aortic valve. RESULTS Seven patients developed late aortic dissections during the follow-up period. All patients with aortic dissection underwent aortic valve replacement for aortic regurgitation. Multivariable analysis revealed that aortic regurgitation was an independent predictor of aortic dissection (p < 0.0001). The mean ascending aortic diameter at aortic valve replacement for aortic regurgitation was significantly greater in patients with aortic dissection than in those without aortic dissection (46 [43.5-46] mm vs. 39 [36-42] mm, p < 0.001). The predictive cutoff value of ascending aortic diameter was indicated using receiver operating characteristic curve analysis; 46.0 mm (area under the curve: 0.8987). Freedom rates from aortic dissection in patients with aortic regurgitation and an ascending aortic diameter ≥ 46 mm were significantly lower than those in patients with an ascending aortic diameter < 46 mm (66.7% vs. 100% at 5 years, p < 0.0001). CONCLUSION Aortic regurgitation combined with ascending aortic dilatation at aortic valve replacement could be a significant risk factor for late aortic dissection.
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Affiliation(s)
- Yuki Tamagawa
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan
| | - Masashi Kawamura
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan.
| | - Kana Shibata
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan
| | - Satoshi Asada
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan
| | - Masahiro Ryugo
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan
| | - Yasush I Tsutsumi
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan
| | - Osamu Monta
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui City, Fukui Prefecture, Japan
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Egbe AC, Miranda WR, Abozied O, Jain CC, Burchill LJ, Karnakoti S, Ahmed MH, Francois CJ, Connolly HM. Coarctation of Aorta With Tricuspid Aortic Valve Is Not Associated With Ascending Aortic Aneurysm. J Am Coll Cardiol 2024; 83:1136-1146. [PMID: 38508846 DOI: 10.1016/j.jacc.2024.01.026] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/05/2024] [Accepted: 01/29/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Aortic aneurysm is common in patients with coarctation of aorta (COA), but it is unclear whether the risk of aortic aneurysms is due to COA or related to the presence of other risk factors such as bicuspid aortic valve (BAV) and hypertension. OBJECTIVES The purpose of this study was to assess the relationship among COA, BAV, and thoracic aortic aneurysms. METHODS A total of 867 patients with COA (COA group) were matched 1:1:1 to 867 patients with isolated BAV (BAV group) and 867 patients without structural heart disease (SHD) (no-SHD group). The COA group was further subdivided into a COA+BAV subgroup (n = 304 [35%]), and COA with tricuspid aortic valve (TAV) (COA+TAV subgroup [n = 563 (65%)]). Aortic dimensions were assessed at baseline and at 3, 5, and 7 years. RESULTS Compared with the no-SHD group, the COA+BAV subgroup had larger aortic root diameter (37 mm [Q1-Q3: 30-43 mm] vs 32 mm [Q1-Q3: 27-35 mm]; P < 0.001) and mid ascending aorta dimeter (34 mm [Q1-Q3: 29-40 mm] vs 28 mm [Q1-Q3: 24-31 mm]; P = 0.008). Similarly, the BAV group had larger aortic root diameter (37 mm [Q1-Q3: 30-42 mm] vs 32 mm [Q1-Q3: 27-35 mm]; P < 0.001), and mid ascending aorta dimeter (35 mm [Q1-Q3: 30-40 mm] vs 28 mm [Q1-Q3: 24-31 mm]; P < 0.001). Compared with the COA+TAV subgroup, the COA+BAV subgroup and BAV group were associated with larger aortic root and mid ascending aorta diameter at baseline and follow-up. The risk of acute aortic complications was low in all groups. CONCLUSIONS These findings suggest that BAV (and not COA) was associated with ascending thoracic aorta dimensions, and that patients with COA+TAV were not at a greater risk of developing ascending aortic aneurysms as compared with patients without SHD.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, Minnesota, USA.
| | - William R Miranda
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, Minnesota, USA
| | - Omar Abozied
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, Minnesota, USA
| | - C Charles Jain
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, Minnesota, USA
| | - Luke J Burchill
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, Minnesota, USA
| | - Snigdha Karnakoti
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, Minnesota, USA
| | - Marwan H Ahmed
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, Minnesota, USA
| | | | - Heidi M Connolly
- Department of Cardiovascular Medicine Mayo Clinic, Rochester, Minnesota, USA
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Sweeney JC, Trivedi JR, Endo T, Ankem A, Pahwa SV, Slaughter MS, Ganzel BL. Cannula Placement for Cerebral Protection Without Circulatory Arrest in Patients Undergoing Hemiarch Aortic Aneurysm Repair. Tex Heart Inst J 2024; 51:e228026. [PMID: 38345901 DOI: 10.14503/thij-22-8026] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND Aortic aneurysms involving the proximal aortic arch, which require hemiarch-type repair, typically require circulatory arrest with antegrade cerebral perfusion. Left carotid antegrade cerebral perfusion (LCP) via distal arch cannulation without circulatory arrest was used in this study's patient population. The goal was to assess the operative efficiency and clinical outcomes of using a distal arch cannulation technique that would not require any hypothermic circulatory arrest (HCA) time compared with more traditional brachiocephalic artery cannulation with right-sided unilateral antegrade cerebral perfusion (RCP) and HCA. METHODS A single-center retrospective review of patients with replacement of the distal ascending aorta involving the proximal arch was performed. Patients with an intramural hematoma or dissection were excluded. Between January 2015 and December 2019, 68 adult patients had undergone a hemiarch repair because of aneurysmal disease. Analysis of baseline demographics, operative data, and clinical outcomes was performed. RESULTS Comparing the 68 patients: 21 patients were treated with RCP (via brachiocephalic artery graft with HCA), and 47 patients were treated with LCP (via distal aortic arch cannulation with cross-clamp between the brachiocephalic and left common carotid arteries without HCA). Baseline characteristics and outcomes were evaluated for both groups. The LCP group was younger (LCP median [IQR] age, 60 [53-65] years vs RCP median [IQR] age, 67 [59-71] years]. Sex, race, body mass index, comorbidities, and ejection fraction were similar between the groups. Cardiopulmonary bypass time (LCP, 123 minutes vs RCP, 149 minutes) and unilateral cerebral perfusion time (LCP, 17 minutes vs RCP, 22 minutes) were longer in the RCP group. Bleeding, prolonged ventilatory support, kidney failure, and length of stay were similar. In-hospital mortality was 2% in the LCP group vs 0% in the RCP group. Stroke occurred in 2 patients (4.2%) in the LCP group and in 0% of the RCP group. Mortality at 6 months in the LCP and RCP groups was 3% and 10%, respectively. CONCLUSION Distal arch cannulation with LCP without HCA is a reasonable and safe alternative strategy for patients requiring hemiarch replacement for aneurysmal disease. This technique may provide additional benefits by avoiding circulatory arrest in these complex cases.
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Affiliation(s)
- Joseph C Sweeney
- Department of General Surgery, University of Louisville, Louisville, Kentucky
| | - Jaimin R Trivedi
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky
| | - Toyokazu Endo
- Department of General Surgery, University of Louisville, Louisville, Kentucky
| | - Akhila Ankem
- School of Medicine, University of Louisville, Louisville, Kentucky
| | - Siddharth V Pahwa
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky
| | - Mark S Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky
| | - Brian L Ganzel
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky
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4
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Bianco L, Rebonato M, Butera G. Intra-stent aortic wall aneurysm formation after Be-graft covered stent implant. Catheter Cardiovasc Interv 2024; 103:322-325. [PMID: 38091330 DOI: 10.1002/ccd.30934] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 11/26/2023] [Accepted: 12/03/2023] [Indexed: 01/31/2024]
Abstract
Aortic wall injuries may occur after interventional treatment of aortic coarctation (CoA), especially after balloon angioplasty. We reported on a patient who presented with an intra-stent aneurysm formation after direct stenting of a native near atretic aortic CoA by using a BeGraft Aortic stent. This evidence supports the need to maintain a strict follow-up protocol. A computed tomography scan is mandatory, after covered stent implantation as well, especially in high-risk cases and even in the absence of any immediate apparent complication.
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Affiliation(s)
- Lisa Bianco
- Department of Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
| | - Micol Rebonato
- Department of Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
| | - Gianfranco Butera
- Department of Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
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Malyshev M, Safuanov A, Malyshev A, Rostovykh A, Sinyukov D, Rostovykh N, Trushina V. Surgery for Ascending Aortic Aneurysm and Aortic Valve Insufficiency in Conditions of Active Proceeding Syphilitic Aortitis and Valvulitis. Ann Thorac Cardiovasc Surg 2024; 30:n/a. [PMID: 36967122 PMCID: PMC10902664 DOI: 10.5761/atcs.cr.22-00236] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023] Open
Abstract
A syphilitic aortitis is a late cardiovascular lesion of tertiary syphilis that has become exceptionally rare in the antibiotic era but not eradicated completely. Syphilitic aortitis of ascending aorta complicates in ascending aortic aneurysm formation and aortic valve regurgitation, both requiring surgical treatment. After surgery, lifelong surveillance of the remainder of the aorta is recommended because of a priori supposed high incidence of delayed involvement of noninvolved aortic segments. A 3-year follow-up result of surgery of syphilitic ascending aortic aneurysm with aortic valve regurgitation in condition of active ongoing syphilitic aortitis and valvulitis is described with addressing the dimensions of remaining aortic segments. This case demonstrates that the dilatation of the remainder of the aorta does not occur during 3 years, at least when anti-syphilitic course of antibiotic is used just after operation without additional treatment during the follow-up period. A few reports on surgical treatment of syphilitic aneurysms of the ascending aorta are discussed.
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Affiliation(s)
| | | | - Anton Malyshev
- Center of Cardiac Surgery, Chelyabinsk, Russian Federation
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Nakajima T, Iba Y, Naraoka S, Shibata T, Sugita S, Kawaharada N. Scattered Media Elastic Fibers from the Aortic Root to the Ascending Aorta in a 30-Year-Old Marfan Syndrome Patient. Ann Thorac Cardiovasc Surg 2024; 30:22-00044. [PMID: 35584950 PMCID: PMC10851445 DOI: 10.5761/atcs.cr.22-00044] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
We present a case report of a 30-year-old Marfan syndrome patient who underwent a David procedure for severe aortic valve insufficiency and Valsalva aneurysm. Harvested aortic walls were examined by pathologists. Although the tunica media of the ascending aorta contained aligned elastic fibers, the aortic root media lacked aligned elastic fibers.
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Affiliation(s)
- Tomohiro Nakajima
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yutaka Iba
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Syuichi Naraoka
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tsuyoshi Shibata
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Shintaro Sugita
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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7
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Wadiwala IJ, Garg P, Pham V, Taner CB, Farres H, Krishna M, Pham SM. Iatrogenic Acute Ascending Aortic Dissection During Combined Heart/Liver Transplant for Amyloidosis. Transplant Proc 2023; 55:1978-1980. [PMID: 37652784 DOI: 10.1016/j.transproceed.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/06/2023] [Accepted: 07/31/2023] [Indexed: 09/02/2023]
Abstract
We report a case of iatrogenic acute type A aortic dissection (ATAAD) during a combined heart-liver transplant in a patient with amyloid-associated cardiac and hepatic failure. The patient developed ATAAD of the recipient's aorta during the heart transplantation. Because there was no sign of malperfusion or proximal extension into the donor aorta, we proceeded with the liver transplantation and continued medical management for ATAAD. The patient was discharged uneventfully 30 days after the transplant, and computed tomography coronary angiogram after 4 months showed stable dissection. During a heart transplant, ATAAD of the native aorta without malperfusion syndrome can be managed conservatively with close progress monitoring.
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Affiliation(s)
- Ishaq J Wadiwala
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Pankaj Garg
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Vivienne Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - C Burcin Taner
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida
| | - Houssam Farres
- Department of Surgery, Mayo Clinic, Jacksonville, Florida
| | - Murli Krishna
- Department of Pathology, Mayo Clinic, Jacksonville, Florida
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida.
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Rossi PJ. The continued pursuit of the holy grail - a novel method for reducing the risk of aortic aneurysm growth. J Vasc Surg 2023; 78:936. [PMID: 37739746 DOI: 10.1016/j.jvs.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Peter J Rossi
- Division of Vascular and Endovascular Surgery, Medical College of Wisconsin, Milwaukee, WI
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9
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Wu P, Yu S, Zeng J, Yang L. Aortic sinus aneurysm invading ventricular septum and dissection caused by Behcet's disease: a case report and literature review. BMC Cardiovasc Disord 2023; 23:429. [PMID: 37648972 PMCID: PMC10468877 DOI: 10.1186/s12872-023-03420-7] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 07/27/2023] [Indexed: 09/01/2023] Open
Abstract
Few case reports have mentioned the aortic sinus aneurysm invading ventricular septum and dissection caused by Behcet's disease. Here, we reported a 36-year-old male patient with an aortic sinus aneurysm invading the ventricular septum and dissection caused by Behcet's disease, who manifested as recurrent chest tightness and shortness of breath. Cardiac ultrasound showed the rupture of the right aortic sinus and the formation of ventricular septal dissection. Ascending aortic valve prosthesis replacement, mitral valvuloplasty with ring implantation and tricuspid valvuloplasty were performed. Postoperatively, he was treated with hormones, hydroxychloroquine sulfate, mycophenolate mofetil tablets, thalidomide and warfarin, and his symptoms were relieved. This is a rare case easily being misdiagnosed and missed, early diagnosis and in-time treatment are crucial to avoid surgical complications. The diagnostic and therapeutic approaches of this patient were reported and related literature was reviewed in this case report.
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Affiliation(s)
- Pengjia Wu
- Department of Rheumatology and Immunology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China
| | - Shaomei Yu
- Department of Rheumatology and Immunology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China
| | - Jiashun Zeng
- Department of Rheumatology and Immunology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China.
| | - Lei Yang
- Department of Rheumatology and Immunology, The Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, China
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Cunha MJS, Teivelis MP, Mendes CDA, Baptistella CDPA, Sant´Anna PVH, Wolosker N. Shared decision-making and specific informed consent in patients with aortic aneurysms. Einstein (Sao Paulo) 2023; 21:eAO0197. [PMID: 37585885 PMCID: PMC10421603 DOI: 10.31744/einstein_journal/2023ao0197] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/16/2022] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE To analyze the refusal rate of elective aortic aneurysm surgery in asymptomatic patients after the presentation of a detailed informed consent form followed by a meeting where patient and their families can analyze each item. METHODS We conducted a retrospective analysis of 49 patients who had aneurysms and were offered surgical treatment between June 2017 and February 2019. The patients were divided into two groups: the Rejected Surgery Group, which was composed of patients who refused the proposed surgical treatment, and the Accepted Surgery Group, comprising patients who accepted the proposed surgeries and subsequently underwent them. RESULTS Of the 49 patients, 13 (26.5%) refused surgery after reading the informed consent and attending the comprehensive meeting. We observed that patients who refused surgery had statistically smaller aneurysms than those who accepted surgery (9% versus 26%). These smaller aneurysms were above the indication size, according to the literature. CONCLUSION One-quarter of patients who were indicated for elective surgical repair of aortic aneurysms rejected surgery after shared decision-making, which involved presenting patients with an informed consent form followed by a clarification meeting for them and their families to analyze each item. The only factor that significantly influenced a rejection of the procedure was the size of the aneurysm; patients who rejected surgery had smaller aneurysms than those who accepted surgery. Up to 26% of patients with aortic aneurysms refused surgical repair. The proposed technique, whether open or endovascular, did not influence patients' decisions. Patients with smaller aneurysms were more likely to refuse aortic aneurysm treatment.
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Affiliation(s)
- Marcela Juliano Silva Cunha
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de CarvalhoBrazilHospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Hospital Israelita Albert EinsteinSão PauloSPBrazil
| | - Marcelo Passos Teivelis
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de CarvalhoBrazilHospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Hospital Israelita Albert EinsteinSão PauloSPBrazil
| | - Cynthia de Almeida Mendes
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de CarvalhoBrazilHospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Hospital Israelita Albert EinsteinSão PauloSPBrazil
| | - Conrado Dias Pacheco Annicchino Baptistella
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de CarvalhoBrazilHospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Hospital Israelita Albert EinsteinSão PauloSPBrazil
| | - Pedro Vasconcelos Henry Sant´Anna
- Hospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de CarvalhoBrazilHospital Municipal da Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Hospital Israelita Albert EinsteinSão PauloSPBrazil
| | - Nelson Wolosker
- Hospital Israelita Albert EinsteinSão PauloSPBrazil Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Faculdade Israelita de Ciências da Saúde Albert EinsteinHospital Israelita Albert EinsteinSão PauloSPBrazil Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Behzadi F, Simon JE, Zielke TJ, Cook JT, Costa RA, Bechara CF, Prabhu VC. Risk Factors Associated with Spinal Cord Ischemia During Aortic Aneurysm Repair. Ann Vasc Surg 2023; 91:36-49. [PMID: 36603707 DOI: 10.1016/j.avsg.2022.12.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/12/2022] [Revised: 10/17/2022] [Accepted: 12/16/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The risk of spinal cord ischemia (SCI) with aortic aneurysm repair can cause significant neurological morbidity. Prevention of SCI is critical. We sought to identify risk factors that predispose to SCI that may guide strategies to mitigate the occurrence of SCI during and following these procedures. METHODS This study includes all adults who underwent atraumatic, unruptured, thoracic, and suprarenal aortic aneurysm repairs (endovascular or open) at our institution over 11 years (2010-2020). Our database included patient demographics, aneurysm anatomic features, and operative characteristics and an extreme gradient boost (XGB) machine method was used to develop a predictive model for SCI. The model was trained on an 80% randomly stratified cohort of the data and tested on the remaining 20% testing cohort. Shapley values were used to determine the most important predictive factors of SCI and decision trees were used to identify risk factor threshold values and highest risk factor combinations. RESULTS Information was collected for 174 adult patients undergoing thoracic and suprarenal aortic repair from 2010 to 2020. Fifty eight percent of the patients were male. Ninety seven (55.7%) patients had open aortic repair and 87 (44.3%) had endovascular repair. Twenty seven (15%) of all patients had major complications and were considered to have SCI. The XGB model converged over the training cohort with a testing cohort accuracy of 0.841 [Sensitivity = 75%, Specificity = 68%] and area under the curve of receiver operating characteristic of 0.774. The XGB model identified older age (> 65 years), history of neurologic disease, hyperlipidemia, diabetes, coronary artery disease, heart failure, poor renal function, < 6 months since last aortic repair, chronic anticoagulant use, preoperational anemia (Hemoglobin < 9), thrombocytopenia (platelet < 90,000), coagulopathy (prothrombin time > 15s and activated partial thromboplastin time > 40s), hypotension (mean arterial pressure < 70 mm Hg), longer operations (> 100 min), aneurysms longer than 5 cm, and anatomic location of aneurysm caudal to T-11 as risk factors for SCI in all types of aortic repair. Diabetic and heart failure patients undergoing longer operations (> 100 min) with thrombocytopenia or aneurysms longer than 5 cm were at the highest risk. CONCLUSIONS The XGB model accurately identified risk factors of SCI with aortic aneurysm repair that may guide patient selection, timing of surgery, and strategies to minimize the risk of SCI.
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Affiliation(s)
- Faraz Behzadi
- Department of General Surgery, Loyola University Medical Center, Maywood, IL
| | - Joshua E Simon
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL
| | - Tara J Zielke
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - John T Cook
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Renzo A Costa
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Carlos F Bechara
- Department of Vascular Surgery, Loyola University Medical Center, Maywood, IL
| | - Vikram C Prabhu
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL.
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12
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Azam R, Acharya M, Vadera S, Adair W, Mariscalco G. Late Giant Aortic Root Aneurysm Following Aortic Valve Replacement. Methodist Debakey Cardiovasc J 2022; 18:59-61. [PMID: 35935098 PMCID: PMC9306668 DOI: 10.14797/mdcvj.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/17/2022] [Accepted: 04/22/2022] [Indexed: 11/08/2022] Open
Abstract
A 74-year-old female with previous permanent pacemaker insertion for complete heart block and no history of connective tissue disease presented to our regional cardiothoracic center with progressive exertional shortness of breath. Nine years later, when the patient was 83 years old, a computed tomography scan of the thoracic aorta revealed an isolated aneurysm of the aortic root measuring 7.6 × 5.1 cm at the sinus of Valsalva.
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Gomez A, Wang Z, Xuan Y, Hope MD, Saloner DA, Guccione JM, Ge L, Tseng EE. Regional wall stress differences on tricuspid aortic valve-associated ascending aortic aneurysms. Interact Cardiovasc Thorac Surg 2022; 34:1115-1123. [PMID: 34718581 PMCID: PMC10634398 DOI: 10.1093/icvts/ivab269] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/15/2021] [Accepted: 08/27/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Ascending thoracic aortic aneurysms (aTAAs) carry a risk of acute type A dissection. Elective repair guidelines are based on diameter, but complications often occur below diameter threshold. Biomechanically, dissection can occur when wall stress exceeds wall strength. Aneurysm wall stresses may better capture dissection risk. Our aim was to investigate patient-specific aTAA wall stresses associated with a tricuspid aortic valve (TAV) by anatomic region. METHODS Patients with aneurysm diameter ≥4.0 cm underwent computed tomography angiography. Aneurysm geometries were reconstructed and loaded to systemic pressure while taking prestress into account. Finite element analyses were conducted to obtain wall stress distributions. The 99th percentile longitudinal and circumferential stresses were determined at systole. Wall stresses between regions were compared using one-way analysis of variance with post hoc Tukey HSD for pairwise comparisons. RESULTS Peak longitudinal wall stresses on aneurysms (n = 204) were 326 [standard deviation (SD): 61.7], 246 (SD: 63.4) and 195 (SD: 38.7) kPa in sinuses of Valsalva, sinotubular junction (STJ) and ascending aorta (AscAo), respectively, with significant differences between AscAo and both sinuses (P < 0.001) and STJ (P < 0.001). Peak circumferential wall stresses were 416 (SD: 85.1), 501 (SD: 119) and 340 (SD: 57.6) kPa for sinuses, STJ and AscAo, respectively, with significant differences between AscAo and both sinuses (P < 0.001) and STJ (P < 0.001). CONCLUSIONS Circumferential and longitudinal wall stresses were greater in the aortic root than AscAo on aneurysm patients with a TAV. Aneurysm wall stress magnitudes and distribution relative to respective regional wall strength could improve understanding of aortic regions at greater risk of dissection in a particular patient.
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Affiliation(s)
- Axel Gomez
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Zhongjie Wang
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Yue Xuan
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Michael D Hope
- Department of Radiology, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA
| | - David A Saloner
- Department of Radiology, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Julius M Guccione
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Liang Ge
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA
| | - Elaine E Tseng
- Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco and San Francisco VA Medical Center, San Francisco, CA, USA
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Takahara M, Iida O, Tazaki J, Nishikawa R, Nanto K, Chiba Y, Sakamoto K, Kinoshita M, Takahashi N, Kamihira S, Yamaoka T, Higami H, Nakane T, Ohmine T, Guntani A. Clinical features and prognosis of patients with and without diabetes mellitus undergoing endovascular aortic aneurysm repair. BMC Endocr Disord 2022; 22:92. [PMID: 35392888 PMCID: PMC8988424 DOI: 10.1186/s12902-022-01008-4] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This study aimed to compare the clinical features and prognoses of patients with and without diabetes mellitus (DM) who underwent endovascular repair for aortic aneurysm (AA). METHODS We analyzed the clinical database of a prospective multicenter study, registering 929 patients who underwent their first endovascular AA repair in Japan between January 2016 and June 2018. The baseline characteristics and prognoses (including all-cause mortality and cardiovascular events) after repair were compared between the DM and non-DM groups. Prognoses were also compared between the groups after propensity score matching. RESULTS In total, 226 patients (24.3%) had DM. Compared with non-DM patients, DM patients had higher pack-years of smoking (P = 0.011), higher body mass index (P = 0.009), lower high-density lipoprotein cholesterol levels (P = 0.038), higher triglyceride levels (P = 0.025), and lower left ventricular ejection fraction (P = 0.005). Meanwhile, the low-density lipoprotein cholesterol and blood pressure levels showed no significant intergroup difference (all P > 0.05). DM patients had a higher prevalence of myocardial infarction (P = 0.016), history of coronary revascularization (P = 0.015), and lower extremity artery disease (P = 0.019). Lesion characteristics and procedures were similar between the groups (all P > 0.05). DM patients had a higher risk of all-cause mortality and cardiovascular events than non-DM patients (both P < 0.001). Subsequent propensity score matching also demonstrated that DM patients had a significantly lower rate of overall survival (P = 0.001) and freedom from cardiovascular events (P = 0.010). The Kaplan-Meier estimates at 1 year for the overall survival were 85.6% (95% confidence interval [CI], 80.9% to 90.5%) and 94.3% (95% CI, 91.7% to 97.0%) for patients with and without DM, respectively. The corresponding estimates for freedom from cardiovascular events were 79.8% (95% CI, 74.5% to 85.5%) and 87.7% (95% CI, 84.2% to 91.3%), respectively. CONCLUSIONS Among patients undergoing endovascular AA repair, those with DM had more cardiovascular risk factors. DM patients had a higher incidence rate of all-cause mortality and cardiovascular events. Matching analysis indicated that DM per se would be a risk factor for poor prognoses after AA repair.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki City, Hyogo, 660-8511, Japan
| | - Junichi Tazaki
- Department of Cardiovascular Medicine and Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto City, Kyoto, 606-8501, Japan
| | - Ryusuke Nishikawa
- Department of Cardiovascular Medicine, Shizuoka General Hospital, 4-27-1 Kita Ando Aoi-ku, Shizuoka City, Shizuoka, 420-8527, Japan
| | - Kiyonori Nanto
- Cardiovascular Center, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki City, Hyogo, 660-8511, Japan
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital, 3-3-10 Futabadai, Mito City, , Ibaraki, 311-4198, Japan
| | - Kazuhisa Sakamoto
- Department of Cardiovascular Medicine and Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto City, Kyoto, 606-8501, Japan
| | - Makoto Kinoshita
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe-city, Hyogo, 650-0047, Japan
| | - Naoki Takahashi
- Cardiovascular Center, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji-ku, Osaka City, Osaka, 543-8555, Japan
| | - Satoshi Kamihira
- Department of Cardiovascular Surgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo City, Shimane, 693-8555, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, 1 Bunkyocho, Matsuyama City, Ehime, 790-0826, Japan
| | - Hirooki Higami
- Department of Cardiovascular Medicine, Japanese Red Cross Otsu Hospital, 1-1-35 Nagara, Otsu City, Shiga, 520-0046, Japan
| | - Takeichiro Nakane
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, 1 Katsuragosho-cho, Nishikyo-ku, Kyoto City, Kyoto, 615-8087, Japan
| | - Takahiro Ohmine
- Department of Vascular Surgery, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, 1-9-6 Sendamachi, Naka-ku, Hiroshima City, Hiroshima, 730-8619, Japan
| | - Atsushi Guntani
- Department of Vascular Surgery, Saiseikai Yahata General Hospital, 5-9-27 Harunomachi, Yahatahigashi-ku, Kitakyushu City, Fukuoka, 805-0050, Japan
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Hashemi H, Khera S, Anastasius M, Tang GHL, Sharma SK, Kini A, Lerakis S. Acute Type A Aortic Dissection After TAVR in an Octogenarian With Ascending Aorta Aneurysm. JACC Cardiovasc Interv 2022; 15:220-222. [PMID: 34973906 DOI: 10.1016/j.jcin.2021.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/13/2021] [Accepted: 10/19/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Helen Hashemi
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sahil Khera
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Malcolm Anastasius
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samin K Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stamatios Lerakis
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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Mikołajczyk K, Spyt D, Zielińska W, Żuryń A, Faisal I, Qamar M, Świniarski P, Grzanka A, Gagat M. The Important Role of Endothelium and Extracellular Vesicles in the Cellular Mechanism of Aortic Aneurysm Formation. Int J Mol Sci 2021; 22:ijms222313157. [PMID: 34884962 PMCID: PMC8658239 DOI: 10.3390/ijms222313157] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022] Open
Abstract
Homeostasis is a fundamental property of biological systems consisting of the ability to maintain a dynamic balance of the environment of biochemical processes. The action of endogenous and exogenous factors can lead to internal balance disorder, which results in the activation of the immune system and the development of inflammatory response. Inflammation determines the disturbances in the structure of the vessel wall, connected with the change in their diameter. These disorders consist of accumulation in the space between the endothelium and the muscle cells of low-density lipoproteins (LDL), resulting in the formation of fatty streaks narrowing the lumen and restricting the blood flow in the area behind the structure. The effect of inflammation may also be pathological dilatation of the vessel wall associated with the development of aneurysms. Described disease entities strongly correlate with the increased migration of immune cells. Recent scientific research indicates the secretion of specific vesicular structures during migration activated by the inflammation. The review focuses on the link between endothelial dysfunction and the inflammatory response and the impact of these processes on the development of disease entities potentially related to the secretion of extracellular vesicles (EVs).
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Affiliation(s)
- Klaudia Mikołajczyk
- Department of Histology and Embryology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-092 Bydgoszcz, Poland; (K.M.); (D.S.); (W.Z.); (A.Ż.); (I.F.); (M.Q.); (A.G.)
| | - Dominika Spyt
- Department of Histology and Embryology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-092 Bydgoszcz, Poland; (K.M.); (D.S.); (W.Z.); (A.Ż.); (I.F.); (M.Q.); (A.G.)
| | - Wioletta Zielińska
- Department of Histology and Embryology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-092 Bydgoszcz, Poland; (K.M.); (D.S.); (W.Z.); (A.Ż.); (I.F.); (M.Q.); (A.G.)
| | - Agnieszka Żuryń
- Department of Histology and Embryology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-092 Bydgoszcz, Poland; (K.M.); (D.S.); (W.Z.); (A.Ż.); (I.F.); (M.Q.); (A.G.)
| | - Inaz Faisal
- Department of Histology and Embryology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-092 Bydgoszcz, Poland; (K.M.); (D.S.); (W.Z.); (A.Ż.); (I.F.); (M.Q.); (A.G.)
| | - Murtaz Qamar
- Department of Histology and Embryology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-092 Bydgoszcz, Poland; (K.M.); (D.S.); (W.Z.); (A.Ż.); (I.F.); (M.Q.); (A.G.)
| | - Piotr Świniarski
- Department of Urology and Andrology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-092 Bydgoszcz, Poland;
| | - Alina Grzanka
- Department of Histology and Embryology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-092 Bydgoszcz, Poland; (K.M.); (D.S.); (W.Z.); (A.Ż.); (I.F.); (M.Q.); (A.G.)
| | - Maciej Gagat
- Department of Histology and Embryology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-092 Bydgoszcz, Poland; (K.M.); (D.S.); (W.Z.); (A.Ż.); (I.F.); (M.Q.); (A.G.)
- Correspondence:
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Huang C, Fang X, Xie X, Liu Y, Xu D, Meng X, Long J. Effect of miR-126 on the Proliferation and Migration of Vascular Smooth Muscle Cells in Aortic Aneurysm Mice Under PI3K/AKT/mTOR Signaling Pathway. Mol Biotechnol 2021; 63:631-637. [PMID: 33970415 DOI: 10.1007/s12033-021-00327-6] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/09/2021] [Indexed: 12/01/2022]
Abstract
This paper is to investigate the expression changes of Phosphatidylinositol-3 Kinase (PI3K), protein kinase B (AKT), and Mammalian Target of Rapamycin (mTOR) in Vascular Smooth Muscle Cells (VSMCs) of aortic aneurysm mice, and to analyze the mechanism of VSMCs proliferation and migration. Aortic VSMCs cells were cultured using BALB/c mice as the research object. VSMCs were identified using artificial intelligence-based digital microscopy equipment, and liposome-transfected VSMCs experiments were performed. Real-time PCR was used for the mRNA expression levels of miR-126 and Phosphatase and Tensin Homolog (PTEN). Western blot was used for the protein expression levels of PTEN, PI3K, AKT, and mTOR. The cultured cells were identified as mouse VSMCs using digital microscopes based on artificial intelligence. Compared with the normal group, the expression of miR-126 and PTEN mRNA in the model group were significantly increased and reduced, respectively. Compared with the model group, the expression level of miR-126 and PTEN mRNA in the inhibitor group were significantly reduced and increased, respectively. Compared with the model group, the expression of miR-126 and PTEN mRNA in the ursolic acid group was significantly reduced and increased, respectively. After liposome transfection, compared with the normal group, the expression of PTEN protein in the model group was significantly reduced, and the expression of PI3K protein was significantly increased. Compared with the model group, the expression of PTEN protein was significantly increased and the expression of PI3K protein was significantly decreased in the transfection group. Compared with the control group, the expression of PI3K, AKT and mTOR protein in the model group was significantly increased. Compared with the model group, the expression of PI3K, AKT, and mTOR protein in the ursolic acid group was significantly reduced. The expressions of PI3K, AKT and mTOR protein in PI3K inhibitor group and AKT inhibitor group were significantly reduced. In conclusion, ursolic acid can inhibit the proliferation and migration of VSMCs in aortic aneurysm mice through the miR-126/PTEN/PI3K/AKT/mTOR signaling pathway. Furthermore, PTEN gene and miR-126 negatively regulate PI3K/AKT/mTOR and PTEN/PI3K/AKT/mTOR signaling pathway, respectively .
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Affiliation(s)
- Changpin Huang
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China
| | - Xin Fang
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China.
| | - Xupin Xie
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China
| | - Yongchang Liu
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China
| | - Dong Xu
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China
| | - Xiaohu Meng
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China
| | - Jianyun Long
- Department of Vascular Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, China
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Shad R, Kong S, Fong R, Quach N, Kasinpila P, Bowles C, Lee A, Hiesinger W. Computational Fluid Dynamics Simulations to Predict False Lumen Enlargement After Surgical Repair of Type-A Aortic Dissection. Semin Thorac Cardiovasc Surg 2021; 34:443-448. [PMID: 34091015 DOI: 10.1053/j.semtcvs.2021.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 11/11/2022]
Abstract
We aim to use computational fluid dynamics to investigate the hemodynamic conditions that may predispose to false lumen enlargement in this patient population. Nine patients who received surgical repairs of their type-A aortic dissections between 2017-2018 were retrospectively identified. Multiple contrast-enhanced post-operative CT scans were used to construct 3D models of aortic geometries. Computational fluid dynamics simulations of the models were run on a high-performance computing cluster using SimVascular - an open-source simulation package. Physiological pulsatile flow conditions (4.9 L/min) were used at the aortic true lumen inlet, and physiological vascular resistances were applied at the distal vascular ends. Exploratory analyses showed no correlation between rate of false lumen growth and blood pressure, immediate post-op aortic diameter, or the number of fenestrations (p = 0.2). 1-year post-operative CT scans showed a median false lumen growth rate of 4.31 (3.66, 14.67) mm/year Median (Interquartile range) peak systolic, mid-diastolic, and late diastolic velocity magnitudes were 0.90 (1.40); 0.10 (0.16); and 0.06 (0.06) cm/s respectively. Spearman's ranked correlations between fenestration velocity and 1-year false lumen growth rates were found to be statistically significant: Velocity magnitude at peak systolic (p = 0.025; rho = 0.75), mid diastolic (p = 0.025; rho = 0.75) and late diastolic phases of the cardiac cycle (p = 0.006; rho = 0.85). We have shown that false lumen growth is strongly correlated to fenestration flow velocity, which has potential implications for post-operative surveillance and risk stratification.
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Affiliation(s)
- Rohan Shad
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, California
| | - Sandra Kong
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, California
| | - Robyn Fong
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, California
| | - Nicolas Quach
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, California
| | - Patpilai Kasinpila
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, California
| | - Cayley Bowles
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, California
| | - Anson Lee
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, California
| | - William Hiesinger
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, California.
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Qi X, Wang F, Chun C, Saldarriaga L, Jiang Z, Pruitt EY, Arnaoutakis GJ, Upchurch GR, Jiang Z. A validated mouse model capable of recapitulating the protective effects of female sex hormones on ascending aortic aneurysms and dissections (AADs). Physiol Rep 2020; 8:e14631. [PMID: 33242364 PMCID: PMC7690909 DOI: 10.14814/phy2.14631] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 12/19/2022] Open
Abstract
Fewer females develop AADs (ascending aortic aneurysms and dissections) and the reasons for this protection remain poorly understood. The present study seeks to develop a mouse model that may be utilized to address this sexual dimorphism. Adult normolipidemic mice were challenged with BAPN (β-aminopropionitrile), AngII (angiotensin II), or BAPN + AngII. An initial protocol optimization found that 0.2% BAPN in drinking water plus AngII-infusion at 1,000 ng kg-1 min-1 produced favorable rates of AAD rupture (~50%) and dilation (~40%) in 28 days. Using these dosages, further experiments revealed that BAPN is toxic to naïve mature aortas and it acted synergistically with AngII to promote aortic tears and dissections. BAPN + AngII provoked early infiltration of myeloid cells and subsequent recruitment of lymphoid cells to the aortic wall. AADs established with BAPN + AngII, but not AngII alone, continued to expand after the cessation of AngII-infusion. This indefinite growth precipitated a 61% increase in the AAD diameter in 56 days. More importantly, with the optimized protocol, significant differences in AAD dilation (p = .012) and medial degeneration (p = .036) were detected between male and female mice. Treatment of ovariectomized mice with estradiol protected AAD formation (p = .014). In summary, this study developed a powerful mouse AAD model that can be used to study the sexual dimorphism in AAD formation.
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Affiliation(s)
- Xiaoyan Qi
- Division of Vascular Surgery and Endovascular TherapyUniversity of Florida College of MedicineGainesvilleFLUSA
- Institute of Cardiovascular DiseaseUniversity of South ChinaHengyangChina
| | - Fen Wang
- Division of Vascular Surgery and Endovascular TherapyUniversity of Florida College of MedicineGainesvilleFLUSA
| | - Changzoon Chun
- Division of Vascular Surgery and Endovascular TherapyUniversity of Florida College of MedicineGainesvilleFLUSA
| | - Lennon Saldarriaga
- Division of Vascular Surgery and Endovascular TherapyUniversity of Florida College of MedicineGainesvilleFLUSA
| | - Zhisheng Jiang
- Institute of Cardiovascular DiseaseUniversity of South ChinaHengyangChina
| | - Eric Y. Pruitt
- Division of Vascular Surgery and Endovascular TherapyUniversity of Florida College of MedicineGainesvilleFLUSA
| | - George J. Arnaoutakis
- Division of Vascular Surgery and Endovascular TherapyUniversity of Florida College of MedicineGainesvilleFLUSA
- Division of Thoracic and Cardiovascular SurgeryUniversity of Florida College of MedicineGainesvilleFLUSA
| | - Gilbert R. Upchurch
- Division of Vascular Surgery and Endovascular TherapyUniversity of Florida College of MedicineGainesvilleFLUSA
| | - Zhihua Jiang
- Division of Vascular Surgery and Endovascular TherapyUniversity of Florida College of MedicineGainesvilleFLUSA
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20
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Chewcharat A, Hamaya R, Thongprayoon C, Cato LD, Mao MA, Cheungpasitporn W. The association between simple renal cyst and aortic diseases: A systematic review and meta-analysis of observational studies. J Evid Based Med 2020; 13:265-274. [PMID: 32452169 DOI: 10.1111/jebm.12385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 03/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this meta-analysis of observational studies was to evaluate the association between simple renal cysts (SRC) and presence of aortic pathology such as aortic aneurysms and dissection. METHODS We conducted searches in Ovid MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from January 1960 to August 2019 to identify observational studies that examined the association between SRCs and any aortic diseases, including aortic aneurysms and dissection. Two reviewers independently extracted the data and assessed the risk of bias. The meta-analysis was performed by STATA 14.1. RESULTS In total, 11 observational studies with 19 719 participants were included in this meta-analysis. Compared to individuals without SRCs, patients with SRCs had higher odds of abdominal aortic aneurysm (AAA) (adjusted OR = 2.61, 95% CI 2.34-2.91, P < 0.001, I2 = 0%), ascending thoracic aortic aneurysm (TAA) (adjusted OR = 1.98, 95% CI 1.09-3.63, P = 0.03, I2 = 90.1%), descending TAA (adjusted OR = 3.44, 95% CI, 2.67-4.43, P < 0.001, I2 = 0%), type A aortic dissection (AD) (adjusted OR = 1.98, 95% CI 1.32-2.96, P = 0.001, I2 = 12.9%), and type B AD (adjusted OR = 2.55, 95% CI, 1.31-4.96, P = 0.006, I2 = 76.2%). There was a higher average in the sum of diameter of SRCs among AAA compared to patients without AAA (WMD = 19.80 mm, 95% CI 13.92-25.67, P < 0.001, I2 = 63.8%). CONCLUSION SRC is associated with higher odds of aortic diseases including AAA, ascending and descending TAA, type A and type B dissection even after adjusting for confounders.
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Affiliation(s)
- Api Chewcharat
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Rikuta Hamaya
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Liam D Cato
- Department of Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Michael A Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida
| | - Wisit Cheungpasitporn
- Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
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Mikami T, Kamada T, Uchiyama H, Kuroda Y, Harada R, Naraoka S, Kawaharada N. A rare case of pseudoaneurysm at the site of untreated coarctation of the aorta in an adult patient. Gen Thorac Cardiovasc Surg 2020; 69:740-743. [PMID: 33111217 PMCID: PMC7981309 DOI: 10.1007/s11748-020-01525-w] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/13/2020] [Indexed: 12/04/2022]
Abstract
Here we report a rare case of pseudoaneurysm at the site of aortic coarctation. Aortic coarctation and a saccular aortic aneurysm protruding from the site of this coarctation were detected in a 50-year-old woman. Owing to the shape of the aneurysm and high risk of rupture, an open surgical repair was performed. The pathological findings of the removed aneurysm revealed a pseudoaneurysm consisting of only a thin adventitial wall. Adult uncorrected aortic coarctation has a poor prognosis. One of its causes may be the formation of such a pseudoaneurysm.
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Affiliation(s)
- Takuma Mikami
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Takeshi Kamada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Hiroki Uchiyama
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Yosuke Kuroda
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Ryo Harada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Syuichi Naraoka
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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22
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Tseng EE, Wang Z, Ge L. Reply from authors: Aortic aneurysm biomechanics: Perfect is the enemy of good. J Thorac Cardiovasc Surg 2020; 160:e105-e106. [PMID: 32595031 PMCID: PMC8505005 DOI: 10.1016/j.jtcvs.2020.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Elaine E Tseng
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, Calif
| | - Zhongjie Wang
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, Calif
| | - Liang Ge
- Division of Cardiothoracic Surgery, Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, Calif
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23
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Etz CD, Haunschild J, Girdauskas E, Della Corte A, Fedak PWM, Schäfers HJ, Sundt TM, Borger MA. Surgical management of the aorta in BAV patients. Prog Cardiovasc Dis 2020; 63:475-481. [PMID: 32640281 DOI: 10.1016/j.pcad.2020.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 12/12/2022]
Abstract
Patients with a bicuspid aortic valve (BAV) frequently develop aneurysms of the aortic root and tubular ascending aorta. Aneurysms of the aortic arch, in the absence of concomitant aortopathies, are much less common. According to the 2018 American Association of Thoracic Surgery consensus guidelines on BAV-related aortopathy, prophylactic surgical aortic repair / replacement is recommended starting at a maximum aortic diameter of 50 mm in patients with risk factors. Concomitant aortic surgery is also recommended at an aortic diameter of 45 mm in those patients with other indications for cardiac surgery (most commonly aortic valve procedures). The ultimate goal of prophylactic aortic surgery is the prevention of aortic catastrophes, e.g. aortic rupture or acute aortic dissection, which are associated with high morbidity and mortality. The surgical technique used - in elective and emergency cases - depends on the involvement and nature of the aortic valve disease, as well as the extent of aortic aneurysm formation. The current review focusses on the surgical management of the aortic root, tubular ascending aorta, and proximal aortic arch in BAV patients. Despite the abovementioned recommendations, many BAV patients develop acute aortic syndromes below the recommended aortic diameter thresholds. Further research is therefore required in order to identify high-risk BAV subgroups that would benefit from earlier surgical repair.
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Affiliation(s)
- Christian D Etz
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | | | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Paul W M Fedak
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Libin Cardiovascular Institute, Calgary, Canada
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
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Pulignani S, Borghini A, Foffa I, Vecoli C, Ait-Alì L, Andreassi MG. Functional characterization and circulating expression profile of dysregulated microRNAs in BAV-associated aortopathy. Heart Vessels 2020; 35:432-440. [PMID: 31562552 DOI: 10.1007/s00380-019-01509-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023]
Abstract
Compelling evidence has shown that microRNAs (miRs) are involved in the pathophysiology of BAV-associated aortopathy. The purpose of this study was to assess the biological role as well as the circulating expression of two miRs (miR-424-3p and miR-3688-3p) that have been previously identified as significantly dysregulated in thoracic aortic aneurysm specimens of BAV patients. Bioinformatic tools were used to predict miR gene targets followed by functional validation transfecting synthetic miR mimics and negative controls into human aortic smooth muscle cells (HASMCs). Levels of miRs and target genes were evaluated by qRT-PCR. The circulating miR expression profile analysis was assessed on plasma samples collected from a cohort of 72 patients with aortopathy including 39 BAV (33 males; 58 ± 13 years) and 33 TAV patients (26 males; 67 ± 9 years). Computational analysis revealed that SMAD7 and YAP1 were potential targets of miR-424-3p and miR-3688-3p, respectively. Transfection with mimics confirmed a significantly decreased gene expression of SMAD7 and YAP1 compared to mimic negative control (p = 0.04 and p = 0.0005, respectively) or blank control (p = 0.01 and p = 0.0007, respectively). Overexpression of miR-3688-3p also significantly upregulated pro-apoptotic caspase-3 gene expression compared to mimic negative control (p = 0.02) or blank control (p = 0.01). Furthermore, a significant down-regulation of the circulating miR-424-3p was observed in BAV compared to TAV patients (p = 0.001). In multiple linear regression analysis, the aortic valve morphology (β = - 0.29, p = 0.04) and the presence of aortic stenosis (β = - 0.28, p = 0.03) had a significant effect on the miR-424-3p expression. In conclusion, our study demonstrated that miR-424-3p and miR-3688-3p directly targeted SMAD7 and YAP1 in HASMCs, pivotal genes of the TGF-β and Hippo-signaling pathways. Circulating miR-424-3p was also found to be significantly decreased in BAV patients when compared to TAV patients, especially in patients with aortic stenosis. Further large studies of well-characterized BAV patient cohorts are needed to define the clinical significance of the miR-424-3p.
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Affiliation(s)
- Silvia Pulignani
- Institute of Clinical Physiology (IFC), Via Moruzzi 1, 56124, Pisa, Italy
| | - Andrea Borghini
- Institute of Clinical Physiology (IFC), Via Moruzzi 1, 56124, Pisa, Italy
| | - Ilenia Foffa
- Institute of Clinical Physiology (IFC), Via Moruzzi 1, 56124, Pisa, Italy
| | - Cecilia Vecoli
- Institute of Clinical Physiology (IFC), Via Moruzzi 1, 56124, Pisa, Italy
| | - Lamia Ait-Alì
- Institute of Clinical Physiology (IFC), Via Moruzzi 1, 56124, Pisa, Italy
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25
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Nakanishi Y, Yuzaki M, Honda K, Kaneko M, Funahashi R, Nishimura Y. Staged hybrid aortic procedure for chronic type B aortic dissection in two patients with Marfan syndrome. Gen Thorac Cardiovasc Surg 2020; 68:1472-1474. [PMID: 32006249 DOI: 10.1007/s11748-020-01296-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 01/17/2020] [Indexed: 01/24/2023]
Abstract
We here report two patients with Marfan syndrome treated by a combination of surgical grafting and endovascular repair in our hospital. One was a 32-year-old woman who underwent thoracoabdominal aortic replacement for a Crawford type III dissected aortic aneurysm. Subsequently, the Bentall procedure and total arch replacement was performed for an aortic root and arch aneurysm. Finally, thoracic endovascular aortic repair bridging implanted grafts was performed. The second was a 67-year-old woman with Stanford type A acute aortic dissection who underwent the Bentall procedure and total arch replacement at the age of 64. Subsequently, she underwent thoracoabdominal replacement for a dilated dissected aortic aneurysm and finally, bridging endovascular aortic repair was performed. This procedure is less invasive than open repair for patients with Marfan syndrome.
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Affiliation(s)
- Yasuka Nakanishi
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Kimiidera, Wakayama, Wakayama, Japan.
| | - Mitsuru Yuzaki
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Kimiidera, Wakayama, Wakayama, Japan
| | - Kentaro Honda
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Kimiidera, Wakayama, Wakayama, Japan
| | - Masahiro Kaneko
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Kimiidera, Wakayama, Wakayama, Japan
| | - Ryosuke Funahashi
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Kimiidera, Wakayama, Wakayama, Japan
| | - Yoshiharu Nishimura
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Kimiidera, Wakayama, Wakayama, Japan
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26
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Bansal PB, Chaliki HP, Kolla KR, Click RL, Pochettino A. Unusual Cause of Heart Failure in a Patient with Marfan Syndrome: A Late Complication of Bioprosthetic Valved Graft Replacement. Tex Heart Inst J 2020; 47:38-40. [PMID: 32148452 DOI: 10.14503/thij-18-6618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
A high-velocity gradient across the left ventricular outflow tract is most often caused by aortic valve stenosis. We describe the unusual case of a high-velocity gradient caused by a kinked ascending aortic graft in a 69-year-old man who had Marfan syndrome. The patient had a history of ascending aortic aneurysm and had previously undergone replacement of the aortic root and ascending aorta with use of a bioprosthetic valved graft. The kinking was caused by dilation of the native aortic arch. The patient underwent successful hemi-arch replacement and repair of the kinked graft. Late complications and reoperation after proximal aortic surgery in patients with Marfan syndrome are rare, and a high-velocity left ventricular outflow tract gradient caused by the kinking of the aorta is unusual.
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27
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Lee FY, Chen WK, Lin CL, Kao CH, Yang TY, Lai CY. Risk of aortic dissection, congestive heart failure, pneumonia and acute respiratory distress syndrome in patients with clinical vertebral fracture: a nationwide population-based cohort study in Taiwan. BMJ Open 2019; 9:e030939. [PMID: 31753874 PMCID: PMC6886957 DOI: 10.1136/bmjopen-2019-030939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Studies on the association between clinical vertebral fractures (CVFs) and the subsequent risk of cardiopulmonary diseases, including aortic dissection (AD), congestive heart failure (CHF), pneumonia and acute respiratory distress syndrome (ARDS) are scarce. Therefore, we used the National Health Insurance Research Database to investigate whether patients with CVF have a heightened risk of subsequent AD, CHF, pneumonia and ARDS. DESIGN The National Health Insurance Research Database was used to investigate whether patients with CVFs have an increased risk of subsequent AD, CHF, pneumonia and ARDS. PARTICIPANTS This cohort study comprised patients aged ≥18 years with a diagnosis of CVF and were hospitalised at any point during 2000-2010 (n=1 08 935). Each CVF patient was frequency-matched to a no-CVF hospitalised patients based on age, sex, index year and comorbidities (n=1 08 935). The Cox proportional hazard regressions model was used to estimate the adjusted effect of CVF on AD, CHF, pneumonia and ARDS risk. RESULTS The overall incidence of AD, CHF, pneumonia and ARDS was higher in the CVF group than in the no-CVF group (4.85 vs 3.99, 119.1 vs 89.6, 283.3 vs 183.5 and 9.18 vs 4.18/10 000 person-years, respectively). After adjustment for age, sex, comorbidities and Charlson comorbidity index score, patients with CVF had a 1.23-fold higher risk of AD (95% CI=1.03-1.45), 1.35-fold higher risk of CHF (95% CI=1.30-1.40), 1.57-fold higher risk of pneumonia (95% CI=1.54-1.61) and 2.21-fold higher risk of ARDS (95% CI=1.91-2.57) than did those without CVF. Patients with cervical CVF and SCI were more likely to develop pneumonia and ARDS. CONCLUSIONS Our study demonstrates that CVFs are associated with an increased risk of subsequent cardiopulmonary diseases. Future investigations are encouraged to delineate the mechanisms underlying this association.
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Affiliation(s)
- Feng-You Lee
- Department of Emergency Medicine, Taichung Tzu Chi Hospital, Taichung City, Taiwan
- Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Wei-Kung Chen
- Department of Emergency Medicine, Trauma and Emergency Center, China Medical University Hospital, Taichung City, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung City, Taiwan
- College of Medicine, China Medical University, Taichung City, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung City, Taiwan
- Center of Augmented Intelligence in Healthcare, Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung City, Taiwan
| | - Tse-Yen Yang
- Department of Medical Research & Molecular and Genomic Epidemiology Center, China Medical University Hospital, Taichung City, Taiwan
- Center for General Education & Master Program of Digital Health Innovation, China Medical University, Taichung City, Taiwan
| | - Ching-Yuan Lai
- Department of Emergency Medicine, Trauma and Emergency Center, China Medical University Hospital, Taichung City, Taiwan
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28
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García-Fernández-Bravo I, González-Munera A, Ordieres-Ortega L, Ruiz Chiriboga D, González-Leyte M. Thrombosis of an infrarenal aortic aneurysm secondary to Salmonella enteritidis infection. Rev Gastroenterol Mex (Engl Ed) 2019; 84:522-524. [PMID: 31122795 DOI: 10.1016/j.rgmx.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/12/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Affiliation(s)
| | - A González-Munera
- Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L Ordieres-Ortega
- Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - D Ruiz Chiriboga
- Servicio de Angiología y Cirugía Vascular, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M González-Leyte
- Unidad de Radiología Vascular, Servicio de Radiodiagnóstico, Hospital General Universitario Gregorio Marañón, Madrid, España
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29
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Affiliation(s)
- Lachlan F Miles
- From the Department of Anaesthesia, Austin Health, Melbourne, Australia
| | - Andrew J Roscoe
- Department of Anaesthesia and Intensive Care, Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
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30
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Guala A, Rodriguez-Palomares J, Galian-Gay L, Teixido-Tura G, Johnson KM, Wieben O, Sao Avilés A, Evangelista A. Partial Aortic Valve Leaflet Fusion Is Related to Deleterious Alteration of Proximal Aorta Hemodynamics. Circulation 2019; 139:2707-2709. [PMID: 31158004 DOI: 10.1161/circulationaha.119.039693] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrea Guala
- Hospital Universitari Vall d´Hebron, Department of Cardiology, CIBER-CV. Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Spain (A.G., J.R.-P., L.G.-G., G.T.-T., A.S.A., A.E.)
| | - Jose Rodriguez-Palomares
- Hospital Universitari Vall d´Hebron, Department of Cardiology, CIBER-CV. Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Spain (A.G., J.R.-P., L.G.-G., G.T.-T., A.S.A., A.E.)
| | - Laura Galian-Gay
- Hospital Universitari Vall d´Hebron, Department of Cardiology, CIBER-CV. Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Spain (A.G., J.R.-P., L.G.-G., G.T.-T., A.S.A., A.E.)
| | - Gisela Teixido-Tura
- Hospital Universitari Vall d´Hebron, Department of Cardiology, CIBER-CV. Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Spain (A.G., J.R.-P., L.G.-G., G.T.-T., A.S.A., A.E.)
| | - Kevin M Johnson
- Departments of Medical Physics & Radiology, University of Wisconsin, Madison (K.M.J., O.W.)
| | - Oliver Wieben
- Departments of Medical Physics & Radiology, University of Wisconsin, Madison (K.M.J., O.W.)
| | - Augusto Sao Avilés
- Hospital Universitari Vall d´Hebron, Department of Cardiology, CIBER-CV. Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Spain (A.G., J.R.-P., L.G.-G., G.T.-T., A.S.A., A.E.)
| | - Arturo Evangelista
- Hospital Universitari Vall d´Hebron, Department of Cardiology, CIBER-CV. Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Spain (A.G., J.R.-P., L.G.-G., G.T.-T., A.S.A., A.E.)
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31
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Oner T, Akgun G, Ergin SO, Karadag H, Yucel İK, Celebi A. Risk Factors Associated with Ascending Aortic Aneurysms and Aortic Elasticity Parameters in Children with a Bicuspid Aortic Valve. Pediatr Cardiol 2019; 40:980-986. [PMID: 31016325 DOI: 10.1007/s00246-019-02102-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 04/05/2019] [Indexed: 11/28/2022]
Abstract
Aneurysms of the ascending aorta are frequently found in patients with a bicuspid aortic valve (BAV). This study assessed the risk factors of ascending aortic aneurysms and aortic elasticity in children with BAV. The study included 66 patients with no history of transcatheter intervention or surgical procedure who had been diagnosed with isolated BAV. Echocardiographic, blood pressure, and pulse measurements were obtained for all patients. The BAVs were classified as described by Sievers et al. (J Thorac Cardiovasc Surg 133:1226-1233, 2007), and aortic elasticity parameters were calculated using various formulas. The patients were divided into groups with and without cusp fusion, aortic stenosis (AS), aortic regurgitation (AR), or mixed lesions; the groups were then compared. The mean patient age was 10.43 ± 3.91 years; 15%he patients had no AS or AR, 33% had both AS and AR, 17% had AS alone, and 35% had AR alone. The most common type of BAV was type 5, and the ascending aorta z-scores were higher in children with mixed lesions and without a cusp fusion. Aortic distensibility (AD) was significantly higher, and the stiffness index was significantly lower, in patients with an ascending aorta z-score > 4. The ascending aortic z-scores were higher in the no-fusion and mixed lesion (AS + AR) groups, especially those originating from post-stenotic dilation due to AS. The AD was increased in patients with an ascending aorta z-score > 4. Patients should thus be monitored closely for dissection risk, and preventive medical treatment should be started early in those with AS without cusp fusion.
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Affiliation(s)
- Taliha Oner
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Uskudar, Istanbul, Turkey.
| | - Gokmen Akgun
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Uskudar, Istanbul, Turkey
| | - Selma Oktay Ergin
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Uskudar, Istanbul, Turkey
| | - Huseyin Karadag
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Uskudar, Istanbul, Turkey
| | - İlker Kemal Yucel
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Uskudar, Istanbul, Turkey
| | - Ahmet Celebi
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Uskudar, Istanbul, Turkey
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32
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Frikha F, Garbaa S, Bouattour Y, Snoussi M, Loukil H, Ben Salah R, Bahloul Z. [Tocilizumab for refractory Takayasu arteritis with aortic aneurysm]. J Med Vasc 2019; 44:237-239. [PMID: 31029281 DOI: 10.1016/j.jdmv.2019.02.004] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 01/27/2019] [Indexed: 06/09/2023]
Abstract
Takayasu arteritis (TA) is a form of large vessel vasculitis (LVV) which affects the aorta and the main arteries. Many reports showed efficacy of biologic drugs (TNF α inhibitors and interleukin 6 inhibitors) in refractory TA cases. We report the case of a 46-year-old woman with refractory TA complicated by giant aortic aneurysm (AA) and severe hypertension, treated efficacy with tocilizumab (anti-interleukin 6 receptor monoclonal antibody).
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Affiliation(s)
- F Frikha
- Service de médecine interne, CHU Hédi Chaker, 3029 Sfax, Tunisie.
| | - S Garbaa
- Service de médecine interne, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - Y Bouattour
- Service de médecine interne, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - M Snoussi
- Service de médecine interne, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - H Loukil
- Service de médecine interne, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - R Ben Salah
- Service de médecine interne, CHU Hédi Chaker, 3029 Sfax, Tunisie
| | - Z Bahloul
- Service de médecine interne, CHU Hédi Chaker, 3029 Sfax, Tunisie
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33
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Zhou Z, Peters AM, Wang S, Janda A, Chen J, Zhou P, Arthur E, Kwartler CS, Milewicz DM. Reversal of Aortic Enlargement Induced by Increased Biomechanical Forces Requires AT1R Inhibition in Conjunction With AT2R Activation. Arterioscler Thromb Vasc Biol 2019; 39:459-466. [PMID: 30602301 PMCID: PMC6400319 DOI: 10.1161/atvbaha.118.312158] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective- Pharmacological inhibition of the AT1R (angiotensin II type 1 receptor) with losartan can attenuate ascending aortic remodeling induced by transverse aortic constriction (TAC). In this study, we investigated the role of the AT2R (angiotensin II type 2 receptor) and MasR (Mas receptor) in TAC-induced ascending aortic dilation and remodeling. Approach and Results- Wild-type C57BL/6J mice were subjected to sham or TAC surgeries in the presence and absence of various drugs. Aortic diameters were assessed by echocardiography, central blood pressure was measured in the ascending aorta 2 weeks post-operation, and histology and gene expression analyses completed. An angiotensin-converting enzyme inhibitor, captopril, decreased systolic blood pressure to the same level as losartan but did not attenuate aortic dilation, adventitial inflammation, medial collagen deposition, elastin breakage, or Mmp9 (matrix metalloproteinase-9) expression when compared with TAC mice. In contrast, co-administration of captopril with an AT2R agonist, compound 21, attenuated aortic dilation, medial collagen content, elastin breaks, and Mmp9 expression, whereas co-administration of captopril with a MasR agonist (AVE0991) did not reverse aortic dilation and led to aberrant aortic remodeling. An AT2R antagonist, PD123319, reversed the protective effects of losartan in TAC mice. Treatment with compound 21 alone showed no effect on TAC-induced aortic enlargement, blood pressure, elastin breakage, or Mmp9 expression. Conclusions- Our data indicate that when AT1R signaling is blocked, AT2R activation is a key modulator to prevent aortic dilation that occurs with TAC. These data suggest that angiotensin-converting enzyme inhibitor may not be as effective as losartan for slowing aneurysm growth because losartan requires intact AT2R signaling to prevent aortic enlargement.
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Affiliation(s)
- Zhen Zhou
- From the Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center at Houston (Z.Z., A.M.P., S.W., A.J., J.C., P.Z., E.A., C.S.K., D.M.M.)
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China (Z.Z.)
| | - Andrew M Peters
- From the Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center at Houston (Z.Z., A.M.P., S.W., A.J., J.C., P.Z., E.A., C.S.K., D.M.M.)
| | - Shanzhi Wang
- From the Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center at Houston (Z.Z., A.M.P., S.W., A.J., J.C., P.Z., E.A., C.S.K., D.M.M.)
| | - Alexandra Janda
- From the Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center at Houston (Z.Z., A.M.P., S.W., A.J., J.C., P.Z., E.A., C.S.K., D.M.M.)
| | - Jiyuan Chen
- From the Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center at Houston (Z.Z., A.M.P., S.W., A.J., J.C., P.Z., E.A., C.S.K., D.M.M.)
| | - Ping Zhou
- From the Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center at Houston (Z.Z., A.M.P., S.W., A.J., J.C., P.Z., E.A., C.S.K., D.M.M.)
| | - Erin Arthur
- From the Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center at Houston (Z.Z., A.M.P., S.W., A.J., J.C., P.Z., E.A., C.S.K., D.M.M.)
| | - Callie S Kwartler
- From the Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center at Houston (Z.Z., A.M.P., S.W., A.J., J.C., P.Z., E.A., C.S.K., D.M.M.)
| | - Dianna M Milewicz
- From the Division of Medical Genetics, Department of Internal Medicine, The University of Texas Health Science Center at Houston (Z.Z., A.M.P., S.W., A.J., J.C., P.Z., E.A., C.S.K., D.M.M.)
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Wen J, Trolle C, Viuff MH, Ringgaard S, Laugesen E, Gutmark EJ, Subramaniam DR, Backeljauw P, Gutmark-Little I, Andersen NH, Mortensen KH, Gravholt CH. Impaired aortic distensibility and elevated central blood pressure in Turner Syndrome: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2018; 20:80. [PMID: 30541571 PMCID: PMC6292015 DOI: 10.1186/s12968-018-0497-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 10/23/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Women with Turner Syndrome have an increased risk for aortic dissection. Arterial stiffening is a risk factor for aortic dilatation and dissection. Here we investigate if arterial stiffening can be observed in Turner Syndrome patients and is an initial step in the development of aortic dilatation and subsequent dissection. METHODS Fifty-seven women with Turner Syndrome (48 years [29-66]) and thirty-six age- and sex-matched controls (49 years [26-68]) were included. Distensibility, blood pressure, carotid-femoral pulse wave velocity (PWV), the augmentation index (Aix) and central blood pressure were determined using cardiovascular magnetic resonance, a 24-h blood pressure measurement and applanation tonometry. Aortic distensibility was determined at three locations: ascending aorta, transverse aortic arch, and descending aorta. RESULTS Mean aortic distensibility in the descending aorta was significantly lower in Turner Syndrome compared to healthy controls (P = 0.02), however, this was due to a much lower distensibility among Turner Syndrome with coarctation, while Turner Syndrome without coarctation had similar distensibility as controls. Both the mean heart rate adjusted Aix (31.4% vs. 24.4%; P = 0.02) and central diastolic blood pressure (78.8 mmHg vs. 73.7 mmHg; P = 0.02) were higher in Turner Syndrome compared to controls, and these indices correlated significantly with ambulatory night-time diastolic blood pressure. The presence of aortic coarctation (r = - 0.44, P = 0.005) and a higher central systolic blood pressure (r = - 0.34, P = 0.03), age and presence of diabetes were inversely correlated with aortic distensibility in TS. CONCLUSION Aortic wall function in the descending aorta is impaired in Turner Syndrome with lower distensibility among those with coarctation of the aorta, and among all Turner Syndrome higher Aix, and elevated central diastolic blood pressure when compared to sex- and age-matched controls. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov ( #NCT01678274 ) on September 3, 2012.
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Affiliation(s)
- Jan Wen
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Christian Trolle
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Mette H. Viuff
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Steffen Ringgaard
- Department of Clinical Medicine, MR Research Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Esben Laugesen
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Ephraim J. Gutmark
- Department of Aerospace Engineering and Engineering Mechanics, CEAS, University of Cincinnati, Cincinnati, OH USA
- UC Department of Otolaryngology – Head and Neck Surgery, Cincinnati, OH USA
| | | | - Philippe Backeljauw
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Iris Gutmark-Little
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Niels H. Andersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian H. Mortensen
- Cardiovascular Imaging Department, Cardio-respiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH UK
| | - Claus H. Gravholt
- Department of Endocrinology and Internal Medicine and Medical Research Laboratories, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
- Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
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Hatton GE, Tanaka A, Estrera AL. Ascending aortic aneurysm repair 44 years after Starr-Edwards caged-ball aortic valve replacement. Eur J Cardiothorac Surg 2018; 54:962-963. [PMID: 29697781 DOI: 10.1093/ejcts/ezy161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/25/2018] [Indexed: 11/12/2022] Open
Abstract
We report a case of ascending aortic aneurysm repair and redo aortic valve replacement with a bioprosthesis 44 years after aortic valve replacement with a Starr-Edwards metal caged-ball prosthesis. The patient presented with a moderately stenotic caged-ball valve and a 50-mm ascending aortic aneurysm on a routine follow-up transthoracic echocardiography. We replaced the valve with a bioprosthesis at the time of aortic repair as the patient wished to stop anticoagulation therapy. Intraoperatively, we found that the cloth covering of the cage was nearly completely destroyed.
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Affiliation(s)
- Gabrielle E Hatton
- Department of Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Akiko Tanaka
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Anthony L Estrera
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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Staiculescu MC, Cocciolone AJ, Procknow JD, Kim J, Wagenseil JE. Comparative gene array analyses of severe elastic fiber defects in late embryonic and newborn mouse aorta. Physiol Genomics 2018; 50:988-1001. [PMID: 30312140 PMCID: PMC6293116 DOI: 10.1152/physiolgenomics.00080.2018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 01/17/2023] Open
Abstract
Elastic fibers provide reversible elasticity to the large arteries and are assembled during development when hemodynamic forces are increasing. Mutations in elastic fiber genes are associated with cardiovascular disease. Mice lacking expression of the elastic fiber genes elastin ( Eln-/-), fibulin-4 ( Efemp2-/-), or lysyl oxidase ( Lox-/-) die at birth with severe cardiovascular malformations. All three genetic knockout models have elastic fiber defects, aortic wall thickening, and arterial tortuosity. However, Eln-/- mice develop arterial stenoses, while Efemp2-/- and Lox-/- mice develop ascending aortic aneurysms. We performed comparative gene array analyses of these three genetic models for two vascular locations and developmental stages to determine differentially expressed genes and pathways that may explain the common and divergent phenotypes. We first examined arterial morphology and wall structure in newborn mice to confirm that the lack of elastin, fibulin-4, or lysyl oxidase expression provided the expected phenotypes. We then compared gene expression levels for each genetic model by three-way ANOVA for genotype, vascular location, and developmental stage. We found three genes upregulated by genotype in all three models, Col8a1, Igfbp2, and Thbs1, indicative of a common response to severe elastic fiber defects in developing mouse aorta. Genes that are differentially regulated by vascular location or developmental stage in all three models suggest mechanisms for location or stage-specific disease pathology. Comparison of signaling pathways enriched in all three models shows upregulation of integrins and matrix proteins involved in early wound healing, but not of mature matrix molecules such as elastic fiber proteins or fibrillar collagens.
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Affiliation(s)
| | - Austin J Cocciolone
- Department of Biomedical Engineering, Washington University , St. Louis, Missouri
| | - Jesse D Procknow
- Department of Mechanical Engineering and Materials Science, Washington University , St. Louis, Missouri
| | - Jungsil Kim
- Department of Mechanical Engineering and Materials Science, Washington University , St. Louis, Missouri
| | - Jessica E Wagenseil
- Department of Mechanical Engineering and Materials Science, Washington University , St. Louis, Missouri
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Li R, Pu L, Sun Z, Wang Y, Liu G, Xie J, Yang Y. Echocardiographic findings of cardiovascular involvement in Behçet's disease and post-operative complications after cardiac surgery. Clin Exp Rheumatol 2018; 36:103-109. [PMID: 30582508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/30/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES The aim of this study was to analyse the spectrum of echocardiographic findings in patients with cardiovascular involvement in Behçet's disease (BD) and followed up the post-operative complications. METHODS We enrolled 26 BD patients who underwent first cardiac surgery in Anzhen Hospital, Beijing, China. Medical records and echocardiographic findings were retrospectively analysed. RESULTS The 26 patients consisted of 4 women and 22 men. 22 (84.6%) of the patients were diagnosed with moderate/severe aortic regurgitation (AR). Some distinctive echocardiographic features with AR were observed, including prolapse of aortic cusps, vegetation-like mobile lesions, an echo-free space mimicking aortic root abscess and aortic aneurysm formation. 3 (11.5%) of the patients were diagnosed with isolated descending aortic aneurysm. 1(3.8%) of the patients was diagnosed with pulmonary artery aneurysm. BD was preoperatively diagnosed by clinicians in 20 patients. And 6 patients were diagnosed post-operatively by clinicians. In a total of 26 patients, post-operative complications occurred in 8 (30.7%) patients. The complications occurred in the 6 patients diagnosed post-operatively and 2 patients diagnosed pre-operatively. The post-operative complications of these patientsincluded aortic paravalvular leakage, coronary-graft anastmotic leakage and mitral paravalvular leakage. CONCLUSIONS The most common echocardiographic feature of cardiovascular involvement in BD is severe aortic regurgitation with prolapse of aortic cusps, vegetation-like mobile lesions, an echo-free space mimicking aortic root abscess or aortic aneurysm formation. Accurate preoperative diagnosis of BD is beneficial to the choice of immunosuppressive therapy before and after surgery, which is likely to reduce postoperative complications especially for patients with severe lesions.
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Affiliation(s)
- Rongjuan Li
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Lihong Pu
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Zhonghua Sun
- Department of Medical Radiation Sciences, Curtin University, Perth, Australia
| | - Yueli Wang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Guowen Liu
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Jinjie Xie
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Ya Yang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, and Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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Jiménez-Altayó F, Meirelles T, Crosas-Molist E, Sorolla MA, Del Blanco DG, López-Luque J, Mas-Stachurska A, Siegert AM, Bonorino F, Barberà L, García C, Condom E, Sitges M, Rodríguez-Pascual F, Laurindo F, Schröder K, Ros J, Fabregat I, Egea G. Redox stress in Marfan syndrome: Dissecting the role of the NADPH oxidase NOX4 in aortic aneurysm. Free Radic Biol Med 2018; 118:44-58. [PMID: 29471108 DOI: 10.1016/j.freeradbiomed.2018.02.023] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/12/2018] [Accepted: 02/15/2018] [Indexed: 11/16/2022]
Abstract
Marfan syndrome (MFS) is characterized by the formation of ascending aortic aneurysms resulting from altered assembly of extracellular matrix fibrillin-containing microfibrils and dysfunction of TGF-β signaling. Here we identify the molecular targets of redox stress in aortic aneurysms from MFS patients, and investigate the role of NOX4, whose expression is strongly induced by TGF-β, in aneurysm formation and progression in a murine model of MFS. Working models included aortae and cultured vascular smooth muscle cells (VSMC) from MFS patients, and a NOX4-deficient Marfan mouse model (Fbn1C1039G/+-Nox4-/-). Increased tyrosine nitration and reactive oxygen species levels were found in the tunica media of human aortic aneurysms and in cultured VSMC. Proteomic analysis identified nitrated and carbonylated proteins, which included smooth muscle α-actin (αSMA) and annexin A2. NOX4 immunostaining increased in the tunica media of human Marfan aorta and was transcriptionally overexpressed in VSMC. Fbn1C1039G/+-Nox4-/- mice aortas showed a reduction of fragmented elastic fibers, which was accompanied by an amelioration in the Marfan-associated enlargement of the aortic root. Increase in the contractile phenotype marker calponin in the tunica media of MFS mice aortas was abrogated in Fbn1C1039G/+-Nox4-/- mice. Endothelial dysfunction evaluated by myography in the Marfan ascending aorta was prevented by the absence of Nox4 or catalase-induced H2O2 decomposition. We conclude that redox stress occurs in MFS, whose targets are actin-based cytoskeleton members and regulators of extracellular matrix homeostasis. Likewise, NOX4 have an impact in the progression of the aortic dilation in MFS and in the structural organization of the aortic tunica media, the VSMC phenotypic modulation, and endothelial function.
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Affiliation(s)
- Francesc Jiménez-Altayó
- Departament de Farmacologia, Terapèutica i Toxicologia, Institut de Neurociències, Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Thayna Meirelles
- Department de Biomedicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, and IDIBAPS, Barcelona, Spain
| | - Eva Crosas-Molist
- TGF-β and Cancer Group, Oncobell Program, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - M Alba Sorolla
- Institut de Recerca Biomèdica de Lleida (IRB Lleida), Lleida, Spain; Departament de Ciències Mèdiques Bàsiques, Universitat de Lleida, Lleida, Spain
| | - Darya Gorbenko Del Blanco
- Department de Biomedicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, and IDIBAPS, Barcelona, Spain
| | - Judit López-Luque
- TGF-β and Cancer Group, Oncobell Program, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Ana-Maria Siegert
- Department de Biomedicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, and IDIBAPS, Barcelona, Spain
| | - Fabio Bonorino
- Department de Biomedicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, and IDIBAPS, Barcelona, Spain
| | - Laura Barberà
- Department de Biomedicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, and IDIBAPS, Barcelona, Spain
| | - Carolina García
- Department of Pathology, Hospital de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, and Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain
| | - Enric Condom
- Department of Pathology, Hospital de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, and Department of Pathology and Experimental Therapeutics, University of Barcelona, Barcelona, Spain
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clinic, IDIBAPS-University of Barcelona, Barcelona, Spain
| | | | - Francisco Laurindo
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - Katrin Schröder
- German Center of Cardiovascular Research (DZHK), Partner site Rhein Main, Frankfurt am Main, Germany
| | - Joaquim Ros
- Institut de Recerca Biomèdica de Lleida (IRB Lleida), Lleida, Spain; Departament de Ciències Mèdiques Bàsiques, Universitat de Lleida, Lleida, Spain
| | - Isabel Fabregat
- TGF-β and Cancer Group, Oncobell Program, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Department de Ciències Fisiològiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Gustavo Egea
- Department de Biomedicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, and IDIBAPS, Barcelona, Spain.
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Lorenzini M, Guha N, Davison JE, Pitcher A, Pandya B, Kemp H, Lachmann R, Elliott PM, Murphy E. Isolated aortic root dilation in homocystinuria. J Inherit Metab Dis 2018; 41:109-115. [PMID: 28980096 PMCID: PMC5786652 DOI: 10.1007/s10545-017-0094-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 08/17/2017] [Accepted: 09/15/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Vascular complications in homocystinuria have been known for many years, but there have been no reports to date on involvement of the ascending aorta. METHODS We conducted a cross-sectional study of patients with homocystinuria, known to a single metabolic centre, and evaluated in 2016 with a transthoracic echocardiogram. Aortic root dilation was defined as Z-score ≥ 2.0 SD, and graded mild (Z-score 2.0-3.0), moderate (Z-score 3.01-4.0) and severe (Z-score > 4.0). RESULTS The study population included 34 patients, median age of 44.3 years (IQR 33.3-52.2), 50% males, 69% diagnosed aged <18 years and 29% pyridoxine-responsive. Eight (24%) had a history of hypertension. Seven patients (21%) were found to have a dilation of the aortic root, mild in two cases (6%), moderate in four (12%) and severe in one (3%). None had dilation of the ascending aorta. Significant aortic regurgitation, secondary to moderate aortic root dilation, was documented in two patients. A single patient had significant mitral regurgitation due to prolapse of both valve leaflets, as well as mild aortic root dilation. Comparing patients with a dilation of the aortic root to those without, there were no significant clinical, laboratory or echocardiographic differences, with the only exception being that the diameter of the ascending aorta was larger in the group with a dilated aortic root, albeit within normal limits. CONCLUSIONS A subset of patients with homocystinuria have isolated dilation of the aortic root similar to that observed in Marfan syndrome.
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Affiliation(s)
- Massimiliano Lorenzini
- University College London Institute for Cardiovascular Science and Barts Heart Centre, St. Bartholomew's Hospital, London, UK
- Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Nishan Guha
- Department of Clinical Biochemistry, John Radcliffe Hospital and Nuffield Division of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
| | - James E Davison
- Metabolic Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Alex Pitcher
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Bejal Pandya
- Adult Congenital Heart Disease Department, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - Helena Kemp
- Department of Clinical Biochemistry, North Bristol NHS Trust, Bristol, UK
| | - Robin Lachmann
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Perry M Elliott
- University College London Institute for Cardiovascular Science and Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - Elaine Murphy
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
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Corbitt H, Maslen C, Prakash S, Morris SA, Silberbach M. Allometric considerations when assessing aortic aneurysms in Turner syndrome: Implications for activity recommendations and medical decision-making. Am J Med Genet A 2017; 176:277-282. [PMID: 29243875 DOI: 10.1002/ajmg.a.38584] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/06/2017] [Accepted: 11/26/2017] [Indexed: 01/15/2023]
Abstract
In Turner syndrome, the potential to form thoracic aortic aneurysms requires routine patient monitoring. However, the short stature that typically occurs complicates the assessment of severity and risk because the relationship of body size to aortic dimensions is different in Turner syndrome compared to the general population. Three allometric formula have been proposed to adjust aortic dimensions, all employing body surface area: aortic size index, Turner syndrome-specific Z-scores, and Z-scores based on a general pediatric and young adult population. In order to understand the differences between these formula we evaluated the relationship between age and aortic size index and compared Turner syndrome-specific Z-scores and pediatric/young adult based Z-scores in a group of girls and women with Turner syndrome. Our results suggest that the aortic size index is highly age-dependent for those under 15 years; and that Turner-specific Z-scores are significantly lower than Z-scores referenced to the general population. Higher Z-scores derived from the general reference population could result in stigmatization, inappropriate restriction from sports, and increasing the risk of unneeded medical or operative treatments. We propose that when estimating aortic dissection risk clinicians use Turner syndrome-specific Z-score for those under fifteen years of age.
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Affiliation(s)
- Holly Corbitt
- Knight Cardiovascular Institute, Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, Oregon
| | - Cheryl Maslen
- Knight Cardiovascular Institute, Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, Oregon
| | - Siddharth Prakash
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center, Houston, Texas
| | - Shaine A Morris
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Michael Silberbach
- Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
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Veldhoen S, Behzadi C, Lenz A, Henes FO, Rybczynski M, von Kodolitsch Y, Bley TA, Adam G, Bannas P. Non-contrast MR angiography at 1.5 Tesla for aortic monitoring in Marfan patients after aortic root surgery. J Cardiovasc Magn Reson 2017; 19:82. [PMID: 29084542 PMCID: PMC5661928 DOI: 10.1186/s12968-017-0394-y] [Citation(s) in RCA: 10] [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: 06/27/2017] [Accepted: 10/09/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Contrast-enhanced cardiovascular magnetic resonance angiography (CE-CMRA) is the established imaging modality for patients with Marfan syndrome requiring life-long annual aortic imaging before and after aortic root replacement. Contrast-free CMRA techniques avoiding side-effects of contrast media are highly desirable for serial imaging but have not been evaluated in the postoperative setup of Marfan patients. The purpose of this study was to assess the feasibility of non-contrast balanced steady-state free precession (bSSFP) magnetic resonance imaging for aortic monitoring of postoperative patients with Marfan syndrome. METHODS Sixty-four adult Marfan patients after aortic root replacement were prospectively included. Fourteen patients (22%) had a residual aortic dissection after surgical treatment of type A dissection. bSSFP imaging and CE-CMRA were performed at 1.5 Tesla. Two radiologists evaluated the images regarding image quality (1 = poor, 4 = excellent), artifacts (1 = severe, 4 = none) and aortic pathologies. Readers measured the aortic diameters at defined levels in both techniques. Statistics included observer agreement for image scoring and diameter measurements and ROC analyses for comparison of the diagnostic performance of bSSFP and CE-CMRA. RESULTS Both readers observed no significant differences in image quality between bSSFP and CE-CMRA and found a median image quality score of 4 for both techniques (all p > .05). No significant differences were found regarding the frequency of image artifacts in both sequences (all p > .05). Sensitivity and specificity for detection of aortic dissections was 100% for both readers and techniques. Compared to bSSFP imaging, CE-CMRA resulted in higher diameters (mean bias, 0.9 mm; p < .05). The inter-observer biases of diameter measurements were not significantly different (all p > .05), except for the distal graft anastomosis (p = .001). Using both techniques, the readers correctly identified a graft suture dehiscence with aneurysm formation requiring surgery. CONCLUSION Unenhanced bSSFP CMR imaging allows for riskless aortic monitoring with high diagnostic accuracy in Marfan patients after aortic root surgery.
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Affiliation(s)
- Simon Veldhoen
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Bavaria, Germany
| | - Cyrus Behzadi
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Lenz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Oliver Henes
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Meike Rybczynski
- Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yskert von Kodolitsch
- Department of General and Interventional Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Bavaria, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
One of the most challenging conditions to manage after previous cardiac surgery is chronic dissection of the ascending aorta. We operated on a 54-year-old man who had aortic dissection in addition to large aortic dimensions very close to the sternum, severe aortic regurgitation, and a false lumen in the descending aorta. We used a combination of perfusion and myocardial protection techniques, arising from port-access technology, that enabled antegrade flow into the aorta, endoclamping of the ascending aorta, the administration of cardioplegic solution before opening the sternum, and left ventricular venting to prevent ventricular distention. Our technique resulted in minimal blood loss, shorter circulatory-arrest and operative times, the ability to operate on a decompressed heart and descending aorta, good myocardial protection, and easier and safer access to the heart. Three years postoperatively, our patient was doing well. Other patients might benefit from this approach; however, the surgeon must ensure that an aortic segment is suitable for endoclamping.
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Fernandes B, Santos A, Carvalho L. Syphilitic Aortitis Diagnosis in Clinical Setting. Rev Port Cir Cardiotorac Vasc 2017; 24:166. [PMID: 29701397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Cardiovascular syphilis can manifest as aortic aneurysms, aortic regurgitation and coronary ostial stenosis. Tertiary syphilis was the most commom reported cause of thoracic aortic aneurysm in the pre-antibiotic era, contributing to 5- 10% of cardiovascular deaths. However, in the 21st century, it has virtually disappered from the devoloping nations. Tertiay syphilis may develop in about one third of cases of untreated syphilis. In the pre-penicilin era, it was calculated that cardiovascular syphilis was responsible for 10-15% of clinical syphilis. METHODS We present a rare case of syphilitic aortitis in a era of highly effective antibiotics. RESULTS A 48-year-old man with no known clinical cardiac pathology went to emergency with an episode of chest pain of short duration and great intensity, being hospitalized with a differential diagnosis of coronary disease, ascending aortic aneurysm and aortic valve regurgitation. Two segments of the aorta, 5cm and 9.5cm length were observed, both had thickened wall (1cm), and firm plaques with diferent shapes and sizes. The intima of the aorta appeared rough and pitted, with the appearance of tree bark. There were heterogeneous lesions of the tunica media: hyalinization and calcification, macrophages aggregates, areas of hemorrhage and lymphoplasmacytic infiltrate forming vascular sheaths. Adventitia exhibited hyperplasia of nerve pathways with surrounding lymphoplasmocytic infiltrate. The diagnosis of syphilitic aortitis was purposed and serological analysis revealed positivity for Treponema pallidum. Patient underwent surgical correction of an aortic aneurysm. CONCLUSION The serological positivity for Treponema pallidum and the histopathological study allowed the currently rare diagnosis of Ascending Aortic Aneurysm by Tertiary Syphilis. In the present scenario with early and widespread use of antibiotics, it is considered a very rare disease.
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Affiliation(s)
| | | | - Lina Carvalho
- Institute of Pathological Anatomy and Molecular Pathology of FMUC, Portugal
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Doig F, Naidoo R, Sharma V, Tesar P. A Unique Hybrid Approach to Complex Re-Do Aortic Root Surgery. Heart Lung Circ 2017; 26:e68-e70. [PMID: 28655533 DOI: 10.1016/j.hlc.2017.05.126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 04/27/2017] [Accepted: 05/08/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND We present the case of a 23-year-old male with ventriculo-aortic dehiscence and a retrosternal false aneurysm communicating to the left ventricular outflow tract (LVOT) and ascending aorta. His history included aortic valve replacement (AVR) and mitral valve (MV) repair remotely, followed by two further operations for endocarditis and aortic root abscess. METHODS The risk associated with the redo surgery required detailed planning and innovative techniques to allow it to be performed safely. These included femoral cannulation for cardiopulmonary bypass, venting the left ventricular apex via a small left anterior thoracotomy, use of a CODA® (COOK Medical, Bloomington USA) balloon to occlude the distal ascending aorta (placed via left brachial artery) and finally, the use of a PROPLEGE® (Edwards Lifesciences, Irvine, USA) retrograde cardioplegia cannula (placed via right internal jugular vein).
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Affiliation(s)
- Fiona Doig
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia.
| | - Rishen Naidoo
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Vinod Sharma
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Peter Tesar
- Department of Cardiothoracic Surgery, The Prince Charles Hospital, Brisbane, Qld, Australia
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Wang S, Wang Q, Liu H, Sun S, Sun X, Zhang Y, Wang Z, Cheng Z. Endovascular treatment of thoracic aortic pseudoaneurysm due to brucellosis: a rare case report. BMC Infect Dis 2017; 17:387. [PMID: 28576116 PMCID: PMC5457607 DOI: 10.1186/s12879-017-2485-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 05/22/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Arterial damage is a known complication of brucellosis, but the occurrence of a thoracic aortic pseudoaneurysm secondary to brucellosis has not been previously reported. CASE PRESENTATION A 65-year-old Chinese man presented with a pseudoaneurysm in the descending segment of the thoracic aorta that caused symptoms of chest pain and intermittent fever. He was diagnosed with a thoracic aortic pseudoaneurysm secondary to brucellosis based on a positive brucella serology test (standard-tube agglutination test) and imaging examination (computed tomography angiography). Anti-brucellosis treatment and covered stent graft implantation were attempted to eliminate the brucellosis and pseudoaneurysm, respectively, and were ultimately successful, with no symptoms after 6 months of follow-up. CONCLUSION Endovascular repair may be effective and safe for treating a thoracic aortic pseudoaneurysm resulting from brucellosis.
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Affiliation(s)
- Shuai Wang
- Department of Vascular Surgery, the First Hospital of Jilin University, Xinmin Street 71, Changchun, Jilin, China
| | - Qi Wang
- Department of Vascular Surgery, the First Hospital of Jilin University, Xinmin Street 71, Changchun, Jilin, China
| | - Han Liu
- Department of Respiration, the First Hospital of Jilin University, Xinmin Street 71, Changchun, Jilin, China
| | - Siqiao Sun
- Department of Vascular Surgery, the First Hospital of Jilin University, Xinmin Street 71, Changchun, Jilin, China
| | - Xiwei Sun
- Department of Vascular Surgery, the First Hospital of Jilin University, Xinmin Street 71, Changchun, Jilin, China
| | - Yang Zhang
- Department of Vascular Surgery, the First Hospital of Jilin University, Xinmin Street 71, Changchun, Jilin, China
| | - Zhongying Wang
- Department of Vascular Surgery, the First Hospital of Jilin University, Xinmin Street 71, Changchun, Jilin, China
| | - Zhihua Cheng
- Department of Vascular Surgery, the First Hospital of Jilin University, Xinmin Street 71, Changchun, Jilin, China
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Koizumi S, Fukunaga N, Kinoshita M, Koyama T. False Aneurysm Formation at Both Anastomotic Sites after Descending Aortic Replacement for Aortic Coarctation. Ann Vasc Surg 2017; 43:313.e1-313.e3. [PMID: 28478170 DOI: 10.1016/j.avsg.2017.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/18/2016] [Revised: 01/19/2017] [Accepted: 01/26/2017] [Indexed: 11/19/2022]
Abstract
Prosthetic graft interposition is performed in some patients with coarctation of the aorta (CoA), and all procedures for treating CoA are associated with a risk of aneurysm formation at the site of repair. A 53-year-old woman underwent coarctectomy and descending aortic replacement with a 16-mm Dacron graft for CoA when she was 18 years old. Thirty years later, she was referred to our hospital for a false aneurysm at the proximal anastomotic site, and total arch replacement was performed to resect the false aneurysm. One year after the operation, follow-up computed tomography revealed a dissecting aneurysm on the descending aorta, originating from the distal anastomotic site, namely the first 16-mm Dacron graft and the native descending aorta. The length between the branch of the arch graft and the dissecting aneurysm was adequate for endovascular repair, which was successfully performed.
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Affiliation(s)
- Shigeki Koizumi
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan.
| | - Naoto Fukunaga
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Makoto Kinoshita
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
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47
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De Lorenzi C, Rosa GM, Camellino D, Morbelli S, Dorighi U, Masoero G, Sambuceti G, Brunelli C, Cimmino MA. Cardiac and aortic involvement in patients with polymyalgia rheumatica: a study with echocardiography and FDG-PET/CT. Clin Exp Rheumatol 2017; 35 Suppl 103:224. [PMID: 28375837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 01/03/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Cecilia De Lorenzi
- Radiology Unit, Department of Health Sciences, University of Genova, Italy
| | - Gian Marco Rosa
- Cardiovascular Diseases Unit, Department of Internal Medicine, University of Genova, Italy
| | - Dario Camellino
- Autoimmunology Laboratory, Department of Internal Medicine University of Genova, Italy
| | - Silvia Morbelli
- Nuclear Medicine Unit, Department of Health Sciences, University of Genova, Italy
| | - Ulrico Dorighi
- Cardiovascular Diseases Unit, Department of Internal Medicine, University of Genova, Italy
| | - Giovanni Masoero
- Cardiovascular Diseases Unit, Department of Internal Medicine, University of Genova, Italy
| | - Gianmario Sambuceti
- Nuclear Medicine Unit, Department of Health Sciences, University of Genova, Italy
| | - Claudio Brunelli
- Cardiovascular Diseases Unit, Department of Internal Medicine, University of Genova, Italy
| | - Marco Amedeo Cimmino
- Research Laboratory and Academic Unit of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Italy.
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Galea J, Manché A. Method of Hemorrhage Control From the Aorta After Repair of a Dissected Aortic Aneurysm. Ann Thorac Surg 2017; 103:e299-e300. [PMID: 28219577 DOI: 10.1016/j.athoracsur.2016.08.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/22/2016] [Indexed: 11/19/2022]
Abstract
Patients with Marfan syndrome and presenting with acute aortic dissection have fragile aorta, causing bleeding problems in the anastomosis between the graft and the aorta. Hemostatic impairment following circulatory arrest and prolonged cardiopulmonary bypass contribute to these problems. We describe a technique to control persistent bleeding from the anastomosis in the aortopulmonary recess using two kissing inflated balloons at the tip of two Foley catheters to tamponade the bleeding sites.
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Affiliation(s)
- Joseph Galea
- Department of Cardiothoracic Surgery, Mater Dei Hospital, Malta.
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49
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Bozzani A, Arici V, Rodolico G, Brunetto MB, Argenteri A. Endovascular Exclusion of Aortobronchial Fistula and Distal Anastomotic Aneurysm after Extra-Anatomic Bypass for Aortic Coarctation. Tex Heart Inst J 2017; 44:55-57. [PMID: 28265214 DOI: 10.14503/thij-15-5542] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The treatment of choice for aortic coarctation in adults remains open surgical repair. Aortobronchial fistula is a rare but potentially fatal late sequela of surgical correction of isthmic aortic coarctation via the interposition of a graft. The endovascular treatment of aortobronchial fistula is still under discussion because of its high risk for infection, especially if the patient has a history of cardiovascular prosthetic implantation. Patients need close monitoring, most notably those with secondary aortobronchial fistula. We discuss the case of a 65-year-old man who presented with the combined conditions, and we briefly review the relevant medical literature.
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50
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Asahina M, Matsumoto H, Yasuhara Y, Suzuki N, Takami R, Takeyama M, Tozawa R. Osborne-Mendel rats simultaneously develop cardiac and renal dysfunction, left atrial thrombosis, peripheral artery occlusion, and ascending aortic dissection. Biochem Biophys Res Commun 2017; 485:550-555. [PMID: 28088517 DOI: 10.1016/j.bbrc.2017.01.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/11/2017] [Indexed: 11/19/2022]
Abstract
Although chronic kidney disease (CKD) is strongly associated with onsets of cardiovascular disease (CVD), the pathogenic mechanism between these diseases has not been fully understood. To develop and validate new therapeutic strategies for this complication, appropriate experimental models that reflect the complexity of the underlying pathophysiology are needed. The Osborne-Mendel (OM) rat was identified as an atherosclerosis-prone and a premature-death rat strain among 16 inbred rat strains when fed high-cholesterol containing diet. When fed high-cholesterol diet, OM rats showed simultaneous occurrence of aortic aneurysm, aortic dissection, peripheral artery occlusion, and left atrial thrombosis. OM rats had significantly lower max dP/dt and higher min dP/dt than F344 rats did, indicating impaired left ventricle contractility and relaxation. OM rats developed renal dysfunction, showing increased urinary albumin excretion. OM rats also showed mild hypertension, decreased endothelial function, and enhanced coagulation and platelet aggregation, compared with F344 rats. We now report that OM rat would be a novel spontaneous animal model which simultaneously demonstrates cardiac and renal dysfunction, and CVD events. This model could be a useful model for the pre-clinical testing of pharmacological therapies and could provide new insight into potential targets and pathways for the treatment of CKD and CVD.
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Affiliation(s)
- Makoto Asahina
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Ltd., 26-1, Muraoka-Higashi 2chome, Fujisawa, Kanagawa, 251-8555, Japan.
| | - Hideki Matsumoto
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Ltd., 26-1, Muraoka-Higashi 2chome, Fujisawa, Kanagawa, 251-8555, Japan
| | - Yoshitaka Yasuhara
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Ltd., 26-1, Muraoka-Higashi 2chome, Fujisawa, Kanagawa, 251-8555, Japan
| | - Noriko Suzuki
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Ltd., 26-1, Muraoka-Higashi 2chome, Fujisawa, Kanagawa, 251-8555, Japan
| | - Ritsuko Takami
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Ltd., 26-1, Muraoka-Higashi 2chome, Fujisawa, Kanagawa, 251-8555, Japan
| | - Michiyasu Takeyama
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Ltd., 26-1, Muraoka-Higashi 2chome, Fujisawa, Kanagawa, 251-8555, Japan
| | - Ryuichi Tozawa
- Pharmaceutical Research Division, Takeda Pharmaceutical Company Ltd., 26-1, Muraoka-Higashi 2chome, Fujisawa, Kanagawa, 251-8555, Japan
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