Aorta, Thoracic – ABC CARDIOL

IJCS

Original Article

The Relationship between Basal Serum Lipoprotein(a) Levels and the Pulmonary Artery to Ascending Aorta Ratio in COVID-19 Survivors

Uğur Küçük et al. Bahadır Kırılmaz

Abstract

Background:

Coronavirus disease (COVID-19) can cause permanent damage to vascular structures by directly or indirectly affecting the cardiopulmonary system. Lipoprotein(a) [Lp(a)] is an important identified risk factor for vascular endothelial cell dysfunction.

Objective:

The aim of this study was to reveal the relationship between Lp(a) levels measured at the time of COVID-19 diagnosis and the pulmonary artery (PA) to the ascending aorta (Ao) ratio (PA:Ao ratio) in survivors evaluated by transthoracic echocardiography (TTE).

Methods:

The study sample consisted of 100 patients who recovered from COVID-19 in the past 3 to 6 months. The relationship between the change in the PA:Ao ratio (ΔPA:Ao) and the Lp(a) levels measured at the time of diagnosis was evaluated. Diameter measurements at baseline and follow-up were evaluated with TTE.

Results:

A significant increase was found in PA, Ao, and epicardial adipose tissue (EAT) thickness in TTE (p< 0.001 for all). There was a weak correlation between D-dimer and high-sensitivity cardiac troponin measured at the time of diagnosis and ΔPA:Ao and ΔEAT in survivors. However, a positive and strong correlation was observed between Lp(a) levels and ΔPa:Ao (r = 0.628, p< 0.001) and ΔEAT (r = 0.633, p< 0.001).

Conclusion:

There may be dysfunction in vascular structures due to COVID-19. For the first time in the literature, a strong correlation was shown between the Lp(a) levels measured at the time of diagnosis and ΔPA:Ao and ΔEAT values in patients with COVID-19.

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Research Letter

Tetralogy of Fallot Associated with Aberrant Right Subclavian Artery. Clinical Implications

Maciej Michałowski et al. Pawel Tyczynski Magdalena Lipczynska Anna Wójcik … Piotr Hoffman Adam Witkowski Ilona Michałowska

Abstract

Since the first description of Tetralogy of Fallot (ToF) in 1671 by Niels Stensen and in 1888 by Étienne-Louis Arthur Fallot, numerous papers have reported on this anomaly, along with its variants and concomitant cardiovascular anomalies. Aberrant right subclavian artery (ARSA) is the most common anomaly of the aortic arch. Different from the left aberrant subclavian artery, occurrence of ARSA in ToF-patients has only casuistically been reported so far. The present study reports on two ToF-patients with ARSA. It is important to note that knowledge of the coexistence of both anomalies has highly practical points during surgical or endovascular corrections of congenital heart defects (including ToF).

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ABCIC

Case Report

Coronary-Cameral Fistula and Aneurysmal Dilatation of the Anterior Descending Artery: A Case Report

Ariane Silveira Fusco et al. Adriana de Nazaré Miziara Oliveira Valéria Cardoso Alves Cunali Fabio Vieira Fernandes Fabiana Jorge Bueno Galdino Barsam

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IJCS

Case Report

Takayasu Arteritis as a Secondary Cause of Arterial Hypertension

Pedro Manuel Oliveira et al. Paula Fereira Fábio Murteira Inês Rueff Rato Marta Barbedo

Abstract

Takayasu arteritis (TA) is a rare type of vasculitis that affects mainly the aorta and its major branches. It is highly similar to giant cell arteritis (GCA), and differentiation between them may not be achieved even by histological examination. Arterial hypertension is typical of TA and is caused by stenosis of the renal arteries. Here we report the case of a 59-year-old woman, with a history of dyslipidemia and anemia, seen in the Internal Medicine department for resistant hypertension. Evaluation of secondary causes led to stenosis of the renal arteries. Assessment of target organ involvement was performed by computed tomography angiograph which revealed ectasia of the aortic arch and ascending aorta, tortuous course of the brachiocephalic trunk and the proximal portion of the right common carotid artery; positron-emission tomography which showed diffuse increased uptake in the ascending aorta, compatible with large vessels vasculitis. The patient was submitted to aortic valve replacement with a biological prosthesis combined with myocardial revascularization (Bentall-De Bono procedure). Aortic biopsy specimens showed anatomical and pathological features of GCA and TA. Due to persistently uncontrolled hypertension, prednisone 60 mg was initiated,with significant improvement in patient’s condition.

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ABC

Case Report

Antenatal Diagnosis of Double Aortic Arch

Natália Noronha et al. Angie Hobbs Patricia Caldas

Introduction

Congenital anomalies of the aortic arch affect 1-2% of the population and comprise a wide variety of abnormalities in the position and/or branching pattern of the aortic arch. Double aortic arch (DAA) represents 1-2% of all aortic arch anomalies and is characterized by persistence of both left and right embryonic aortic arches. It can be found either in isolation or, less frequently, in association with other cardiovascular or chromosomal abnormalities. Antenatal diagnosis of DAA may be challenging, as its distinction from other arch abnormalities like right aortic arch with left arterial duct or with an aberrant left subclavian artery is not always straightforward. The authors describe a case of antenatal diagnosis of DAA.

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ABC

Letter to the Editor

Confounding Factors in the Analysis of the Relationship between Aortic Arch Calcification with a Non-Dipper Blood Pressure Pattern

Pedro Pereira Tenório et al. Carlos Alberto de Lima Botelho Filho Romero Henrique de Almeida Barbosa Johnnatas Mikael Lopes

Dear Editor,

We read the following article with great interest: “Aortic Arch Calcification on Routine Chest Radiography is Strongly and Independently Associated with Non-Dipper Blood Pressure Pattern”. In this study, the aim was to evaluate a possible relationship between aortic arch calcification on chest radiographs and the non-dipper blood pressure pattern. Altogether, 406 patients were analyzed and divided into two groups: dipper and non-dipper. Approximately 261 (64%) patients presented the pattern of non-dipper blood pressure, against 145 (36%) with dipper blood pressure. It was found that the non-dipper group presented a higher prevalence of aortic arch calcification (70% vs. 33%, p<0.0001).

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Image

Dysphagia Caused by Right-Sided Aortic Arch and Lusorian Artery

Julio Gil et al. Bruno Marmelo Davide Moreira Luís Ferreira dos Santos José Costa Cabral

This case report describes a 75-year-old male patient presenting with persistent cough. His chest X-ray showed a right-sided paratracheal opacification. A thoracic CT ( and ) was subsequently performed to better characterize the radiographic findings. The exam revealed a Neuhauser Vascular Anomaly, that pertains a right-sided aortic arch and lusorian artery.

[…]

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Case Report

Middle Aortic Syndrome Treated by Implantation of an Advanta V12 Large Diameter Stent

Meng-Luen Lee et al. Ing-Sh Chiu Albert D Yang

Introduction

Middle aortic syndrome (MAS) was coined by Sen et al. depicting diffuse hypoplasia or stenosis of the distal thoracic aorta and abdominal aorta. Most often MAS is idiopathic; however, it may be associated with a variety of underlying diseases.^, Systemic hypertension, which is the most common feature of MAS, is usually found incidentally. Hypertensive encephalopathy was seen in 42% of patients with abdominal aortic coarctation, 45% of whom died before reaching 34 years of age. Thus, early recognition of hypertensive encephalopathy is crucial for patient survival. We report of a 12-year-old girl presenting with hypertensive encephalopathy as a harbinger of idiopathic MAS, which manifested as an isolated long-segment mid-thoracic aortic coarctation, and was successfully treated by endovascular implantation of an Advanta V12 Large Diameter Stent (AVLDS, Atrium, Hudson, NH, USA).

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ABC

Artigo Original

Mortality impact of thoracic aortic disease in São Paulo state from 1998 to 2007

Ricardo Ribeiro Dias et al. Omar Asdrubal Vilca Mejia Fábio Fernandes Félix José Alvarez Ramires … Charles Mady Noedir Antonio Groppo Stolf Fabio Biscegli Jatene

BACKGROUND: The epidemiological characteristics of thoracic aortic diseases (TAD) in the State of São Paulo and in Brazil, as well as their impact on the survival of these patients have yet to be analyzed. OBJECTIVES: To evaluate the mortality impact of TAD and characterize it epidemiologically. METHODS: Retrospective analysis of data from the public health system for the TAD registry codes of hospitalizations, procedures and deaths, from the International Code of Diseases (ICD-10), registered at the Ministry of Health of São Paulo State from January 1998 to December 2007. RESULTS: They were 9.465 TAD deaths, 5.500 men (58.1%) and 3.965 women (41.9%); 6.721 dissections (71%) and 2.744. aneurysms. In 86.3% of cases the diagnosis was attained during autopsy. There were 6.109 hospitalizations, of which 67.9% were males; 21.2% of them died (69% men), with similar proportions of dissection and aneurysm between sexes, respectively 54% and 46%, but with different mortality. Men with TAD die more often than women (OR = 1.5). The age distribution for deaths and hospitalizations was similar with predominance in the 6th decade. They were 3.572 surgeries (58% of hospitalizations) with 20.3% mortality (patients kept in clinical treatment showed 22.6% mortality; p = 0.047). The number of hospitalizations, surgeries, deaths of in-patients and general deaths by TAD were progressively greater than the increase in population over time. CONCLUSIONS: Specific actions for the early identification of these patients, as well as the viability of their care should be implemented to reduce the apparent progressive mortality from TAD seen among our population.

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Anatomopathological Session

Case 1/2013: 69-year-old male patient with sudden back and lower right limb pain and shock

Carlos Vinícius Abreu do Espirito Santo et al. Rafael Alves Franco Luiz Alberto Benvenuti

The patient, MSM, a 69-year-old man, sought medical care due to left dorsal and right lower limb pain. The chest x-ray showed mediastinal enlargement. He was undergoing examination when he lost consciousness and went into shock. Subcutaneous emphysema was observed in the left hemithorax, as well as abolition of breath sounds at auscultation. Tracheal intubation was performed with draining of blood-tinged fluid from the left hemithorax. Echocardiography showed left ventricle with 44/29 mm; septum, 12 mm; posterior wall, 13 mm; mild aortic root dilation, dissection of the lamina and periaortic hematoma. The valves and pericardium were normal. The patient was transferred to Instituto do Coraçao – InCor. Physical examination (21 Oct 2004: 10:45) showed that the patient was sedated with tracheal intubation, pale, heart rate at 90 bpm, blood pressure 130 x 80 mmHg, bloody drainage in the chest tube. Electrocardiogram – frequency 90 bpm, sinus rhythm, low voltage in the frontal plane and decreased voltage in left leads (Fig. 1). Computed tomography showed bilateral subcutaneous emphysema, thoracic aorta with inaccurate borders in its descending portion (from the subclavian artery to the middle portion), collapsed left lung and extensive collection of hematic characteristics in same hemithorax and middle and posterior mediastinum. Small right pneumothorax; small right pleural effusion with underlying parenchymal alterations. The analysis of the heart was impaired by the presence of hemothorax. While undergoing computed tomography, the patient showed no pulse, mydriasis, with asystole unresponsive to resuscitation and died (21 Oct 2011; 15:00 h).

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Case Report

Aorta after stent grafting for mycotic aneurysm

Ufuk Alpagut et al. Murat Ugurlucan Emin Tireli Izzet Rozanes Enver Dayioglu

Endovascular stent grafting is applied for the treatment of different aortic pathologies in the current medical era. It may be lifesaving in patients with comorbidities and virtually inoperable when adopting conventional techniques. This manuscript reports on a 40-year-old patient, who was previously treated for a mycotic saccular aneurysm at the aortic arch and who presented with a descending aortic rupture at the mid-term follow-up. The descending aortic rupture was also managed successfully by endovascular measures.

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Case Report

Interrupted aortic arch type B in A patient with cat eye syndrome

Sintia Iole Nogueira Belangero et al. Fernanda Teixeira da Silva Bellucco Mirlene C. S. P. Cernach April M. Hacker … Beverly S. Emanuel Maria Isabel Melaragno

We report a patient with cat eye syndrome and interrupted aortic arch type B, a typical finding in the 22q11.2 deletion syndrome. Chromosomal analysis and fluorescent in situ hybridization (FISH) showed a supernumerary bisatellited isodicentric marker chromosome derived from chromosome 22. The segment from 22pter to 22q11.2 in the supernumerary chromosome found in our patient does not overlap with the region deleted in patients with the 22q11.2 deletion syndrome. However, the finding of an interrupted aortic arch type B is unusual in CES, although it is a frequent heart defect in the 22q11 deletion syndrome.

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Case Report

Aortobronchopulmonary fistula in the postoperative period of aortic coarctation

Antônio Fernando Coelho Júnior et al. Antônio Amorim de Araújo Filho João Paulo de Vasconcelos Leitão Francisco Cabral Júnior

BACKGROUND AND OBJECTIVES: In patients with hemoptysis and a history of aortic surgery, the possibility of aortobronchopulmonary fistula must always be considered. The objective of this study was to report a rare case of hemoptysis due to aortobronchopulmonary fistula in the late postoperative period of aortic surgery. CASE REPORT: Female patient, 34 years, surgical correction of aortic coarctation, presenting massive hemoptysis. The echocardiogram disclosed a pseudoaneurysm. The surgical correction was performed and a Dacron tube graft was implanted in the affected aortic segment successfully. CONCLUSIONS: Aortobronchopulmonary fistulas must be considered in patients with previous aortic surgery, due to the elevated morbimortality if they are not promptly diagnosed and treated.

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Case Report

Patent ductus arteriosus: endovascular treatment in adult patient

Diego Felipe Gaia et al. José Honório Palma Hyung Chun Kim José Augusto Marcondes de Souza … Cláudia Rodrigues Alves Enio Buffolo

The patent ductus arteriosus (PDA) is a common type of congenital heart defect and its correction is simple when performed early in life. Surgery is performed using stitches or clips. In adults, the anomaly can lead to pulmonary hypertension and ventricular dysfunction. Surgery in adults is controversial and high-risk. This report describes an alternative endovascular approach in an adult patient.

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Case Report

Interrupted aortic arch with cardiac heart failure in young adult

Rogério Fortes Lobato et al. Luis Augusto R. Saliba Carlos Regenga Ferreiro Fernando Bacal

The interrupted aortic arch (IAA) is a rare cardiopathy, with high morbimortality when treatment is delayed. This study is a case of IAA with atypical clinical behavior in a 19-year-old patient. The history and the clinical assessment were compatible with recent heart failure, associated to syncope episodes and reduction of pulses in the lower limbs. The electrocardiogram showed biventricular and biatrial overload. The echocardiogram showed severe ventricular dysfunction and altered blood flow in the descending aorta. The angiotomography disclosed occlusion of the thoracic aorta after the left subclavian artery. The attained diagnosis was interrupted aortic arch and surgical treatment was indicated.

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Case Report

Pregnancy follow-up and outcome in a patient with Takayasu's arteritis

Alexandre Jorge Gomes de Lucena et al. Antonio Carlos Carvalho Jose Augusto M. Souza Antonio Fernandes Moron … Sue Y. Sun Daniel Born

We describe here the pregnancy follow-up and outcome in a patient with Takayasu’s arteritis, with a detailed account of the complications during gestation and delivery and the impact of the disease on the newborn’s health.

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