Aortic Aneurysm

2018 ◽  
Author(s):  
Christine E Lee ◽  
Leily Naraghi ◽  
Beatrice Hoffmann
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Intramural Hematoma ◽  
Aortic Disease ◽  
Magnetic Resonance Images ◽  
Aortic Aneurysms ◽  
High Morbidity ◽  
Aortic Diseases ◽  
Decision Algorithm ◽  
Type B Dissection

Aortic diseases are relatively rare but are associated with high morbidity and mortality. Emergency physicians (EPs) should consider aortic disease in all patients with pain in the torso, particularly those with other diverse or seemingly unconnected complaints. This review summarizes the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes for patients with abdominal aortic aneurysms (AAAs), thoracic aortic aneurysms (TAAs), and aortic dissection. Figures show a transverse image of an AAAs with a transmural hematoma, a three-dimensional computed tomographic angiogram (CTA) rendering of a thoracic aneurysm associated with a bicuspid aortic valve in the typical ascending aortic location, a chest x-ray film demonstrating prominent and blurred aortic knob due to TAA, acute aortic dissection subtypes, an electrocardiogram and transesophageal echocardiography of a patient with acute ascending aortic dissection, magnetic resonance images of a patient with dissection of the proximal descending aorta, CT representations of a type A dissection involving a dilated ascending aorta and a type B dissection involving the descending thoracic aorta, and a decision algorithm for evaluation and treatment of a suspected aortic dissection. Tables list normal aortic dimensions by CTA and echocardiography, average annual rate of expansion and rupture of AAA based on current diameter, and the etiology of TAA. This review contains 3 figures, 3 tables, 4 videos and 66 references. Key words: AAA, aorta, aortic dissection, ascending aortic dissection, descending aortic dissection, intimal tear, intramural hematoma, thoracic aortic aneurysm

Aortic Aneurysm

2018 ◽  
Author(s):  
Christine E Lee ◽  
Leily Naraghi ◽  
Beatrice Hoffmann
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Intramural Hematoma ◽  
Aortic Disease ◽  
Magnetic Resonance Images ◽  
Aortic Aneurysms ◽  
High Morbidity ◽  
Aortic Diseases ◽  
Decision Algorithm ◽  
Type B Dissection

Aortic diseases are relatively rare but are associated with high morbidity and mortality. Emergency physicians (EPs) should consider aortic disease in all patients with pain in the torso, particularly those with other diverse or seemingly unconnected complaints. This review summarizes the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes for patients with abdominal aortic aneurysms (AAAs), thoracic aortic aneurysms (TAAs), and aortic dissection. Figures show a transverse image of an AAAs with a transmural hematoma, a three-dimensional computed tomographic angiogram (CTA) rendering of a thoracic aneurysm associated with a bicuspid aortic valve in the typical ascending aortic location, a chest x-ray film demonstrating prominent and blurred aortic knob due to TAA, acute aortic dissection subtypes, an electrocardiogram and transesophageal echocardiography of a patient with acute ascending aortic dissection, magnetic resonance images of a patient with dissection of the proximal descending aorta, CT representations of a type A dissection involving a dilated ascending aorta and a type B dissection involving the descending thoracic aorta, and a decision algorithm for evaluation and treatment of a suspected aortic dissection. Tables list normal aortic dimensions by CTA and echocardiography, average annual rate of expansion and rupture of AAA based on current diameter, and the etiology of TAA. Key words: AAA, aorta, aortic dissection, ascending aortic dissection, descending aortic dissection, intimal tear, intramural hematoma, thoracic aortic aneurysm

scholarly journals Tryptophan Catabolism and Inflammation: A Novel Therapeutic Target For Aortic Diseases

2021 ◽  
Vol 12 ◽  
Author(s):  
Tharmarajan Ramprasath ◽  
Young-Min Han ◽  
Donghong Zhang ◽  
Chang-Jiang Yu ◽  
Ming-Hui Zou
Keyword(s):  
Mammalian Cells ◽  
Inflammatory Process ◽  
Cell Types ◽  
Aortic Disease ◽  
Kynurenine Pathway ◽  
Aortic Aneurysms ◽  
Health Concern ◽  
High Morbidity ◽  
Aortic Diseases ◽  
And Migration

Aortic diseases are the primary public health concern. As asymptomatic diseases, abdominal aortic aneurysm (AAA) and atherosclerosis are associated with high morbidity and mortality. The inflammatory process constitutes an essential part of a pathogenic cascade of aortic diseases, including atherosclerosis and aortic aneurysms. Inflammation on various vascular beds, including endothelium, smooth muscle cell proliferation and migration, and inflammatory cell infiltration (monocytes, macrophages, neutrophils, etc.), play critical roles in the initiation and progression of aortic diseases. The tryptophan (Trp) metabolism or kynurenine pathway (KP) is the primary way of degrading Trp in most mammalian cells, disturbed by cytokines under various stress. KP generates several bioactive catabolites, such as kynurenine (Kyn), kynurenic acid (KA), 3-hydroxykynurenine (3-HK), etc. Depends on the cell types, these metabolites can elicit both hyper- and anti-inflammatory effects. Accumulating evidence obtained from various animal disease models indicates that KP contributes to the inflammatory process during the development of vascular disease, notably atherosclerosis and aneurysm development. This review outlines current insights into how perturbed Trp metabolism instigates aortic inflammation and aortic disease phenotypes. We also briefly highlight how targeting Trp metabolic pathways should be considered for treating aortic diseases.

scholarly journals Association of osteoprotegerin with ascending aortic dissection

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Goliopoulou ◽  
A Antonopoulos ◽  
E Oikonomou ◽  
A Miliou ◽  
P Theofilis ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Survival Rates ◽  
Aortic Disease ◽  
Aortic Aneurysms ◽  
Control Group ◽  
Aortic Dilatation ◽  
Serum Samples ◽  
Significant Difference ◽  
Aortic Aneurysm And Dissection

Abstract Background Thoracic aortic dissections are among the cardiovascular diseases with the highest mortality rates. Their often belated diagnosis and, hence, poor prognosis call for further research of their pathophysiology and possible biomarkers that will aid early diagnosis and increase survival rates. Osteoprotegerin is a known biomarker in cardiovascular disease, but it is yet to be determined whether it participates in aortic disease and thoracic aortic dissection in particular. Purpose This clinical study aimed at researching the role of osteoprotegerin in thoracic aortic aneurysm and dissection. Methods We compared three groups of patients; 20 patients with ascending aortic aneurysm (AAA), 10 patients with acute ascending aortic dissection (AAD) and 16 patients with normal aortic diameter undergoing cardiac surgery for other indication (control group). Serum samples were obtained from patients before surgery and osteoprotegerin levels were measured using the ELISA method. Results One-way analysis of variance revealed a significant association between the examined groups of patients and levels of osteoprotegerin (AAD: 62.72±44.53 pmol/L, AAA: 33.43±8.08 pmol/L, Control: 48.61±29.47 pmol/L, p=0.03). Importantly, after post-hoc analysis osteoprotegerin levels were found to be increased in patients with AAD compared to patients with uncomplicated AAA (62.72±44.53 pmol/L vs 33.43±8.08 pmol/L, p=0.03) (Figure 1), whereas there was no statistically significant difference between patients with AAA and the control group (33.43±8.08 pmol/L vs 48.61±29.47 pmol/L, p=0.34). Conclusions These findings suggest that osteoprotegerin may participate in the pathophysiology of aortic dissection but not in mechanisms of aortic dilatation. Therefore, detection of elevated osteoprotegerin levels in patients with diagnosed ascending aortic aneurysms might suggest an increased probability of dissection and, therefore, aid the decision-making process. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Preventive Effects of Quercetin against the Onset of Atherosclerosis-Related Acute Aortic Syndromes in Mice

2020 ◽  
Vol 21 (19) ◽  
pp. 7226
Author(s):  
Masateru Kondo ◽  
Yuki Izawa-Ishizawa ◽  
Mitsuhiro Goda ◽  
Mayuko Hosooka ◽  
Yuu Kagimoto ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Oxidase Inhibitor ◽  
Aortic Aneurysms ◽  
Protective Effects ◽  
Ang Ii ◽  
Aortic Diseases ◽  
Nitric Oxide Synthase Inhibitor ◽  
Elastin Degradation ◽  
Acute Aortic Syndromes

Atherosclerosis-related acute aortic syndromes, such as aortic aneurysms or aortic dissection are life-threatening diseases. Since they develop suddenly and progress rapidly, the establishment of preventive strategies is urgently needed. Quercetin, a flavonoid abundant in various vegetables and fruits, is suggested to reduce the risk of cardiovascular disease. Therefore, in this study, the preventive effect of quercetin was evaluated using a mouse model of aortic aneurysm and dissection. The model was established by administering angiotensin II (Ang II) and β-aminopropionitrile (BAPN), a lysyl oxidase inhibitor, to mice to induce hypertension and degeneration of the elastic lamina, which would eventually result in the onset of an aortic aneurysm. Ang II, BAPN, and a nitric oxide synthase inhibitor was administered to induce aortic dissection via endothelial dysfunction. Quercetin (60 mg/kg/day) was administered 2 weeks before inducing aortic diseases by the end of the experiments (8 weeks in the aneurysm model, 6 weeks in the dissection model). It was found to reduce the incidence of aneurysm (from 72 to 45%), dissection (from 17 to 10%), and rupture (from 33 to 15%) in mice. Elastin degradation was ameliorated in the quercetin-treated mice compared to that in the mice without quercetin treatment (degradation score 2.9 ± 0.3 vs 2.2 ± 0.2). Furthermore, quercetin suppressed the expression of vascular cell adhesion molecule-1, macrophage infiltration, and pro-matrix metalloproteinase-9 activity. Our results suggest that quercetin might prevent the onset of atherosclerosis-related acute aortic syndromes through its anti-inflammatory and endothelial cell-protective effects.

scholarly journals Classification of Dissecting Aortic Aneurysm as a Guide for Surgical Management

2020 ◽  
pp. 61-68
Author(s):  
L. Kulyk ◽  
D. Beshley ◽  
I. Protsyk ◽  
S. Lishchenko ◽  
V. Pezentiy ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Surgical Management ◽  
Limb Ischemia ◽  
Type A ◽  
Aortic Aneurysms ◽  
Common Denominator ◽  
Acute Type ◽  
Type B Dissection

Mortality in acute dissecting type A aortic aneurysm remains high. The existing classifications are intended to give an accurate, and, very importantly (given the acute course of the pathology), a prompt answer to the clinician’s and the cardiac surgeon’s questions: how the patients should be treated, and which of them should undergo surgical intervention, and which procedure is to be used. Aim. A review and analysis of the existing classifications of dissecting aortic aneurysms and their transformation taking into account the advances in diagnostic technologies and methods of surgical management. The first classification was proposed by DeBakey; it systematized morphological variants of the disease and explained the origin of its accompanying phenomena such as heart tamponade, acute aortic valve insufficiency, and visceral and limb ischemia, but provided no guidelines on treatment techniques. A more recent Stanford classification was based on the principle of differentiation into conservative or operative approach. Owing to the use of CT and MRI angiography, new dissection subtypes were discovered and formulated in the Svensson classification. The Penn classification recommends that the choice of management can be based on the extent of aortic dissection, the site of the primary intimal tear, and the presence of malperfusion. The latest TEM classification identifies type A and type B dissection, as well as additional non-A-non-B type, in which the descending aorta and the arch, but not the ascending aorta, are involved. The most appropriate surgical procedures for the retrograde type A aortic dissection treatment are discussed as well. Conclusions. 1. The purpose of clinical classification of acute aortic dissection is, in addition to systematizing concepts and categories, facilitating the selection of an optimal state-of-the-art treatment method. 2. Introducing such classifications as Penn or TEM will bring to a common denominator the results of surgical management of acute type A dissection by unifying the characteristics of the patients and eliminating their deliberate or accidental pre-selection, which possibly accounts for the difference in mortality rates among different surgical groups.

scholarly journals Cardiomyopathy in Genetic Aortic Diseases

2021 ◽  
Vol 9 ◽  
Author(s):  
Laura Muiño-Mosquera ◽  
Julie De Backer
Keyword(s):  
Marfan Syndrome ◽  
Myocardial Dysfunction ◽  
Genetic Defect ◽  
Positive Family History ◽  
Aortic Disease ◽  
Aortic Aneurysms ◽  
Aortic Diseases ◽  
Pathogenic Variants ◽  
Fibrillin 1

Genetic aortic diseases are a group of illnesses characterized by aortic aneurysms or dissection in the presence of an underlying genetic defect. They are part of the broader spectrum of heritable thoracic aortic disease, which also includes those cases of aortic aneurysm or dissection with a positive family history but in whom no genetic cause is identified. Aortic disease in these conditions is a major cause of mortality, justifying clinical and scientific emphasis on the aorta. Aortic valve disease and atrioventricular valve abnormalities are known as important additional manifestations that require careful follow-up and management. The archetype of genetic aortic disease is Marfan syndrome, caused by pathogenic variants in the Fibrillin-1 gene. Given the presence of fibrillin-1 microfibers in the myocardium, myocardial dysfunction and associated arrhythmia are conceivable and have been shown to contribute to morbidity and mortality in patients with Marfan syndrome. In this review, we will discuss data on myocardial disease from human studies as well as insights obtained from the study of mouse models of Marfan syndrome. We will elaborate on the various phenotypic presentations in childhood and in adults and on the topic of arrhythmia. We will also briefly discuss the limited data available on other genetic forms of aortic disease.

Aortic diseases

ESC CardioMed ◽  
2018 ◽  
pp. 2861-2863
Author(s):  
Bernard Iung
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Marfan Syndrome ◽  
Bicuspid Aortic Valve ◽  
Young Women ◽  
Beta Blockers ◽  
Aortic Aneurysms ◽  
Maximum Diameter ◽  
Aortic Diseases

Aortic diseases encountered in young women are mainly associated with syndromic diseases, which are often heritable, or bicuspid aortic valve. The most frequent syndromic disease is Marfan syndrome. In Marfan syndrome, the risk of aortic dissection is low during pregnancy when the maximum diameter of the ascending aorta is less than 45 mm. Dissection may affect the thoracic ascending or descending aorta. The risk of aortic dissection is low in bicuspid aortic valve when the aortic diameter is less than 50 mm. Beta blockers are recommended throughout pregnancy in Marfan syndrome and are often used in other causes of aortic aneurysms. Close echocardiographic follow-up is needed during pregnancy and after delivery.

Aortic diseases

ESC CardioMed ◽  
2018 ◽  
pp. 2861-2863
Author(s):  
Bernard Iung
Keyword(s):  
Aortic Valve ◽  
Aortic Dissection ◽  
Marfan Syndrome ◽  
Bicuspid Aortic Valve ◽  
Young Women ◽  
Beta Blockers ◽  
Aortic Aneurysms ◽  
Maximum Diameter ◽  
Aortic Diseases

Aortic diseases encountered in young women are mainly associated with syndromic diseases, which are often heritable, or bicuspid aortic valve. The most frequent syndromic disease is Marfan syndrome. In Marfan syndrome, the risk of aortic dissection is low during pregnancy when the maximum diameter of the ascending aorta is less than 45 mm. Dissection may affect the thoracic ascending or descending aorta. The risk of aortic dissection is low in bicuspid aortic valve when the aortic diameter is less than 50 mm. Beta blockers are recommended throughout pregnancy in Marfan syndrome and are often used in other causes of aortic aneurysms. Close echocardiographic follow-up is needed during pregnancy and after delivery.

Clinical outcomes in hybrid repair procedures for pathologies involving the aortic arch

Vascular ◽  
2014 ◽  
Vol 23 (1) ◽  
pp. 9-16 ◽  
Author(s):  
Sebastian Zerwes ◽  
Giesbert Leissner ◽  
Yvonne Gosslau ◽  
Rudolf Jakob ◽  
Hans-Kees Bruijnen ◽  
...  
Keyword(s):  
Success Rate ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Aortic Disease ◽  
Aortic Aneurysms ◽  
Type I ◽  
Technical Success ◽  
Aortic Diseases ◽  
Promising Alternative ◽  
Technical Success Rate

Objective Fifty patients with complex aortic disease, who received hybrid treatment of the aortic arch with supra-aortic debranching and endovascular stent-graft repair, were evaluated in regard to events of primary (survival and technical success) and secondary (procedure-related complications) interest. Methods The single-center study was conducted over an eight-year period from December 2004 to December 2012. Treated medical conditions included 23 aortic aneurysms (46%), 21 aortic dissections (42%), and six penetrating aortic ulcers (12%). Procedures were divided into groups of elective, urgent, and emergent. Results Twenty-eight (56%) patients were operated electively, 15 (30%) urgently, and seven (14%) emergently. Sternotomy, cardiopulmonary bypass, and deep hypothermic circulatory arrest were required in 12 (24%) patients. The primary technical success rate was 86% and raised to 92% ( n = 46) of secondary technical success rate after therapy of three type I endoleaks. The 30-day mortality added up to 16.0%, and the mean time of survival was 49.3 months. In a total of eight (16%) patients, an endoleak occurred (five endoleaks type I, three endoleaks type II), while nine (18%) of patients suffered a perioperative stroke. Conclusions In severely ill patients with complex aortic diseases, hybrid therapy may offer a promising alternative to conventional open repair.

scholarly journals Inhibition of HIPK2 Alleviates Thoracic Aortic Disease in Mice With Progressively Severe Marfan Syndrome

2021 ◽  
Author(s):  
Cristina I. Caescu ◽  
Jens Hansen ◽  
Brittany Crockett ◽  
Wenzhen Xiao ◽  
Pauline Arnaud ◽  
...  
Keyword(s):  
Protein Kinase ◽  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Marfan Syndrome ◽  
Thoracic Aortic Aneurysm ◽  
Acute Aortic Dissection ◽  
Transforming Growth Factor ◽  
Transforming Growth Factor Β ◽  
Aortic Disease ◽  
Computational Analyses

Objective: Despite considerable research, the goal of finding nonsurgical remedies against thoracic aortic aneurysm and acute aortic dissection remains elusive. We sought to identify a novel aortic protein kinase that can be pharmacologically targeted to mitigate aneurysmal disease in a well-established mouse model of early-onset progressively severe Marfan syndrome (MFS). Approach and Results: Computational analyses of transcriptomic data derived from the ascending aorta of MFS mice predicted a probable association between thoracic aortic aneurysm and acute aortic dissection development and the multifunctional, stress-activated HIPK2 (homeodomain-interacting protein kinase 2). Consistent with this prediction, Hipk2 gene inactivation significantly extended the survival of MFS mice by slowing aneurysm growth and delaying transmural rupture. HIPK2 also ranked among the top predicted protein kinases in computational analyses of genes differentially expressed in the dilated aorta of 3 MFS patients, which strengthened the clinical relevance of the experimental finding. Additional in silico analyses of the human and mouse data sets identified the TGF (transforming growth factor)-β/Smad3 signaling pathway as a potential target of HIPK2 in the MFS aorta. Chronic treatment of MFS mice with an allosteric inhibitor of HIPK2-mediated stimulation of Smad3 signaling validated this prediction by mitigating thoracic aortic aneurysm and acute aortic dissection pathology and partially improving aortic material stiffness. Conclusions: HIPK2 is a previously unrecognized determinant of aneurysmal disease and an attractive new target for antithoracic aortic aneurysm and acute aortic dissection multidrug therapy.

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