CT Perspective of Normal Cardiovascular Anatomy
Paul Schoenhagen, Frank Dong in Cardiac CT Made Easy, 2023
The anatomy of the tubular aorta is reconstructed along the centreline of the vessel, with longitudinal and cross-sectional images. This can be done by manual reconstruction or semi-automated centreline reconstructions (Figure 2.12). The aorta is divided into several segments. Beyond the aortic root, these segments include: Ascending aortaAortic arch with the ostia of the arch branch vesselsDescending aortaJuxtarenal aorta with the origin of the arch branch vesselsInfrarenal aorta and the iliac arteries
Specific Arterial Disease
Wilmer W Nichols, Michael F O'Rourke, Elazer R Edelman, Charalambos Vlachopoulos in 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 Disease
Vincenzo Berghella in Maternal-Fetal Evidence Based Guidelines, 2022
Aortic stenosis in a younger pregnancy age patient is most often due to bicuspid aortic valve, which can also be associated with both aortopathy and coarctation of the aorta. Aortic stenosis is a fixed outflow obstruction of the left ventricle and is therefore sensitive to preload and hypotension which can result in hemodynamic collapse if not recognized and treated early. Complications can occur in up to 10% of aortic stenosis patients, with heart failure reported as high as 42% in one report; mortality is rare (<1%) [6]. Progressively increasing volume and cardiac output during pregnancy, as well as, postpartum increases in preload are what lead to heart failure from acute pulmonary edema in severe aortic stenosis. In highly symptomatic patients, aortic valve balloon valvuloplasty may be considered if no significant aortic regurgitation. If too late, invasive hemodynamic monitoring with a pulmonary artery catheter may prove useful in the peripartum period. Due to a genetic predisposition for bicuspid aortic valve, fetal echocardiography or postpartum pediatric echocardiography should be offered.
A pharmacovigilance study of adverse event profiles and haemorrhagic safety of bevacizumab based on the FAERS database
Published in Expert Opinion on Drug Safety, 2023
Linlin Tang, Chuanhua Ding, Hongying Li, Guoqiang Yin, Haixia Zhang, Wen Shan Liu, Yinghui Ji, Hui Li
Posterior reversible encephalopathy syndrome (PRES) is a catastrophic neurological complication of bevacizumab [25]. According to the package insert, the incidence of bevacizumab-associated PRES is < 0.5%, thus making it a rare condition. Bevacizumab-induced PRES has been reported recently [26]. The most common symptoms of PRES are headaches, visual disturbances, seizures, and lethargy. Magnetic resonance imaging (MRI) findings of symmetrical white matter edema in the parieto-occipital region are necessary for diagnosis. In addition, bevacizumab is said to cause PRES due to dysregulation of the blood-brain barrier [26]. Bevacizumab-induced necrotizing fasciitis is rare, with only a few sporadic cases reported [27,28]. In our study, 48 cases of necrotizing fasciitis were identified, and data analysis from the Japanese Adverse Reaction Database showed that the risk of aortic dissection increased in patients receiving bevacizumab. The database included 21 cases of bevacizumab-induced aortic dissection [29]. In the present study, 51 patients had bevacizumab-induced AD. Aortic dissection involves tearing of the intima of the aorta and pressing of blood into the middle layer of the aorta to create a false lumen. Because of its lethality, it is important to pay attention to bevacizumab-induced aortic dissection, make an early diagnosis, and start timely active treatment.
Cleistanthin A causes peripheral vasoconstriction and myocardial depression in isolated tissue preparations
Published in Toxicology Mechanisms and Methods, 2023
Kawin Padmaja, Roshni Parameswaran, G. Srisangeetha, Shikha Mary Zachariah, Neetu Prince, Soosai Manickam Amirtham, Uwe Beifuss, Juergen Conrad, Sathya Subramani
Wistar rats, (n = 5 each in the test and control arms) were anesthetized with ketamine (80 mg/kg body weight) and midazolam (1.5 mg/kg body weight) administered intraperitoneally. Once the animal was under the influence of anesthesia, the thoracic cavity was opened by dissecting the ribs. The aorta was then identified and clamped and carefully separated from the chest wall, just above its origin from the base of the heart. Rest of the great vessels and soft tissue attachments were cut to free the heart. The heart was then immediately transferred to a Petri dish with ice-cold mammalian extracellular solution. The thoracic aorta was then mounted onto the Langendorff setup such that the tip of the cannula is positioned just above the coronary artery opening thus ensuring circulation of perfusate through the coronary arteries. The heart was then perfused through the aorta to obtain a robustly beating heart. A pressure cannula was placed in the left ventricle and connected to a pressure transducer. Left ventricular pressures were recorded using CMCdaq.
Management of congenitally corrected transposition from fetal diagnosis to adulthood
Published in Expert Review of Cardiovascular Therapy, 2023
Congenitally corrected transposition of the great arteries (ccTGA) is a complex congenital heart disease first described from an autopsy by a Bohemian pathologist working in Vienna, Karl von Rokitansky, in 1875 [1]. The anomaly is characterized by atrioventricular and ventriculo-arterial discordance [2]. Deoxygenated blood from the right atrium flows through the mitral valve into the morphological left ventricle, which gives rise to the pulmonary artery. Then, oxygenated blood flows into the left atrium that communicates with the morphological tricuspid valve and right ventricle, that is connected to the aorta. The aorta is located usually anterior and to the left. Consequently, the double discordance results in hemodynamic compensation, but the morphologically right ventricle works as systemic ventricle (systemic right ventricle, sRV). The most common anomalies are ventricular septal defect, pulmonary or subpulmonary stenosis, and systemic atrioventricular (morphological tricuspid) valve abnormalities [3] (Table 1). Additionally, cardiac malposition (dextrocardia or mesocardia) occurs in up to one-third of the patients. Associated malformations, especially the Ebstein-like anomaly of the systemic atrioventricular valve, have a significant impact on the clinical course of the disease. Conduction disturbances, including complete atrio-ventricular block, are another common cause of increased morbidity in ccTGA patients and might be the first manifestation of the disease.
Related Knowledge Centers
- Aortic Bifurcation
- Common Iliac Artery
- Artery
- Abdomen
- Heart
- Circulatory System
- Oxygen Saturation
- Ventricle
- Thoracic Aorta
- Thoracic Diaphragm