Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 2.344
Filter
2.
Arq. bras. cardiol ; 118(2): 448-460, 2022. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1364325

ABSTRACT

Resumo Fundamentos Uma metodologia para identificação de pacientes portadores de aneurisma de aorta ascendente (AAAs) sob alto risco de remodelamento aórtico não está completamente definida. Objetivo Esta pesquisa objetiva caracterizar numericamente o fluxo sanguíneo aórtico, relacionando a distribuição do estresse mecânico resultante com o crescimento de AAAs. Métodos Estudo analítico, observacional, unicêntrico, em que um protocolo de fluidodinâmica computacional (CFD - Computacional Fluid Dynamics) foi aplicado a imagens de angiotomografia computadorizada (ATC) de aorta de pacientes portadores de AAAs. Duas ATC de aorta com pelo menos um ano de intervalo foram obtidas. Dados clínicos dos pacientes foram registrados e, a partir das imagens de ATC, foram gerados modelos tridimensionais. Foram realizados estudos do campo de velocidade e estruturas coerentes (vórtices) com o objetivo de relacioná-los ao crescimento ou não do aneurisma e, posteriormente, compará-los com os dados clínicos dos pacientes. O teste de Kolmogorov-Smirnov foi utilizado para avaliar a normalidade da amostra e o teste não-paramétrico Wilcoxon signed-rank foi aplicado para comparações de dados pareados entre os ângulos aórticos. A significância estatística foi fixada em 5%. Resultados Para o grupo que apresentou crescimento do aneurisma, a incidência do jato na parede aórtica gerou áreas de recirculação posterior ao jato, induzindo à formação de vórtices complexos, ocasionando um incremento na pressão média no endotélio aórtico. O grupo sem crescimento do aneurisma apresentou diminuição na pressão média. Conclusão Este estudo piloto mostrou que a CFD baseada em ATC pode, em um futuro próximo, ser uma ferramenta auxiliar na identificação dos padrões de fluxo associados ao processo de remodelamento de AAAs.


Abstract Background A methodology to identify patients with ascending aortic aneurysm (AsAA) under high risk for aortic growth is not completely defined Objetive This research seeks to numerically characterize the aortic blood flow by relating the resulting mechanical stress distribution with AsAA growth. Methods Analytical, observational, single-center study in which a computational fluid dynamics (CFD) protocol was applied to aortic computed tomography angiogram (CTA) images of patients with AsAA. Two CTA exams taken at a minimum interval of one year were obtained. From the CTA-gathered images, three-dimensional models were built, and clinical data were registered. Study of velocity field and coherent structures (vortices) was performed aiming to relate them to the presence or absence of aneurysm growth, as well as comparing them to the patients' clinical data. The Kolmogorov-Smirnov test was used to evaluate the normality of the distribution, and the non-parametric Wilcoxon signed-rank test, for non-normal distribution, was used to compare the paired data of the aortic angles. Statistical significance was set at 5%. Results The incident jet in the aortic wall generated recirculation areas in the posterior region of the jet, inducing complex vortices formation in the group with aneurysm growth, leading to an average pressure increase in the ascending aortic wall between exams. In the group without aneurysm growth, the average pressure decreased. Conclusion This pilot study showed that CFD based on CTA may in the near future be a tool to help identify flow patterns associated with AsAA remodeling process.


Subject(s)
Humans , Aortic Aneurysm/diagnostic imaging , Hydrodynamics , Aorta/diagnostic imaging , Pilot Projects , Hemodynamics/physiology
3.
Medicina UPB ; 40(2): 84-87, 13 oct. 2021. Ilus
Article in Spanish | LILACS, COLNAL | ID: biblio-1342239

ABSTRACT

Se describe el caso de un paciente de 70 años que consultó por cefalea súbita, tipo trueno, sin alteración del estado de consciencia, acompañada de dolor torácico de una hora de evolución y de baja intensidad. A su ingreso fue enfocado como cefalea en trueno, que es clasificada, en cuanto a la atención, como bandera roja. La medición de troponina fue negativa y una tomografía de cráneo fue leída como normal. Desde el ingreso presentaba signos vitales normales, cuando iba a ser dado de alta se torna hipotenso (completamente asintomático) y por su síntoma cardinal (cefalea), que se asoció a dolor torácico leve y no anginoso, se solicitó angiotomografía toracoabdominal, con la que se demostró aneurisma disecante de la aorta. Con la presentación de este caso, se busca resaltar la importancia en el servicio de urgencias de la asociación de la cefalea tipo trueno, con condiciones vasculares como la disección aórtica.


We describe the case of a 70-year-old patient, who seeks medical advice due to sudden, thunder headache, without alteration of the state of consciousness, accompanied by chest pain of 1 hour of evolution and of low intensity. Upon his admission, the patient was treated as a thunderclap headache, which is considered a red flag. His troponin was negative, and his head tomography was interpreted as normal. From admission he had normal vital signs, but when he was going to be discharged, he became hypotensive (completely asymptomatic) and due to his cardinal symptom (headache) that was asso-ciated with mild non-anginal chest pain, a thoracoabdominal angioCT was requested, with which dissecting aneurysm of the aorta was evidenced. With the presentation of this case, we seek to highlight the importance of the association of thunder-type headache with possible vascular conditions such as aortic dissection in the emergency department.


Descrevemos o caso de uma paciente de 70 anos que consultou por quadro de cefaleia súbita, tipo trovão, sem alteração do estado de consciência, acompanhada de dor torácica de uma hora de evolução e de baixa intensidade. Na admissão, foi tratado como cefaleia em trovoada, que é classificada, em termos de atenção, como bandeira vermelha. A me-dição da troponina foi negativa e uma tomografia de crânio foi lida como normal. Desde a admissão apresentava sinais vitais normais, quando ia receber alta ficou hipotenso (totalmente assintomático) e devido ao seu sintoma cardinal (cefaleia), que se associou a dores torácicas ligeiras e não anginosas, foi solicitada angiografia toracoabdominal, com cujo aneurisma dissecante da aorta foi demonstrado. Com a apresentação deste caso, o objetivo é destacar a importância no pronto-socorro da associação da cefaleia do tipo trovão com afecções vasculares como a dissecção da aorta.


Subject(s)
Humans , Aneurysm, Dissecting , Aorta , Chest Pain , Angiography , Headache
5.
Arq. bras. cardiol ; 116(6): 1119-1126, Jun. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1278324

ABSTRACT

Resumo Fundamento A aterosclerose, em alguns casos, é uma condição assintomática, sendo necessário conhecer o grau de comprometimento arterial provocado pelas placas e sua associação com os fatores de risco. O exame de autópsia permite a compreensão dos processos básicos de doenças, assim como a avaliação e fornecimento de dados sobre a característica macroscópica do acometimento aterosclerótico. Objetivo Avaliar macroscopicamente e padronizar o acometimento aterosclerótico das artérias aorta, carótidas e ilíacas e comparar com a idade, o sexo e a causa de morte. Métodos Foram coletados 53 artérias aorta, 53 artérias carótida direita, 53 artérias carótida esquerda, 53 artérias ilíaca direita e 53 artérias ilíaca esquerda. Para essa avaliação, foi considerada a extensão de estrias lipídicas, de placas ateromatosas, de fibrose e de calcificação, as quais serviram de referência para pontuar a intensidade do acometimento aterosclerótico. Foram observados vários graus da aterosclerose e valores acurados para a classificação discreta, moderada e acentuada. Para a análise estatística, os dados foram analisados utilizando-se o software GraphPad Prism ® 7.0. As diferenças foram consideradas estatisticamente significativas quando "p" foi menor que 5% (p<0,05). Resultados As artérias carótidas apresentaram maior acometimento aterosclerótico em comparação às outras artérias avaliadas (K=15,73, p=0,0004). A ocorrência da aterosclerose se mostrou progressiva e significativa com o decorrer da idade (carótidas: t=6,321; p<0,0001; aortas: U=83,5; p<0,0001; ilíacas: U=306; p<0,0001) e na causa de morte cardiovascular (carótidas: t=5,047; p<0,0001; aortas: U=98,5; p=0,0068; ilíacas: U=467,5; p=0,0012). Conclusão A avaliação macroscópica da aterosclerose trata-se de uma forma inovadora e de baixo custo de avaliação através da visualização direta das placas ateroscleróticas, possibilitando uma associação com fatores de risco como idade avançada e doenças cardiovasculares, fornecendo dados importantes para a prática clínica.


Abstract Background Atherosclerosis, in some cases, is an asymptomatic condition, and it is important to know the degree of arterial impairment caused by plaques and its association with risk factors. Autopsy examination provides understanding of basic disease processes and assessment to data about macroscopic characteristic of atherosclerotic involvement. Objective To macroscopically assess and standardize atherosclerotic involvement of aorta, carotid and iliac arteries and compare with age, gender and causes of death. Methods We collected 53 aortic arteries, 53 right carotid arteries, 53 left carotid arteries, 53 right iliac arteries and 53 left iliac arteries. For this assessment, the extension of fatty streaks, atheromatous plaques, fibrosis and calcification were considered, being the reference to score the degree of atherosclerotic involvement. Many degrees of atherosclerosis and accurate values were observed for mild, moderate and severe classification. For statistical analysis, data were analyzed using the software GraphPad Prism® 7.0. Differences were considered statistically significant if p-value was less than 5% (p <0.05). Results Carotid arteries had greater atherosclerotic involvement compared to the other arteries (K = 15.73, p = 0.0004). Atherosclerosis was progressive and significant with increasing age (carotid arteries: t = 6.321; p <0.0001; aorta: U = 83.5; p <0.0001; iliac: U = 306; p <0.0001) and as cause of cardiovascular death (carotids: t = 5.047; p <0.0001; aorta: U = 98.5; p = 0.0068; iliac: U = 467.5; p = 0.0012). Conclusion Macroscopic assessment of atherosclerosis is an innovative and low-cost way of direct visualization of atherosclerotic plaques, enabling an association with risk factors such as increasing age and cardiovascular diseases, providing important data for clinical practice.


Subject(s)
Humans , Atherosclerosis , Plaque, Atherosclerotic , Aorta , Autopsy , Carotid Arteries , Risk Factors
6.
Arq. bras. med. vet. zootec. (Online) ; 73(2): 406-410, Mar.-Apr. 2021. ilus
Article in English | LILACS, VETINDEX | ID: biblio-1248953

ABSTRACT

The anomalous origin of the pulmonary trunk in the ascending aorta, defined as arterious hemitruncus, is a rare congenital malformation in dogs, caused by a defect in the spiral septum. Thus, given the unusual occurrence in the canine species, the systemic severity and the high lethality, the aim of this study was to describe this heart disease in a three-month-old male German Spitz puppy, emphasizing clinical changes of the necropsy and microscopics. The animal had cyanosis, dyspnea and weakness and was forwarded for necropsy after sudden death. Numerous changes were detected in the post-mortem examination, including in the heart, as cardiomegaly and absence of the arterial ligament, which was replaced by the complete fusion between the ascending aorta and the pulmonary trunk, after leaving both the left and right ventricles, respectively and, among the microscopic findings, cardiomyocyte hypertrophy stood out. The association of these findings with the history indicated the diagnosis of arterious hemitruncus followed by cardiorespiratory failure, emphasizing the importance of out complementary cardiological exams in young symptomatic patients for the survival of those affected. Arterious hemitruncus, although rare, must be added in the differential diagnosis of other heart diseases that cause similar clinical signs.(AU)


A origem anômala do tronco pulmonar em aorta ascendente, definida como hemitruncus arterioso, é uma malformação congênita rara em cães, causada por defeito no septo espiral. Assim, diante da ocorrência incomum na espécie canina, da gravidade sistêmica e da alta letalidade, o objetivo deste trabalho foi descrever essa doença cardíaca em um filhote de três meses de idade, macho, Spitz Alemão, enfatizando as alterações clínicas, de necropsia e microscópicas. O animal apresentava cianose, dispneia e fraqueza e foi encaminhado para necropsia após morte súbita. Inúmeras alterações foram detectadas no exame post-mortem, inclusive no coração, como cardiomegalia e ausência do ligamento arterioso, o qual foi substituído pela fusão completa entre aorta ascendente e tronco pulmonar, após a saída de ambas dos ventrículos esquerdo e direito, respectivamente, e, dentre os achados microscópicos, destacou-se a hipertrofia de cardiomiócitos. A associação desses achados com o histórico indicou o diagnóstico de hemitruncus arterioso seguido de insuficiência cardiorrespiratória, ressaltando-se a importância de exames complementares cardiológicos em pacientes jovens sintomáticos na sobrevida dos acometidos. O hemitruncus arterioso, apesar de raro, deve ser acrescido no diagnóstico diferencial de outras cardiopatias que causam sinais clínicos similares.(AU)


Subject(s)
Animals , Dogs , Aorta/abnormalities , Pulmonary Artery/abnormalities , Heart Septal Defects/pathology , Heart Septal Defects/veterinary , Congenital Abnormalities/veterinary
7.
Rev. colomb. cir ; 36(2): 237-247, 20210000. tab, fig
Article in Spanish | LILACS | ID: biblio-1223829

ABSTRACT

Introducción. La presión arterial sistólica puede ser un factor determinante para la toma de decisiones en el manejo de pacientes con trauma severo y hemorragia no compresible del torso. El objetivo de este trabajo fue determinar el punto óptimo de presión arterial sistólica previo a la oclusión endovascular de aorta asociado con la mortalidad a las 24 horas. Métodos. Se realizó un análisis combinado de dos bases de datos de registro de REBOA, ABO-Trauma Registry y AAST-AORTA, que incluye pacientes de Norte América, Suramérica, Europa, Asia y África. Pacientes sin efecto hemodinámico con el uso del REBOA fueron excluidos. Se describieron las características demográficas, clínicas y de la colocación del REBOA en los pacientes que fallecieron en las primeras 24 horas. Se analizó la asociación entre la presión arterial sistólica previa a la oclusión aortica y la mortalidad a través de modelos de regresión logística y se evaluó el poder predictivo de la presión arterial sistólica en un intervalo entre 60 y 90 mmHg. Resultados. Fueron identificados 871 registros, pero solo 693 pacientes cumplieron con los criterios de inclusión. El trauma cerrado se presentó en el 67,2 % de los pacientes y la severidad del trauma tuvo una mediana de ISS de 34 (RIQ: 25-45). La mediana de la presión arterial sistólica previa al REBOA fue de 61 mmHg (RIQ: 46-80). La mortalidad a las 24 horas fue del 34,6 %. La asociación entre la presión arterial sistólica pre-oclusión de la aorta y la mortalidad a las 24 horas tiene una capacidad predictiva de acuerdo con el área bajo la curva ROC para trauma cerrado de 0,64 (IC95% 0,59-0,70) y para trauma penetrante de 0,61 (IC95% 0,53-0,69). Se identificó que la presión arterial sistólica de 70 mmHg se asocia con un aumento por encima del 25 % de la mortalidad a las 24 horas. Discusión. La presión arterial sistólica de 70 mmHg en pacientes con trauma severo y hemorragia no compresible puede ser el punto crítico para la oclusión endovascular de aorta para mejorar la supervivencia de los pacientes, sin importar el mecanismo de trauma. Sin embargo, la presión arterial sistólica debe complementarse con otros factores clínicos para tomar la decisión oportuna


Introduction. Systolic blood pressure (SBP) can be a determining factor for decision-making in the management of patients with severe trauma and non-compressible torso bleeding (NTCH). The objective of this study was to determine the optimal SBP threshold value prior to endovascular occlusion of the aorta associated with 24-hour mortality.Methods. A combined analysis of two REBOA registry databases, ABO-Trauma Registry and AAST-AORTA, was performed, which includes patients from North America, South America, Europe, Asia, and Africa. Patients without hemodynamic effect with the use of REBOA were excluded. Demographic, clinical, and REBOA placement characteristics were described in patients who died in the first 24 hours. The association between SBP prior to aortic occlusion and mortality was analyzed using logistic regression models and the predictive power of SBP was evaluated in an interval between 60 and 90 mmHg.Results. 871 records were identified, but only 693 patients met the inclusion criteria. Blunt trauma occurred in 67.2% of the patients and the severity of the trauma had a median ISS of 34 (IQR: 25-45). The median systolic blood pressure prior to REBOA was 61 mmHg (IQR: 46-80). The 24-hour mortality was 34.6%. The association between systolic blood pressure pre-occlusion of the aorta and mortality at 24 hours has a predictive capacity according to the area under the ROC curve for blunt trauma of 0.64 (95% CI: 0.59-0.70) and for penetrating trauma of 0.61 (95% CI: 0.53-0.69). A systolic blood pressure of 70 mmHg was found to be associated with an increase of over 25% in mortality at 24 hours. Discussion. SBP of 70 mmHg in patients with severe trauma and non-compressible hemorrhage may be the critical point for endovascular aortic occlusion to improve patient survival, regardless of the mechanism of trauma. However, systolic blood pressure must be supplemented with other clinical factors to make the timely decision


Subject(s)
Humans , Blood Pressure , Endovascular Procedures , Aorta , Wounds and Injuries , Mortality , Balloon Occlusion , Hemorrhage
8.
Rev. bras. cir. cardiovasc ; 36(1): 125-129, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1155789

ABSTRACT

Abstract Although aortic valve replacement remains the gold standard treatment for aortic valve diseases like stenosis (AS) or insufficiency, new surgical methods have been developed with a focus in the reconstruction of the aortic valve rather than replacing it. The Ozaki procedure involves a tailored replacement of each individual valvular leaflet with glutaraldehyde-treated autologous pericardium and aims to reproduce the normal anatomy of the aortic valve. Cases of patients with unicuspid aortic valve treated with the Ozaki procedure are uncommon in the litrature and become even more rare when it comes to concomitant diseases like AS and ascending aorta aneurysm. We present the case of a 21-year-old, fit and asymptomatic male, with unicuspid aortic valve with severe stenosis and ascending aorta dilatation, surgically treated with tricuspidization of the aortic valve with glutaraldehyde-treated autologous pericardium and replacement of the ascending aorta with a straight synthetic graft. Postoperative studies showed a fully functional, neo-tailored tricuspid aortic valve with trivial regurgitation. The patient had an uncomplicated recovery, stayed in the intensive care unit for 2 days and was discharged on the 7th postoperative day.


Subject(s)
Humans , Male , Adult , Young Adult , Aortic Aneurysm/surgery , Aortic Aneurysm/diagnostic imaging , Heart Valve Diseases , Aorta , Aortic Valve/surgery
9.
Rev. Col. Bras. Cir ; 48: e20202587, 2021. graf
Article in English | LILACS | ID: biblio-1155357

ABSTRACT

ABSTRACT Objectives: the aim of this study was to compare the outcomes of a new silicone vascular prostheses with PTFE vascular prostheses, on a rabbit experimental model. Methods: forty rabbits underwent infra-renal aorta replacement with 4 mm diameter prostheses, twenty animals with PDMS and twenty animals with PTFE (control group). Retrograde aortic angiography was performed to assess patency. Histological graft samples were examined by electron microscopy to evaluate prostheses endothelialization. Results: patency rates were 100% for both grafts after 30 days; after 60 days, patency rate for PDMS was 92.3% (±7.4), and 73,8% (±13.1) at 90 days. PTFE grafts had patency rates of 87.5% (±11.7) at 60 and 90 days. No statistically significant difference was found in between groups for patency rates (p=0.62). Postoperative complications (death, paraplegia) rates (p=0.526) and aortic clamping times (p=0.299) were comparable in both groups. No statistically significant difference for stenosis was found on angiographical analysis between groups (p=0.650). Electron microscopy revealed limited anastomotic endothelial ingrowth in both prostheses. Conclusion: in this experimental model, PDMS and PTFE vascular prostheses had comparable outcomes and PDMS prosthesis could be used as a vascular graft.


RESUMO Objetivo: analisar novo tubo de silicone como material para prótese vascular e compará-lo a prótese de PTFE, em modelo experimental com coelhos. Métodos: quarenta coelhos foram submetidos a interposição, na aorta infrarrenal, de próteses de 4mm de diâmetro, sendo 20 animais com PDMS e 20 com PTFE (grupo controle). Foi realizada arteriografia retrógrada da aorta para avaliar a patência das próteses. Para avaliar a endotelização das próteses foi realizada microscopia eletrônica de maneira amostral pareada. Resultados: a patência em 30 dias foi de 100% para as duas próteses. Aos 60 dias, a taxa de patência do PDMS foi de 92,3% (± 7,4), e de 73,8% (±13,1) em 90 dias; as próteses de PTFE tiveram taxas de patência de 87,5% (± 11,7) aos 60 e 90 dias. Não foi observada diferença significativa entre as taxas de patência dos grupos (p=0,62). Não foi observada diferença entre os grupos quanto à evolução com complicações pós-operatórias (p=0,526) e quanto ao tempo de clampeamento da aorta (p=0,299). Não houve diferença significativa entre os grupos quanto ao grau de estenose das próteses (p=0,650) à avaliação angiográfica. A microscopia eletrônica mostrou crescimento endotelial limitado às regiões próximas às anastomoses nos dois tipos de próteses. Conclusões: o PDMS mostrou-se passível de utilização como prótese vascular, com resultados comparáveis aos do PTFE no modelo utilizado.


Subject(s)
Animals , Aorta/surgery , Polytetrafluoroethylene/therapeutic use , Silicones/therapeutic use , Blood Vessel Prosthesis , Polyesters , Rabbits
10.
Braz. J. Pharm. Sci. (Online) ; 57: e19187, 2021. graf
Article in English | LILACS | ID: biblio-1350232

ABSTRACT

Propolis from stingless bees (Heterotrigona itama) is a resinous compound that exhibits antihyperglycaemia, free radical scavenging, and cardioprotective properties. The effect of propolis on diabetic vessels has not been investigated. Thus, this research aimed to determine the effect of propolis supplementation on the level of antioxidants and its mechanism of action in the aorta of diabetic rats. Male Sprague-Dawley rats were divided into five groups (n=8/group): healthy (control), untreated diabetes (DM), metformin-treated diabetes (DM+M, 300 mg/kg/day metformin), propolis-treated diabetes (DM+P, 300 mg/kg/day propolis extract) and diabetes with combined treatment (DM+M+P, dosage as former). Oral supplementation was conducted for four weeks immediately upon successful induction of diabetes by streptozotocin (60 mg/kg, intraperitoneal injection). At the end of the study, the rats were euthanised, and thoracic aorta was processed into tissue homogenates to determine the levels of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase-1 (GPx-1) and soluble receptor for advanced glycation end-products (sRAGE). Aorta segments were harvested to examine their relaxation response towards graded concentration of acetylcholine (Ach; 10-8-10-4) M following precontraction with phenylephrine (PE; 10-6 M). Vasorelaxation towards a cumulative dose of propolis (0.01-1.00%) using PE-precontracted healthy aorta (n=6/experiments) was investigated under various simulated conditions: physiological buffer, L-NAME (10-4 M), methylene blue (10-5 M), indomethacin (10-5 M) and elevated glucose (25 mM). Propolis maintained antioxidative enzymes and sRAGE decoy molecules in the aortic tissue of the diabetic rats. The amelioration of diabetes-induced impairment of endothelium-dependent relaxation by propolis was mediated through the nitric oxide(NO)-cyclic guanosine monophosphate (cGMP) pathway. This non-clinical study reports vasoprotective property of propolis in diabetes mellitus.


Subject(s)
Animals , Male , Rats , Propolis/analysis , Bees/anatomy & histology , Rats, Sprague-Dawley/classification , Diabetes Mellitus/drug therapy , Endothelium/abnormalities , Nitric Oxide/adverse effects , Aorta/abnormalities , Relaxation , Vasodilation , Antioxidants/pharmacology
11.
Rev. bras. cir. cardiovasc ; 35(6): 869-877, Nov.-Dec. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1143995

ABSTRACT

Abstract Introduction: The objective of this study was to evaluate whether a surgery with the use of valved conduit is capable of leading to better immediate and late results than those obtained by the valve-sparing aortic root reconstruction technique. Methods: Between January 2002 and June 2016, 448 patients underwent aortic root reconstruction. These were divided into three groups according to the technique used: 319 (71.2%) patients received mechanical valved conduits, 49 (10.9%) received biological valved conduits, and 80 (17.9%) underwent the valve-sparing aortic root reconstruction technique. The results were examined by univariate and multivariate analyses of Cox proportional hazards models with multiple logistic regression. Results: The hospital mortality rate was 7.5%. The mortality rates were 8.2%, 12%, and 2.5% in the mechanical valved conduit, biological valved conduit, and aortic valve-sparing groups, respectively, with no significant difference between groups (P=0.1). Thromboembolic complications and reoperation-free survival were also similar (P=0.169 and P=0.688). However, valve-sparing aortic root replacement was superior in terms of long-term survival (P<0.001), hemorrhagic-free survival (P<0.001), and endocarditis-free survival (P=0.048). Multivariate analysis showed that the following aspects had an impact on mortality: age > 70 years (P<0.001; hazard ratio [HR] 1.05), preoperative acute kidney injury (P<0.0042; HR 2.9), diagnosis of dissection (P<0.01; HR 2.0), previous cardiac surgery (P<0.027; HR 2.3), associated coronary artery bypass grafting (P<0.038; HR 1.8), reoperation for postoperative tamponade (P<0.004; HR 2.2) and postoperative acute kidney injury (P<0.02; HR 3.35). Conclusion: Valve-sparing technique seems to be the operation of choice, whenever possible, for aortic root reconstruction.


Subject(s)
Humans , Male , Aortic Valve/surgery , Heart Valve Prosthesis Implantation , Aorta/surgery , Postoperative Complications , Reoperation , Brazil , Retrospective Studies , Treatment Outcome
12.
Rev. bras. ter. intensiva ; 32(4): 606-610, out.-dez. 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1156244

ABSTRACT

RESUMO Os autores relatam um raro caso de uso de Suporte Avançado de Vida no contexto de uma parada cardíaca ocorrida em razão de uma origem aórtica anômala da artéria coronária direita em um paciente de 49 anos de idade. O paciente foi admitido com dor torácica e dispneia, evoluindo rapidamente para taquicardia ventricular sem pulso e parada cardiopulmonar. Considerou-se um infarto agudo do miocárdio e, na ausência de um laboratório de hemodinâmica no hospital, realizou-se trombólise. Subsequentemente, uma angiografia coronária revelou ausência de lesões angiográficas nas artérias coronárias e origem anômala da artéria coronária direita do seio de Valsalva oposto. Uma angiografia coronária por tomografia computadorizada confirmou o achado e determinou um trajeto entre a artéria pulmonar e a aorta. O paciente foi submetido à cirurgia cardíaca com realização de ponte de mamária para a artéria coronária direita, sem qualquer novo episódio de arritmia.


ABSTRACT The authors report a rare case of successful Advanced Life Support in the context of cardiac arrest due to the presence of an anomalous aortic origin of the right coronary artery in a 49-year-old patient. The patient was admitted due to chest pain and dyspnea, with rapid evolution of pulseless ventricular tachycardia and cardiopulmonary arrest. Acute myocardial infarction was considered, and in the absence of a hemodynamic laboratory in the hospital, thrombolysis was performed. Subsequently, coronary angiography revealed no angiographic lesions in the coronary arteries and an anomalous right coronary artery originating from the opposite sinus of Valsalva. Coronary computed tomography angiography confirmed this finding and determined the course between the pulmonary artery and the aorta. The patient underwent cardiac surgery with a bypass graft to the right coronary artery, with no recurrent episodes of arrythmia.


Subject(s)
Humans , Middle Aged , Sinus of Valsalva , Coronary Vessel Anomalies/complications , Heart Arrest/etiology , Aorta , Coronary Angiography
13.
Rev. bras. cir. cardiovasc ; 35(5): 834-837, Sept.-Oct. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137354

ABSTRACT

Abstract Giant ascending aortic aneurysm is a rare condition. In this paper, we present an uncommon case of giant ascending aortic aneurysm with a maximal diameter of 14 cm in a 77-year-old woman presenting with unusual symptoms. The patient underwent a successful surgery involving ascending aortic replacement, and was discharged without any complication. After discharge, she was followed regularly and no major problem was observed in her control visits. To the best of our knowledge, our case is the largest ascending aortic aneurysm reported to date in the existing literature.


Subject(s)
Humans , Female , Aged , Aortic Aneurysm/surgery , Aortic Aneurysm/complications , Aortic Aneurysm/diagnostic imaging , Superior Vena Cava Syndrome/etiology , Aorta/surgery , Aorta/diagnostic imaging , Cardiopulmonary Bypass , Tomography, X-Ray Computed , Blood Vessel Prosthesis Implantation
14.
Arq. bras. cardiol ; 115(4): 680-687, out. 2020. graf
Article in Portuguese | SES-SP, LILACS, SES-SP | ID: biblio-1131356

ABSTRACT

Resumo Fundamento O implante valvar aórtico percutâneo (TAVR, do inglês Transcatheter Aortic Valve Replacement) reduz a mortalidade de pacientes portadores de estenose aórtica grave. O conhecimento da distribuição da pressão e tensão de cisalhamento na parede aórtica pode ajudar na identificação de regiões críticas, onde o processo de remodelamento aórtico pode ocorrer. Neste trabalho é apresentado um estudo de simulação computacional da influência do posicionamento do orifício valvar protético na hemodinâmica na raiz de aorta e segmento ascendente. Objetivos A presente análise apresenta um estudo da variação do padrão de fluxo devido a alterações no ângulo do orifício valvar. Métodos Um modelo tridimensional foi gerado a partir do exame de angiotomografia computadorizada da aorta de um paciente que foi submetido ao procedimento de TAVR. Diferentes vazões de fluxo foram impostas através do orifício valvar. Resultados Pequenas variações no ângulo de inclinação causaram mudanças no padrão de fluxo, com deslocamento na posição dos vórtices, na distribuição de pressão e no local de alta tensão cisalhante na parede aórtica. Conclusão Essas características hemodinâmicas podem ser importantes no processo de remodelamento aórtico e distribuição de tensão, além de auxiliar, em um futuro próximo, a otimização do posicionamento da prótese valvar percutânea. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Abstract Backgroud Transcatheter aortic valve replacement (TAVR) can reduce mortality among patients with aortic stenosis. Knowledge of pressure distribution and shear stress at the aortic wall may help identify critical regions, where aortic remodeling process may occur. Here a numerical simulation study of the influence of positioning of the prosthetic valve orifice on the flow field is presented. Objective The present analysis provides a perspective of great variance on flow behavior due only to angle changes. Methods A 3D model was generated from computed tomography angiography of a patient who had undergone a TAVR. Different mass flow rates were imposed at the inlet valve. Results Small variations of the tilt angle could modify the nature of the flow, displacing the position of the vortices, and altering the prerssure distribution and the location of high wall shear stress. Conclusion These hemodynamic features may be relevant in the aortic remodeling process and distribution of the stress mapping and could help, in the near future, the optimization of the percutaneous prosthesis implantation. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)


Subject(s)
Humans , Aortic Valve Stenosis/diagnostic imaging , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation , Transcatheter Aortic Valve Replacement/adverse effects , Aorta , Aortic Valve/surgery , Aortic Valve/diagnostic imaging , Aortic Valve Stenosis/surgery , Prosthesis Design , Treatment Outcome , Computed Tomography Angiography , Hemodynamics
16.
Rev. bras. cir. cardiovasc ; 35(4): 589-590, July-Aug. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137282

ABSTRACT

Abstract Aneurysms of the sinuses of Valsalva are defined as dilatation of the aortic root region between the aortic annulus and the sinotubular junction. Isolated aneurysms of the sinus of Valsalva are rare cardiovascular pathologies. They may be congenital, especially secondary to connective tissue disorders or in conjunction with congenital cardiac defects, or acquired such as secondary to infections or trauma. Small sized aneurysm without rupture in asymptomatic patients may be followed; however, latter cases require intervention and surgery is the gold standard treatment modality. In this report, a 41-year-old male patient was reported with giant aneurysm of the non-coronary sinus of Valsalva whom underwent aortic root sparing surgical aortic sinus of Valsalva reconstruction.


Subject(s)
Humans , Male , Adult , Aortic Aneurysm/surgery , Aortic Aneurysm/diagnostic imaging , Sinus of Valsalva/surgery , Sinus of Valsalva/diagnostic imaging , Heart Defects, Congenital , Aorta , Dilatation, Pathologic
17.
19.
Rev. am. med. respir ; 20(1): 72-74, mar. 2020. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1178762

ABSTRACT

Paciente masculino de 25 años sin antecedentes patológicos conocidos que se desempeña en el rubro gastronómico. Consulta por dolor pleurítico en hemitórax izquierdo asociado a sudoración nocturna y pérdida de peso de 1 kg en el último mes. Niega fiebre, tos, disnea o contacto con personas enfermas. En el laboratorio no presenta anemia ni leucocitosis, con VSG 30 mm/h y PCR 12 mg/L. La radiografía de tórax evidencia derrame pleural bilateral a predominio izquierdo. Se punza, con criterios para exudado, obteniéndose un cultivo para gérmenes comunes, BAAR y cultivo KOCH negativos.


Subject(s)
Humans , Male , Aorta , Referral and Consultation , Sweating , Fever , Anemia
SELECTION OF CITATIONS
SEARCH DETAIL