ABSTRACT
Takayasu arteritis is a chronic inflammatory arteritis affecting large vessels, predominantly the aorta and its main branches. We report the case of a patient presenting with the rapid growth of a thoracic aortic aneurysm during pregnancy leading to the diagnosis of Takayasu disease and treated by a rapid delivery by cesarean section followed by an open aortic repair. One year after the operation the patient and her baby are alive and well.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation , Cesarean Section , Pregnancy Complications, Cardiovascular/surgery , Takayasu Arteritis/diagnostic imaging , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/etiology , Aortography/methods , Computed Tomography Angiography , Disease Progression , Female , Humans , Immunosuppressive Agents/therapeutic use , Pregnancy , Pregnancy Complications, Cardiovascular/diagnostic imaging , Pregnancy Complications, Cardiovascular/etiology , Takayasu Arteritis/complications , Takayasu Arteritis/drug therapy , Treatment OutcomeABSTRACT
Divergent concepts on the origin of the dicrotic notch are widespread in medical literature and education. Since most medical textbooks explain the origin of the dicrotic notch as caused by the aortic valve closure itself, this is commonly transmitted in medical physiology courses. We present clinical data and numerical simulations to demonstrate that reflected pressure waves could participate as one of the causes of the dicrotic notch. Our experimental data from continuous arterial pressure measurements from adult patients undergoing vascular surgery suggest that isolated changes in peripheral vascular resistance using an intravenous bolus of phenylephrine (a selective alpha 1-receptor agonist and thus a potent vasoconstrictor) modify the dicrotic notch. We then explore the mechanisms behind this phenomenon by using a numerical model based on integrated axisymmetric Navier-Stokes equations to compute the hemodynamic flow. Our model illustrates clearly how modifications in peripheral artery resistance may result in changes in the amplitude of the dicrotic notch by modifying reflected pressure waves. We believe that this could be a useful tool in teaching medical physiology courses.
Subject(s)
Models, Theoretical , Adult , Blood Pressure , HumansABSTRACT
Ballistic injuries of the descending aorta are uncommon and of extremely severe prognosis. We report the case of a 55-year-old man treated for such a thoracic trauma that combined wounds of the heart and descending thoracic aorta. A combination of conventional surgical and endovascular approaches enabled successful treatment.
