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Aortic dissection, a critical cardiovascular condition with life-threatening implications, is distinguished by the development of a tear and its propagation within the aortic wall. A thorough understanding of the initiation and progression of these tears, or cracks, is essential for accurate diagnosis and effective treatment. This paper undertakes a fracture mechanics approach to delve into the mechanics of tear propagation in aortic dissection. Our objective is to elucidate the impact of geometric and material parameters, providing valuable insights into the determinants of this pivotal cardiovascular event. Through our investigation, we have gained an understanding of how various parameters influence the energy release rate for tear propagation in both longitudinal and circumferential directions, aligning our findings with clinical data.

This study compared the prognostic value of quantified thoracic artery calcium (TAC) including aortic arch on chest CT and coronary artery calcium (CAC) score on ECG-gated cardiac CT.MethodsA total of 2412 participants who underwent both chest CT and ECG-gated cardiac CT at the same period were included in the Multi-Ethnic Study of Atherosclerosis Exam 5. All participants were monitored for incident atherosclerotic cardiovascular disease (ASCVD) events. TAC is defined as calcification in the ascending aorta, aortic arch and descending aorta on chest CT. The quantification of TAC was measured using the Agatston method. Time-dependent receiver-operating characteristic (ROC) curves were used to compare the prognostic value of TAC and CAC scores.ResultsParticipants were 69±9 years of age and 47% were male. The Spearman correlation between TAC and CAC scores was 0.46 (p

Exercise promotes pulsatile shear stress in the arterial circulation and ameliorates cardiometabolic diseases. However, exercise-mediated metabolic transducers for vascular protection remain under-investigated. Untargeted metabolomic analysis demonstrated that wild-type mice undergoing voluntary wheel running exercise expressed increased endothelial stearoyl-CoA desaturase 1 (SCD1) that catalyzes anti-inflammatory lipid metabolites, namely, oleic (OA) and palmitoleic acids (PA), to mitigate NF-κB-mediated inflammatory responses. In silico analysis revealed that exercise augmented time-averaged wall shear stress but mitigated flow recirculation and oscillatory shear index in the lesser curvature of the mouse aortic arch. Following exercise, endothelial Scd1-deleted mice (Ldlr-/- Scd1EC-/-) on high-fat diet developed persistent VCAM1-positive endothelium in the lesser curvature and the descending aorta, whereas SCD1 overexpression via adenovirus transfection mitigated endoplasmic reticulum stress and inflammatory biomarkers. Single-cell transcriptomics of the aorta identified Scd1-positive and Vcam1-negative endothelial subclusters interacting with other candidate genes. Thus, exercise mitigates flow recirculation and activates endothelial SCD1 to catalyze OA and PA for vascular endothelial protection.

Endothelial cells of mammalian blood vessels have multiple levels of heterogeneity along the vascular tree and among different organs. Further heterogeneity results from blood flow turbulence and variations in shear stress. In the aorta, vascular endothelial protein tyrosine phosphatase (VE-PTP), which dephosphorylates tyrosine kinase receptor Tie2 in the plasma membrane, undergoes downstream polarization and endocytosis in endothelial cells exposed to laminar flow and high shear stress. VE-PTP sequestration promotes Tie2 phosphorylation at tyrosine992 and endothelial barrier tightening. The present study characterized the heterogeneity of VE-PTP polarization, Tie2-pY992 and total Tie2, and claudin-5 in anatomically defined regions of endothelial cells in the mouse descending thoracic aorta, where laminar flow is variable and IgG extravasation is patchy. We discovered that VE-PTP and Tie2-pY992 had mosaic patterns, unlike the uniform distribution of total Tie2. Claudin-5 at tight junctions also had a mosaic pattern, whereas VE-cadherin at adherens junctions bordered all endothelial cells. Importantly, the amounts of Tie2-pY992 and claudin-5 in aortic endothelial cells correlated with downstream polarization of VE-PTP. VE-PTP and Tie2-pY992 also had mosaic patterns in the vena cava, but claudin-5 was nearly absent and extravasated IgG was ubiquitous. Correlation of Tie2-pY992 and claudin-5 with VE-PTP polarization supports their collective interaction in the regulation of endothelial barrier function in the aorta, yet differences between the aorta and vena cava indicate additional flow-related determinants of permeability. Together, the results highlight new levels of endothelial cell functional mosaicism in the aorta and vena cava, where blood flow dynamics are well known to be heterogeneous.

Background and Aims This study assessed whether a model incorporating clinical features and a polygenic score for ascending aortic diameter would improve diameter estimation and prediction of adverse thoracic aortic events over clinical features alone. Methods Aortic diameter estimation models were built with a 1.1 million-variant polygenic score (AORTA Gene) and without it. Models were validated internally in 4394 UK Biobank participants and externally in 5469 individuals from Mass General Brigham (MGB) Biobank, 1298 from the Framingham Heart Study (FHS), and 610 from All of Us. Model fit for adverse thoracic aortic events was compared in 401 453 UK Biobank and 164 789 All of Us participants. Results AORTA Gene explained more of the variance in thoracic aortic diameter compared to clinical factors alone: 39.5% (95% confidence interval 37.3%–41.8%) vs. 29.3% (27.0%–31.5%) in UK Biobank, 36.5% (34.4%–38.5%) vs. 32.5% (30.4%–34.5%) in MGB, 41.8% (37.7%–45.9%) vs. 33.0% (28.9%–37.2%) in FHS, and 34.9% (28.8%–41.0%) vs. 28.9% (22.9%–35.0%) in All of Us. AORTA Gene had a greater area under the receiver operating characteristic curve for identifying diameter ≥ 4 cm: 0.836 vs. 0.776 (P <.0001) in UK Biobank, 0.808 vs. 0.767 in MGB (P <.0001), 0.856 vs. 0.818 in FHS (P <.0001), and 0.827 vs. 0.791 (P =.0078) in All of Us. AORTA Gene was more informative for adverse thoracic aortic events in UK Biobank (P =.0042) and All of Us (P =.049). Conclusions A comprehensive model incorporating polygenic information and clinical risk factors explained 34.9%–41.8% of the variation in ascending aortic diameter, improving the identification of ascending aortic dilation and adverse thoracic aortic events compared to clinical risk factors. [ABSTRACT FROM AUTHOR]

Background: Understanding the distinct anatomical differences between patients with type B aortic dissection (TBAD) and control patients (CPs) can enhance our knowledge of normal and pathological aortic dimensions. This study aimed to deepen our knowledge of these dimensions by measuring and comparing the anatomical indices of the aortic arch in male patients with TBAD and non-TBAD male patients. Methods: In this cross-sectional observational study, 62 TBAD patients (TBADPs) and 43 CPs were assessed. Using a fit centerline approach, we identified three pivotal anatomical landmarks: Point A, Point B, and Point C. These landmarks represented intersections of the aortic arch with the brachiocephalic trunk, left common carotid artery, and left subclavian artery, respectively. These points defined Zones 1, 2, and 3, which collectively span the entire proximal aorta from the proximal end of the aortic valve to Point C. Our analyses compared key anatomical indices such as diameter of the circumscribed circle (Dcirc), ellipticity, curvature, tortuosity between TBADP and CP at critical points and regions. Results: TBADPs showed a more circular cross-sectional shape at Points A, B and C, as indicated by reduced values of Dcirc_A (P = 0.031), ellipticity_A (P = 0.034) and ellipticity_B (P = 0.048), together with a significant decrease in Dcirc_C (P = 0.015) and ellipticity_C (P = 0.007). The aortic arch in TBADPs showed enhanced tortuosity in Zone 1 (p = 0.002) and extended elongation in Zone 3 (p = 0.001). Conclusions: The study found that the aortic arch in male TBAD patients is more circular near its primary branches, has greater tortuosity in Zone 1, and is longer in Zone 3 compared to male control patients. [ABSTRACT FROM AUTHOR]

Acquired pulmonary artery branch stenosis without main pulmonary artery involvement due to external compression by neoplasia has been described in human and veterinary medicine. Over time, this can result in right ventricular hypertension and right-sided heart failure. Endovascular stenting offers quick relief from signs, while the underlying cause is addressed. Here, we present a dog with severe right pulmonary artery compression caused by a chemodectoma, which was treated with two, overlapping, self-expanding vascular stents and chemotherapy. The patient experienced immediate symptomatic relief, progressive stent expansion over time, and has been free of clinical symptoms for 5 months post implantation. [ABSTRACT FROM AUTHOR]

Objective Discuss the application methods and effects of closed femoro - femoral partial bypass (C-FPB) in thoracoabdominal aortic replacement (TAAAR) surgery. Methods A retrospective analysis of the clinical data of 70 cases of TAAAR assisted by C-FPB from April 2021 to May 2023, some of which combined with abdominal organ perfusion. The main evaluation indicators were in-hospital mortality, postoperative stroke, postop¬erative spinal cord injury, and the incidence of hemodialysis. Based on an open-type conventional Cardiopulmonary bypass (CPB) circuit, the venous tubing was split with a 10 x 10 x 10 mm "Y" connector directly connected to the inlet of the centrifugal pump, and the tubing after the roller pump was connected to the outlet of the centrifugal pump, while the front of the membrane oxygenator with another 10 x 10 x 10 mm "Y" connector to establish a closed femoro-femoral bypass. During bypass, the lower body is perfused by the centrifugal pump, while the upper body is perfused by the roller pump. Results No system failures happen in all cases. The average bypass time was (101.0 ± 22.2) minutes, the average time for intercostal artery reconstruction was (18.6 ± 5.4) minutes, with an average of (4.7 ± 1.8) pairs. The average length of stay in the ICU was (5.1 ± 1.5) days, and the average length of hospital stay was (34.4 ± 12.5) days. 2 cases (2.9%) experienced postoperative stroke, 1 case (1.4%) resulted in in-hospital mortality, 2 cases (2.9%) experienced postoperative paraplegia, 7 cases (10.0%) underwent postoperative hemodialysis, and 3 cases (4.3%) experienced prolonged mechanical ventilation. Conclusion The Closed-type femoro-femoral partial bypass takes the whole surgical process into account, reduces the management difficulty for perfusionist, and provides a unique advantage for distal perfusion during thoracoabdominal aortic replacement surgery. [ABSTRACT FROM AUTHOR]

The 'shark-fin' ECG-sign is a rare electrocardiographic pattern seen in ACS, typically associated with poor prognosis. However, its manifestation in acute aortic syndromes remains largely unexplored. Here, we present a case of a patient diagnosed with Ascending Aortic Dissection, who presented to ED with acute chest pain and shark-fin ECG-pattern. [ABSTRACT FROM AUTHOR]

Background: The Oxidative Balance Score (OBS) was created to evaluate an individual's overall antioxidant status. The objective of this study was to examine the association between OBS and abdominal aortic calcification (AAC) among individuals aged ≥ 40 years. Methods: This population-based cross-sectional study used data from the National Health and Nutrition Examination Survey in 2013–2014 and included adults aged ≥ 40 years. Survey-weighted multivariable logistic and restricted cubic spline models were used to assess the association between OBS and AAC. Results: Among 2520 participants, 744 were diagnosed with AAC (weighted percentage, 28.13%). Survey-weighted multivariable logistic revealed an inverse association between OBS and AAC [0.98 (0.96, 1.00)], and the nonlinear dose-response relationship was observed. Subgroup analysis and interaction tests revealed that this inverse relationship was consistent across different populations (all P for interaction > 0.05). Conclusions: OBS was inversely associated with the prevalence of AAC among individuals aged ≥ 40 years. Maintaining a higher OBS may be beneficial in reducing the burden of AAC. [ABSTRACT FROM AUTHOR]

Although mechanical thrombectomy for acute ischemic stroke has a high recanalization rate, procedurally challenging lesions remain in approximately 10% of the cases. Type III aortic arches, due to their anatomical configuration, are a fundamental problem impacting this procedure. This study aimed to determine whether optimal catheter selection for type III aortic arches, using magnetic resonance angiography (MRA)-based road mapping of the para-aortic transfemoral access route, reduces the time required for mechanical thrombectomy. We retrospectively evaluated 203 consecutive patients who underwent mechanical thrombectomy at multiple centers between April 2018 and July 2022. 23 patients were diagnosed with a type III aortic arch using MRA-based road mapping performed to visualize the para-aortic access route before neuro-interventional procedures. Among the 23 patients with type III aortic arches, 10 received a Simmons-type catheter (initial Simmons group) and 13 received a JB-2-type catheter (initial JB-2 group) as their first inner catheter. The time required for mechanical thrombectomy was compared between the groups. Compared with the initial JB-2 group, the initial Simmons group exhibited a significantly shorter "puncture-to-recanalization time" (105 vs. 53 minutes, P = 0.009) and "door-to-recanalization time" (164 vs. 129 minutes, P = 0.032). Optimal catheter selection by identifying the aortic arch before mechanical thrombectomy using MRA-based road mapping effectively reduced the mechanical thrombectomy time. This suggests that even in type III aorta cases, appropriate catheter selection may shorten the mechanical thrombectomy time and improve acute ischemic stroke prognosis. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate the two-year outcomes of covered endovascular reconstruction (CERAB) of the aortic bifurcation in patients with complex aortoiliac occlusive dis ease. Methods: This study was prospectively initiated, with data retrospectively collected from 40 patients categorized as TASC II B, C, and D based on computed tomography angiography (CTA) findings. All patients underwent the CERAB procedure. We assessed the procedural outcomes, including clinical and symptomatic improvements, as well as patency rates over a two-year follow-up period. Results: A total of 40 patients (33 males and 7 females) with aorto-occlusive disease were treated using the CERAB procedure and included in this observational study. The technical success rate was 100% across all procedures. At 36 months, the overall primary patency, assisted primary patency, and secondary patency rates were 85%, 90%, and 92.5%, respectively. Conclusions: The two-year results of this study suggest that CERAB offers patency rates comparable to those reported in other studies for complex aorto-occlusive bifurcation diseases. The procedure showed favorable patency rates, particularly for more advanced TASC II B, C, and D lesions. [ABSTRACT FROM AUTHOR]

While point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) is broadly perceived as having value in intravascular volume status assessment, this has not been borne out in large-scale meta-analyses containing heterogenous populations of acutely ill patients. While the limitations of IVC POCUS could be largely due to the complexity of the relationship between IVC appearance and volume status, another confounder not widely appreciated is the ease with which the aorta or right hepatic vein (RHV) can be mistaken for the IVC. While misidentification of the aorta as the IVC has been recognized elsewhere, misidentification of the RHV for the IVC has not and, in our experience, occurs frequently, even in the hands of experienced sonographers. We demonstrate how these errors occur and provide guidance on how to systematically avoid them. [ABSTRACT FROM AUTHOR]

Circulating biomarkers have been proposed for early identification of aortic dilatation progression associated with bicuspid aortic valve (BAV), but matrix metalloproteinases (MMPs) are distinguished as signatures of increased extracellular matrix degradation, a landmark of aneurysm formation. The current study aims to identify the role of MMP-1, MMP-2, MMP-9, and the MMP inhibitor, TIMP-1, in identifying aortic dilation in children with BAV. We conducted a study on 73 children divided into two study groups, depending on the presence of aortic dilatation (group 1–43 BAV controls and group 2–30 children with BAV and aortic dilatation). Each patient underwent a cardiac ultrasound and, in each case, serum MMP-1, MMP-2, MMP-9, and TIMP-1 were quantified using xMAP technology. Comparison of the MMPs between the two study groups revealed significantly higher values only in the case of TIMP-1, among BAV controls. Moreover, the same TIMP-1 inversely correlated with aortic annulus absolute size and z score, as well as with ascending aorta z score. No particular correlation between the aortic phenotype and the presence of aortic dilatation was found. Future longitudinal research starting at pediatric ages could show the significance of MMPs screening in BAV individuals as predictors of aortic aneurysm formation. [ABSTRACT FROM AUTHOR]

Objectives Our aim was to introduce a standardized system for assessing the extent of GCA on MRI, i.e. the Magnetic Resonance Vasculitis Activity Score (MRVAS). To obtain a comprehensive view, we used an extensive MRI protocol including cranial vessels and the aorta with its branches. To test reliability, MRI was assessed by four readers with different levels of experience. Methods A total of 80 patients with suspected GCA underwent MRI of the cranial arteries and the aorta and its branches (20 vessel segments). Every vessel was rated dichotomous [inflamed (coded as 1) or not (coded as 0)], providing a summed score of 0–20. Blinded readers [two experienced radiologists (ExR) and two inexperienced radiologists (InR)] applied the MRVAS on an individual vessel and an overall level (defined as the highest score of any of the individual vessel scores). To determine interrater agreement, Cohen's κ was calculated for pairwise comparison of each reader for individual vessel segments. Intraclass correlation coefficients (ICCs) were used for the MRVAS. Results Concordance rates were excellent for both subcohorts on an individual vessel-based (GCA: ICC 0.95; non-GCA: ICC 0.96) and overall MRVAS level (GCA: ICC 0.96; non-GCA: ICC 1.0). Interrater agreement yielded significant concordance (P  < 0.001) for all pairs (κ range 0.78–0.98). No significant differences between ExRs and InRs were observed (P  = 0.38). Conclusion The proposed MRVAS allows standardized scoring of inflammation in GCA and achieved high agreement rates in a prospective setting. [ABSTRACT FROM AUTHOR]

Background: Aortic wrapping (AW) has been performed as a less invasive alternative to aortoplasty. However, AW can also cause long-term aortic complications. In this report, we present a rare case of a dissecting aortic aneurysm between the proximal side of the wrap and the sinotubular junction after AW. Case presentation: A female patient had undergone urgent aortic valve replacement with a 19-mm mechanical valve to treat infective endocarditis and AW to treat an enlarged ascending aorta 26 years prior. At the age of 71 years, the patient was diagnosed with a dissecting aortic aneurysm between the proximal side of the wrap and the sinotubular junction. We performed graft replacement of the ascending aorta, including complete resection of the wrap. The patient was discharged on postoperative day 10, and there have been no cardiovascular events during her ongoing follow up. Conclusions: AW in younger patients can lead to late aortic complications. Careful consideration should be paid when performing AW in young patients, and patients who have previously undergone AW require strict life-long follow-up. [ABSTRACT FROM AUTHOR]

Stereotactic ablative body radiotherapy (SABR) is increasingly used for early-stage lung cancer, however the impact of dose to the heart and cardiac substructures remains largely unknown. The study investigated doses received by cardiac substructures in SABR patients and impact on survival. SSBROC is an Australian multi-centre phase II prospective study of SABR for stage I non-small cell lung cancer. Patients were treated between 2013 and 2019 across 9 centres. In this secondary analysis of the dataset, a previously published and locally developed open-source hybrid deep learning cardiac substructure automatic segmentation tool was deployed on the planning CTs of 117 trial patients. Physical doses to 18 cardiac structures and EQD2 converted doses (α/β = 3) were calculated. Endpoints evaluated include pericardial effusion and overall survival. Associations between cardiac doses and survival were analysed with the Kaplan–Meier method and Cox proportional hazards models. Cardiac structures that received the highest physical mean doses were superior vena cava (22.5 Gy) and sinoatrial node (18.3 Gy). The highest physical maximum dose was received by the heart (51.7 Gy) and right atrium (45.3 Gy). Three patients developed grade 2, and one grade 3 pericardial effusion. The cohort receiving higher than median mean heart dose (MHD) had poorer survival compared to those who received below median MHD (p = 0.00004). On multivariable Cox analysis, male gender and maximum dose to ascending aorta were significant for worse survival. Patients treated with lung SABR may receive high doses to cardiac substructures. Dichotomising the patients according to median mean heart dose showed a clear difference in survival. On multivariable analyses gender and dose to ascending aorta were significant for survival, however cardiac substructure dosimetry and outcomes should be further explored in larger studies. • Eighteen cardiac structure automatic segmentation tool deployed on planning datasets. • Data from phase II multicentre trial of stereotactic lung radiotherapy. • Dichotomising patients according to mean heart dose showed a difference in survival. • Gender and maximum dose to ascending aorta were significant on multivariable analysis. [ABSTRACT FROM AUTHOR]

Background: Epinephrine (EPI) or norepinephrine (NOR) is widely used to treat cardiovascular collapse during lipid emulsion (LE) resuscitation for drug toxicity. However, the effect of LE on the vasoconstriction caused by EPI or NOR remains unknown. The purpose of this study was to examine the effect of an LE (Intralipid) on the vasoconstriction caused by EPI and NOR in isolated rat aorta. Methods: The effect of LE on the vasoconstriction caused by EPI or NOR in isolated rat aorta was examined. Additionally, the effect of LE on the calcium increase caused by EPI or NOR was investigated. The distribution constant (KD: lipid to aqueous phase) of EPI or NOR between a LE (1%) and an aqueous phase was determined. Results: LE (1 and 2%) did not significantly alter vasoconstriction caused by EPI or NOR in isolated endothelium-intact aorta. Moreover, the LE did not significantly alter the increased calcium level caused by EPI or NOR. The log KD of EPI in the LE (1%) was -0.71, -0.99, and -1.00 at 20, 50, and 100 mM ionic strength, respectively. The log KD of NOR in the LE (1%) was -1.22, -1.25, and -0.96 at 20, 50, and 100 mM ionic strength, respectively. Conclusions: Taken together, the Intralipid emulsion did not alter vasoconstriction induced by EPI or NOR that seems to be due to the hydrophilicity of EPI or NOR, leading to sustained hemodynamic support produced by EPI or NOR used during LE resuscitation. [ABSTRACT FROM AUTHOR]

In individuals with Turner syndrome, the risk of death from aortic dissection or rupture during pregnancy may be as high as 1%, and it is unclear whether this risk persists during the postpartum period owing to pregnancy-related aortic changes. Turner syndrome is a relative contraindication for pregnancy; however, it is an absolute contraindication for pregnancy in a patient with an aortic size index of >2.5 cm/m2 or an aortic size index of ≥2.0 cm/m2 with a documented cardiac anomaly or other risk factors. This document replaces the 2012 document of the same name. [ABSTRACT FROM AUTHOR]

Neurological complexities resulting from surgery requiring cardiopulmonary bypass (CPB) remain a major concern, encompassing a spectrum of complications including thromboembolic stroke and various cognitive impairments. Surgical manipulation during CPB is considered the primary cause of these neurological complications. This study addresses the overall lack of knowledge concerning CPB hemodynamics within the aorta, employing a combined experimental-computational modeling approach, featuring computational fluid dynamics simulations validated with an in vitro CPB flow loop under steady conditions. Parametric studies were systematically performed, varying parameters associated with CPB techniques (pump flow rate and hemodiluted blood viscosity) and properties related to formed emboli (size and density). This represents the first comprehensive investigation into the individual and combined effects of these factors. Our findings reveal critical insights into the operating conditions of CPB, indicating a positive correlation between pump flow rate and emboli transport into the aortic branches, potentially increasing the risk of stroke. It was also found that larger emboli were more often transported into the aortic branches at higher pump flow rates, while smaller emboli preferred lower flow rates. Further, as blood is commonly diluted during CPB to decrease its viscosity, more emboli were found to enter the aortic branches with greater hemodilution. The combined effects of these parameters are captured using the non-dimensional Stokes number, which was found to positively correlate with emboli transport into the aortic branches. These findings contribute to our understanding of embolic stroke risk factors during CPB and shed light on the complex interplay between CPB parameters. [ABSTRACT FROM AUTHOR]

• Ultrasound and d- dimer were integrated for diagnosis of acute aortic syndromes. • The protocol allowed rapid triage for urgent computed tomography angiography. • Protocol based rule-out was safe since no major events were missed within 30 days. • The protocol averted 41 % of computed tomography angiography exams. • Age-adjusted interpretation of d -dimer maximized protocol efficiency. In patients complaining common symptoms such as chest/abdominal/back pain or syncope, acute aortic syndromes (AAS) are rare underlying causes. AAS diagnosis requires urgent advanced aortic imaging (AAI), mostly computed tomography angiography. However, patient selection for AAI poses conflicting risks of misdiagnosis and overtesting. We assessed the safety and efficiency of a diagnostic protocol integrating clinical data with point-of-care ultrasound (POCUS) and d- dimer (single/age-adjusted cutoff), to select patients for AAI. This prospective study involved 12 Emergency Departments from 5 countries. POCUS findings were integrated with a guideline-compliant clinical score, to define the integrated pre-test probability (iPTP) of AAS. If iPTP was high, urgent AAI was requested. If iPTP was low and d -dimer was negative, AAS was ruled out. Patients were followed for 30 days, to adjudicate outcomes. Within 1979 enrolled patients, 176 (9 %) had an AAS. POCUS led to net reclassification improvement of 20 % (24 %/-4 % for events/non-events, P < 0.001) over clinical score alone. Median time to AAS diagnosis was 60 min if POCUS was positive vs 118 if negative (P = 0.042). Within 941 patients satisfying rule-out criteria, the 30-day incidence of AAS was 0 % (95 % CI, 0–0.41 %); without POCUS, 2 AAS were potentially missed. Protocol rule-out efficiency was 48 % (95 % CI, 46–50 %) and AAI was averted in 41 % of patients. Using age-adjusted d -dimer, rule-out efficiency was 54 % (difference 6 %, 95 % CI, 4–9 %, vs standard cutoff). The integrated algorithm allowed rapid triage of high-probability patients, while providing safe and efficient rule-out of AAS. Age-adjusted d -dimer maximized efficiency. CLINICAL TRIAL REGISTRATION: Clinicaltrials.gov, NCT04430400 [Display omitted] [ABSTRACT FROM AUTHOR]

BACKGROUND: The 1.5 mm Baby J hydrophilic narrow J-tipped wire is a development of the standard 0.035” 3-mm J-tipped peripheral guidewire, designed to improve efficiency of transradial coronary procedures by safely navigating small caliber radial arteries to the aorta. There is currently a lack of evidence comparing the procedural success and safety of different peripheral guidewires used in transradial cardiac procedures. We compared the efficacy and safety of a narrow J-tipped hydrophilic 0.035” wire (intervention, Radifocus Baby J guidewire; TERUMO Co, Tokyo, Japan) versus a standard fixed-core 0.035” J wire (control). METHODS: Investigator-initiated, blinded, Australian, multicenter randomized trial in patients undergoing clinically indicated coronary angiography or percutaneous coronary intervention. Patients were randomized 1:1 to use either the control guidewire or the intervention guidewire. The primary end point (technical success) was defined as gaining aortic root access with the randomized guidewire. RESULTS: In all, 330 patients were randomized between October 2022 and June 2023 (median age was 69 years, 36% were female, and body mass index was 29 kg/m²). The primary end point was achieved more frequently in the intervention group (96% versus 84%; absolute risk reduction 12% [95% CI, 5.7–18.3]; P<0.001). Women assigned to the control wire experienced a higher failure rate compared with men (31% versus 8% in men; P<0.001). Fluoroscopy time was significantly lower in the Baby J group (median, 344 versus 491 seconds; P=0.024). The main mechanisms of failure using the control wire were radial artery spasm (15/26; 57%) and subclavian tortuosity (5/26; 19.2%). There were no differences in overall procedure times, major adverse cardiovascular events, or vascular complications between guidewires. CONCLUSIONS: A narrow 1.5 mm J-tipped hydrophilic guidewire resulted in greater technical success and reduced fluoroscopy time compared with the standard 3-mm J-tipped nonhydrophilic guidewire. The guidewire is safe and demonstrated key incremental benefits for the transradial approach, particularly in women. [ABSTRACT FROM AUTHOR]

(1) Background and Objectives: Flow assessment using cardiovascular magnetic resonance (CMR) provides important implications in determining physiologic parameters and clinically important markers. However, post-processing of CMR images remains labor- and time-intensive. This study aims to assess the validity and repeatability of fully automated segmentation of phase contrast velocity-encoded aortic root plane. (2) Materials and Methods: Aortic root images from 125 patients are segmented by artificial intelligence (AI), developed using convolutional neural networks and trained with a multicentre cohort of 160 subjects. Derived simple flow indices (forward and backward flow, systolic flow and velocity) and complex indices (aortic maximum area, systolic flow reversal ratio, flow displacement, and its angle change) were compared with those derived from manual contours. (3) Results: AI-derived simple flow indices yielded excellent repeatability compared to human segmentation (p < 0.001), with an insignificant level of bias. Complex flow indices feature good to excellent repeatability (p < 0.001), with insignificant levels of bias except flow displacement angle change and systolic retrograde flow yielding significant levels of bias (p < 0.001 and p < 0.05, respectively). (4) Conclusions: Automated flow quantification using aortic root images is comparable to human segmentation and has good to excellent repeatability. However, flow helicity and systolic retrograde flow are associated with a significant level of bias. Overall, all parameters show clinical repeatability. [ABSTRACT FROM AUTHOR]

Objectives: The presence of a mechanical aortic valve has been a contraindication to the use of an arch branch aortic endograft due to the risk of damaging the valve, resulting in acute aortic regurgitation, or a trapped endograft. Methods: We present a 67-year-old woman, with a background of Marfan's syndrome and a previous Bentall's procedure, who presented with a symptomatic enlarging aortic arch and descending thoracic aortic aneurysm, with a type 1A endoleak. Results: Using an inner branch arch endograft (Cook Medical, Bloomington, Indiana), the nose cone of the delivery system was passed laterally through the semi-circular aperture of the mechanical aortic valve to facilitate deployment just distal to the coronary buttons. Conclusions: With advancement of endovascular technology, techniques and experience, endovascular aortic arch repair in the presence of a mechanical aortic valve is feasible. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) has emerged as a pervasive source of illness and a prominent factor in death rates throughout the majority of nations. Atherosclerosis has been identified as the primary cause of this global health concern. Methods: 150 cases older than 30 years were subjected to medicolegal autopsy in the Department of Forensic Medicine, Government Medical College, Kannur. During a medicolegal autopsy, while dissecting the aorta, coronary arteries and cerebral arteries; gross macroscopic changes brought on by atherosclerosis were examined and documented. Results: The study group consisted primarily of males (62.7%) with an average age of 46.90±16.34 years. Nearly half of them were in their fourth and fifth decades of life. A total of 67 instances were diagnosed with atherosclerosis, with 22 of them falling within the age range of 40 to 49 years. 79 percent of these incidents involved males. Conclusion: Atherosclerosis is becoming increasingly recognized as the primary cause of around one-third of all fatalities in India. Conducting a study on atherosclerosis in living individuals is challenging, as it requires invasive and costly procedures. This is particularly true in underdeveloped nations. Therefore, autopsies are crucial for documenting the occurrence of atherosclerosis in the population. This study will assist doctors in evaluating the overall arterial health of patients and developing therapeutic protocols and courses of treatment. Additionally, it will aid forensic pathologists in determining the cause of death in cases of sudden death. [ABSTRACT FROM AUTHOR]

Aims Increasing aortic dilation increases the risk of aortic dissection. Nevertheless, dissection occurs at dimensions below guideline-directed cut-offs for prophylactic surgery. Currently, there are no large-scale population imaging data assessing aortic dimensions before dissection. Methods and results Patients within the National Echo Database of Australia were stratified according to absolute, height-indexed, and body surface area (BSA)-indexed aortic dimensions. Fatal thoracic aortic dissections (ICD-10-AM Code I71) were identified via linkage with the National Death Index. A total of 524 994 individuals were assessed, comprising patients with normal aortic dimensions (n = 460 992), mild dilation (n = 53 402), moderate dilation (n = 10 029), and severe dilation (n = 572). A total of 274 992 (52.4%) were males, with a median age of 64 years and a median follow-up time of 6.9 years. Eight hundred and ninety-nine fatal aortic dissections occurred (normal diameter = 610, mildly dilated aorta = 215, moderately dilated = 53, and severely dilated = 21). Using normal aortas as the reference population, odds of fatal dissection increased with aortic diameter [mild = odds ratio (OR) 3.05, 95% confidence interval (CI) 2.61–3.56; moderate = OR 4.0, 95% CI 3.02–5.30; severe = OR 28.72, 95% CI 18.44–44.72]. Due to the much larger number of patients without severe aortic dilation, 97.7% of fatal aortic dissections occurred in non-severely dilated aortas. Following sensitivity analysis, severe aortic dilation was responsible for at most 24.4% of fatal aortic dissections. The results were robust for absolute, height-indexed, or BSA-indexed aortic measurements. Conclusion Although severe aortic dilatation is associated with a near-30-fold increase in fatal dissections, severely dilated aortas are implicated in only 2.3–24.4% of fatal dissections. This highlights the 'aortic paradox' and limitations of current guidelines. Future studies should seek to refine risk predictors in patients without severe aortic dilation. [ABSTRACT FROM AUTHOR]

Aims Understanding the mechanisms underlying ascending aortic dilation is imperative for refined risk stratification of these patients, particularly among incidentally identified patients, most commonly presenting with tricuspid valves. The aim of this study was to explore associations between ascending aortic haemodynamics, assessed using four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR), and circulating biomarkers in aortic dilation. Methods and results Forty-seven cases with aortic dilation (diameter ≥ 40 mm) and 50 sex-and age-matched controls (diameter < 40 mm), all with tricuspid aortic valves, underwent 4D flow CMR and venous blood sampling. Associations between flow displacement, wall shear stress (WSS), and oscillatory shear index in the ascending aorta derived from 4D flow CMR, and biomarkers including interleukin-6, collagen type I α1 chain, metalloproteinases (MMPs), and inhibitors of MMPs derived from blood plasma, were investigated. Cases with dilation exhibited lower peak systolic WSS, higher flow displacement, and higher mean oscillatory shear index compared with controls without dilation. No significant differences in biomarkers were observed between the groups. Correlations between haemodynamics and biomarkers were observed, particularly between maximum time-averaged WSS and interleukin-6 (r = 0.539, P < 0.001), and maximum oscillatory shear index and collagen type I α1 chain (r = −0.575, P < 0.001 in cases). Conclusion Significant associations were discovered between 4D flow CMR derived whole-cardiac cycle WSS and circulating biomarkers representing inflammation and collagen synthesis, suggesting an intricate interplay between haemodynamics and the processes of inflammation and collagen synthesis in patients with early aortic dilation and tricuspid aortic valves. [ABSTRACT FROM AUTHOR]

The enlarged size of the aortic bulb is thought to enhance the ability of marine mammals to remain underwater for extended periods. However, a convincing link between aortic bulb size and diving capacity has not been established. Using new and existing data, we examined the relationships between body size, maximum and routine dive duration, and aortic bulb size of pinnipeds. Comparisons among seven species of pinnipeds showed that the diameter of the aortic bulb increases allometrically with body mass (aortic bulb diameter = 0.58 × body mass0.41). We also found a linear relationship between routine dive duration and relative aortic bulb diameter (routine dive duration = 0.20 × relative aortic bulb diameter − 3.30), but no apparent relationship with maximum dive duration. Our results indicate that relative aortic bulb diameter influences diving capacity, providing further evidence that the aortic bulb is an adaptation to diving. Specifically, the relative diameter of the aortic bulb partially determines how long pinnipeds can routinely remain underwater. This has implications for the ability of different species of marine mammals to adapt to projected environmental changes and effectively forage or evade threats in altered habitats. [ABSTRACT FROM AUTHOR]

Background: Chronic Rapid eye movement (REM) sleep deprivation has been associated with various cardiovascular alterations, including disruptions in antioxidant defense mechanisms, lipid metabolism, and inflammatory responses. This study investigates the therapeutic potential of green tea extract (GTE) in mitigating these adverse effects. Methods: A total of 24 male Wistar albino rats were used in this study and divided into the control group (n = 8), Chronic-REM Sleep Deprivation (CRSD) Group (n = 8) and Chronic-REM SD + Green Tea 200 (CRSD + GTE200) Group (n = 8). After 21 days, a comprehensive analysis of paraoxonase (PON1), arylesterase (ARE), malondialdehyde (MDA), glutathione (GSH), nitric oxide (NOx), proinflammatory cytokines, and lipid profiles in aortic tissue, heart tissue, and serum was conducted in a sleep-deprived rat model. Results: Chronic REM sleep deprivation led to a significant reduction in PON1 and ARE levels in aortic (p = 0.046, p = 0.035 respectively) and heart tissues (p = 0.020, p = 0.019 respectively), indicative of compromised antioxidant defenses. MDA levels increased, and NOx levels decreased, suggesting oxidative stress and impaired vascular function. Lipid profile alterations, including increased triglycerides and total cholesterol, were observed in serum. Elevated levels of inflammatory cytokines (IL-6 and TNF-alpha) further indicated an inflammatory response (p = 0.007, p = 0.018 respectively). GTE administration demonstrated a protective role, restoring antioxidant enzyme levels, suppressing lipid peroxidation, and improving NOx levels. Conclusion: These findings suggest the therapeutic potential of GTE in alleviating the cardiovascular impairments of chronic REM sleep deprivation, emphasizing its candidacy for further clinical exploration as a natural intervention in sleep-related disorders and associated cardiovascular risks. [ABSTRACT FROM AUTHOR]

Traumatic injuries continue to be on the rise globally and with it, the role interventional radiology (IR) has also expanded in managing this patient cohort. The role of damage control surgery (DCS) has been well established in the trauma management pathway, however it is only recently that Damage Control IR (DCIR) has become increasingly utilized in managing the extremis trauma and emergency patient. Visceral artery embolizations (both temporary and permanent), temporary balloon occlusions including Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in iliac arteries and aorta respectively are amongst the treatment options now available for the trauma (and non-traumatic bleeding) patient. We review the literature for the role of DCS and utilization of IR in trauma, outcomes and the paradigm shift towards minimally invasive techniques. The focus of this paper is to highlight the importance of multi-disciplinary working and having established pathways to ensure timely treatment of trauma patients as well as careful patient selection. We show that outcomes are best when both surgical and IR are involved in patient care from the outset and that DCIR should not be defined as Non-Operative Management (NOM) as it currently is categorized as. [ABSTRACT FROM AUTHOR]

Background: Remnant cholesterol (RC) predicts cardiovascular risk and is associated with a range of diseases, including asthma, hypertension, depression, periodontitis, and alcoholic fatty liver disease. However, its correlation with abdominal aortic calcification (AAC) has not been reported. Methods: Using a cross-sectional approach, this study examined data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) cycle. Multiple logistic regression, generalized summation models, and subgroup analyses were used in examining the correlation between RC and the prevalence of severe AAC. Results: The mean age of participants in this study was 57.70 ± 11.73 years, with 142 individuals (9.67%) suffering from severe AAC. The median RC was 0.52 mmol/L (Q1-Q3, 0.36-0.75 mmol/L). Among female participants, a significant positive correlation was observed between RC and severe AAC (per natural log [RC] increment: 2.14; 95% CI, 1.07-4.27). Smooth curve fitting and threshold effect analysis revealed a saturation effect at an RC level of 0.57 mmol/L. Conversely, in male participants, no significant correlation was found between RC and the prevalence of severe AAC (per natural log [RC] increment: 0.88; 95% CI, 0.43-1.78). Our findings suggest a significant interaction between gender and RC in relation to severe AAC (P for interaction = 0.0042). Conclusions: Higher RC levels were significantly associated with an increased prevalence of severe AAC in women. [ABSTRACT FROM AUTHOR]

Objective: To investigate potential mechanisms of anti-atherosclerosis by berberine (BBR) using ApoE−/− mice. Methods: Eight 8-week-old C57BL/6J mice were used as a blank control group (normal), and 56 8-week-old AopE−/− mice were fed a high-fat diet for 12 weeks, according to a completely random method, and were divided into the model group, BBR low-dose group (50 mg/kg, BBRL), BBR medium-dose group (100 mg/kg, BBRM), BBR high-dose group (150 mg/kg, BBRH), BBR+nuclear factor erythroid 2-related factor 2 (NRF2) inhibitor group (100 mg/kg BBR+30 mg/kg ML385, BBRM+ML385), NRF2 inhibitor group (30 mg/kg, ML385), and positive control group (2.5 mg/kg, atorvastatin), 8 in each group. After 4 weeks of intragastric administration, samples were collected and serum, aorta, heart and liver tissues were isolated. Biochemical kits were used to detect serum lipid content and the expression levels of malondialdehyde (MDA) and superoxide dismutase (SOD) in all experimental groups. The pathological changes of atherosclerosis (AS) were observed by aorta gross Oil Red O, aortic sinus hematoxylin-eosin (HE) and Masson staining. Liver lipopathy was observed in mice by HE staining. The morphology of mitochondria in aorta cells was observed under transmission electron microscope. Flow cytometry was used to detect reactive oxygen species (ROS) expression in aorta of mice in each group. The content of ferrous ion Fe2+ in serum of mice was detected by biochemical kit. The mRNA and protein relative expression levels of NRF2, glutathione peroxidase 4 (GPX4) and recombinant solute carrier family 7 member 11 (SLC7A11) were detected by quantitative real time polymerase chain reaction (RT-qPCR) and Western blot, respectively. Results: BBRM and BBRH groups delayed the progression of AS and reduced the plaque area (P<0.01). The characteristic morphological changes of ferroptosis were rarely observed in BBR-treated AS mice, and the content of Fe2+ in BBR group was significantly lower than that in the model group (P<0.01). BBR decreased ROS and MDA levels in mouse aorta, increased SOD activity (P<0.01), significantly up-regulated NRF2/SLC7A11/GPX4 protein and mRNA expression levels (P<0.01), and inhibited lipid peroxidation. Compared with the model group, the body weight, blood lipid level and aortic plaque area of ML385 group increased (P<0.01); the morphology of mitochondria showed significant ferroptosis characteristics; the serum Fe2+, MDA and ROS levels increased (P<0.05 or P<0.01), and the activity of SOD decreased (P<0.01). Compared with BBRM group, the iron inhibition effect of BBRM+ML385 group was significantly weakened, and the plaque area significantly increased (P<0.01). Conclusion: Through NRF2/SLC7A11/GPX4 pathway, BBR can resist oxidative stress, inhibit ferroptosis, reduce plaque area, stabilize plaque, and exert anti-AS effects. [ABSTRACT FROM AUTHOR]

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AbstractThe simulation of the aortic valve (AV) remains challenging due to its geometric complexity and the multi-physics nature of the problem. In this study, we utilized COMSOL to establish a three-dimensional, three-leaflet AV fluid-structure interaction model and investigated the influence of material properties on the valve's mechanical behavior in a healthy state. The results indicated that variations in the aortic wall material model had a minor impact on AV hemodynamics. Additionally, while the linear elastic properties of the leaflets limit valve opening and closing, this material model allows for rapid assessment of AV performance within the range of material deformation. [ABSTRACT FROM AUTHOR]

Connective tissue disorders such as Marfan- and Loeys-Dietz syndrome (LDS) can lead to aortic aneurysms and aortic dissections in children. Patients with LDS often necessitating multiple aortic surgeries throughout their lives to extend their lifespan. A boy with LDS underwent Bentall procedure at the age of three for aortic aneurysm. At the age of six, this boy was referred to the hospital again due to severe abdominal pain. Computed tomographic angiography (CTA)indicates aortic dissection (DeBakey Type III, Stanford Type B). After a multidisciplinary team discussion, a successful thoracoabdominal aortic replacement was performed. [ABSTRACT FROM AUTHOR]

BACKGROUND: The expression efficiency of recombinant adeno-associated virus serotype 9 (rAAV9) carrying the macrophage-specific promoter synthetic promoter 146-C1 (SP146-C1) and the exogenous gene vascular endothelial growth factor C (VEGFC) in atherosclerosis is uncertain. OBJECTIVE: To investigate the expression efficiency of rAAV9-SP146-C1-VEGFC in atherosclerotic mice and its effect on lymphangiogenesis. METHODS: Thirty ApoE-/- mice were fed high-fat diet for 12 weeks to establish atherosclerosis models and were randomly divided into six groups, five in each group: 7-, 14-, 21-, 28-, and 35-day transfection groups and control group. The mice in the transfection groups were transfected with 5.0×1011 vg rAAV9-SP146- C1-VEGFC by caudal vein injection. In the control group, the mice were injected with the same amount of control virus rAAV9-SP146-C1-Scramble. Animals in the first five groups were killed under anesthesia at 7, 14, 21, 28 and 35 days after transfection, respectively, and those in the control group were killed under anesthesia at 7 days. Serum, femur, tibia, heart and aorta tissue samples were collected and retained in each group. The femur and tibia of mice in each group were used to extract bone marrow-derived macrophages. The gene expression of vascular endothelial growth factor C (VEGFC), vascular endothelial growth factor receptor 3 (VEGFR3), Podoplanin and lymphatic vessel endothelial hyaluronan receptor-1 (LYVE-1) in bone marrow-derived macrophages and the aorta were detected by RT-qPCR. VEGFC protein expression levels in bone marrow-derived macrophages and the aorta were detected by western blot, serum level of VEGFC was detected by ELISA, and VEGFC expression in the aortic sinus and LYVE-1 expression around the aorta and in the myocardium was detected by immunofluorescence. RESULTS AND CONCLUSION: The serum level of VEGFC, the mRNA expression of VEGFC, VEGFR3, Podoplanin, and LYVE-1 in bone marrow-derived macrophages and the aorta, the protein expression of VEGFC in bone marrow-derived macrophages, and the fluorescence intensity of VEGFC in aortic sinus plaques were significantly increased in the 7-day transfection group compared with the control group (P < 0.05, P < 0.01). Serum VEGFC level of mice transfected with rAAV9- SP146-C1-VEGFC gradually increased with time and began to decrease at 28 days. mRNA levels of VEGFC, VEGFR3, Podoplanin and LYVE-1 in mouse aorta and bone marrow-derived macrophages, VEGFC protein level in bone marrow-derived macrophages, VEGFC fluorescence intensity in aortic sinus plaques, LYVE1 fluorescence intensity around the aortic sinus and in the myocardium gradually increased with time (P < 0.05). In addition, the mRNA level of LYVE-1 in the aorta and the fluorescence intensity of LYVE-1 around the aortic sinus and in the myocardium were the highest at 28 days (P < 0.05), and gradually decreased (P < 0.05). The expression of the other indicators reached the peak at 21 days. To conclude, rAAV9-SP146-C1-VEGFC could effectively transfect bone marrowderived macrophages and promote lymphatic hyperplasia in atherosclerotic mice. [ABSTRACT FROM AUTHOR]

Simple Summary: Contrast-enhanced computed tomography (CT) is the standard radiologic examination for evaluating mediastinal tumors. In equivocal cases, cine magnetic resonance imaging (cine-MRI) and magnetic resonance imaging (MRI)/T1-weighted spin echo sequences (T1TSE) may be additionally performed. We retrospectively analyzed patients undergoing surgical resection of mediastinal tumors (benign and malignant) with prior CT, cine-MRI, and T1TSE for (re-)evaluation and comparison to the intraoperative findings and postoperative histology reports, which were defined as a gold standard. Unclear CT cases were further investigated. A total of 47 patients were included in the study. Cine-MRI is of crucial benefit in unclear CT findings compared with T1TSE, especially when infiltration into the large central vessels and atria is suspected. Background/Objectives: Contrast-enhanced computed tomography (CT) is the standard radiologic examination for evaluating the extent of mediastinal tumors. If tumor infiltration into the large central thoracic vessels, the pericardium, or the myocardium is suspected, cine magnetic resonance imaging (cine-MRI) can provide additional valuable information. Methods: We conducted a retrospective study of patients with mediastinal tumors who were staged with CT, cine-MRI, and a T1-weighted turbo spin echo (T1TSE) prior to surgical resection. Imaging was re-evaluated regarding tumor infiltration into the pericardium, myocardium, superior vena cava, aorta, pulmonary arteries, and atria and compared with intraoperative findings and postoperative histopathological reports (gold standard). Unclear CT findings were further investigated. Results: Forty-seven patients (29 female and 18 male patients; median age: 58 years) met the inclusion criteria. Cine-MRI was able to predict infiltration of the aorta in 86%, pulmonary arteries in 85%, and atria in 80% of unclear CT cases. Aortic tumor infiltration in unclear CT cases was significantly more often correctly diagnosed with cine-MRI than with T1TSE sequence. Conclusions: Additional cine-MRI is of crucial benefit in unclear CT cases. We recommend performing cine-MRI if infiltration into the large central vessels and atria is suspected. T1TSE sequence is of very limited additional value. [ABSTRACT FROM AUTHOR]

Aortic calcification is a common diabetes complication, increasing the risk of cardiovascular disease and contributing significantly to higher mortality rates in diabetic patients. A comprehensive understanding of the mechanisms involved in diabetes-related aortic calcification and early imaging evaluation of aortic calcified plaques in diabetic patients are crucial for delaying its onset and progression. This article provides a review of the latest findings in these two areas. [ABSTRACT FROM AUTHOR]

Aortopathy encompasses a spectrum of conditions predisposing to dilation, aneurysm, dissection, or rupture of the aorta and other blood vessels. Aortopathy is diagnosed commonly in children, from infancy through adolescence, primarily affecting the thoracic aorta, with variable involvement of the peripheral vasculature. Pathogeneses include connective tissue disorders, smooth muscle contraction disorders, and congenital heart disease, including bicuspid aortic valve, among others. The American Heart Association has published guidelines for diagnosis and management of thoracic aortic disease. However, these guidelines are predominantly focused on adults and cannot be applied adeptly to growing children with emerging features, growth and developmental changes, including puberty, and different risk profiles compared with adults. Management to reduce risk of progressive aortic dilation and dissection or rupture in children is complex and involves genetic testing, cardiovascular imaging, medical therapy, lifestyle modifications, and surgical guidance that differ in many ways from adult management. Pediatric practice varies widely, likely because aortopathy is pathogenically heterogeneous, including genetic and nongenetic conditions, and there is limited published evidence to guide care in children. To optimize care and reduce variation in management, experts in pediatric aortopathy convened to generate this scientific statement regarding the cardiovascular care of children with aortopathy. Available evidence and expert consensus were combined to create this scientific statement. The most common causes of pediatric aortopathy are reviewed. This document provides a general framework for cardiovascular management of aortopathy in children, while allowing for modification based on the personal and familial characteristics of each child and family. [ABSTRACT FROM AUTHOR]

Etravirine (ETV) is an antiretroviral agent that belongs to the class of non-nucleoside reverse transcriptase inhibitors. This study explores the uptake and distribution of ETV in human aortic endothelial cells (HAECs) using Raman spectroscopy combined with chemometrics. The distinctive chemical structure of ETV facilitates tracking of its uptake by observing the Raman band at 2225 cm−1 in the Raman-silent region. The perinuclear distribution pattern in HAECs depends on drug concentration and incubation time. The uptake of ETV is observed within 5 minutes at a concentration of 10 μM, as evidenced by Raman images. Lower ETV concentrations, reflective of those found in human plasma, are detectable in HAECs by applying chemometric methods to Raman spectra from the perinuclear region. The ETV accumulation process is crucial in advancing our understanding of the drug's impact on biochemical alterations within endothelial cells. Additionally, ETV emerges as a promising Raman reporter for marking subcellular compartments, leveraging the 2225 cm−1 band in the cellular Raman silent region. This research contributes valuable insights into the behavior of ETV at the subcellular level, shedding light on its potential applications and impact on subcellular dynamics. [ABSTRACT FROM AUTHOR]

This retrospective study investigates perivascular adipose tissue (PVAT) alterations in CT as a marker of inflammation in patients with abdominal aortic aneurysms (AAA). 100 abdominal CT scans of patients with abdominal aortic aneurysms and 100 age and sex matched controls without underlying aortic disease were included. Artificial Intelligence (AI) assisted segmentation of the aorta and the surrounding adipose tissue was performed. Adipose tissue density was measured in Hounsfield units (HU) close (2-5mm, HUclose) and distant (10-12mm, HUdistant) to the aortic wall. To investigate alterations in adipose tissue density close to the aorta (HUclose) as a potential marker of inflammation, we calculated the difference HUΔ = HUclose-HUdistant and the fat attenuation ratio HUratio = HUclose/HUdistant as normalized attenuation measures. These two markers were compared i) inter-individually between AAA patients and controls and ii) intra-individually between the aneurysmal and non-aneurysmal segments in AAA patients. Since most AAAs are generally observed infrarenal, the aneurysmal section of the AAA patients was compared with the infrarenal section of the aorta of the control patients. In inter-individual comparisons, higher HUΔ and a lower HUratio were observed (aneurysmal: 8.9 ± 5.1 HU vs. control: 6.9 ± 4.8 HU, p-value = 0.006; aneurysmal: 89.8 ± 5.7% vs. control: 92.1 ± 5.5% p-value = 0.004). In intra-individual comparisons, higher HUΔ and lower HUratio were observed (aneurysmal: 8.9 ± 5.1 HU vs. non-aneurysmal: 5.5 ± 4.1 HU, p-value < 0.001; aneurysmal: 89.8 ± 5.7% vs. non-aneurysmal 93.3 ± 4.9%, p-value < 0.001). The results indicate PVAT density alterations in AAA patients. This motivates further research to establish non-invasive imaging markers for vascular and perivascular inflammation in AAA. [ABSTRACT FROM AUTHOR]

Introduction While the 44-mm clay penetration criterion was developed in the 1970s for soft body armor applications, and the researchers acknowledged the need to conduct additional tests, the same behind the armor blunt trauma displacement limit is used for both soft and hard body armor evaluations and design considerations. Because the human thoraco-abdominal contents are heterogeneous, have different skeletal coverage, and have different functional requirements, the same level of penetration limit does not imply the same level of protection. It is important to determine the regional responses of different thoraco-abdominal organs to better describe human tolerance and improve the current behind armor blunt trauma standard. The purpose of this study was to report on the methods, procedures, and data collected from swine. Materials and Methods Live swine tests were conducted after obtaining approvals from the local institution and the Army Care and Use Review Office of the U.S. Department of Defense. Trachea tubes and an intravenous line were introduced before administering anesthesia. Pressure transducers were inserted into the lungs and aorta. An indenter simulating the backface deformation profiles produced by body armor from military-relevant ballistics to human cadavers was used to deliver impact loading to the liver region. A triaxial accelerometer was included in the indenter design. The animals were monitored for 6 hours, necropsies were performed, and injuries were identified. Biomechanical data of the energy, velocity, deflection, viscous criterion, force, and impulse variables were obtained for each test. Results Peak accelerations, velocities, deflections, forces, impulse, and energies ranged from 897 to 5,808 g, 21 to 59 m/s, 1.96 to 8.87 cm, 2.3 to 13.1 kN, 1.1 to 7.1 Ns, and 58 to 387 J, respectively. The peak viscous criterion ranged from 0.8 to 5.8 m/s. All animals survived the 6-hour survival period. Three animals responded with liver lacerations while the remaining 4 did not have any injuries. Conclusion The experimental design based on parallel tests with whole body human cadavers and cadaver swine was found to be successful in delivering controlled impacts to the liver region of live swine and reproducing liver injuries. Previously used biomechanical measures as potential candidates for injury criteria development were obtained. Using this proven model, tests with additional samples are needed to develop injury risk curves for liver impacts and obtain regional (liver) injury criteria. [ABSTRACT FROM AUTHOR]

Introduction Retrograde Endovascular Balloon Occlusion of the Aorta (REBOA) is an effective management for the transient responder, but the ischemic consequences of complete aortic occlusion currently limit its use. Multiple DoD-funded preclinical studies have clearly demonstrated that partial REBOA reduces distal ischemia to potentially extend safe occlusion times, while still providing effective temporization of noncompressible torso hemorrhage. Early versions of REBOA devices were designed to completely occlude the aorta and had little ability to provide partial occlusion. Recently, a new REBOA device (pREBOA-PRO) was designed specifically to allow for partial occlusion, with the hypothesis that this may reduce the complications of aortic occlusion and extend safe occlusion times while maintaining the benefits on cardiac and cerebrovascular circulation as well as reductions in resuscitation requirements. Materials and Methods To ascertain the impact of a new purpose-built partial REBOA device on the extension of safe occlusion time, the Partial REBOA Outcomes Multicenter ProspecTive (PROMPT) trial compared available data from the pREBOA-PRO with existing data from 200 clinical uses of pREBOA-PRO and available data in the AAST AORTA Registry were reviewed to design primary endpoints and clinical evidence for a prospective multi-center trial, the PROMPT Study. Together with the endpoints identified in preclinical studies of partial REBOA, primary endpoints for the PROMPT study were identified and power analyses were conducted to determine the target patient enrollment goals. Results Results from the clinical implementation of partial REBOA at a single trauma center were used to conduct the initial power analysis for the primary endpoint of Acute Kidney Injury (AKI) after prolonged occlusion. The rate of AKI after complete REBOA was 55% (12/20) compared to 33% (4/12) after partial REBOA (Madurska et al. 2021). With an alpha of 0.05 and power (β) of 0.8, the projected sample size for comparison on a dichotomous outcome is 85 patients for the assessment of AKI. Initial power and endpoint analyses have been confirmed and extended with the ongoing analysis of partial and complete REBOA reported in the AORTA database. These analyses confirm preclinical findings which show that compared to complete REBOA, partial REBOA is associated with extended occlusion time in zone 1 (complete: 31 min vs. partial: 45 min, P  = 0.003), lower rates of AKI after zone 1 occlusion (complete: 33% vs. partial: 19%, P  = 0.05) and reduced resuscitation requirements (e.g. 25% reduction in pRBC administration: complete: 18 units vs. partial: 13 units, P  = 0.02). Conclusions The DoD-funded PROMPT study of partial REBOA will provide prospective observational clinical data on patients being treated with pREBOA-PRO. Outcomes will be stratified based on partial or complete occlusion to address whether partial REBOA has additional clinical benefits over complete REBOA, such as decreased distal ischemia, extension of safe occlusion time, improved hemodynamics during transition to and from occlusion, and reduced interoperative bleeding and blood product use. The results from this study are expected to confirm previous data demonstrating reduction of ischemic sequalae, improved transition to reperfusion, and reduced resuscitative requirements compared to complete REBOA. [ABSTRACT FROM AUTHOR]

Introduction Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a temporizing hemorrhage control intervention, but its inevitable effect on time to operating room (OR) has not been assessed. The aim of our study is to assess the impact of undergoing REBOA before surgery (RBS) on time to definitive hemorrhage control surgery. Methods In this retrospective analysis of 2017–2021 ACS-TQIP database, all adult (≥18 years) patients who underwent emergency hemorrhage control laparotomy (≤4 hours of admission) and received early blood products (≤4 hours) were included, and patients with severe head injury (Head-abbreviated injury score > 2) were excluded. Patients were stratified into those who did (RBS) vs those who did not undergo REBOA before surgery (No-RBS). Primary outcome was time to laparotomy. Secondary outcomes were complications and mortality. Multivariable linear and binary logistic regression analyses were performed to identify the independent associations between RBS and outcomes. Results A total of 32,683 patients who underwent emergency laparotomy were identified (RBS: 342; No-RBS: 32,341). The mean age was 39 (16) years, 78% were male, mean SBP was 107 (34) mmHg, and the median injury severity score was 21 [14–29]. The median time to emergency hemorrhage control surgery was 50 [32–85] minutes. Overall complication rate was 16% and mortality was 19%. On univariate analysis, RBS group had longer time to surgery (RBS 56 [41–89] vs No-RBS 50 [32–85] minutes, P  < 0.001). On multivariable analysis, RBS was independently associated with a longer time to hemorrhage control surgery (β + 14.5 [95%CI 7.8–21.3], P  < 0.001), higher odds of complications (aOR = 1.72, 95%CI = 1.27–2.34, P  < 0.001), and mortality (aOR = 3.42, 95%CI = 2.57–4.55, P  < 0.001). Conclusion REBOA is independently associated with longer time to OR for hemorrhaging trauma patients with an average delay of 15 minutes. Further research evaluating center-specific REBOA volume and utilization practices, and other pertinent system factors, may help improve both time to REBOA as well as time to definitive hemorrhage control across US trauma centers. Level of Evidence III Study Type Epidemiologic [ABSTRACT FROM AUTHOR]

OBJECTIVES To analyze how the experience of the surgical team went to impact the outcomes after open surgical repair (OSR) of intact abdominal aortic aneurysms (AAAs). METHODS This is a single-center, observational cohort study with retrospective analysis of all OR for intact AAA performed between 1 January 2010 and 31 December 2022. The primary outcome was survival at 30 days and in follow-up, and a composite outcome of mortality and major complication. The secondary outcome was freedom from aorta-related reintervention. All outcomes were stratified according to the experience of the operating team (surgeons and anesthesiology). RESULTS We analyzed 103 (7.2%) patients: 97 (94.2%) males and 6 (5.8%) females. The mean age was 76 ± 8 years (range, 55–93). The best possible team composition was present in 52 (50.5%) interventions. The follow-up index was 0.82 ± 0.18 (range, 0.6–1.0). Mean follow-up duration was 59 ± 43 months (range, 0–158). We observed no differences between teams in major complications (best, 17.3% vs mixed, 21.6%; OR: 0.4, P = 0.622), 30 days mortality (best, 0% vs mixed, 5.9%; OR: 7.6, P = 0.118) and composite outcome (best, 11.5% vs mixed, 17.6%; OR: 0.8, P = 0.416). Cox regression analysis identified the best possible team as a protective factor against the need for reintervention (hazard ratio: 0.2; 95% confidence interval: 0.06–0.88, P = 0.032). CONCLUSIONS In our experience, OR of AAA yielded satisfactory results in terms of safety and efficacy independently of the team's experience. A more experienced team may protect against aorta-related reintervention. [ABSTRACT FROM AUTHOR]

Clinical cases referring to the EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ aim to assist physicians in selecting the best management strategies for individual patients with a given condition. These expert opinions consider the impact on patient outcomes as well as the risk–benefit ratio of different diagnostic or therapeutic methods. These cases serve as a vital tool to aid physicians in making decisions in their daily practice. However, in essence, although these recommendations serve as a valuable resource to guide clinical practice, their application should be tailored to the needs of the individual patient. Each patient's case is unique, presenting its own set of variables and circumstances. This editorial is a tool designed to support, but not supersede, the decision-making process of physicians, based on their knowledge, expertise and understanding of their patients' individual situations. Furthermore, these clinical cases are based on the EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ but should not be interpreted as legally binding documents. The legal responsibilities of healthcare professionals remain firmly grounded in applicable laws and regulations, and the guidelines and the clinical cases presented in this document do not alter these obligations. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the prevalence of double anterior interventricular artery using the dissection method. Metode: A retrospective study was conducted between 2010 and 2024 at the Anatomy and Embryology Laboratory of the Victor Babes University of Medicine and Pharmacy in Timisoara. Eighty cases were analyzed for morphological variants of the coronary arteries, especially the anterior interventricular artery. Results: Two cases of double anterior interventricular arteries were identified. In the first case, the two anterior interventricular arteries originated from the anterior interventricular branch of the left coronary artery. In the second case, an additional anterior interventricular artery with an aortic origin was found running along the lower third of the two interventricular grooves. This shape has not been described before in the specialized literature. Conclusions: Knowing the potential variations of the double left anterior descending artery is critical for interpreting cardiac imaging and choosing and planning percutaneous and surgical reperfusion strategies. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve implantation has revolutionized the treatment of aortic stenosis. The small aortic annulus is one of the most challenging aspects of aortic stenosis treatment and since the beginning, TAVI has shown promising results in this subgroup of patients. This systematic literature review aims to investigate the short and long-term outcomes of TAVI in the small aortic annulus. The literature was meticulously screened for this topic until April 2024 using the PRISMA guidelines. Technical aspects, characteristics of this subgroup of patients, hemodynamic performances, and outcomes are discussed. The importance of device selection has shown up, with insight into the differences between self-expandable and the balloon-expandable valves. Two special populations were also taken into account: outcomes of TAVI in the small aortic annulus with bicuspid aortic valve and extra-small aortic annulus. The last 10 years have been paramount in technological advancements, bringing TAVI to broader use in this population. While several important trials underscored the usefulness of TAVI in the small aortic annulus population, the clinical practice still lacks consensus on the ideal device, and the outcomes are debated. The pivotal role of TAVI in this context needs to be addressed with a patient-tailored approach to optimize patient care. [ABSTRACT FROM AUTHOR]