DOCSLIB.ORG

THÈSE DE DOCTORAT DE « Clémentine SHAO »

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
THÈSE DE DOCTORAT DE « Clémentine SHAO » THÈSE DE DOCTORAT DE L’UNIVERSITE DE RENNES 1 COMUE UNIVERSITE BRETAGNE LOIRE Ecole Doctorale N°601 Mathématique et Sciences et Technologies de l’Information et de la Communication Spécialité : Signal, Image, Vision Par « Clémentine SHAO » « Images and models for decision support in aortic dissection surgery » «Images et modèles pour l’aide à la décision clinique de la chirurgie de la dissection aortique» Thèse présentée et soutenue à RENNES , le 16/12/19 Unité de recherche : LTSI, Inserm U1099 Thèse N° : Rapporteurs avant soutenance : Frans Van De Vosse, PR, Eindhoven University of Technology (TU/e), Netherlands Alain Lalande, MCU-PH, Université de Bourgogne Franche-Comté, France Composition du jury : Président : Examinateurs : Alain Lalande, MCU-PH, Université de Bourgogne Franche-Comté, France Nadjia Kachenoura, CR INSERM, Sorbonne Universités, France Frans Van De Vosse, PR, Eindhoven University of Technology (TU/e), Netherlands Jean-Philippe Verhoye, PU-PH, CHU de Rennes, France Dir. de thèse : Pascal Haigron, PR, Université de Rennes 1, France Co-dir. de thèse : Gabriele Dubini, PR, Politecnico di Milano, Italie Invité(s) Michel Rochette, Directeur Technique, Ansys France, France ACKNOWLEDGEMENT Je tiens à remercier I would like to thank. my parents.. J’adresse également toute ma reconnaissance à .... .... i LIST OF ABBREVIATIONS AA Ascending Aorta AD Aortic Dissection BC Boundary Condition BT Brachiocephalic Trunk CFD Computational Fluid Dynamics CT Computed Tomography CVS Cardiovascular System DA Descending Aorta DOE Design Of Experiment DNS Direct Numerical Simulation DSC Dice Similarity Coefficient FL False Lumen FSI Fluid-Structure Interaction HD Hausdorff Distance HED Holisticallynested Edge Detect LCC Left Common Carotid LES Large Eddy Simulation LS Left Subclavian MRI Magnetic Resonance Imaging PC MRI Phase-Contrast Magnetic Resonance Imaging RANS Reunold Averaged Navier-Stokes RBC Red Blood Cell RMS Root Mean Square RNG Renormalization Group ROM Reduced Order Model SAS Scale Adaptative Simulation TL True Lumen WSS Wall Shear Stress iii TABLE OF CONTENTS List of abbreviations iii List of Figures ix List of Tables xvii Résumé en Français xix Introduction 1 1 Clinical context 5 1.1 Cardiovascular system . 5 1.1.1 The heart . 6 1.1.2 Pulmonary and systemic circulations . 8 1.1.3 Aorta anatomy . 11 1.2 Aortic dissection . 12 1.2.1 Pathology, symptoms and causes . 13 1.2.2 Classification of ADs . 14 1.2.3 Treatment . 15 1.3 Conclusion . 16 2 Image segmentation of aortic dissection 19 2.1 Context and difficulties of the segmentation of type B AD . 19 2.2 State of the art . 22 2.3 Semi-automatic method for type B aortic segmentation . 24 2.3.1 Pre-processing . 25 2.3.2 Initialization of the two lumina . 27 2.3.3 Segmentation of the two lumina . 30 2.3.4 Post processing . 32 2.3.5 From segmentation to surface mesh . 33 v TABLE OF CONTENTS 2.3.6 Implementation of the method . 34 2.4 Results . 36 2.4.1 CT Image acquisition . 37 2.4.2 Parameters setup . 37 2.4.3 Segmentation error criteria . 38 2.4.4 Quantitative analysis . 38 2.4.5 Qualitative analysis . 43 2.4.6 Comparison with deep-learning based methods . 45 2.4.7 Comparison of CFD results using different smoothing methods . 48 2.5 Discussion . 51 2.6 Conclusion . 53 3 Patient specific CFD simulation of the aorta 55 3.1 State of the arts of CFD for AD . 55 3.1.1 Fluid modeling . 56 3.1.2 Model of the aorta wall . 58 3.1.3 Boundary conditions . 59 3.1.4 Summary . 60 3.2 0D models of the CVS as BCs for 3D CFD . 62 3.2.1 0D model of the systemic and pulmonary circulation . 63 3.2.2 0D model of the heart . 65 3.2.3 Multiscale coupling . 65 3.2.4 Personalization of the 0D model . 66 3.3 Method . 67 3.3.1 Geometry and meshes . 68 3.3.2 Creation of the hybrid 0D model of the aorta . 69 3.3.3 Initialization of the 0D model of the CVS . 75 3.3.4 Personalization of the 0D model of the CVS . 80 3.3.5 Setup of the 3D patient specific CFD . 83 3.4 Results . 84 3.4.1 Response surface from the static simulations . 84 3.4.2 Optimization processes . 85 3.4.3 3D transient fluid simulations of the AD . 88 3.4.4 Focus on the tear regions of the AD . 97 vi TABLE OF CONTENTS 3.5 Discussion . 97 3.6 Conclusion . 101 4 Dynamic ROM based on CFD 103 4.1 State of the arts . 103 4.2 Method . 105 4.2.1 SVD to obtain 3D dynamic ROM . 105 4.2.2 Dynamic ROM method . 107 4.2.3 Generation of the learning and validation data for the ROMs . 108 4.2.4 Integration of the ROM in the 0D model of the full CVS . 109 4.2.5 Computation of different clinical scenarios . 109 4.3 Results . 111 4.3.1 0D dynamic ROMs . 112 4.3.2 Final coupled 0D models . 115 4.3.3 ROMs computing the pressure at the wall . 119 4.3.4 ROMs computing the WSS . 126 4.3.5 ROMs computing the velocity vectors . 130 4.3.6 Simulation of clinical scenarios for AD . 135 4.4 Discussion . 139 4.5 Conclusion . 141 Conclusion 143 Bibliography 167 vii LIST OF FIGURES 1 Stucture de l’aorte. a) Différentes parties de l’aorte. b) Couches de la paroi de l’aorte. xx 2 Dissection aortique. a) Déchirure de l’intima. b) Classification de Stan- ford. xx 3 Schéma des différentes étapes de la méthodes de segmentation. xxii 4 Schéma des différentes étapes de la méthode de simulation dynamique spécifique patient. xxiv 5 Résultat de la simulation dynamique de l’aorte au pic de la systole. a) Pression à la paroi. b) Contraintes de cisaillement. c) Champs de vi- tesse. xxv 6 Schéma de l’approche basée sur les modèles d’ordre réduit pour le cas de la dissection aortique. xxvii 1.1 Scheme of the cardiovascular system. 6 1.2 Heart anatomy. 7 1.3 Cardiac cycle phases. 8 1.4 Vessels composing the pulmonary and systemic circulations. 9 1.5 Structure of the wall of the veins and arteries. 10 1.6 Structure of blood vessels. The values for medium arteries, arterioles, venules, and veins are merely illustrative because the dimensions can range widely. The drawings of the vessels are not to scale. 11 1.7 Anatomy of the aorta. a) Structure of the aorta. b) Branches of the aorta. 12 1.8 AD with a zoom on the entry tear. 13 1.9 Stanford and De Bakey AD classifications. 15 1.10 Type B dissection and endovascular devices (Stent-graft and delivery system) [105] . 16 ix LIST OF FIGURES 2.1 CT slices of ADs with various shapes. a) Typical case. b) Difference of contrast between the two lumina. c) Noise giving the flap blurry. d) True lumen completely surrounded by the false lumen. e) Moving flap. f) Partially thrombosed false lumen. g) Aneurysm in the aortic arch. h) Aneurysm and separated lumina. i) Stent in one lumen. 21 2.2 Image processing pipeline of the segmentation method. 25 2.3 Preprocessing steps of the image. a) Ct-scan image. b) Smoothed image. c) Gradient image. d) Sigmoid image. 27 2.4 Pathlines of the two lumina : initialization points and different parts of TL. 28 2.5 Segmentation steps of the two lumina. a) Result from the fast-marching method for the true lumen. b) Result from the active contour geodesic method for the true lumen. c) Result from the fast-marching method for the false lumen. d) Result from the active contour geodesic method for the false lumen. 32 2.6 Steps of the Laplacian smoothing. a) Original points. b) Center of gravity calculation G. c) Moving the initial point in the direction of G by a fraction λ of the distance. d) New point position. 33 2.7 Screenshot of the interface of 3D Slicer. 35 2.8 Screenshot of the graphic user interface of the developed segmentation module. 35 2.9 Screenshot of the final segmentation results. 36 2.10 Example of the uncertainty of the manual segmentation on a CT slice with noise. a) CT scan slice. b) First example of segmentation. c) Second example of segmentation. 39 2.11 Distance error for patient 2. a) Absolute distance between the manually segmented dissection and the semi-automatically extracted one. b) Seg- mentation results on the slice with the highest distances. c) Correspon- ding CT slice. 41 2.12 Distance error of patient 4.1. a) Absolute distance between the manually segmented dissection and the semi-automatically extracted one. b) Seg- mentation results on slice 1. c) CT slice of slice 1. d) Segmentation re- sults on slice 2. e) CT slice of slice 2. 42 x LIST OF FIGURES 2.13 Distance error of patient 7.1. a) Absolute distance between the manually segmented dissection and the semi-automatically extracted one. b) Seg- mentation results on slice 1. c) CT slice of slice 1. d) Segmentation re- sults on slice 2. e) CT slice of slice 2. 43 2.14 CT slice of the case where the true lumen was too thin and the segmen- tation failed. 44 2.15 Segmentation on various geometries of the lumina. a) Typical AD slice b) Case where three lumina appear on the same slice. c) Case with a partially thrombosed FL. d) Case with an aneurysm in the aortic arch. e) Case with an aneurysm and a stent.
Load more

Recommended publications
  • Bentall Procedure: Quarter Century of Clinical Experiences of a Single
    Benke et al. Journal of Cardiothoracic Surgery (2016) 11:19 DOI 10.1186/s13019-016-0418-y RESEARCHARTICLE Open Access Bentall procedure: quarter century of clinical experiences of a single surgeon Kálmán Benke1,3*, Bence Ágg1,3, Lilla Szabó1, Bálint Szilveszter1,4, Balázs Odler2, Miklós Pólos1, Chun Cao1, Pál Maurovich-Horvat1,4, Tamás Radovits1, Béla Merkely1 and Zoltán Szabolcs1,3 Abstract Background: We retrospectively analyzed 25 years of experiences with the button Bentall procedure in patients with aortic root pathologies. Even though this procedure has become widespread, there are only a few very long term follow-ups available in the clinical literature, especially regarding single surgeon results. Methods: Between 1988 and 2013, a total of 147 patients underwent the Bentall procedure by the same surgeon. Among them there were 62 patients with Marfan syndrome. At the time of the surgery the mean age was 46.5 ± 17.6 years. The impact of surgical experience on long-term survival was evaluated using a cumulative sum analysis chart. Results: The Kaplan-Meier estimated overall survival rates for the 147 patients were 91.8 ± 2.3 %, 84.3 ± 3.1 %, 76.3 ± 4.9 % and 59.5 ± 10.7 % at 1,5,10 and 20 years, respectively. Multivariate Cox regression analysis identified EuroSCORE II over 3 % (OR 4.245, 95 % CI, 1.739–10.364, p = 0.002), acute indication (OR 2.942, 95 % CI, 1.158–7.480, p = 0.023), use of deep hypothermic circulatory arrest (OR 3.267, 95 % CI, 1.283–8.323, p = 0.013), chronic kidney disease (OR 6.865, 95 % CI, 1.339–35.189, p = 0.021) and early complication (OR 3.134, 95 % CI, 1.246–7.883, p = 0.015) as significant risk factors for the late overall death.
    [Show full text]
  • Selected Terms Used in Adult Congenital Heart Disease Jack M
    SELECTED TERMS USED IN ADULT CONGENITAL HEART DISEASE JACK M. COLMAN | ERWIN NOTKER OECHSLIN | MATTHIAS GREUTMANN | DANIEL TOBLER ambiguus A With reference to cardiac situs, neither right nor left sided aberrant innominate artery (indeterminate). Latin spelling is generally used for situs ambig- A rare abnormality associated with right aortic arch compris- uus. Syn: ambiguous sidedness. See also situs. ing a sequence of arteries arising from the aortic arch—right carotid artery, right subclavian artery, and then (left) innomi- Amplatzer device nate artery—with the last passing behind the esophagus. This A group of self-centering devices delivered percutaneously by is in contrast to the general rule that the first arch artery gives catheter for closure of abnormal intracardiac and vascular con- rise to the carotid artery contralateral to the side of the aortic nections such as secundum atrial septal defect, patent foramen arch (ie, right carotid artery in left aortic arch and left carotid ovale or patent ductus arteriosus. artery in right aortic arch). Syn: retroesophageal innominate artery. Anderson-Fabry disease See Fabry disease aberrant subclavian artery Right subclavian artery arising from the aorta distal to the left aneurysm of sinus of Valsalva subclavian artery. Left aortic arch with (retroesophageal) aber- See sinus of Valsalva/aneurysm. rant right subclavian artery is the most common aortic arch anomaly. It was first described in 1735 by Hunauld and occurs anomalous pulmonary venous connection in 0.5% of the general population. Syn: lusorian artery. See also Pulmonary venous connection to the right side of the heart, vascular ring. which may be total or partial.
    [Show full text]
  • Table of Contents Introduction
    Congenital Heart Surgery Database v.3.3 effective July 1, 2015 Training Manual October 2017 Table of Contents Introduction ................................................................................................................................................................2 1. Administrative ...............................................................................................................................................2 2. Demographics ...............................................................................................................................................5 3. Noncardiac Congenital Anatomic Abnormalities ....................................................................................... 21 4. Chromosomal Abnormalities ..................................................................................................................... 22 5. Syndromes ................................................................................................................................................. 23 6. Hospitalization ........................................................................................................................................... 24 7. Preoperative Factors .................................................................................................................................. 28 8. Diagnosis .................................................................................................................................................... 30 9. Procedures ................................................................................................................................................
    [Show full text]
  • Eighteen Years of Clinical Experience with a Modification of the Bentall Button Technique for Total Root Replacement
    6741 Original Article Eighteen years of clinical experience with a modification of the Bentall button technique for total root replacement Dimos Karangelis, Dimitrios Tzertzemelis, Alexandros A. Demis, Stella Economidou, Matthew Panagiotou Cardiac Surgery Department, Athens Medical Center, Distomou 5, Amaroussio 151 25, Greece Contributions: (I) Conception and design: D Karangelis, M Panagiotou; (II) Administrative support: S Economidou, M Panagiotou; (III) Provision of study materials or patients: D Tzertzemelis, AA Demis; (IV) Collection and assembly of data: D Tzertzemelis, AA Demis; (V) Data analysis and interpretation: D Karangelis, D Tzertzemelis, S Economidou; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Matthew Panagiotou, MD, FECTS. Cardiac Surgery Department, Athens Medical Center, Distomou 5, Amaroussio 151 25, Greece. Email: [email protected]. Background: We retrospectively reviewed our experience with the modified Bentall procedure and evaluated the short- and long-term results over a period of 18 years. Methods: Between 1999 and 2017, 89 patients with a mean age of 57.3±13.9 years underwent the modified Bentall operation with a slight modification for the correction of aortic root disease. Results: The operative mortality was 1.1% while the overall early mortality rate, defined as death within 30 days of initial hospitalization, was 2.2% (2/89). Logistic regression analysis revealed that increased Euroscore and aortic cross-clamp times were associated with greater likelihood for complications. The overall survival rates for the 89 patients (including deaths occurred at the initial hospitalization) were 93.0% (SE =3.0%) at 6 months, 93.0% (SE =3.0%) at 1 year, 89% (SE =5.0%) at 5 years and 73.0% (SE =5.0%) at 10, 15 and 18 years.
    [Show full text]
  • Case Report Bentall Surgery for Acute Aortic Dissection
    KYAMC Journal Vol. 9, No.2, July 2018 Case Report Bentall surgery for acute aortic dissection (type-a) in a patient with marfan syndrome Mohammad Arifur Rahman1, Md. Lutfar Rahman2, Prakash Chandra Munshi3, Taslim Yusuf Tamal4, Mejbaur Rahman5, Mehedi Hassan Romel6, Joyanta Kumar Saha7, Mohammad Quamruzzaman8 Abstract Background: Marfan syndrome is an autosomal-dominant hereditary connective tissue disorder with the clinical manifestations involving the ocular, skeletal, and cardiovascular systems. The cardiovascular manifestations include aortic root dilatation, aortic valvular insufficiency, mitral valve prolapse, mitral regurgitation, aortic dissection and aortic rupture. Acute aortic dissection is one of the most common catastrophes involving the aorta. A high index of suspicion is important in patients who have predisposing risk factors. Classification is based on the location of dissection and its duration. Stanford type A (De bakey type I /type II) dissection should be treated surgically in essentially all cases. Objective: To report our experience in Bentall surgery in Acute aortic dissection (type A ). The efficacy of right axillary artery cannulation was investigated. Materials & Methods: Patient with acute type A aortic dissection involving coronary sinuses with 3 vessels of the arch free of lesions underwent aortic valve with ascending aorta and hemiarch replacement with composite valve graft (Bentall procedure) and reimplantation of coronary arteries under moderate hypothermia. The axillary artery was used for arterial cannulation. Results: Weaning from CPB was smooth. Perioperative period was eventless. Follow-up Echo revealed normal cardiac parameters. Conclusion: Prompt establishment of the diagnosis, through focused physical examination and noninvasive imaging, followed by rapid medical and surgical therapy, are the only effective methods to alter survival in patients with acute aortic dissection.
    [Show full text]
  • Pericardial Dysfunction Postoperative Cardiac Surgery
    An Exploration of Issues Associated with Pericardial Dysfunction in Postoperative Cardiac Surgery Patients Glenda Pack, RN, NP, MN, CCCN(C), CCN(C) Dynamics 2013 Nurse Practitioner, CV Surgery September 23/13 Eastern Health, St. John’s, Newfoundland Review the anatomy and pathophysiology associated with conditions involving the pericardium Explore the trajectory of pericardial dysfunction Assist the nurse to hone assessment skills to detect pericardial dysfunction Review historical and current treatment methodologies Approach to Excising Approach to Closing Open Improved hemodynamics in the early phase Decreased incidence of graft failure ? Reduced incidence of cardiac tamponade Closed Protective from sternal adhesions in redo-operations Might not have control over how the pericardium is handled, but knowing how it was handled is important for patient management Pericardial Effusion Excess accumulation of fluid in the pericardium May or may not be clinically significant Pericarditis Inflammation of the Cardiac Tamponade pericardium Pericardial Effusion that causes significant compression of the heart Acute Latent PPtost-PPiericardi ditotomy Synd rome 70 yo male POD #1 CABG x3 Chest tubes removed 3 hours ago Complaining of vague chest discomfort Unable to take a deep breath Pericardial friction rub LSB POD #! Inflammation of the pericardium CV patient Idiopathic Direct and/or indirect trauma Benign and self limiting Diagnosis Treatment ECG Relieve Symptoms Symptoms Analgesics Friction rub NSAIDs Corticosteriods
    [Show full text]
  • Clinician Update Feb
    Clinician Update Feb. 4, 2021 Countdown to the Cures Act: Virtua’s Release Set for Feb. 23 The date is now set. On Tuesday, Feb. 23, in accordance with the federally mandated 21st Century Cures Act, Virtua plans to begin immediate electronic release of all inpatient and outpatient clinical results to the patient’s MyChart account. The Cures Act will bring major changes in how health information is delivered and shared, giving patients greater access and control through full and immediate access to their record, as well as their ability to share that record for whom they give authorization. We support this policy toward the goal of achieving the best outcomes for our patients. The Cures Act will require readiness on all our parts. Virtua is working diligently to support our clinicians through this dramatic shift in data management. We will continue to provide updates and are planning future opportunities for education. Remember, we have a Cures Act resource section available to all Virtua clinicians on Digital 411. In the coming days, we will continue to update content with tip sheets and resource documents. Feel free to direct any questions to [email protected]. Case Summaries Highlight Virtua’s CT Surgery Capabilities At a recent cardiovascular services summit, council leads shared updates and achievements that demonstrate the comprehensive nature of Virtua’s heart program. Each of the sections, including congestive heart failure, clinical cardiology, interventional cardiology, heart rhythm, and structural heart, as well as cardiothoracic surgery, were represented. Case reviews highlighted the expertise of several clinical sections, including the following presented on behalf of the cardiac surgery program by Arthur Martella, MD, Chief of Cardiothoracic Surgery at Virtua: • Dr.
    [Show full text]
  • Copyrighted Material
    Index Note: Page numbers in italics refer to Figures; those in bold to Tables. activated clotting time (ACT), 35–9 interrupted aortic arch, 121 Blalock–Taussig shunt (BTS), 95, 114, Alfieri stitch, 172 luminal variation, 24, 25 115, 117, 129, 142, 149, 152, 155, alpha-stat blood gas management see placement, 79–80 159, 173, 177, 180 blood gas management regional perfusion strategies, 52–4, 115 blood coagulation see anticoagulation anomalous aortic origin of a coronary arterial decannulation, inadvertent, 73, management artery (AAOCA), 88 170 blood gas management anomalous left coronary artery from the arterial head occlusion, 29–30 alpha-stat management, 40–44 pulmonary artery (ALCAPA), 86 arterial line filters (ALF) on bypass, 80–81 anticoagulation management blood flow path, 13, 13 oxygenation strategy, 42–4 activated clotting time (ACT), 35–9 external, 12, 12, 13, 14, 61–2 pH-stat management, 40–44 blood coagulation pathways, 35, 35, 36 integral, 5–8, 9 blood pressure management coagulation factors, 35, 35 arterial pump failure (roller head), 164 cardiopulmonary bypass, 47–8 heparin concentration management, 37 arterial switch operation (ASO), 85, 112, cerebral blood flow (CBF), 47 prime volume 140, 141, 174–7 see also Jatene higher than expected, 148 circuit exposure, 36 procedure lower than expected, 149 examples, 14, 187, 188 arterio venous MUF (AVMUF), 56–9, 57 ranges, 48, 48 oxygenator primes, 5–8 atrial line, 77 blood prime see also priming procoagulant factors, 35, 36 placement, 82 blood volume, 31, 31 protamine dosing, 38–9
    [Show full text]
  • Fate of the Coronary Ostial and Distal Aortic Anastomoses After Modified Bentall’S Operation (UKC’S Modification)
    Chowdhury UK, George N, Singh S, Hasija S, Sankhyan LK, Sharma S, Pandey NN, Sengupta S, Kalaivani M. Fate of the Coronary Ostial and Distal Aortic Anastomoses after Modified Bentall’s Operation (UKC’s Modification). J Surg & Journal of Surgical Tech.2020;2(1):11-20 Surgery and Surgical Technology Original Research Article Open Access Fate of the Coronary Ostial and Distal Aortic Anastomoses after Modified Bentall’s Operation (UKC’s Modification) Ujjwal K. Chowdhury1*, Niwin George1, Sukhjeet Singh1, Suruchi Hasija2, Lakshmikumari Sankhyan1, Srikant Sharma1, Niraj Nirmal Pandey3, Sanjoy Sengupta1, Mani Kalaivani4 1Departments of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India. 2Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India. 3Department of Cardiac Radiology ,All India Institute of Medical Sciences, New Delhi, India. 4Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India. Article Info Article Notes Received: May 04, 2020 Accepted: June 13, 2020 *Correspondence: Dr. Ujjwal Kumar Chowdhury, M.Ch, Diplomate NB, Professor, Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India; Telephone No: 91-11-26594835; Fax No: 91-11- 26588663, 26588641; Email: [email protected], [email protected]; Orcid ID: http://orcid.org/0000-0002-1672-1502. ©2020 Chowdhury UK. This article is distributed under the terms of the Creative Commons Attribution
    [Show full text]
  • Ascending Aortic Disease in a Patient with Marfan Syndrome
    Case reports 2017; 3(2) https://doi.org/10.15446/cr.v3n2.61493 ASCENDING AORTIC DISEASE IN A PATIENT WITH MARFAN SYNDROME Palabras clave: Aneurisma de la Aorta; Cirugía torácica; Aorta Torácica; Disección aórtica aguda, Marfan. Keywords: Aortic Aneurysm; Thoracic surgery; Thoracic aorta; Acute Aortic Dissection, Marfan. Edison Ricardo Espinoza Saquicela General Surgeon Cardiothoracic Surgery resident Instituto Nacional de Cardiología Ignacio Chávez Universidad Nacional Autónoma de México Mexico City – México Stefanía del Cisne Serrano Olmedo General Surgeon Urology resident. Hospital Juárez de México Universidad Nacional Autónoma de México Mexico City - México Corresponding author: Edison Ricardo Espinoza Saquicela Instituto Nacional de Cardiología Ignacio Chávez Universidad Nacional Autónoma de México Ciudad de México. México Email: [email protected] Received: 10/12/2016 Accepted: 15/10/2017 ascending aortic disease in a patient with marfan syndrome ABSTRACT this condition, hence the importance of prop- 99 er diagnosis and management. Introduction. Acute thoracic aortic dissection is caused by a tear in the intimal lining of RESUMEN the aorta, and is a symptom of acute aortic syndrome. The dissection allows the blood to Introducción. La incidencia de síndrome de pass through the rupture and separates the tu- Marfan que ha sido reportada a nivel mundial nica intima from the tunica media or the tunica es de 1 en 5000 casos, de los cuales apro- adventitia, creating a false intravascular light. ximadamente el 80% o más desarrollan com- Early diagnosis directly affects the chances of plicaciones cardiovasculares. La disección survival, since it is a medical emergency that aórtica torácica aguda requiere una rotura en can lead to death, even with optimal treatment.
    [Show full text]
  • SPECIAL ISSUE Dear Colleagues
    INSIDE THIS ISSUE Bilateral Lung Tx ‘Hemi-Commando’ Branched Frozen Plus CABG for CAD for Bivalvular Elephant Trunk for with End-Stage Endocarditis – p. 6 Aortic Dissection Lung Disease – p. 4 – p. 8 Cardiac Consult Heart and Vascular News from Cleveland Clinic | Winter 2017 › SPECIAL ISSUE Dear Colleagues: If the past decade didn’t make it clear enough, 2016 has left no doubt: Continuing change is the surest constant we can count on in U.S. healthcare in the years ahead. The inevitability of that change is something we all must grapple with, par- ticularly when change increasingly comes in the form of tightening reimburse- ments. Those sorts of changes can make it all too tempting for organizations to hunker down and play it too safe, avoiding the most complex cases that might sometimes skew outcomes numbers or draw disproportionate staff time and resources. That’s a temptation Cleveland Clinic’s Miller Family Heart & Vascular Institute is Cardiac Consult offers updates and insights committed to never give in to. This special issue of Cardiac Consult is devoted from specialists in Cleveland Clinic’s Sydell exclusively to brief reports of complex cases managed at Cleveland Clinic in the and Arnold Miller Family Heart & Vascular past few years — years of unprecedented healthcare system change. Institute. Direct correspondence to: These case studies show how our institute’s interdisciplinary corps of clini- Medical Editors cians — cardiothoracic surgeons, vascular surgeons and all manner of cardio- Lars G. Svensson, MD, PhD vascular medicine subspecialists — pool their expertise in creative ways to Institute Chair solve problems for patients who’ve often been told elsewhere that their cases [email protected] are beyond intervention.
    [Show full text]
  • Cardiovascular/Thoracic Surgery CAQ Blueprint
    1 Cardiovascular/Thoracic Surgery CAQ Blueprint Content Area Percentage 1. Cardiac 40 2. Thoracic 15 3. Vascular 5 4. Assist Devices 5 5. ICU Management 15 6. Clinical Skill Requirements 5 7. Pharmacotherapy 10 8. Quality Metrics 5 The following clinical tasks apply to all categories below: – Patient presentation – Anatomy and physiology – Preoperative evaluation and management – Invasive and noninvasive imaging – Operative and non-operative intervention – Postoperative management 1. CARDIAC (40%) o Non–ST-segment elevation A. Aortic disease myocardial infarction • Aneurysm • Incomplete revascularization Root o • Prinzmetal variant angina Arch o • Post infarct complications Ascending o Dressler syndrome Pseudoaneurysm o o Left ventricular aneurysm • Aortic root disorders o Left ventricular wall rupture • o Connective tissue disorders Papillary muscle rupture • Dissection o o Ventricular septal defect B. Congenital conditions • Revascularization techniques and • Anomalous origin of the coronary artery conduits • Atrial septal defect • Coarctation of the aorta • Patent ductus arteriosus D. Electrophysiologic disorders • Patent foramen ovale • Atrial fibrillation/flutter • Persistent left superior vena cava • Blocks (atrioventricular, bundle branch, • Tetralogy of Fallot complete) • Ventricular septal defect • Bradycardia C. Coronary artery disease • Device-related infection • Acute coronary syndrome • Intraventricular conduction delay o Stable angina • Paroxysmal supraventricular tachycardia o Unstable angina • Tachycardia-bradycardia syndrome
    [Show full text]