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

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.

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

Atherothrombosis Journal ◽

10.21518/2307-1109-2021-11-1-157-163 ◽

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.

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A novel method of treament of ascending aortic aneurysm

Cardiac Surgery and Interventional Cardiology ◽

10.31928/2305-3127-2020.4.2933 ◽

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.

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

Clinical & experimental pathology ◽

10.24061/1727-4338.xx.2.76.2021.5 ◽

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.

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Genes Associated with Thoracic Aortic Aneurysm and Dissection: 2018 Update and Clinical Implications

Aorta ◽

10.1055/s-0038-1639612 ◽

2018 ◽

Vol 06 (01) ◽

pp. 013-020 ◽

Cited By ~ 31

Author(s):

Adam Brownstein ◽

Valentyna Kostiuk ◽

Bulat Ziganshin ◽

Mohammad Zafar ◽

Helena Kuivaniemi ◽

...

Keyword(s):

Surgical Treatment ◽

Aortic Aneurysm ◽

General Population ◽

Thoracic Aortic Aneurysm ◽

Pathogenic Mutation ◽

Aortic Aneurysms ◽

Clinical Implications ◽

Thoracic Aortic Aneurysms ◽

Exponential Increase ◽

Aortic Aneurysm And Dissection

AbstractThoracic aortic aneurysms, with an estimated prevalence in the general population of 1%, are potentially lethal, via rupture or dissection. Over the prior two decades, there has been an exponential increase in our understanding of the genetics of thoracic aortic aneurysm and/or dissection (TAAD). To date, 30 genes have been shown to be associated with the development of TAAD and ∼30% of individuals with nonsyndromic familial TAAD have a pathogenic mutation in one of these genes. This review represents the authors' yearly update summarizing the genes associated with TAAD, including implications for the surgical treatment of TAAD. Molecular genetics will continue to revolutionize the approach to patients afflicted with this devastating disease, permitting the application of genetically personalized aortic care.

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

Archive of Clinical Medicine ◽

10.21802/acm.2021.1.5 ◽

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.

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Marfan syndrome: diagnosis and treatment of cardiovascular lesions

Paediatric Surgery Ukraine ◽

10.15574/ps.2021.70.63 ◽

2021 ◽

pp. 63-67

Author(s):

V.I. Kravchenko ◽

◽

I.M. Kravchenko ◽

I.A. Osadovska ◽

V.D. Lybavka ◽

...

Keyword(s):

Surgical Treatment ◽

Aortic Aneurysm ◽

Marfan Syndrome ◽

Mitral Valve Insufficiency ◽

Aortic Aneurysms ◽

Long Term Results ◽

Key Words Marfan Syndrome ◽

Valve Insufficiency ◽

Long Term Observation

Purpose – to analise of results, long-term experience of surgical treatment of cardiovascular diseases in patients with Marfan syndrome to improve quality and prolong life. Materials and methods. A conducted prospective analysis of consecutive patients (292) with Marfan syndrome treated at the institute during 1980–2018. The age of patients was 7–57 years, mean 31.6±9.4 years. Among them, men – 220 (75.3%), women – 72 (24.7%). Marfan syndrome was diagnosed according to the criteria of Gent Nosology (2010). 24 (8.2%) patients were not operated on for various reasons. The remaining 268 (91.8%) were managed surgicaly: 257 – ascending aortic aneurysm; 4 – abdominal; 7 patients – only mitral valve insufficiency. Results. Hospital mortality was 9.3% (25 patients). Long-term results were studied in 224 (92.2%) patients from all who had been discharged from the clinic within 6 months – 20 years on average 63 months. Good long-term results were admitted in 145 (64.7%), satisfactory in 41 (18.3%), unsatisfactory in 14 (6.3%) patients. 24 (9.9%) patients died in the long term observation. Conclusions. Aortic aneurysms in patients with Marfan syndrome are formed at a young age. The most common cause sof death in the unoperated cases are rupture of aneurism or heart failure. The «gold-standarg» remains the Bentall De Bono operation. The patients who underwent surgical treatment requires observation during all-life period. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: Marfan syndrome, aortic aneurysm, aortic dissection.

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Current evidence and prospects for medical treatment of abdominal aortic aneurysms

VASA ◽

10.1024/0301-1526.34.4.217 ◽

2005 ◽

Vol 34 (4) ◽

pp. 217-223 ◽

Cited By ~ 11

Author(s):

Diehm ◽

Schmidli ◽

Dai-Do ◽

Baumgartner

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Medical Treatment ◽

Endovascular Treatment ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Current Evidence ◽

Significant Morbidity ◽

Abdominal Aortic ◽

Risk Of Rupture

Abdominal aortic aneurysm (AAA) is a potentially fatal condition with risk of rupture increasing as maximum AAA diameter increases. It is agreed upon that open surgical or endovascular treatment is indicated if maximum AAA diameter exceeds 5 to 5.5cm. Continuing aneurysmal degeneration of aortoiliac arteries accounts for significant morbidity, especially in patients undergoing endovascular AAA repair. Purpose of this review is to give an overview of the current evidence of medical treatment of AAA and describe prospects of potential pharmacological approaches towards prevention of aneurysmal degeneration of small AAAs and to highlight possible adjunctive medical treatment approaches after open surgical or endovascular AAA therapy.

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Glutathione system participation in thoracic aneurysms from patients with Marfan syndrome

VASA ◽

10.1024/0301-1526/a000609 ◽

2017 ◽

Vol 46 (3) ◽

pp. 177-186 ◽

Cited By ~ 8

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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Gender differences in abdominal aortic aneurysm therapy – a systematic review

VASA ◽

10.1024/0301-1526/a000703 ◽

2018 ◽

Vol 47 (4) ◽

pp. 267-272 ◽

Cited By ~ 9

Author(s):

Konstanze Stoberock ◽

Tilo Kölbel ◽

Gülsen Atlihan ◽

Eike Sebastian Debus ◽

Nikolaos Tsilimparis ◽

...

Keyword(s):

Gender Differences ◽

Abdominal Aortic Aneurysm ◽

Survival Rate ◽

Aortic Aneurysm ◽

Endovascular Treatment ◽

Aortic Aneurysms ◽

Lower Survival Rate ◽

Lower Survival ◽

Abdominal Aortic ◽

Risk Of Rupture

Abstract. This article analyses if and to what extent gender differences exist in abdominal aortic aneurysm (AAA) therapy. For this purpose Medline (PubMed) was searched from January 1999 to January 2018. Keywords were: “abdominal aortic aneurysm”, “gender”, “prevalence”, “EVAR”, and “open surgery of abdominal aortic aneurysm”. Regardless of open or endovascular treatment of abdominal aortic aneurysms, women have a higher rate of complications and longer hospitalizations compared to men. The majority of studies showed that women have a lower survival rate for surgical and endovascular treatment of abdominal aneurysms after both elective and emergency interventions. Women receive less surgical/interventional and protective medical treatment. Women seem to have a higher risk of rupture, a lower survival rate in AAA, and a higher rate of complications, regardless of endovascular or open treatment. The gender differences may be due to a higher age of women at diagnosis and therapy associated with higher comorbidity, but also because of genetic, hormonal, anatomical, biological, and socio-cultural differences. Strategies for treatment in female patients must be further defined to optimize outcome.

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Epigenetic Profiling Identifies Novel Genes for Ascending Aortic Aneurysm Formation with Bicuspid Aortic Valves

The Heart Surgery Forum ◽

10.1532/hsf.1247 ◽

2015 ◽

Vol 18 (4) ◽

pp. 134 ◽

Cited By ~ 12

Author(s):

Asad A Shah

Keyword(s):

Gene Expression ◽

Aortic Aneurysm ◽

Methylation Status ◽

Aortic Aneurysms ◽

Aortic Valves ◽

Ascending Aortic Aneurysm ◽

Novel Genes ◽

Aneurysm Formation ◽

Aortic Replacement ◽

Bicuspid Aortic Valves

Background: Bicuspid aortic valves predispose to ascending aortic aneurysms, but the mechanisms underlying this aortopathy remain incompletely characterized. We sought to identify epigenetic pathways predisposing to aneurysm formation in bicuspid patients.Methods: Ascending aortic aneurysm tissue samples were collected at the time of aortic replacement in subjects with bicuspid and trileaflet aortic valves. Genome-wide DNA methylation status was determined on DNA from tissue using the Illumina 450K methylation chip, and gene expression was profiled on the same samples using Illumina Whole-Genome DASL arrays. Gene methylation and expression were compared between bicuspid and trileaflet individuals using an unadjusted Wilcoxon rank sum test. Results: Twenty-seven probes in 9 genes showed significant differential methylation and expression (P<5.5x10-4). The top gene was protein tyrosine phosphatase, non-receptor type 22 (PTPN22), which was hypermethylated (delta beta range: +15.4 to +16.0%) and underexpressed (log 2 gene expression intensity: bicuspid 5.1 vs. trileaflet 7.9, P=2x10-5) in bicuspid patients, as compared to tricuspid patients. Numerous genes involved in cardiovascular development were also differentially methylated, but not differentially expressed, including ACTA2 (4 probes, delta beta range: -10.0 to -22.9%), which when mutated causes the syndrome of familial thoracic aortic aneurysms and dissectionsConclusions: Using an integrated, unbiased genomic approach, we have identified novel genes associated with ascending aortic aneurysms in patients with bicuspid aortic valves, modulated through epigenetic mechanisms. The top gene was PTPN22, which is involved in T-cell receptor signaling and associated with various immune disorders. These differences highlight novel potential mechanisms of aneurysm development in the bicuspid population.

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