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International Heart Journal Nov 2005The objective of the present study was to examine cases of acute aortic dissection in order to analyze the clinical and diagnostic findings, and to summarize their...
The objective of the present study was to examine cases of acute aortic dissection in order to analyze the clinical and diagnostic findings, and to summarize their treatment modalities, as well as their hospital outcomes. Between July 1998 and June 1999, we prospectively studied patients who were newly diagnosed as having acute aortic dissection at 25 hospitals in Mie prefecture. These cases were examined for their demographics, the characteristics of the clinical findings, diagnostic methods, treatment modalities according to the type of aortic dissection, and the early morbidity and mortality of the hospital outcomes. Of 66 newly diagnosed aortic dissections (43 males), 30 were type A and 36 were type B. Seventy-six percent of the cases arrived at a medical facility within 6 hours from the onset of symptoms. Frequent initial symptoms and clinical findings were pain in 95.5%, cardiac arrest and/or hypotension in 21%, pericardial effusion in 29%, pleural effusion in 25%, and neurological signs in 30%. Twenty-one patients underwent surgical repair, 36 were treated medically, and 5 underwent endovascular stenting. Overall early mortality was 12.1%, which included 2 DOA. Fifty percent of these deaths occurred within 48 hours, and 63% by 72 hours of the initial event. In spite of the relatively rare incidence of acute aortic dissection in our study, the calculated incidence was 4.0/100,000/year. The overall mortality rate was relatively low compared to the figures reported in the literature, suggesting the earliest possible diagnosis and timely intervention are critically important to attain successful outcomes.
Topics: Acute Disease; Adult; Age Distribution; Aged; Aged, 80 and over; Aortic Dissection; Aortic Aneurysm; Cause of Death; Combined Modality Therapy; Female; Humans; Hypertension; Incidence; Male; Middle Aged; Prospective Studies; Stents; Survival Analysis; Treatment Outcome
PubMed: 16394604
DOI: 10.1536/ihj.46.1083 -
Acta Biochimica Et Biophysica Sinica Sep 2020Acute aortic dissection (AAD) is a cardiovascular emergency caused by the formation of hematoma in the middle layer of the aortic wall. Adiponectin (APN) is an adipose...
Acute aortic dissection (AAD) is a cardiovascular emergency caused by the formation of hematoma in the middle layer of the aortic wall. Adiponectin (APN) is an adipose tissue-specific protein that has anti-inflammation and anti-atherosclerosis functions. Pyroptosis, as an inflammatory cell death, depends on the activation of caspase1, while nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) is a typical representative of the pyroptosis pathway. In this study, we aimed to find whether APN affects the AAD process. The results showed that APN overexpression (OE) inhibited the AAD development and the levels of glucose, triglyceride, and total cholesterol in mice model. In addition, APN OE inhibited the productions of gasdermin D (GSDMD), NLRP3, caspase1, interleukin-1β (IL-1β), IL-18, and osteopontin (OPN), as well as α-smooth muscle actin (α-SMA) downregulation in vitro and in vivo. In addition, NLRP3 was found to be a target gene of miR-133a and miR-133a OE showed similar effects to APN OE in attenuating the LPS-induced productions of GSDMD, NLRP3, caspase1, IL-1β, IL-18, and OPN, as well as α-SMA downregulation in vascular smooth muscle cells (vSMCs). Moreover, the beneficial effects of APN OE were abolished by miR-133a knockdown in vSMCs. In conclusion, our present results indicated that the upregulation of miR-133a by APN inhibits pyroptosis pathway, which potentially rescues AAD.
Topics: Acute Disease; Adiponectin; Aortic Dissection; Animals; Male; Mice; MicroRNAs; Pyroptosis; Signal Transduction; Up-Regulation
PubMed: 32634201
DOI: 10.1093/abbs/gmaa078 -
BMC Cardiovascular Disorders May 2022In patients with systemic lupus erythematosus (SLE), lengthy treatment and long-term steroid use are the main risk factors for developing aortic aneurysms or aortic...
BACKGROUND
In patients with systemic lupus erythematosus (SLE), lengthy treatment and long-term steroid use are the main risk factors for developing aortic aneurysms or aortic dissections. In patients with cardiac tamponade, hemodynamic collapse may lead to acute renal and hepatic failure.
CASE PRESENTATION
We report the successful treatment of a 55-year-old woman with SLE since the age of 21. She suddenly felt chest pain approximately 2 weeks before developing fever and vomiting and was admitted to our hospital. Initially, she had severe liver dysfunction and was admitted to the hepatology department, where treatment for fulminant hepatitis was initiated. However, computed tomography (CT) showed an acute aortic dissection (DeBakey type II) and severe bloody pericardial effusion. Therefore, we performed emergency pericardial drainage. Plasma exchange therapy was initiated as emergency aortic surgery was deemed impossible due to impaired liver function tests and coagulation. Ten days later, the patient developed peritonitis due to small bowel perforation, and laparotomy was performed for abscess drainage and perforation closure. She had received steroid pulse therapy at the age of 21. At 40 years of age, she developed deep vein thrombosis due to antiphospholipid antibodies and was prescribed prednisolone. She was ambulatory at 3 months after the onset of acute aortic dissection, and CT revealed a rapidly enlarging true aneurysm in the distal arch. We performed elective aortic surgery. Although there were no antiphospholipid antibodies, surgery could have led to a devastating antiphospholipid syndrome. Therefore, we decided to treat the patient with triple therapy. Methylprednisolone was intravenously administered intraoperatively and at 1 day postoperatively. The patient was discharged without complications after returning to her usual oral prednisolone regimen.
CONCLUSIONS
The patient described herein had a systemic circulatory failure due to cardiac tamponade, accompanied by liver failure. This condition is a significant cause of death in patients with aortic dissection-associated SLE and is extremely dangerous. However, multi-specialty intervention helped the patient recover, and she has been attending the outpatient clinic. Aortic surgery requiring hypothermia in SLE patients with antiphospholipid syndrome and a history of thrombocytopenia or thrombosis requires a multi-disciplinary treatment team, including cardiac surgeons and medical experts.
Topics: Aortic Dissection; Antiphospholipid Syndrome; Cardiac Tamponade; Female; Humans; Lupus Erythematosus, Systemic; Methylprednisolone; Middle Aged
PubMed: 35562652
DOI: 10.1186/s12872-022-02659-w -
Cellular and Molecular Life Sciences :... Jun 2010Arterial dissection (AD) is defined as the longitudinal splitting up of the arterial wall caused by intramural bleeding. It can occur as a spontaneous event in all large... (Review)
Review
Arterial dissection (AD) is defined as the longitudinal splitting up of the arterial wall caused by intramural bleeding. It can occur as a spontaneous event in all large and medium sized arteries. The histological hallmark of AD is medial degeneration. Histological investigations, gene expression profiling and proteome studies of affected arteries reveal disturbances in many different biological processes including inflammation, proteolytic activity, cell proliferation, apoptosis and smooth muscle cell (SMC) contractile function. Medial degeneration can be caused by various rare dominant Mendelian disorders. Genetic linkage analysis lead to the identification of mutations in different disease-causing genes involved in the biosynthesis of the extracellular matrix (FBN1, COL3A1), in transforming growth factor (TGF) beta signaling (FBN1, TGFBR1, TGFBR2) and in the SMC contractile system (ACTA2, MYH11). Genome wide association studies suggest that the CDKN2A/CDKN2B locus plays a role in the etiology AD and other arterial diseases.
Topics: Aortic Dissection; Animals; Female; Gene Expression Profiling; Genetic Predisposition to Disease; Humans; Male; Models, Cardiovascular; Mutation; Myocytes, Smooth Muscle; Peptide Hydrolases; Phenotype; Transforming Growth Factor beta
PubMed: 20155481
DOI: 10.1007/s00018-010-0276-z -
Annals of Vascular Surgery May 1995
Review
Topics: Aortic Dissection; Aortic Aneurysm; Humans; Postoperative Complications
PubMed: 7632561
DOI: 10.1007/BF02135293 -
British Journal of Hospital Medicine... Apr 2022Most life-threatening conditions form a coherent clinical picture, with examination findings confirming the patient's history. However, pain out of proportion to...
Most life-threatening conditions form a coherent clinical picture, with examination findings confirming the patient's history. However, pain out of proportion to examination findings can also signify an emergency - acute compartment syndrome, bowel ischaemia, necrotising fasciitis and acute aortic dissection may all present in this way. A lack of situational awareness leads doctors to erroneously rely on examination findings to flag impending catastrophe, but in such cases misdiagnosis or delayed treatment can have dire consequences. Patients with unexplained pain risk significant morbidity and mortality, and doctors are vulnerable to litigation and reputational damage. This article addresses this danger, exploring the causes and pathology of pain that is out of proportion, and presenting an approach to mitigate risk and prevent catastrophe.
Topics: Aortic Dissection; Diagnostic Errors; Fasciitis, Necrotizing; Humans; Mesenteric Ischemia; Pain
PubMed: 35506720
DOI: 10.12968/hmed.2021.0599 -
The Medical Journal of Malaysia Feb 2019Aortic disease includes conditions such as chronic aortic aneurysms, acute aortic syndromes and congenital aortic abnormalities, amongst others. This paper reviews all... (Review)
Review
INTRODUCTION
Aortic disease includes conditions such as chronic aortic aneurysms, acute aortic syndromes and congenital aortic abnormalities, amongst others. This paper reviews all research on aortic disease performed in Malaysia and published between 2000-2016.
METHODS
A literature search was conducted in PubMed, Scopus, MyJurnal and the UKM Journal Repository. The search process was based on a previously published methodology. The medical subject headings (MeSH) search terms used were "aortic", "aorta" and "Malaysia".
RESULTS
Two-hundred-thirteen papers were identified, of which 60 papers were selected and reviewed on the basis of their relevance. The epidemiology, pathophysiology, clinical presentations, case reports, investigations, treatment and outcomes of aortic disease in Malaysia were reviewed and summarised. The clinical relevance of the studies performed are discussed.
CONCLUSION
The review provided an insight into the pathophysiology, prevalence and epidemiology of aortic diseases in Malaysia, how the condition is managed, and the outcomes of treatment. Limitations of the research performed in Malaysia to date were identified and recommendations for further research and improvement in clinical practice were recommended.
Topics: Aortic Dissection; Aortic Aneurysm; Aortic Diseases; Biomedical Research; Humans; Malaysia
PubMed: 30846666
DOI: No ID Found -
Journal of Cardiothoracic Surgery May 2024Acute type A aortic dissection is a life-threatening cardiovascular disease characterized by rapid onset and high mortality. Emergency surgery is the preferred and... (Review)
Review
Acute type A aortic dissection is a life-threatening cardiovascular disease characterized by rapid onset and high mortality. Emergency surgery is the preferred and reliable treatment option. However, postoperative complications significantly impact patient prognosis. Hypoxemia, a common complication, poses challenges in clinical treatment, negatively affecting patient outcomes and increasing the risk of mortality. Therefore, it is crucial to study and comprehend the risk factors and treatment strategies for hypoxemia following acute type A aortic dissection to facilitate early intervention.
Topics: Humans; Aortic Dissection; Risk Factors; Hypoxia; Postoperative Complications; Acute Disease; Aortic Aneurysm, Thoracic
PubMed: 38702812
DOI: 10.1186/s13019-024-02775-y -
BMC Cardiovascular Disorders Oct 2022Acute aortic dissection (AAD) is a life-threatening cardiovascular disease. Recent studies have shown that DNA methylation may be associated with the pathological...
BACKGROUND
Acute aortic dissection (AAD) is a life-threatening cardiovascular disease. Recent studies have shown that DNA methylation may be associated with the pathological mechanism of AAD, but the panorama of DNA methylation needs to be explored.
METHODS
DNA methylation patterns were screened using Infinium Human Methylation 450 K BeadChip in the aortic tissues from 4 patients with Stanford-A AAD and 4 controls. Gene enrichment was analyzed by Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway and gene ontology (GO). DNA methylation levels of candidate genes were determined by pyrosequencing in the replication cohort including 16 patients with AAD and 7 controls. Protein expression level of candidate gene was assessed by Western blot.
RESULTS
A total of 589 differentially methylated positions including 315 hypomethylated and 274 hypermethylated positions were found in AAD group. KEGG analysis demonstrated that differentially methylated position-associated genes were enriched in MAPK signaling pathway, TNF signaling pathway and apoptosis pathway, et al. GO analysis demonstrated that differentially methylated position-associated genes were enriched in protein binding, angiogenesis and heart development et al. The differential DNA methylation in five key genes, including Fas, ANGPT2, DUSP6, FARP1 and CARD6, was authenticated in the independent replication cohort. The protein expression level of the Fas was increased by 1.78 times, indicating the possible role of DNA methylation in regulation of gene expression.
CONCLUSION
DNA methylation was markedly changed in the aortic tissues of Stanford-A AAD and associated with gene dysregulation, involved in AAD progression.
Topics: Humans; DNA Methylation; Aortic Dissection
PubMed: 36309656
DOI: 10.1186/s12872-022-02882-5 -
Revista de NeurologiaTerminology, concept, pathology and phisiopathology, clinical presentation, imaging diagnosis and treatment of the giant intracranial aneurysms are reviewed. (Review)
Review
AIM
Terminology, concept, pathology and phisiopathology, clinical presentation, imaging diagnosis and treatment of the giant intracranial aneurysms are reviewed.
DEVELOPMENT
Saccular, fusiform, dissecting and serpentine giant aneurysms are discussed. Giant saccular aneurysms are developed from small regular congenital lesions growing far away of their critical rupture size due to the reinforcement of their wall. Fusiform and dissecting aneurysms are formed after a wide rupture of some of their wall layers and, therefore, both of them are considered to have some similarities. Finally, serpentine aneurysms are rare lesions and their growing mechanism is still under discussion.
CONCLUSION
Any type of giant aneurysm represents a great deal for the neurosurgical management.
Topics: Aortic Dissection; Aneurysm, Ruptured; Cerebral Angiography; Cerebrovascular Circulation; Humans; Intracranial Aneurysm
PubMed: 16981167
DOI: No ID Found