Thoracic Aortic Diseases: What the Practicing Cardiologist Needs to Know

2022 ◽  
Author(s):  
Jean-Francois Dorval ◽  
Guillaume Marquis-Gravel ◽  
Philippe Demers ◽  
Raymond Cartier ◽  
Cherrie Abraham
Keyword(s):  
Aortic Diseases

Contrast-enhanced ultrasound of the abdominal aorta – current status and future perspectives

VASA ◽  
2019 ◽  
Vol 48 (2) ◽  
pp. 115-125 ◽  
Author(s):  
Xin Li ◽  
Daniel Staub ◽  
Vasileios Rafailidis ◽  
Mohammed Al-Natour ◽  
Sanjeeva Kalva ◽  
...  
Keyword(s):  
Real Time ◽  
Vascular Diseases ◽  
Aneurysm Rupture ◽  
Vasa Vasorum ◽  
Current Status ◽  
Contrast Enhanced Ultrasound ◽  
Aortic Diseases ◽  
Cross Sectional ◽  
Vascular Abnormalities ◽  
Contrast Enhanced

Abstract. Ultrasound has been established as an important diagnostic tool in assessing vascular abnormalities. Standard B-mode and Doppler techniques have inherent limitations with regards to detection of slow flow and small vasculature. Contrast-enhanced ultrasound (CEUS) is a complementary tool and is useful in assessing both the macro- and microvascular anatomy of the aorta. CEUS can also provide valuable physiological information in real-time scanning sessions due to the physical and safety profiles of the administered microbubbles. From a macrovascular perspective, CEUS has been used to characterize aortic aneurysm rupture, dissection and endoleaks post-EVAR repair. With regard to microvasculature CEUS enables imaging of adventitial vasa vasorum thereby assessing aortic inflammation processes, such as monitoring treatment response in chronic periaortitis. CEUS may have additional clinical utility since adventitial vasa vasorum has important implications in the pathogenesis of aortic diseases. In recent years, there have been an increasing number of studies comparing CEUS to cross-sectional imaging for aortic applications. For endoleak surveillance CEUS has been shown to be equal or in certain cases superior in comparison to CT angiography. The recent advancement of CEUS software along with the ongoing development of drug-eluting contrast microbubbles has allowed improved targeted detection and real-time ultrasound guided therapy for aortic vasa vasorum inflammation and neovascularization in animal models. Therefore, CEUS is uniquely suited to comprehensively assess and potentially treat aortic vascular diseases in the future.

Spectrum of aortic diseases in adults using 128 slice CT angiography

2018 ◽  
Vol 7 (1) ◽  
pp. 12-16
Author(s):  
Panchmahalkar A C ◽  
◽  
Warkad M B ◽  
Nanivadekar A ◽  
◽  
...  
Keyword(s):  
Ct Angiography ◽  
Aortic Diseases

Statins in Aortic Disease

2018 ◽  
Vol 23 (46) ◽  
pp. 7109-7120
Author(s):  
Vasiliki Tsigkou ◽  
Gerasimos Siasos ◽  
Evanthia Bletsa ◽  
Maria-Paraskevi Panoilia ◽  
Angeliki Papastavrou ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Genetic Disorders ◽  
Aortic Disease ◽  
Current Data ◽  
Valve Regurgitation ◽  
Aortic Diseases ◽  
Cochrane Database ◽  
Effect Of Treatment ◽  
Pleiotropic Actions ◽  
Optimal Type

Background: Numerous studies indicate that statins have multiple beneficial actions (known as ‘pleiotropic actions&#39;) on cardiovascular system through the improvement of endothelial dysfunction, inflammation, oxidative stress, excessive arterial thrombosis, and stabilization of the atherosclerotic plaque. Aortic disease primarily consists of aortic valve stenosis, aortic valve regurgitation, aneurysm disease, and genetic disorders such as Marfan syndrome, bicuspid aortic valve and aortic coarctation. Many studies have revealed the cardioprotective actions of statins in aortic disease. </P><P> Objective: Our aim was to present current data concerning the value of treatment with statins in aortic diseases. </P><P> Methods: A thorough search of PubMed and the Cochrane Database was conducted to identify the studies and novel articles related to the use of statins in aortic disease. </P><P> Results: Numerous studies in animals and humans indicate a beneficial effect of treatment with statins in the previous conditions apart from a few conflicting data. </P><P> Conclusion: There is a need of further investigation in this field, especially for the estimation of the optimal type and dose of statins required in each clinical condition of aortic disease.

Use of Three-dimensional Printing in the Development of Optimal Cardiac CT Scanning Protocols

2020 ◽  
Vol 16 (8) ◽  
pp. 967-977
Author(s):  
Zhonghua Sun
Keyword(s):  
Cardiovascular Disease ◽  
Cardiac Computed Tomography ◽  
Three Dimensional ◽  
Ct Scanning ◽  
Aortic Diseases ◽  
Clinical Value ◽  
Three Dimensional Printing ◽  
Doctor Patient Communication ◽  
Medical Education And Training ◽  
3D Printed

Three-dimensional (3D) printing is increasingly used in medical applications with most of the studies focusing on its applications in medical education and training, pre-surgical planning and simulation, and doctor-patient communication. An emerging area of utilising 3D printed models lies in the development of cardiac computed tomography (CT) protocols for visualisation and detection of cardiovascular disease. Specifically, 3D printed heart and cardiovascular models have shown potential value in the evaluation of coronary plaques and coronary stents, aortic diseases and detection of pulmonary embolism. This review article provides an overview of the clinical value of 3D printed models in these areas with regard to the development of optimal CT scanning protocols for both diagnostic evaluation of cardiovascular disease and reduction of radiation dose. The expected outcomes are to encourage further research towards this direction.

scholarly journals Parental mosaicism in Marfan and Ehlers–Danlos syndromes and related disorders

2021 ◽  
Author(s):  
Bertrand Chesneau ◽  
Aurélie Plancke ◽  
Guillaume Rolland ◽  
Nicolas Chassaing ◽  
Christine Coubes ◽  
...  
Keyword(s):  
High Resolution ◽  
Marfan Syndrome ◽  
High Resolution Melting ◽  
De Novo ◽  
Direct Sequencing ◽  
Causal Variant ◽  
Connective Tissue Disorder ◽  
High Resolution Melting Analysis ◽  
Aortic Diseases ◽  
Melting Analysis

AbstractMarfan syndrome (MFS) is a heritable connective tissue disorder (HCTD) caused by pathogenic variants in FBN1 that frequently occur de novo. Although individuals with somatogonadal mosaicisms have been reported with respect to MFS and other HCTD, the overall frequency of parental mosaicism in this pathology is unknown. In an attempt to estimate this frequency, we reviewed all the 333 patients with a disease-causing variant in FBN1. We then used direct sequencing, combined with High Resolution Melting Analysis, to detect mosaicism in their parents, complemented by NGS when a mosaicism was objectivized. We found that (1) the number of apparently de novo events is much higher than the classically admitted number (around 50% of patients and not 25% as expected for FBN1) and (2) around 5% of the FBN1 disease-causing variants were not actually de novo as anticipated, but inherited in a context of somatogonadal mosaicisms revealed in parents from three families. High Resolution Melting Analysis and NGS were more efficient at detecting and evaluating the level of mosaicism compared to direct Sanger sequencing. We also investigated individuals with a causal variant in another gene identified through our “aortic diseases genes” NGS panel and report, for the first time, on an individual with a somatogonadal mosaicism in COL5A1. Our study shows that parental mosaicism is not that rare in Marfan syndrome and should be investigated with appropriate methods given its implications in patient’s management.

Bentall–de Bono procedure for acute aortic dissection

2021 ◽  
Keyword(s):  
Aortic Dissection ◽  
Aortic Root ◽  
Acute Aortic Dissection ◽  
Aortic Surgery ◽  
Acute Type ◽  
Aortic Diseases ◽  
Type A Aortic Dissection ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Valve Sparing

We present a patient with an acute type A aortic dissection that involves the aortic root. The high mortality of patients with this condition is often associated with operations performed by surgeons with minimal experience dealing with aortic diseases. Therefore, less-experienced surgeons often opt for less complicated techniques like supracoronary ascending aortic replacement. However, according to the latest guidelines for the management of aortic diseases, the aortic root should be replaced when it is compromised by the dissection. The Bentall–de Bono technique treats the aortic root and demands less experience than valve-sparing aortic surgery.

Excess of visceral adipose tissue with or without aortic elongation leads to a steeper heart position

2021 ◽  
pp. 028418512110340
Author(s):  
S Petteri Kauhanen ◽  
Petri Saari ◽  
Tarmo Korpela ◽  
Timo Liimatainen ◽  
Ritva Vanninen ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Visceral Adipose Tissue ◽  
Interquartile Range ◽  
Obese Patients ◽  
Aortic Diseases ◽  
Clinical Value ◽  
Abdominal Aortic ◽  
History Of ◽  
Axial Ct ◽  
Visceral Adipose

Background The heart’s position determined as the heart–aorta angle (HAA) has been demonstrated to associate with ascending aortic (AA) dilatation. Visceral adipose tissue (VAT) and aortic elongation may shift the heart to the steeper position. Purpose To investigate whether VAT and aortic length influence the HAA. Material and Methods We examined 346 consecutive patients (58.4% men; mean age = 67.0 ± 14.1 years) who underwent aortic computed tomography angiography (CTA). HAA was measured as the angle between the long axis of the heart and AA midline. The amount of VAT was measured at the level of middle L4 vertebra from a single axial CT slice. Aortic length was measured by combining four anatomical segments in different CTA images. The amount of VAT and aortic length were determined as mild with values in the lowest quartile and as excessive with values in the other three quartiles. Results A total of 191 patients (55.2%) had no history of aortic diseases, 134 (38.7%) displayed AA dilatation, 8 (2.3%) had abdominal aortic aneurysm (AAA), and 13 (3.8%) had both AA dilatation and AAA. There was a strong nonlinear regression between smaller HAA and VAT/height, and HAA and aortic length/height. Median HAA was 124.2° (interquartile range 119.0°–130.8°) in patients with a mild amount of VAT versus 120.5° (interquartile range 115.4°–124.7°) in patients with excessive VAT ( P < 0.001). Conclusion An excessive amount of VAT and aortic elongation led to a steeper heart position. These aspects may possess clinical value when evaluating aortic diseases in obese patients.

scholarly journals Evaluation of preoperative computed tomography angiography in association with conventional angiography versus computed tomography angiography only, in the endovascular treatment of aortic diseases

2013 ◽  
Vol 46 (5) ◽  
pp. 265-272 ◽  
Author(s):  
Patrick Bastos Metzger ◽  
Eduardo Rafael Novero ◽  
Fabio Henrique Rossi ◽  
Samuel Martins Moreira ◽  
Frederico Augusto Linhares ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Retrospective Study ◽  
Endovascular Treatment ◽  
Computed Tomography Angiography ◽  
Therapeutic Intervention ◽  
Technical Success ◽  
Aortic Diseases ◽  
Conventional Angiography ◽  
Therapeutic Success ◽  
Abdominal Aortic

Objective To evaluate the association of conventional angiography (AG) with computed tomography angiography (CTA) as compared with CTA only, preoperatively, in the treatment of aortic diseases. Materials and Methods Retrospective study involving patients submitted to endovascular treatment of aortic diseases, in the period from January 2009 to July 2010, with use of preoperative CTA + conventional AG or CTA only. The patients were divided into two groups, namely: G1 – thoracic aortic diseases; and G2 – abdominal aortic diseases. G1 was subdivided into 1A (preoperative AG + CTA) and 1B (preoperative CTA). G2 was subdivided into 2C (CTA + AG) and 2D (CTA only). Results The authors evaluated 156 patients. In subgroups 1A and 1B, the rate of technical success was, respectively, 100% and 94.7% (p = 1.0); and the rate of therapeutic success was, respectively, 81% and 58% (p = 0.13). A higher number of complications were observed in subgroup 1B (p = 0.057). The accuracy in the calculation of the prosthesis was higher in subgroup 1A (p = 0.065). In their turn, the rate of technical success in subgroups 2C and 2D was, respectively, 92.3% and 98.6% (p = 0.17). The rate of therapeutic success was 73% and 98.6% (p = 0.79). Conclusion Preoperative conventional AG should be reserved for cases where CTA cannot provide all the information in the planning of a therapeutic intervention.

scholarly journals Open Replacement of the Thoracoabdominal Aorta: Short- and Long-term Outcomes at a Single Institution

2018 ◽  
Vol 27 (02) ◽  
pp. 114-120
Author(s):  
Davide Carino ◽  
Young Erben ◽  
Mohammad Zafar ◽  
Mrinal Singh ◽  
Adam Brownstein ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Open Surgery ◽  
Elective Surgery ◽  
Aortic Diseases ◽  
Long Term Outcomes ◽  
Thoracoabdominal Aorta ◽  
Primary Endpoints ◽  
Short And Long Term ◽  
Optimal Approach

Background Despite much progress in the surgical and endovascular treatment of thoracoabdominal aortic diseases (TAADs), there is no consensus regarding the optimal approach to minimize operative mortality and end-organ dysfunction. We report our experience in the past 16 years treating TAAD by open surgery. Methods A retrospective review of all TAAD patients who underwent an open repair since January 2000 was performed. The primary endpoints included early morbidity and mortality, and the secondary endpoints were overall death and rate of aortic reintervention. Results There were 112 patients treated by open surgery for TAAD. Mean age was 66 ± 10 years and 61 (54%) were male. Seventy-seven (69%) patients had aneurysmal degeneration without aortic dissection and the remaining 35 (31%) had a concomitant aortic dissection. There were 12 deaths (10.7%) and they were equally distributed between the aneurysm and dissection groups (p = 0.8). The mortality for elective surgery was 3.2% (2/61). The rate of permanent paraplegia and stroke were each 2.6% (3/112). The rate of cerebrovascular accident was significantly higher in the dissection group (8.5% vs. 1.2%, p = 0.05). The survival at 1, 5, and 10 years was 80.6, 56.1, and 32.7%, respectively. Conclusion Our data confirm that open replacement of the thoracoabdominal aorta can be performed in expert centers quite safely. Different aortic pathologies (degenerative aneurysm vs. dissection) do not influence the short- and long-term outcomes. Open surgery should still be considered the standard in the management of TAAD.

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