scholarly journals Cellular/intercellular interrelations in various parts of aorta after reconstructive treatment of aortic stenosis in infants

2017 ◽  
Vol 21 (2) ◽  
pp. 52 ◽  
Author(s):  
S. S. Todorov
Keyword(s):  
Aortic Stenosis ◽  
Conflict Of Interest ◽  
Aortic Coarctation ◽  
Ascending Aorta ◽  
Coagulation Necrosis ◽  
Elastic Fibers ◽  
Thin Walled ◽  
Medical University ◽  
Smooth Myocytes ◽  
Intercellular Relationships

<p><strong>Aim.</strong> The article focuses on the evaluation of cellular/intercellular relationships in various parts of the aorta after reconstructive treatment of aortic stenosis in infants.<br /><strong>Methods.</strong> Medical histories and protocols of autopsies of three newborns were studied after surgical treatment of aortic coarctation. The operations were performed in children at 8th, 10th and 15th day after birth. In two cases, resection of the aortic lumen narrowing, botulinum duct ligation and formation of a direct aortic anastomosis were performed. In one observation, a closed balloon dilatation of the aorta in the area of constriction was used. When performing autopsy, the size of the heart, the perimeter of the aorta at the surgical sites and various parts of the aorta were examined. The fragments of the wall of the aortic sections were cut out and fixed in 10% neutral formalin. Histologic sections were prepared in a conventional way followed by staining them with hematoxylin-eosin or picrofuxin by Van Gieson, while elastic fibers were stained with rezorcin-fuchsin by Hotchkiss and Periodic acid–Schiff (PAS) in order to detect mucopolysaccharides.<br /><strong>Results.</strong> Cellular/intercellular relationships in various parts of the aorta following aortic coarctation in infants have some morphological features. Morphometric examination of the heart and aorta showed a significant increase in the volume and mass of the heart compared with the normal values due to myocardial hypertrophy of the right and left ventricles of the heart. An uneven narrowing of the aortic lumens was most pronounced in the arch and isthmus as compared to the ascending and thoracic parts of aorta. Morphological examination of the aortic wall in the constriction zones demonstrated the presence of coagulation necrosis, lysis of elastic, collagen fibers with surrounding hyperplasia of smooth myocytes, newly formed thin-walled capillary vessels. Outside the coarctation zone, the most significant changes characterized by the development of hypoelastosis, non-uniform accumulation of acid mucopolysaccharides were observed in the walls of the arch and the ascending aorta. <br /><strong>Conclusion.</strong> In infants with coarctation of the aorta, dilatation of the ascending aorta with compensatory hypertrophy of the heart is observed, and a muscle-fibrous tissue, rich in smooth myocytes and newly formed thin-walled vessels, tends to develop in stenotic zones. The risk of restenosis development is believed to depend on the prevalence and severity of proliferative processes of the cellular elements of the aorta, which allows us to consider early surgical interventions to prevent irreversible destructive changes as justifiable.</p><p>Received 2 February 2017. Accepted 27 May 2017.</p><p><strong>Funding:</strong> The study required no additional funding and sponsorship.<br /><strong>Conflict of interest:</strong> The author declares no conflict of interest.<br /><strong>Acknowledgements</strong><br />The author expresses his gratitude towards Professor S.V. Shlyk, Dr. Sci. (Medicine), Rector of Rostov State Medical University, Professor N.I. Volkova, Dr. Sci. (Medicine), Pro-Rector for Research of Rostov State Medical University and the researchers of the Molecular/Biological &amp; Optical Research Methods Department.</p>

P1778Changes in size of ascending aorta in patients with bicuspid aortic valves

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M V Garcia-Ruiz ◽  
V M Becerra Munoz ◽  
J Robledo-Carmona ◽  
I Rodriguez-Bailon ◽  
E De Teresa Galvan
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Coarctation ◽  
Severe Aortic Stenosis ◽  
Adult Congenital Heart Disease ◽  
Type A ◽  
Ascending Aorta ◽  
P Value ◽  
Type B

Abstract Introduction It is well known that bicuspid aortic valve (BAV) is associated with premature valve dysfunction and ascending aorta dilation. However, limited data still exists regarding the rate of growth of the ascending aorta and the risk factors associated with it in these patients. Methods We analyzed prospectively baseline characteristics and echocardiographic data from 192 adult patients with BAV followed in an Adult Congenital Heart Disease Unit from 2007 until 2018. The exclusion criteria were: patient's without at least 2 echocardiographic examinations >6 months apart, and patients with aortic valve and/or ascending aorta surgery at baseline o at follow up (except aortic coarctation). Following the ASE guidelines two cardiologists experts in echocardiography made all the studies at baseline and follow-up where they measured the aortic root and ascending aortic diameters, as well as typified the aortic valve and analyzed the degree of stenosis (AS) and regurgitation (AR). Statistical analysis was performed using Stata 13.1, and a p value of ≤0.05 was considered significant. Results 97 patients were finally included (70 male, mean age 37.56±18.9 years). 66 patients had type A BAV (68.04%), 21 type B (21.7%), 2 type C (2.06%) and 7 unicuspid (7.22%). 19 patients had hypertension (19.59%) and 9 had a corrected aortic coarctation. In baseline echocardiogram, 20 had aortic stenosis ≥ moderate (20.6%) and 38 regurgitation ≥ grade II (39.18%). Mean diameter of ascending aorta was 35.78mm ± 6.73. With a mean follow-up time of 50.53±27.05 months, mean rate of diameter progression was 0.76 mm/year at the proximal ascending aorta (95% CI 0.6 to 1.2). Progression was significantly higher in patients with moderate or severe aortic stenosis (0.65 vs. 1.17 mm/year, p=0.021). Age, sex, hypertension, AR and high baseline diameters (≥40mm or ≥45mm) were not associated with progression. In a direct comparison between the two more frequent forms of BAV, Type A and Type B, rate of diameter progression was significantly higher in Type B (0.61 vs. 1.05 mm/year, p=0.044). In a multivariate analysis, none of the variables statistically associated to major progression were found to be predictors of growth of the ascending aorta. Conclussions In our population of BAV patients, mean rate of diameter progression at the proximal ascending aorta was 0.76 mm/year. Moderate-severe AS, and having type B BAV were associated, but not predictors, of higher growth rates.

A Novel Approach: Trans-ascending Aorta Balloon Aortic Valvuloplasty via Sternotomy for Treating Severe Valvular Aortic Stenosis in a Low-Weight Infant

2014 ◽  
Vol 17 (1) ◽  
pp. 25 ◽  
Author(s):  
Lei Gao ◽  
Qin Wu ◽  
Xinhua Xu ◽  
Tianli Zhao ◽  
Wancun Jin ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Transesophageal Echocardiography ◽  
Severe Aortic Stenosis ◽  
Ascending Aorta ◽  
Balloon Aortic Valvuloplasty ◽  
Congenital Aortic Stenosis ◽  
Novel Approach ◽  
Low Weight ◽  
Aortic Valvuloplasty ◽  
Peak Gradient

<p><b>Background:</b> Severe congenital aortic stenosis in infants is a life-threatening congenital heart anomaly that is typically treated using percutaneous balloon aortic valvuloplasty.</p><p><b>Methods:</b> The usual route is the femoral artery under radiographic guidance. However, this procedure may be limited by the small size of the femoral artery in low-weight infants. An infant weighing only 7 kg with severe aortic stenosis (peak gradient was 103 mmHg) was successfully treated with a novel approach, that is trans-ascending aorta balloon aortic valvuloplasty guided by transesophageal echocardiography.</p><p><b>Results:</b> The patient tolerated the procedure well, and no major complications developed. After the intervention, transesophageal echocardiography indicated a significant reduction of the aortic valvular peak gradient from 103 mmHg to 22 mmHg, no aortic regurgitation was found. Eighteen months after the intervention, echocardiography revealed that the aortic valvular peak gradient had increased to 38 mmHg and that still no aortic regurgitation had occurred.</p><p><b>Conclusions:</b> In our limited experience, trans-ascending aorta balloon aortic valvuloplasty for severe aortic stenosis under transesophageal echocardiography guidance effectively reduces the aortic peak gradient. As this is a new procedure, long-term follow up and management will need to be established. It may be an alternative technique to treat congenital aortic stenosis in low-weight patients.</p>

scholarly journals Dill Extract Induces Elastic Fiber Neosynthesis and Functional Improvement in the Ascending Aorta of Aged Mice with Reversal of Age-Dependent Cardiac Hypertrophy and Involvement of Lysyl Oxidase-Like-1

Biomolecules ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 173 ◽  
Author(s):  
Wassim Fhayli ◽  
Quentin Boëté ◽  
Nadjib Kihal ◽  
Valérie Cenizo ◽  
Pascal Sommer ◽  
...  
Keyword(s):  
Cardiac Hypertrophy ◽  
Lysyl Oxidase ◽  
Elastic Fiber ◽  
Ascending Aorta ◽  
Functional Improvement ◽  
Elastic Fibers ◽  
Aged Mice ◽  
Age Related ◽  
And Function

Elastic fibers (90% elastin, 10% fibrillin-rich microfibrils) are synthesized only in early life and adolescence mainly by the vascular smooth muscle cells through the cross-linking of its soluble precursor, tropoelastin. Elastic fibers endow the large elastic arteries with resilience and elasticity. Normal vascular aging is associated with arterial remodeling and stiffening, especially due to the end of production and degradation of elastic fibers, leading to altered cardiovascular function. Several pharmacological treatments stimulate the production of elastin and elastic fibers. In particular, dill extract (DE) has been demonstrated to stimulate elastin production in vitro in dermal equivalent models and in skin fibroblasts to increase lysyl oxidase–like-1 (LOXL-1) gene expression, an enzyme contributing to tropoelastin crosslinking and elastin formation. Here, we have investigated the effects of a chronic treatment (three months) of aged male mice with DE (5% or 10% v/v, in drinking water) on the structure and function of the ascending aorta. DE treatment, especially at 10%, of aged mice protected pre-existing elastic lamellae, reactivated tropoelastin and LOXL-1 expressions, induced elastic fiber neo-synthesis, and decreased the stiffness of the aging aortic wall, probably explaining the reversal of the age-related cardiac hypertrophy also observed following the treatment. DE could thus be considered as an anti-aging product for the cardiovascular system.

Comparison of Diameter of Ascending Aorta in Patients With Severe Aortic Stenosis Secondary to Congenital Versus Degenerative Versus Rheumatic Etiologies

2005 ◽  
Vol 96 (11) ◽  
pp. 1549-1552 ◽  
Author(s):  
Itsik Ben-Dor ◽  
Alex Sagie ◽  
Daniel Weisenberg ◽  
Sagit Ben Zekry ◽  
Avigail Fraser ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Ascending Aorta

scholarly journals Severe Aortic Coarctation in a 75-Year-Old Woman: Total Simultaneous Repair of Aortic Coarctation and Severe Aortic Stenosis

2012 ◽  
Vol 42 (1) ◽  
pp. 62 ◽  
Author(s):  
Ju Hyun Park ◽  
Kook Jin Chun ◽  
Sung Gook Song ◽  
Jeong Su Kim ◽  
Yong Hyun Park ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Aortic Coarctation ◽  
Severe Aortic Stenosis

scholarly journals Transcatheter implantation of a new prototype of self-expanding aortic valve prosthesis: first experience

2016 ◽  
Vol 20 (4) ◽  
pp. 83 ◽  
Author(s):  
E. I. Kretov ◽  
K. V. Kozyr ◽  
A. R. Tarkova ◽  
D. S. Sergeevichev ◽  
A. A. Korobeynikov ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Conflict Of Interest ◽  
Aortic Valve Disease ◽  
Open Surgery ◽  
Valve Prosthesis ◽  
Aortic Valves ◽  
Calcific Aortic Stenosis ◽  
Aortic Valve Prosthesis ◽  
Transcatheter Implantation

<p>Calcific aortic stenosis is an aortic valve disease of atherosclerotic origin occurring in 2-4 % of persons older than 65 years, for whom open surgery is contraindicated. Models of self-expanding aortic valves available today have a number of significant drawbacks. The authors have developed a prototype of a new aortic valve and present its first successful implantation in the experiment.</p><p>Received 17 October 2016. Accepted 22 November 2016.</p><p><strong>Funding:</strong> The study had no sponsorship.<br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest.</p>

scholarly journals Impact of valve morphology, hypertension and age on aortic wall properties in patients with coarctation: a two-centre cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e034853
Author(s):  
Niky Ghorbani ◽  
Vivek Muthurangu ◽  
Abbas Khushnood ◽  
Leonid Goubergrits ◽  
Sarah Nordmeyer ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Aortic Coarctation ◽  
Cross Sectional Study ◽  
Ascending Aorta ◽  
Uncontrolled Hypertension ◽  
Specific Reference ◽  
Sectional Study ◽  
Cross Sectional ◽  
Descending Aorta

ObjectiveWe aimed to investigate the combined effects of arterial hypertension, bicuspid aortic valve disease (BAVD) and age on the distensibility of the ascending and descending aortas in patients with aortic coarctation.DesignCross-sectional study.SettingThe study was conducted at two university medical centres, located in Berlin and London.ParticipantsA total of 121 patients with aortic coarctation (ages 1–71 years) underwent cardiac MRI, echocardiography and blood pressure measurements.Outcome measuresCross-sectional diameters of the ascending and descending aortas were assessed to compute aortic area distensibility. Findings were compared with age-specific reference values. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology statement and reporting guidelines.ResultsImpaired distensibility (below fifth percentile) was seen in 37% of all patients with coarctation in the ascending aorta and in 43% in the descending aorta. BAVD (43%) and arterial hypertension (72%) were present across all ages. In patients >10 years distensibility impairment of the ascending aorta was predominantly associated with BAVD (OR 3.1, 95% CI 1.33 to 7.22, p=0.009). Distensibility impairment of the descending aorta was predominantly associated with arterial hypertension (OR 2.8, 95% CI 1.08 to 7.2, p=0.033) and was most pronounced in patients with uncontrolled hypertension despite antihypertensive treatment.ConclusionFrom early adolescence on, both arterial hypertension and BAVD have a major impact on aortic distensibility. Their specific effects differ in strength and localisation (descending vs ascending aorta). Moreover, adequate blood pressure control is associated with improved distensibility. These findings could contribute to the understanding of cardiovascular complications and the management of patients with aortic coarctation.

scholarly journals P190 Chest pain and syncope in Turner"s syndrome: going beyond the obvious to not miss the critical diagnosis. Role of multimodality imaging approach

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Ruocco ◽  
M Previtero ◽  
N Bettella ◽  
D Muraru ◽  
S Iliceto ◽  
...  
Keyword(s):  
Chest Pain ◽  
Pericardial Effusion ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Dissection ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Rule Out ◽  
Typical Chest Pain

Abstract Clinical Presentation: a 18-year-old woman with Turner’s syndrome (TS), with history of hypothyroidism treated with L-thyroxin, asymptomatic moderately stenotic bicuspid aortic valve (AV) and without any known cardiovascular risk factor, was admitted to our emergency department (ED) because of syncope and typical chest pain after dinner associated with dyspnea. Chest pain lasted for an hour with spontaneous regression. In the ED the patient (pt) was normotensive. An ECG showed sinus rhythm (88 bpm), nonspecific repolarization anomalies (T wave inversion) in the inferior and anterior leads. Myocardial necrosis biomarkers were negative. A 3D transthoracic echocardiography showed normal biventricular systolic function with left ventricular hypertrophy, dilatation of the ascending aorta, unicuspid AV with severe aortic stenosis (peak/mean gradient 110/61 mmHg, aortic valve area 0,88 cm2-0,62 cm2/m2), mild pericardial effusion (Figure Panel A, B, C). Five days after, the pt had a new episode of typical chest pain without ECG changes. A computerized tomography (CT) was performed to rule out the hypothesis of aortic dissection and showed a dilation of the ascending aorta and pericardial effusion localized in the diaphragmatic wall, no signs of dissection or aortic hematoma. However, CT was of suboptimal quality because of sinus tachycardia (120 bpm) and so the pt underwent a coronary angiography and aortography that ruled out coronary disease, confirmed the dilatation of ascending aorta (50 mm) and showed images of penetrating atherosclerotic ulcer of the ascending aorta (Figure panel D). The pt underwent urgent transesophageal echocardiography (TOE) that confirmed the severely stenotic unicuspid AV and showed a localized type A aortic dissection (Figure Panel E, F, G). The pt underwent urgent AV and ascending aorta replacement (Figure Panel H). Learning points Chest pain and syncope are challenging symptoms in pts presenting in ED. AV pathology and aortic dissection should be always suspected and ruled out. TS is associated with multiple congenital cardiovascular abnormalities and is the most common established cause of aortic dissection in young women. 30% of Turner’s pts have congenitally AV abnormalities, and dilation of the ascending aorta is frequently associated. However, unicuspid AV is a very rare anomaly, usually stenotic at birth and requiring replacement. The presence of pericardial effusion in a pt with chest pain and syncope should raise the suspicion of aortic dissection, even if those symptoms usually accompany severe aortic stenosis. Even if CT is the gold standard imaging technique to rule out aortic dissection, the accuracy of a test is critically related to the image quality. When the suspicion of dissection is high and the reliability of the reference test is low, it’s reasonable to perform a different test to rule out the pathology. Aortography and TOE were pivotal to identify the limited dissection of the ascending aorta. Abstract P190 Figure.

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