AORTA最新文献

Two pregnant siblings presented with thoracic aortic dissection during the second trimester. A pathogenic MYH11 was identified following the first sibling's diagnosis. The second sibling, previously known to be at risk but lost to follow-up, reengaged during pregnancy, tested positive for the familial variant, and dissected before her initial evaluation. This case highlights the importance of genetic diagnosis, surveillance, and multidisciplinary care in managing heritable thoracic aortic disease during pregnancy.

Diameter of the aorta is a significant contributor and predictor for complications and a fundamental parameter for intervention. It is recognized that age, sex, and ethnicity play a role in aortic size. We thus sought to determine the normal dimensions among our population.A retrospective analysis of images was done of all polytrauma patients admitted between January 2018 and December 2022 who underwent protocolized noncontrast computed tomography of the chest and abdomen to measure the aortic diameter at established reference points.There were 513 patients; the mean age was 36.5 ± 14.6 (range: 18-86), and 382 (74.5%) were males. Aortic dimensions at sinus, mid-ascending, arch, descending, suprarenal, and infrarenal aorta were 30.7 ± 3.8, 29.3 ± 4.5, 24.9 ± 3.3, 20.1 ± 3.0, 19.4 ± 2.9, and 15.3 ± 2.2, respectively. Age demonstrated a positive correlation to the diameter at the ascending, descending, and infrarenal aorta (r = 0.58, p = 0.001 [95% confidence interval, CI = 0.519; 0.634]; r = 0.69, p = 0.001 [95% CI = 0.641; 0.732]; r = 0.57, p = 0.001 [95% CI = 0.509; 0.626]) along with the length of the ascending aorta (r = 0.420, p = 0.001 [95% CI = 0.345; 0.488]; r = 0.536, p = 0.001 [95% CI = 0.471; 0.595]; r = 0.476, p = 0.001 [95% CI = 0.406; 0.540), respectively. There was a positive correlation of aortic diameters to body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP). Females had smaller dimension at the reference points, but without any statistical significance. There were 50 (9.8%) patients with bovine aortic arch and 10 (1.9%) with separate origin of left vertebral artery.Normal values of the diameter of the aorta for a South Asian population are provided. Diameter is affected by age, length of the ascending aorta, BMI, SBP, and DBP. This study suggests that the aorta size is smaller in the South Asian population than the referenced Western population, more significantly for distal descending and abdominal aorta and that ethnicity plays a role in determining aortic dimensions.

Erdheim Chester disease (ECD) is a rare fibroinflammatory disease that affects different segments of aorta. It appears as diffuse wall thickening and periaortic accumulation of scar tissue on computerized tomography (CT). The CT scans describe the size and the external structure, with minimal description of endoluminal surface of the aorta. In this report, CT images were used to visualize the interior surface of the aorta and the response to treatment in a patient with ECD.

Acute type A aortic dissection (ATAAD) is traumatic and life-threatening involving a split of the intima media along a variable length of the aorta from aortic root to aortic bifurcation. The pathology results in a local and systemic inflammatory process with elevated inflammatory markers observed at hospital admission. This systematic literature review aimed to compare the effectiveness of admission inflammatory markers in predicting adverse outcomes in postoperative ATAAD patients. Eligibility criteria included studies reporting postoperative outcomes or receiver operating characteristic results stratified by routine admission markers of inflammation in ATAAD patients. The study protocol was registered with PROSPERO (CRD42022366509). Following abstract and full-text screening, 79 studies were included in the analysis, with 39 included in the meta-analysis. Meta-analyses using random effects models of white blood cell count, neutrophil count, and neutrophil to lymphocyte ratio stratified by survival indicated that levels were significantly lower in survivors than nonsurvivors. The mean difference for white blood cell count was 1.51 (confidence interval [CI = 1.07, 1.95]), neutrophil count 1.50 [CI = 1.05, 1.95], and neutrophil to lymphocyte ratio 3.45 [CI = 2.50, 4.41]. Similarly, survivors had lower C-reactive protein levels than nonsurvivors (standardized mean difference = 0.5227 [CI = 0.1781, 0.8672]). Conversely, lymphocyte counts were higher in survivors than nonsurvivors (mean difference = -0.12 [CI = -0.18, -0.06]). All models had significant heterogeneity despite using random effects models, likely due to the multitude of presentations. Hierarchical summary receiver operating characteristic models were performed for neutrophil-to-lymphocyte ratio and C-reactive protein and showed similar sensitivity at detecting mortality in ATAAD patients for each fixed specificity. Data showed that deranged inflammatory markers are associated with poorer outcomes in ATAAD; however, none of these measures provide suitable prognostic markers alone. Continued development of multifactorial risk scores, including inflammatory markers and other factors, such as thrombotic measures, may enable clinically relevant prognostic tools and risk stratification.

Acute aortic dissection (AAD) is a potentially lethal condition with a high rate of misdiagnosis during the initial evaluation. In addition to established clinical variables, previous studies have consistently demonstrated a relationship between full blood count (FBC) and its various differentials with acute aortic syndromes, even identifying patients with worse outcome. Although FBC is a simple, inexpensive and routinely performed test, it is easily overlooked by clinicians. However, nearly all components of FBC, including white blood count, red blood cells, and platelets, may contribute to the underlying pathogenesis of AAD and therefore, we should fully explore and pinpoint precisely their potential diagnostic or prognostic performances. Herein, we summarize the results of such studies and discuss controversies regarding utility in future clinical practice.

We aim to better define the association between thoracic aortic aneurysm (TAA) and giant cell arteritis (GCA), thereby enhancing cross-diagnosis, monitoring, and therapy.Literature review: We used a two-step search approach to the available literature on the relationship between TAA and GCA. First, databases including PubMed, Web of Science, and Embase were searched. Additionally, relevant studies were identified through secondary sources including references of initially selected articles.Retrospective cohort study: We identified patients at our institution who were diagnosed with both TAA and GCA from January 1980 through December 2024. Descriptive statistics were used to support the association between these two diseases described in the literature.The literature review disclosed an increased incidence and relative risk of TAA among patients with GCA. GCA patients experienced progressive aortic enlargement, which may be due to vascular inflammation and disruption of elastin and collagen fiber biology in the vessel wall, resulting in mechanical weakness. Progressive aortic enlargement, including the aortic annulus, often results in aortic insufficiency (AI); in surgery, complete aortic replacement is recommended. Predictors of aneurysmal disease included AI and severe inflammatory response at the time of GCA diagnosis, as well as risk factors such as male sex, hypertension, hyperlipidemia, coronary disease, diabetes, and smoking.The investigation at our institution revealed that among 2,344 patients with GCA, 72 developed TAA, an incidence of 3.1%. Among those, 61 (84.7%) had an ascending aortic aneurysm, 5 (6.9%) had a descending aortic aneurysm, and 6 (8.3%) had both. Of these, 33 (45.8%) were male, 66 (91.7%) had hypertension, 44 (61.1%) were former or current smokers, 16 (22.2%) had diabetes mellitus, 66 (91.7%) had hyperlipidemia, 31 (43.1%) had coronary disease, 33 (45.8%) had concomitant polymyalgia rheumatica, and 21 (29.2%) had AI at the time of GCA diagnosis.Our study highlights a 3.1% incidence of TAA in GCA patients, with hypertension, smoking, and hyperlipidemia as the most common additional risk factors. Ascending aortic aneurysms were the most frequent, occurring in 84.7% of TAA in GCA cases. These findings emphasize the importance of monitoring for TAA in the GCA population.

Prior research provided evidence that diabetes mellitus (DM) may convey protection to patients with abdominal aortic aneurysm (AAA) and/or thoracic aortic aneurysm (TAA).We sought recent publications that support or elaborate on this concept using PubMed and Cochrane, searching for publications that combine the search terms "aortic aneurysm" and "diabetes mellitus." We collate and summarize evidence from the literature on this topic.We examined pertinent data on AAA, TAA, and aortic aneurysms in general (AA). Patients with DM have lower risk of developing AAA and a lower rate of growth of AAA. Patients with DM have a lower risk of mortality following hospitalizations for AA. That said, however, patients with DM who undergo AAA repair show higher risk of mortality. Patients with DM have lower aneurysm diameter and lower homocysteine and D-dimer levels. Research is emerging regarding a possible genetic explanation: the gene PSMD12 may play a role in the connection between AAA and DM. Patients with AAA taking diabetic medication metformin show reduced rate of growth of AAA as well as decreased mortality and complications. In TAA, however, no statistically significant differences in mortality or complications are consistently found. We find positive evidence to support the concept that diabetes does confer protection from AAA rupture. Current data does confirm significant protective effect for TAA.We confirm that metformin does exert protective properties. Diabetic protection against AAA may be mediated via Laplace's Law, as diabetic aortas have thicker walls, thus decreasing wall tension.

Valve-sparing root replacement (VSRR) is an alternative to traditional valve-replacing root replacement. We examined early- and mid-term outcomes after VSRR.We performed a retrospective review of a prospectively maintained aortic registry. All patients undergoing VSRR from 2005 to 2023 were included. Statistical analysis was performed in R version 4.3.1. Kaplan-Meier curves were used to describe mortality and freedom from mortality, aortic insufficiency (AI) > 1 + , and aortic valve-related reoperation.Eighty-one patients underwent VSRR, 59 (72.8%) through full sternotomy (FS) and 22 (27.2%) through upper hemisternotomy. There were no cases of AI > 1+ in the perioperative period, 1 (1.2%) stroke, and no in-hospital mortality. Mean intensive care unit and hospital stay were 3 and 7 days, respectively. Mean follow-up time was 8 years. Freedom from all-cause mortality at 1, 5, and 10 years was 100, 96.6, and 94.4%, respectively. Composite freedom from reoperation, recurrence, or mortality at 1, 5, and 10 years was 98.8, 92.1, and 87.3%, respectively.With careful preoperative selection, VSRR is a durable procedure for patients with aortic root aneurysm.

Deep hypothermic circulatory arrest (DHCA) is associated with coagulopathy but facilitates aortic arch surgery. Conflicting data suggest moderate hypothermic circulatory arrest (MHCA) may reduce transfusion requirements. We hypothesized MHCA would reduce transfusion requirements.We studied patients undergoing aortic hemiarch surgery for nondissected, aneurysmal disease from July 2014 to May 2023 utilizing a multicenter collaborative. Patients were stratified by DHCA (14.1-20°C) and MHCA (20.1-28°C). Packed red blood cells (pRBC), fresh frozen plasma (FFP), cryoprecipitate, and platelet transfusion requirements were assessed. A negative binomial model accounting for hospital random effect was fitted to identify risk factors for increased transfusion requirements.Of the 451 patients undergoing hemiarch surgery, 373 (83%) had MHCA and 78 (17%) had DHCA. MHCA patients had shorter cardiopulmonary bypass (135 minutes [105, 182] vs. 216 minutes [183, 263], p < 0.001) and circulatory arrest times (12 minutes [8, 17] vs. 21 minutes [16, 34], p < 0.001). MHCA patients received fewer pRBC (0 [0, 1] vs. 1 [0, 3], p < 0.001), FFP (0 [0, 3] vs. 2 [0, 4], p = 0.003), cryoprecipitate (1 [0, 1] vs. 1 [0, 2], p = 0.045), and platelet transfusions (0 [0, 1] vs. 2 [0, 2], p < 0.001). Unadjusted operative mortality was lower in the MHCA group (1.9 vs. 7.7%, p < 0.01). After risk adjustment, MHCA was associated with reduced FFP transfusion requirements (β = -0.48, SE = 0.2, p = 0.017). Increasing bypass time per minute was associated with increased pRBC (β = +0.01, 95% CI = 0.006-0.013, p < 0.001), FFP (β = +0.006, 95% CI = 0.004-0.009, p < 0.001), cryoprecipitate (β = +0.008, 95% CI = 0.005-0.01, p < 0.001), and platelet transfusions (β = +0.009, 95% CI = 0.006-0.011, p < 0.001).MHCA was associated with decreased mortality and FFP transfusions in aortic hemiarch repair. MHCA may mitigate transfusion needs via shorter cardiopulmonary bypass time compared with DHCA.

The Western Aortic Collaborative (WAC) is a new, hybrid, multi-institutional academic model that seeks to perform aortic surgery research and education.The WAC has three fundamental thoracic aortic surgery goals: (1) advancing surgical techniques, (2) furthering education and development of aortic surgeons, and (3) performing multi-institutional clinical research. The WAC utilizes a hybrid model of annual in-person meetings at the Western Thoracic Surgical Association (WTSA) combined with videoconferencing platforms that regularly connect surgeons dispersed throughout the Western region. The structure of WAC is intentionally horizontal. The goal is to promote cross-pollination of ideas, techniques, and experiences between surgeons at different institutions.For its research goals, the WAC first identified the principal areas of aortic surgery with the greatest knowledge gaps and which of those knowledge gaps could best be addressed by institutional practice differences within WAC. Using this natural experiment design, five high-priority research topics from the aortic root to the left subclavian artery were created. In order to perform this subspecialized, multi-institutional research, the WAC created a novel, cloud-based database that piggybacks on the Society for Thoracic Surgeon database. The combined database also preserves the ability to generate subspecialized variables and to link with each institution's medical record system for semi-automated functionality.In its inaugural year, the WAC succeeded in its primary goals of utilizing remote technology platforms and the annual WTSA meeting to create a regional community of aortic surgeons with shared research and educational goals.