BACKGROUND: The prevalence and outcomes of the unicuspid aortic valve (UAV) in patients undergoing the Ross procedure have been strongly underreported in the current literature. We sought to evaluate this in comparison with bicuspid (BAV) and tricuspid valve (TAV) in our Ross cohort. METHODS: This was a retrospective observational study of patients undergoing the Ross procedure at 2 dedicated centers between 2009 and 2020. Primary end points were the risks of midterm autograft reoperation and the onset of at least moderate aortic regurgitation during follow-up. The secondary end point was to compare the perioperative outcomes between the groups. RESULTS: Included in the analysis were 286 patients, of those 39% with UAV, 52% with BAV, and 9% with TAV. UAV patients were operated on at the youngest age (P < .001) and more often for a combined hemodynamic aortic valve pathology (P = .02). They had the largest aortic root dimensions: annulus (P = .01), Valsalva sinuses (P = .11), sinotubular junction (P = .001), and ascending aorta (P < .0001). The risks of reoperation (P = .86) and the onset of aortic regurgitation (P = .75) were comparable among the groups over the follow-up of 4.1 years. There was no difference in perioperative outcomes. CONCLUSIONS: UAV is a separate unit characterized by a distinct hemodynamic pathology and generated aortopathy. It is not associated with a higher risk of reoperation or new onset of aortic regurgitation after the Ross procedure in the midterm postoperatively. At the current state, UAV remains acceptable for the Ross procedure.
Personalized External Aortic Root Support (PEARS) is an evolving method of treatment for patients with a dilated aortic root or ascending aorta. This treatment is being adopted in an increasing number of centres. For the sake of the safety of the procedure a standardized surgical technique is necessary. The authors describe a surgical technique of implantation that is derived from their extensive experience.
- MeSH
- aorta * chirurgie MeSH
- aortální chlopeň chirurgie MeSH
- cévní protézy * MeSH
- chirurgické síťky MeSH
- dilatace patologická MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Úvod: Operace torakoabdominální aorty představují technicky náročnou léčbu, která má svoje nezastupitelné místo i v éře endovaskulárních technik. Pro zajištění co nejlepších výsledků je vyžadován dokonale sehraný tým chirurgů, anesteziologů, lékařů intenzivní péče i ostatního zdravotnického personálu Metody: Autoři představují sestavu 300 pacientů operovaných v období od 1. 1. 2003 do 15. 3. 2022. Jednalo se ojediněle i o nemocné s těžkým obliterujícím postižením viscerální aorty, ale v naprosté většině to byli pacienti s výdutí torakoabdominální aorty (TAAA). Při operacích byly použity všechny známé postupy orgánové ochrany. V naprosté většině případů TAAA jsme použili torakofrenoretroperitoneální přístup, jen v letech 2003–2008 a u dvou reoperací byl zvolen přístup torakofrenotransperitoneální. Výsledky: V uvedeném souboru bylo nejvíce (33 %) zastoupeno torakoabdominální aneuryzma typ II klasifikace podle Crawforda. Dále následoval typ IV (32 %), typ III (15,3 %), typ I (8,7 %), typ V (6,7 %) a ostatní výkony v oblasti torakoabdominální aorty (4,3 %). Třicetidenní mortalita byla v uvedeném souboru 9,6 % (2019 – 6 %, 2020 – 9,5 %, 2021 – 3,8 %), chirurgické pooperační komplikace se vyskytly u 36 pacientů (12 %). Neurologické komplikace byly v 16 případech (5,3 %), z toho pooperační paraplegie byla zaznamenána 6× (2 %). Přechodná pooperační dialýza z důvodu renální insuficience byla u 19 nemocných (6,3 %) a 4 pacienti (1,3 %) jsou v chronickém dialyzačním programu. U 67 operovaných (23,3 %) byla pooperačně provedena dočasná tracheostomie. Závěr: Chirurgická léčba torakobadominální aorty patří mezi nejrozsáhlejší zákroky a výskyt mortality i morbidity je zde stále poměrně vysoký. K úspěšnému provádění těchto operací je zcela nezbytný multioborový přístup, dostatek zkušeností a sehraný tým, který se touto problematikou zabývá.
Introduction: Thoracoabdominal aortic surgery is a technically demanding and extensive treatment that has its place in the era of endovascular techniques. To ensure the best possible outcomes, it requires a well-coordinated team of surgeons, anaesthetists, intensive care physicians and other medical staff. Methods: The authors present a series of 300 patients operated on between 1 January 2003 and 15 March 2022. Although the group included sporadic cases of severe obliterating involvement of the visceral aorta, patients with thoracoabdominal aortic aneurysms (TAAA) constituted the vast majority. All known organ preservation procedures were used during the operations. The thoraco-phreno-retroperitoneal approach was chosen in almost all TAAA cases; the thoraco-phreno-transperitoneal approach was used only in two reoperations. Results: In this cohort, type II thoracoabdominal aneurysm according to Crawford classification was most common (33%). This was followed by type IV (32%), type III (15.3%), type I (8.7%), type V (6.7%) and other thoracoabdominal aortic procedures (4.3%). Thirty-day mortality rate was 9.6% (2019 – 6%, 2020 – 9.5%, 2021 – 3.8%) in this group; surgical postoperative complications occurred in 36 patients (12%). Neurological complications were reported in 16 cases (5.3%), of which postoperative paraplegia was noted 6 times (2%). Temporary postoperative dialysis due to renal insufficiency was performed in 19 patients (6.3%) and 4 patients (1.3%) have entered the chronic dialysis programme. In 67 patients (23.3%), temporary tracheostomy was done postoperatively due to prolonged withdrawal from the lung ventilator. Conclusion: Surgical treatment of the thoracoabdominal aorta is one of the most extensive procedures in vascular surgery and the mortality and morbidity rates still remain relatively high. A multidisciplinary approach, sufficient experience and a dedicated team are essential for a successful outcome of these highly specialised operations.
Závažný akutní aortální syndrom (ruptura, disekce, transekce aorty) může vzácně nastat v přímém důsledku sportovní činnosti. Fyzicky zdraví a zpravidla mladí jedinci se tak náhle ocitají v závažném ohrožení života. K porušení aortální stěny dochází při překonání pevnostních limitů, buď při extrémním zvýšení krevního tlaku, nebo při prudkém působení střižných sil během deceleračních úrazů. Nadhraniční hypertenzní zátěž je doložena při izometrickém cvičení (vzpírání apod.). Decelerační úrazy jsou nejčastější u sportů, jako je paragliding, skok padákem, lyžování, ale byly kazuisticky popsány i u řady dalších sportovních aktivit. Přehled literatury poukazuje na často bizarní okolnosti úrazů a sníženou klinickou bdělost vůči kardiovaskulárnímu poranění u mladých sportovců. Morfologicky závažná poranění aortální stěny vyžadují bezodkladnou chirurgickou nebo endovaskulární léčbu. Pouze v případě tzv. minimal aortic injury je postup konzervativní.
Serious acute aortic syndrome (rupture, dissection, transection) may rarely occur in direct association with a sporting activity. In such a case, physically healthy and usually young individuals are suddenly at a serious risk of death. Damage to the aortic wall occurs after exceeding the integrity limits resulting from either excessive hypertension or shear stress during deceleration trauma. Extreme hypertensive overload has been documented in the course of isometric exercise. Deceleration trauma typically occurs in certain types of sports (parachuting, paragliding, downhill skiing), but has also been reported in various other sporting activities. In literature reviews, sometimes bizarre clinical scenarios and decreased physician's vigilance are of note. A morphologically severe aortic injury necessitates a prompt surgical or endovascular treatment. Only in the case of minimal aortic injury, the treatment is conservative.
- Klíčová slova
- aortální syndrom,
- MeSH
- aorta chirurgie zranění MeSH
- disekce aorty etiologie MeSH
- kardiovaskulární chirurgické výkony metody MeSH
- lidé MeSH
- ruptura aorty * etiologie MeSH
- sportovní úrazy * MeSH
- sporty MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
V kazuistice prezentujeme případ pacienta se známou těžkou systolickou dysfunkcí levé komory, u kterého se díky projevům kardiálního selhání nově diagnostikovala přítomnost gigantického aneurysmatu aorty s významnou regurgitací. Stejně jako je v dnešní době díky dobře dostupným zobrazovacím metodám raritní nález gigantického aneurysmatu ascendentní aorty, tak je také toto onemocnění vzácnou příčinou srdečního selhání.
In the case report the case of patient with a very well-known severe systolic dysfunction of the left ventricle is being presented. The same patient has been diagnosed with presence of the gigantic aneurysm of the aorta with signifi cant regurgitation because of show symptoms of heart failure. Nowadays thanks to well-available imaging methods it is rare to diagnose the gigantic aneurysm of aorta. This disease is also uncommon cause of heart failure.
- MeSH
- aorta chirurgie patofyziologie MeSH
- aortální aneurysma * chirurgie diagnostické zobrazování MeSH
- lidé MeSH
- senioři MeSH
- srdeční selhání MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
OBJECTIVES: Implantation of a personalized external aortic root support (PEARS) can prevent dilatation of the aortic root and ascending aorta in patients with aortopathy of various aetiologies. Because PEARS is an emerging technology, all aspects concerning indications, surgical technique and safety should be elucidated. Our goal was to summarize all of these aspects so that physicians and patients would have sufficient information to evaluate this alternative approach. METHODS: Between April 2004 and March 2020, 317 patients underwent PEARS operations at 25 surgical centres in 9 countries. RESULTS: The most common indication was Marfan syndrome (57%). The single perioperative death represented a mortality of 0.3%. The long-term experience comprises 871 patient/years with 1 patient living for 15 years and 19 patients living for more than 10 years. CONCLUSIONS: PEARS seems to be a promising method of treatment of dilatation of the aortic root and/or ascending aorta. Multicentre observational studies are needed to gain more experience because this operation is still uncommon and the number of operations per surgeon/centre is low.
The author presents a case study of the use of resuscitative endovascular balloon occlusion (REBOA) as a suitable alternative to thoracotomy and clamping of the descending aorta to control retroperitoneal bleeding in a patient with a pelvic injury. The patient who suffered multiple trauma after car accident, type C pelvic injury and retroperitoneal bleeding among other things, was following the pre-hospital ambulance care transported to the department of emergency medicine, with catecholamine infusion to support the blood flow. After the primary survey following the ATLS principles, the patient was taken for a CT scan. The CT examination revealed also multiple sources of retroperitoneal bleeding. Subsequently, the patient was brought to the operating room, where endovascular balloon occlusion of the descending aorta was performed to temporarily control retroperitoneal bleeding, which provided more time to treat the patient in line with the damage control surgery principles. In bleeding patients who suffered blunt torso traumas and serious haemorrhagic shock, or patients "in extremis", the survival after emergency thoracotomy ranges only around 1%. The to date results of REBOA technique applied in same indications are very promising globally. The survival rate increases multiple times especially in hypotensive patients, without the necessity of their immediate cardiopulmonary resuscitation. Key words:resuscitative balloon occlusion of the aorta, REBOA, haemorrhagic shock, retroperitoneal bleeding.
- MeSH
- aorta chirurgie MeSH
- balónková okluze * MeSH
- dopravní nehody MeSH
- fraktury kostí komplikace MeSH
- hemoragický šok chirurgie MeSH
- lidé MeSH
- pánevní kosti zranění MeSH
- polytrauma etiologie terapie MeSH
- resuscitace metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Histone deacetylase (HDAC) inhibitors have shown beneficial effects in animal models of cardiovascular diseases. We hypothesized that HDAC inhibitor, sodium valproate (VPA), has cardiac and vascular protective effects in rats with pressure overload cardiac hypertrophy induced by transverse aortic constriction (TAC). Sections of the heart were visualized after hematoxylin and eosin staining, picrosirius red staining and immunohistochemistry. The expression of genes related to cardiac hypertrophy, fibrosis, and oxidative stress was determined by quantitative real-time polymerase chain reaction. The aortic ring tension analysis was conducted using both the ascending aorta and descending thoracic aorta. TAC increased the expression of hypertrophic, fibrotic, and oxidative stress genes, which was attenuated by VPA. In the ascending aorta with intact endothelium, there was a significant decrease in the relaxation response, which was recovered by VPA treatment. These results indicate that VPA has cardiac and vascular protective effects in rats with pressure overload cardiac hypertrophy.
- MeSH
- aorta chirurgie patofyziologie účinky léků MeSH
- arteriální tlak účinky léků MeSH
- fibróza MeSH
- funkce levé komory srdeční účinky léků MeSH
- hypertrofie levé komory srdeční metabolismus patofyziologie patologie prevence a kontrola MeSH
- inhibitory histondeacetylas farmakologie MeSH
- kyselina valproová farmakologie MeSH
- ligace MeSH
- modely nemocí na zvířatech MeSH
- myokard metabolismus patologie MeSH
- oxidační stres účinky léků MeSH
- potkani Sprague-Dawley MeSH
- regulace genové exprese MeSH
- remodelace komor účinky léků MeSH
- vazodilatace účinky léků MeSH
- vazodilatancia farmakologie MeSH
- zvířata MeSH
- Check Tag
- mužské pohlaví MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: To evaluate the diagnostic performance of 18F-FDG PET/CT in the detection of stent graft infection (SGI). METHODS: In a retrospective study, two nuclear medicine physicians have independently analyzed 17 18F-FDG PET/CT examinations performed for clinical suspicion of SGI. The images were evaluated for the uptake pattern and intensity, and by the maximum standard uptake value (SUVmax), the target-to-background ratio with blood pool (TBRBP) and liver uptake (TBRhep) as a reference. The SGI was defined as the presence of focal hyperactivity with an intensity exceeding hepatic uptake. CT images were independently assessed for signs of SGI. Clinical review of all further patients' data served as the standard of reference. RESULTS: Nine cases were established as SGI by the clinical review. PET/CT correctly diagnosed SGI in eight and yielded a sensitivity of 89% and specificity of 100%. The mean SUVmax, TBRBP, and TBRhep values were 9.8 ± 4.0, 6.9 ± 2.6, and 4.6 ± 1.7 in the group of patients with true SGI, and 4.0 ± 1.1, 2.5 ± 0.4 (p < 0.001) and 1.9 ± 0.2 (p < 0.001) in true negative cases, respectively. CT alone showed a sensitivity of 78% and specificity of 100% and was concordant with PET/CT in 14 cases. The best performing threshold values of SUVmax, TBRBP, and TBRhep were 5.6, 3.5, and 2.2, respectively. CONCLUSION: 18F-FDG PET/CT with expert evaluation, semiquantitative and quantitative image analysis with the proposed threshold values for SUVmax, TBRBP, and TBRhep has good diagnostic accuracy in the detection of SGI. We propose that visual grading scale for SGI should use hepatic uptake as a visual reference.
- MeSH
- aorta chirurgie MeSH
- fluorodeoxyglukosa F18 * MeSH
- infekce spojené s protézou diagnostické zobrazování etiologie MeSH
- lidé MeSH
- PET/CT * MeSH
- počítačové zpracování obrazu MeSH
- retrospektivní studie MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- stenty škodlivé účinky mikrobiologie MeSH
- výkony cévní chirurgie škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH