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10 results on '"MESH: Aortic Aneurysm"'

1. Is the Natural Anatomical Evolution of Type B Intramural Hematomas Reliable to Identify the Patients at Risk of Aneurysmal Progression?

Author

Julien Mancini, Pierre-Antoine Barral, Arnaud Blanchard, Mariangela De Masi, Philippe Piquet, Laurence Bal, David Lagier, Marine Gaudry, Sonia Bolomey, Alexis Jacquier, Hôpital de la Timone [CHU - APHM] (TIMONE), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Biostatistique et technologies de l'information et de la communication (BioSTIC) - [Hôpital de la Timone - APHM] (BiosTIC ), Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), and Dupuis, Christine

Subjects
Male, Time Factors, Computed Tomography Angiography, [SDV]Life Sciences [q-bio], 030204 cardiovascular system & hematology, MESH: Risk Assessment, 030218 nuclear medicine & medical imaging, MESH: Aged, 80 and over, 0302 clinical medicine, Risk Factors, MESH: Risk Factors, MESH: Aneurysm, Dissecting, Computed tomography angiography, Aged, 80 and over, MESH: Aged, Aortic dissection, Hematoma, MESH: Middle Aged, medicine.diagnostic_test, General Medicine, Middle Aged, MESH: Predictive Value of Tests, Aortic Aneurysm, [SDV] Life Sciences [q-bio], Predictive value of tests, Disease Progression, cardiovascular system, Female, MESH: Disease Progression, Aortic diameter, Radiology, Cardiology and Cardiovascular Medicine, medicine.medical_specialty, Aortography, Lumen (anatomy), Risk Assessment, 03 medical and health sciences, Aneurysm, Predictive Value of Tests, medicine, Humans, MESH: Aortography, Aged, Retrospective Studies, MESH: Humans, business.industry, MESH: Time Factors, MESH: Retrospective Studies, Retrospective cohort study, medicine.disease, MESH: Male, MESH: Computed Tomography Angiography, MESH: Aortic Aneurysm, body regions, MESH: Hematoma, Aortic Dissection, Surgery, business, MESH: Female
Abstract

International audience; Background: The natural history of type B intramural hematomas is little-known. Aneurysmal progression or an aortic dissection occurs in 15 to 20% of the cases. The study of the natural anatomical evolution could help identify the patients at risk of unfavorable evolution.Methods: All the patients monitored for a type B intramural hematoma between 2009 and 2018 were included in this monocentric retrospective study. Computed tomography angiography centerline measurement of diameters was obtained in various points of aortic segmentation on day (D) 0 and at one month (M1). Aortic volumes (lumen, intramural hematoma, and total volume) were calculated. The circulating volume was calculated using the volume rendering method. The volume of the intramural hematoma was measured using a manual section-by-section segmentation tool, and the total volume was obtained by summing up the two preceding volumes. Two groups of patients were compared: group 1 (favorable anatomical evolution) and group 2 (unfavorable anatomical evolution).Results: Between January 2008 and August 2018, 25 patients were managed for a type B intramural hematoma in our center. After an average follow-up of 15.5 months (1-52), 13 patients (52%) presented a favorable evolution and 12 (48%) an unfavorable evolution. At M1, a significant increase of the luminal diameters (37 mm vs. 32 mm; P < 0.01) and a significant reduction in the longitudinal extension (19 mm vs. 26 mm; P < 0.01) were observed. The maximum aortic diameter evolved significantly between D0 and M1 in the unfavorable evolution group (49 mm vs. 44 mm, respectively; P = 0.038). Such a difference was not found in the favorable evolution group (37.4 vs. 37.1, respectively; P = 0.552). An overall significant reduction in the total aortic volume (166 cm3 vs. 219 cm3; P < 0.01), the circulating volume (124 cm3 vs. 145 cm3; P = 0,026), and the volume of the hematoma (42 cm3 vs. 39 cm3; P < 0.01) was observed. The circulating volume decreased significantly between D0 and M1 in the favorable evolution group (110 cm3 vs. 135 cm3; P = 0.05), whereas no difference was noted in the unfavorable group (142 cm3 vs, 157 cm3; P = 0.24).Conclusions: The progression of the maximum aortic diameter and of the circulating volume after one month of follow-up could be predictive factors of the poor long-term evolution of type B intramural hematomas.

Published
2020

2. Ability of the Third-Generation FloTrac/Vigileo Software to Track Changes in Cardiac Output in Cardiac Surgery Patients: A Polar Plot Approach

Author

Olivier Bastien, Roland Henaine, Catherine Koffel, Jean-Jacques Lehot, Lester A. H. Critchley, Olivier Desebbe, Marek Haftek, Hans Garcia, Pascal Rosamel, Jean-François Obadia, Geoffray Keller, Service d'anesthésiologie et de soins intensifs, Hospices Civils de Lyon (HCL)-Hôpital Louis Pradel [CHU - HCL], Hospices Civils de Lyon (HCL), Fonctions Normales et Pathologiques de la Barrière Cutanée [Hôpital Edouard Herriot - HCL], Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Service de chirurgie cardiaque, Hospices Civils de Lyon (HCL)-Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Anaesthesia and Intensive Care, and The Chinese University of Hong Kong [Hong Kong]-Prince of Wales Hospital

Subjects
Adult, Male, medicine.medical_specialty, Cardiac output, MESH: Heart Valve Prosthesis, medicine.medical_treatment, Thermodilution, MESH: Prostheses and Implants, 030204 cardiovascular system & hematology, law.invention, MESH: Marfan Syndrome, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, law, Monitoring, Intraoperative, Internal medicine, medicine, Humans, Prospective Studies, Polar plot, Cardiac Output, Cardiac Surgical Procedures, Aged, Hetastarch, Aged, 80 and over, MESH: Humans, business.industry, Hemodynamics, Pulmonary artery catheter, Repeated measures design, MESH: Adult, MESH: Aortic Valve Insufficiency, Middle Aged, Intensive care unit, MESH: Male, MESH: Aortic Aneurysm, Cardiac surgery, Anesthesiology and Pain Medicine, ROC Curve, Cardiothoracic surgery, Data Interpretation, Statistical, Anesthesia, Cardiology, Female, Cardiology and Cardiovascular Medicine, business, Software, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; OBJECTIVE: To evaluate the ability of the third-generation (3.01) of FloTrac/Vigileo monitor (Edwards Lifesciences, Irvine, CA) to follow variations in cardiac output (∆CO) using the new polar plot approach. DESIGN: Prospective interventional study. SETTING: Single hospital university study. PARTICIPANTS: Twenty-five patients referred for cardiac surgery. INTERVENTIONS: CO was measured simultaneously by 3 to 5 bolus thermodilution (COtd measurements), using a pulmonary artery catheter and by arterial pulse contour analysis, using the FloTrac/Vigileo (COvi). Data were collected at eight time points: before incision, after sternotomy, before and after protamine sulfate infusion, at the start of sternal closure, at the end of surgery, on arrival to intensive care unit, and after a standardized volume expansion with 500 mL of hetastarch 6%. MEASUREMENTS AND MAIN RESULTS: One-hundred thirty-five pairs of CO data were collected; the mean bias of all CO measurements corrected for repeated measures was 0.2 L/min with limits of agreements of -3.3 L/min and +2.9 L/min. The percentage error was 66.5%. The polar plot analysis included 71 significant ∆CO and showed a mean polar angle of -3.4 degrees with 95% polar percentage error equivalent limits of -61 to 55; 69% of analysed data points fell within the 30-degree limits and provided a correct polar concordance rate. CONCLUSIONS: Third-generation FloTrac/Vigileo software still lacks the accuracy to reliably detect changes in cardiac output (∆CO) in cardiac surgery. Improvements to FloTrac/Vigileo CO algorithm and software still are needed in this particular setting.

Published
2013

3. Preoperative predictive factors of aneurysmal regression using the reporting standards for endovascular aortic aneurysm repair

Author

Issam Abouliatim, Adrien Kaladji, Boris Campillo-Gimenez, Alain Cardon, Jean François Heautot, Jean-Philippe Verhoye, Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes], CHU Pontchaillou [Rennes], Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Laboratoire d'Informatique Médicale (LIM), Université de Rennes (UR), Modélisation Conceptuelle des Connaissances Biomédicales, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service de radiologie et imagerie médicale [Rennes] = Radiology [Rennes], The authors are indebted to the Centre of Clinical Investigation and Technological Innovation 804 for its support in the processing of imaging datas., Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), and Senhadji, Lotfi

Subjects
Male, [SDV.MHEP.CHI] Life Sciences [q-bio]/Human health and pathology/Surgery, medicine.medical_treatment, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, MESH: Risk Assessment, Inferior mesenteric artery, Endovascular aneurysm repair, Severity of Illness Index, 030218 nuclear medicine & medical imaging, MESH: Proportional Hazards Models, MESH: Blood Vessel Prosthesis, 0302 clinical medicine, MESH: Aged, 80 and over, MESH: Practice Guidelines as Topic, [INFO.INFO-TS]Computer Science [cs]/Signal and Image Processing, Risk Factors, MESH: Risk Factors, MESH: Treatment Outcome, Aged, 80 and over, MESH: Aged, Univariate analysis, MESH: Middle Aged, Endovascular Procedures, Age Factors, Middle Aged, Abdominal aortic aneurysm, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Aortic Aneurysm, Treatment Outcome, Practice Guidelines as Topic, Female, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Radiology, France, MESH: Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, [SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing, MESH: Prosthesis Design, medicine.medical_specialty, MESH: Endovascular Procedures, [INFO.INFO-TS] Computer Science [cs]/Signal and Image Processing, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, Prosthesis Design, Aortography, Risk Assessment, MESH: Multivariate Analysis, 03 medical and health sciences, Blood Vessel Prosthesis Implantation, Aneurysm, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, medicine.artery, MESH: Severity of Illness Index, medicine, MESH: Quality Indicators, Health Care, Humans, MESH: Aortography, Thrombus, MESH: Kaplan-Meier Estimate, [SPI.SIGNAL] Engineering Sciences [physics]/Signal and Image processing, Aged, Proportional Hazards Models, Quality Indicators, Health Care, Retrospective Studies, [SDV.IB] Life Sciences [q-bio]/Bioengineering, MESH: Age Factors, MESH: Humans, business.industry, Retrospective cohort study, MESH: Retrospective Studies, MESH: Blood Vessel Prosthesis Implantation, Vascular surgery, medicine.disease, MESH: Male, Surgery, Blood Vessel Prosthesis, MESH: Aortic Aneurysm, MESH: France, Multivariate Analysis, business, Tomography, X-Ray Computed, MESH: Female
Abstract

International audience; BACKGROUND: Aneurysmal regression is a reliable marker for long-lasting success after endovascular aneurysm repair (EVAR). The aim of this study was to identify the preoperative factors that can predictably lead to aneurysmal sac regression after EVAR, according to the reporting standards of the Society for Vascular Surgery and the International Society of Cardiovascular Surgery (SVS/ISCVS). METHODS: From 199 patients treated by EVAR between 2000 and 2009, 164 completed computed tomography angiographies and duplex scan follow-up images were available. All computed tomography angiographies for enrolled patients in this retrospective study were analyzed with Endosize software (Therenva, Rennes, France) to provide spatially correct 3-dimensional data in accordance with SVS/ISCVS recommendations. Anatomic parameters were graded according to the relevant severity grades. A severity score was calculated at the aortic neck, the abdominal aortic aneurysm, and the iliac arteries. Clinical and demographic factors were studied. Patients with aneurysmal regression >5 mm were assigned to group A (mean age, 71.4 ± 8.9 years) and the others to group B (76.3 ± 8.3 years). RESULTS: Aneurysmal regression occurred in 66 patients (40.2%; group A). Univariate analyses showed smaller severity scores at the aortic neck (P = .02) and the iliac arteries (P = .002) in group A and calcifications and thrombus were less significant at the aortic neck (P = .003 and P = .02) and at the iliac arteries (P = .001 and P = .02), and inferior mesenteric artery patency was less frequent (68.2% vs 82.7%, P = .04). Two multivariate analyses were done: one considered the scores and the other the variables included in the scores. In the first, the patients of group A were younger (P = .002) and aortic neck calcifications were less significant (P = .007). In the second, group A patients were younger (P < .001) and the aortic neck scores were smaller (P = .04). There was no difference between the two groups in the type of implanted endoprosthesis or in the follow-up (group A: 46.4 ± 24 months; group B: 47.2 ± 22 months; P = .35). CONCLUSIONS: In this study, the young age of the patients and their aortic neck quality, in particular the absence of neck calcification, appear to have been the main factors affecting aneurysm shrinkage, such that they represent a target population for the improvement of EVAR results.

Published
2012
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4. Abdominal Aortic Diameter and Vascular Atherosclerosis: The Multi-Ethnic Study of Atherosclerosis

Author

Nicole E. Jensky, Robert Detrano, Nathan D. Wong, Gail A. Laughlin, Victor Aboyans, Matthew A. Allison, Michael H. Criqui, Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges], CHU Limoges, Neuroépidémiologie Tropicale et Comparée (NETEC), and Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Université de Limoges (UNILIM)

Subjects
Carotid Artery Diseases, Male, MESH: Dilatation, Pathologic, Epidemiology, MESH: Aorta, Abdominal, 030204 cardiovascular system & hematology, 030230 surgery, MESH: Risk Assessment, MESH: Linear Models, Aortic aneurysm, MESH: Aged, 80 and over, 0302 clinical medicine, Risk Factors, MESH: Risk Factors, Ethnicity, Aorta, Abdominal, 030212 general & internal medicine, Aorta, Ultrasonography, Medicine(all), Aged, 80 and over, MESH: Aged, Body surface area, education.field_of_study, MESH: Middle Aged, medicine.diagnostic_test, Abdominal aorta, Middle Aged, Aortic Aneurysm, 3. Good health, medicine.anatomical_structure, cardiovascular system, Cardiology, Female, MESH: Ethnic Groups, MESH: Tomography, X-Ray Computed, Cardiology and Cardiovascular Medicine, Dilatation, Pathologic, medicine.medical_specialty, Aortography, Population, Risk Assessment, Article, 03 medical and health sciences, MESH: Cross-Sectional Studies, Aneurysm, Internal medicine, medicine.artery, MESH: United States, medicine, Humans, MESH: Aortography, education, Aged, MESH: Humans, MESH: Carotid Artery Diseases, business.industry, Atherosclerosis, medicine.disease, United States, MESH: Male, MESH: Aortic Aneurysm, Cross-Sectional Studies, Linear Models, Abdomen, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Surgery, Tomography, X-Ray Computed, business, MESH: Female
Abstract

International audience; OBJECTIVES: To gain insight into early mechanisms of aortic widening, we examined associations between the diameter of the abdominal aorta (AD) and cardiovascular disease (CVD) risk factors and biomarkers, as well as measures of subclinical atherosclerosis, in a multi-ethnic population. DESIGN: Cross-sectional cohort. METHODS: A total of 1926 participants (mean age 62, 50% women) underwent chest and abdomen scanning by computed tomography, ultrasound of the carotid arteries, and CVD risk factor assessment. AD was measured 5 cm above and at the bifurcation. RESULTS: In a model containing traditional CVD risk factors, biomarkers and ethnicity, only age (standardized β = 0.97), male sex (β = 1.88), body surface area (standardized β = 0.92), current smoking (β = 0.42), D-dimer levels (β = 0.19) and hypertension (β = 0.53) were independently and significantly associated with increasing AD (in mm) at the bifurcation; use of cholesterol-lowering medications predicted smaller AD (β = -0.70) (P < 0.01 for all). These findings were similar for AD 5 cm above the bifurcation with one exception: compared to Caucasian-Americans, Americans of Chinese, African and Hispanic descent had significantly smaller AD 5 cm above the bifurcation (β's = -0.59, -0.49, and -0.52, respectively, all P < 0.01), whereas AD at the bifurcation did not differ by ethnicity. Physical activity, alcohol consumption, diabetes and levels of IL-6, CRP and homocysteine were not independently associated with AD. Higher aortic and coronary artery calcium burden, but not common carotid artery intima-media thickness, were independently, but modestly (β = 0.11 to 0.19), associated with larger AD. CONCLUSIONS: Incremental widening of the aortic diameter shared some, but not all, risk factors for occlusive vascular disease.

Published
2011

5. [IgG4-related disease and renal and urological involvement]

Author

Zaidan, Mohamad, Ebbo, Mikael, Brochériou, Isabelle, Ronco, Pierre, Schleinitz, Nicolas, Boffa, Jean-Jacques, Remodelage et Reparation du Tissu Renal, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Néphrologie et Dialyses [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Service d'anatomie pathologique [CHU Tenon], Aix Marseille Université (AMU), CHU Tenon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), RONCO, Pierre, Service de Département de Néphrologie = Service de Néphrologie et Dialyses [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and Service d'Anatomie et cytologie pathologiques [CHU Tenon]

Subjects
MESH: Glomerulonephritis, Membranous, pancreatitis, Kidney, Glomerulonephritis, Membranous, MESH: Retroperitoneal Fibrosis, MESH: Aortitis, aneurysms, [SDV.BBM.GTP]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Genomics [q-bio.GN], Humans, Tubulointerstitial nephritis, IgG4-related disease, Glucocorticoids, IgG4, MESH: Immunoglobulin G, MESH: Humans, Aortitis, Aortic, MESH: Kidney, Retroperitoneal fibrosis, Aortitis Autoimmune, Aortic Aneurysm, Prostatitis, MESH: Aortic Aneurysm, Immunoglobulin G, [SDV.BBM.GTP] Life Sciences [q-bio]/Biochemistry, Molecular Biology/Genomics [q-bio.GN], Nephritis, Interstitial, MESH: Glucocorticoids, MESH: Nephritis, Interstitial
Abstract

International audience; Hyper-IgG4 syndrome, or IgG4-related disease, is an emerging disorder, involving one or more organ(s), and characterized by "storiform" fibrosis and inflammatory lesions with a predominance of IgG4+ plasma cells and increased IgG4 serum levels. Since the first report of auto-immune pancreatitis, numerous organ lesions have been reported and have been found to occur in a same patient including: sialadenitis, dacryoadenitis, lymphadenopathy, liver and biliary tract involvement, and renal and retroperitoneal lesions. Renal involvement was first described in 2004 and usually presents as functional and/or morphological abnormalities. In most cases, renal pathological analysis reveals tubulointerstitial nephritis that is rarely associated with glomerular lesions. Retroperitoneal fibrosis is also a typical feature that may be associated with periaortitis or inflammatory abdominal aortic aneurysm. First line treatment is based on corticosteroid therapy. Short-term outcome is usually favorable. However, patients should be carefully monitored for relapses and long-term complications. Although the multiple organ lesions share common clinical, biological, radiological and pathological features, no consensus diagnostic criteria have yet been validated for IgG4-related disease. Ruling out differential diagnoses is thus mandatory. Our literature review provides nephrologists, urologists and pathologists with key elements that will help in the early diagnosis and proper management of this new and emerging disorder.

Published
2012

6. Aortic dissection in a patient treated by sunitinib for metastatic renal cell carcinoma

Author

Jean-Jacques Patard, Julien Edeline, Brigitte Laguerre, Yan Rolland, De Villemeur, Hervé, Service de Biologie, CRLCC Eugène Marquis (CRLCC), Service d'urologie [Rennes] = Urology [Rennes], Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Service d'urologie [Rennes], Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes]

Subjects
medicine.medical_specialty, Pathology, MESH: Combined Modality Therapy, medicine.medical_treatment, Urology, [SDV.CAN]Life Sciences [q-bio]/Cancer, 030204 cardiovascular system & hematology, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, MESH: Hypertension, Metastasis, 03 medical and health sciences, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Renal cell carcinoma, medicine, Carcinoma, ComputingMilieux_MISCELLANEOUS, MESH: Aneurysm, Dissecting, Aortic dissection, MESH: Indoles, MESH: Antihypertensive Agents, MESH: Middle Aged, MESH: Humans, Sunitinib, business.industry, Hematology, MESH: Neoplasm Staging, MESH: Carcinoma, Renal Cell, medicine.disease, [SDV.MHEP.UN] Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Nephrectomy, MESH: Male, 3. Good health, MESH: Lung Neoplasms, MESH: Aortic Aneurysm, MESH: Nephrectomy, Oncology, 030220 oncology & carcinogenesis, MESH: Pyrroles, MESH: Antineoplastic Agents, MESH: Sirolimus, MESH: Kidney Neoplasms, business, Kidney cancer, Kidney disease, medicine.drug
Abstract

International audience

Published
2010

7. Comparison of clinical presentations and outcomes between patients with TGFBR2 and FBN1 mutations in Marfan syndrome and related disorders

Author

David Attias, Philippe Gabriel Steg, Franck Iserin, Daniel Sidi, Mireille Claustres, Laurence Faivre, Marlène Rio, Marie-Ange Delrue, Philippe Ravaud, Catherine Boileau, Carine Roy, Christine Francannet, Henri Plauchu, Sylvie Odent, Christophe Béroud, Guillaume Jondeau, Martine Le Merrer, Chantal Stheneur, Gwenaëlle Collod-Béroud, Stanislas Lyonnet, Philippe Khau Van Kien, Annick Rossi, Laurence Cohen, Didier Lacombe, Delphine Detaint, Consultation Marfan, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Bichat, Service de cardiologie, Université Paris Diderot - Paris 7 (UPD7)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Génétique et épigénétique des maladies métaboliques, neurosensorielles et du développement (Inserm U781), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de pédiatrie, urgences enfants [CHU Ambroise-Paré], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Ambroise Paré [AP-HP], Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques, Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département d'épidémiologie, biostatistique et recherche clinique, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Laboratoire de génétique des maladies rares. Pathologie moleculaire, etudes fonctionnelles et banque de données génétiques (LGMR), Université Montpellier 1 (UM1)-IFR3, Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Centre de génétique - Centre de référence des maladies rares, anomalies du développement et syndromes malformatifs (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Service de génétique médicale, Université de Bordeaux (UB)-CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Unité de Cardiologie Pédiatrique, Hôpital Privé Jacques Cartier [Massy], Unité de Génétique Médicale, Hôtel-Dieu-CHU Clermont-Ferrand-Université d'Auvergne - Clermont-Ferrand I (UdA), Service de cardiologie pédiatrique [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Necker - Enfants Malades [AP-HP], Service de Génétique Médicale [CHU Necker], Service de Génétique Clinique, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Sud, Service de Génétique, Hôpital de l'Hôtel Dieu [CHU-HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon, Service de génétique [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Hémostase, bio-ingénierie et remodelage cardiovasculaires (LBPC), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Institut Galilée-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de biochimie, d'hormonologie et de génétique moléculaire [CHU Amrboise Paré], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 (UPD7), Service de pédiatrie, urgences enfants [Ambroise-Paré], Hôpital Ambroise Paré [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), CHU Necker - Enfants Malades [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université Paris Diderot - Paris 7 (UPD7)-Université Paris 13 (UP13)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Galilée, Service de biochimie, d'hormonologie et de génétique moléculaire [Amrboise Paré], Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Ambroise Paré [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bichat, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Laboratoire de Recherche Magellan, Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université de Lyon-Institut d'Administration des Entreprises (IAE) - Lyon, Service de Génétique Médicale [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Institut de génétique humaine (IGH), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], CHU Necker - Enfants Malades [AP-HP], Unité de génétique médicale, hôpital Sud, Hôpital Bichat - Claude Bernard, Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques (U738 / UMR_S738), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Bichat, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 ( UPD7 ), Génétique et épigénétique des maladies métaboliques, neurosensorielles et du développement ( Inserm U781 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service de pédiatrie, urgences enfants, Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Ambroise Paré, Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Laboratoire de génétique des maladies rares. Pathologie moleculaire, etudes fonctionnelles et banque de données génétiques, Université Montpellier 1 ( UM1 ) -IFR3-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université de Montpellier ( UM ), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Université de Bordeaux ( UB ) -CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Hôtel-Dieu-CHU Clermont-Ferrand-Université d'Auvergne - Clermont-Ferrand I ( UdA ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Sud, Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Hôtel Dieu, CHU Rouen-Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Hémostase, bio-ingénierie et remodelage cardiovasculaires ( LBPC ), Université Paris 13 ( UP13 ) -Université Paris Diderot - Paris 7 ( UPD7 ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut Galilée, Service de biochimie, d'hormonologie et de génétique moléculaire, IFR3, Université Montpellier 1 (UM1)-Université Montpellier 1 (UM1)-Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Diderot - Paris 7 (UPD7)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Recherche Magellan, Institut d'Administration des Entreprises (IAE) - Lyon-Université Jean Moulin - Lyon 3 (UJML), Université de Lyon-Université de Lyon, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7), and COLLOD-BEROUD, Gwenaëlle

Subjects
Male, MESH : Receptors, Transforming Growth Factor beta, MESH : Mitral Valve Prolapse, Gene mutation, Gastroenterology, Marfan Syndrome, 0302 clinical medicine, MESH: Pregnancy, MESH : Child, Pregnancy, Mitral valve, MESH: Child, Medicine, MESH: Incidence, Child, MESH: Aneurysm, Dissecting, Aortic dissection, 0303 health sciences, Mitral Valve Prolapse, MESH: Middle Aged, Incidence, Prognosis, MESH: Case-Control Studies, MESH : Incidence, Aortic Aneurysm, 3. Good health, Survival Rate, MESH : Phenotype, MESH: Young Adult, Cardiology and Cardiovascular Medicine, musculoskeletal diseases, MESH : Case-Control Studies, medicine.medical_specialty, MESH : Young Adult, MESH : Cohort Studies, Fibrillins, MESH: Phenotype, Sudden death, MESH: Prognosis, MESH: Protein-Serine-Threonine Kinases, 03 medical and health sciences, MESH: Mitral Valve Prolapse, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, MESH : Adolescent, Physiology (medical), Humans, MESH : Middle Aged, MESH : Aneurysm, Dissecting, MESH: Adolescent, [SDV.GEN]Life Sciences [q-bio]/Genetics, MESH: Humans, MESH : Humans, Receptor, Transforming Growth Factor-beta Type II, Case-control study, [SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology, MESH: Adult, medicine.disease, MESH: Aortic Aneurysm, MESH : Pregnancy, MESH : Mitral Valve Insufficiency, Case-Control Studies, Mutation, [ SDV.GEN ] Life Sciences [q-bio]/Genetics, Receptors, Transforming Growth Factor beta, MESH: Female, Marfan syndrome, MESH: Mitral Valve Insufficiency, Fibrillin-1, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, [SDV.BBM.BM] Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology, Cohort Studies, MESH : Female, MESH: Kaplan-Meiers Estimate, MESH: Cohort Studies, MESH : Prognosis, Incidence (epidemiology), Microfilament Proteins, Mitral Valve Insufficiency, MESH : Adult, [ SDV.MHEP.CSC ] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Middle Aged, MESH : Survival Rate, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, MESH : Aortic Aneurysm, Phenotype, medicine.anatomical_structure, Female, MESH: Receptors, Transforming Growth Factor beta, MESH : Mutation, MESH : Protein-Serine-Threonine Kinases, Adult, MESH: Mutation, MESH : Microfilament Proteins, Adolescent, MESH: Survival Rate, MESH : Male, [SDV.GEN.GH] Life Sciences [q-bio]/Genetics/Human genetics, Protein Serine-Threonine Kinases, MESH: Marfan Syndrome, Young Adult, MESH: Microfilament Proteins, Internal medicine, Survival rate, 030304 developmental biology, MESH : Marfan Syndrome, business.industry, MESH : Kaplan-Meiers Estimate, MESH: Male, Surgery, Aortic Dissection, [SDV.GEN.GH]Life Sciences [q-bio]/Genetics/Human genetics, business
Abstract

Background— TGFBR2 mutations were recognized recently among patients with a Marfan-like phenotype. The associated clinical and prognostic spectra remain unclear. Methods and Results— Clinical features and outcomes of 71 patients with a TGFBR2 mutation (TGFBR2 group) were compared with 50 age- and sex-matched unaffected family members (control subjects) and 243 patients harboring FBN1 mutations (FBN1 group). Aortic dilatation was present in a similar proportion of patients in both the TGFBR2 and FBN1 groups (78% versus 79%, respectively) but was highly variable. The incidence and average age for thoracic aortic surgery (31% versus 27% and 35±16 versus 39±13 years, respectively) and aortic dissection (14% versus 10% and 38±12 versus 39±9 years) were also similar in the 2 groups. Mitral valve involvement (myxomatous, prolapse, mitral regurgitation) was less frequent in the TGFBR2 than in the FBN1 group (all P TGFBR2 mutations, versus 32% with FBN1 mutations ( P =0.002). The rate of death was greater in TGFBR2 families before diagnosis but similar once the disease had been recognized. Most pregnancies were uneventful (without death or aortic dissection) in both TGFBR2 and FBN1 families (38 of 39 versus 213 of 217; P =1). Seven patients (10%) with a TGFBR2 mutation fulfilled international criteria for Marfan syndrome, 3 of whom presented with features specific for Loeys-Dietz syndrome. Conclusions— Clinical outcomes appear similar between treated patients with TGFBR2 mutations and individuals with FBN1 mutations. Prognosis depends on clinical disease expression and treatment rather than simply the presence of a TGFBR2 gene mutation.

Published
2009

8. Mycotic aneurysm of the ascending aorta: an unusual infectious complication of left ventricular assist device explantation

Author

Stéphane Combes, Lionel Camilleri, Pascal Chabrot, Image Science for Interventional Techniques (ISIT), Université d'Auvergne - Clermont-Ferrand I (UdA)-Clermont Université-Centre National de la Recherche Scientifique (CNRS), Institut Pascal (IP), SIGMA Clermont (SIGMA Clermont)-Centre National de la Recherche Scientifique (CNRS)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), CHU Clermont-Ferrand, and SIGMA Clermont (SIGMA Clermont)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS)

Subjects
medicine.medical_specialty, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, medicine.medical_treatment, 030209 endocrinology & metabolism, 030204 cardiovascular system & hematology, MESH: Aneurysm, Infected, law.invention, 03 medical and health sciences, Aortic aneurysm, 0302 clinical medicine, Aneurysm, law, Artificial heart, Internal medicine, medicine.artery, Ascending aorta, medicine, Myocardial infarction, ComputingMilieux_MISCELLANEOUS, Heart transplantation, MESH: Humans, MESH: Middle Aged, business.industry, MESH: Prosthesis-Related Infections, MESH: Pseudomonas Infections, Mycotic aneurysm, medicine.disease, MESH: Male, 3. Good health, Surgery, MESH: Aortic Aneurysm, Ventricular assist device, Cardiology, Cardiology and Cardiovascular Medicine, business, MESH: Heart-Assist Devices, MESH: Tomography, X-Ray Computed, [SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing
Abstract

A 57-year-old patient was hospitalized due to recurrent Pseudomonas aeruginosa sepsis. One year before, he underwent implantation of Heart-Mate II LVAD (Thoratec) for refractory heart failure after acute myocardial infarction as a bridge to heart transplantation. Eleven months later, he presented with persistent low-grade fever. Three of the blood cultures were …

Published
2009

9. NOX1 deficiency protects from aortic dissection in response to angiotensin II

Author

Michela G. Schäppi, Gaëtan Gavazzi, Karl-Heinz Krause, Candice Trocmé, Christine Deffert, François Herrmann, Groupe de Recherche et d’Étude du Processus Inflammatoire (TIMC-IMAG-GREPI), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), and VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF)

Subjects
Male, Aneurysm, Dissecting/ chemically induced/ prevention & control, Aorta, Thoracic/metabolism, Matrix Metalloproteinase 2/metabolism, RNA, Messenger/metabolism, Gene Expression Regulation/drug effects, Aorta, Thoracic, Blood Pressure, 030204 cardiovascular system & hematology, ddc:616.07, medicine.disease_cause, MESH: Mice, Knockout, MESH: Hypertension, NADPH Oxidase/ deficiency, Norepinephrine, Mice, 0302 clinical medicine, Vasoconstrictor Agents, MESH: Animals, MESH: NADPH Oxidase, MESH: Aneurysm, Dissecting, Aortic dissection, Mice, Knockout, 0303 health sciences, Angiotensin II, MESH: Blood Pressure, MESH: Gene Expression Regulation, 3. Good health, Aortic Aneurysm, Matrix Metalloproteinase 9, Hypertension, NADPH Oxidase 1, cardiovascular system, Matrix Metalloproteinase 2, Disease Susceptibility, MESH: Angiotensin II, Matrix Metalloproteinase 9/metabolism, medicine.medical_specialty, MESH: Aorta, Thoracic, MESH: Disease Susceptibility, Biology, Sudden death, Blood Pressure/drug effects, Norepinephrine/pharmacology, 03 medical and health sciences, MESH: Vasoconstrictor Agents, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, MESH: Mice, Inbred C57BL, Internal medicine, medicine.artery, MESH: Norepinephrine, Renin–angiotensin system, Internal Medicine, medicine, Animals, RNA, Messenger, MESH: Mice, 030304 developmental biology, MESH: RNA, Messenger, Aorta, Tissue Inhibitor of Metalloproteinase-1, Hypertension/chemically induced, NADPH Oxidases, MESH: Matrix Metalloproteinase 9, Tissue inhibitor of metalloproteinase, medicine.disease, Tissue Inhibitor of Metalloproteinase-1/genetics/metabolism, MESH: Male, MESH: Aortic Aneurysm, Mice, Inbred C57BL, MESH: Matrix Metalloproteinase 2, B vitamins, Aortic Dissection, Endocrinology, Gene Expression Regulation, MESH: Tissue Inhibitor of Metalloproteinase-1, Aortic Aneurysm/ chemically induced/ prevention & control, Oxidative stress
Abstract

Oxidative stress leads to vascular damage and participates in the pathomechanisms of aortic dissection and aneurysm formation. Here we study aortic dissection in mice deficient in the superoxide-generating reduced nicotinamide-adenine dinucleotide phosphate oxidase NOX1. Seven days of treatment with the hypertensive agent angiotensin II (3 mg/kg per day) led to aortic dissection in 23% of wild-type C57BL/6J mice but in only 4% of NOX1-deficient mice ( P =0.05). In contrast, treatment of wild-type C57BL/6J mice with the hypertensive agent norepinephrine (12 mg/kg per day), did not lead to aortic dissection or sudden death, suggesting that hypertension is not sufficient to cause aortic dissection. Interestingly, norepinephrine-dependent blood pressure elevations were conserved in NOX1-deficient mice, demonstrating that, different from angiotensin II, it acts through NOX1-independent hypertensive mechanisms. The resistance of NOX1-deficient mice to angiotensin II-induced aortic dissection suggests a role for NOX1-dependent alterations of the vascular wall. We, therefore, studied gene expression and protease/inhibitor equilibrium. cDNA array analysis demonstrated differential effects of angiotensin II on gene expression in wild-type and NOX1-deficient mice. Tissue inhibitor of metalloproteinase 1 was increased both on the mRNA and the protein level in aortas from NOX1-deficient mice. Thus, our results demonstrate that NOX1 is involved in the mechanisms of angiotensin II-dependent aortic dissection. As one underlying mechanism, we have identified NOX1-dependent suppression of tissue inhibitor of metalloproteinase 1 expression, which could lead to tissue damage through an altered protease/inhibitor balance.

Published
2007

10. Heterogeneity in the remodeling of aneurysms of the ascending aorta with tricuspid aortic valves

Author

E.W. Matthias Kirsch, Daniel Loisance, N. Costin Radu, Eric Allaire, Marianne Gervais, Thérapeutiques substitutives du coeur et des vaisseaux (TSCV), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS), Centre de recherche en économie et management (CREM), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Centre National de la Recherche Scientifique (CNRS), GREMAN (matériaux, microélectronique, acoustique et nanotechnologies) (GREMAN - UMR 7347), Université de Tours-Institut National des Sciences Appliquées - Centre Val de Loire (INSA CVL), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Centre National de la Recherche Scientifique (CNRS), Centre National de la Recherche Scientifique (CNRS)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU), Centre National de la Recherche Scientifique (CNRS)-Université de Tours (UT)-Institut National des Sciences Appliquées - Centre Val de Loire (INSA CVL), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA), Université de Tours (UT)-Institut National des Sciences Appliquées - Centre Val de Loire (INSA CVL), and Normandie Université (NU)-Normandie Université (NU)-Université de Rennes (UR)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Male, Vascular Endothelial Growth Factor A, Aortic valve, CD31, MESH: Dilatation, Pathologic, Vascular smooth muscle, Heart Valve Diseases, 030204 cardiovascular system & hematology, chemistry.chemical_compound, Aortic aneurysm, 0302 clinical medicine, Medicine, MESH: Endothelial Cells, MESH: Antigens, Differentiation, Myelomonocytic, Microvessel, MESH: Antigens, CD, Aorta, MESH: Aged, MESH: Middle Aged, Neovascularization, Pathologic, MESH: Enzyme-Linked Immunosorbent Assay, MESH: Myocytes, Smooth Muscle, MESH: Aorta, Middle Aged, Abdominal aortic aneurysm, Aortic Aneurysm, Platelet Endothelial Cell Adhesion Molecule-1, Vascular endothelial growth factor, medicine.anatomical_structure, Matrix Metalloproteinase 9, Aortic Valve, 030220 oncology & carcinogenesis, Disease Progression, Cardiology, Matrix Metalloproteinase 2, Female, MESH: Disease Progression, Cardiology and Cardiovascular Medicine, Dilatation, Pathologic, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Myocytes, Smooth Muscle, Antigens, Differentiation, Myelomonocytic, Enzyme-Linked Immunosorbent Assay, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, MESH: Actins, 03 medical and health sciences, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Antigens, CD, medicine.artery, Internal medicine, Ascending aorta, Humans, Aged, MESH: Humans, business.industry, Macrophages, MESH: Vascular Endothelial Growth Factor A, Endothelial Cells, MESH: Macrophages, MESH: Matrix Metalloproteinase 9, MESH: Antigens, CD31, MESH: Heart Valve Diseases, medicine.disease, Actins, MESH: Male, MESH: Aortic Aneurysm, MESH: Matrix Metalloproteinase 2, chemistry, Surgery, business, MESH: Neovascularization, Pathologic, MESH: Aortic Valve, MESH: Female
Abstract

Objectives The study addresses mechanisms driving the formation of ascending aortic aneurysms by comparing the maximal dilatation area with the transition area immediately adjacent to the normal aortic tissue left in place during surgical repair. Methods Aortic wall specimens were taken from the maximal dilatation area and transition area in 10 patients undergoing surgery for ascending aortic aneurysms and fixed for histology and immunohistochemistry for vascular smooth muscle cells (alpha-actin), endothelial cells (CD31), and macrophages (CD68). Tissue concentrations of vascular endothelial growth factor, matrix metalloproteinase-2, and matrix metalloproteinase-9 were determined by enzyme-linked immunosorbent assay. The results are expressed as medians with their 25th and 75th centiles. Results Vascular smooth muscle cells were significantly more abundant in the maximal dilatation area than in the transition area (20.3 [14.8-24.4]/10 −2 mm 2 vs 8.0 [6.4-9.3]/10 −2 mm 2 , respectively, P = .002). In the maximal dilatation area, vascular smooth muscle cells had lost their typical lamellar organization, whereas it was preserved in the transition area. Microvessels were significantly more abundant in the media of transition area than in the maximal dilatation area (7.5 [2.9-10.1]/mm 2 vs 1.75 [1.5-2.0]/mm 2 , respectively, P = .008) and were associated with an inflammatory cell infiltration that predominated in their immediate vicinity. There were no significant differences in vascular endothelial growth factor, matrix metalloproteinase-2, and matrix metalloproteinase-9 between both areas. Conclusions The transition area appears as a disease progression front characterized by microvessel formation and inflammatory cell infiltration. In contrast, increased vascular smooth muscle cell density in the maximal dilatation area suggests a healing process, although inefficient to prevent aortic dilatation.

Published
2006

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