Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 2.385
Filter
1.
Int. j. morphol ; 42(4): 999-1004, ago. 2024. ilus
Article in English | LILACS | ID: biblio-1569281

ABSTRACT

SUMMARY: Samples were collected from five goats (Capra hircus) from the ascending aorta, aortic arch, descending thoracic aorta, and descending abdominal aorta. These samples were histologically processed to reveal elastic structures in their media. The mean number of elastic lamellae discovered was 91.5 in the mean ascending aorta, 78.5 in the mean aortic arch, 66 in the mean descending thoracic aorta, and 31.7 in the mean descending abdominal aorta. Because they all have a large number of elastic laminae on average, they all fall into the elastic artery category, but not all are typical elastic arteries. Thus, the ascending aorta, the aortic arch, and the descending thoracic aorta contain, on average, in addition to elastic tissue, polymorphous muscle islands, which distinguishes them from typical elastic arteries, which is why we call them particular elastic arteries. The descending abdominal aorta contains no such islands so that it can be classified as a typical elastic artery. The goat aortic segment is the only one comparable in structure to the elastic arteries of humans, which is why we suggest that it is the only one suitable for studying aortic disease in humans.


Se recogieron muestras de cinco cabras (Capra hircus) de la aorta ascendente, el arco aórtico, la aorta torácica descendente y la aorta abdominal descendente. Estas muestras se procesaron histológicamente para revelar estructuras elásticas en sus capas. El número medio de laminillas elásticas descubiertas fue de 91,5 en la aorta ascendente, 78,5 en el arco aórtico, 66 en la aorta torácica descendente y 31,7 en la aorta abdominal descendente. Debido a que todas tienen en promedio una gran cantidad de láminas elásticas, caen en la categoría de arterias elásticas, pero no todas son arterias elásticas típicas. Así, la aorta ascendente, el arco aórtico y la aorta torácica descendente contienen, en promedio, además de tejido elástico, islas de músculos polimorfos, lo que las distingue de las arterias elásticas típicas, por lo que las llamamos arterias elásticas particulares. La aorta abdominal descendente no contiene tales islas, por lo que puede clasificarse como una arteria elástica típica. El segmento aórtico de cabra es el único comparable en estructura a las arterias elásticas de los humanos, por lo que sugerimos que es el único adecuado para estudiar la enfermedad aórtica en humanos.


Subject(s)
Animals , Aorta/anatomy & histology , Goats/anatomy & histology , Elastic Tissue
2.
Rev. colomb. cir ; 39(1): 113-121, 20240102. tab
Article in Spanish | LILACS | ID: biblio-1526857

ABSTRACT

Introducción. Se describe la utilidad del umbral crítico de administración (CAT por su denominación en inglés) como herramienta para la reanimación hemostática en pacientes con trauma severo y oclusión endovascular aórtica. Métodos. Revisión retrospectiva de pacientes adultos con hemorragia por trauma, con o sin oclusión endovascular aórtica (REBOA), atendidos entre enero de 2015 y junio de 2020, en un centro de trauma nivel I en Cali, Colombia. Se registraron variables demográficas, severidad del trauma, estado clínico, requerimiento transfusional, tiempo hasta CAT+ y CAT alcanzado (1, 2 ó 3). Resultados. Se incluyeron 93 pacientes, se utilizó REBOA en 36 y manejo tradicional en 57. El grupo REBOA presentó mayor volumen de sangrado (mediana de 3000 ml, RIC: 1950-3625 ml) frente al grupo control (mediana de1500 ml, RIC: 700-2975ml) (p<0,001) y mayor cantidad de glóbulos rojos transfundidos en las primeras 6 horas (mediana de 5, RIC:4-9); p=0,015 y en las primeras 24 horas (mediana de 6, RIC: 4-11); p=0,005. No hubo diferencias estadísticamente significativas en número de pacientes CAT+ entre grupos o tiempo hasta alcanzarlo. Sin embargo, el estado CAT+ durante los primeros 30 minutos de la cirugía fue mayor en grupo REBOA (24/36, 66,7 %) frente al grupo control (17/57, 29,8 %; p=0,001), teniendo este mayor tasa de mortalidad intrahospitalaria frente a los pacientes CAT-. Conclusión. El umbral crítico de administración es una herramienta útil en la reanimación hemostática de pacientes con trauma y REBOA, que podría predecir mortalidad precoz.


Introduction. The objective is to describe the utility of the Critical Administration Threshold (CAT) as a tool in hemostatic resuscitation in patients with severe trauma and REBOA. Methods. Retrospective review between January 2015 and June 2020 of adult patients with hemorrhage secondary to trauma with or without REBOA in a level I trauma center in Cali, Colombia. Demographic variables, trauma severity, clinical status, transfusion needs, time to CAT+ and number of CAT achieved (1, 2 or 3) were recorded. Results. Ninety-three patients were included, in which REBOA was used in 36 and traditional management in 57. The REBOA group had a higher bleeding volume (3000 ml), IQR: 1950-3625 ml vs the control group (1500 ml, IQR: 700-2975 ml) (p<0.001) and a higher rate of PRBC units transfused in the first 6 hours (median 5, IQR: 4-9); p=0.015 and in the first 24 hours (median 6, IQR: 4-11); p=0.005. There were no statistically significant differences in the number of CAT+ patients between groups or time to CAT+. However, CAT+ status during the first 30 minutes of surgery was higher in the REBOA Group (24/36, 66.7%) vs. the control group (17/57, 29.8%; p=0.001), having this group a higher in-hospital mortality rate vs. CAT- patients. Conclusion. CAT is a useful tool in the hemostatic resuscitation of patients with trauma and REBOA that could predict early mortality.


Subject(s)
Humans , Wounds and Injuries , Cardiopulmonary Resuscitation , Endovascular Procedures , Aorta , Blood Transfusion , Balloon Occlusion , Hemorrhage
3.
Rio de Janeiro; s.n; 2024. 79 p. ilus, tab.
Thesis in Portuguese | LILACS | ID: biblio-1577747

ABSTRACT

Fundamentos: O aneurisma de aorta ascendente é uma doença silenciosa, com alta mortalidade, cujos fatores relacionados ao seu crescimento não são totalmente conhecidos. O padrão hemodinâmico na aorta ascendente aneurismática pode estar associado a um maior risco de complicação. O objetivo deste estudo foi identificar variáveis do escoamento sanguíneo, determinadas numericamente que poderiam estar associadas ao crescimento do aneurisma de aorta ascendente. Método: Estudo observacional, longitudinal, retrospectivo e unicêntrico. Modelos anatomia-específicos foram obtidos através de imagens de duas angiotomografias de aorta realizadas com intervalo de um a três anos. A partir de estudo numérico por fluidodinâmica computacional, buscou-se padrões de escoamento presentes na primeira angiotomografia associados ao crescimento do aneurisma (definido pelo aumento do volume da aorta ascendente em 5% ou mais), através dos testes qui-quadrado e Exato de Fisher. Admitiu-se erro alfa de 5% e consideraram-se significantes valores de p ≤ 0,05. Resultados: Trinta pacientes foram incluídos no estudo, dos quais 16 (53,3%) apresentaram crescimento do aneurisma. O crescimento do aneurisma foi associado às seguintes variáveis: alta pressão relativa na parede (≥ 100 Pa); alta tensão cisalhante na parede (≥ 7 Pa) combinada com alta pressão relativa; e carga de tensão cisalhante. Conclusão: Este estudo demonstrou associação entre as variáveis de alta pressão relativa e alta tensão cisalhante, obtidas através da fluidodinâmica computacional, e o crescimento do aneurisma de aorta ascendente(AU)


Background: Ascending aortic aneurysm is a silent disease, with high mortality, whose factors related to its growth are not fully known. The hemodynamic pattern in the ascending aorta may be associated with a higher risk of complications. The aim of this study was to identify blood flow variables, numerically obtained that could be related to ascending aortic aneurysm growth. Methods: Observational, longitudinal, single-center study. Specific anatomy models were obtained through images of two angiotomographies of the aorta performed one to three years apart. Based on a numerical study by computational fluid dynamics, flow patterns present in the first angiotomography associated with aneurysm growth (defined as an increase in the volume of the ascending aorta ≥ 5%) were sought, using the chi-square test and Fisher's exact test. An alpha error of 5% was admitted and p values ≤ 0.05 were considered significant. Results: 30 patients were included in the study, of which 16 (53.3%) had aneurysm growth. Aneurysm growth was related to: high relative pressure (≥ 100 Pa); high shear stress (≥ 7 Pa) in the intersection region with the high relative pressure region; and stress load over time. Conclusion: This study demonstrated an association between the variables of high relative pressure and high shear stress, obtained through computational fluid dynamics, and ascending aortic aneurysm growth(AU)


Subject(s)
Humans , Aorta , Computer Simulation , Aneurysm, Ascending Aorta , Hemodynamics , Longitudinal Studies , Computed Tomography Angiography
4.
Zhonghua xinxueguanbing zazhi ; (12): 990-994, 2023.
Article in Chinese | WPRIM | ID: wpr-1045727

ABSTRACT

Objective: To explore the safety and efficacy of transcatheter aortic valve replacement (TAVR) using the "All in One" single-artery/vessel technique. Methods: This is a retrospective study. A total of 30 consecutive patients underwent TAVR using the single artery/vascular technique in Beijing Anzhen Hospital from August to December 2021 were included. Baseline clinical data, operative situation, postoperative outcomes, and incidence of adverse events during hospitalization and at one month post TAVR were analyzed. Results: Mean age was (72.6±9.7) years, 16 were male patients, STS score was (4.73±3.12)%. Four patients were diagnosed as isolated aortic regurgitation (all with tricuspid aortic valves), and 26 patients were diagnosed as aortic stenosis (AS), 10 of whom with tricuspid aortic valves and 16 of whom with bicuspid aortic valves. The single-vessel technique was applied in 3 aortic stenosis cases; the single-artery technique was applied in 27 cases. Echocardiography was performed immediately after procedure and results showed no or trace perivalvular leak in 27 cases and small perivalvular leak in 3 cases; the mean aortic transvalvular gradient of 26 AS patients decreased from (50.4±16.0) mmHg (1 mmHg=0.133 kPa) to (9.4±3.2) mmHg (P<0.001). The procedure time was (64.8±18.9) min. There were no intraoperative death, valve displacement, conversion to surgery, coronary artery occlusion in all 30 patients. There were no major cardiac adverse events such as myocardial infarction or stroke occurred during hospitalization or at follow-up. One-month follow-up echocardiography indicated prosthesis works well. The symptoms were significantly alleviated, and the Kansas City Cardiomyopathy Score (KCCQ score) of all patients increased from 48.1±18.4 to 73.5±17.6 (P<0.001). Conclusions: TAVR using the single artery/vessel technique is safe and feasible. This technique is related to reduced access complications and worthy of wide application.


Subject(s)
Humans , Male , Middle Aged , Aged , Aged, 80 and over , Female , Transcatheter Aortic Valve Replacement , Retrospective Studies , Arteries , Aorta , Aortic Valve Stenosis/surgery
5.
Zhonghua xinxueguanbing zazhi ; (12): 990-994, 2023.
Article in Chinese | WPRIM | ID: wpr-1046050

ABSTRACT

Objective: To explore the safety and efficacy of transcatheter aortic valve replacement (TAVR) using the "All in One" single-artery/vessel technique. Methods: This is a retrospective study. A total of 30 consecutive patients underwent TAVR using the single artery/vascular technique in Beijing Anzhen Hospital from August to December 2021 were included. Baseline clinical data, operative situation, postoperative outcomes, and incidence of adverse events during hospitalization and at one month post TAVR were analyzed. Results: Mean age was (72.6±9.7) years, 16 were male patients, STS score was (4.73±3.12)%. Four patients were diagnosed as isolated aortic regurgitation (all with tricuspid aortic valves), and 26 patients were diagnosed as aortic stenosis (AS), 10 of whom with tricuspid aortic valves and 16 of whom with bicuspid aortic valves. The single-vessel technique was applied in 3 aortic stenosis cases; the single-artery technique was applied in 27 cases. Echocardiography was performed immediately after procedure and results showed no or trace perivalvular leak in 27 cases and small perivalvular leak in 3 cases; the mean aortic transvalvular gradient of 26 AS patients decreased from (50.4±16.0) mmHg (1 mmHg=0.133 kPa) to (9.4±3.2) mmHg (P<0.001). The procedure time was (64.8±18.9) min. There were no intraoperative death, valve displacement, conversion to surgery, coronary artery occlusion in all 30 patients. There were no major cardiac adverse events such as myocardial infarction or stroke occurred during hospitalization or at follow-up. One-month follow-up echocardiography indicated prosthesis works well. The symptoms were significantly alleviated, and the Kansas City Cardiomyopathy Score (KCCQ score) of all patients increased from 48.1±18.4 to 73.5±17.6 (P<0.001). Conclusions: TAVR using the single artery/vessel technique is safe and feasible. This technique is related to reduced access complications and worthy of wide application.


Subject(s)
Humans , Male , Middle Aged , Aged , Aged, 80 and over , Female , Transcatheter Aortic Valve Replacement , Retrospective Studies , Arteries , Aorta , Aortic Valve Stenosis/surgery
6.
Rev. Ciênc. Méd. Biol. (Impr.) ; 21(2): 180-186, out.2022. tab, fig
Article in Portuguese | LILACS | ID: biblio-1399804

ABSTRACT

Introdução: estudos sugerem forte associação da exposição perinatal e pós-natal a dietas ricas em gordura e complicações cardiovasculares. Objetivo: avaliar os efeitos da exposição a dieta hiperlipídica no período perinatal e pós desmame sobre indicadores de risco cardiometabólico e alterações histomorfometrica na aorta em ratos. Metodologia: Ratas Wistar foram separadas em grupos de acordo com a dieta durante a gestação e lactação: dieta controle (n=3) e dieta hiperlipídica (n=3). No 21º dia de vida filhotes machos foram divididos em subgrupos (n=6): CC: formado por ratos expostos a dieta controle durante toda a vida; CH: formado por ratos cuja a mãe consumiu dieta controle e após o desmame os filhotes consumiram dieta hiperlipídica; HH: formado por filhotes expostos a dieta hiperlipídica durante toda a vida e HC: formado por ratos cuja a mãe consumiu dieta hiperlipídica e após o desmame os filhotes consumiram dieta controle. No 60º dia de vida, IMC, índices aterogênicos, proteína C reativa e histomorfometria da aorta dos descendentes foram avaliados. Resultados: o grupo HC apresentou maior IMC em comparação aos grupos HH e CH (p= 0,0004). A razão colesterol total / HDL-colesterol foi maior para o grupo CH comparado ao CC e HC (p = 0,016). Coeficiente aterogênico (p = 0,003), espessura da aorta (p = 0,003) e quantidade de lamelas elásticas (p = 0,0002) foram maiores nos grupos CH e HH em comparação a CC e HC. Conclusão: exposição a dieta hiperlipídica nos períodos perinatal e pós desmame aumentou o risco cardiometabólico e alterou a histomorfometria aórtica de ratos.


Background: studies suggest a strong association of perinatal and postnatal exposure to high-fat diets and cardiovascular complications. Objective: to evaluate the effects of exposure to a high-fat diet in the perinatal and post-weaning period on indicators of cardiometabolic risk and aorta histomorphometric changes in the rats. Methodology: Wistar rats were separated into groups according to the diet during pregnancy and lactation: control diet (n=3) and high fat diet (n=3). On the 21st day of life, male pups were divided into subgroups (n=6): CC: formed by rats exposed to a control diet for all life; CH: formed by rats whose mother consumed a control diet and after weaning the pups consumed a high-fat diet; HH: formed by pups exposed to a high-fat diet for all life and HC: formed by rats whose mother consumed a high-fat diet and after weaning the pups consumed a control diet. On the 60th day of life, BMI, atherogenic indices, C-reactive protein and histomorphometry of the aorta of the offspring were evaluated. Results: the HC group showed higher BMI compared to the HH and CH groups (p=0.0004). The total cholesterol / HDL-cholesterol ratio was higher for the CH group compared to CC and HC (p = 0.016). Atherogenic coefficient (p= 0,003), aortic thickness (p = 0.003) and amount of elastic lamellae (p = 0.0002) were higher in CH and HH groups compared to CC and HC. Conclusion: exposure to a high-fat diet in the perinatal and post-weaning periods increased cardiometabolic risk and altered aortic histomorphometry in rats.


Subject(s)
Animals , Male , Female , Rats , Aorta , Rats , Rats, Wistar , Diet, High-Fat , Lipids
7.
Int. j. morphol ; 40(3): 697-705, jun. 2022. ilus, tab
Article in English | LILACS | ID: biblio-1385688

ABSTRACT

SUMMARY: An association between certain food additives and chronic diseases is reported. Current study determined whether administering toxic doses of the food additive monosodium glutamate (MSG) into rats can induce aortopathy in association with the oxidative stress and inflammatory biomarkers upregulation and whether the effects of MSG overdose can be inhibited by vitamin E. MSG at a dose of (4 mg/kg; orally) that exceeds the average human daily consumption by 1000x was administered daily for 7 days to the rats in the model group. Whereas, rats treated with vitamin E were divided into two groups and given daily doses of MSG plus 100 mg/ kg vitamin E or MSG plus 300 mg/kg vitamin E. On the eighth day, all rats were culled. Using light and electron microscopy examinations, a profound aortic injury in the model group was observed demonstrated by damaged endothelial layer, degenerated smooth muscle cells (SMC) with vacuoles and condensed nuclei, vacuolated cytoplasm, disrupted plasma membrane, interrupted internal elastic lamina, clumped chromatin, and damaged actin and myosin filaments. Vitamin E significantly protected aorta tissue and cells as well as inhibited MSG-induced tissue malondialdehyde (MDA), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). The highest used vitamin E dosage was more effective. Additionally, a significant correlation was observed between the aortic injury degree and tissue MDA, TNF-α, IL-6, and superoxide dismutase (SOD) levels (p=0.001). Vitamin E effectively protects against aortopathy induced by toxic doses of MSG in rats and inhibits oxidative stress and inflammation.


RESUMEN: Se reporta una asociación entre ciertos aditivos alimentarios y enfermedades crónicas. El objetivo de este estudio fue determinar si la administración de dosis tóxicas del aditivo alimentario glutamato monosódico (MSG) en ratas puede inducir aortopatía en asociación con el estrés oxidativo y la regulación positiva de los biomarcadores inflamatorios y si el efecto de una sobredosis de MSG se puede inhibir con vitamina E. Se administró MSG diariamente durante 7 días una dosis de (4 g/kg; por vía oral) que excede el consumo diario humano promedio, en 1000x a las ratas del grupo modelo. Mientras que las ratas tratadas con vitamina E se dividieron en dos grupos y se administraron dosis diarias de MSG más 100 mg/kg de vitamina E o MSG más 300 mg/kg de vitamina E. Todas las ratas fueron sacrificadas en el octavo día. Usando exámenes de microscopía óptica y electrónica, se observó una lesión aórtica profunda en el grupo modelo demostrada por una capa endotelial dañada, células musculares lisas degeneradas (SMC) con vacuolas y núcleos condensados, citoplasma vacuolado, membrana plasmática rota, lámina elástica interna interrumpida, cromatina agrupada y filamentos de actina y miosina dañados. La vitamina E protegió significativamente el tejido y las células de la aorta, además de inhibir el malondialdehído tisular (MDA) inducido por MSG, la interleucina-6 (IL-6) y el factor de necrosis tumoral alfa (TNF-α). La dosis más alta de vitamina E utilizada fue más efectiva. Además, se observó una correlación significativa entre el grado de lesión aórtica y los niveles tisulares de MDA, TNF-α, IL-6 y superóxido dismutasa (SOD) (p=0,001). La vitamina E efectivamente protege contra la aortopatía inducida por dosis tóxicas de MSG en ratas e inhibe el estrés oxidativo y la inflamación.


Subject(s)
Animals , Rats , Aorta/drug effects , Aortic Diseases/chemically induced , Sodium Glutamate/toxicity , Vitamin E/pharmacology , Aorta/pathology , Sodium Glutamate/administration & dosage , Vitamin E/administration & dosage , Microscopy, Electron , Interleukin-6/antagonists & inhibitors , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Rats, Sprague-Dawley , Oxidative Stress/drug effects , Disease Models, Animal , Malondialdehyde/antagonists & inhibitors
8.
Article in English | WPRIM | ID: wpr-939832

ABSTRACT

Transcatheter aortic valve replacement (TAVR) has emerged as a viable treatment option for patients with severe aortic stenosis regardless of its surgical risk stratification (Otto et al., 2021). Aortic angulation is usually measured as the angle between the horizontal and the aortic annulus planes based on preproced‍ural multidetector computed tomography (MDCT) (Al-Lamee et al., 2011). Extremely horizontal aorta, defined as an aortic angulation greater than 70°, is an unfavorable anatomic structure that poses particular technical challenges for TAVR. Abramowitz et al. (2016) have proved that an extremely horizontal aorta increased the risk of procedural complications, such as lower device success rates, more moderate or even severe perivalvular leakage (PVL), and the need for second valve implantation. Because of the long stent frame, inflexibility, and non-steerability, it is challenging to pass the delivery system of self-expanding valves (SEVs) through an extremely horizontal aorta. As a result, patients with an extremely horizontal aorta have always been excluded from the clinical trials of TAVR, and transfemoral (TF)-TAVR with SEV is considered as an "off-label" use of TAVR (Adams et al., 2014; Kaneko et al., 2020). Herein, we present a technically difficult case, in which a patient with an extremely horizontal aorta underwent TF-TAVR with SEV by applying a unique apical-to-femoral rail strategy.


Subject(s)
Humans , Aorta , Lower Extremity , Multidetector Computed Tomography , Transcatheter Aortic Valve Replacement
9.
Chin. med. j ; Chin. med. j;(24): 441-446, 2022.
Article in English | WPRIM | ID: wpr-927526

ABSTRACT

BACKGROUND@#Massive bleeding is the main concern for the management of placenta percreta (PP). Intra-abdominal aortic balloon occlusion (IABO) is one method for pelvic devascularization, but the efficacy of IABO is uncertain. This study aims to investigate the outcomes of IABO in PP patients.@*METHODS@#We retrospectively reviewed the clinical data of PP cases from six tertiary centers in China between January 2011 and December 2015. PP cases with/without the use of IABO were analyzed. Propensity score matching analysis was performed to reduce the effect of selection bias. Postpartum hemorrhage (PPH) and the rate of hysterectomy, as well as neonatal outcomes, were analyzed.@*RESULTS@#One hundred and thirty-two matched pairs of patients were included in the final analysis. Compared with the control group, maternal outcomes, including PPH (68.9% vs. 87.9%, χ2 = 13.984, P < 0.001), hysterectomy (8.3% vs. 65.2%, χ2 = 91.672, P < 0.001), and repeated surgery (1.5% vs. 12.1%, χ2 = 11.686, P = 0.001) were significantly reduced in the IABO group. For neonatal outcomes, Apgar scores at 1 minute (8.67 ± 1.79 vs. 8.53 ± 1.68, t = -0.638, P = 0.947) and 5 minutes (9.43 ± 1.55 vs. 9.53 ± 1.26, t = 0.566, P = 0.293) were not significantly different between the two groups.@*CONCLUSIONS@#IABO can significantly reduce blood loss, hysterectomies, and repeated surgeries. This procedure has not shown harmful effects on neonatal outcomes.


Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Aorta , Balloon Occlusion/methods , Blood Loss, Surgical , Hysterectomy , Placenta Accreta/surgery , Placenta Previa/surgery , Postpartum Hemorrhage , Retrospective Studies
10.
Arq. bras. cardiol ; 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
11.
Int. j. morphol ; 40(5): 1236-1241, 2022. ilus, tab
Article in English | LILACS | ID: biblio-1405279

ABSTRACT

SUMMARY: Statins inhibit cholesterol synthesis, but also have other pleiotropic effects. There are indications that they affect macrophage survival trough the regulation of apoptosis. We analyzed 50 samples of aortic wall, selected based on statins in patients' therapy (n=25, Th-S group) or statin-free therapy (n=25, Th-nonS group). Each group had 5 samples of healthy aortic tissue, 10 samples of mild and 10 samples of severe atherosclerotic changes in aortic wall. Tissue was stained with hematoxylin-eosin and immunohistochemical methods (anti-Bcl-2 antibody). Presence of Bcl2-positive macrophages (Bcl-2+ MP) was determined semiquantitatively, and data were processed in Microsoft Excell and IMB SPSS 23 Statistics. 60 % of patients in the Th-S group had a mild increase of Bcl-2+ MP The use of statins leads to a significantly more frequent increase in Bcl2+ macrophages in the intima of the healthy aortic tissue. Analysis of all aortic samples with pathohistological diagnosis showed that statin therapy was statistically significantly more often leading to a markedly increased presence of Bcl-2+ MP. In the media, all samples of the Th-S group have a mild increase of Bcl-2+ MP, and in adventitia 40 % of patients. The use of statins more often leads to a markedly increased presence of Bcl-2+ MP in aortic tissue with diagnosed mild and severe atherosclerosis. In samples of severe atherosclerosis, statins lead to a markedly increased presence of Bcl-2+ MP in the parts of the plaque towards the intima and towards the media. Statins lead to an increased presence of Bcl-2+ macrophages, prolong their life, both in healthy and atherosclerotic altered aortic tissue. This indicates potentiation of inflammation and damage to the aortic wall, and calls into question the positive effect of statins on the aortic wall with atherosclerosis.


RESUMEN: Las estatinas inhiben la síntesis de colesterol, pero también tienen otros efectos pleiotrópicos. Hay indicios de que afectan la supervivencia de los macrófagos a través de la regulación de la apoptosis.Se analizaron 50 muestras de pared aórtica, seleccionadas en base a estatinas en tratamiento de pacientes (n=25, grupo Th-S) o en tratamiento libre de estatinas (n=25, grupo Th- nonS). Cada grupo tenía 5 muestras de tejido aórtico sano, 10 muestras de cambios ateroscleróticos leves y 10 muestras de cambios ateroscleróticos severos en la pared aórtica. El tejido se tiñó con hematoxilina-eosina y métodos inmunohistoquímicos (anticuerpo anti-Bcl-2). La presencia de macrófagos positivos para Bcl2 (Bcl- 2+ MP) se determinó semicuantitativamente y los datos se procesaron en Microsoft Excell e IMB SPSS 23 Statistics. El 60 % de los pacientes del grupo Th-S tuvo un aumento leve de Bcl-2+ MP. El uso de estatinas conduce a un aumento significativamente más frecuente de macrófagos Bcl2+ en la íntima del tejido aórtico sano. El análisis de todas las muestras aórticas con diagnóstico anatomopatológico mostró que la terapia con estatinas fue significativamente más frecuente desde el punto de vista estadístico, lo que condujo a una presencia marcadamente mayor de Bcl-2+ MP. En los medios, todas las muestras del grupo Th-S tienen un leve aumento de Bcl-2+ MP, y en adventicia en el 40 % de los pacientes. El uso de estatinas con mayor frecuencia conduce a una presencia marcadamente mayor de MP Bcl-2+ en el tejido aórtico con aterosclerosis leve y grave diagnosticada. En muestras de aterosclerosis severa, las estatinas conducen a una presencia aumentada de Bcl-2+ MP en las partes de la placa hacia la íntima y hacia la media. Las estatinas conducen a una mayor presencia de macrófagos Bcl-2+, prolongan su vida, tanto en tejido aórtico sano como aterosclerótico alterado. Esto indica la potenciación de la inflamación y el daño a la pared aórtica y pone en duda el efecto positivo de las estatinas en la pared aórtica con aterosclerosis.


Subject(s)
Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Atherosclerosis/metabolism , Aorta/drug effects , Risk Factors , Apoptosis/drug effects , Risk Assessment , Genes, bcl-2/physiology , Atherosclerosis/drug therapy , bcl-X Protein/metabolism , Plaque, Atherosclerotic , Macrophages/drug effects
13.
Rev. bras. cir. cardiovasc ; Rev. bras. cir. cardiovasc;36(6): 817-821, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1351676

ABSTRACT

Abstract The coarctation of the aorta is a relatively highly prevalent congenital heart disease and may be diagnosed as an underline cause of hypertension in adolescents and adults. The gold standard treatment for coarctation of the aorta in these patients is being replaced - from open surgery to endovascular therapy. Some prostheses have been developed to treat the coarctation with less acute and chronic complications. The Dominus® Coarctation Aorta (Braile Biomédica) is the first self-expandable prosthesis created specifically to treat coarctation of the aorta, reducing possible acute complications, like aortic rupture or aortic dissection. Here, we discuss the step-by-step method for using this prosthesis.


Subject(s)
Humans , Adolescent , Adult , Aortic Coarctation/surgery , Aortic Coarctation/complications , Aortic Coarctation/diagnostic imaging , Aortic Dissection/complications , Aorta/surgery , Blood Vessel Prosthesis/adverse effects , Stents/adverse effects , Treatment Outcome
14.
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 , Aortic Dissection , Aorta , Chest Pain , Angiography , Headache
15.
Int. j. morphol ; 39(4): 1042-1047, ago. 2021. ilus, tab
Article in English | LILACS | ID: biblio-1385449

ABSTRACT

SUMMARY: Formaldehyde (FA) is a toxic substance used frequently in the field of medicine as well as in many industrial areas. Especially people working in the field of anatomy, histology, and pathology are in high risk group because of the use of the FA. Studies showing the effects of FA on the cardiovascular system are few in number. The purpose of the present study was to investigate the effects of FA exposure, which we believe can cause oxidative stress, on the heart and aorta with various biochemical analyses. A total of 24 Wistar Albino rats were used in our study. We divided the rats into 3 groups as the Control Group (CG), the group exposed to low-dose FA (avg. 1 ppm) (DDG) Group, and the group exposed to high-dose FA (avg. 10 ppm) (YDG). At the end of the subchronic FA exposure, the blood samples, heart and aorta tissues of the rats were taken and subjected to biochemical analyses. As a result of the analyses, statistically significant differences were detected between CG (2.96?0.85 ng/mg), and HDG (2.08?0.77 ng/mg) in aortic tissues in TXNIP analysis (p<0.05). In heart tissues, significant differences were detected between CG (0.73?0.27 ng/mg) and LDG (1.13?0.22 ng/mg) (p<0.05). Statistically significant differences were also detected between CG (1.98?0.31 mM/ml) and YDG (2.43?0.31 mM/ml) in serum MDA analyses (p<0.05). It was shown that subchronic application of FA to LDG rats through inhalation had no effects on apoptosis markers in heart tissues. More studies are required to show FA toxicity and the mechanism of action of pathology on the cardiovascular system. We believe that our study will contribute to clarifying the roles of mild and subchronic exposure of FA in heart and aortic tissues in terms of oxidative stress risk.


RESUMEN: El formaldehído es una sustancia tóxica que se utiliza con frecuencia en el campo de la medicina, así como en muchas áreas industriales. Especialmente las personas que trabajan en el area de la anatomía, y patología se encuentran en el grupo de alto riesgo debido al uso de esta sustancia. Pocos son los estudios que muestran los efectos del formaldehído en el sistema cardiovascular. El propósito del presente estudio fue investigar a través de análisis bioquímicos, los efectos de la exposición a formaldehído, que podría causar estrés oxidativo, en el corazón y la aorta. Se utilizaron un total de 24 ratas Albinas Wistar. Dividimos a las ratas en 3 grupos: grupo control (GC), grupo expuesto a dosis bajas de AG (promedio 1 ppm) (DDG) y grupo expuesto a dosis altas de AG (promedio 10 ppm) (YDG). Al término de la exposición a FA subcrónica, se tomaron muestras de sangre, tejido cardíaco y aorta de las ratas y se sometieron a análisis bioquímicos. Como resultado de los análisis, se detec- taron diferencias estadísticamente significativas entre GC (2,96 ? 0,85 ng / mg) y HDG (2,08 ? 0,77 ng / mg) en los tejidos aórticos en el análisis TXNIP (p <0,05). En los tejidos cardíacos se detectaron diferencias significativas entre GC (0,73 ? 0,27 ng / mg) y LDG (1,13 ? 0,22 ng / mg) (p <0,05). También se detectaron diferencias estadísticamente significativas entre CG (1,98 ? 0,31 mM / ml) y YDG (2,43 ? 0,31 mM / ml) en los análisis de MDA en suero (p <0,05). Se demostró que la aplicación subcrónica de formaldehído a ratas LDG a través de la inhalación no tuvo efectos sobre los marcadores de apoptosis en los tejidos del corazón. Se requieren más estudios para demostrar la toxicidad de los AG y el mecanismo de acción de la patología en el sistema cardiovascular. Creemos que nuestro estudio contribuirá a aclarar las funciones de la exposición leve y subcrónica de formaldehído en los tejidos cardíacos y aórticos en términos de riesgo al estrés oxidativo.


Subject(s)
Animals , Rats , Aorta/drug effects , Oxidative Stress/drug effects , Formaldehyde/pharmacology , Heart/drug effects , Aorta/chemistry , Thioredoxins/analysis , Biochemical Phenomena , Inhalation , Rats, Wistar , Peroxidase/analysis , Formaldehyde/administration & dosage , Hydroxyproline/analysis , Myocardium/chemistry
16.
Rev. bras. cir. cardiovasc ; Rev. bras. cir. cardiovasc;36(4): 515-521, July-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1347148

ABSTRACT

Abstract Objectives: Ischemia-reperfusion injury is an important cause of multiple organ failure in cardiovascular surgery. Our aim is to investigate the effect of the probiotic Saccharomyces boulardii on oxidative stress, inflammatory response, and lung injury in an experimental model of aortic clamping. Methods: Twenty-one Wistar rats were randomized into three groups (n=7). Control group animals received saline gavage for a week before undergoing median laparotomy. In other groups, supraceliac aorta was clamped for 45 minutes to induce ischemia followed by reperfusion for 60 minutes. In the ischemia-reperfusion group, saline gavage was given preoperatively for one week. Ischemia-reperfusion+probiotic group rats received probiotic gavage for seven days before aortic clamping. The levels of oxidative stress markers and pro-inflammatory cytokines were determined in both serum and lung tissue samples. Ileum and lung tissues were harvested for histological examination. Results: Ischemia-reperfusion caused severe oxidative damage and inflammation evident by significant increases in malondialdehyde and cytokine levels (tumor necrosis factor alpha and interleukin-1 beta) and decreased glutathione levels in both serum and lung tissues. There was severe histological tissue damage to the lung and ileum in the ischemia-reperfusion group. Probiotic pretreatment before aortic clamping caused significant suppression of increases in serum and lung tissue malondialdehyde and tumor necrosis factor alpha levels. Histological damage scores in tissue samples decreased in the ischemia-reperfusion+probiotic group (P<0,005). Conclusions: Oral supplementation of probiotic S. boulardii before supraceliac aortic ischemia-reperfusion in rats alleviates lung injury by reducing oxidative stress, intestinal cellular damage, and modulation of inflammatory processes.


Subject(s)
Animals , Rats , Reperfusion Injury/prevention & control , Probiotics/therapeutic use , Lung Injury , Saccharomyces boulardii , Aorta , Cytokines , Rats, Wistar , Oxidative Stress , Lung
17.
Rev. bras. cir. cardiovasc ; Rev. bras. cir. cardiovasc;36(4): 535-549, July-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1347168

ABSTRACT

Abstract Thoracic aortic diseases contribute to a major part of cardiac surgeries. The severity of pathologies varies significantly from emergency and life-threatening to conservatively managed conditions. Life-threatening conditions include type A aortic dissection and rupture. Aortic aneurysm is an example of a conservatively managed condition. Pathologies that affect the arterial wall can have a profound impact on the presentation of such cases. Several risk factors have been identified that increase the risk of emergency presentations such as connective tissue disease, hypertension, and vasculitis. The understanding of aortic pathologies is essential to improve management and clinical outcomes.


Subject(s)
Humans , Aortic Aneurysm , Aortic Aneurysm, Thoracic/surgery , Thoracic Surgical Procedures , Aortic Dissection/surgery , Aorta
18.
Rev. cir. (Impr.) ; 73(4): 514-518, ago. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1388846

ABSTRACT

Resumen Introducción: La hemorragia no compresible de torso, actualmente tiene una alta morbimortalidad aún en los centros de referencia más especializados. El REBOA es una herramienta emergente que se utiliza como control hemostático precoz en este tipo de pacientes. Caso Clínico: Presentamos el caso de una paciente femenina de 25 años que sufre un trauma pélvico grave tras caer de altura. Ingresa hemodinámicamente inestable por lo cual se activa protocolo de transfusión masiva y realiza acceso arterial femoral común derecho. Al presentar una respuesta transitoria a la reanimación, se instala balón de REBOA en zona 3, logrando aumentar presión sistólica hasta 130 mmHg, trasladando posteriormente a quirófano. Se realiza packing pélvico preperitoneal y fijación externa, desinflando el balón después de 29 min en zona 3. La paciente sale a unidad de cuidados intensivos sin drogas vasoactivas, para completar cirugía a las 48 h y fijación definitiva 6 días después. La paciente evoluciona en buenas condiciones generales.


Introduction: Non-compressible torso hemorrhage currently has a high morbidity and mortality even in the most specialized referral centers. REBOA is an emerging tool that is used as early hemostatic control in this type of patient. Clinical Case: We present the case of a 25-year-old female patient who suffers severe pelvic trauma after falling from a height. He was admitted hemodynamically unstable, for which a massive transfusion protocol was activated and a right common femoral arterial access was performed. After presenting a transient response to resuscitation, a REBOA balloon was installed in zone 3, increasing systolic pressure up to 130 mmHg, later transferring to the operating room. Preperitoneal pelvic packing and external fixation were performed, deflating the balloon after 29 minutes in zone 3. The patient left the intensive care unit without vasoactive drugs, to complete surgery 48 hours later and definitive fixation 6 days later. The patient evolves in good general condition.


Subject(s)
Humans , Female , Adult , Aorta/surgery , Balloon Occlusion/methods , Endovascular Procedures/methods , Resuscitation/methods , Hemorrhage/therapy
20.
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
SELECTION OF CITATIONS
SEARCH DETAIL