Aortic Aneurysm – ABC CARDIOL

ABCIC

Case Report

Use of Contrast-Enhanced Ultrasound for the Diagnosis of Endoleak After EVAR: A Case Report

Ana Carolina N. Netto Djaló et al. Glauber Lutterbach de Oliveira Pires Adriana Ferraz Carlos Gustavo Abath … Idalécio Souto Fonseca Filho Milena O. Marques

Introduction

Abdominal aortic aneurysm (AAA), with an estimated prevalence of 4–8% and a higher incidence in men, older people, hypertensive patients, and smokers, can be treated with surgical or endovascular aneurysm repair (EVAR). When well-indicated, EVAR is primarily used since it is less invasive and has lower morbidity and mortality rates. However, due to possible complications, routine clinical and imaging surveillance is necessary to identify or prevent periprosthetic leaks (endoleaks) associated with aneurysmal disease progression.

Accordingly, computed tomography angiography (CTA) has always been considered the gold standard for endoleak surveillance due to its high image quality and usefulness for two- and three-dimensional reconstruction; however, its use of iodinated contrast and exposure to ionizing radiation are disadvantages. Therefore, other post-EVAR control imaging methods such as contrast-enhanced ultrasound (CEUS) have been studied as an endoleak dynamic and high-quality assessment method.^,

[…]

Read Full Article

ABC

Original Article

Computational Fluid Dynamics to Assess the Future Risk of Ascending Aortic Aneurysms

Gabriela de C. Almeida et al. Bruno Alvares de Azevedo Gomes Fabiula Schwartz de Azevedo Karim Kalaun … Ivan Ibanez Pedro S. Teixeira Ilan Gottlieb Marcelo M. Melo Glaucia Maria Moraes de Oliveira Angela O. Nieckele

Abstract

Background

A methodology to identify patients with ascending aortic aneurysm (AsAA) under high risk for aortic growth is not completely defined

Objetive

This research seeks to numerically characterize the aortic blood flow by relating the resulting mechanical stress distribution with AsAA growth.

Methods

Analytical, observational, single-center study in which a computational fluid dynamics (CFD) protocol was applied to aortic computed tomography angiogram (CTA) images of patients with AsAA. Two CTA exams taken at a minimum interval of one year were obtained. From the CTA-gathered images, three-dimensional models were built, and clinical data were registered. Study of velocity field and coherent structures (vortices) was performed aiming to relate them to the presence or absence of aneurysm growth, as well as comparing them to the patients’ clinical data. The Kolmogorov-Smirnov test was used to evaluate the normality of the distribution, and the non-parametric Wilcoxon signed-rank test, for non-normal distribution, was used to compare the paired data of the aortic angles. Statistical significance was set at 5%.

Results

The incident jet in the aortic wall generated recirculation areas in the posterior region of the jet, inducing complex vortices formation in the group with aneurysm growth, leading to an average pressure increase in the ascending aortic wall between exams. In the group without aneurysm growth, the average pressure decreased.

Conclusion

This pilot study showed that CFD based on CTA may in the near future be a tool to help identify flow patterns associated with AsAA remodeling process.

Read Full Article

ABCIC

Image

A Deceiving Aorta

Helder Santos et al. Hugo Miranda Inês Almeida Mariana Santos … Samuel Almeida Lurdes Almeida

[…]

Read Full Article

ABC

Clinicoradiological Session

Case 5 / 2014 – 26-year-old Male with Moderate Stenosis of Bivalved Aortic Valve and Dilation of Ascending Aorta

Edmar Atik et al. Ricardo Ribeiro Dias José Lázaro Andrade

Complementary tests

Electrocardiogram: () presented normal sinus rhythm and morphology of P, QRS and T waves, without signs of cavity overload. Ventricular repolarization was normal. AP: +40º, AQRS: 0º, AT: 20 º.

Chest radiography: Shows normal heart region and pulmonary vascular markings on expiration radiography. Mild dilation on upper right arch indicating dilation of ascending aorta ().

[…]

Read Full Article

ABC

Anatomopathological Session

Case 1/2014 – Syncope Due to Cardiogenic Shock in a 25-year-old Male Patient

Tiago Rodrigues Politi et al. Paulo Gutierrez

Clinical aspects

This is a case of a male patient, 25 years of age with no previously described clinical history that sought medical attention complaining of malaise and feeling faint. The clinical picture had started 1 hour before he sought the local hospital emergency room. The patient clinical evolution was dramatic, presenting at the examination as shock, initially of undetermined etiology, going to aortic dissection and cardiac tamponade, and culminating in death within hours of symptom onset, before any surgical intervention. Acute dissection of the ascending aorta was then identified, with rapid and catastrophic clinical deterioration, a determining factor for the diagnosis to be attained as early as possible, as well as an early and accurate intervention.

Acute aortic dissection is a cardiovascular emergency with high mortality, ranging from 50 to 68% in 48 hours, 70% at 1 week and 85% in 1 month. The intimal tear is transversal, located in 70% of cases in the aorta ascending (just above the aortic valve), 20% in the descending aorta after the aortic arch, and 10% in the transverse aorta. Once started, the dissection progression can be distal, retrograde or occur in both directions and be of varying extension ^, . In the present case, the aortic dissection started in the ascending portion, retrograde, with bending of the anterior plan between the true and false lumen, generating a mechanical obstruction to the left ventricular outflow tract ().

[…]

Read Full Article

ABC

Artigo Original

Features of the onset of Takayasu's arteritis acccording to gender

Andrea Rocha de Saboia Mont'Alverne et al. Luiz Eduardo de Paula Samuel Katsuyuki Shinjo

BACKGROUND: Although there are various published epidemiological studies regarding Takayasu’s arteritis (TA), none have analyzed the influence of gender on the clinical and laboratory manifestations or vascular alterations at disease onset. OBJECTIVES: To analyze the influence of gender on clinical and laboratory manifestations and variations in vascular imaging at TA onset. METHODS: A retrospective, unicentric cohort study that evaluated 55 consecutive TA patients between 1982 and 2012. All available clinical data and laboratory test results related to the onset of the disease were analyzed. We included only patients aged 12-35 years at diagnosis to exclude age-related factors. RESULTS: We analyzed 17 men and 38 women, mostly Caucasian, with a comparable mean age between genders. There was no gender difference regarding the clinical or laboratory characteristics, comorbidities, or smoking habit, except for abdominal pain, which was more common in men. Regarding vascular lesions, the presence of ascending aortic aneurysms was significantly more frequent in males. Male gender represented an independent risk factor for the occurrence of abdominal pain and ascending aortic aneurysms in TA patients. CONCLUSION: Abdominal pain and ascending aortic aneurysms occurred more frequently in men with TA, suggesting a more severe disease profile in males.

Read Full Article

ABC

Correlação Clínico-Radiográfica

Case 05/12: a 67 year-old hypertensive woman with atrial fibrillation who presented shock followed by cardiac arrest with pulseless electric activity two months after surgical repair of ascending aorta aneurysm

Fernanda Marinho Mangione et al. Thiago Nunes Pereira Leite Paulo Sampaio Gutierrez

ANATOMOPATHOLOGICAL SESSION

Case 05/12 – a 67 year-old hypertensive woman with atrial fibrillation who presented shock followed by cardiac arrest with pulseless electric activity two months after surgical repair of ascending aorta aneurysm

[…]

Read Full Article

ABC

Case Report

Aortic aneurysm rupture into the esophagus

Christiano da Silveira de Barcellos et al. Paulo Ceratti de Azambuja Marcelo Kunh Momolli Clóvis Manfredini Rigoni … Marcelo Lopes Henrique Biavatti Wagnes Franceschi Claudio Borges Fortes

We present the case of a patient with a descending aorta aneurysm rupture into the esophagus, which, after aortoplasty with Dacron tube interposition and suture of esophageal laceration, developed a pleural-esophagus fistula on the 3rd postoperative day. She needed re-intervention and intensive care, followed by adequate recovery. Considering this unusual case and the knowledge acquired through its management, we reviewed the literature in order to discuss the best alternative for the correction of this rare and often fatal form of presentation of aortic diseases.

Read Full Article

ABC

Artigo Original

Ischemic preconditioning and spinal cord function monitoring in the descending thoracic aorta approach

Bernardo Assumpção de Mônaco et al. Anderson Benício Ivan Salvador Bonillo Contreras Larissa Eckmann Mingrone … Gerson Ballester Luiz Felipe Pinho Moreira

OBJECTIVES: To evaluate the effectiveness of acute ischemic preconditioning (IP), based on somatosensory evoked potentials (SSEP) monitoring, as a method of spinal cord protection and to asses SSEP importance in spinal cord neuromonitoring. METHODS: Twenty-eight dogs were submitted to spinal cord ischemic injury attained by descending thoracic aorta cross-clamping. In the C45 group, the aortic cross-clamping time was 45 min (n=7); in the IP45 group, the dogs were submitted to IP before the aortic cross-clamping for 45 min (n=7). In the C60 group, the dogs were submitted to 60 min of aortic cross-clamping (n=7), as in the IP60 group that was previously submitted to IP. The IP cycles were determined based on SSEP changes. RESULTS: Tarlov scores of the IP groups were significantly better than those of the controls (p = 0.005). Paraplegia was observed in 3 dogs from C45 and in 6 from C60 group, although all dogs from IP45 group were neurologically normal, as 4 dogs from IP60. There was a significant correlation between SSEP recovery time until one hour of aortic reperfusion and the neurological status (p = 0.011), showing sensitivity of 75% and specificity of 83%. CONCLUSION: Repetitive acute IP based on SSEP is a protection factor during spinal cord ischemia, decreasing paraplegia incidence. SSEP monitoring seems to be a good neurological injury assessment method during surgical procedures that involve spinal cord ischemia.

Read Full Article

ABC

Artigo Original

Prevalence and risk factors for combined coronary artery disease and aortic aneurysm

Carlos Romério Costa Ferro et al. Dinaldo Cavalcanti de Oliveira Fábio de Freitas Guimarães Guerra Alexandre Jorge de Lucena … Fabiana Piech Nunes Sergio Tranchesi Ortiz Enilton Sergio Tabosa Egito Luis Carlos Bento de Sousa Adib Domingos Jatene Leopoldo Soares Piegas

OBJECTIVE: To evaluate CAD prevalence in patients with aortic aneurysm, as well as differences related to aneurysm topographies. To describe the primary risk factors for CAD related to this association and their occasional differences according to AA topographies. METHODS: This was an open, prospective, nonrandomized study that evaluated 95 patients (66 men and 33 women, mean age 63 ± 11.8). All patients, asymptomatic for CAD, had undergone aortic CT and coronary angiography. According to the AA topography, they were classified into three groups: 1) patients with thoracic aortic aneurysm (TAA); 2) thoracoabdominal aortic aneurysm (TAAA); and 3) abdominal aortic aneurysm (AAA). A database was created to store information from clinical data and complementary examinations. Statistical analysis was performed using the Student’s t test or analysis of variance (ANOVA) for continuous variables and chi-square test for categorical variables. P values 70% and 19 (31.6%), > 50%. Fifteen patients (25%) had single-vessel disease, 11 (18%) had two-vessel disease, and 34 (57%) had three-vessel disease. CONCLUSION: Asymptomatic CAD is highly prevalent in AA patients, particularly among those with AAA. Study results suggest the need for diagnostic stratification for CAD in patients with AA, especially those with AAA.

Read Full Article