The biomechanical rupture risk assessment (BRRA) of abdominal aortic aneurysms (AAA) has higher sensitivity than maximal diameter criterion (DSEX) but its estimation is time-consuming and relies on an uncertain estimation of wall thickness. The aim of this study is to test tension-based criterion in the BRRA of AAA which removes the necessity of wall thickness measurement and should be faster. For that, we retrospectively analyzed 99 patients with intact AAA (25 females). Nineteen of them experienced a rupture later. BRRA was performed with wall tension PRRIT as a primary criterion. The ability of criterion to separate intact and ruptured AAAs at 1,3,6,9 and 12 months was estimated. Next, the receiver operating characteristics and the percentage of true negative cases for a different time to an outcome were estimated. Finally, the computational time was recorded. The results were compared to stress-based criterion PRRI and DSEX which served as a reference. All three criterions were able to discriminate between intact and ruptured AAAs up to 9 months (p < 0.05) while none of them could do for a 12 month prediction. PRRIT exhibited a significantly higher percentage of true negatives for 12 and 9 month predictions (45 % and 20 % respectively) and similar to other criteria for other prediction times. The mean computational time for estimating PRRIT was 19 h per patient compared to 67 h for PRRI. The tension- based BRRA of AAA leads to better outcomes for a 9 and 12 month prediction while the computational time drops by more than 70 % compared to PRRI.

• MeSH
• aneurysma břišní aorty * patofyziologie   diagnostické zobrazování   MeSH
• biomechanika MeSH
• hodnocení rizik metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• modely kardiovaskulární MeSH
• retrospektivní studie MeSH
• ruptura aorty * patofyziologie   diagnostické zobrazování   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND AND OBJECTIVE: Estimating patient specific annual risk of rupture of abdominal aortic aneurysm (AAA) is currently based only on population. More accurate knowledge based on patient specific data would allow surgical treatment of only those AAAs with significant risk of rupture. This would be beneficial for both patients and health care system. METHODS: A methodology for estimating annual risk of rupture (EARR) of abdominal aortic aneurysms (AAA) that utilizes Bayesian statistics, mechanics and patient-specific blood pressure monitoring data is proposed. EARR estimation takes into consideration, peak wall stress in AAA computed by patient-specific finite element modeling, the probability distributions of wall thickness, wall strength, systolic blood pressure and the period of time that the patient is known to have already survived with the intact AAA. Initial testing of proposed approach was performed on fifteen patients with intact AAA (mean maximal diameter 51mm±8mm). They were equipped with a pressure holter and their blood pressure was recorded over 24 hours. Then, we calculated EARR values for four possible scenarios - without considering any days of survival prior identification of AAA at computed tomography scans (EARR_0), considering past survival of 30 (EARR_30), 90 (EARR_90) and 180 days (EARR_180). Finally, effect of patient-specific blood pressure variability was analyzed. RESULTS: Consideration of past survival does indeed significantly improve predictions of future risk: EARR_30 (1.04%± 0.87%), EARR_90 (0.67%± 0.56%) and EARR_180 (0.47%± 0.39%) which are unrealistically high otherwise (EARR_0 5.02%± 5.24%). Finally, EARR values were observed to vary by an order as a consequence of blood pressure variability and by factor of two as a consequence of neglected growth. CONCLUSIONS: Methodology for computing annual risk of rupture of AAA was developed for the first time. Sensitivity analyses showed respecting patient specific blood pressure is important factor and should be included in the AAA rupture risk assessment. Obtained EARR values were generally low and in good agreement with confirmed survival time of investigated patients so proposed method should be further clinically validated.

• MeSH
• aneurysma břišní aorty * diagnostické zobrazování   MeSH
• Bayesova věta MeSH
• hodnocení rizik MeSH
• lidé MeSH
• mechanický stres MeSH
• modely kardiovaskulární MeSH
• počítačová rentgenová tomografie MeSH
• počítačové modelování podle konkrétního pacienta MeSH
• rizikové faktory MeSH
• ruptura aorty * diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Background: The standard ATLS protocol calls for chest drain insertion in patients with hemothorax before performing further diagnostic steps. However, if trauma-induced thoracic aortic rupture is the underlying cause, such drainage can lead to massive bleeding and death of the patient. Case report: This report describes a case of a polytrauma patient (car accident), aged 21, with symmetrical chest and decreased breath sounds dorsally on the left. An urgent CT scan revealed subadventitial Grade III thoracic aortic transection with mediastinal hematoma, a massive left-sided hemothorax with mediastinal shift to the right, and other injuries. Stent-graft implantation with subsequent left hemithorax drainage was urgently performed, during which the patient became increasingly unstable from the circulatory point of view. This traumatic hemorrhagic shock was successfully managed at the ICU. Conclusion: Although hemothorax is a serious condition requiring rapid treatment, the knowledge of its origin is of utmost importance; performing chest drainage without bleeding control can lead to circulatory instability and death of the patient. Hence, where aortic injury can be suspected based on the mechanism of the injury, it is beneficial to perform spiral CT angiography for accurate diagnosis first and, in cases of aortic injury, to control the bleeding prior to drainage.

• MeSH
• hemotorax * diagnostické zobrazování   etiologie   chirurgie   MeSH
• lidé MeSH
• počítačová rentgenová tomografie MeSH
• ruptura aorty * komplikace   diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• kazuistiky MeSH

OBJECTIVE: Blunt thoracic aortic injury is life-threatening injury. High suspicion on this clinical condition can be made by initial chest X-ray on emergency department. The aim of study was to detect which other signs, except widened mediastinum, are specific for rupture of the thoracic aorta. METHODS: To the study were included all Triage positive patients primary headed from the scene of injury to the Trauma center Level I from January to December 2014 and which have performed chest X-ray on emergency department followed by CT of chest, abdomen and pelvis. On chest X-ray were evaluated diameter of superior mediastinum, deviation of trachea, deviation of left and right main bronchus, aortic arch, fracture of first or second rib on the left side and obliteration of aortopulmonary space. RESULTS: Totally n=208 patients were enrolled to the study. Seven patients had blunt thoracic aortic injury on CT angiography. All these patients had widened superior mediastinum more than 80 mm (p=0.021). Six patients with blunt thoracic aortic injury had obliteration of aortic arch (p=0.0001) and obliteration of aortopulmonary space (p=0.0001). CONCLUSION: All patients after high energy trauma with widened mediastinum together with obliteration of aortic arch and obliteration of aortopulmonary space on initial chest X-ray without initial CT, must be indicated to the CT after initial stop the bleeding procedures for the exclusion of traumatic rupture of thoracic aorta.

• MeSH
• aorta thoracica diagnostické zobrazování   MeSH
• bronchy diagnostické zobrazování   MeSH
• CT angiografie MeSH
• dospělí MeSH
• fraktury žeber diagnostické zobrazování   MeSH
• kohortové studie MeSH
• lidé MeSH
• mediastinum diagnostické zobrazování   MeSH
• polytrauma diagnostické zobrazování   MeSH
• poranění hrudníku diagnostické zobrazování   MeSH
• rentgendiagnostika hrudníku MeSH
• retrospektivní studie MeSH
• ruptura aorty diagnostické zobrazování   MeSH
• skóre závažnosti úrazu MeSH
• trachea diagnostické zobrazování   MeSH
• tupá poranění diagnostické zobrazování   MeSH
• zkrácená stupnice závažnosti úrazů MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: This retrospective study aimed to analyze the trend of mortality due to thoracic aortic ruptures caused by deceleration injuries that occurred within the catchment area of Hradec Kralove University Hospital. MATERIALS AND METHODS: The study sample comprised 175 patients who had sustained thoracic aortic ruptures caused by deceleration injuries and were transported to Hradec Kralove University Hospital in 2009-2014. The small proportion of patients enrolled in this retrospective study were diagnosed and treated at the emergency department (ED). However, the overwhelming majority of the sample comprised of patients who died at the accident scene and later underwent an autopsy at the Institute of Forensic Medicine in our hospital. RESULTS: Of 175 patients, 150 underwent an autopsy. Of these, 139 individuals (79%) died at the incident scene, and 11 (6%) were transported to the ED and later died of their injuries. A total of 36 patients were admitted to the hospital; 29 were admitted primary (11 later died), and 7 were transferred. No deaths occurred in the group of secondary admissions. Thus, 31% of all patients hospitalized died following transport to the hospital. Of 175 patients, 15% (or 69% of all hospitalized patients) survived their injuries. Among patients who died as a result of thoracic aortic injury, no unexpected deaths were recorded (i.e., no deaths among patients with survival probability more than 50% = PS > 0.5). CONCLUSION: Our results suggested that the lethality of thoracic aortic injuries might be minimized by transporting triage-positive patients directly to trauma centers. Accurate diagnoses and treatments were supported by admission chest X-rays, a massive transfusion protocol, and particularly, CT angiography, which is not routinely included in primary surveys. An additional prognostic parameter was clinical collaboration between an experienced trauma surgeon, an interventional radiologist, and a vascular or thoracic surgeon.

• MeSH
• aorta thoracica diagnostické zobrazování   zranění   MeSH
• dopravní nehody mortalita   statistika a číselné údaje   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• radiografie MeSH
• retrospektivní studie MeSH
• ruptura aorty diagnostické zobrazování   epidemiologie   etiologie   mortalita   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• traumatologická centra statistika a číselné údaje   MeSH
• zpomalení škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Hongkong MeSH

We report a case of aortic rupture during transcatheter aortic valve replacement (TAVR) managed successfully by urgent stent-graft implantation.

• MeSH
• ambulantní péče MeSH
• aorta thoracica chirurgie   MeSH
• endovaskulární výkony metody   MeSH
• lidé MeSH
• počítačová rentgenová tomografie MeSH
• pooperační komplikace etiologie   chirurgie   MeSH
• ruptura aorty diagnostické zobrazování   etiologie   chirurgie   MeSH
• senioři MeSH
• stenty MeSH
• transkatetrální implantace aortální chlopně škodlivé účinky   MeSH
• výsledek terapie MeSH
• zobrazování trojrozměrné MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

V tomto článku popisujeme dosud nepopsaný případ, a to pacientky, která přežila akutní aortální syndrom bez chirurgické intervence.

The case demonstrates a hitherto undescribed phenomenon of a case of survival following an acute aortic syndrome without surgical intervention.

• MeSH
• aorta * zranění   MeSH
• lidé MeSH
• ruptura aorty diagnostické zobrazování   MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH

• MeSH
• aneurysma břišní aorty komplikace   diagnostické zobrazování   MeSH
• aorta abdominalis diagnostické zobrazování   MeSH
• bolesti břicha etiologie   MeSH
• cévní píštěle diagnostické zobrazování   etiologie   MeSH
• lidé MeSH
• multidetektorová počítačová tomografie MeSH
• ruptura aorty komplikace   diagnostické zobrazování   MeSH
• senioři MeSH
• šok etiologie   MeSH
• vena cava inferior diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

Akutní aortální syndromy jsou život ohrožující stavy vyžadující rychlou a přesnou diagnózu. Pro anesteziology a intenzivisty na resuscitačních odděleních a urgentních příjmech je nejrychleji dostupnou zobrazovací metodou ultrazvuk. Autoři seznamují v předkládaném stručném textu čtenáře pouze se základy echokardiografické diagnostiky používané v těchto klinických situacích a záměrně opomíjejí prevalenci, klasifikaci, epidemiologii, rizikové faktory, příznaky onemocnění, další použitelná zobrazovací vyšetření i podrobnosti týkající se léčby.

Acute aortic syndromes are life-threatening situation necessitating prompt and correct diagnosis. Ultrasound is the fastest available imaging method for the anaesthetists and intensivists in the intensive care units and emergency rooms. In this brief article, the authors present specifically just the basics of echocardiography in these situations while intentionally omitting other important points concerning the issue: the prevalence, classification, epidemiology, risk factors, symptoms, other imaging methods and details of treatment of acute aortic syndromes.

• Klíčová slova
• intramurální hematom, penetrující aortální ulcerace, aortální trauma,
• MeSH
• akutní aortální syndrom MeSH
• akutní nemoc MeSH
• aorta diagnostické zobrazování   zranění   MeSH
• bolesti na hrudi diagnostické zobrazování   etiologie   MeSH
• disekce aorty * diagnostické zobrazování   MeSH
• echokardiografie * metody   MeSH
• hematom diagnostické zobrazování   MeSH
• lidé MeSH
• nemoci aorty * diagnostické zobrazování   MeSH
• ruptura aorty diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH