Ortnerův nebo též kardiovokální syndrom je vzácná příčina chrapotu způsobená kompresí levého zvratného nervu v důsledku patologie kardiovaskulárních struktur v mediastinu. První popis pochází od Norberta Ortnera z roku 1897, kdy syndrom spojil s mitrální stenózou. Typicky se projevuje parézou levého rekurentního laryngeálního nervu, který je mechanicky stlačen v oblasti aortálního oblouku. Kazuistika popisuje případ 81letého nekuřáka, který byl vyšetřen pro 2 měsíce trvající chrapot. Laryngoskopické vyšetření odhalilo obrnu levé hlasivky, CT krku a mediastina s kontrastní látkou prokázalo ektázii ascendentní aorty a aneurysma oblouku aorty. Pacient byl konzultován kardiochirurgem i intervenčním radiologem, ale vzhledem k věku a náhodnému nálezu nebyla doporučena chirurgická či endovaskulární léčba. Nemocný byl propuštěn domů, kde později zemřel v kruhu rodiny. Prognóza těchto pacientů závisí na rychlé diagnóze a léčbě. Včasná intervence může zlepšit nebo obnovit hlasové funkce. Neméně důležitým faktorem je pro optimální péči o pacienty i pravidelné sledování a mezioborová spolupráce.

Ortner’s syndrome, also known as cardiovocal syndrome, is a rare cause of hoarseness due to compression of the left recurrent laryngeal nerve caused by pathology of cardiovascular structures in the mediastinum. It was first described by Norbert Ortner in 1897, who associated the syndrome with mitral stenosis. It typically presents as paresis of the left recurrent laryngeal nerve, which is mechanically compressed in the area of the aortic arch. The case report describes an 81-year-old non-smoker who was examined for two months of hoarseness. Laryngoscopic examination revealed paralysis of the left vocal cord, and CT of the neck and mediastinum with contrast showed ectasia of the ascending aorta and aneurysm of the aortic arch. The patient was consulted by both a cardiothoracic surgeon and an interventional radiologist, but due to his age and the incidental nature of the finding, neither surgical nor endovascular treatment was recommended. The patient was discharged home, where he later passed away surrounded by his family. The prognosis of these patients depends on prompt diagnosis and treatment. Early intervention can improve or restore vocal function. Regular monitoring and interdisciplinary collaboration are also crucial factors for optimal patient care.

• Klíčová slova
• Ortnerův syndrom,
• MeSH
• aneurysma aortálního oblouku * diagnostické zobrazování   terapie   MeSH
• aneurysma hrudní aorty diagnostické zobrazování   terapie   MeSH
• chrapot etiologie   MeSH
• fatální výsledek MeSH
• lidé MeSH
• ochrnutí hlasivek * diagnostické zobrazování   etiologie   terapie   MeSH
• senioři nad 80 let MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• Publikační typ
• kazuistiky MeSH

• O autorovi
• Ortner, Norbert, 1865-1935 Autorita

OBJECTIVE: Evidence is lacking to guide the management of infective native aortic aneurysm (INAA). The aim of this study was to establish expert consensus on surgical and antimicrobial treatment and follow up, and to define when an INAA is considered cured. METHODS: Delphi methodology was used. The principal investigators invited 47 international experts (specialists in infectious diseases, radiology, nuclear medicine, and vascular and cardiothoracic surgery) via email. Four Delphi rounds were performed, three weeks each, using an online questionnaire with initially 28 statements. The panellists rated the statements on a five point Likert scale. Comments on statements were analysed, statements were revised and added or deleted, and the results were presented in the iterative rounds. Consensus was defined as ≥ 75% of the panel rating a statement as strongly agree or agree on the Likert scale, and consensus on the final assessment was defined as Cronbach's alpha > 0.80. RESULTS: All 49 panellists completed all four rounds, resulting in 100% participation. One statement was added based on the results and comments of the panel, resulting in 29 final statements: three on need for consensus, 20 on treatment, five on follow up, and one on definition of cure. All 29 statements reached agreement of ≥ 86%. Cronbach's alpha increased for each consecutive round; round 1, 0.85; round 2, 0.90; round 3, 0.91; and round 4, 0.94. Thus, consensus was reached for all statements. CONCLUSION: INAAs are rare, and high level evidence to guide optimal management is lacking. This consensus document was established with the aim of helping clinicians manage these challenging patients, as a supplement to current guidelines. The presented consensus will need future amendments in accordance with newly acquired knowledge.

• MeSH
• aortální aneurysma * MeSH
• delfská metoda MeSH
• konsensus MeSH
• lidé MeSH
• následné studie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Thoracic aorta false aneurysms (TAFA) are unexplored complications after cardiac surgery associated with significant morbidity and mortality. Therefore, the purpose of this study was to examine the clinical profiles, surgical techniques, and operative outcomes, of patients treated for TAFA at a single institution. METHODS: From 1996 to 2022, 112 patients were treated for aortic pseudoaneurysm (mean age 55 ± 14 years, 78 patients were male). In the majority of the patients (90%) TAFA developed after previous cardiovascular surgery, the most common diagnosis and surgical procedure preceding the TAFA development was an aortic dissection (52%) and Bentall procedure (47%). In the rest of the cohort, the leading cause was trauma. RESULTS: Sixty-one percent of patients were indicated for reintervention (surgical reoperation, endoluminal graft implantation, septal occluder implantation, coil embolization, or a combination of procedures). Overall, 52 patients had undergone cardiac reoperation. TAFA was resected and the aorta was repaired in 55% or replaced in 45%. Operative mortality was 5.7%. In postoperative follow-up, a hypoechogenic lesion encircling aortic prosthesis was present in 94%, therefore it was determined as a negative prognostic factor. The mean follow-up was 13.2 ± 19.4 years. CONCLUSION: Although there is no specific approach how to prevent TAFA development, maintaining normal blood pressure and regular follow-up should be applied. More frequent follow-ups should be performed in patients with a hypoechogenic lesion encircling and aortic prosthesis. Early detection during long-term postoperative follow-up, an individually tailored approach of a multidisciplinary team is necessary for favorable treatment outcomes.

• MeSH
• aneurysma hrudní aorty * chirurgie   MeSH
• aorta thoracica chirurgie   diagnostické zobrazování   MeSH
• časové faktory MeSH
• cévy - implantace protéz škodlivé účinky   MeSH
• dospělí MeSH
• endovaskulární výkony škodlivé účinky   MeSH
• kombinovaná terapie MeSH
• lidé středního věku MeSH
• lidé MeSH
• nepravé aneurysma * chirurgie   etiologie   diagnostické zobrazování   terapie   MeSH
• pooperační komplikace etiologie   chirurgie   MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: We investigated long-term outcomes of bicuspid aortic valve (BAV) repair, with external annuloplasty, according to aorta phenotype. METHODS: Between 2003 and 2020, all patients with BAV operated on for aortic insufficiency (AI) and/or aneurysm were included. Repairs included isolated AI repair with subvalvular with or without sinotubular junction (STJ) (single or double) annuloplasty, supracoronary aorta replacement (with or without hemiroot remodeling), and root remodeling with external subvalvular ring annuloplasty. RESULTS: Among 343 patients operated, reparability rate was 81.3% (n = 279; age 46 ± 13.3 years). At 10 years (median follow-up: 3.42 years; interquartile range, 1.1, 5.8), survival was 93.9% (n = 8 deaths, similar to general population), cumulative incidence of reoperation was 6.2% (n = 10), AI grade >2 was 5.8% (n = 9), and grade >1 was 23.0% (n = 30). BAV repair stabilizing both the annulus and STJ with annuloplasty, compared with nonstabilized STJ repair (single annuloplasty), had lower incidence of reoperation (2.6% vs 22.5%, P = .0018) and AI grade >2 (1.2% vs 23.6%, P < .001) at 9 years. Initial commissural angle <160° was not a risk factor for reoperation, compared with angle ≥160° if symmetrical repair was achieved (2.7% and 4.1%, respectively, at 6 years, P = .85). Multivariable model showed that absence of STJ stabilization (odds ratio, 6.7; 95% confidence interval, 2.1-20, P = .001) increased recurrent AI, but not initial commissural angle <160° (odds ratio, 1.01; 95% confidence interval, 0.39-2.63, P = .98). Commissures adjusted symmetrically led to lower transvalvular gradient, compared with nonsymmetrical repair (8.7 mm Hg vs 10.2 mm Hg, P = .029). CONCLUSIONS: BAV repair, tailored to aorta phenotype, is associated with excellent durable outcomes if both annulus and STJ are reduced and stabilized with external ring annuloplasty. Commissural angle <160° is not associated with reoperation if symmetrical repair is achieved.

• MeSH
• anuloplastika srdeční chlopně * škodlivé účinky   mortalita   metody   MeSH
• aortální aneurysma chirurgie   diagnostické zobrazování   mortalita   MeSH
• aortální chlopeň chirurgie   abnormality   diagnostické zobrazování   patofyziologie   MeSH
• aortální insuficience * chirurgie   patofyziologie   diagnostické zobrazování   mortalita   MeSH
• bikuspidální aortální chlopeň * chirurgie   patofyziologie   MeSH
• časové faktory MeSH
• chirurgická náhrada chlopně škodlivé účinky   přístrojové vybavení   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace etiologie   MeSH
• reoperace statistika a číselné údaje   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• aortální aneurysma diagnóza   klasifikace   komplikace   MeSH
• chronická kritická ischemie končetin diagnóza   farmakoterapie   terapie   MeSH
• nemoci aorty * diagnóza   klasifikace   komplikace   MeSH
• onemocnění periferních arterií * diagnóza   etiologie   farmakoterapie   klasifikace   terapie   MeSH
• plicní embolie diagnóza   farmakoterapie   MeSH
• plicní hypertenze diagnóza   farmakoterapie   MeSH
• žilní insuficience diagnóza   farmakoterapie   klasifikace   MeSH
• žilní tromboembolie diagnóza   farmakoterapie   klasifikace   prevence a kontrola   MeSH
• Publikační typ
• přehledy MeSH

BACKGROUND: The outcomes after prolonged treatment in the intensive care unit (ICU) after surgery for Stanford type A aortic dissection (TAAD) have not been previously investigated. METHODS: This analysis included 3538 patients from a multicenter study who underwent surgery for acute TAAD and were admitted to the cardiac surgical ICU. RESULTS: The mean length of stay in the cardiac surgical ICU was 9.9±9.5 days. The mean overall costs of treatment in the cardiac surgical ICU 24086±32084 €. In-hospital mortality was 14.8% and 5-year mortality was 30.5%. Adjusted analyses showed that prolonged ICU stay was associated with significantly lower risk of in-hospital mortality (adjusted OR 0.971, 95%CI 0.959-0.982), and of five-year mortality (adjusted OR 0.970, 95%CI 0.962-0.977), respectively. Propensity score matching analysis yielded 870 pairs of patients with short ICU stay (2-5 days) and long ICU stay (>5 days) with balanced baseline, operative and postoperative variables. Patients with prolonged ICU stay (>5 days) had significantly lower in-hospital mortality (8.9% vs. 17.4%, <0.001) and 5-year mortality (28.2% vs. 30.7%, P=0.007) compared to patients with short ICU-stay (2-5 days). CONCLUSIONS: Prolonged ICU stay was common after surgery for acute TAAD. However, when adjusted for multiple baseline and operative variables as well as adverse postoperative events and the cluster effect of hospitals, it was associated with favorable survival up to 5 years after surgery.

• MeSH
• aortální aneurysma chirurgie   ekonomika   mortalita   MeSH
• délka pobytu * ekonomika   MeSH
• disekce aorty * chirurgie   ekonomika   mortalita   MeSH
• jednotky intenzivní péče * ekonomika   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mortalita v nemocnicích * MeSH
• prognóza MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH

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

• MeSH
• akutní aortální syndrom * diagnostické zobrazování   terapie   MeSH
• aneurysma břišní aorty MeSH
• aneurysma hrudní aorty diagnostické zobrazování   terapie   MeSH
• koarktace aorty MeSH
• lidé MeSH
• rizikové faktory MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

OBJECTIVES: Class I triggers for severe and chronic aortic regurgitation surgery mainly rely on symptoms or systolic dysfunction, resulting in a negative outcome despite surgical correction. Therefore, US and European guidelines now advocate for earlier surgery. We sought to determine whether earlier surgery leads to improved postoperative survival. METHODS: We evaluated the postoperative survival of patients who underwent surgery for severe aortic regurgitation in the international multicenter registry for aortic valve surgery, Aortic Valve Insufficiency and Ascending Aorta Aneurysm International Registry, over a median follow-up of 37 months. RESULTS: Among 1899 patients (aged 49 ± 15 years, 85% were male), 83% and 84% had class I indication according to the American Heart Association and European Society of Cardiology, respectively, and most were offered repair surgery (92%). Twelve patients (0.6%) died after surgery, and 68 patients died within 10 years after the procedure. Heart failure symptoms (hazard ratio, 2.60 [1.20-5.66], P = .016) and either left ventricular end-systolic diameter greater than 50 mm or left ventricular end-systolic diameter index greater than 25 mm/m2 (hazard ratio, 1.64 [1.05-2.55], P = .030) predicted survival independently over and above age, gender, and bicuspid phenotype. Therefore, patients who underwent surgery based on any class I trigger had worse adjusted survival. However, patients who underwent surgery while meeting early imaging triggers (left ventricular end-systolic diameter index 20-25 mm/m2 or left ventricular ejection fraction 50% to 55%) had no significant outcome penalty. CONCLUSIONS: In this international registry of severe aortic regurgitation, surgery when meeting class I triggers led to postoperative outcome penalty compared with earlier triggers (left ventricular end-systolic diameter index 20-25 mm/m2 or ventricular ejection fraction 50%-55%). This observation, which applies to expert centers where aortic valve repair is feasible, should encourage the global use of repair techniques and the conduction of randomized trials.

• MeSH
• aneurysma vzestupné aorty MeSH
• aortální aneurysma chirurgie   mortalita   diagnostické zobrazování   MeSH
• aortální chlopeň chirurgie   diagnostické zobrazování   patofyziologie   MeSH
• aortální insuficience * chirurgie   mortalita   diagnostické zobrazování   patofyziologie   MeSH
• čas zasáhnout při rozvinutí nemoci MeSH
• časové faktory MeSH
• chirurgická náhrada chlopně škodlivé účinky   mortalita   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• registrace * MeSH
• rizikové faktory MeSH
• senioři MeSH
• stupeň závažnosti nemoci MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• srovnávací studie MeSH

OBJECTIVES: Gender difference in the outcome after type A aortic dissection (TAAD) surgery remains an issue of ongoing debate. In this study, we aimed to evaluate the impact of gender on the short- and long-term outcome after surgery for TAAD. METHODS: A multicentre European registry retrospectively included all consecutive TAAD surgery patients between 2005 and 2021 from 18 hospitals across 8 European countries. Early and late mortality, and cumulative incidence of aortic reoperation were compared between genders. RESULTS: A total of 3902 patients underwent TAAD surgery, with 1185 (30.4%) being females. After propensity score matching, 766 pairs of males and females were compared. No statistical differences were detected in the early postoperative outcome between genders. Ten-year survival was comparable between genders (47.8% vs 47.1%; log-rank test, P = 0.679), as well as cumulative incidences of distal or proximal aortic reoperations. Ten-year relative survival compared to country-, year-, age- and sex-matched general population was higher among males (0.65) compared to females (0.58). The time-period subanalysis revealed advancements in surgical techniques in both genders over the years. However, an increase in stroke was observed over time for both populations, particularly among females. CONCLUSIONS: The past 16 years have witnessed marked advancements in surgical techniques for TAAD in both males and females, achieving comparable early and late mortality rates. Despite these findings, late relative survival was still in favour of males.

• MeSH
• aneurysma hrudní aorty chirurgie   mortalita   MeSH
• disekce aorty * chirurgie   mortalita   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace epidemiologie   MeSH
• registrace * MeSH
• reoperace statistika a číselné údaje   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• sexuální faktory MeSH
• tendenční skóre MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Evropa MeSH