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Cleveland Clinic Journal of Medicine Dec 2017The number of aorta procedures performed annually in the United States has grown substantially during the past decade. Cleveland Clinic is a leader in research on the... (Review)
Review
The number of aorta procedures performed annually in the United States has grown substantially during the past decade. Cleveland Clinic is a leader in research on the risk of aortic dissection in patients with a bicuspid or tricuspid aortic valve and associated aneurysm, which has led to changes in the recommendations of when to operate. Safety and efficacy data support more proactive treatment for most patients with thoracic aortic aneurysm and/or dissection with a growing emphasis on the need to provide life-long care to patients with aortic conditions.
Topics: Aortic Dissection; Aortic Aneurysm, Thoracic; Aortic Valve; Heart Valve Prosthesis Implantation; Humans; Postoperative Complications; Risk Adjustment; Risk Factors; Treatment Outcome
PubMed: 29281610
DOI: 10.3949/ccjm.84.s4.07 -
Seminars in Vascular Surgery Mar 2022Pregnancy-associated aortic dissection (AD) is a rare event, with an incidence of 0.0004% per pregnancy. The work of the Aortic Dissection Collaborative identified... (Review)
Review
Pregnancy-associated aortic dissection (AD) is a rare event, with an incidence of 0.0004% per pregnancy. The work of the Aortic Dissection Collaborative identified pregnancy-associated AD as a high-priority topic, despite its rarity. The Pregnancy Working Group, which included physicians and patient stakeholders, performed a systematic literature review of pregnancy-associated AD from 1960 to 2021 and identified 6,333 articles through PubMed, OVID MEDLINE, Cochrane, Embase, CINAHL and Web of Science. The inclusion criterion was AD in pregnant populations and exclusion criteria were case reports, conference abstracts, and languages other than English. Assessment of full-text articles for eligibility after removal of duplicates from all databases yielded 68 articles to be included in the final review. Topics included were timing of AD in pregnancy, type of AD, and management considerations of pregnancy-associated AD. The Pregnancy Working Group identified gaps in knowledge and future areas of research for pregnancy-associated AD, including clinical management, mental health outcomes post AD, reproductive and genetic counseling, and contraception after AD. Future collaborative projects could be a multicenter, international registry for all pregnancy-associated AD to refine the risk factors, best practice and management of AD in pregnancy. In addition, future mixed methodology studies may be useful to explore social, mental, and emotional factors related to pregnancy-associated AD and to determine support groups' effect on anxiety and depression related to these events in the pregnancy and postpartum period.
Topics: Aortic Dissection; Female; Humans; Multicenter Studies as Topic; Postpartum Period; Pregnancy; Risk Factors
PubMed: 35501042
DOI: 10.1053/j.semvascsurg.2022.02.010 -
Vascular Medicine (London, England) Jun 2016Aortic dissection remains a challenging clinical scenario, especially when complicated by peripheral malperfusion. Improvements in medical imaging have furthered... (Review)
Review
Aortic dissection remains a challenging clinical scenario, especially when complicated by peripheral malperfusion. Improvements in medical imaging have furthered understanding of the pathophysiology of malperfusion events in association with aortic dissection, including the elucidation of different mechanisms of branch vessel obstruction. Despite these advances, malperfusion syndrome remains a deadly entity with significant mortality. This review presents the latest knowledge regarding the pathogenesis of aortic dissection complicated by malperfusion syndrome, and discusses the diagnostic and therapeutic guidelines for management of this vicious entity.
Topics: Aortic Dissection; Animals; Aortic Aneurysm; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Hemodynamics; Humans; Ischemia; Regional Blood Flow; Stents; Treatment Outcome; Ultrasonography, Doppler, Color; Vascular Patency
PubMed: 26858183
DOI: 10.1177/1358863X15625371 -
BMC Cardiovascular Disorders Oct 2022The incidence and mortality of aortic dissection (AD) are increasing. In pathological studies, macrophages, T lymphocytes and dendritic cells were found in the tunica...
BACKGROUND
The incidence and mortality of aortic dissection (AD) are increasing. In pathological studies, macrophages, T lymphocytes and dendritic cells were found in the tunica media of the aorta. Acetaldehyde dehydrogenase 2 (ALDH) gene polymorphisms are associated with a high incidence of hypertension in Asian populations. However, there is no clear evidence of the relationship between ALDH and aortic dissection in Asians. The aim of this study was to investigate the incidence of aortic dissection in different ALDH genotypes and explore changes in the vasculature.
MATERIALS AND METHODS
Three-week-old male mice were administered freshly prepared β-aminopropionitrile solution dissolved in drinking water (1 g/kg/d) for 28 days to induce TAD. An animal ultrasound imaging system was used to observe the formation of arterial dissection and changes in cardiac function. Subsequently, mice were euthanized by cervical dislocation. The aortas were fixed for HE staining and EVG staining to observe aortic elastic fiber tears and pseudoluma formation under a microscope.
RESULTS
Knockout of ALDH mitigated β-aminopropionitrile-induced TAD formation in animal studies. Ultrasound results showed that ALDH knockout reduced the degree of ascending aortic widening and the incidence of aortic dissection rupture. Pathological sections of multiple aortic segments showed that the protective effect of ALDH knockout was observed in not only the ascending aorta but also the aortic arch and descending aorta. The expression levels of genes related to NK CD56bright cells, Th17 cells, T cells and T helper cells were decreased in ALDH knockout mice treated with β-aminopropionitrile for 28 days.
CONCLUSION
ALDH knockout protects against aortic dissection by altering the inflammatory response and immune response and protecting elastic fibers.
Topics: Aldehyde Dehydrogenase, Mitochondrial; Aminopropionitrile; Aortic Dissection; Animals; Aortic Aneurysm, Thoracic; Aortic Rupture; Disease Models, Animal; Drinking Water; Male; Mice; Mice, Inbred C57BL; Mice, Knockout
PubMed: 36229771
DOI: 10.1186/s12872-022-02874-5 -
Seminars in Vascular Surgery Mar 2022Although the topics of surgical techniques and medical therapies have been widely studied in aortic dissection (AD), studies examining the short- and long-term impact of... (Review)
Review
Although the topics of surgical techniques and medical therapies have been widely studied in aortic dissection (AD), studies examining the short- and long-term impact of this event on mental health are largely lacking. Many of the studies have used the 36-Item Short Form Survey at variable time points after the event. However, AD as medical trauma has a complex impact on a person's identity. Its implications for emotional, mental, social, existential, and self-concept could be explored more robustly. This topic was identified as a topic of interest by the AD Collaborative. The AD Collaborative Mental Health Working Group was formed and performed a landscape review to summarize current literature surrounding quality of life research in those who have experienced AD, identify gaps in knowledge, and to outline future research questions.
Topics: Aortic Dissection; Humans; Mental Health; Quality of Life; Surveys and Questionnaires
PubMed: 35501046
DOI: 10.1053/j.semvascsurg.2022.02.005 -
Current Problems in Cardiology Jun 2023Coronavirus disease 19 (Covid-19) has been declared as a pandemic disease since March 2020; causing wide array of signs and symptoms, many of which result in increased... (Review)
Review
Coronavirus disease 19 (Covid-19) has been declared as a pandemic disease since March 2020; causing wide array of signs and symptoms, many of which result in increased mortality rates worldwide. Although it was initially known as an acute respiratory disease, Covid-19 is accompanied with several extrapulmonary manifestations, of which the cardiovascular ones are of major importance. Among other cardiovascular complications of Covid-19, aortic dissection has been a significant yet underrated problem. The pathophysiology of aortic dissection consists of various inflammatory pathways, that could be influenced by Covid-19 infection. We herein have reviewed articles inclusive of aortic dissection concurrent with Covid-19 infection in a systematic manner, along with the probable similarities in pathophysiology of aortic dissection with Covid-19 infection.
Topics: Humans; Aortic Dissection; COVID-19; SARS-CoV-2
PubMed: 35139402
DOI: 10.1016/j.cpcardiol.2022.101129 -
Missouri Medicine 2017Acute aortic syndromes are disorders of the thoracic and abdominal aorta that are usually symptomatic and require urgent evaluation and treatment. They include acute... (Review)
Review
Acute aortic syndromes are disorders of the thoracic and abdominal aorta that are usually symptomatic and require urgent evaluation and treatment. They include acute aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. Knowledge of the natural history of these conditions, prompt diagnosis, and surgical intervention, when indicated, are the keys to successful outcomes.
Topics: Acute Disease; Aortic Dissection; Aortic Diseases; Hematoma; Humans; Risk Factors
PubMed: 30228665
DOI: No ID Found -
Clinical Cardiology Sep 2022Lipoprotein(a) [Lp(a)] is associated with coronary atherosclerotic heart disease, aortic stenosis, stroke, and heart failure. We aimed to determine the relationship...
BACKGROUND
Lipoprotein(a) [Lp(a)] is associated with coronary atherosclerotic heart disease, aortic stenosis, stroke, and heart failure. We aimed to determine the relationship between Lp(a) and aortic dissection (AD).
METHODS
Two hundred patients with AD were included in our case group. The control group consisted of 200 non-AD people who were age- (±5 years) and gender-matched to the case group. Data were collected retrospectively, including hypertension, smoking, coronary artery disease, diabetes mellitus, Lp(a), total cholesterol, triglyceride, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. The association between Lp(a) and AD was studied using univariate and multivariate logistic regression analysis.
RESULTS
Patients with AD had greater median Lp(a) concentrations than non-AD people (152.50 vs. 81.75 mg/L). Lp(a) was associated with AD in a multivariate logistic regression analysis (odds ratio, 8.03; 95% confidence interval, 2.85-22.62), comparing those with Lp(a) quartile 4 with those with Lp(a) quartile 1. Stratified analysis showed that this relationship was observed in both men and women, as well as in older and younger individuals.
CONCLUSIONS
High levels of Lp(a) are strongly associated with AD, independent of other cardiovascular risk factors.
Topics: Aged; Aortic Dissection; Cholesterol, LDL; Coronary Artery Disease; Female; Humans; Lipoprotein(a); Male; Retrospective Studies; Risk Factors
PubMed: 35925003
DOI: 10.1002/clc.23834 -
The Journal of Thoracic and... Jun 2022
Topics: Aortic Dissection; Humans
PubMed: 33752890
DOI: 10.1016/j.jtcvs.2021.02.079 -
Vascular Medicine (London, England) Feb 2020Aortic aneurysms were the primary cause of nearly 10,000 deaths in 2014 according to data from the Centers for Disease Control and may involve segments of the thoracic... (Review)
Review
Aortic aneurysms were the primary cause of nearly 10,000 deaths in 2014 according to data from the Centers for Disease Control and may involve segments of the thoracic or abdominal aorta. Thoracic aortic aneurysms and dissections are more commonly associated with an underlying genetic etiology. In the past several decades, in parallel with the burst of new genome sequencing technologies, a number of genetic aortopathies have been identified. These have provided important insights into the molecular mechanisms of aneurysmal disease, but pose challenges in clinical practice as there are limited consensus recommendations at this time. In this review, we aim to address the pathophysiology, clinical presentation, and treatment considerations in the key heritable thoracic aortopathies.
Topics: Aortic Dissection; Aortic Aneurysm; Clinical Decision-Making; Decision Support Techniques; Genetic Predisposition to Disease; Humans; Molecular Diagnostic Techniques; Phenotype; Predictive Value of Tests; Risk Factors; Treatment Outcome
PubMed: 32000633
DOI: 10.1177/1358863X19886361