Acute Aortic Disease.. - Index of

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Natural History of Thoracic Aortic Aneurysms 201 Wall stress (kPa) 1000 800 600 400 200 0 Normals < 4cm 4.1-5cm 5.1-6cm > 6 cm aortic diameter(cm) Figure F Impact of increasing diameter on aortic wall stress. Dark bars indicate stress at an ambient blood pressure of 100 mmHg systolic; light bars, an ambient blood pressure of 200 mmHg. The dotted line represents the known ultimate tensile strength (breaking point) of aortic tissue. For enlarged aortas, in a hypertensive situation, the wall stress approaches or exceeds the ultimate tensile strength of the aortic tissue; it is no wonder, then, that rupture or dissection occur at these dimensions. Figure G (See color insert) A large thoracoabdominal aortic aneurysm. The head is to the top and the feet to the bottom of the picture. The chest and abdomen have been opened widely, revealing a large, extensive aneurysm of the thoracoabdominal aorta. A soda can is about 6 cm in diameter. If a patient’s aorta is approaching this dimension, the aorta should be extirpated surgically to prevent rupture or dissection.
202 Coady and Elefteriades There is theoretical and limited clinical evidence that statin drugs, above and beyond their lipid-lowering properties, have a beneficial effect on the aortic wall, suppressing inflammation. It is possible that these drugs may have a role in the treatment of thoracic aortic aneurysm. Further studies are warranted. We and others have demonstrated a role for matrix metalloproteinases (MMPs) in the pathogenesis of thoracic aortic aneurysm (7,8). It is clear that MMP expression is elevated in patients with thoracic aortic aneurysm and dissection, and that some of the tissue inhibitors of MMPs (TIMPs) are not upregulated, in patients with thoracic aortic aneurysm. This raises the possibility of applying drugs that inhibit MMPs in the treatment of thoracic aortic aneurysms. Doxycycline is an antibiotic that is used very widely in the treatment of gingivitis. Preliminary studies of doxycycline in randomized trials for abdominal aortic aneurysm have been equivocal. Many inhibitors of specific MMPs are in the drug pipelines at several manufacturers. All of these promising avenues will be explored in the next decade. There is hope for viable medical treatments for thoracic aortic aneurysm, which may delay or preclude aortic expansion, rupture, and dissection. At this time, no medications can be said to be of proven benefit. References 1. Shores J, Berger K, Murphy EA, Pyeritz PE. Progression of aortic dilatation and the benefit of long-term beta-adrenergic blockade in Marfan’s syndrome. N Engl J Med 1994; 330:1335–1341. 2. Fuster V, Andrews P. Medical treatment of the aorta I. Cardiol Clin 1999; 17:697–715. 3. Propanolol Aneurysm Trial Investigators. Propanolol for small abdominal aortic aneurysms: results of a randomized trial. J Vasc Surg 2002; 35:72–79. 4. Lindholt JS, Henneberg EW, Juul S, Fasting H. Impaired results of a randomized double blinded clinical trial of propranolol versus placebo on the expansion rate of small abdominal aortic aneurysm. Int Angiol 1999; 18:52–57. 5. Habashi JP, Judge DP, Holm TM, et al. Losartan, an AT1 antagonist, prevents aortic aneurysm in a mouse model of Marfan syndrome. Science 2006; 312:117–121. 6. Liao S, Miralles M, Kelley BJ, Curci JA, Borhani M, Thompson RW. Suppression of experimental abdominal aortic aneurysms in the rat by treatment with angiotensinconverting enzyme inhibitors. J Vasc Surg 2001; 33:1057–1064. 7. Koullias GJ, Ravichandran P, Korkolis DP, Rimm DL, Elefteriades JA. Increased tissue microarray matrix metalloproteinase expression favors proteolysis in thoracic aortic aneurysms and dissections. Ann Thorac Surg 2004; 78:2106–2110. 8. Koullias GJ, Korkolis DP, Ravichandran P, Psyrri A, Hatzaras I, Elefteriades JA. Tissue microarray detection of matrix metalloproteinases in diseased tricuspid and bicuspid aortic valves with or without pathology of the ascending aorta. Eur J Cardiothorac Surg 2004; 26:1098–2003. Many cardiac specialists are aware of individual patients who have suffered dissection of the aorta at a relatively small dimension, in the range of 4 cm. These patients would not be selected for surgery based on the criteria enumerated in this chapter. What response do the authors have to this point?
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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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INTRODUCTION 9 Inflammation and Rem
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Inflammation and Remodeling in the
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Page 190 and 191: 10 Weight Lifting and Aortic Dissec
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Page 202 and 203: SECTION IV: TREATMENT OF ACUTE AORT
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Page 278: 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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