scholarly journals Evaluation of the Relationship between Para-aortic Adipose Tissue and Ascending Aortic Diameter using a New Method

2022 ◽  
Author(s):  
Adem Adar ◽  
Orhan Onalan ◽  
Fahri Cakan ◽  
Ertan Akbay ◽  
Sinan Akıncı ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Aortic Aneurysm ◽  
Transthoracic Echocardiography ◽  
Multivariate Logistic Regression Analysis ◽  
Ascending Aorta ◽  
Aortic Dilatation ◽  
Aortic Dilation ◽  
Patients At Risk ◽  
Relationship Of ◽  
Ascending Aortic Diameter

Abstract Purpose: Para-aortic adipose tissue (PAT) is the local adipose tissue that externally surrounds the aorta. It contributes significantly to aortic atherosclerosis and enlargement. Studies conducted with computed tomography and magnetic resonance have shown that individuals with aortic aneurysm had more PAT than healthy individuals. In this study, we measured PAT for the first time using transthoracic echocardiography (TTE).The aim of this study is to investigate the possible relationship of TTE measured PAT with ascending aortic width.Methods: PAT was defined as the hypoechoic space in front of ascending aortic 2 cm above the sinotubular junction at the end of the systole. Patients were divided into 2 groups according to the presence of dilatation in the ascending aorta using Roman's classification (aortic size index, ASI). ASI of less than 21 was considered no aortic dilation and an ASI of 21mm/m2 or greater was considered to have aortic dilation.Results: A total of 321 unselected patients were divided into the ascending aortic dilatation (AAD) group (n=96) and the normal ascending aorta diameter group (n=225 patients). PAT was significantly higher in the AAD group compared with the non-ADD group (0.9 (0.48) vs. 0.7 (0.91) mm, p < 0.0001). Univariate and multivariate logistic regression analysis revealed that PAT (OR: 3.005, 95%CI (1.445–6.251)) were significantly associated with AAD.Conclusion: Our results showed an association between PAT measured by transthoracic echocardiography and ascending aorta width. PAT appears to be an important follow-up parameter in patients at risk of developing aortic aneurysm.

scholarly journals Hemodynamic Environment Characteristics in the Ascending Aorta After Dilation Formed for the Bicuspid Aortic Valve Patients

2020 ◽  
Author(s):  
Tie Zheng ◽  
Shuai Zhu ◽  
Shijie Lu ◽  
Jiafu Ou ◽  
Jun-Ming Zhu
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Numerical Models ◽  
Flow Patterns ◽  
Ascending Aorta ◽  
Aortic Dilatation ◽  
Aortic Dilation ◽  
Distribution Features ◽  
Ascending Aortic Diameter ◽  
Asymmetrically Distributed

Abstract Background: The bicuspid aortic valve is one of the common congenital heart anomalies in adults. Although many studies have proved the coincidence between bicuspid aortic valve and the occurrence of ascending aortic dilation, seldom study has focused on the hemodynamic environments after the dilation already formed. Four numerical models of bicuspid aortic valve were constructed in this study, based on medical images, with different ascending aortic dilation levels. The diameters of ascending aortic are 3.5cm, 4.0cm, 4.5cm and 5.0cm, respectively; while, the size and the geometry of other parts are fixed. Then hemodynamics in these models was simulated numerically and the flow patterns and loading distributions were investigated. Aim of this study is to investigate the hemodynamic environment characteristics in the ascending aorta after dilation formed for the bicuspid aortic valve (BAV) patients. Results: Hemodynamics environments in the dilated ascending aorta were simulated, with different level of dilation. As the diameter increases, the blood flow becomes more disturbing. The wall shear stress at the ascending aortic decreases while oscillatory shear index increases with the increase of diameter. The pressure at ascending aortic increases as the diameter increases. Moreover, all these hemodynamic parameters described above are asymmetrically distributed with the increase of ascending aortic diameter and more parts of aorta would be affected with the increasing ascending aorta diametersConclusions: The study revealed that the ascending aortic dilation levels can significantly influence the magnificent and distribution of the dynamics. There are altered flow patterns, pressure difference, WSS and OSI distribution features in bicuspid aortic valve patients with valvular dilation. As the extent of aortic dilatation increases, more parts of aorta like aortic arch should be paid more attention to when an individual is referred for surgery

The “Auto-sliding Graft” Aortic Wrapping Technique

2018 ◽  
Vol 67 (05) ◽  
pp. 393-394 ◽  
Author(s):  
Francisco Estevez-Cid ◽  
Jose María Herrera-Norena ◽  
Carlos Velasco-García de Sierra
Keyword(s):  
At Risk ◽  
Protective Effect ◽  
Simple Technique ◽  
Circulatory Arrest ◽  
Suture Line ◽  
Ascending Aorta ◽  
Aortic Dilatation ◽  
Aortic Graft ◽  
Patients At Risk ◽  
Wrapping Technique

AbstractWe describe the “auto-sliding graft” technique, a different anastomotic option for reconstructive prosthetic procedures on the ascending aorta especially in patients at risk of circulatory arrest with mild aortic dilatation. This simple technique provides not only an important hemostatic reinforcement for the distal aortic graft anastomosis but also a protective effect on the native ascending aorta beyond the suture line.

scholarly journals Deletion of AT1a (Angiotensin II Type 1a) Receptor or Inhibition of Angiotensinogen Synthesis Attenuates Thoracic Aortopathies in Fibrillin1 C1041G/+ Mice

2021 ◽  
Author(s):  
Jeff Z. Chen ◽  
Hisashi Sawada ◽  
Dien Ye ◽  
Yuriko Katsumata ◽  
Masayoshi Kukida ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Antisense Oligonucleotide ◽  
Thoracic Aortic Aneurysm ◽  
Renin Angiotensin System ◽  
Ascending Aorta ◽  
Ang Ii ◽  
Angiotensin Receptor ◽  
Aortic Dilation ◽  
Angiotensin System ◽  
Renin Angiotensin

Objective: A cardinal feature of Marfan syndrome is thoracic aortic aneurysm. The contribution of the renin-angiotensin system via AT1aR (Ang II [angiotensin II] receptor type 1a) to thoracic aortic aneurysm progression remains controversial because the beneficial effects of angiotensin receptor blockers have been ascribed to off-target effects. This study used genetic and pharmacological modes of attenuating angiotensin receptor and ligand, respectively, to determine their roles on thoracic aortic aneurysm in mice with fibrillin-1 haploinsufficiency ( Fbn1 C1041G/+ ). Approach and Results: Thoracic aortic aneurysm in Fbn1 C1041G/+ mice was found to be strikingly sexual dimorphic. Males displayed aortic dilation over 12 months while aortic dilation in Fbn1 C1041G/+ females did not differ significantly from wild-type mice. To determine the role of AT1aR, Fbn1 C1041G/+ mice that were either +/+ or −/− for AT1aR were generated. AT1aR deletion reduced expansion of ascending aorta and aortic root diameter from 1 to 12 months of age in males. Medial thickening and elastin fragmentation were attenuated. An antisense oligonucleotide against angiotensinogen was administered to male Fbn1 C1041G/+ mice to determine the effects of Ang II depletion. Antisense oligonucleotide against angiotensinogen administration attenuated dilation of the ascending aorta and aortic root and reduced extracellular remodeling. Aortic transcriptome analyses identified potential targets by which inhibition of the renin-angiotensin system reduced aortic dilation in Fbn1 C1041G/+ mice. Conclusions: Deletion of AT1aR or inhibition of Ang II production exerted similar effects in attenuating pathology in the proximal thoracic aorta of male Fbn1 C1041G/+ mice. Inhibition of the renin-angiotensin system attenuated dysregulation of genes within the aorta related to pathology of Fbn1 C1041G/+ mice.

Clinical significance of the periaortic adipose tissue inflammation in patients with abdominal aortic aneurysms

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Yamaguchi ◽  
M Hoshino ◽  
K Nogami ◽  
H Ueno ◽  
T Misawa ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Clinical Significance ◽  
Multivariate Logistic Regression Analysis ◽  
Aortic Aneurysms ◽  
P Value ◽  
Adipose Tissue Inflammation ◽  
Aortic Dilation ◽  
Tissue Inflammation ◽  
Abdominal Aortic

Abstract Background Recent studies have reported the association between periaortic adipose tissue volumes identified by multi-detector computed tomography (MDCT) and the periaortic adipose tissue inflammation (PATI) identified by positron emission tomography, which may suggest the link between perivascular inflammation and aortic dilation. However, clinical significance of the PATI identified by MDCT remains elusive in patients with asymptomatic abdominal aortic aneurysm (AAA). Methods A total of 77 patients with AAA (diameter &gt;30mm) who underwent the initial and follow-up MDCT examinations were studied retrospectively. PATI was assessed by the crude analysis of the mean CT attenuation value (−190 to −30 Hounsfield units; higher values indicating inflammation). The AAA progression (AP) was defined as the growth of AAA diameter &gt;5.0mm/year from the initial to follow-up. Univariate and multivariate logistic regression analysis were performed to determine the predictors for AP. Results AP was observed in 19 (24.7%) patient, the median initial AAA diameter was 38.9 (32.7–42.9) mm, and the median progression of AAA diameter was 3.1 (1.5–4.9) mm/year. The initial AAA diameter (odds ratio [OR]: 1.16; 95% confidence interval [CI]: 1.05–1.28; p-value=0.001) and the initial PATI (OR: 1.12; 95% CI: 1.05–1.20; p-value=0.004) were independent predictors of AP. PATI of −71.08 at initial MDCT and the initial AAA diameter of 37.7mm were the best cut-off value to predict AP. Receiver operating characteristic curve analysis revealed that the best cut-off values of PATI at initial MDCT and the initial AAA diameter for predicting AP were −71.08 (AUC: 0.68, 95% CI: 0.50–0.82) and 37.7 (AUC: 0.71, 95% CI: 0.59–0.84), respectively. Addition of the initial AAA diameter to PATI at initial MDCT significantly increased the accuracy for discriminating AP (net reclassification improvement; 95% CI: 0.67 [0.17–1.17]; p-value = 0.007, integrated discrimination improvement; 95% CI: 0.14 [0.04–0.24]; p-value =0.007). Conclusions PATI was an independent and significant predictor of aortic dilation, supporting the notion that local adipose tissue inflammation may contribute to aortic remodeling. Comprehensive assessment of MDCT including PATI evaluation may provide a highly accurate information for identifying high risk lesions potentially leading to future AAA rupture. Funding Acknowledgement Type of funding source: None

scholarly journals Pregnancy in women with bicuspid aortic valve

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Belkadi ◽  
O Milleron ◽  
L Eliahou ◽  
F Arnoult ◽  
G Delorme ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Bicuspid Aortic Valve ◽  
Ascending Aorta ◽  
Aortic Diameter ◽  
Z Score ◽  
Aortic Dilation ◽  
Genetic Syndrome ◽  
Pregnancy And Postpartum ◽  
Ascending Aortic Diameter

Abstract Background Aortic dissection during pregnancy is uncommon, however, the risk of aortic dissection is increased if there is underlying aortopathy. Bicuspid aortic valve (BAV) is common in the general population and is associated with the presence of an aortic aneurysm, but this condition is mostly asymptomatic and ignored in women of childbearing age. Data on pregnancy in patients with BAV are scarce, and guidelines on this topic are based on the consensus opinion of experts. The risk of occurrence of aortic dissection as a function of aortic diameter during pregnancy remains poorly known in women with BAV. Purpose To investigate demographic and echocardiographic characteristics and aortic events associated with pregnancy in women with BAV and to estimate ascending aortic diameter at the time of pregnancy. Methods We performed a retrospective study using data from our tertiary centre. All women seen at our centre between 1996 and 2020 with BAV, at least 1 pregnancy, and no genetic syndrome were included. We have collected data from echocardiograms performed in and out of our centre and aortic events. Assuming from the literature an annual aortic dilation rate of 0.2 mm at the sinus of Valsalva and 0.4 mm at the tubular ascending aorta, we estimated ascending aortic size and Z-score at the time of pregnancy. Results We identified 47 women with BAV with occurrence of 103 pregnancies. The median age of BAV diagnosis was 43 years. The aorta was measured at a median of 13.3 years since the last delivery. At BAV diagnosis, the median largest ascending aortic diameter was 44mm, and the median Z-score was +4.3. Ascending aortic diameter was ≥40mm in 37/47 (79%) and Z-score ≥2 in 44/47 (94%). No aortic dissection was observed during pregnancy and postpartum in all 103 pregnancies. At the time of pregnancy, the estimated median diameter of the ascending aorta was 37mm and the estimated median Z-score was +3.3. The largest aortic diameter during pregnancy was estimated to be ≥40mm in 36/103 pregnancies, ≥45mm in 13/103, and ≥50mm in 1/103; Z-score was estimated to be ≥2 in 81/103 and ≥4 in 40/103. Type A aortic dissection occurred in 1 woman, 13 years after pregnancy, and type B aortic dissection in 1 woman, 14 years after pregnancy. Planned surgery was performed in 8 women at a median of 17.5 years after the last pregnancy: 1 isolated aortic valve replacement and 7 prophylactic aortic surgeries associated with aortic valve surgery. Conclusions In our population of women with BAV, pregnancy is not associated with the occurrence of aortic dissection even though, when estimating aortic diameter at the time of pregnancy, the rate of aortic dilation was high (Z-score ≥2 in 81/103 pregnancies). Prospective studies of a large population of women with BAV are needed to assess the risk of aortic complication during pregnancy according to aortic diameter. FUNDunding Acknowledgement Type of funding sources: None.

Relationship between the Inflammation/immune Indexes and Deep Venous Thrombosis (DVT) following Tibial Plateau Fractures

2020 ◽  
Author(s):  
Dawei Liu ◽  
Wei Chen ◽  
Junyong Li ◽  
Kuo Zhao ◽  
Junzhe Zhang ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Multivariate Logistic Regression Analysis ◽  
Predictive Ability ◽  
Lower Extremities ◽  
Tibial Plateau Fractures ◽  
Targeted Prevention ◽  
Lymphocyte Ratio ◽  
Patients At Risk ◽  
Relationship Of ◽  
The Relationship

Abstract Objective To determine the relationship between inflammation/immune-based indexes and preoperative DVT of lower extremities following tibial plateau fracturesMethods Retrospective analysis of a prospectively collected data on patients undergoing surgeries of tibial plateau fractures between October 2014 and December 2018 was performed. Duplex ultrasonography (DUS) was routinely used to screen for preoperative DVT of bilateral lower extremities. Data on biomarkers (neutrophil-, lymphocyte-, monocyte- and platelet counts) at admission were collected, based on which neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte/lymphocyte (MLR) and systemic immune-inflammation index (SII, neutrophil* platelet/ lymphocyte) were calculated. Receiver operating characteristic (ROC) was used to determine the optimal cut-off value for each variable. Multivariate logistic regression analysis was used to evaluate the independent relationship of each biomarker or index with DVT, after adjustment for demographics, co-morbidities and injury-related variables.Results Among 1179 patients included, 16.3% (192/1179) of them had (16.3%) had a preoperative DVT. Among the biomarkers and indexes, only platelet and neutrophil were identified to be independently associated with DVT, and their predictive ability was stable regardless of open fracture with or without included. The other independent variables were elevated D-dimer level (>0.55mg/L), male gender and hypertension in the sensitivity analysis with open fractures excluded.Conclusion These identified factors are conducive to the initial screening for patients at-risk of DVT, individualized risk assessment, risk stratification and accordingly development of targeted prevention programs.

Aortic disease and interventions in adults with tetralogy of Fallot

Heart ◽  
2018 ◽  
pp. heartjnl-2018-314115 ◽  
Author(s):  
Alexander C Egbe ◽  
William R Miranda ◽  
Naser M Ammash ◽  
Nandan S Anavekar ◽  
Venkata R Missula ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Aortic Valve Disease ◽  
Aortic Surgery ◽  
Leading Edge ◽  
Ascending Aorta ◽  
Valve Disease ◽  
Aortic Dilation ◽  
Progressive Aortic Dilation

BackgroundAortic dilation and aortic valve disease are known long-term complication of tetralogy of Fallot (TOF), but the risk of aortic dissection and the indications for prophylactic aortic surgery are unknown in this population. The purpose of this study was to: (1) determine the prevalence of significant aortic valve disease and/or significant aortic aneurysm (AVD-AA); (2) determine the incidence of progressive aortic dilation and aortic dissection in patients with TOF.MethodsRetrospective review of adults with repaired TOF, and no prior aortic valve/aorta surgery, who had ≥2 measurements of the thoracic aorta >12 months apart, 1990–2017. The aortic root and mid-ascending aorta were measured at the onset of QRS complex from leading edge to leading edge. Significant aortic valve disease was defined as the presence of ≥moderate aortic stenosis and/or ≥moderate aortic regurgitation. Significant aortic aneurysm was defined as aortic root or mid-ascending aorta dimension ≥50 mm. Progressive aortic dilation was defined as increase in aortic dimension ≥2 mm.ResultsOf the 453 consecutive patients (37±13 years, men 216 (49%)) in the study, aortic aneurysm was present in 312 (69%) based on normative data; progressive aortic dilation occurred in 40 (9%), and there was no case of aortic dissection. Significant AVD-AA occurred in 52 (12%) patients; and 15 of them (29%) underwent aortic surgery without any surgical mortality.ConclusionsAlthough aortic aneurysm was common, progressive aortic dilation was uncommon and aortic dissection did not occur in our patients with TOF with significant aortic aneurysms who did not undergo aortic surgery. This has important clinical implication in deciding the frequency of imaging follow-up and timing of surgical intervention in this population.

Intraoperative Detection of Ascending Aortic Dissection by Transesophageal Echocardiography in a Patient with Bicuspid Aortic Valve and Ascending Aortic Aneurysm

2015 ◽  
Vol 3 (1) ◽  
pp. 29-31
Author(s):  
Rajkumar K Vishwakarma
Keyword(s):  
Aortic Valve ◽  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Transesophageal Echocardiography ◽  
Bicuspid Aortic Valve ◽  
Ascending Aorta ◽  
Aortic Dilatation ◽  
Ascending Aortic Aneurysm ◽  
Intraoperative Detection ◽  
High Index Of Suspicion

ABSTRACT Bicuspid aortic valve is a common congenital heart defect frequently associated with complications of aortic valve and dilatation of ascending aorta. High index of suspicion is required for diagnosis of aortic dissection in patient with bicuspid aortic valve and ascending aortic dilatation. We present a case of bicuspid aortic valve with ascending aortic aneurysm in which aortic dissection was detected by intraoperative transesophageal echocardiography (TEE). A careful review of patient's preoperative computed tomography (CT) scan showed dissection flap in the ascending aorta, which was overlooked in CT reporting. We present how intraoperative TEE helped in surgical planning for the patient. How to cite this article Vishwakarma RK, Raj R, Puri GD. Intraoperative Detection of Ascending Aortic Dissection by Transesophageal Echocardiography in a Patient with Bicuspid Aortic Valve and Ascending Aortic Aneurysm. J Perioper Echocardiogr 2015;3(1):29-31.

Ascending Aortic Endoballoon Occlusion Feasible despite Moderately Enlarged Aorta to Facilitate Robotic Mitral Valve Surgery

2016 ◽  
Vol 11 (5) ◽  
pp. 355-359 ◽  
Author(s):  
Sarah L. Breves ◽  
Inki Hong ◽  
James McCarthy ◽  
Mohammed Kashem ◽  
G. William Moser ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Surgery ◽  
Balloon Occlusion ◽  
Ascending Aorta ◽  
Valve Surgery ◽  
Preoperative Imaging ◽  
Aortic Dilatation ◽  
Aortic Dilation ◽  
Artery Cannulation ◽  
Established Technique

Objective Aortic occlusion with an endoballoon is a well-established technique to facilitate robotic and minimally invasive mitral valve surgery. Use of the endoballoon has several relative contraindications including ascending aortic dilatation greater than 38 mm in size. We sought to review our experience using the endoballoon in cases of totally endoscopic mitral valve surgery with aortic diameters greater than 38 mm. Methods A retrospective review of our single-site database was conducted to identify patients undergoing totally endoscopic mitral valve surgery by a single surgeon using an endoballoon and who had ascending aortic dilation. We defined aortic dilation as greater than 38 mm. Computed tomography was done preoperatively on all patients to evaluate the aortic anatomy as well as iliofemoral access vessels. Femoral artery cannulation was done in a standardized fashion to advance and position the endoballoon, to occlude the ascending aorta, and to deliver cardioplegia. Results From October 2011 through June 2015,196 patients underwent totally endoscopic mitral valve surgery using an endoballoon at our institution. Twenty-two patients (11.2%) had ascending aortic diameters greater than 38 mm (range, 38.1–16.6 mm; mean, 40.5 ± 2.5 mm). In these cases, there were no instances of aortic dissection or other injury due to balloon rupture, balloon migration, device movement leading to loss of occlusion, or inability to complete planned surgery due to occlusion failure. Conclusions Our experience suggests that it is possible to successfully use endoaortic balloon occlusion in patients with ascending aortic dilation with proper preoperative imaging and planning.

Glutathione system participation in thoracic aneurysms from patients with Marfan syndrome

VASA ◽  
2017 ◽  
Vol 46 (3) ◽  
pp. 177-186 ◽  
Author(s):  
Alejandra María Zúñiga-Muñoz ◽  
Israel Pérez-Torres ◽  
Verónica Guarner-Lans ◽  
Elías Núñez-Garrido ◽  
Rodrigo Velázquez Espejel ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Marfan Syndrome ◽  
Aortic Aneurysms ◽  
Aortic Dilatation ◽  
Glutathione S Transferase ◽  
Reduced And Oxidized Glutathione ◽  
Total Antioxidant ◽  
Elevated Activity ◽  
Acute Dissection ◽  
Thoracic Aneurysms

Abstract. Background: Aortic dilatation in Marfan syndrome (MFS) is progressive. It is associated with oxidative stress and endothelial dysfunction that contribute to the early acute dissection of the vessel and can result in rupture of the aorta and sudden death. We evaluated the participation of the glutathione (GSH) system, which could be involved in the mechanisms that promote the formation and progression of the aortic aneurysms in MFS patients. Patients and methods: Aortic aneurysm tissue was obtained during chest surgery from eight control subjects and 14 MFS patients. Spectrophotometrical determination of activity of glutathione peroxidase (GPx), glutathione-S-transferase (GST), glutathione reductase (GR), lipid peroxidation (LPO) index, carbonylation, total antioxidant capacity (TAC), and concentration of reduced and oxidized glutathione (GSH and GSSG respectively), was performed in the homogenate from aortic aneurysm tissue. Results: LPO index, carbonylation, TGF-β1, and GR activity were increased in MFS patients (p < 0.04), while TAC, GSH/GSSG ratio, GPx, and GST activity were significantly decreased (p < 0.04). Conclusions: The depletion of GSH, in spite of the elevated activity of GR, not only diminished the activity of GSH-depend GST and GPx, but increased LPO, carbonylation and decreased TAC. These changes could promote the structural and functional alterations in the thoracic aorta of MFS patients.

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