Acute Aortic Disease.. - Index of

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Natural History of Thoracic Aortic Aneurysms 189 Incidence of Negative Events (%) 60% 40% 20% 0% < 0.05 0.05 to 0.1 0.1 to 0.14 cm/yr 0.15 to 0.19 = 0.20 Figure 8 The incidence of negative events (rupture, acute dissection, and death) as a function of growth rate. Source: From Ref. 44. % increased risk of complication 40 30 20 10 0 -10 * Hinge point at 6.0 cm (p
190 Coady and Elefteriades Figure 11 Probabilities that rupture or dissection will occur have been calculated for aortic aneurysms in the chest. There is a dramatic surge in danger when aneurysms reach 6 cm. Based on this information, we conclude that many patients with aneurysms in the range of5.5 cm should undergo elective, pre-emptive aortic replacement to prevent aortic rupture. Such a criterion spares most patients from naturally occurring rupture, dissection, or death, P. Source: From Ref. 42. fewer lamellae than the ascending and is normally smaller in the preaneurysmal state (53). We would expect the descending aorta to rupture earlier, but this does not appear to be the case. Fluid dynamics, flow patterns, wall stress, and the like may underlie this observation. A “Holy Grail” has been to make predictions of specific yearly dissection, rupture, and mortality rates for each size of the thoracic aorta. We were not able to do this until relatively recently, as this requires extremely robust data, with many “hard end-points” for each aortic size. Our database has recently reached a size where such calculations have become possible. As can be seen in Figure 11, the risks of rupture, dissection, and death increase in stepwise fashion as the aorta grows, with high risk being seen at the vital aortic dimension of 6 cm. At that 6 cm dimension, yearly risk of rupture is about 4%, dissection is about 4%, death is about 10%, and risk of rupture, dissection, or death is about 14%. Surgical Decision Making for Prophylactic Resection of the Thoracic Aorta We believe that these observations permit evidence-based conclusions regarding when the asymptomatic aneurysmal thoracic aorta should be resected, to prevent rupture, dissection, and death. Recommendations are indicated in Figure 12 (54). This data indicates that replacement of the ascending aorta at about 5.5 cm will preclude most ruptures and dissections, while not exposing affected patients unduly early to the risks and discomforts of surgery. For the descending aorta, surgery at about 6.5 cm will, similarly, pre-empt most adverse aortic-related events. We apply more stringent criteria for patients with Marfan’s disease, whose disease is more aggressive. We intervene prophylactically at 5.0 cm for the ascending
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Acute Aortic Disease
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15. Heart Failure: Basic Science an
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52. Clinical, Interventional, and I
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Informa Healthcare USA, Inc. 270 Ma
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Introduction Informa Healthcare has
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Foreword There is no disease more c
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Preface Over 100 years ago, the gre
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Preface xi Some distinguishing feat
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xiv Acknowledgments Above all, than
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xvi Contents 6. Genetic Basis of Th
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Contributors Nili Avidan Division o
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Contributors xxi Arun Raghupathy Di
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2 Nienaber and Ince Table 1 Risk Co
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4 Nienaber and Ince In addition to
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6 Nienaber and Ince CLASSIFICATION
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8 Nienaber and Ince Lansman’s Cla
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10 Nienaber and Ince Figure 4 Curve
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12 Nienaber and Ince Figure 6 Evolu
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14 Nienaber and Ince dissection, su
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16 Nienaber and Ince (A) (B) Probab
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18 Nienaber and Ince Table 5 Risk P
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20 Nienaber and Ince of the predila
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22 Nienaber and Ince 34. Pieters FA
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24 Nienaber and Ince 75. Mehta RH,
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26 Nienaber and Ince hematoma (IMH)
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28 Nienaber and Ince One good featu
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30 Isselbacher SYMPTOMS Pain Experi
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32 Isselbacher and wane in severity
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34 Isselbacher The mechanisms are u
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36 Isselbacher deficits are most co
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38 Isselbacher 3. Nallamothu BK, Me
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40 Danias spinal arteries) and the
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42 Danias Figure 2 Anteroposterior
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44 Danias However, due to the dista
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46 Danias TEE is highly sensitive f
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48 Danias faster, with higher resol
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50 Danias Figure 6 Transverse slice
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52 Danias hematoma, CT was reported
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54 Danias Figure 9 Transverse black
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56 Danias Figure 12 Single phase-co
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58 Danias restricted to the absolut
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60 Danias In conclusion, in the rig
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62 Danias DISCUSSION AND COMMENTARY
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64 Danias tomography, among others.
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66 Danias cardiac silhouette. The a
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68 Raghupathy and Eagle the inciden
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70 Raghupathy and Eagle Figure 1 Sp
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72 Raghupathy and Eagle SIGNS A tho
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74 Raghupathy and Eagle patients ma
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76 Raghupathy and Eagle Table 5 Dia
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78 Raghupathy and Eagle Table 6 A S
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80 Raghupathy and Eagle Figure 6 (A
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82 Raghupathy and Eagle Figure 9 (A
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84 Raghupathy and Eagle EDITOR’S
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86 Raghupathy and Eagle 30. Erbel R
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88 Raghupathy and Eagle is highly l
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90 Elefteriades and Rizzo required
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92 Elefteriades and Rizzo Table 1 S
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94 Elefteriades and Rizzo 70s, this
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96 Elefteriades and Rizzo Table 3 C
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98 Elefteriades and Rizzo DISCUSSIO
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100 Milewicz et al. KNOWN GENETIC S
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102 Milewicz et al. Table 2 Quick G
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104 Milewicz et al. ascending aorti
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106 Milewicz et al. Turner syndrome
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108 Milewicz et al. dissection in t
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110 Milewicz et al. Figure 5 Haplot
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112 Milewicz et al. A genome wide s
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114 Milewicz et al. Structural anal
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116 Milewicz et al. assembly of a h
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118 Milewicz et al. in the nuclei o
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120 Milewicz et al. 22. Furlong J,
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122 Milewicz et al. DISCUSSION AND
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124 Milewicz et al. Figure A Distri
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126 Elefteriades and Koullias Figur
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128 Elefteriades and Koullias prope
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8 Matrix Metalloproteinases in Aort
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Matrix Metalloproteinases in Aortic
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Page 168 and 169: Matrix Metalloproteinases in Aortic
Page 176 and 177: INTRODUCTION 9 Inflammation and Rem
Page 178 and 179: Inflammation and Remodeling in the
Page 190 and 191: 10 Weight Lifting and Aortic Dissec
Page 192 and 193: Weight Lifting and Aortic Dissectio
Page 198 and 199: 11 Timing of Acute Aortic Events: H
Page 200 and 201: Timing of Acute Aortic Events 171 F
Page 202 and 203: SECTION IV: TREATMENT OF ACUTE AORT
Page 204 and 205: Natural History of Thoracic Aortic
Page 232: Natural History of Thoracic Aortic
Page 235 and 236: 206 Shahriari and Farkas properties
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Page 239 and 240: 210 Shahriari and Farkas Less than
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Page 243 and 244: 214 Shahriari and Farkas Figure 6 A
Page 245 and 246: 216 Shahriari and Farkas (68). Many
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Page 249 and 250: 220 Shahriari and Farkas fistula is
Page 251 and 252: 222 Shahriari and Farkas MEGS is de
Page 253 and 254: 224 Shahriari and Farkas 26. Svenss
Page 255 and 256: 226 Shahriari and Farkas 63. Fehren
Page 258 and 259: 14 Acute Aortic Dissection: Anti-im
Page 260 and 261: Acute Aortic Dissection 231 lamella
Page 262 and 263: Acute Aortic Dissection 233 P t is
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Page 266 and 267: Acute Aortic Dissection 237 Figure
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Acute Aortic Dissection 239 concern
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Acute Aortic Dissection 241 Table 2
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Acute Aortic Dissection 243 dissect
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Acute Aortic Dissection 245 22. Bax
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Acute Aortic Dissection 247 62. Lin
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Acute Aortic Dissection 249 DISSCUS
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252 Elefteriades and Griepp ACUTE A
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254 Elefteriades and Griepp Figure
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256 Elefteriades and Griepp sometim
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262 Elefteriades and Griepp to a se
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264 Elefteriades and Griepp Natural
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266 Elefteriades and Griepp CONCLUS
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268 Elefteriades and Griepp DISCUSS
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270 Brinster et al. thoracic aneury
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272 Brinster et al. Figure 1 Retrop
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274 Brinster et al. artery. Z3 land
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276 Brinster et al. or ischemia of
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278 Brinster et al. registry arm (2
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280 Brinster et al. Table 3 Early P
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282 Brinster et al. According to th
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284 Brinster et al. ranged from 1 t
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Table 4 Meta-Analysis of Tevar for
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288 Brinster et al. conventional op
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290 Brinster et al. using no (or lo
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292 Brinster et al. Table 5 Risk Fa
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294 Brinster et al. wire manipulati
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296 Brinster et al. Thoracoabdomina
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298 Brinster et al. 25. Hagan PG, N
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300 Brinster et al. 60. Elefteriade
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302 Brinster et al. 98. Liu ZG, Sun
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304 Brinster et al. 131. Szeto WY,
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306 Brinster et al. 100% 90% 80% 70
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308 Brinster et al. ● “Long-ter
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310 Hackmann et al. treatment. New
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312 Hackmann et al. tissue than in
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314 Hackmann et al. Table 1 Pharmac
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316 Hackmann et al. Some anti-hyper
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318 Hackmann et al. inhibits NF-κB
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320 Hackmann et al. Patients with C
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322 Hackmann et al. ACKNOWLEDGMENTS
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324 Hackmann et al. 34. Thompson RW
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326 Hackmann et al. 70. LeMaire SA,
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328 Hackmann et al. 105. Marra DE,
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330 Hackmann et al. DISCUSSION AND
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332 Elefteriades Diseases of the th
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334 Elefteriades Table 1 Individual
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336 Elefteriades Table 1 Individual
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338 Elefteriades Failure to Diagnos
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340 Elefteriades of physicians on t
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342 Elefteriades Figure 3 Computed
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344 Elefteriades reviewed over the
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346 Elefteriades DISCUSSION AND COM
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348 Elefteriades Figure 1 (See colo
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350 Elefteriades that are the subje
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SECTION VII: SYNTHESIS 20 The Key L
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The Key Lessons of This Book—In a
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362 Index Aging, aortic aneurysms a
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364 Index Cytokines, aortic aneurys
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366 Index Pathoanatomy classificati
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368 Index [Thoracic aortic aneurysm
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Figure 1.C Note from schematic depi
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Figure 8.1 Dramatic clinical exampl
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Figure 11.2 Proposed schema for the
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Figure 19.1 Future prospects in car
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