Aortic Diseases – ABC CARDIOL

ABCIC

Review Article

What do Cardiologists Expect Regarding Echocardiogram in Aortopathies

Gustavo de Azevedo Martinhago et al. Alan Rodrigues Andrade Vinicius Machado Correia Fabio Fernandes … Jose Augusto Duncan Santiago Ricardo Ribeiro Dias Vagner Madrini Junior

Abstract

The echocardiogram is an available and essential imaging tool for the evaluation of thoracic aortic diseases. This examination plays a significant role in the identification and diagnosis, as well as the follow-up of chronic cases. Its availability, portability, cost-effectiveness, and the absence of exposure to radiation or contrast make it an important tool for monitoring patients with known aortopathy, who usually require serial examinations for follow-up. Although it is inferior in the total and detailed characterization of the aorta in all its sections compared to aortic angiotomography or angioresonance, the echocardiogram allows for functional assessment of the aortic valve and valve apparatus. In acute aortopathies, it also enables the evaluation of complications and can be performed on hemodynamically unstable patients. This article will discuss the theoretical and practical aspects of the applicability of the echocardiogram in the context of aortopathies.

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Original Article

Characteristics of Older Patients with Takayasu’s Arteritis: A Two-Center, Cross-Sectional, Retrospective Cohort Study

João Calvino Soares de Oliveira et al. Alexandre Moura dos Santos Mariana Freitas de Aguiar Jucier Gonçalves Junior … Alexandre Wagner Silva de Souza Rosa Maria R. Pereira Samuel Katsuyuki Shinjo

Abstract

Background

Few studies have assessed elderly patients with Takayasu’s arteritis (TAK).

Objectives

To evaluate the progression of TAK in different age groups and its possible effects on drug treatment and disease activity.

Methods

This cross-sectional and retrospective cohort study included 66 TAK patients. Patients were interviewed and data of the 12 preceding months were collected from electronic medical records. The patients were divided into four quartiles according to current age and compared for clinical and laboratory data, treatment, comorbidities, disease status, and functional status. Statistical significance was set at p<0.05.

Results

The groups were Q1(22-36 years, n=16), Q2(37-42 years, n=18), Q3(43-49 years, n=17), and Q4(51-66 years, n=15). The frequency of patients with disease activity, fatigue, comorbidities and vascular impairments, and the TAK disease extent index were also comparable between the groups. With age, disease duration was longer (p=0.001), fewer patients used prednisone (Q1:43.8%, Q2:33.3%, Q3:11.8%, and Q4:6.7%; p=0.049) and immunosuppressive drugs [Q1:100.0%, Q2:66.7%, Q3:58.8%, and Q4:46.7%; Q1 versus Q3 (p=0.043), and Q1 versus Q4 (p=0.005) in post-hoc analyses], and patients had greater functional status impairment (Q2 versus Q3, p=0.003). In addition, the levels of disease damage, new TAK symptoms, and complications in the preceding 12 months were not different between the groups.

Conclusions

Older patients with TAK require minimal drug treatment, and have greater impairment of functional status, which may be attributed to aging-related factors.

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IJCS

Case Report

Differential Diagnosis of Marfan Syndrome in a Teenage Volleyball Athlete

Fabrissio Portelinha Graffunder et al. Sabrina Weiss Sties Ana Inês Gonzáles Tales de Carvalho

Introduction

Marfan syndrome (MFS) is an autosomal dominant hereditary disease mainly caused by mutations in the fibrillin-1 (FBN1) gene. It is characterized by the occurrence of thoracic aortic aneurysm and/or dissection, ectopia lentis, and systemic abnormalities.

The highest risk of death associated with the syndrome is attributed to cardiovascular abnormalities, in particular, progressive aortic root aneurysm, leading to aortic dissection and rupture if not corrected surgically. The clinical diagnosis of MFS may be established by the revised Ghent nosology, although this can be challenging, since many characteristics of this disease are dependent on the age of the patient, while others are frequently seen in the general population, with substantial phenotypic variability. In addition, MFS has considerable overlap with other connective tissue diseases.^,

[…]

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ABC

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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What do Cardiologists Expect Regarding Echocardiogram in Aortopathies

Abstract

Characteristics of Older Patients with Takayasu’s Arteritis: A Two-Center, Cross-Sectional, Retrospective Cohort Study

Abstract

Background

Objectives

Methods

Results

Conclusions

Differential Diagnosis of Marfan Syndrome in a Teenage Volleyball Athlete

Introduction

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

Introduction

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

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