Cardiothoracic surgery
Philip Stather, Helen Cheshire in Cases for Surgical Finals, 2012
A 60-year-old man presents to A&E due to a tearing pain in his chest. You suspect he has an aortic dissection. Give three other symptoms of aortic dissection. (3 marks)Give three causes of aortic dissection. (3 marks)What characteristic signs may you see on chest X-ray? (1 mark)What is the mortality rate for this condition? (1 mark)Give two reasons why this patient may develop a pleural effusion. (2 marks)
Prognosis: Studies of disease course and outcomes
Milos Jenicek in Foundations of Evidence-Based Medicine, 2019
Making a prognosis based simply on knowing how many patients will survive a certain time period (e.g. five years following the detection of a cancer or any other disease) would rely on very poor information since the exact timing (moment of occurrence) of the events in this five-year period would be ignored. As shown by Fletcher et al.,11 several diseases may show a comparable survival rate at a given moment, 10% for example. Such a prognosis can be made for a rapidly dissecting aortic aneurysm: Subjects mainly die within the first one or two years following its discovery. A similar five-year survival rate can be observed in chronic granulocytic leukemia, but more patients survive beyond the first year and years after within the same five-year period. Similarly, Figure 10.4 represents two survival curves for glioma patients.27
About What to Think in Step-by-Step Clinical Work and Care: Risk, Diagnosis, Treatment, Prognosis 1
Milos Jenicek in How to Think in Medicine, 2018
Making a prognosis based simply on knowing how many patients will survive a certain time period (e.g., five years following the detection of a cancer or any other disease) might yield very poor information. This is because thee the exact timing (moment of occurrence) of the events in this five-year period would be ignored. As shown by Fletcher et al.,40 several diseases may show a comparable survival rate at a given moment. Such a prognosis can be made with fairly good accuracy for a rapidly dissecting aortic aneurysm; subjects mainly die within the first one or two years following its discovery, and its discovery is known immediately. However, for a disease like chronic granulocytic leukemia, the exact timing when the disease occurred is not known with certainty. It may have developed over a period of years. While a five-year survival rate can be observed in chronic granulocytic leukaemia, more patients survive beyond the first year and years after within the same five-year period.
Numerical simulation of two-phase non-Newtonian blood flow with fluid-structure interaction in aortic dissection
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
Yonghui Qiao, Yujie Zeng, Ying Ding, Jianren Fan, Kun Luo, Ting Zhu
Aortic dissection is a serious hazardous cardiovascular disease in which blood enters the middle layer of the aortic wall through an entrance tear. This causes the layer to split, forming a “true lumen” (TL) and a “false lumen” (FL) (Wan Ab Naim et al. 2014). Currently, there is a lack of sufficient understanding of the pathogenesis and pathophysiological changes involved in aortic dissection. Detailed knowledge of flow-related variables such as wall pressure and wall shear stress (WSS) can provide better insight into the progression of aortic dissection, aid clinicians in tailoring treatment to individual patients, and optimize management of the disease. In the last several decades, many researchers have applied numerical approaches to obtain the hemodynamic parameters of aortic dissection (Sun & Chaichana 2016). Khanafer and Berguer (2009) found that the highest shear stress occurs in the medial layer, and this may contribute to the dissection. Tse et al. (2011) investigated blood flow in a pre-aneurismal aorta model and inferred that elevated TAWSS would extend the tear. Ab Naim et al. (2016) reported vortical structure in the FL and its interaction with WSS to predict thrombus formation.
Evaluation of the relationship between para-aortic adipose tissue and ascending aortic diameter using a new method
Published in Acta Cardiologica, 2022
Adem Adar, Orhan Onalan, Fahri Cakan, Hakan Keles, Ertan Akbay, Sinan Akıncı, Ali Coner, Cevahir Haberal, Haldun Muderrisoglu
Untreated and unmonitored aortic aneurysm may result in aortic dissection leading to mortality. The aetiology of aortic dilatation is multifactorial such as hypertension, infections, genetic factors, Marfan syndrome, bicuspid aortic valve, Ehler-danlos syndrome and idiopathic conditions [14]. In this context, PAT, as a paracrine organ, also may play an important role in the aetiology of aortic dilatation through the cytokines it secretes [15], which has been reported to result in more aortic function, width, and atherosclerosis [16,17]. PAT measurement can be used safely in the follow-up of aortic dilatation [18]. Various studies in the literature have discussed the measurement of PAT using CT and MRI. PAT measurement has not received the attention it deserves in clinical practice since measurements are predominately performed using CT and MRI, which are commonly requested for other indications, However, such methods require the use of special software and requires expensive equipment and time to perform. Conversely, TTE is available in almost every healthcare facility around the globe. We found that PAT measured using TTE is an important predictor of ascending aortic width.
Features of Marfan syndrome not listed in the Ghent nosology – the dark side of the disease
Published in Expert Review of Cardiovascular Therapy, 2019
Yskert von Kodolitsch, Anthony Demolder, Evaldas Girdauskas, Harald Kaemmerer, Katharina Kornhuber, Laura Muino Mosquera, Shaine Morris, Enid Neptune, Reed Pyeritz, Svend Rand-Hendriksen, Alexander Rahman, Nina Riise, Leema Robert, Ingmar Staufenbiel, Katalin Szöcs, Thy Thy Vanem, Stephan J. Linke, Marina Vogler, Anji Yetman, Julie De Backer
In conclusion, extra-aortic vascular disease may occur in Marfan syndrome. Both spontaneous coronary artery dissection and anomalous coronary artery origins have been described, although it is unclear if the prevalence of these conditions is higher than in the healthy population. Minimal data exist about the atherosclerotic disease in Marfan syndrome, but clinical risk factors appear to be similar to the rest of the population. The most common extra-aortic vascular manifestations of Marfan syndrome are aneurysms of the medium and large vessels and the visceral arteries. These aneurysms are most common in patients who have had a prior aortic dissection or prior cardiovascular surgery. Intermittent serial screening by MR and CT angiography from neck to pelvis in this subpopulation of patients with Marfan syndrome should be considered. Literature to date does not support a significantly increased risk of spontaneous artery dissection or cerebral artery aneurysms in Marfan syndrome.
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