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Valvular Heart Disease and Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Kali Polytarchou, Constantina Aggeli
Patients with aortic root or ascending aorta aneurysm should undergo aortic valve repair or replacement, irrespective of the severity of valvular disease. In general, surgery is recommended for patients with aortic dimension ≥55 mm. In Marfan syndrome, surgery is recommended when the ascending aorta dimension is ≥50 mm or ≥45 mm with concomitant risk factors (such as personal or family history of aortic or other vascular dissection, severe aortic or mitral regurgitation, desire for pregnancy, arterial hypertension, or annual increase of aortic diameter ≥3 mm/year). Patients with Loeyz–Dietz syndrome or TGFBR1 or TGFBR2 gene mutations should undergo surgery when aortic dimension is ≥45 mm. Patients with bicuspid aortic valve or coarctation of the aorta and presence of the above risk factors should procced to surgery when aortic dimension is ≥50 mm. For patients with an indication for aortic valve replacement or repair, aortic root and ascending aorta replacement is indicated when dimension is ≥45 mm.21
Specific Arterial Disease
Published in Wilmer W Nichols, Michael F O'Rourke, Elazer R Edelman, Charalambos Vlachopoulos, McDonald's Blood Flow in Arteries, 2022
Aortic dissection is a medical emergency, requiring prompt and aggressive reduction in disruptive forces within the aorta, complemented by surgery when the ascending aorta is involved (with the threat of aortic valve incompetence and rupture into the pericardial sac) (Nienaber and Eagle, 2003a, 2003b; Isselbacher, 2007). Studies of aortic dissection have emphasized the importance of pulsatile phenomena and the rate of rise (dP/dt) of aortic pressure in the initiation and progression of dissection (Beller et al., 2004). Nevertheless, the contribution of shear stress at the aortic wall and of blood flow acceleration (dV/dt) has been challenged. Yin et al. (1989) (using appropriate high-fidelity manometry and flow measurement) found this dV/dt not to be reduced by β-blocking agents or by nitroprusside in patients with Marfan syndrome, although such therapy did reduce mean, pulsatile and maximal tensile stress in the wall.
Cardiac Emergencies in Obstetrics
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Sanjeewa Padumadasa, Sanjeewa Rajapakse
Aortic dissection in pregnancy occurs most commonly in the third trimester and also in the early postpartum period due to the hyperdynamic circulation and hormonal effects on the vasculature. Oestrogen suppresses the synthesis of collagen and elastin, leading to a weakening of vascular walls. Systolic hypertension is a key factor in the causation of aortic dissection. This emphasises the importance of monitoring for and treatment of hypertension in pregnancy. The ascending aorta is the commonest site affected accounting for 65% of cases, followed by the descending aorta, aortic arch and abdominal aorta.
Freedom in the chest
Published in Acta Cardiologica, 2023
Sébastien Piron, Julien Tridetti, Stella Marchetta, Patrizio Lancellotti
Pericardium being totally absent, positional anomalies of the heart can however be more important. So, some cases of twist of major blood vessels due to cardiac malposition have been described. Tricuspid insufficiencies can also occur [7], explained by an abnormal ventricular geometry favoured by heart’s laevorotation, causing anterior pillar’s chordae distension and ultimately weakening subvalvular apparatus [8,9]. This disability leads to more tricuspid insufficiencies, especially traumatic ones although spontaneous tricuspid insufficiencies have also been described [8]. Apart from theses rares complications, total ageneses are asymptomatic and have, as only consequence, possible technical difficulties during cardiac auscultation and certain complementary examinations. One case of delayed diagnosis of rupture of ascending aorta has been described, which has been evidenced by a severe progressive left haemothorax and the absence of haemopericardium due to absence of pericardium [10].
Double right coronary artery: a plea for a standardized nomenclature
Published in Acta Chirurgica Belgica, 2022
Sotirios D. Moraitis, Apostolos C. Agrafiotis, Panagiotis Strempelas, Georgios Kagialaris, Pantelis Tsipas
Double coronary artery is a rare anomaly with just a few cases reported in the literature [1]. This anomaly started being reported recently (first case reported in 1994) with the wide use of coronary angiography. Before the advent of advanced imaging and catheterization facilities most of the available data came from the work of anatomists. A 42-year-old patient was recently operated in our department due to a severe bicuspid aortic valve stenosis. Preoperative coronary angiography showed two right coronary arteries (RCA). A 37-year-old patient was admitted for surgery because of aortic root and ascending aorta aneurysm, combined with bicuspid aortic valve regurgitation. In both cases, during surgery two ostia were encountered in the right coronary sinus. The aim of this small case series is to address the problem of classification and nomenclature while referring to the term ‘double RCA’ and underline the clinical implications of this anomaly.
Evaluation of the Neuroprotective Effects of Methylprednisolone and Surgical Decompression in a Rodent Model of Traumatic Optic Neuropathy
Published in Current Eye Research, 2022
Philippe Korn, Nils-Claudius Gellrich, Simon Spalthoff, Philipp Jehn, Ulf T. Eysel, Martin Zerfowski
As shown in preliminary tests although there is a correlation between the magnitude of compression trauma and pupillary response; however, this dependency showed a greater range of variation than that of the number of neurons lost on the affected retina.24 Hence, pupillary response was considered an unreliable test method, and whole mount preparation of retinae was performed for histological evaluation of neuron number and size. After 30 days, in vivo fixation with 4% buffered formaldehyde solution containing 0.2% heparin was performed after intraperitoneal anesthesia. To this end, transventricular arterial access was introduced into the ascending aorta. Venous drainage was ensured via an incision in the jugular vein. After a fixation period of 12–15 min, animals were sacrificed using an overdose of chloral hydrate. Both eyes with the attached intraorbital optic nerve were removed. For subsequent fixation, the explanted tissue was kept in 4% formaldehyde solution for at least 24 h after excision of the lens and portions of the vitreous.