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Related Concept Videos

Aortic Regurgitation II: Clinical Features and Diagnostic Tests01:22

Aortic Regurgitation II: Clinical Features and Diagnostic Tests

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Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
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Aneurysm I: Introduction01:30

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An aortic aneurysm is a localized outpouching or dilation at a weak point in the artery wall. It may involve different parts of the aorta, such as the abdominal aorta, aortic arch, or thoracic aorta.Etiological factorsSeveral disorders are associated with aortic aneurysms.Congenital causes, such as primary connective tissue disorders like Marfan syndrome, impact the integrity and strength of connective tissues, notably affecting the aorta. Marfan syndrome is a genetic disorder that specifically...
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Aneurysm II: Clinical Manifestations and Diagnostic Studies01:21

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Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
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Aneurysm III: Interprofessional Care01:26

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Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
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Aortic Regurgitation I: Introduction01:15

Aortic Regurgitation I: Introduction

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IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
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Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
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Root Dilatation Is More Malignant Than Ascending Aortic Dilation.

Paris D Kalogerakos1, Mohammad A Zafar1, Yupeng Li2

  • 1Aortic Institute at Yale-New Haven Hospital Yale University School of Medicine New Haven CT.

Journal of the American Heart Association
|July 9, 2021
PubMed
Summary

Current guidelines for ascending aortic dissection intervention miss cases. This study suggests separate intervention criteria for the aortic root (5.0 cm) and ascending aorta (5.25 cm) due to their distinct natural histories and risks.

Keywords:
aneurysmaortic rootdissectionmid‐ascending aortanatural historysurgical threshold

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Area of Science:

  • Cardiovascular Surgery
  • Aortic Aneurysm Research
  • Thoracic Aortic Disease

Background:

  • Ascending aortic dissection guidelines (5.5 cm) may miss dissections at smaller sizes.
  • Aortic root and ascending aorta are often studied as a single unit, ignoring distinct characteristics.
  • Existing research lacks segment-specific intervention criteria for thoracic aortic aneurysms.

Purpose of the Study:

  • To differentiate the natural histories of the aortic root and ascending aorta.
  • To establish distinct, natural behavior-defined intervention criteria for each aortic segment.
  • To improve risk stratification and management for ascending thoracic aortic aneurysms.

Main Methods:

  • Separate measurement of aortic root and mid-ascending aortic diameters.
  • Retrospective analysis of long-term complications in 1162 patients with ascending thoracic aortic aneurysm.
  • Cox regression analysis to identify predictors of adverse events (dissection, rupture, death).

Main Results:

  • Aortic root dilation (P=0.017) is a more significant predictor of adverse events than mid-ascending aortic dilation (P=0.087).
  • Short stature identified as a significant risk factor for adverse events.
  • Risk curves indicate critical diameters: 5.0 cm for the aortic root and 5.25 cm for the mid-ascending aorta.

Conclusions:

  • The aortic root and mid-ascending aorta exhibit unique natural histories and risk profiles.
  • Aortic root dilation carries a significantly higher risk of adverse events.
  • Consideration of lower intervention thresholds (5.0 cm for root, 5.25 cm for ascending aorta) at expert centers is recommended.