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1.
Int. j. morphol ; 37(2): 647-653, June 2019. graf
Article in English | LILACS | ID: biblio-1002271

ABSTRACT

Excessive consumption of carbohydrate and fat increases the risk of cardiovascular disease. We sought to determine the potential ultrastructural alterations in large blood vessels induced by a high fat and fructose diet (HFD) in a rat model of prediabetes. Rats were either fed with HFD (model group) or a standard laboratory chow (control group) for 15 weeks before being sacrificed. The harvested thoracic aorta tissues were examined using transmission electron microscopy (TEM), and blood samples were assayed for biomarkers of pre-diabetes.TEM images showed that HFD induced profound pathological changes to the aortic wall layers, tunica intima and tunica media ultrastructures in the pre-diabetic rats as shown by apoptotic endothelial cells with pyknotic nuclei, damaged basal lamina, deteriorated smooth muscle cells that have irregular plasma membranes, shrunken nucleus with clumped nuclear chromatin, damaged mitochondria and few cytoplasmic lipid droplets and vacuoles. In addition, HFD significantly (p<0.05) decreased adiponectin and increased biomarkers of lipidemia, glycaemia, inflammation, oxidative stress, vascular injury such as soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion protein 1 (sVCAM-1), endothelin-1 (ET-1), and coagulation and thrombosis such as Von Willebrand factor (vWF), and plasminogen activator inhibitor-1 (PAI-1), compared to normal levels of these parameters in the control group. Thus, we demonstrated that feeding rats with a HFDisable to develop a pre-diabetic animal model that is useful to study the aortic ultrastructural alterations.


El consumo excesivo de carbohidratos y grasas aumenta el riesgo de enfermedades cardiovasculares. Intentamos determinar las posibles alteraciones ultraestructurales en los grandes vasos sanguíneos, inducidas por una dieta alta en grasas y fructosa (HFD) en un modelo de rata de prediabetes. Las ratas se alimentaron con HFD (grupo modelo) o una comida de laboratorio estándar (grupo de control) durante 15 semanas antes de ser sacrificadas. Los tejidos de la aorta torácica recolectados se examinaron mediante microscopía electrónica de transmisión (TEM) y las muestras de sangre se analizaron para detectar biomarcadores de prediabetes. Las imágenes TEM mostraron que HFD indujo cambios patológicos profundos en las capas de la pared aórtica, túnica íntima y túnica media en la ratas pre-diabéticas como lo muestran las células endoteliales apoptóticas con núcleos picnóticos, lámina basal dañada, células musculares lisas deterioradas que tienen membranas plasmáticas irregulares, núcleo encogido con cromatina nuclear aglomerada, mitocondrias dañadas y pocas gotitas lipídicas citoplásmicas y vacuolas. Además, HFD presentó disminución significativa de adiponectina (p <0,05), y aumento de biomarcadores de lipidemia, glucemia, inflamación, estrés oxidativo, lesión vascular como la molécula de adhesión intercelular soluble 1 (sICAM-1), proteína de adhesión de células vasculares soluble 1 (sVCAM-1), endotelina 1 (ET-1), y la coagulación y la trombosis, como el factor de Von Willebrand (vWF), y el inhibidor del activador del plasminógeno-1 (PAI -1), en comparación con los niveles normales de estos parámetros en el grupo de control. Por tanto, la alimentación de ratas con HFD es capaz de desarrollar un modelo animal prediabético que es útil para estudiar las alteraciones ultraestructurales aórticas.


Subject(s)
Animals , Aorta, Thoracic/pathology , Aorta, Thoracic/ultrastructure , Prediabetic State/pathology , Aorta/pathology , Aorta/ultrastructure , Prediabetic State/metabolism , Dietary Fats/adverse effects , Rats, Sprague-Dawley , Microscopy, Electron, Transmission , Disease Models, Animal , Vascular System Injuries/etiology , Vascular System Injuries/pathology , Fructose
2.
Rev. bras. cir. cardiovasc ; 31(1): 52-59, Jan.-Feb. 2016. tab, graf
Article in English | LILACS | ID: lil-778374

ABSTRACT

Abstract Aberrant origin of vertebral artery is rare. The anatomical features and clinical significance of this lesion remain to be clarified. A comprehensive collection of the pertinent literature resulted in a cohort of 1286 cases involving 955 patients and 331 cadavers. There were more left than right and more unilateral than bilateral aberrant vertebral arteries. Patients with aberrant origin of vertebral artery were often asymptomatic and in only 5.5% of the patients their symptoms were probably related to the aberrant origin of vertebral artery. The acquired cardiovascular lesions were present in 9.5% of the patients, 20.9% of which were vertebral artery-associated lesions. Eight (0.8%) patients had a vertebral artery dissection. Logistic regression analysis showed significant regressions between bovine trunk and left vertebral artery (P=0.000), between the dual origins of vertebral artery and cerebral infarct/thrombus (P=0.041), between associated alternative congenital vascular variants and cervical/aortic dissection/atherosclerosis (P=0.008). Multiple logistic regression demonstrated that side of the aberrant origin of vertebral artery (left vertebral artery) (P=0.014), arch branch pattern (direct arch origin) (P=0.019), presence of the common trunk (P=0.019), associated acquired vascular disorder (P=0.034) and the patients who warranted management (P=0.000) were significant risk predictors for neurological sequelea. The patients with neurological symptoms and those for neck and chest operations/ interventions should be carefully screened for the possibility of an aberrant origin of vertebral artery. The results from the cadaver metrology study are very helpful in the design of the aortic stent. The arch branch pattern has to be taken into consideration before any maneuver in the local region so as to avoid unexpected events in relation to aberrant vertebral artery.


Subject(s)
Female , Humans , Male , Aorta, Thoracic/abnormalities , Subclavian Artery/abnormalities , Vertebral Artery/abnormalities , Aorta, Thoracic/pathology , Cardiovascular Diseases/etiology , Cardiovascular Diseases/pathology , Nervous System Diseases/etiology , Nervous System Diseases/pathology , Risk Factors , Subclavian Artery/pathology , Vascular Malformations/complications , Vertebral Artery Dissection/etiology , Vertebral Artery Dissection/pathology , Vertebral Artery/pathology
4.
Int. j. morphol ; 33(4): 1411-1418, Dec. 2015. ilus
Article in English | LILACS | ID: lil-772331

ABSTRACT

This study aims at establishing whether transverse diameter (TD) and cross sectional-area (CSA) of the ascending aorta (AA), descending aorta (DA) and pulmonary trunk (PT) measured by computerized tomographic angiography (CTA) altered by sex, age, hypertension, smoking and diabetes. CTA examinations of the TD and CSA of the AA, DA and PT of 100 patients aged 49.5±16.9 years (range 16­78 years) selected between January 2009 to May 2011 from those referred to Radiology Department, Jordan University Hospital, Faculty of Medicine, University of Jordan, Amman, Jordan for advanced evaluation. Measurements were made in the axial plane at the upper border of the six thoracic vertebrae. Patients were divided into three age groups. Significance of differences in parameters between age groups was calculated. Assessment ratios were considered. It was found that parameters of the three arteries were significantly larger in men than in women (P= < 0.05) and increased with age. Hypertension increased diameters of AA and DA in both genders (P= 0.001) and of PT in men (P= 0.01). Smoking significantly decreased parameters of PT in men (P= 0.01). Diabetes increased parameters of the three arteries in both genders, significantly increased parameters of PT in men (P= <0.05) and parameters of DA in women (P= <0.05). It is concluded that studied parameters were larger in men and increased with age of our patients. Distinctive differences in measurements appeared in hypertensive, smokers, and diabetic patients.


El objetivo fue determinar si el sexo, edad, hipertensión, tabaquismo y la diabetes alteran el diámetro transversal (DT) y área transversal (AT) de la parte ascendente de la aorta (AA), parte descendente de la aorta (AD) y tronco pulmonar (TP), medidos por angiografía por tomografía computadorizada (ATC). Exámenes de ATC de 100 pacientes de 49,5±16,9 años (rango 16­78 años) fueron seleccionados entre enero del año 2009 a mayo del año 2011 por el Departamento de Radiología, Hospital de la Universidad de Jordania, Facultad de Medicina de la Universidad de Jordania, Amman, Jordania para una evaluación avanzada del DT y AT de la AA, AD y TP. Las mediciones se realizaron en el plano axial en el margen superior de las seis vértebras torácicas. Los pacientes fueron divididos en tres grupos según edad. Se determinó la existencia de significancia estadística de los diferentes parámetros entre los grupos etarios. La evaluación de las razones también fueron consideradas. Se encontró que los parámetros de las tres arterias fueron significativamente mayores en los hombres que en las mujeres (p= <0,05) y que aumentaron con la edad. La hipertensión aumentó los diámetros de la AA y AD en ambos sexos (p= 0,001) y del TP en los hombres (p= 0,01). En fumadores disminuyeron significativamente los parámetros del TP en los hombres (p= 0,01). La diabetes aumentó los parámetros de las tres arterias en ambos sexos. Ademas, aumentaron significativamente los parámetros del TP en los hombres (p= <0,05) y los parámetros de la AD en las mujeres (p = <0,05). Se concluye que los parámetros estudiados eran mayores en los hombres y aumentaron con la edad de nuestros pacientes. Diferencias distintivas en las mediciones aparecieron en hipertensos, fumadores y pacientes diabéticos.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Aorta/diagnostic imaging , Aorta/pathology , Pulmonary Artery/pathology , Age Factors , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/pathology , Computed Tomography Angiography , Diabetes Mellitus/pathology , Hypertension/pathology , Pulmonary Artery/diagnostic imaging , Sex Factors , Tobacco Use Disorder/pathology
5.
Ann Card Anaesth ; 2014 Oct; 17(4): 311- 313
Article in English | IMSEAR | ID: sea-153707

ABSTRACT

We present a case report of a 55‑year‑old lady who presented with progressive dysphagia and was diagnosed with a Kommerell’s aneurysm and a right‑sided aortic arch. This case report outlines our management strategy and the challenges encountered during the perioperative period in a patient with this rare anomaly.


Subject(s)
Aorta, Thoracic/pathology , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/surgery , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging/methods , Middle Aged , Tomography, X-Ray Computed/methods
6.
Rev. bras. ter. intensiva ; 25(4): 345-347, Oct-Dec/2013. graf
Article in Portuguese | LILACS | ID: lil-701404

ABSTRACT

Descrevemos o caso de um paciente com hematoma intramural e trombo flutuante após ressuscitação cardiopulmonar. Esse homem, de 92 anos de idade, teve uma parada cardíaca causada por fibrilação atrial e testemunhas iniciaram imediatamente manobras manuais de ressuscitação cardiopulmonar. Ao ser admitido no hospital, o paciente apresentava-se em choque cardiogênico, sendo, então, imediatamente submetido a ecocardiografia transesofágica. Além de uma parede anterior acinética, o exame da aorta torácica descendente mostrou um hematoma intramural e um trombo intra-aórtico flutuante a uma distância de 40cm do arco dental. Não havia dissecção da aorta. O trombo foi atribuído à compressão aórtica durante a ressuscitação cardiopulmonar. Embora o trombo aórtico e o hematoma intramural não tenham se associado a qualquer complicação nesse paciente, a inserção de um balão intra-aórtico poderia ter levado a uma ruptura da aorta ou a eventos embólicos. Recomenda-se a realização de ecocardiografia transesofágica, quando disponível, antes da inserção de um balão intra-aórtico de contrapulsação em pacientes submetidos à ressuscitação cardiopulmonar.


We describe the case of a patient with an intramural hematoma and floating thrombus after cardiopulmonary resuscitation. The 92-year old man had a cardiac arrest due to ventricular fibrillation and witnesses immediately initiated manual cardiopulmonary resuscitation. Transesophageal echocardiography was performed immediately on hospital admission because the patient was in cardiogenic shock. In addition to an akinetic anterior wall, examination of the descending thoracic aorta demonstrated an intramural hematoma and a floating intra-aortic thrombus at a distance of 40cm from the dental arch. There was no aortic dissection. The thrombus was attributed to aortic compression during cardiopulmonary resuscitation. Although the aortic thrombus and intramural hematoma were not associated with any complications in this patient, insertion of an intra-aortic balloon may have led to aortic rupture or embolic events. Transesophageal echocardiography should be performed, when available, prior to insertion of an intra-aortic balloon for counterpulsation in patients who have undergone cardiopulmonary resuscitation.


Subject(s)
Aged, 80 and over , Humans , Male , Aortic Diseases/etiology , Cardiopulmonary Resuscitation/adverse effects , Hematoma/etiology , Thrombosis/etiology , Aorta, Thoracic/pathology , Aortic Diseases/pathology , Cardiopulmonary Resuscitation/methods , Echocardiography, Transesophageal/methods , Heart Arrest/etiology , Heart Arrest/therapy , Hematoma/pathology , Thrombosis/pathology , Ventricular Fibrillation/complications
7.
Rev. bras. cir. cardiovasc ; 28(4): 545-549, out.-dez. 2013. ilus
Article in Portuguese | LILACS | ID: lil-703125

ABSTRACT

A estenose aórtica supravalvar é uma rara cardiopatia congênita, bastante incomum em adultos. Apresentamos um caso de estenose aórtica supravalvar em adulto com anomalia de vasos do arco aórtico, já com presença de insuficiência aórtica importante, tratado com êxito por meio de plastia da aorta ascendente e troca valvar aórtica.


The supravalvular aortic stenosis is a rare congenital heart defect being very uncommon in adults. We present a case of supravalvular aortic stenosis in adult associated with anomalies of the aortic arch vessels and aortic regurgitation, which was submitted to aortic valve replacement and arterioplasty of the ascending aorta with a good postoperative course.


Subject(s)
Adult , Humans , Male , Aorta, Thoracic/surgery , Aortic Stenosis, Supravalvular/surgery , Aortic Valve Insufficiency/surgery , Aorta, Thoracic/pathology , Aortic Stenosis, Supravalvular/pathology , Aortic Valve Insufficiency/pathology , Brachiocephalic Trunk/pathology , Brachiocephalic Trunk/surgery , Coronary Angiography , Heart Valve Prosthesis , Subclavian Artery/pathology , Subclavian Artery/surgery , Treatment Outcome
9.
Rev. Col. Bras. Cir ; 39(2): 133-138, mar.-abr. 2012. ilus
Article in Portuguese | LILACS | ID: lil-626632

ABSTRACT

OBJETIVO: Investigar os efeitos da remoção da adventícia da aorta em suínos. MÉTODOS: O experimento foi realizado com oito suínos. Removeu-se a camada adventícia da aorta descendente. Após a eutanásia com duas, quatro, seis e oito semanas, o segmento aórtico era removido. Após, eram feitos cortes histológicos com a coloração de hematoxilina e eosina (HE) e pelo método de Weigert - Van Gieson. RESULTADOS: Após duas semanas identificou-se um leve desarranjo do terço externo da túnica média. Nos animais sacrificados após quatro semanas observou-se um desarranjo estrutural dos terços externos da túnica média. Após seis semanas observou-se necrose da parede aórtica. Finalmente, após oito semanas além da fibrose da parede aórtica identificou-se a destruição da lâmina elástica interna. CONCLUSÃO: A remoção da adventícia da aorta em suínos levou à alterações degenerativas da média, determinando perda da estrutura da parede aórtica que é variável em sua localização, intensidade e forma, dependendo do tempo a partir do qual se estabeleceu a lesão isquêmica.


OBJECTIVE: To investigate the effects of removal of the adventitia on the tunica media in a pig model. METHODS: The experiment was performed in eight pigs. The adventitia of the descending aorta was removed. Following euthanasia, at two, four, six and eight weeks, the aortic segment was removed. Next, slices of the aorta were stained with hematoxylin and eosin (HE) and Weigert - Van Gieson. RESULTS: After two weeks there was a slight cellular breakdown in the outer third of the media. After four weeks structural breakdown of elastic fibers was observed in the outer two thirds of the same layer. In six weeks, several areas of necrosis and almost complete disruption of elastic fibers were identified. Finally, after eight weeks, there was fibrosis of the entire wall with disruption of the internal elastic lamina. CONCLUSION: The removal of the adventitia leads to degeneration of the media, determining loss of the normal structure of the aortic wall that is variable in its location, intensity and shape, depending on the length and duration of the ischemic insult.


Subject(s)
Animals , Female , Aorta, Thoracic/surgery , Connective Tissue/surgery , Tunica Media/surgery , Aorta, Thoracic/pathology , Swine , Tunica Media/pathology
10.
Rev. argent. cir. cardiovasc. (Impresa) ; 10(1): 40-44, ene-abr. 2012. ilus
Article in Spanish | LILACS | ID: lil-730174

ABSTRACT

La resolución de la patología del arco aórtico constituye un desafío quirúrgico. En el presente reporte se describen 3 casos, detallando las estrategias utilizadas en nuestro servicio para reemplazar el arco cuando se debe asociar a reemplazo de aorta ascendente por esternotomía o cuando se requiere reemplazo simultáneo de aorta descendente por toracotomía.


A resoluçâo da patologia do arco aórtico constitui um desafio cirúrgico. No presente relato descrevem-se 3 casos, detalhando as estratégias utilizadas em nosso serviço para substituir o arco quando e deve associar a substituiçâo da aorta ascendente por esternotomía ou quando é necessária uma substituiçâo da aorta descendente por toracotomía.


The resolution of aortic arch disease is a surgical challenge. This report describes 3 cases indicating the strategies used in our department to replace the arch combining the replacement of the ascending aorta by sternotomy or when it is necessary to simultaneously replace the descending aorta by thoracotomy.


Subject(s)
Humans , Male , Female , Aged , Aortic Aneurysm, Thoracic/surgery , Aorta, Thoracic/pathology , Sternotomy , Thoracic Surgical Procedures
11.
Rev. bras. ecocardiogr. imagem cardiovasc ; 24(4): 73-76, out.-dez. 2011. ilus
Article in Portuguese | LILACS | ID: lil-605344

ABSTRACT

La úlcera penetrante de aorta describe una condición en la que una placa ateroesclerótica se ulcera y penetra con las laminas elástica interna y media de la aorta. Esta lesión puede asociarse o complicarse con la formación de un hematoma intramural, disección, dilatación aneurismática, pseudoaneurisma o ruptura de la aorta. Se presenta el caso de un paciente masculino de 58 años quien consultó a urgencias con disnea, síncope y dolor torácico agudo con diagnosticó final de úlcera aórtica penetrante.


Penetrating aortic ulcer describes the condition in which an ulceration of an atherosclerotic plaque penetrates the internal and medial elastic laminas of the aorta. This lesion can be associated or complicated with the formation of an intramural hematoma, dissection,aneurysmatic dilatation, pseudo aneurysm or aortic rupture. We report the case of a 58 year old male who entered the emergency department with dispnoea, syncope and acute chest pain, with final diagnosis of penetrating aortic ulcer.


Subject(s)
Humans , Male , Female , Aorta, Thoracic/surgery , Aorta, Thoracic/pathology , Arteriosclerosis/surgery , Ulcer/surgery
12.
Rev. argent. cir. cardiovasc. (Impresa) ; 9(2): 99-107, mayo-ago. 2011. ilus, tab
Article in Spanish | LILACS | ID: lil-696157

ABSTRACT

Introducción: La clasificación de los ángulos aórticos (entre el cayado y la aorta descendente) incluye 3 tipos, en donde el 3 (arco gótico) es el más angulado y el que mayores dificultades proporciona para la correcta fijación proximal de una endoprótesis torácica. El objetivo de este trabajo es presentar la experiencia del Instituto Argentino de la Aorta (I.A.A.O.) en este tipo de situaciones utilizando varios recursos terapéuticos. Métodos: Sobre un total de 130 pacientes tratados por diversas patologías torácicas (aneurismas ateroscleróticos, transección aórtica traumática, disección Tipo B, úlceras aórticas, hematomas intramurales, seudoaneurismas post cirugía de coartación aórtica), en 31 pacientes (24%) fue necesaria la utilización de algún recurso para mejorar la fijación proximal, como la oclusión subclavia izquierda, el uso de stents expandibles por balón de refuerzo, y en los últimos 2 años, además, el uso de una endoprótesis especialmente diseñada para estos casos. Resultados: en todos los casos se logró un sellado adecuado a nivel proximal, debiendo en 5 ocasiones(3.84%) recurrir al uso de un stent expandible por balón, de refuerzo proximal, por persistencia de una fuga inferior. Esta combinación de dispositivos se produjo en los pacientes tratados previamente al uso de la endoprótesis especial para cuellos angulados. Discusión: El uso de dispositivos endovasculares para tratamiento de patologías torácicas diversas ha ganado el terreno de manera exponencial, siendo mucho más aceptado su uso que en el territorio abdominal, debido a la morbimortalidad que la patología torácica acarrea. Recursos como refuerzo proximal de la endoprótesis con stents expandibles por balón o la oclusión de la arteria subclavia izquierda, o ambos, han sido utilizados en esta serie para evitar el fenómeno del “pico de pájaro” que lleva al endoleak Tipo 1 y a la posibilidad de la migración distal de la endoprótesis, transformado el implante en una pesadilla difícil de ...


Introdução: A classificação dos ângulos aórticos (entre o cajado e a aorta descendente) inclui 3 tipos, onde o 3º (arco gótico) é o mais angulado e proporcionando maiores dificuldades para a correta fixação proximal de uma endoprótese torácica. O objetivo deste trabalho é apresentar aexperiência do Instituto Argentino da Aorta (I.A.A.O.) neste tipo de situações, utilizando vários recursos terapêuticos. Métodos: Sobre um total de 130 pacientes tratados por diversas patologias torácicas (aneurismas ateroscleróticos, transecção aórtica traumática, disecção tipo B, úlceras aórticas, hematomas intramurais, pseudoaneurismas pós cirurgia de coarctação aórtica), em 31 pacientes (24%), foi necessária a utilização de algum recurso para melhorar a fixação proximal, como a oclusão subclávia esquerda, o uso de stents expansíveis por balão de reforço, e nos últimos 2 anos também, o uso de uma endoprótese especialmente desenhada para estes casos. Resultados: em todos os casos se obteve um fechamento adequado completo a nível proximal, sendo preciso, em 5 ocasiões (3.84%) recorrer ao uso de um stent expansível por balão, de reforço proximal, por persistência de uma fuga inferior. Esta combinação de dispositivos ocorreu nos pacientes tratados previamente ao uso da endoprótese especial para colos angulados. Discussão: O uso de dispositivos endovasculares para o tratamento de patologias torácicas diversas ganhou terreno de forma destacada, sendo o seu uso muito mais aceito do que no território abdominal, devido à morbimortalidade que a patologia torácica acarreta. Recursos como reforço proximal da endoprótese com stents expansíveis por balão ou a oclusão da artéria subclávia esquerda, ou ambos, foram utilizados nesta série para evitar o fenômeno do “sinal do bico”, que leva ao endoleaks tipo 1 e à possibilidade da migração distal da endoprótese, transformando oimplante em um problema difícil de resolver...


Introduction: The classification of the aortc angulations (between transverse aorta and descending aorta) include three different types. The third one (gotic arch) is the most angulated and the worst for a good endoprostheses fixation to avoid a proximal type 1 endoleak because ofthe “bird beak phenomenom” that occurs. Methods: 130 patients were treated in the I.A.A.O. because of various thoracic aortic diseases including atherosclerotic aneurysms, type B dissections, aortic trauma, aortic ulcers, post coarctation surgery false aneurysms, and in 31 (24%) of them we need to use one of the next resources, left subclavian occlusion, bare stent deployment to reinforce the proximal fixation or a new thoracic endoprostheses specially designed for this kind of angles. Results: all patients were successfully treated, but in 5 of them (3.84%) a balloon expandable stent was deployed to strengthen the proximal fixation. This combination was used previously to the availability of the new endoprostheses (TX2 Prof Form). Conclusions: the use of the mentioned resources to improve the proximal landing zone allowed us to successfully treat pathologies that were located near or over the left subclavian artery.


Subject(s)
Humans , Aneurysm, Dissecting , Aortic Aneurysm, Thoracic/surgery , Aorta, Thoracic/pathology , Blood Vessel Prosthesis Implantation/methods , Stents , Aortic Aneurysm, Thoracic , Endovascular Procedures
13.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 21(1): 46-53, jan.-mar. 2011. ilus, graf
Article in Portuguese | LILACS | ID: lil-588382

ABSTRACT

Alterações da matriz extracelular (MEC), cujos principais componentes são os proteoglicanos, o colágeno e o tecido elástico, têm papel proeminente nas doenças da aorta. Proteoglicanos são uma família de macromoléculas com esqueleto proteico e cadeias laterais de um tipo de açúcares, os glicosaminoglicanos. O sistema elástico tem um componente microfibrilar, constituído por proteínas tais como fibrilina e emilina, sobre as quais elastina se deposita, moldando as fibras elásticas. Colégenos, principalmente dos tipos I e III, são as proteínas estruturais mais importantes nos corpos dos mamíferos. Destruição do tecido elástico é considerada o mais importante fator subjacente a todos os tipos de aneurisma. As dissecções aórticas e os aneurisma de aorta ascedente (AAAsc) têm as mesmas alterações histopatológicas na túnica média: fragmentação das fibras elásticas, acúmulos de material mucoide (proteoglicanos) cuja natureza real não está ainda esclarecida , e um possível decréscimo na população de células musculares lisas. O colágeno está diminuído nessas doenças, em toda a parede nos AAAsc e na metade externa na dissecções. Na arterite de Takayasu, a inflamação e a destruíção do tecido tecido elástico...


Alterations in the extracellular matrix (ECM), whose main components are proteoglycans, collagen and the elastic tissue play a prominent role in aortic diseases. Proteoglycans are a family of macromolecules with a proteic core and lateral chains of highly charged sugars, the glycosaminoglycans. The elastic system has a microfibrillar component, constituted by many proteins such as fibrillin and emilin, over which elastin deposits in order to mold elastic sheets. Collagens, mostly types I and III, are the most important structural proteins in mammal bodies. Elastic tissue destruction is considered the most important factor related to all types of aneurysms. Aortic dissections and ascending aortic aneurysms (AscAA) share their histopathological features, on the medial layer: fragmentation of elastic tissue, deposits of mucoid (proteoglycan) content whose actual constitution is not clear yet, and a probable decrease in the population of smooth muscle cells. Collagen is diminished in these conditions, in the whole wall in AscAA and in the external half only in dissections. In Takayasu’s arteritis, the inflammation and elastic destruction area are associated to a dense fibrosis that causes stenosis in arterial lumen.


Subject(s)
Humans , Aortic Aneurysm, Thoracic/genetics , Aorta, Thoracic/surgery , Aorta, Thoracic/pathology , Heart Valve Diseases/complications , Heart Valve Diseases/diagnosis
14.
Int. j. morphol ; 29(1): 182-186, Mar. 2011. ilus
Article in English | LILACS | ID: lil-591972

ABSTRACT

The aortic arch branches variations have called the attention of several authors, who have handled studies and classifications, both human and in different animals. The common trunk, which is between the brachiocephalic trunk and the common left carotid artery, is the most common variation. We conducted a descriptive and randomized study of the presence of the trunk mentioned before, trying to establish the possible relationship between this variation and the distribution plates of atheroma. The lumen observation makes it possible to define and check the distribution of the ostium, among the common ostium and the ones with common trunks. Regarding the plates of atheroma, it was found that there is a slight prevalence in common trunks cases, with respect to the classics (no variety) or the ones who had common ostium. In all cases, the presence of a plaque in the distal aortic arch was certified near the left subclavian artery. The knowledge of the existence of the common trunk sets up an act of academic interest, as practice interventions and diagnostic imaging and clinical work, since the presence of the common trunk might be related to the prevalence of the plates of atheroma at the level of its origin.


Las variaciones de las ramas del arco aórtico han llamado la atención de diversos autores, quienes han realizados estudios y clasificaciones, tanto en humanos, como en diferentes animales. El tronco común, entre el tronco braquiocefálico y la arteria carótida común izquierda, es la variación más frecuente. Realizamos un estudio descriptivo y randomizado de la presencia del mencionado tronco, tratando de verificar la posible relación entre dicha variación y la distribución de placas de ateroma. La observación luminal permitió precisar, entre los casos de ostios comunes y aquellos con troncos comunes, y comprobar la distribución de los ostios. En cuanto a las placas de ateroma, se observó una leve prevalencia en los casos de troncos comunes respecto de los clásicos (sin variedad) o de los que presentaron ostios comunes. En todos los casos se verificó la presencia de una placa en el arco aórtico distal, inmediato a la arteria subclavia izquierda. El conocimiento de la existencia del tronco común, constituye un hecho de interés académico, como práctico en intervencionismo, diagnóstico por imagen y la clínica. La presencia del tronco común pareciera estar relacionada con cierta prevalencia de placas de ateroma a nivel de su origen.


Subject(s)
Humans , Male , Female , Aorta, Thoracic/anatomy & histology , Aorta, Thoracic/abnormalities , Aorta, Thoracic/cytology , Aorta, Thoracic/pathology , Aorta, Thoracic/ultrastructure , Carotid Artery Diseases , Brachiocephalic Trunk/anatomy & histology , Brachiocephalic Trunk/abnormalities , Brachiocephalic Trunk/cytology , Brachiocephalic Trunk/pathology
15.
Pan Arab Journal of Neurosurgery. 2010; 14 (1): 102-104
in English | IMEMR | ID: emr-98319

ABSTRACT

The authors describe a case of a 48-year-old man with spinal hydatid disease, at T8, 19 levels, invading the wall of the thoracic aortic artery and complicated by a false aneurysm. The diagnosis was made by MRI and angio MRI. The patient was successfully operated by neuro and vascular surgeons. The follow-up was good without recurrence of symptoms after 10 months. Difficulties of preoperative diagnosis and operative management are discussed and the literature was reviewed


Subject(s)
Humans , Male , Middle Aged , Aneurysm, False , Spinal Cord Diseases/parasitology , Aorta, Thoracic/pathology
16.
J. vasc. bras ; 9(1): 51-56, 2010. ilus, tab
Article in Portuguese | LILACS | ID: lil-557198

ABSTRACT

A correção endovascular da dissecção de aorta tipo B tem se mostrado como uma nova alternativa para reduzir o trauma cirúrgico. No entanto, as complicações de médio e longo prazo, tais como a fístula aortoesofágica, são ainda pouco conhecidas e pouco relatadas. O objetivo deste trabalho é descrever três casos de fístula aortoesofágica após o tratamento endovascular de 23 casos de dissecção de aorta descendente conduzidos pela equipe de Cirurgia Vascular da Santa Casa de São Paulo em um estudo retrospectivo. Esses pacientes apresentavam características em comum, como dissecção crônica, pós-operatório imediato sem intercorrências, necessidade de reintervenções, oclusão de troncos arteriais como a artéria subclávia, mesentérica, tronco celíaco, e, ainda, uma rápida evolução para o óbito após os primeiros sinais de fístula. Portanto, embora raramente descrita na literatura, a ocorrência de fístula aortoesofágica é uma complicação de causa até o momento indefinida do tratamento endovascular da dissecção de aorta descendente que merece atenção, dada sua recorrência e evolução fatal.


Endoluminal stent-graft for type B aortic dissection is a new alternative to reduce surgical trauma. However, medium- and long-term complications are still little known and poorly reported, such as the aortic-esophageal fistula. The objective of this study is to describe three cases of aortic-esophageal fistula after the endovascular treatment of 23 cases of descending aortic dissection conducted by the vascular surgery team of Santa Casa de São Paulo in a retrospective study. These patients presented some common characteristics: chronic dissection, successful early outcome, need of reinterventions, occlusion of arterial trunks such as subclavian artery, mesenteric artery, celiac trunk, and finally, a fast fatal course after the first fistula-related symptoms. Therefore, despite rarely described in the literature, aortic-esophageal fistula is a complication of the endovascular treatment of descending aortic dissection which demands attention due to its unpredictability, recurrence, and fatal outcome.


Subject(s)
Humans , Male , Middle Aged , Aorta, Thoracic/pathology , Esophagus/pathology , Esophageal Fistula/diagnosis , Postoperative Care/nursing , Dissection/methods , Time Factors , Tomography, Emission-Computed/methods
17.
Arq. bras. cardiol ; 93(3): 312-315, set. 2009. ilus
Article in English, Spanish, Portuguese | LILACS | ID: lil-529180

ABSTRACT

Paciente de 27 anos, portador de sífilis terciária, manifestando isquemia miocárdica, com angina instável, secundária à oclusão do tronco da coronária esquerda. O diagnóstico foi confirmado pelos achados da sorologia e da patologia do fragmento da aorta.


A 27-year-old patient with tertiary syphilis, manifested as myocardial ischemia, presenting unstable angina, secondary to left coronary trunk occlusion. The diagnosis was confirmed by the serological findings and the pathological assessment of the aorta fragment.


Paciente de 27 años, portador de sífilis terciaria, manifestando isquemia miocárdica, con angina inestable, secundaria a la oclusión del tronco de la coronaria izquierda. El diagnóstico fue confirmado por los resultados de la serología y de la patología del fragmento de la aorta.


Subject(s)
Adult , Humans , Male , Coronary Artery Disease/pathology , Syphilis, Cardiovascular/pathology , Aorta, Thoracic/pathology
18.
Rev. bras. cir. cardiovasc ; 23(3): 330-335, jul.-set. 2008. ilus
Article in English, Portuguese | LILACS | ID: lil-500517

ABSTRACT

OBJETIVO: Estudar a viabilidade técnica e resultados imediatos da modificação técnica proposta por Caliani et al. para correção da coarctação aórtica com hipoplasia do arco aórtico. MÉTODOS: Entre janeiro de 2005 e julho de 2006, nove neonatos com coarctação aórtica e hipoplasia do arco aórtico foram submetidos a uma nova abordagem cirúrgica para correção do defeito. A definição de hipoplasia do arco aórtico seguiu os critérios de Moulaert, segundo os quais o arco aórtico é considerado hipoplásico quando seu diâmetro atinge 50% do diâmetro da aorta ascendente. Nesta série, foram selecionados apenas pacientes com hipoplasia proximal e distal do arco aórtico. Várias técnicas foram propostas anteriormente, mas gradientes residuais importantes foram observados, assim como há o inconveniente da ligadura definitiva da artéria subclávia esquerda. A modificação técnica consiste em: toracotomia póstero-lateral esquerda, ampla mobilização da aorta descendente, com ligadura dos dois primeiros ramos intercostais, transecção da artéria subclávia esquerda em sua base, ressecção ampla de toda zona hipoplásica e adjacências do ducto arterioso, anastomose término-terminal entre o arco aórtico e aorta descendente com fio de PDS 7-0 e reimplante da artéria subclávia sobre a artéria carótida esquerda com anastomose látero-terminal. RESULTADOS: Não houve óbito per-operatório ou tardio, o gradiente residual médio foi de 5 mmHg. Até o presente, não observamos nenhum caso de recoarctação ou de lesão neurológica medular. CONCLUSÃO: A despeito do reduzido número de casos e do seguimento curto, esta modificação técnica pode representar uma excelente opção para tratamento deste complexo grupo de pacientes.


OBJECTIVES: To study technical feasibility and early results of the technical modification suggested by Caliani et al. for correction of aortic coarctation and aortic arc. METHODS: Between January 2005 and July 2006, nine newborn patients with aortic coarctation and significant aortic hypoplasia were selected, and underwent a new surgical approach in order to correct this aortic defect. The definition of aortic arch hypoplasia according to Moulaert's criteria is an aortic arch with a diameter that is less than 50% of the diameter of the ascending aorta. In this study, only patients with proximal and distal aortic hypoplasia were selected. Many techniques were previously used, but significant residual gradients were observed, as well as the incovenience of definitive occlusion of the left subclavian artery. The aim of this study is to describe a new surgical technique that includes left posterolateral thoracotomy, wide mobilization of descending aorta with occlusion of the first two intercostal branches, transection of the left subclavian artery at its base, wide resection of the hypoplastic area and the surronding regions of the ductus arteriosus; end-to-end anastomosis between the aortic arch and descending aorta, with 7-0 PDS thread and reimplantation of the subclavian artery into the left carotid artery with side-to-end anastomosis. RESULTS: There were no perioperative or late deaths. The mean residual gradient was 5 mmHg. Up to now, there were no cases of recoarctation or medullary neurological lesions. CONCLUSION: Despite the small number of cases and the short follow-up, this technique modification may be an excellent option for the treatment of this complex situation.


Subject(s)
Humans , Infant, Newborn , Aorta, Thoracic/surgery , Aortic Coarctation/surgery , Cardiovascular Surgical Procedures/methods , Anastomosis, Surgical , Aorta, Thoracic/abnormalities , Aorta, Thoracic/pathology , Aortic Coarctation/pathology , Carotid Arteries/surgery , Medical Illustration , Reference Values , Replantation , Subclavian Artery/surgery , Treatment Outcome
19.
Arch. cardiol. Méx ; 76(4): 448-453, oct.-dic. 2006.
Article in Spanish | LILACS | ID: lil-568602

ABSTRACT

A case of Williams' syndrome in a 22 years old man, is described. Clinical data, as well as those of laboratory and of imageneology study, are reported. An electro-anatomical comparison permitted to verify the value of electrocardiographic signs of enlargement of the four heart chambers, due to a mixed overload. It permitted also to establish the value of the signs of the interatrial block, probably due to myocardial atrial fibrosis, and those suggesting hyperkalemia. The electrocardiogram always is very useful because it furnishes certain functional aspects permitting to allow structural inferences, in following subjects with congenital or acquired heart diseases.


Subject(s)
Adult , Humans , Male , Electroencephalography , Williams Syndrome , Williams Syndrome/pathology , Autopsy , Aorta, Abdominal/pathology , Aorta, Thoracic/pathology , Aorta/pathology , Heart Atria/pathology , Heart Ventricles/pathology , Mitral Valve Insufficiency/pathology , Mitral Valve/pathology , Pulmonary Artery/pathology , Williams Syndrome/mortality , Williams Syndrome
20.
J. vasc. bras ; 5(2): 95-100, jun. 2006. ilus
Article in English | LILACS | ID: lil-446576

ABSTRACT

Objectives: To determine the percentage and type of aortic arch variations in Indian subjects and their clinical surgical importance and embryological basis. Patients and methods: In our investigation, branching patterns of the aortic arch were studied in 62 formalinfixed cadavers of booth sexes of Indian origin, aged 45-79. The dissections were carried out in formalin preserved after exposing the thoracic and cervical region during routine dissection of undergraduate students of Indiam origin in Kasturba Medical College, Mangalore. Results: The usual three-branched aortic arch was found in 56 cadavers (91,4 percent); variations were found in six cadavers (9,6 percent); 4,8 percent presented common origin of the carotid arteries; 1,6 percent had biinnominate sequence, and the same specimen had left coronary artery arising from arch of aorta directly; 1,6 percent presented right subclavian artery arising directy from the aorta; 1,6 percent had left vertebral artery a branch of aortic arch...


Subject(s)
Humans , Male , Female , Middle Aged , Aorta, Thoracic/injuries , Aorta, Thoracic/pathology , Vertebral Artery/anatomy & histology , Vertebral Artery/pathology , Brachiocephalic Trunk/injuries , Brachiocephalic Trunk/pathology
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