Holodiastolic Retrograde Flow in the Ascending Aorta in a Dog with Severe Aortic Regurgitation, Aortic Mineralization, and Systemic Hypertension.
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SUBMITTER: Sirochman A
PROVIDER: S-EPMC10264257 | biostudies-literature | 2023 May
REPOSITORIES: biostudies-literature
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Holodiastolic Retrograde Flow in the Ascending Aorta in a Dog with Severe Aortic Regurgitation, Aortic Mineralization, and Systemic Hypertension.
Sirochman Anna A Kellihan Heidi B HB
CASE (Philadelphia, Pa.) 20230330 5
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Project description:We report a rare case of a quinticuspid aortic valve associated with regurgitation and dilation of the ascending aorta, which was diagnosed and post-surgically followed up by cardiovascular magnetic resonance and dual source computed tomography.
| S-EPMC2734562 | biostudies-literature
Project description:BackgroundAortic remodeling after aortic valve replacement (AVR) might be influenced by the postoperative blood flow pattern in the ascending aorta. This pilot study used flow-sensitive four-dimensional magnetic resonance imaging (4D-flow) to describe ascending aortic flow characteristics after various types of AVR.Methods4D-flow was acquired in 38 AVR patients (n=9 mechanical, n=8 stentless bioprosthesis, n=14 stented bioprosthesis, n=7 autograft) and 9 healthy controls. Analysis included grading of vortex and helix flow (0-3 point scale), assessment of systolic flow eccentricity (1-3 point scale), and quantification of the segmental distribution of peak systolic wall shear stress (WSS(peak)) in the ascending aorta.ResultsCompared to controls, mechanical prostheses showed the most distinct vorticity (2.7±0.5 vs. 0.7±0.7; p<0.001), while stented bioprostheses exhibited most distinct helicity (2.6±0.7 vs. 1.6±0.5; p=0.002). Instead of a physiologic central flow, all stented, stentless and mechanical prostheses showed eccentric flow jets mainly directed towards the right-anterior aortic wall. Stented and stentless prostheses showed an asymmetric distribution of WSS(peak) along the aortic circumference, with significantly increased local WSS(peak) where the flow jet impinged on the aortic wall. Local WSS(peak) was higher in stented (1.4±0.7 N/m(2)) and stentless (1.3±0.7 N/m(2)) compared to autografts (0.6±0.2 N/m(2); p=0.005 and p=0.008) and controls (0.7±0.1 N/m(2); p=0.017 and p=0.027). Autografts exhibited lower absolute WSS(peak) than controls (0.4±0.1 N/m(2) vs. 0.7±0.2 N/m(2); p=0.003).ConclusionsFlow characteristics in the ascending aorta after AVR are different from native aortic valves and differ between various types of AVR.
| S-EPMC5099073 | biostudies-literature
Project description:AimsTo assess the reproducibility of 4D-Flow cardiac magnetic resonance (CMR) parameters in the descending thoracic aorta-DTAo-(regurgitant fraction [RF], end-diastolic reverse flow [EDRF], and holodiastolic flow reversal [HDR]), and the relationship with RF in the sinotubular junction (STJ), and the left ventricular end-diastolic volume index (LVEDVI) in patients with chronic aortic regurgitation (AR).Methods and resultsA descriptive study of these variables was conducted. A receiver operating characteristic curve was used to determine the optimal cut-off point. Thirty patients had severe AR (RF ≥ 30%, STJ) and 60 mild-to-moderate (RF < 30%). The mean age was 59 ± 17 years. Left ventricular ejection fraction (LVEF) was 56% (53-61%) and LVEDVI was 94 (76-128) mL/m2. Flow in the DTAo at the left inferior pulmonary vein (LIPV) was easily identifiable and measurements were highly reproducible. The intraclass correlation coefficient was 0.969 (95% CI: 0.954-0.980) for RF and 0.929 (95% CI: 0.893-0.952) for EDRF. Flow parameters measured at the LIPV were all significantly greater in the severe AR group: RF (21% vs. 6%, P < 0.001), EDRF (20 vs. 4 mL/s; P < 0.001), and HDR (20% vs. 8%; P < 0.001). Three parameters-presence of HDR, RF ≥ 17%, and EDRF ≥ 7 mL/s at the LIPV-were associated with RF ≥ 30% in the STJ and elevated LVEDVI.Conclusion4D-flow CMR can reproducibly assess flow in the DTAo in patients with chronic AR. An RF ≥ 17%, EDRF ≥ 7 mL/s, and/or the presence of HDR in the DTAo (LIPV) were associated with an RF ≥ 30% in STJ and elevated LVEDVI.
| S-EPMC11758371 | biostudies-literature
Project description:BackgroundAortic regurgitation remains a challenge for transcatheter aortic valve replacement (TAVR), because of the high risk of post-procedural migration or paravalvular leakage resulting from the anatomical and pathophysiological features.Case summaryA 75-year-old male with symptomatic severe aortic regurgitation underwent transfemoral TAVR due to poor physical condition and a Society of Thoracic Surgeons score of 11.3%. However, complete dislodgement of the valve into the ascending aorta occurred during the operation. We performed a modified valve-in-valve technique by using an ablation catheter (instead of performing urgent surgery), and no post-interventional complications were found during hospitalization. The patient was discharged in a stable condition on postoperative Day 12. At the 6-month follow-up, echocardiography showed trivial paravalvular leakage. The left ventricular ejection fraction further improved from 30 to 48%.DiscussionThe management of valve migration can be troublesome. In this case, we performed a modified valve-in-valve technique by using an ablation catheter without post-interventional complications. This is a novel strategy for the management of emergencies, which could avoid surgical thoracotomy. Our strategy may be an alternative option in some cases of valve jumping up to the ascending aorta.
| S-EPMC9382568 | biostudies-literature
Project description:Background Penetrating ulcers of aorta, aortic dissections and intramural hematomas all come under acute aortic syndromes and have important similarities and differences. Case report We report a 67?year old man with rupture of a large penetrating ulcer of the distal ascending aorta with hemopericardium and left hemothorax. He underwent interposition graft replacement of ascending aorta and hemi-arch with a 30?mm Gelweave Vascutek graft but represented 6?months later with development of a penetrating ulcer which ruptured into a huge 14?cm pseudoaneurysm. This was repaired with a 28?mm Vascutek Gelseal graft replacement of arch and interposition graft reconstruction of innominate and left common carotid arteries. 6?weeks later, however, he ruptured his proximal descending aorta and underwent TEVAR satisfactorily. Unfortunately, 2?days later, he developed a pathological fracture of left proximal tibia with metastasis from a primary renal cell carcinoma. He died 3?weeks later from respiratory failure. We shall briefly outline the similarities and differences in presentation and management of penetrating aortic ulcers, aortic dissections and intramural haematomas. We shall discuss, in greater detail, penetrating ulcers of thoracic aorta, their natural history, location, complications and management. Conclusion This case report is unique on account of initial successful surgical redressal following rupture of penetrating ulcer of distal ascending aorta into left pleural and pericardial cavities, normally associated with instant death. The haemodynamic effects of the rupture were staggered due to initial contained rupture into a smaller pseudoaneurysm, followed by a further rupture into a false aneurysmal sac followed eventually by generalised rupture into the pleural and pericardial cavities - a unique way of aortic rupture. Further development of another penetrating ulcer and a small pseudoaneurysm in the distal arch 6?months later which further ruptured into a larger 14?cm false aneurysmal sac, which again did not result in exsanguination, is again extraordinarily rare. Thereafter he underwent emergency thoracic endovascular aortic repair (TEVAR) for a further rupture of descending thoracic aorta. All three ruptures were managed successfully and would usually be associated with near-certain death, only for the patient to succumb eventually to the complications of metastatic renal cell carcinoma.
| S-EPMC7541281 | biostudies-literature
Project description:BackgroundAlthough a bicuspid aortic valve (BAV) is known to be associated with progressive ascending aortic dilatation, the fate of the residual aorta after aortic valve and ascending aorta surgery is unknown. We reviewed surgical outcomes and explored serial changes in the size of the sinus of Valsalva (SOV) and distal ascending aorta (DAAo) in 89 patients with a BAV undergoing aortic valve replacement (AVR) and graft replacement (GR) of the ascending aorta.MethodsWe retrospectively examined patients who underwent AVR and GR of the ascending aorta for BAV-and related disease and thoracic aortic dilatation at our institution between January 2009 and December 2018. Patients who underwent AVR alone or required intervention for the aortic root and aortic arch and patients with connective tissue diseases were excluded. Aortic diameters were examined using computed tomography (CT). Late CT more than 1 year after surgery was performed in 69 patients (78%) with a mean follow-up of 4.9±2.8 years.ResultsThe surgical indication for aortic valve etiology was stenosis in 61 patients (69%), regurgitation in 10 (11%), and mixed in 18 (20%). Preoperative maximum short diameters of the ascending aorta, SOV, and DAAo were 47.3±4.7, 36.0±5.2, and 37.2±3.6 mm, respectively. The diameter of the SOV increased non-significantly by 0.08±0.45 mm per year [95% confidence interval (CI): -0.12 to 0.11, P=0.150], while that of the DAAo increased significantly by 0.11±0.40 mm per year (95% CI: 0.02-0.21, P=0.005). One patient required reoperation 6 years postoperatively due to a pseudo-aneurysm at the proximal anastomotic site. No patient required reoperation due to progressive dilatation of the residual aorta. According to the Kaplan-Meier analysis, the long-term survival rates were 98.9%, 98.9%, and 92.7% at 1, 5, and 10 years postoperatively, respectively.ConclusionsRapid dilatation of the residual aorta rarely occurred in patients with a BAV who underwent AVR and GR of the ascending aorta in the mid-term follow-up. For selected patients with a surgical indication for ascending aortic dilatation, simple AVR and GR of the ascending aorta may be sufficient surgical options.
| S-EPMC10089858 | biostudies-literature
Project description:BackgroundThere are limited data regarding the clinical outcomes of reoperative aortic root or ascending aorta replacement after prior aortic valve replacement (AVR). We aimed to analyze outcomes of reoperative aortic root or ascending aorta replacement after prior AVR.MethodsEighty patients with prior AVR underwent reoperative aortic root or ascending aorta replacement in our hospital. The indications were root or ascending aortic aneurysm in 36 patients, root or ascending aortic dissection in 37, root false aneurysm in 2, prosthesis valve endocarditis (PVE) with root abscess in 2, Behçet's disease (BD) with root destruction in 3 patients. An elective surgery was performed in 63 patients and an emergent surgery in 17. The survival and freedom from aortic events during the follow-up were evaluated with the Kaplan-Meier survival curve and the log-rank test.ResultsThe operative techniques included ascending aorta replacement in 14 patients, ascending aorta replacement with AVR in 3, prosthesis-sparing root replacement (PSRR) in 35, Bentall procedure in 24, and Cabrol procedure in 4 patients. Operative mortality was 1.3% (1/80). A composite of adverse events occurred in 5 patients, including 1 operative death, 2 stroke and 3 renal failure necessitating hemodialysis. The mean follow-up was 35.5±22.1 months. Five late deaths occurred. The Kaplan-Meier survival at 1 year, 3 years and 6 years were 97.5%, 91.1% and 84.1%, respectively. Aortic events developed in 3 patients. The freedom from aortic events at 1-year, 3-year, and 6-year were 100%, 96.3% and 88.9%, respectively. There were no differences in survival and freedom from aortic events between the elective group and the emergent group.ConclusionsReoperative aortic root or ascending aorta replacement after prior AVR could be performed to treat the root or ascending pathologies after AVR, with satisfactory early and midterm outcomes.
| S-EPMC8024838 | biostudies-literature
Project description:IntroductionVentricular septal defect (VSD) is one of the most common congenital cardiac anomalies. Patients with perimembranous VSD may have aortic regurgitation (AR) secondary to prolapse of the aortic cusp.Case presentationWe present a case of 23-year-old White man with VSD, AR and ascending aortic aneurysm. The patient presented to outpatient clinic with weakness and gradual worsening shortness of breath for the past 5 years. Clinical examination revealed regular heart rhythm and loud continuous systolic-diastolic murmur (Lewin's grade 6/6), heard all over the precordium, associated with a palpable thrill. The ECG showed right axis deviation, fractionated QRS in V1 and signs of biventricular hypertrophy. The chest X-ray showed cardiomegaly. Transthoracic and transesophageal echocardiograms showed a perimembranous VSD with moderate restrictive shunt (Qp/Qs = 1.6), aortic regurgitation (AR), and ascending aortic aneurysm. Other clinical and laboratory findings were within normal limits.ConclusionsPerimembranous VSD, may be associated with aortic regurgitation and ascending aortic aneurysm as secondary phenomenon if it is not early diagnosed and successfully treated.
| S-EPMC10601169 | biostudies-literature
Project description:BackgroundIntimal sarcomas are rare tumors that typically affect the major vessels, such as the pulmonary artery and aorta, and are associated with a particularly poor prognosis. Intimal sarcomas found in the aorta are most commonly located in the abdominal section between the celiac artery and the iliac bifurcation. The descending aorta is involved in 30% of cases, while involvement of the ascending aorta is rare. Additionally, the symptoms of intimal sarcomas are usually nonspecific, making preoperative diagnosis difficult. The majority of neoplasms can only be found by histological analysis of the surgical specimen.Case descriptionA 69-year-old female patient was diagnosed with intimal sarcoma of the ascending aorta and aortic valve, which was initially thought to be nonbacterial thrombotic endocarditis. The patient complained of chest discomfort accompanied by reduced activity tolerance and had elevated serum levels of interleukin 6, lactic dehydrogenase, high-sensitivity troponin I, and brain natriuretic peptide, along with mild anemia. Echocardiography and computed tomography with contrast-enhanced angiography revealed a vegetation measuring 9.8 mm × 6.6 mm between the root of the aorta and aortic valve, suggesting an initial diagnosis of nonbacterial thrombotic endocarditis. However, an aortic intimal sarcoma was detected by immunohistochemistry and postoperative histology. Additionally, 18F-fluorodeoxyglucose positron emission tomography detected metastasis in the right adrenal gland and left humeral head.ConclusionsIntimal sarcomas are an uncommon and extremely aggressive type of primary malignant aortic tumor. Diagnosis might be challenging and requires a high level of suspicion. Standard surgical treatment may include resection of the affected segment followed by interposition graft replacement. Given the poor prognosis even after complete resection, it is essential to rule out metastasis.
| S-EPMC11635269 | biostudies-literature
Project description:We evaluated the operative outcomes of an extra-anatomic bypass from the ascending aorta to the abdominal aorta in patients with type II or III Takayasu arteritis (TA) with mid-aortic syndrome.From 1988 to 2014, 8 patients with type II (n=2) or III (n=6) TA underwent an ascending aorta to abdominal aorta bypass. The mean patient age was 43.5±12.2 years and the mean peak pressure gradient between the upper and lower extremities was 54.8±39.0 mm Hg. The median follow-up duration was 54.4 months (range, 17.8 to 177.4 months).There were no cases of operative mortality. The mean peak pressure gradient significantly decreased to -2.4±32.3 mm Hg (p=0.017 compared to the preoperative value). Late death occurred in 2 patients. The symptoms of upper extremity hypertension and claudication improved in all patients. The bypass grafts were patent at 47.1±58.9 months in 7 patients who underwent follow-up imaging studies.An extra-anatomic ascending aorta to abdominal aorta bypass could be an effective treatment option for severe aortic steno-occlusive disease in patients with type II or III TA, with favorable early and long-term outcomes.
| S-EPMC5548203 | biostudies-other