scholarly journals A novel method of treament of ascending aortic aneurysm

2020 ◽  
pp. 29-33
Author(s):  
V.B. Demyanchuk ◽  
◽  
V.V. Pogrebnyak ◽  
O.I. Kvasha ◽  
B.M. Todurov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Aortic Aneurysm ◽  
Left Ventricular ◽  
Vascular Prosthesis ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Surgical Trauma ◽  
Long Term Treatment ◽  
Duration Of Surgery ◽  
Prosthesis Fixation

The need for surgical treatment of ascending aortic aneurysms is due to a number of severe complications that occur during the natural course of the disease, such as aortic dissection and rupture. Such interventions show good immediate and long-term treatment outcomes, but they are often accompanied by high blood loss and surgical trauma, which in elderly patients with concomitant pathology can lead to serious cardiac and extracardiac complications and prolongation of treatment in general. We present a technology of external wrapping of the aorta that reduces surgical trauma while maintaining effect of operation. A clinical case of application of this technology in a 63-year-old patient hospitalized to the clinic of the Heart Institute, Ministry of Health of Ukraine, with a diagnosis of aortic insufficiency of the 3rd degree (tricuspid aortic valve), dilatation of the root and ascending aorta, tricuspid insufficiency of the 2nd degree, high pulmonary hypertension, heart failure with reduced left ventricular systolic function. The use of the proposed method has following advantages compared to the established method of fixation of the vascular prosthesis: fixation of the proximal part of the vascular prosthesis is performed using vascular suture material; elimination of the risk of damage to the aortic wall; elimination of the risk of massive bleeding from the aorta at the site of the prosthesis fixation; decreased duration of surgery. Key words: aortic aneurysm, surgical treatment, wrapping of the ascending aorta.

scholarly journals The Role of Bicuspid Aortic Valve in Aortic Aneurysm Occurrence and Development

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Vitaliy Kravchenko ◽  
Ivan Kravchenko ◽  
Olha Pantas ◽  
Valentyna Zakharova
Keyword(s):  
Surgical Treatment ◽  
Aortic Valve ◽  
Aortic Aneurysm ◽  
Aortic Arch ◽  
Histological Examination ◽  
Bicuspid Aortic Valve ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Ascending Aortic Aneurysm

The paper presents the data on the diagnosis of bicuspid aortic valve (BAV) disease in the patients operated for ascending aortic (AA) aneurysm. A brief historical review of the study of the BAV problem is presented; the data on the BAV incidence in the development of ascending aortic aneurysm and its dissection, the results of surgical treatment of BAV disease in patients with AA aneurysm are displayed. The objective of the research was to study the role of the bicuspid aortic valve in the occurrence (dissection) of ascending aortic aneurysms. Materials and methods The retrospective analysis of the patients operated at the institute during the period of 1.01.2013 to 1.01.2019 for ascending aortic aneurysm or aneurysms of both ascending aorta and aortic arch confirmed that aneurysm occurrence (dissection) was caused by the presence of bicuspid valve. During this time, 1120 patients were operated on for ascending aortic aneurysm or aneurysms of both ascending aorta and aortic arch. 340 (30.4%) patients with diagnosed and confirmed BAV disease were included in the analysis. BAV diagnosis was based on echocardiography with obligatory intraoperative confirmation and on the basis of histological examination. Histological examination of the fragments of the aortic wall and aortic valve taken during operations was performed in 68 (20.0%) patients. Results and discussion BAV is the most common of all cardiac failures with a prevalence of up to 2% in the population constituting up to 30-50% of cases among the patients with aortal disorders. Two-dimensional echocardiography gives better results and provides an opportunity to detect BAV in 95% of cases, which was confirmed by our studies. According to our research, cases with BAV included 30.4% of all possible aneurysm causes, and BAV as a cause of dissection was noted in 46 (13.5%) of all dissecting aneurysms. Regarding the results of the surgical treatment, 2 patients out of 340 operated at the hospital stage died constituting 0.6%. Conclusions Among all ascending aortic aneurysms or aneurysms of both ascending aorta and aortic arch, BAV was determined as their cause in 30.4% of cases. Dissection (rupture) of the aortic aneurysm occurred in 13.5% of patients with aneurysm and bicuspid valve and thus required an urgent surgery.  Patients with BAV require lifelong care.

scholarly journals A case of successful surgical treatment of a ruptured giant aneurysm of the infrarenal aorta in an elderly patient

2021 ◽  
pp. 157-163
Author(s):  
A. E. Zotikov ◽  
M. R. Khokonov ◽  
K. Kh. Eminov ◽  
A. M. Solovieva ◽  
A. V. Kozhanova ◽  
...  
Keyword(s):  
Elderly Patient ◽  
Abdominal Aortic Aneurysm ◽  
Surgical Treatment ◽  
Aortic Aneurysm ◽  
Giant Aneurysm ◽  
Aneurysm Rupture ◽  
Aortic Aneurysms ◽  
Infrarenal Aorta ◽  
Giant Aneurysms ◽  
Abdominal Aortic

Today, abdominal aortic aneurysm surgery is a fairly well-studied area of medicine. Nevertheless, some questions remain rather debatable. No clear criteria for giant aneurysms have been developed so far. The available foreign and domestic literature reports about 40 cases of surgical treatment of giant abdominal aortic aneurysms, 16 of which are cases of aneurysm rupture. Open surgery remains the method of choice in the treatment of giant aneurysms due to the pronounced technical difficulties of endovascular intervention. The authors present a case of successful surgical treatment of a giant aneurysm rupture in an elderly patient. The peculiarity of this patient's condition is the occurrence of aneurysm rupture after hospital admission. The patient refused surgical treatment for two years after aneurysm detection. On examination after admission, multispiral computed tomography revealed an aneurysm size of 101 mm. On the eve of surgery, pain syndrome in the left abdomen and tachycardia appeared. Aneurysm rupture was suspected and the patient was urgently admitted to the operating room. The surgery was performed under the conditions of machine reinfusion of autoblood. The patient underwent abdominal aortic aneurysm resection with linear prosthesis and retroperitoneal hematoma removal. The postoperative period had no peculiarities. On the 10th day after the operation the patient was discharged in satisfactory condition to the outpatient treatment. This clinical case demonstrates the possibility of successful surgical treatment of giant aneurysm rupture in elderly patients.

scholarly journals An evaluation of the long-term patency of the aortocoronary bypass graft anastomosed to a vascular prosthesis

2020 ◽  
Vol 58 (4) ◽  
pp. 832-838
Author(s):  
Ai Kawamura ◽  
Daisuke Yoshioka ◽  
Koichi Toda ◽  
Ryoto Sakaniwa ◽  
Shigeru Miyagawa ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Aneurysm ◽  
Thoracic Aortic Aneurysm ◽  
Vascular Prosthesis ◽  
Ascending Aorta ◽  
Graft Occlusion ◽  
Proximal Anastomosis ◽  
Left Circumflex Artery ◽  
Anastomosis Site

Abstract OBJECTIVES Although concomitant surgery for coronary artery disease (CAD) and thoracic aortic aneurysm is performed often, the long-term patency of the coronary artery bypass grafting (CABG) anastomosed to a vascular prosthesis has not been fully investigated. Here, we explored the long-term patency of the graft in comparison with the proximal anastomosis site on the native ascending aorta or vascular prosthesis. METHODS A total of 84 patients with concomitant CABG who underwent surgery for thoracic aortic aneurysm at 3 Osaka Cardiovascular Research Group institutes were retrospectively investigated for this study. The patency of 109 aortocoronary bypasses using saphenous vein grafts was evaluated with computed tomography angiography or coronary angiography, comparing the grafts anastomosed on the vascular prosthesis (group P, n = 75) to those anastomosed on the native ascending aorta (group N, n = 34). RESULTS During 45.9 ± 39.7 months follow-up, significantly worse patency of the grafts in group P was revealed when compared with those in group N (100% vs 77.6% in 12 months, 100% vs 52.7% in 36 months and 100% vs 31.6% in 57 months, log rank P < 0.001). The poor patency of the grafts was confirmed in each target lesions (left anterior descending artery: P = 0.050, right coronary artery: P = 0.045, left circumflex artery: P = 0.051) and regardless of the severities of the target coronary vessels (severe stenosis: P = 0.013, mild-to-moderate stenosis: P = 0.029). Furthermore, an analysis of graft occlusion risk factors using the univariate Cox proportional hazards model revealed that the proximal anastomosis site on the vascular prosthesis was the sole risk factor for graft occlusion (P < 0.001). CONCLUSIONS In the simultaneous surgery for CAD and thoracic aortic aneurysm, CABG design from vascular prosthesis to coronary artery should be avoided if possible, although further studies are warranted.

scholarly journals FORECAST OF THE OUTCOME OF SURGICAL TREATMENT OF PATIENTS WITH AORTIC ANEURISM TO CHANGE THE CONCENTRATION OF VESSEL ENDOTHELIUM GROWTH FACTOR (VEGF) AND CONTENT OF IMMUNOLOGICAL MARKERS

2020 ◽  
pp. 127-133
Author(s):  
E. M. Klimova ◽  
O. V. Buchneva ◽  
O. S. Merezhko ◽  
J. V. Kalashnikova
Keyword(s):  
Surgical Treatment ◽  
Growth Factor ◽  
Aortic Aneurysm ◽  
Reference Group ◽  
Prognostic Significance ◽  
Reference Value ◽  
Fold Increase ◽  
Aortic Aneurysms ◽  
Vascular Pathology ◽  
Complement Factor

Summary. Despite all the successes of surgical treatment of patients with aortic aneurysm, there are a number of questions, the search for answers to which remains relevant now. It is important to have prognostic markers for assessing postoperative complications. The aim. To determine the diagnostic and prognostic significance of indicators characterizing immunoresistance, the degree of adaptive reactions and the regenerative ability of immunophysiological factors affecting the outcome of the disease. Materials and methods. The study examined 23 patients with vascular pathology (13 patients with aortic aneurysm (chest and abdominal) and 10 patients with coronary heart disease (CHD)). Results and discussion. The determination of significant biomarkers in patients with aortic aneurysms revealed violations of the barrier function of neutrophil phagocytosis. An increase in the oxidative activity of SP, % in the spontaneous NBT-test to (20,2 ± 2,2)% at a reference value of (10 ± 1,1)% and a 1,2-fold increase in the number of cells that absorbed the dye after stimulation with zymosan (ST). In all examined patients with aortic aneurysm, CD2+ and CD3+ stimulation was observed. The decrease in CD4+ and CD8+ in 1,7 and 1,6 times, respectively, in all terms of the survey. A significant increase in cytotoxic factors opsonized by the C3 complement factor by 1,5 times was revealed. In the preoperative period revealed a multiple increase in the concentration of IL-6 (in 60 times) and IL-10 (in 50 times) in all patients with aortic aneurysm. In 3 patients with negative dynamics of the course of the disease (exitus), an extremely low level of VEGF concentration was detected. In all patients with stratified aortic aneurysms, preoperatively reduced AChE activity was observed, an increase in creatinekinase activity to 410 U/l at a reference value of (85 ± 54) U/l, and a decrease in ceruloplasmin content to 214.4 mg/l compared to the reference group (315.0 ± 45.2) mg/l. Conclusion. As significant biomarkers characterizing the severity of the condition of patients with aortic aneurysm, the level of vascular endothelial growth factor (VEGF), cytokines, as well as changes in the activity of the enzyme acetylcholinesterase (AChE) can be used.

scholarly journals Giant Aortic Syphilitic Aneurysm of The Ascending Aorta with Erosion in the Chest Wall: Case Report

2019 ◽  
Vol 22 (5) ◽  
pp. E401-E404
Author(s):  
Ovidiu Stiru ◽  
Roxana Carmen Geana ◽  
Liana Valeanu ◽  
Diana Sorostinean ◽  
Mihai Goicea ◽  
...  
Keyword(s):  
Case Report ◽  
Aortic Aneurysm ◽  
Unusual Case ◽  
Cardiovascular Complications ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Ascending Aortic Aneurysm ◽  
Tertiary Syphilis ◽  
Surgical Aspects ◽  
Syphilitic Aortitis

Since the discovery of penicillin, the incidence of tertiary syphilis dramatically has decreased. However, cases of cardiovascular complications of syphilis still are present. Ascending aortic aneurysms are some of the most devastating complications. Nonetheless, syphilitic aortitis (SA) can appear and should be suspected in patients with syphilis and aortic aneurysm. We report a case of a 57-year-old patient with a large ascending aortic aneurysm with cartilage and rib erosion. The purpose of this article is to discuss the particular surgical aspects of this unusual case.

scholarly journals Extrinsic tricuspid valve compression due to an aortic aneurysm causing significant right to left shunt via a patent foramen ovale: a case report

2020 ◽  
Author(s):  
Rizwan Ahmed
Keyword(s):  
Aortic Aneurysm ◽  
Tricuspid Valve ◽  
Patent Foramen Ovale ◽  
Ambient Air ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Foramen Ovale ◽  
Aorta Aneurysm ◽  
Ct Angiogram ◽  
Adjacent Structures

Abstract Background Aortic aneurysms are known to cause compression of adjacent structures including the tracheobronchial tree, oesophagus, and recurrent laryngeal nerve. Extremely rarely, they can lead to compression of the tricuspid valve (TV) annulus. We describe a case where aortic aneurysm caused TV annulus compression and persistent right-to-left shunt through a patent foramen ovale (PFO). Case summary A 75-year-old female was admitted with headache and dizziness. On examination, she had persistent arterial desaturation with oxygen levels reduced to 69% at rest whilst breathing ambient air. Complete blood count demonstrated polycythaemia (Hb 174 g/L). Right to left cardiac shunt was suspected after significant lung and haematologic pathology was excluded. Transoesophageal echocardiography demonstrated a trileaflet aortic valve with an ascending aorta aneurysm and a stretched PFO with persistent right to left shunt across it. The ascending aortic aneurysm was observed coursing superior to and compressing the TV annulus. Invasive haemodynamic data demonstrated prominent ‘a’ waves in the right atrium, low RV (12/1 mmHg), and pulmonary artery pressures (14/6 mmHg), reduced cardiac output and significant right to left shunt with Qp:Qs 0.6. Computed tomography (CT) angiogram demonstrated a 5 cm fusiform ascending aorta aneurysm that coursed anteriorly causing TV annulus compression. Discussion Tricuspid valve inflow obstruction associated with a right to left shunt across PFO can be an extremely rare complication of aortic aneurysm. This may result in persistent arterial hypoxaemia and secondary polycythaemia.

scholarly journals DIAGNOSTICS AND SURGICAL TREATMENT OF THE AORTA DISSECTING ANEURISM TYPE A, RESULTS OF SURGERY

2021 ◽  
Vol 20 (2) ◽  
Author(s):  
V.I. Kravchenko ◽  
І.М. Kravchenko ◽  
О.А. Tretiak
Keyword(s):  
Cardiac Surgery ◽  
Surgical Treatment ◽  
Aortic Aneurysm ◽  
Hospital Mortality ◽  
Type A ◽  
Acute Stage ◽  
Aortic Aneurysms ◽  
Surgical Experience ◽  
Total Hospital ◽  
Results Of Surgery

The purpose – to evaluate the results of the surgical treatment experience of the aortadissecting aneurysms of type A.Material and methods. Surgical treatment of stratified aortic aneurysms of type Aremains one of the most difficult problems in cardiac surgery. The article presentsall experience (947 stratifying aneurysms of type A) of surgical treatment of suchaneurysms by one team. Factors that could have caused the formation of an aorticaneurysm (aortic dissection) have been identified.Results. The total hospital mortality during surgical treatment of a stratified aorticaneurysm type A was 9.7%, in addition to that – 10.1% in the acute stage and 8.4% inthe chronic stage.Conclusions. Accumulation of surgical experience, improvement of methods ofprotection of heart, brain during surgical treatment of a stratifying aortic aneurysm oftype A made it possible to achieve 4.8% of hospital mortality.

scholarly journals Using Machine Learning to Elucidate the Spatial and Genetic Complexity of the Ascending Aorta

2021 ◽  
Author(s):  
Mahan Nekoui ◽  
James Pirruccello ◽  
Paolo Di Achille ◽  
Seung Hoan Choi ◽  
Samuel Friedman ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Aortic Aneurysm ◽  
Aortic Stenosis ◽  
Aortic Root ◽  
Thoracic Aortic Aneurysm ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Aortic Diameter ◽  
Uk Biobank ◽  
Polygenic Score

Background The left ventricular outflow tract (LVOT) and ascending aorta are spatially complex, with distinct pathologies and embryologic origins. Prior work examined genetics of thoracic aortic diameter in a single plane. We sought to elucidate the genetic basis for the diameter of the LVOT, the aortic root, and the ascending aorta. Methods We used deep learning to analyze 2.3 million cardiac magnetic resonance images from 43,317 UK Biobank participants. We computed the diameters of the LVOT, the aortic root, and at six locations in the ascending aorta. For each diameter, we conducted a genome-wide association study and generated a polygenic score. Finally, we investigated associations between these polygenic scores and disease incidence. Results 79 loci were significantly associated with at least one diameter. Of these, 35 were novel, and a majority were associated with one or two diameters. A polygenic score of aortic diameter approximately 13mm from the sinotubular junction most strongly predicted thoracic aortic aneurysm in UK Biobank participants (n=427,016; HR=1.42 per standard deviation; CI=1.34-1.50, P=6.67x10-21). A polygenic score predicting a smaller aortic root was predictive of aortic stenosis (n=426,502; HR=1.08 per standard deviation; CI=1.03-1.12, P=5x10-6). Conclusions We detected distinct common genetic loci underpinning the diameters of the LVOT, the aortic root, and at several segments in the ascending aorta. We spatially defined a region of aorta whose genetics may be most relevant to predicting thoracic aortic aneurysm. We further described a genetic signature that may predispose to aortic stenosis. Understanding the genetic contributions to the diameter of the proximal aorta may enable identification of individuals at risk for life-threatening aortic disease and facilitate prioritization of therapeutic targets.

scholarly journals Investigation of the correlation between cardiac parameters and aortic diameter in patients with ascending aortic aneurysm

2022 ◽  
Vol 74 (1) ◽  
Author(s):  
Mustafa Etli ◽  
Seda Avnioglu ◽  
Halil Yilmaz ◽  
Oguz Karahan
Keyword(s):  
Female Gender ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Aortic Aneurysms ◽  
Aortic Diameter ◽  
Ct Scans ◽  
Left Ventricular Ejection ◽  
Cardiac Volume ◽  
Ventricular Ejection Fraction ◽  
Ascending Aortic Diameter

Abstract Background Aortic aneurysms (AA) are enlargement of the aorta silently until diagnosing, not detectable on physical examination, and usually incidentally discovered during radiologic scanning for other reasons. It can get bigger sizes and can result in life-threatening outcomes if not detected early on. In this study, we aimed to determine the relationship between ascending aortic diameter and cardiac parameters that can be detected with tomography or/and echocardiography. Newly diagnosed (n: 85) ascending AA patients and healthy individuals (n: 86) who have not any thoracic pathology in computed tomography (CT) scans included to the study. Echocardiographically determined left atrial dimension (LAD), left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVDs), left ventricular ejection fraction (LVEF) and the left ventricular posterior wall thickness (LVPWd) values of each patient were recorded. The thorax diameters, ascending aorta diameters and cardiac volume values recorded from CT scans. The obtained findings were statistically compared. Results Positive correlation was found between aortic diameter and aging (p: 0.000). Increased thorax diameter and cardiac volume values were detected in ascending AA cases (p < 0.05). It was found to be ascending aortic diameter was positively correlated with thorax diameter and cardiac volume (0.50 < r ≤ 0.70) values and higher aortic diameter, cardiac volume, thorax diameter values were detected in male individuals when compared with the female gender. There was no significant correlation between LVEF, LVDd, and LVDs values and aortic diameter. Conclusions Cardiac volume and thorax diameter were found as strongly correlated with the diameter of the ascending aorta. The clarifying of these parameters with larger cohorts might be beneficial for the estimation of the progression of ascending AA.

Sign in / Sign up

Export Citation Format

Share Document