Aortic Disease

Antecedentes: el tratamiento endovascular ofrece la posibilidad de cubrir el origen de la disección y evitar que progrese hasta aneurisma de la aorta, y con ello demuestra una reducción en la mortalidad hasta del 16%. ... Objetivo: evaluar los resultados quirúrgicos en términos de ...

the Bentall procedure is a surgical technique used in the management of aortic root abnormalities with ascending aorta and aortic valve issues. the present study aimed to evaluate the outcomes of 18 patients treated with the Bentall procedure in a single center. the present study was a single-center retrospective case series conducted over a period of 3 years. the patients had either acute ascending dissection and/or dilated ascending aorta with aortic valve dysfunction. the Bentall procedure was performed via standard median sternotomy. St. Jude Medical composite grafts with a valve were applied in all cases. a total number of 18 patients with either acute ascending dissection and/or dilated ascending aorta with aortic valve dysfunction were included in the study. the age of the participants ranged from 27-60 years. the ratio of males to females was 16:2 (males, 88.8%). the symptoms developed 3-4 days prior to hospital admission. Chest pain was the most common presenting symptom (n=10, 55.5%). Hypertension was the most common risk factor (n=12, 66.6%). In total, 14 cases underwent emergency surgery (77.7%). the emergency surgery was performed in 9 patients within 24 h of arrival owing to the association of aortic root dissection with tamponade. For the other cases, the surgery was performed within 2 and 7 days (n=5, 27.7% and n=4, 22.2%) respectively. Early post-operative complications occurred in 5 patients (27.7%). on the whole, as demonstrated herein, the modifications of the Bentall procedure have a notable impact on decreasing the overall mortality rates. raising the awareness of clinicians and the general population as regards aortic dissection may aid in the early referral of patients to specialized centers and may thus decrease the overall mortality rate.

We aimed to assess the clinical outcomes of the internal iliac artery (IIA) coverage during endovascular abdominal aortic aneurysm repair (EVAR). Methods: A retrospective observational study was conducted in patients managed with EVAR for the aorto-iliac aneurysmal disease. The IIA was sacrificed by extension of the stent-graft into the external iliac artery in the absence of the distal landing zone, while it was preserved if the landing zone was available. Results: From 2002 to 2018, 540 patients underwent EVAR for aorto-iliac aneurysmal disease in our center. Sixtyfive (12.04%, n = 65/540) had iliac aneurysm extension. Among these 65 cases, the IIA was not covered in 32 patients (IIA salvage/spared group), while they were covered in 33 patients (IIA sacrifice group). The IIA sacrifice group consisted of 25 unilateral and 8 bilateral coverages. There was 100% technical success and no 30-day mortality in both groups. The IIA sacrifice group had more postoperative complications in general when compared to the IIA salvage group, but they were not significant (P < 0.05). There were one patient with buttock claudication (P = 1.000) with bilateral IIA coverage, two cases of lower limb microembolization (P = 0.492) and one case of erectile dysfunction (P = 1.000) in IIA sacrifice group, while they were not seen in IIA salvage group. There was no ruptured iliac access, device-related malfunction, spinal cord ischemia or bowel ischemia in either group. We found coverage of IIA aneurysmal extension during EVAR of AAA to be technically feasible and safe.

This large multicenter, international bicuspid aortic valve (BAV) registry aimed to define the sex differences in prevalence, valve morphology, dysfunction (aortic stenosis/regurgitation), aortopathy, and complications (endocarditis and aortic dissection). Demographic, clinical, and echocardiographic data at first presentation of 1992 patients with BAV (71.5% men) were retrospectively analyzed. BAV morphology and valve function were assessed; aortopathy configuration was defined as isolated dilatation of the sinus of Valsalva or sinotubular junction, isolated dilatation of the ascending aorta distal to the sinotubular junction, or diffuse dilatation of the aortic root and ascending aorta. New cases of endocarditis and aortic dissection were recorded. There were no significant sex differences regarding BAV morphology and frequency of normal valve function. When presenting with moderate/severe aortic valve dysfunction, men had more frequent aortic regurgitation than women (33.8% versu...

Background: Arterial stiffness assessed noninvasively with aortic pulse wave velocity (PWV) has been associated with atherosclerosis in the coronary arteries and also cardiovascular mortality. The aim of this study was to evaluate the association between aortic PWV and severity of coronary artery disease (CAD) in patients with acute ST elevation myocardial infarction (STEMI). Methods: This cross sectional analytical study was conducted over 200 acute STEMI patients who were purposively selected and agreed to do coronary angiogram during index hospital admission. Assessment of aortic PWV was performed noninvasively with the commercially available SphygmoCor system using applanation tonometry with high fidelity micromanometer on the day before angiogram. Study subjects were subdivided into two groups on the basis of PWV. In group I: aortic PWV was d” 10 m/sec and in group II: aortic PWV was&gt; 10 m/sec. One hundred patients were included in each group. Angiographic severity of CAD wa...

Loeys–Dietz syndrome (LDS) is a rare autosomal-dominant disorder of the connective tissue with some typical vascular findings, skeletal manifestations, craniofacial features, and cutaneous findings with a wide phenotypic spectrum. Six different genes are involved in LDS and the diagnosis is based on the identification of a heterozygous pathogenic variant in TGFBR1, TGFBR2, SMAD3, TGFB2, TGFB3, or SMAD2 in children with suggestive findings. These genes distinguish LDS into six classes (LDS1–LDS6, respectively). Delay in diagnosis of Loeys–Dietz syndrome may be associated with an adverse prognosis due to a very high augmented risk of early complications such as aortic or vascular rupture. The present report describes a case of an early diagnosis of LDS in a neonate with cleft soft palate and aortic root dilatation.

Aortic aneurysms are common in adults due to atherosclerosis but are rare in children and young adults, often overlooked due to infrequent reporting. Acquired aneurysms are usually linked to factors like umbilical artery ligation, connective tissue diseases, or vasculitides. In contrast, the causes of congenital abdominal aortic aneurysms (AAA) remain unknown due to their extreme rarity. Only a few cases have been reported. Prompt diagnosis is essential when symptoms such as abdominal distention, vomiting, or abdominal pulsatility occur. Diagnosis is typically confirmed through ultrasonography and multi-slice spiral computed tomography angiographies (MCSTA). After detection, a comprehensive investigation is necessary to rule out acquired AAA causes. Managing congenital AAA requires a highly personalized approach, with early surgical repair using grafts as a recommended option. After an extensive analysis of numerous academic sources, we have comprehensively understood the epidemiology, clinical features, and diagnostic and treatment techniques for congenital abdominal aortic aneurysms.

Background/Objectives: this systematic review aims to explore the efficacy and safety of the laparoscopic ligation of the inferior mesenteric artery (IMA) as an emerging trend for addressing a type II endoleak following endovascular aortic aneurysm repair (EVAR). Methods: A comprehensive literature search was conducted across several databases including Medline, Scopus, and the Cochrane Central Register of Controlled Trials, adhering to the PRISMA guidelines. The search focused on articles reporting on the laparoscopic ligation of the IMA for the treatment of a type II endoleak post-EVAR. Data were extracted regarding study characteristics, patient demographics, technical success rates, postoperative outcomes, and follow-up results. Results: Our analysis included ten case studies and two retrospective cohort studies, comprising a total of 26 patients who underwent a laparoscopic ligation of the IMA between 2000 and 2023. The mean age of the
cohort was 72.3 years, with a male predominance (92.3%). The mean AAA diameter at the time of intervention was 69.7 mm. The technique demonstrated a high technical success rate of 92.3%, with a mean procedure time of 118.4 min and minimal blood loss. The average follow-up duration was 19.9 months, with 73% of patients experiencing regression of the aneurysmal sac, and no reports of an IMA-related type II endoleak during the follow-up period.
Conclusions: The laparoscopic ligation of the IMA for a type II endoleak following EVAR presents a promising, minimally invasive alternative with high technical success rates and favorable postoperative outcomes. Despite
its potential advantages, including reduced contrast agent use and radiation exposure, its application remains limited to specialized centers. The findings suggest the need for further research in larger prospective studies to validate the effectiveness of this procedure and potentially broaden its clinical adoption.

Takayasu arteritis is a chronic vasculitis mainly involving the aorta and its main branches most commonly subclavian and carotid. It induces clinically varied ischaemic symptoms due to stenotic lesions or thrombus formation, including blindness, retinal haemorrhage, pulselessness, aortic regurgitation and congestive heart failure due to dilatation of the ascending aorta. More acute progression causes destruction of arterial wall, leading to the formation of aneurysms and rupture of the involved arteries. Here we present a case of Takayasu's arteritis in a 28-year-old male who presented with nonspecific symptoms of fever and neck pain with palpitations and feeling of pulsations in right side of neck since last 20 days and was eventually diagnosed as arteritis. This case shows that it can present with many nonspecific symptoms and can be diagnosed with proper examination and a high index of suspicion due to its nonspecific overlapping features with many diseases.

The aim of this work is to report a probable first case of a thoracic aortic aneurysm in the remains of a pre-Columbian individual from South America and to explore the relationship of this case to the only other paleopathological case previously described. We also consider the implications of both cases for the origins of syphilis. This study is based on the macroscopical analysis of human remains recovered during excavation of the Chiu Chiu 273 prehistoric cemetery, in the Antofagasta Region of Northern Chile. Ceramic sherds from the grave have a thermoluminescence date of 2160 ± 100 A.P. or 210 B.C. The skeletal remains of an adult individual display resorptive lesions in both the sternum and the first two thoracic vertebrae, which are suggestive of a thoracic aortic aneurysm. The lesions observed in the case described are clearly compatible with the development of an aneurysm of the thoracic aorta (ascending portion and arch). We suggest that this aneurysm has a syphilitic etiology, considering the vascular segments compromised, the type of lesions observed, and the prevalent etiology of this kind of cardiovascular pathology in pre-penicillin times. Since the only two cases of thoracic aortic aneurysms reported to date have been found in the Americas and are clearly pre-Columbian, it can be suggested that venereal syphilis was present in the Americas in times before European contact.

Introduction and objectives. To review experience at our center with the use of hybrid techniques for treating complex aneurysms of the thoracic aorta. Methods. The medical records of 41 patients (40 male) with complex aortic aneurysms affecting supra-aortic or visceral vessels who underwent hybrid procedures between 1998 and 2007 were reviewed retrospectively. All patients were in American Society of Anesthesiologists category IV. They were divided in two groups: group A comprised 32 patients with aneurysms involving the aortic arch and its branches (2 ascending aorta replacements, 1 arch repair, 13 carotid-carotid bypasses, 12 carotidsubclavian bypasses, and 4 with total arch debranching); and group B comprised 9 patients with thoracoabdominal aneurysms and visceral vessel transpositions (4 partial and 5 total debranching). The mean age in group A was 69.3±1.3 (range, 62-73) years and in group B, 71.5±5.0 (range, 68-74) years. Results. The mean hospital stay was 18±7.1 days (range, 5-35) and 12±8.2 days (range, 2-15) in groups A and B, respectively. Overall mortality was 12.2% (3.4% and 44.4% in groups A and B, respectively) and neurological morbidity was 3.4% and 11.1% in the two groups, respectively. Conclusions. The results obtained with hybrid treatment of the aortic arch area were comparable with those of conventional surgery. However, thoracoabdominal repair with complete revascularization of the visceral branches was associated with high mortality. Consequently, hybrid treatment is a valid option for high-risk patients who do not require complete revascularization in the visceral area.

Introducción y objetivos. Revisar la experiencia de nuestro centro con técnicas híbridas para tratamiento de aneurismas complejos de la aorta torácica. Métodos. Se revisaron retrospectivamente los registros prospectivos de 41 pacientes (40 varones) con aneurismas torácicos que comprometían ramas supraaórticas o viscerales sometidos a procedimientos híbridos, en el periodo 1998-2007. Todos los pacientes fueron clasificados como ASA IV. Éstos fueron divididos en dos grupos: grupo A, 32 pacientes con aneurismas que involucraban el arco aórtico y sus ramas (2 sustituciones de aorta ascendente, 1 reparación de arco, 13 derivaciones carótido-carotídeas, 12 derivaciones carótido-subclavias y 4 transposiciones totales de troncos supraaórticos); grupo B, 9 pacientes con aneurismas toracoabdominales (4 transposiciones parciales y 5 totales de troncos viscerales). En el grupo A la media de edad fue 69,3 ± 1,3 (intervalo, 62-73) años, y en el grupo B fue 71,5 ± 5,0 (intervalo, 68-74) años. Resultados. La media de estancia hospitalaria fue 18 ± 7,1 días (intervalo, 5-35) y 12 ± 8,2 días (intervalo, 2-15) para los grupos A y B, respectivamente. La mortalidad global fue del 12,2% (el 3,4 y el 44,4% para los grupos A y B, respectivamente), con morbilidad neurológica del 3,4 y el 11,1%, respectivamente. Conclusiones. Los resultados de nuestros tratamientos híbridos en la zona del arco aórtico son comparables con los de la cirugía convencional. Las reparaciones toracoabdominales con revascularización completa de las ramas viscerales se asocian a mortalidad elevada. Así, la cirugía híbrida es una alternativa válida para pacientes de alto riesgo que no precisen la revascularización completa del área visceral.

Аортопатия у беременных обусловлена генетически определенной дисплазией соединительной ткани (синдромы Марфана, Элерса-Данло, Лойес-Дитца и др.). Самым тяжелым осложнением является аневризма аорты и ее расслоение с вероятностью фатального исхода. Ключевой фактор предотвращения этого осложнения-частая повторная визуализация (как метод выбора-ультразвуковая диагностика) и междисциплинарное взаимодействие, планирование и координация дородового периода, ведения родов и послеродового ухода.

To present a novel technique that enables safe and effective cannulation of target vessels with challenging anatomy during fenestrated/branched endovascular aortic repair (F/B-EVAR). Technique: Following deployment of the F/B-EVAR endograft, the target vessels (TVs) are cannulated. The bundle wire technique provides a solution to challenging TVs and uses multiple fine atraumatic guidewires that together serve as a stiff guidewire. The technique can be executed in 2 ways using: (1) one 0.018 inch and one 0.014 inch guidewire or (2) three 0.014 inch guidewires. We demonstrate the technique in a case of a complex abdominal aortic aneurysm treated using branched EVAR in which the left renal artery with severe ostial stenosis was catheterized using the bundle wire technique. Conclusions: The bundle wire technique offers a technically feasible and economically viable solution for facilitating catheter and bridging stent delivery in anatomically challenging TVs during F/B-EVAR. It is a useful addition to the therapeutic armamentarium available to physicians for accessing demanding TVs.

Objective
Fenestrated endovascular aneurysm repair (FEVAR) has become one of the standard treatment options for complex abdominal aortic aneurysms (cAAA) and thoraco-abdominal aneurysms (TAAA). Despite technological advances in the main endograft design, the lack of dedicated bridging stents (BSG) is still the achilles heel of the procedure. The aim of this study was to evaluate the midterm outcomes of the BeGraft stent-graft as a dedicated bridging stent for FEVAR and to review the current evidence in literature.
Methods
Retrospective single center study, including all consecutive FEVARs performed between September 2018 and December 2022 for the treatment of cAAAs and TAAAs with implantation of at least one BeGraft peripheral as the main bridging stent-graft in one of the target vessels (TV). Primary endpoints were technical success and target vessel instability of TV bridged with a BeGraft stent, as well as 30-day mortality and re-intervention rates. Secondary endpoints were follow up TV instability, re-interventions and mortality.
Results
A total of 113 patients (93 male, mean age 71.1  9.7) and 440 TV (14 scallops and 426 fenestrations) were included. Of the 440 TV, 406 received primary stenting. Be Grafts were used in 88.9% of these (n = 361; CT= 67, SMA= 98, RRA= 97, LRA= 99). The technical success rate was 99.4 % (359/361). The 30 day TV instability rate was 0.27 % (1/361) with one early renal artery occlusion. During a median follow-up of 20 months ( 6 - 32), target vessel instability rate was 0,8 % (3/361). Freedom from target vessel instability was 99.3%, 98.8% and 98.8% at 1 year, 2- and 3 years respectively.
Conclusion
Early and mid-term results regarding TV instability are satisfactory and support the use of BeGraft as bridging stentgraft in FEVAR for cAAAs and TAAAs.

Ruptured mycotic pararenal aortic aneurysms are rare and serious condition that requires prompt treatment. Open surgery with aortic resection and in-situ or extra-anatomic reconstruction is the standard treatment. The aim of this technical note is to report urgent endovascular treatment using a readily available custom-made device (created for another patient), with a back-table modification using pericardium patch and a new fenestration. Technique: In preoperative measurements on centerline-based workstation, aortic diameter in proximal and distal landing zone and target vessel position matched the measurements of graft plan of custom-made device (CMD) besides left renal artery. To address current patient`s anatomy, closure of the nonsuitable fenestration with pericardial patch and creation of new fenestration (1 cm above and 1:15 hours posterior to original fenestration) for the respective target vessel have been performed. Postoperative computed tomography angiography (CTA) scan showed complete exclusion of aneurysm, perfused target vessels, and no endoleak. Under resistance-based antibiotic therapy, the patient was asymptomatic and showed normal infection parameters in blood samples postoperatively. Conclusion: In the hands of an experienced endovascular aortic surgeon modification of a custom-made device is a quick and feasible technique in this emergency situation. Long-term follow-up must confirm the durability and reliability of this new technique. Clinical Impact The described technique of modification of a custom-made endograft can provide an alternative endovascular treatment option for urgent complex abdominal aortic pathologies. Compared to the current available treatment modalities, like physician modified endografts, off-the-shelf branched devices, parallel grafts and in-situ fenestration, it can save considerable time and provides reasonable sealing in ruptured cases. The technique offers a valuable add-on to the armamentarium of experienced endovascular physicians.

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El seudoaneurisma de aorta ascendente, como complicación en cirugía cardíaca, tiene una incidencia menor del 0,5%, pero una mortalidad que varía del 6,7-60%. La infección del graft y de la mediastinitis son los principales factores predisponentes. Su clínica puede ser variada, o ser hallazgo casual en controles posteriores. Se presenta, a continuación, el caso clínico de un paciente por postoperatorio de cirugía de Bentall, complicado después de 14 meses con un seudoaneurisma de aorta ascendente, como así también su serie de imágenes diagnósticas. La cirugía fue llevada a cabo utilizando canulación arterial subclavia y venosa femoral, requiriendo parada circulatoria para su correcta disección. Este caso refleja una enfermedad poco frecuente, pero altamente desafiante, no solo por la complicación en sí misma, sino también por la necesidad de una reoperación y correcta estrategia quirúrgica.

Case A 55-year-old male with history of tobacco and ethanol consumption consulted to the emergency room complaining of chest pain and dyspnea. Symptoms had begun suddenly at rest, two hours before consultation. At his arrival, blood pressure was 180/120 mmHg, heart rate 120 bpm and arterial oxygen saturation was 95%. The ECG showed sinus rhythm with LBBB (not previously known) (Figure 1A). The chest X radiograph evidenced mild signs of lung congestion and no cardiomegaly (Figure 1B). With the suspicion of acute coronary syndrome, treatment with ASA (250 mg), ticagrelor (180 mg) and nonfractionated heparin (5000 IU) was administered. An emergent coronarography showed no significant lesions. The echocardiogram showed a hypertrophic and non-dilated left ventricle with severe systolic dysfunction (EF 15%

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Objetivos: Analizar la morfología del arco aórtico en pacientes sometidos a cirugía híbrida por patología de arco y aorta torácica descendente, así como evaluar los resultados a corto y a medio plazo. Pacientes y métodos: Catorce pacientes consecutivos (78,6% varones, con edad media de 61,9 ± 10,1 años y euroSCORE logístico medio 19,2 ± 9,6%) operados mediante cirugía híbrida (derivación carótido-subclavia izquierda, 7 casos; translocación de 2 troncos, 2 casos; translocación de 3 troncos, 5 casos) fueron incluidos en el estudio. Se analizaron los diámetros aórticos, la longitud de las zonas de anclaje, la distancia entre troncos supraaórticos, la angulación y el radio de curvatura del arco. Resultados: La longitud media de la zona de anclaje proximal aumentó de 5,9 ± 5,3 a 36,3 ± 9,6 mm tras cirugía de troncos supraaórticos. El radio de curvatura medio del arco fue de 48,7 ± 19,9 mm con angulación media de 84,6 ± 29,1 •. Cuatro pacientes presentaron un radio de curvatura < 40 mm. No hubo mortalidad intrahospitalaria ni complicaciones neurológicas. La supervivencia media fue del 100% a 1 y 2 años y del 83,3% a 4 años. La supervivencia libre de endofugas fue del 100% a un año y del 90,9% a 2 y 4 años. El diámetro aórtico máximo disminuyó de 65,2 ± 17,9 a 50,9 ± 14,2 mm. Conclusiones: Una adecuada valoración morfológica del arco aórtico es fundamental para seleccionar la mejor estrategia híbrida y prevenir la aparición de complicaciones en el implante de endoprótesis a ese nivel. Una angulación < 70 • y un radio de curvatura < 40 mm del arco aórtico recomienda incrementar la longitud de la zona de anclaje proximal a > 2,5 cm para evitar defectos de aposición en la curvatura menor del arco y endofugas tipo ia.

Introduction. Hypertrophic cardiomyopathy is an autosomal dominant genetic disease. The signs and symptoms of disease vary in terms of history and clinical course, ranging from the development of acute heart failure or even sudden death, while other patients may remain asymptomatic throughout life. At the same time, there is a lack of correlation between the genotype and the phenotype of the disease. Thus, within a family, of two members carrying the same genetic abnormality, one may present a clinical manifestation of severe heart failure, the other remaining asymptomatic. Clinical case presentation. In this paper, we report a case of a 34-year-old male who comes to see a cardiologist with complaints of moderate-intensity dyspnea, general weakness, and fatigue installed during the post-COVID-19 recovery period. Management and results. The evolutionary positive dynamics of the disease on the prescribed treatment is followed, as well as the diagnostic criteria for hypertrophic cardio...

The aim of this work is to report a probable first case of a thoracic aortic aneurysm in the remains of a pre-Columbian individual from South America and to explore the relationship of this case to the only other paleopathological case previously described. We also consider the implications of both cases for the origins of syphilis. This study is based on the macroscopical analysis of human remains recovered during excavation of the Chiu Chiu 273 prehistoric cemetery, in the Antofagasta Region of Northern Chile. Ceramic sherds from the grave have a thermoluminescence date of 2160 ± 100 A.P. or 210 B.C. The skeletal remains of an adult individual display resorptive lesions in both the sternum and the first two thoracic vertebrae, which are suggestive of a thoracic aortic aneurysm. The lesions observed in the case described are clearly compatible with the development of an aneurysm of the thoracic aorta (ascending portion and arch). We suggest that this aneurysm has a syphilitic etiology, considering the vascular segments compromised, the type of lesions observed, and the prevalent etiology of this kind of cardiovascular pathology in pre-penicillin times. Since the only two cases of thoracic aortic aneurysms reported to date have been found in the Americas and are clearly pre-Columbian, it can be suggested that venereal syphilis was present in the Americas in times before European contact.

La disección de aorta tipo B de Stanford es aquella que no afecta a la aorta ascendente, pudiendo afectar al resto de segmentos aórticos en distinta medida. En ausencia de complicaciones, el tratamiento establecido actualmente es el médico, aunque nuevos estudios sugieren una mejoría pronóstica en aquellos pacientes tratados precozmente con terapia endovascular. El 20% de las disecciones tipo B se complican con hipertensión o dolor refractario, rotura aórtica o síndromes de malperfusión, requiriendo tratamiento urgente abierto o endovascular. Este artículo es una introducción al resto de artículos relacionados con el tratamiento de la disección tipo B, y desarrolla brevemente las características clínicas, diagnósticas y enfoque terapéutico en cada caso, que será desarrollado en las siguientes revisiones.

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The main purpose of this publication is the proper determination of the fractional order at the Zener viscoelastic models and the analysis of the implications derived from the accuracy in obtaining this. The procedure is performed using the numerical method of Levenberg-Marquardt from values reported in the literature. The parameters used are obtained from an artery segment using a stress relaxation test. After determining the fractional order is proceeded to find the model solution using, the function of Mittag-Leffler with two parameters and the convolution operation in order to compare the behavior of the fractional model vs the integer order and identify their key differences. The displacements present on the artery are obtained, under the stimulus of a normal blood pulse and two dissimilar, simulating the effect in blood flow caused by an arrhythmia and by mechanical ventilation process. Finally the dynamic response from the pulses is analyzed using the convolution operation and Gauss Kronrod numeric method, where the solutions accuracy obtained by the fractional model is observed, an compared with the integer order model.

The aim of this work is to report a probable first case of a thoracic aortic aneurysm in the remains of a pre-Columbian individual from South America and to explore the relationship of this case to the only other paleopathological case previously described. We also consider the implications of both cases for the origins of syphilis. This study is based on the macroscopical analysis of human remains recovered during excavation of the Chiu Chiu 273 prehistoric cemetery, in the Antofagasta Region of Northern Chile. Ceramic sherds from the grave have a thermoluminescence date of 2160 ± 100 A.P. or 210 B.C. The skeletal remains of an adult individual display resorptive lesions in both the sternum and the first two thoracic vertebrae, which are suggestive of a thoracic aortic aneurysm. The lesions observed in the case described are clearly compatible with the development of an aneurysm of the thoracic aorta (ascending portion and arch). We suggest that this aneurysm has a syphilitic etiology, considering the vascular segments compromised, the type of lesions observed, and the prevalent etiology of this kind of cardiovascular pathology in pre-penicillin times. Since the only two cases of thoracic aortic aneurysms reported to date have been found in the Americas and are clearly pre-Columbian, it can be suggested that venereal syphilis was present in the Americas in times before European contact.

Objectives: Peripheral vascular disease patients are at high risk of developing cardiovascular and cerebrovascular events. The aim of this study was to see the association of Coronary artery disease and Carotid artery disease in patients with Peripheral vascular disease. Methods: 2 50 (200 males and 50 females) patients with peripheral vascular disease of lower limbs admitted in the National Institute of Cardiovascular Diseases (NICVD), Dhaka between June 2012 to July 2013. Coronary angiography and carotid Doppler study was done in all patients during their hospital stay. Results: 125 of 250 patients (50%) had significant CAD and 50 patients (20%) had significant carotid artery lesion and 25 patients (10%) had both. In patients with significant CAD, 75 patients of 125 (60%) had severe CAD (left main or triple vessel or proximal LAD lesion). 13 patients (10.5%) had left main, 50 patients (40%) had triple vessel disease and 12 patients (09.5%) had proximal LAD lesion. Among the 25 patients with both lesion, 15 patients (60%) had severe CAD of which 3 patient (12%) had left main, 4 patients (16%) had triple vessel disease and 3 patients (12%) had proximal LAD lesion. The percent of patients with severe CAD (left main, 3 vessel or proximal left anterior descending lesion) among those with Carotid artery disease was higher compared to those without Carotid artery disease. Conclusions: Both or either Coronary artery disease and/or Carotid artery disease are quite prevalent in patients with Peripheral vascular disease. So, all peripheral arterial disease patients should be investigated to see presence of any coronary artery disease or carotid artery disease.

Chronic dissection of the aorta after cardiac surgery in the early or late period has a very high mortality rate. In this report we presented a 37 year old patient who had had a mitral valve replacement (MVR) and was operated on with the intention to perform a second MVR, and was found to have a chronic localized aorta dissection in the previous cardioplegia cannule entrance. The dissection was repaired by suturing from outside with internal support to the intima.

Value of Early Prosthetic Aortic Valve Endocarditis Diagnosis by the Transesophageal Biplane Echodopplercardiography
Afemale patient, 21 years old, was submitted to surgical treatment of severe aortic insufficien- cy. She was doing well until the gth post-operative day, when she presented sepsis and an embolic cerebrovascular attack. The transesophageal echodopplercardiogram showed paraprosthetic abscess and vegetations, that were not seen on the transthoracic echodopplercardiogram performed one day before. We are convinced that the findings on the chocardiogram were very important for the good results obtained by the prompt surgical procedure.

Introducción: El reparo endovascular de la aorta torácica (REVAT) se ha incrementado en el mundo en los últimos años con relación al abierto.Objetivo: Comparar los resultados clínicos del REVAT frente al reparo abierto en la Fundación Cardio Infantil (Bogotá, Colombia) entre 2002 y 2011.Metodología: Análisis retrospectivo de la cohorte de pacientes sometidos a reparo abierto (grupo 1) en comparación de REVAT (grupo 2). En cada uno de los grupos se evaluó tiempo quirúrgico, tasa de morbilidad, mortalidad, reintervención y estancia hospitalaria. Resultados: Se incluyeron 57 pacientes en el análisis (26 % reparo abierto; 74 % REVAT). Se reintervinieron dos pacientes por endofugas tipo 1 en el grupo 2 y un caso por sangrado en el grupo 1. La mortalidad operatoria fue para el grupo 1 de 20 %, y para el grupo 2, de 2,3 %. El tiempo quirúrgico fue de 398 ± 180 min (grupo 1) versus 85,5 ± 35 min (grupo 2 (p = 0,0001) y el tiempo de estancia hospitalaria promedio fue de 9,8 días (grupo 1) y ...

Loeys–Dietz syndrome (LDS) is a rare autosomal-dominant disorder of the connective tissue with some typical vascular findings, skeletal manifestations, craniofacial features, and cutaneous findings with a wide phenotypic spectrum. Six different genes are involved in LDS and the diagnosis is based on the identification of a heterozygous pathogenic variant in TGFBR1, TGFBR2, SMAD3, TGFB2, TGFB3, or SMAD2 in children with suggestive findings. These genes distinguish LDS into six classes (LDS1–LDS6, respectively). Delay in diagnosis of Loeys–Dietz syndrome may be associated with an adverse prognosis due to a very high augmented risk of early complications such as aortic or vascular rupture. The present report describes a case of an early diagnosis of LDS in a neonate with cleft soft palate and aortic root dilatation.

IP Universitatea de Stat de Medicină şi Farmacie “Nicolae Testemiţanu”, Departamentul Pediatrie, IMSP Institutul Mamei şi Copilului, IP Universitatea de Stat de Medicină şi Farmacie “Nicolae Testemiţanu”, Catedra Endocrinologie, IP Universitatea de Stat de Medicină şi Farmacie “Nicolae Testemiţanu”, Catedra de Fiziopatologie și fiziopatologie clinicăIntroduction. Diabetes is one of cardiometabolic syndrome, considered as an important cardiovascular risk factor, having an significant impact in cardiovascular morbidity and mortality. The aim. Raising awareness of cardiovascular disease in diabetic pathology. Material and methods. Analysis of recent bibliographic data aimed at presenting cardiovascular disease in diabetes. Results. Studies report cardiovascular impairment at subjects with diabetes. Diabetic cardiomyopathy is a distinct clinical entity and has clinical aspects ranging from asymptomatic to heart failure. Recognized diagnostic modalities are cardiac biomarkers, cardiac im...

Objectives: Geometric ring annuloplasty has shown promise during bicuspid aortic valve repair for aortic insufficiency. This study examined early outcomes of bicuspid aortic valve repair associated with proximal aortic aneurysm replacement. Methods: From September 2017 to November, 2021, 127 patients underwent bicuspid aortic valve repair with concomitant proximal aneurysm reconstruction. Patient age was 50.6 AE 12.7 years (mean AE standard deviation), male gender was 83%, New York Heart Association Class was 2 (1-2) (median [interquartile range]), and preoperative aortic insufficiency grade was 3 (2-4). Ascending aortic diameter was 50 (46-54) mm, and all patients had ascending aortic replacement. Forty patients had sinus diameters greater than 45 mm, prompting remodeling root procedures. A total of 105 patients had Sievers type 1 valves, 3 patients had type 0, and 7 patients had type 2. A total of 118 patients had primarily right/left fusion, 8 patients had right/nonfusion, and 1 patient had left/nonfusion. Leaflet reconstruction used central leaflet plication and cleft closure, with limited ultrasonic decalcification in 31 patients. Results: Ring size was 23 (21-23) mm, and 26 of 40 root procedures were selective nonfused sinus replacements. Aortic clamp time was 139 (112-170) minutes, and bypass time was 178 (138-217) minutes. Postrepair aortic insufficiency grade was 0 (0-0) (P <.0001), and mean valve gradient was 10 (7-14) mm Hg. No early and 1 late mortality occurred. Four patients required reoperation for bleeding, and 4 patients required pacemakers. At a mean follow-up of 20 months (maximal 93), there were no valve-related complications, 5 late repair failures prompting valve replacement, and 1 death due to Coronavirus Disease 2019. Conclusions: Geometric ring annuloplasty for bicuspid aortic valve repair with proximal aortic aneurysm reconstruction is safe and associated with good early outcomes. Further experience and follow-up will help inform long-term durability. (JTCVS Techniques 2022;14:55-65) BAV repair with hemi-root replacement. Bicuspid repair using geometric ring annuloplasty and root remodeling with single sinus resection followed by aneurysm repair. CENTRAL MESSAGE By using bicuspid ring annuloplasty, leaflet reconstruction, and aortic root remodeling, most types of bicuspid valve defects associated with proximal aortic aneurysms can be repaired with good early results. PERSPECTIVE Routine bicuspid valve repair during aortic aneurysm surgery has been difficult for a variety of reasons. Bicuspid ring annuloplasty produces major annular remodeling and equalizes fused and nonfused segmental annular circumferences, facilitating leaflet reconstruction. Together with ascending aortic and selective sinus replacement, bicuspid valve repair can become routine with good early results.

Bad Nauheim, where she started to decipher the molecular mechanisms of arteriogenesis. After a short detour on stem cells, she again focused on arteriogenesis, becoming a leading expert in the field. By using a peripheral model of arteriogenesis, she demonstrated that collateral artery growth is a matter of innate immunity, and presented a blueprint of sterile inflammation, which is locally triggered by extracellular RNA.

Thoracic aortic disease has a high mortality. We sought to establish the contribution of unwarranted variation in care to regional differences in outcomes observed in patients with thoracic aortic disease in England. Data from the Hospital Episode Statistics (HES) and the National Adult Cardiac Surgery Audit (NACSA) were extracted. A parallel systematic review/meta-analysis through December 2015, and structure and process questionnaire of English cardiac surgery units were also accomplished. Treatment and mortality rates were investigated. A total of 24 548 adult patients in the HES study, 8058 in the NACSA study, and 103 543 from a total of 33 studies in the systematic review were obtained. Treatment rates for thoracic aortic disease within 6 months of index admission ranged from 7.6% to 31.5% between English counties. Risk-adjusted 6-month mortality in untreated patients ranged from 19.4% to 36.3%. Regional variation persisted after adjustment for disease or patient factors. Regio...

Rationale: The thoracic aortic wall can degenerate over time with catastrophic consequences. Vascular smooth muscle cells (SMCs) can resist and repair artery damage but their capacities decline with age and stress. Recently, cellular production of NAD(+) via nicotinamide phosphoribosyltransferase (Nampt) has emerged as a mediator of cell vitality. However, a role for Nampt in aortic SMCs in vivo is unknown. Objective: To determine if a Nampt-NAD(+) control system exists within the aortic media and is required for aortic health. Methods and Results: Ascending aortas from patients with dilated aortopathy were immunostained for NAMPT, revealing an inverse relationship between SMC NAMPT content and aortic diameter. To determine if a Nampt-NAD(+)control system in SMCs impacts aortic integrity, mice with Nampt-deficient SMCs were generated. SMC-Nampt knockout mice were viable but with mildly dilated aortas that had a 43% reduction in NAD(+) in the media. Infusion of angiotensin II led to ...

Role of cardiac magnetic resonance imagery in cardiovascular pathologyImagistica cardiacă prin rezonanță magnetică (RMNc) este o metodă informativă de evaluare diagnostică a patologilor sistemului cardiovascular, inclusiv bolilor aortei, cardiomiopatiilor, bolilor pericardului, viciilor cardiace congenitale și valvulopatiilor dob&acirc;ndite. Metoda este utilă &icirc;n diferențierea cardiomiopatiilor ischemice de non-ischemice cu implicații majore &icirc;n managementul pacientului cardiovascular. Este o metodă sigură și inofensivă &icirc;n evaluarea pacientului caridovascular, deoarece nu se bazează pe radiații ionizante și astfel nu interferează cu structurile nucleare (&icirc;n special cu ADN-ul). RMNc are avantajul de a nu fi limitată de fereastră acustică redusă, fenomen frecvent &icirc;nt&acirc;lnit &icirc;n cadrul examenului ecocardiografic transtoracic. Este necesară integrarea RMNc &icirc;n planul de evaluare imagistică de rutină a pacientului cardiovascular, consider&acirc;...

Modern considerations of heart failure&rsquo;s pathophysiology&Icirc;n pofida unor performanțe spectaculoase realizate de medicina cardiovasculară contemporană &icirc;n managementul majorității patologiilor cardiovasculare, insufi ciența cardiacă (IC) reprezintă o excepție notabilă cu o incidență globală &icirc;n ascensiune continue și cu o rată redusă a supraviețuirii [1,2]. Stabilirea mecanismelor, responsabile pentru dezvoltarea IC, ar permite selectarea unui tratament individualizat, orientat spre corecția verigii fi ziopatogenetice principaleСовременные аспекты патофизиологии сердечной недостаточност

Background: The aims of the study were to evaluate the prevalence of acute coronary syndrome (ACS) among patients presenting with atypical chest pain who are evaluated for acute aortic syndrome (AAS) or pulmonary embolism (PE) with computed tomoangiography (CTA) and discuss the rationale for the use of triple rule-out (TRO) protocol for triaging these patients. Methods: This study is a retrospective analysis of patients presenting with atypical chest pain and evaluated with thoracic (CTA), for suspicion of AAS/PE. Two physicians reviewed patient files for demographic characteristics, initial CT and final clinical diagnosis. Patients were classified according to CTA finding into AAS, PE and other diagnoses and according to final clinical diagnosis into AAS, PE, ACS and other diagnoses. Results: Four hundred and sixty-seven patients were evaluated: 396 (84.8%) patients for clinical suspicion of PE and 71 (15.2%) patients for suspicion of AAS. The prevalence of ACS and AAS was low among the PE patients: 5.5% and 0.5% respectively (P = 0.0001), while the prevalence of ACS and PE was 18.3% and 5.6% among AAS patients (P = 0.14 and P = 0.34 respectively). Conclusion: The prevalence of ACS and AAS among patients suspected clinically of having PE is limited while the prevalence of ACS and PE among patients suspected clinically of having AAS is significant. Accordingly patients suspected for PE could be evaluated with dedicated PE CTA while those suspected for AAS should still be triaged using TRO protocol.

The natural history of aortic diseases in patients with TGFBR1 or TGFBR2 mutations reported by different investigators has varied greatly. In particular, the current recommendations for the timing of surgical repair of the aortic root aneurysms may be overly aggressive. The Montalcino Aortic Consortium, which includes 15 centers worldwide that specialize in heritable thoracic aortic diseases, was used to gather data on 441 patients from 228 families, with 176 cases harboring a mutation in TGBR1 and 265 in TGFBR2. Patients harboring a TGFBR1 mutation have similar survival rates (80% survival at 60 years), aortic risk (23% aortic dissection and 18% preventive aortic surgery), and prevalence of extra-aortic features (29% hypertelorism, 53% cervical arterial tortuosity, and 27% wide scars) when compared with patients harboring a TGFBR2 mutation. However, TGFBR1 males had a greater aortic risk than females, whereas TGFBR2 males and females had a similar aortic risk. Additionally, aortic ...

Role of cardiac magnetic resonance imagery in cardiovascular pathologyImagistica cardiacă prin rezonanță magnetică (RMNc) este o metodă informativă de evaluare diagnostică a patologilor sistemului cardiovascular, inclusiv bolilor aortei, cardiomiopatiilor, bolilor pericardului, viciilor cardiace congenitale și valvulopatiilor dob&acirc;ndite. Metoda este utilă &icirc;n diferențierea cardiomiopatiilor ischemice de non-ischemice cu implicații majore &icirc;n managementul pacientului cardiovascular. Este o metodă sigură și inofensivă &icirc;n evaluarea pacientului caridovascular, deoarece nu se bazează pe radiații ionizante și astfel nu interferează cu structurile nucleare (&icirc;n special cu ADN-ul). RMNc are avantajul de a nu fi limitată de fereastră acustică redusă, fenomen frecvent &icirc;nt&acirc;lnit &icirc;n cadrul examenului ecocardiografic transtoracic. Este necesară integrarea RMNc &icirc;n planul de evaluare imagistică de rutină a pacientului cardiovascular, consider&acirc;...