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Cureus Nov 2023Background Aortic root dilation is an increasingly recognized feature in repaired tetralogy of Fallot (TOF) patients. However, the dilation at the aortic root and...
Background Aortic root dilation is an increasingly recognized feature in repaired tetralogy of Fallot (TOF) patients. However, the dilation at the aortic root and ascending aorta in unrepaired TOF is rarely studied. This study aims to confirm whether aortic dilation is a common feature in unrepaired TOF and investigate the factors attributed to aortic dilation. Methodology Patients with an echocardiographic diagnosis of TOF undergoing computed tomography angiography were retrospectively studied. Diameters and z scores of aortic annular (Ao1), aortic sinotubular junction (Ao2), ascending aorta (Ao3), and distal transverse aortic arch (Ao4) were measured. Preoperative body surface area (BSA), hemoglobin (Hb), hematocrit (HCT), arterial oxygen saturation (SaO), and platelet (PLT) count were recorded. Results A total of 101 TOF patients aged 6.8 ± 9.5 years were included in this study, whose mean BSA (m), Hb (g/L), HCT, SaO (%), and PLT (10/L) were 0.7 ± 0.4, 162.1 ± 3.8, 0.5 ± 0.1, 85.1 ± 9.3, and 238.1 ± 101.1, respectively. The mean z score of Ao1, Ao2, Ao3, and Ao4 were 10.3 ± 3.5, 4.7 ± 2.9, 4.0 ± 2.7, and 4.1 ± 2.4, respectively. Age and BSA were positively correlated with the z scores of Ao1 and Ao2. Preoperative Hb and HCT were positively correlated with the z scores of Ao1, Ao2, Ao3, and Ao4. Preoperative SaO and PLT were negatively correlated with the z scores of Ao1, Ao2, Ao3, and Ao4. Conclusions Aortic dilation is common in unrepaired TOF patients. The dilation of different levels of the aorta was correlated with age, BSA, preoperative Hb, HCT, SaO, and PLT.
PubMed: 38143655
DOI: 10.7759/cureus.49212 -
Monaldi Archives For Chest Disease =... Sep 2019Biological systems ubiquitously and inevitably exhibit stochasticity in traits from the molecular level to the multicellular and morphological level. However, there are...
Biological systems ubiquitously and inevitably exhibit stochasticity in traits from the molecular level to the multicellular and morphological level. However, there are several examples of natural events that might be described in mathematical terms. Plants grow in a structured and geometric way to maximize their sun exposure for photosynthesis while reducing the stress. The 'Fibonacci sequence' and its 'golden ratio' are considered a mathematical regularity and model that is one of the corner-stone of the 'phyllotaxis', the part of the botany that studies how plants branch. Nevertheless, we currently do not know if such mathematical model can be applied to humans. Different authors have hypothesized that 'fractal' might be identified along with the 'golden-ratio' in the human body (coronary artery, heart valves etc.). The aortic valve and the aortic root might represent an interesting model of human fractal geometry, where the phyllotactic rules can be reasonably applied, and where deviation from normality might results in dysfunction. However, in the absence of scientific validations, such report represents only the authors' perceptions of a beautiful shape.
Topics: Aortic Valve; Botany; Fractals; History, 16th Century; History, Ancient; Humans; Plant Leaves
PubMed: 31505914
DOI: 10.4081/monaldi.2019.1139 -
Journal of Atherosclerosis and... Feb 2023We aimed to examine the impact of overweight and obesity on mortality from nonrheumatic aortic valve disease.
AIM
We aimed to examine the impact of overweight and obesity on mortality from nonrheumatic aortic valve disease.
METHODS
In the Japan Collaborative Cohort Study, we analyzed data of 98,378 participants aged 40-79 years, with no history of coronary heart disease, stroke, or cancer at baseline (1988-1990) and who completed a lifestyle questionnaire including height and body weight; they were followed for mortality until the end of 2009. The Cox proportional hazards model was used to calculate the multivariable hazard ratios (HRs) with 95% confidence intervals (CIs) of nonrheumatic aortic valve disease mortality according to body mass index (BMI) after adjusting for potential confounding factors.
RESULTS
During the median 19.2 years follow-up, 60 deaths from nonrheumatic aortic valve disease were reported. BMI was positively associated with the risk of mortality from nonrheumatic aortic valve disease; the multivariable HRs (95% CIs) were 0.90 (0.40-2.06) for persons with BMI <21 kg/m, 1.71 (0.81-3.58) for BMI 23-24.9 kg/m, 1.65 (0.69-3.94) for BMI 25-26.9 kg/m, and 2.83 (1.20-6.65) for BMI ≥ 27 kg/m (p for trend=0.006), compared with persons with BMI 21-22.9 kg/m. Similar associations were observed between men and women (p for interaction=0.56). Excluding those who died during the first ten years of follow-up or a competing risk analysis with other causes of death as competing risk events did not change the association materially.
CONCLUSIONS
Overweight and obesity may be independent risk factors for nonrheumatic aortic valve disease mortality in Asian populations.
Topics: Male; Humans; Female; Overweight; Body Mass Index; Cohort Studies; East Asian People; Obesity; Risk Factors; Aortic Valve; Aortic Valve Disease
PubMed: 35418541
DOI: 10.5551/jat.63452 -
Journal of Nippon Medical School =... Mar 2023Neuroprotection is important in open aortic arch surgery because of the dependence of brain tissues on cerebral perfusion. Therefore, several techniques have been... (Review)
Review
Neuroprotection is important in open aortic arch surgery because of the dependence of brain tissues on cerebral perfusion. Therefore, several techniques have been developed to reduce cerebral ischemia and improve outcomes in open aortic arch surgery. In this review, I describe various neuroprotective strategies, such as profound and deep hypothermic circulatory arrest, selective antegrade cerebral perfusion, retrograde cerebral perfusion, and lower body circulatory arrest; compare their advantages and disadvantages, and discuss their evolution and current status by reviewing relevant literature.
Topics: Humans; Aorta, Thoracic; Temperature; Neuroprotection; Circulatory Arrest, Deep Hypothermia Induced; Perfusion; Cerebrovascular Circulation; Hypothermia, Induced
PubMed: 35644556
DOI: 10.1272/jnms.JNMS.2023_90-103 -
Journal of Physiology and Pharmacology... Dec 2021Vaspin, also known as visceral adipose tissue-derived serine protease inhibitor; expression of this adipokine has been confirmed in many parts of the body like the... (Review)
Review
Vaspin, also known as visceral adipose tissue-derived serine protease inhibitor; expression of this adipokine has been confirmed in many parts of the body like the hypothalamus, pancreas, thyroid gland, ovaries, placenta, and testes, where it may play a crucial role in osteogenesis, steroidogenesis, the formation of blood vessels, and food intake. In addition, there are many studies supporting an interaction between vaspin and cell proliferation and apoptosis, which are crucial processes for maintaining homeostasis of the body. Vaspin has an anti-apoptotic effect in ovarian cells, osteoblasts, macrophages, aortic endothelial cells, hepatocellular carcinoma cells, and cardiomyocytes. On the other hand, vaspin has no effect on apoptosis in aortic smooth muscle cells and cardiomyocytes. Interestingly, vaspin also promotes proliferation in normal and cancerous ovarian cells, pre-adipocytes, hepatocellular carcinoma cells, and bone mesenchymal stem cells, although other studies showed that this adipokine reduces the proliferation of aortic, and vascular smooth muscle cells. Furthermore, vaspin has no effect on the proliferation of chondrocytes, osteoblasts, macrophages, pre-adipocytes, umbilical vein endothelial cells, and coronary artery smooth muscle cells. Dysfunction and dysregulation in the apoptosis/proliferation ratio may lead to cancer development and progression as well as pathogenesis of many diseases. The molecular mechanism of vaspin action on cell apoptosis and proliferation is reviewed in this paper.
Topics: Apoptosis; Cell Proliferation; Endothelial Cells; Myocytes, Smooth Muscle; Serpins
PubMed: 35377336
DOI: 10.26402/jpp.2021.6.02 -
Frontiers in Cardiovascular Medicine 2023One treatment for acute type A aortic dissection is to replace the ascending aorta and aortic arch with a graft during circulatory arrest of the lower body, but this is... (Review)
Review
One treatment for acute type A aortic dissection is to replace the ascending aorta and aortic arch with a graft during circulatory arrest of the lower body, but this is associated with high mortality and morbidity. Maintaining the balance between oxygen supply and demand during circulatory arrest is the key to reducing morbidity and is the primary challenge during body perfusion. The aim of this review is to summarize current knowledge of body perfusion techniques and to predict future development of this field. We present three perfusion techniques based on deep hypothermic circulatory arrest (DHCA): DHCA alone, DHCA with selective cerebral perfusion, and DHCA with total body perfusion. DHCA was first developed to provide a clear surgical field, but it may contribute to stroke in 4%-15% of patients. Antegrade or retrograde cerebral perfusion can provide blood flow for the brain during circulatory arrest, and it is associated with much lower stroke incidence of 3%-9%. Antegrade cerebral perfusion may be better than retrograde perfusion during longer arrest. In theory, blood flow can be provided to all vital organs through total body perfusion, which can be implemented either arterial or venous systems, or by combining retrograde inferior vena caval perfusion with antegrade cerebral perfusion. However, whether total body perfusion is better than other techniques require further investigation in large, multicenter studies. Current techniques for perfusion during circulatory arrest remain imperfect, and a technique that effectively perfuses the upper and lower body effectively during circulatory arrest is missing. Total body perfusion should be systematically compared against selective cerebral perfusion for improving outcomes after circulatory arrest.
PubMed: 37063959
DOI: 10.3389/fcvm.2023.1109401 -
Frontiers in Genetics 2022To examine the causality between hypertension, diabetes, other cardiovascular risk factors, lifestyle behaviors, and the aortic aneurysm among patients of European...
To examine the causality between hypertension, diabetes, other cardiovascular risk factors, lifestyle behaviors, and the aortic aneurysm among patients of European ancestry. We performed two-sample Mendelian randomization (MR) analysis to investigate the causality of 12 modifiable risk factors with aortic aneurysm, including hypertension, body mass index (BMI), waist-hip ratio (WHR), diabetes, tobacco smoking, alcohol and coffee consumption, physical activity, and sleep duration. Genome-wide significant genetic instruments ( < 5 × 10) for risk factors were extracted from European-descent genome-wide association studies, whereas aortic aneurysm genetic instruments were selected from the UK Biobank and FinnGen cohort. The inverse-variance weighted MR was used as the main analysis, and MR-Egger (MRE), weighted median MR, MR pleiotropy residual sum and outlier, and Phenoscanner searching were performed as sensitivity analyses. Furthermore, we calculated MRE intercept to detect pleiotropy and Cochran's Q statistics to assess heterogeneity and conducted bidirectional MR and MR Steiger tests to exclude the possibility of reverse causality. We observed significantly higher risks for the aortic aneurysm in hypertension [pooled OR: 4.30 (95% CI 2.84-6.52)], BMI [OR: 1.58 (95% CI 1.37-1.81)], WHR [OR: 1.51 (95% CI 1.21-1.88)], WHR adjusted for BMI (WHRadjBMI) [OR: 1.35 (95% CI 1.12-1.63)], age of smoking initiation [OR: 1.63 (95% CI 1.18-2.26)], and tobacco use (initiation, cessation, and heaviness) [OR: 2.88 (95% CI 1.85-2.26)]. In sensitivity analysis, the causal effects of hypertension, BMI, WHRadjBMI, and tobacco use (initiation, cessation, and heaviness) remained robust. There was a positive causal relationship between hypertension, BMI, WHR, and WHRadjBMI and aortic aneurysm.
PubMed: 36003339
DOI: 10.3389/fgene.2022.925874 -
European Journal of Vascular and... Mar 2021
Topics: Aorta; Esophagus; Female; Foreign-Body Migration; Gastroplasty; Humans; Middle Aged; Tomography, X-Ray Computed
PubMed: 33223283
DOI: 10.1016/j.ejvs.2020.10.013 -
Structural Heart : the Journal of the... Oct 2022Transcatheter aortic valve replacement (TAVR) is an established procedure for the treatment of patients with severe aortic stenosis. The optimal antithrombotic regimen... (Review)
Review
Transcatheter aortic valve replacement (TAVR) is an established procedure for the treatment of patients with severe aortic stenosis. The optimal antithrombotic regimen following TAVR, currently unknown and inconsistently applied, is impacted by thromboembolic risk, frailty, bleeding risk, and comorbidities. There is a quickly growing body of literature examining the complex issues underlying antithrombotic regimens post-TAVR. This review provides an overview of thromboembolic and bleeding events following TAVR, summarizes the evidence regarding optimal antiplatelet and anticoagulant use post-TAVR, and highlights current challenges and future directions. By understanding appropriate indications and outcomes associated with different antithrombotic regimens post-TAVR, morbidity and mortality can be minimized in a generally frail and elderly patient population.
PubMed: 37288058
DOI: 10.1016/j.shj.2022.100085