P1609Adverse left ventricular remodeling in descending thoracic vs ascending aorta banding in novel porcin model. cMRI study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Popevska ◽  
A Fraser ◽  
F Rademakers ◽  
J D'hooge ◽  
F Rega ◽  
...  
Keyword(s):  
Thoracic Aorta ◽  
Porcine Model ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Descending Thoracic Aorta ◽  
Aortic Constriction ◽  
Native T1 ◽  
Lv Remodeling ◽  
Hemodynamic Measurements

Abstract Background Based on differences in the timing of left ventricular (LV) peak systolic pressure, distinction between early from late LV systolic loading is made. Reduced ascending aortic compliance results with chronic early LV systolic loading. Chronic late LV systolic loading associates with end-systolic wave refection's and developing earlier heart failure. The LV remodeling in chronic late vs early systolic loading has not been studied previously in a porcine model. Objective To develop novel porcin model and to study the LV hypertrophic remodeling in chronic late vs early LV systolic loading, during thoracic aorta banding. Methods Domestic male pigs (28±3.4kg, n=14) underwent thoracic aorta banding. Ascending aorta banding (PB, n=6) induced chronic early LV systolic loading. Descending thoracic aorta banding (DB n=8) provoked chronic late LV systolic loading. 3T cMRI with T1 mapping was performed at baseline, 4 and 8 weeks. Hemodynamic measurements were obtained using 5Fr Millar P-V catheter in LabChart, after 4 and 8 weeks. ANOVA two-way for repeated measurements was performed (R studio 3.5.1). Leven and Shapiro-Wilk normality testing was done. Analysis of variance of aligned rank transformed data was performed. Linear regression showed correlation between relevant parameters. Results Hemodynamic measurements are presented as means±se and means±sd for cMRI, for significant p<0.05. After 8 weeks of thoracic aorta banding, the timing of peak systolic LV pressure was prolonged in DB (PB 159±6 msec; DB 329±16 msec; p<0.01), correlating with LV dPdtmax (p=0.017, r=−0.8), Ea (p=0.04, r=0.73), LVEF (p=0.035, r=−0.74) and native T1 (p=0.01, r=−0.83) in DB. Tau was not different (p=0.8), correlated with the timing of peak LV pressure in DB (p=0.015, r=0.81). The gradients were not different (PB 25±5mmHg; DB 16±1mmHg; p=0.88) and LV systolic pressure (p=0.61). The isovolumic contraction phase was prolonged in DB (PB 34±4msec; DB 56±4msec, p<0.01). LV mass index increased (p=0.013) and was not different between the groups (PB 95±14g/m2; DB 89±12g/m2; p=0.89). RWT was different within (p<0.01) and between the groups (p=0.02),correlating with LVEFas dPdtmax (p=0.013, r=−0.82), whilst with dPdtmin (p=0.018, r=0.8) in DB. There was an interaction for site of aortic constriction and LV remodeling (RWT 0.067±0.08 in PB; 0.45±0.04 in DB, p=0.004; posterior LV wall thickness (PWT) p=0.012). RWT correlated with native T1 in PB (p=0.04) and DB (p<0.01, r=−0.8). Des. aorta banding in late LV loadining Conclusion The LV hypertrophic remodeling, defined by RWT, PWT and hemodynamic correlates is different between chronic late and early LV systolic loading, in this novel porcine model. The timing of peak LV afterload associates with increased LV afterload and adverse LV remodeling in presence of chronic late LV systolic loading, in the porcin model of descending thoracic aorta banding. Increased RWT ratio associates with adverse LV remodeling in the porcine model of descending thoracic aortic constriction.

Total correction of tetralogy of Fallot without “routine”preoperative cardiac catheterization—management of 99 patients

1994 ◽  
Vol 4 (3) ◽  
pp. 262-266
Author(s):  
Ayse Sarioglu ◽  
Gülhis Batmaz ◽  
Mehmet Salih Bilal ◽  
Irfan Levent Saltik ◽  
Gül Saylam ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Thoracic Aorta ◽  
Cardiac Catheterization ◽  
Pulmonary Arteries ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Descending Thoracic Aorta ◽  
Total Correction ◽  
Echocardiographic Examination ◽  
The Right

SummaryBetween January 1989 and March 1993, total correction was performed in 99 patients with tetralogy of Fallot without submitting them to prior cardiac catheterization. The age of the patients ranged from 1.33 to 18 years (mean 5.33±3.77). After complete echocardiographic examination, the diameters of the right and left pulmonary arteries at the prebranching point and the descending thoracic aorta at the diaphragm were measured by cross-sectional echocardiography and the McGoon ratio was calculated. Total correction was performed in all patients with a McGoon ratio greater than 1.7. In none of the patients were the sizes of the pulmonary artery measured by echocardiography smaller than the measurements obtained during surgery. Transannular patching was performed in 76 patients. A conduit from the right ventricle to the pulmonary arteries was constructed in two patients with coronary arterial anomalies. Postrepair right ventricular to left ventricular systolic pressure ratios were between 0.25 and 0.85 (mean 0.54±0.13). There were two hospital deaths, neither being related to the diagnostic method used nor the criteria for surgery. We conclude that the diagnosis of tetralogy of Fallot together with measurements of pulmonary arteries and descending thoracic aorta can safely and reliably be achieved echocardiographically. The McGoon ratio can be adapted to echocardiography and total correction can be performed successfully based on echocardiographic examination.

Cardiac magnetic resonance T1 mapping allows for predicting adverse left ventricular remodeling post-reperfused st-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Zhang ◽  
Y.K Guo ◽  
Z.G Yang ◽  
M.X Yang ◽  
K.Y Diao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
T1 Mapping ◽  
Ventricular Remodeling ◽  
Tissue Injury ◽  
Left Ventricular ◽  
Funding Source ◽  
Native T1 ◽  
End Diastolic Volume ◽  
Significant Difference ◽  
Lv Remodeling

Abstract Background Cardiac magnet resonance (CMR) T1 mapping allows the quantitative characterization of the severity of tissue injury and predict functional recovery in acute myocardial infarction (AMI). Purpose The study aimed to investigate whether native T1 and ECV of infarct myocardium are influenced by microvascular obstruction (MVO) and have predictive value for adverse left ventricular (LV) remodeling post-infarction. Method A cohort of 54 patients with successfully reperfused STEMI underwent CMR imaging at a 3T scanner in AMI and 3 months post-infarction. Native T1 data was acquired using a modified Look-Locker inversion recovery (MOLLI) sequence, and ECV maps were calculated using blood sampled hematocrit. Manual regions-of-interest were drawn within the infarct myocardium to measure native T1 and ECV (native T1infarct and ECVinfarct, respectively). MVO identified as a low-intensity area within the infarct zone on LGE was eliminated. Results MVO was present in 36 patients (66.67%) in AMI. ECVinfarct in patients with MVO was different from those without (58.66±8.71% vs. 49.64±8.82%, P=0.001), while no significant difference in T1infarct was observed between patients with and without MVO (1474.7±63.5ms vs. 1495.4±98.0ms, P=0.352). ECV correlated well with the change in end-diastolic volume (all patients: r=0.564, P&lt;0.001) and predicted LV remodeling in patients with and without MVO (rMVO absent = 0.626, P=0.005; rMVO present = 0.686, P&lt;0.001; all patients: r=0.622, P&lt;0.001); Native T1 was only associated with a 3-month change in LV end-diastolic volume (rMVO absent= 0.483, P=0.042) and predicted LV remodeling in patients without MVO (rMVO absent = 0.659, P=0.003). Furthermore, ECV had an association with LV remodeling (β=0.312, P=0.007) in multivariable logistic analysis. Conclusion Absolute native T1 in infarct myocardium might be affected by MVO but ECV isn't. ECV could predict LV remodeling in MI patients with and without MVO, while native T1 predict it in MI with MVO absent. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): 1·3·5 project for disciplines of excellence, West China Hospital, Sichuan University

scholarly journals Lyme aortitis

2020 ◽  
Vol 13 (1) ◽  
pp. e231957
Author(s):  
Rita Reis Correia ◽  
Fábia Cruz ◽  
Sandra Martin ◽  
Maria Eugenia André
Keyword(s):  
Thoracic Aorta ◽  
Sudden Onset ◽  
Ascending Aorta ◽  
Daily Activities ◽  
Initial Assessment ◽  
Descending Thoracic Aorta ◽  
Type A Aortic Dissection ◽  
Coronary Syndrome ◽  
Prosthesis Replacement ◽  
Cold Extremities

A 72-year-old man was admitted with complaints of sudden-onset oppressive precordial pain radiating to the back for 1 hour. He had hypotension, peripheral cyanosis and cold extremities. An initial assessment was done and acute coronary syndrome was excluded. After the patient was admitted, he developed fever and increased levels of inflammatory markers. Data obtained from CT angiography and transoesophageal echocardiogram revealed diffuse parietal thickening of the arch and the descending thoracic aorta, as well as dilatation of the aortic root and the proximal ascending aorta. In addition, the test for Borrelia burgdorferi was positive, and the patient was diagnosed with Lyme vasculitis of the thoracic aorta. He was treated with doxycycline for 3 weeks. Two months later, the patient exhibited a Stanford type A aortic dissection (clinically stable), which was treated by prosthesis replacement. The patient has remained asymptomatic for 1 year after the episode, performing his routine daily activities.

Diseases of the aorta

2011 ◽  
Author(s):  
Arturo Evangelista ◽  
T. González-Alujas
Keyword(s):  
Aortic Dissection ◽  
Thoracic Aorta ◽  
Imaging Techniques ◽  
Cost Effective ◽  
Transoesophageal Echocardiography ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Emergency Setting ◽  
Aortic Diseases

Evaluation of the aorta is a routine part of the standard echocardiographic examination, because echocardiography plays an important role both in the diagnosis and follow-up of aortic diseases. In particular, echocardiography is useful for assessing aorta size, biophysical properties, and atherosclerotic involvement of the thoracic aorta.Transthoracic echocardiography (TTE) permits adequate assessment of several aortic segments, particularly the aortic root and proximal ascending aorta. Transoesophageal echocardiography (TOE) overcomes the limitations of TTE in thoracic aorta assessment, so TTE and TOE should be used in a complementary manner.Although TOE is the technique of choice in the diagnosis of aortic dissection, TTE may be used as the initial modality in the emergency setting. Intimal flap in proximal ascending aorta, pericardial effusion/tamponade, and left ventricular function can be easily visualized by TTE. However, a negative TTE does not rule out aortic dissection and other imaging techniques must be considered. TOE should define entry tear location, mechanisms of aortic regurgitation, and true lumen compression.In addition, echocardiography is essential in selecting and monitoring surgical and endovascular treatment and in detecting possible complications. Although other imaging techniques have a greater field of view, echocardiography is portable, rapid, accurate, and cost-effective in the diagnosis and follow-up of most aortic diseases.

Effects of free wall ischemia and bundle branch block on systolic ventricular interaction in dog hearts

1994 ◽  
Vol 266 (3) ◽  
pp. H1087-H1094 ◽  
Author(s):  
H. Yaku ◽  
B. K. Slinker ◽  
S. P. Bell ◽  
M. M. LeWinter
Keyword(s):  
Right Ventricular ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Stroke Work ◽  
Free Wall ◽  
Ventricular Pacing ◽  
Aortic Constriction ◽  
Bundle Branch Block ◽  
Ventricular Interaction ◽  
Right Ventricular Stroke Volume

Systolic direct ventricular interaction is thought to occur via the ventricular septum and the coordinated contraction of common fibers shared by both ventricles. The purpose of the present study was to evaluate the effects of transient free wall ischemia and bundle branch block, which disrupt the coordinated contraction of shared common fibers, on left-to-right systolic ventricular interaction. We produced transient right and left ventricular free wall ischemia by 2-min coronary artery occlusions and bundle branch block by ventricular pacing in nine in situ dog hearts. To eliminate any confounding effect of series interaction, we used an abrupt hemodynamic perturbation (aortic constriction), and we measured systolic interaction gain (IG) as delta right ventricular peak systolic pressure/delta left ventricular peak systolic pressure (IG(peak)) and instantaneous delta right ventricular pressure/delta left ventricular pressure at matched data sampling times (IG(inst)), along with changes in right ventricular stroke volume and stroke work before and on the beat immediately after the aortic constriction. To achieve equivalence of the interventricular septal pressure transmission contribution to ventricular interaction, the delta left ventricular peak systolic pressure produced by the aortic constriction was matched under all experimental conditions [average increase: 64 +/- 19 (SD) mmHg]. Control IG(peak) was 0.12 +/- 0.05, and control IG(inst) was 0.11 +/- 0.05. These values did not change with either free wall ischemia or ventricular pacing, with or without an intact pericardium. The changes in right ventricular stroke volume and stroke work produced by the aortic constriction were not different from zero, during either ischemia or ventricular pacing, with or without an intact pericardium.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of gp91phox-containing NADPH oxidase in left ventricular remodeling induced by intermittent hypoxic stress

2008 ◽  
Vol 294 (5) ◽  
pp. H2197-H2203 ◽  
Author(s):  
Tetsuya Hayashi ◽  
Chika Yamashita ◽  
Chika Matsumoto ◽  
Chol-Jun Kwak ◽  
Kiwako Fujii ◽  
...  
Keyword(s):  
Cardiovascular Diseases ◽  
Nadph Oxidase ◽  
Intermittent Hypoxia ◽  
Sleep Apnea Syndrome ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Hypoxic Stress ◽  
Wild Type ◽  
Lv Remodeling

Intermittent hypoxia due to sleep apnea syndrome is associated with cardiovascular diseases. However, the precise mechanisms by which intermittent hypoxic stress accelerates cardiovascular diseases are largely unclear. The aim of this study was to investigate the role of gp91 phox-containing NADPH oxidase in the development of left ventricular (LV) remodeling induced by intermittent hypoxic stress in mice. Male gp91 phox-deficient (gp91−/−) mice ( n = 26) and wild-type ( n = 39) mice at 7–12 wk of age were exposed to intermittent hypoxia (30 s of 4.5–5.5% O2 followed by 30 s of 21% O2 for 8 h/day during daytime) or normoxia for 10 days. Mean blood pressure and LV systolic and diastolic function were not changed by intermittent hypoxia in wild-type or gp91−/− mice, although right ventricular systolic pressure tended to be increased. In wild-type mice, intermittent hypoxic stress significantly increased the diameter of cardiomyocytes and interstitial fibrosis in LV myocardium. Furthermore, intermittent hypoxic stress increased superoxide production, 4-hydroxy-2-nonenal protein, TNF-α and transforming growth factor-β mRNA, and NF-κB binding activity in wild-type, but not gp91−/−, mice. These results suggest that gp91 phox-containing NADPH oxidase plays a crucial role in the pathophysiology of intermittent hypoxia-induced LV remodeling through an increase of oxidative stress.

scholarly journals Sequential ruptures of penetrating atherosclerotic ulcers of ascending aorta, aortic arch and descending thoracic aorta

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Pankaj Kaul ◽  
Rodolfo Paniagua ◽  
Afroditi Petsa ◽  
Raj Singh
Keyword(s):  
Renal Cell Carcinoma ◽  
Case Report ◽  
Thoracic Aorta ◽  
Renal Cell ◽  
Ascending Aorta ◽  
Descending Thoracic Aorta ◽  
Graft Replacement ◽  
Penetrating Ulcer ◽  
Similarities And Differences ◽  
Aortic Dissections

Abstract Background Penetrating ulcers of aorta, aortic dissections and intramural hematomas all come under acute aortic syndromes and have important similarities and differences. Case report We report a 67 year old man with rupture of a large penetrating ulcer of the distal ascending aorta with hemopericardium and left hemothorax. He underwent interposition graft replacement of ascending aorta and hemi-arch with a 30 mm Gelweave Vascutek graft but represented 6 months later with development of a penetrating ulcer which ruptured into a huge 14 cm pseudoaneurysm. This was repaired with a 28 mm Vascutek Gelseal graft replacement of arch and interposition graft reconstruction of innominate and left common carotid arteries. 6 weeks later, however, he ruptured his proximal descending aorta and underwent TEVAR satisfactorily. Unfortunately, 2 days later, he developed a pathological fracture of left proximal tibia with metastasis from a primary renal cell carcinoma. He died 3 weeks later from respiratory failure. We shall briefly outline the similarities and differences in presentation and management of penetrating aortic ulcers, aortic dissections and intramural haematomas. We shall discuss, in greater detail, penetrating ulcers of thoracic aorta, their natural history, location, complications and management. Conclusion This case report is unique on account of initial successful surgical redressal following rupture of penetrating ulcer of distal ascending aorta into left pleural and pericardial cavities, normally associated with instant death. The haemodynamic effects of the rupture were staggered due to initial contained rupture into a smaller pseudoaneurysm, followed by a further rupture into a false aneurysmal sac followed eventually by generalised rupture into the pleural and pericardial cavities - a unique way of aortic rupture. Further development of another penetrating ulcer and a small pseudoaneurysm in the distal arch 6 months later which further ruptured into a larger 14 cm false aneurysmal sac, which again did not result in exsanguination, is again extraordinarily rare. Thereafter he underwent emergency thoracic endovascular aortic repair (TEVAR) for a further rupture of descending thoracic aorta. All three ruptures were managed successfully and would usually be associated with near-certain death, only for the patient to succumb eventually to the complications of metastatic renal cell carcinoma.

scholarly journals Descending Thoracic Aorta–abdominal Aortic Bypass and Bilateral Renal Arterial Blood Circulation Reconstruction Are Effective in Atypical Coarctation of the Aorta With Heart Failure: a Case Report

2021 ◽  
Author(s):  
Takuma Mikami ◽  
Takeshi Kamada ◽  
Toshiyuki Yano ◽  
Tomohiro Nakajima ◽  
Naomi Yasuda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Plasma Renin Activity ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Thoracic Aorta ◽  
Coarctation Of The Aorta ◽  
Plasma Renin ◽  
Left Ventricular ◽  
Descending Thoracic Aorta ◽  
Atypical Coarctation

Abstract Background: There are many reports on renal failure and heart failure due to coarctation of the aorta. However, there are no case reports in which revascularization dramatically improved left ventricular function in patients with progressive decline in left ventricular function. Herein, we present a rare case in which the left ventricular function dramatically improved after surgical treatment in a patient with progressive left ventricular dysfunction due to atypical coarctation of the aorta.Case presentation: A 58-year-old man underwent axilobifemoral bypass at another hospital for atypical coarctation of the aorta due to Takayasu’s arteritis. Approximately 10 years later, he was re-hospitalized for heart failure, and his left ventricular ejection fraction gradually decreased to 28%. Computed tomography showed severe calcification and stenosis at the same site from the peripheral thoracic descending aorta to the lower abdominal aorta up to the renal arteries, and aortography showed delayed bilateral renal artery blood flow. An increase in plasma renin activity was also observed. Despite the administration of multiple antihypertensive drugs, blood pressure control was insufficient. We decided to perform surgical treatment to improve progressive cardiac dysfunction due to increased afterload and activated plasma renin activity. Descending thoracic aorta–abdominal aorta bypass and revascularization of both renal arteries via a great saphenous vein grafts were performed. Postoperative blood pressure control improved, and the dose of antihypertensive drugs could be reduced. Plasma renin activity decreased, and transthoracic echocardiography performed 1.5 years later showed improvement in contractility with a left ventricular ejection fraction of 58%. Conclusion: In patients with atypical coarctation of the aorta and decreased bilateral renal blood flow, heart failure due to renal hypertension, and progressive decrease in left ventricular contractility, descending thoracic aorta–abdominal aortic bypass and bilateral renal artery recirculation can be extremely effective.

scholarly journals Sequential ruptures of penetrating atherosclerotic ulcers of ascending aorta, aortic arch and descending thoracic aorta

2020 ◽  
Author(s):  
Pankaj Kaul ◽  
Rodolfo Paniagua ◽  
Afroditi Petsa ◽  
Raj Singh
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Thoracic Aorta ◽  
Renal Cell ◽  
Ascending Aorta ◽  
Descending Thoracic Aorta ◽  
Graft Replacement ◽  
Interposition Graft ◽  
Penetrating Ulcer ◽  
Aortic Dissections

Abstract BackgroundPenetrating ulcers of aorta, aortic dissections and intramural hematomas all come under acute aortic syndromes and have important similarities and differences.Case ReportWe report a 67 year old man with rupture of a large penetrating ulcer of the distal ascending aorta with hemopericardium and left hemothorax. He underwent interposition graft replacement of ascending aorta and hemi-arch with a 30 mm Gelweave Vascutek graft but represented 6 months later with development of a penetrating ulcer which ruptured into a huge 14 cm pseudoaneurysm. This was repaired with a 28 mm Vascutek Gelseal graft replacement of arch and interposition graft reconstruction of innominate and left common carotid arteries. 6 weeks later, however, he ruptured his proximal descending aorta and underwent TEVAR satisfactorily. Unfortunately, 2 days later, he developed a pathological fracture of left proximal tibia with metastasis from a primary renal cell carcinoma. He died 3 weeks later from respiratory failure.We shall briefly outline the similarities and differences in presentation and management of penetrating aortic ulcers, aortic dissections and intramural haematomas. We shall discuss, in greater detail, penetrating ulcers of thoracic aorta, their natural history, location, complications and management.ConclusionThis case report is unique on account of initial successful surgical redressal following rupture of penetrating ulcer of distal ascending aorta into left pleural and pericardial cavities, normally associated with instant death. The haemodynamic effects of the rupture were staggered due to initial contained rupture into a smaller pseudoaneurysm, followed by a further rupture into a false aneurysmal sac followed eventually by generalised rupture into the pleural and pericardial cavities - a unique way of aortic rupture. Further development of another penetrating ulcer and a small pseudoaneurysm in the distal arch 6 months later which further ruptured into a larger 14 cm false aneurysmal sac, which again did not result in exsanguination, is again extraordinarily rare. Thereafter he underwent emergency thoracic endovascular aortic repair (TEVAR) for a further rupture of descending thoracic aorta. All three ruptures were managed successfully and would usually be associated with near-certain death, only for the patient to succumb eventually to the complications of metastatic renal cell carcinoma.

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