ABSTRACT
Resumen La válvula aórtica bicúspide es la cardiopatía congénita más frecuente en la población general. Lejos de ser solo una malformación valvular inocua, supone una enfermedad compleja y heterogénea. A menudo es identificada como un hallazgo incidental en personas sanas, cursando de manera asintomática. Sin embargo, en un alto porcentaje de pacientes conduce a lo largo de su vida a complicaciones valvulares (estenosis, insuficiencia, endocarditis) o aórticas (dilatación o disección). Con frecuencia estas manifestaciones suceden a una edad temprana y causan una elevada morbimortalidad. A pesar de que en los últimos años se ha producido una intensa investigación en este campo, la fisiopatogenia de la enfermedad no es del todo conocida y muchas preguntas siguen abiertas. En este artículo se revisan de forma actualizada los aspectos clínicos y fisiopatológicos más novedosos y relevantes sobre esta cardiopatía congénita.
Abstract The most common congenital heart disease in the general population is the bicuspid aortic valve. Far from being just a harmless valve malformation, it is a complex and heterogeneous disease. It is often identified as an incidental finding in healthy people. However, in a high percentage of patients it leads throughout their life towards valvular (stenosis, insufficiency, endocarditis) or aortic (dilatation or dissection) complications. Frequently, manifestations occur at an early age, being responsible for high morbidity and mortality. Even though in recent years intense research has been carried out in this field, the pathophysiogenesis of the disease is not fully known and many questions remain open. In this article, we review the most innovative and relevant clinical and pathophysiological aspects of this congenital heart disease.
Subject(s)
Humans , Bicuspid Aortic Valve Disease/physiopathology , Aortic Diseases/etiology , Aortic Diseases/physiopathology , Aortic Diseases/epidemiology , Bicuspid Aortic Valve Disease/complications , Bicuspid Aortic Valve Disease/diagnosis , Heart Valve Diseases/etiology , Heart Valve Diseases/physiopathology , Heart Valve Diseases/epidemiologyABSTRACT
Objetivo: Determinar a prevalência e as características de ateromatose da aorta ascendente e/ou arco aórtico em cirurgia cardiovascular, os fatores de risco de sua ocorrência e a implicação prognóstica imediata da mesma. Métodos: No período de janeiro de 2007 a junho de 2011, 2042 pacientes adultos consecutivos foram analisados, sem critérios de exclusão. A detecção de ateromatose da aorta foi realizada por meio de palpação durante o ato operatório. Os fatores de risco de ateromatose da aorta e a sua implicação prognóstica foram determinados por regressão logística multivariada. Resultados: A prevalência de ateromatose da aorta foi de 3,3% (68 pacientes). Os fatores de risco foram a idade > 61 anos (OR= 2,79; IC95%= 2,43 - 3,15; P<0,0001), doença arterial coronária (OR=3,1; IC95%=2,8 - 3,44; P=0,002), hipertensão arterial sistêmica (OR=2,26; IC95%=1,82 - 2,7; P=0,03) e doença vascular periférica (OR=3,15; IC95%= 2,83 - 3,46; P=0,04). A ateromatose da aorta foi preditor independente da ocorrência de acidente vascular cerebral no pós-operatório (OR=3,46; IC95%=3,18 - 3,76; P=0,01). Conclusão: Embora infrequente, a presença de ateromatose da aorta tem maior ocorrência de acordo com a idade, com a presença de hipertensão arterial sistêmica, doença arterial coronária e doença vascular periférica. Nestas situações, é justificada investigação pré e intraoperatória mais detalhada, pois a presença de ateromatose determina maior chance de acidente vascular cerebral no pós-operatório. .
Objective: To determine the prevalence and profile of ascending aorta or aortic arch atheromatous disease in cardiovascular surgery patients, its risk factors and its prognostic implication early after surgery. Methods: Between January 2007 and June 2011, 2042 consecutive adult patients were analyzed, with no exclusion criteria. Atheromatous aorta diagnosis was determined intraoperatively by surgeon palpation of the aorta. Determinants of atheromatous aorta, as well as its prognostic implication were studied by multivariate logistic regression. Results: Prevalence of atheromatous aorta was 3.3% (68 patients). Determinants were age > 61 years (OR= 2.79; CI95%= 2.43 - 3.15; P<0.0001), coronary artery disease (OR=3.1; CI95%=2.8 - 3.44; P=0.002), hypertension (OR=2.26; CI95%=1.82 - 2.7; P=0.03) and peripheral vascular disease (OR=3.15; CI95%= 2.83 - 3.46; P=0.04). Atheromatous aorta was an independent predictor of postoperative cerebrovascular accident (OR=3.46; CI95%=3.18 - 3.76; P=0.01). Conclusion: Although infrequent, the presence of atheromatous aorta is associated with advanced age, hypertension, coronary artery disease and peripheral vascular disease. In those patients, a more detailed preoperative and intraoperative assessment of the aorta is justified, due to greater risk of postoperative cerebrovascular accident. .
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Aortic Diseases/epidemiology , Cardiovascular Surgical Procedures , Plaque, Atherosclerotic/epidemiology , Age Factors , Aortic Diseases/pathology , Brazil/epidemiology , Coronary Artery Disease/complications , Epidemiologic Methods , Hypertension/complications , Postoperative Complications , Prognosis , Peripheral Vascular Diseases/complications , Plaque, Atherosclerotic/pathology , Stroke/epidemiology , Stroke/etiologyABSTRACT
The incidence, extent and degree of atherosclerosis was studied in descending aorta, common carotid arteries and circle of Willis obtained from 50 cadavers above the age of 30 years. Specimens were stained grossly with Sudan IV and the total atherosclerotic area was measured and atherosclerotic index was calculated. The co-efficient of correlation between extent of atherosclerosis with age and nutritional status was calculated. The incidence of atherosclerosis was 100.0% in the aorta and common carotid arteries in all the specimens. In case of circle of Willis, it was 76.5% in the fourth decade and 87.5% in the fifth decade, rising to 100.0% thereafter. The atherosclerotic index increased with age at all the three locations. However, at any given age, the atherosclerotic index in circle of Willis was much less as compared to the aorta or common carotid arteries. The most prominent lesion in all the three groups of vessels in the fourth and fifth decades was the presence of a fatty streak. There was a sudden spurt in the extent of fibrous plaques in the aorta, carotid arteries and circle of Willis in the sixth decade. Complicated lesions also appeared in this decade, and became more marked after sixty years of age. The correlation between the extent and degree of atherosclerosis with age was found to be highly significant statistically (p < 0.001). A significant correlation (p < 0.001) was also found between the nutritional status and extent and degree of atherosclerosis. No conclusion could be derived regarding differences in the extent and degree of the disease in the two sexes.