Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This article discusses coarctation of the aorta in the adult. Effective treatments for coarctation have come from surgery since 1945 and from interventional cardiology since 1982. Long-term outcome data are available only for surgical approaches. Thirty-year survival rate is 72% to 82%. Complications include recoarctation or residual coarctation, hypertension, aneurysms at the repair site, spinal cord injury. Other sequelae include bicuspid aortic valve disease, ascending aortic aneurysm, premature coronary disease, and infective endocarditis or endarteritis. Interventional catheter therapy is now the preferred therapy for recurrent coarctation, when the anatomy permits and necessary skills are available. Its use in native or unoperated coarctation is less well established. Treatment may be with balloon angioplasty alone or with a stent. Outcomes are good in skilled hands, but residual or recurrent coarctation with resultant hypertension and repair site aneurysms can occur. Catheter treatment can cause death from aortic rupture and dissection, but mortality compares favorably with surgery if coarctation is recurrent, and perhaps for initial treatment.
 ...
PMID:Treatment of coarctation and late complications in the adult. 1608 83

We present clinical follow-up of a 20-year-old male with an aortic aneurysm secondary to aortic coarctation. The diagnosis of aortic aneurysm secondary to aortic coarctation was made in 1997. The patient did not agree to undergo any invasive or therapeutic procedures at that time. He presented to an emergency unit with severe chest pain after chest trauma obtained during judo exercises in 1998. Two-dimensional echocardiography showed bicuspid aortic valves, an ascending aortic aneurysm 6 cm in diameter with an intimal flap and false lumen, aortic coarctation distal to the left subclavian artery, and aortic insufficiency secondary to annular dilatation. Type II aortic dissection was confirmed by transesophageal echocardiography, which showed the dissection was confined to the ascending aorta. The dissection extended to the beginning of the arcus aorta. Following stabilization of the patient's clinical condition, balloon coarctation angioplasty was performed to reduce afterload and hypertension and to facilitate femoral artery cannulation for cardiopulmonary bypass. Surgical procedures included resection of the aortic valve and prosthetic valve implantation, resection of the ascending aorta, and interposition of a 22 mm Hamashied tubular vascular graft. At a follow-up visit 6 years later, the patient reported being easily fatigued and having palpitations. He had been suffering from hemolytic anemia and mild renal function impairment. Cardiac catheterisation and angiography showed a 40 mmHg gradient due to kinking of the aortic graft and no gradient at the coarctation site. We postulated the kinking of the aortic vascular graft may be related to an inappropriate vascular graft length. We also thought that the severe hemolysis was attributable to the disturbance of blood flow by a jet of blood at the site of the kinking aortic vascular graft. A second operation was performed because the renal function of the patient had decreased progressively and hemolysis symptoms increased. After the second operation, hemolysis on peripheral blood smears had disappeared and renal function had shown progressive improvements.
 ...
PMID:Clinical and hemodynamic follow-up of a patient after operation for dissection of an ascending aortic aneurysm secondary to coarctation of the aorta. 1639 8

A young lady with post-subclavian coarctation and cranial hypertension is discussed. She had a jump graft from left subclavian artery to descending aorta, and presented 18 years later with hypertension, calcification of the graft with a gradient of 40 mmHg across it. In the meantime, she also developed moderate aortic regurgitation on a bicuspid aortic valve. Management strategies including trans-catheter options are discussed. We present our reservations on trans-catheter options in an occluded dacron graft.
 ...
PMID:Calcific stenotic jump graft. 1674 63

Only 2 comprehensive surgical series, published in 1977 and 1983, have evaluated clinicopathologic features of the ascending aorta. Retrospective review of medical records and microscopic slides was performed on 513 consecutive patients with surgical resection of ascending aortic tissue (1985 to 1999). Patients were 2 to 89 years old (mean 59 y), and 303 (59%) were men. Aneurysm or dissection was the indication for surgery in 479. Aortic valves were also excised in 360. Systemic hypertension was present in 279, inherited connective tissue disease (ICTD) in 67, arteritis in 33, and acquired connective tissue disease in 16. Microscopy showed cystic medial degeneration (CMD) in 209, aortic dissection (AD) in 109 (with CMD in 56), normal media in 90, aortitis in 57 (with CMD in 14), and other findings in 48. The most significant, independent risk factor of CMD and AD was ICTD (confidence interval=7.61 and 2.26, respectively). Systemic hypertension was more common in patients with AD than without (P=0.0202). Normal media was the most common histologic finding associated with bicuspid aortic valve (P<0.0001). Among 57 patients with aortitis (giant cell in 39), ages ranged from 16 to 85 years (mean 64 y), and 42 (74%) were women; only 8 had Takayasu arteritis, and 11 had temporal or systemic arteritis. In surgically resected ascending aorta, the 3 most common histologic findings were CMD, AD, and normal media. ICTD, systemic hypertension, and bicuspid aortic valve were common comorbid findings. Giant cell aortitis occured predominantly in women, usually without systemic disease.
 ...
PMID:Surgical pathology of the ascending aorta: a clinicopathologic study of 513 cases. 1693 61

Medico-legal post-mortems referred to the Department of Pathology, for the histopathological examination, revealed six cases of acute aortic dissection--two in isolation, three in combination with congenital bicuspid aortic valve; and one isolated case of congenital bicuspid aortic valve. One case of isolated aortic dissection was associated with Marfan's syndrome; and one case of aortic dissection with bicuspid aortic valve was associated with polycystic kidneys. History of hypertension could be elicited in two cases. Cystic medial degeneration of aorta was seen in three cases; one of which was associated with Marfan's syndrome. All five cases of aortic dissection belonged to type II of DeBakey classification.
 ...
PMID:Aortic dissection and bicuspid aortic valve: an autopsy study. 1700 77

An unusual case of total occlusion of aorta just distal to the left subclavian artery, bicuspid aortic valve, and occluded left external iliac artery in a 21-year-old man who was admitted with headache and severe hypertension is presented. We wish to report this case because so far there have been none reported with such multiple aortic abnormalities, although several documented cases of isolated total occlusion of aorta exist. Our patient underwent a successful surgical correction, i.e., patch plasty to the coarcted segment and end to side - end to side aortal-aortal bypass with Dacron graft.
 ...
PMID:An unusual case of multiple aortic abnormalities: total occlusion of aortic arch, left external iliac artery, and bicuspid aortic valve in a 21-year-old man. 1739 Feb 10

We herein report the performance of a successful, modified Bentall procedure and a total arch replacement for a Stanford type A chronic aortic dissection and a bicuspid aortic valve in Turner's syndrome (TS). The patient was a 45-year-old woman with 45, XO karyotype TS, who had had a history of hypertension since the age of 20. She had also been diagnosed as having a dilatation of the ascending aorta and a bicuspid aortic valve 3 years earlier. The patient became aware of back pain 6 months prior to the current admission, and was diagnosed as having a Stanford type A chronic aortic dissection and a bicuspid aortic valve with mild aortic regurgitation. One of the greatest concerns in TS is the risk of aortic dissection. Regarding the operation, aortic root replacement is one of the options for a bicuspid aortic valve so as to avoid high-risk surgical procedures in TS.
 ...
PMID:Aortic dissecting aneurysm with a bicuspid aortic valve in Turner's syndrome: report of a case. 1764 11

Classical treatment of coarctation of the aorta consists of resection and suture through a left thoracotomy. However, over the last 20 years, balloon angioplasty, recently associated with stenting, has progressively supplanted surgery in the adult both in native forms and in recoarctions. Usually, the diameters of the balloon and stent are chosen to be the same as that of the aortic isthmus or proximal aortic arch without exceeding that of the aorta at the diaphragm. Moreover, the tendency now is to recommend stenting in cases of severe, tubular and long stenosis associated with proximal hypoplasia and in cases of residual gradients after dilatation. The complications of percutaneous techniques are the risk of restenosis (11-15%), aneurysm formation (5%), and a very small risk of dissection. However, it is recognised that stenting is associated with fewer complications than dilatation alone or surgery. After correction, the main problem is that of hypertension, often associated with persistence of a pressure gradient at the isthmus. Coarctation is often associated with a congenital bicuspid aortic valve in nearly 50% of cases and the valvular condition may progress to stenosis or incompetence requiring corrective surgery. In these cases, a dilatation of the aorta must also be suspected which may progress to an aneurysm. In addition, pregnancy is often complicated by maternal hypertension. The consequences are a high risk of abortion and, for the child, a prematurity, poor growth, and a small risk of recurrence of the cardiac disease. Pregnant women should be followed up in a multidisciplinary fashion and, when possible, problems of residual stenosis, aneurysm and hypertension should be controlled and corrected before the woman wishes to be pregnant. In practice, medium and long term follow up should be undertaken by specialist teams and comprise clinical examination, blood pressure investigations on effort and by ambulatory recording, Doppler ultrasonography of the aortic arch and aortic valve and MRI which has become the reference examination for the aortic arch. After the initial investigations, these tests should be repeated every 2 or 5 years in adults or sooner depending on the results of the initial work-up.
 ...
PMID:[Management of aortic coarctation at the adult age]. 1764 79

The 2006 practice guidelines from the American College of Cardiology and the American Heart Association recommend prophylactic aortic replacement for even an asymptomatic patient with a bicuspid aortic valve (BAV) when the aortic dimensions exceed arbitrary ranges based on Marfan syndrome, without comparing risk estimates of aortic dissection with operative risks. In the International Registry of Acute Aortic Dissection, which includes >1,000 autopsied subjects, the average age is 63 years; BAVs are found in only 3%, compared with histories of hypertension in 72%. The risk for valve-sparing aortic replacement is 4% and that for late mortality is 10%, on the basis of 5 publications. The aortic dimensions are from guidelines for Marfan syndrome, with a proved genetic weakness of connective tissue, whereas no culprit genes have been demonstrated in BAV. Although cystic medial necrosis is seen in dilated aortas associated with Marfan syndrome and BAV, it is also seen in dilated aortas with other causes. There is no convincing proof that cystic medial necrosis causes dissection or is simply an effect of dilatation. BAV is not associated with dilatation of the pulmonary arteries, in contrast to Marfan syndrome. Hemodynamic explanations for dilatation of the ascending aorta have been largely ignored because of a belief that it requires severe aortic stenosis or regurgitation. In conclusion, vascular dilatation without a genetic weakness is caused by coarse periodic vibrations from even trivial valve disorders, demonstrated experimentally. There is a natural history of progressive deterioration of the BAV, including the valve left in a valve-sparing aortic replacement, that makes the operation ill advised, as opposed to valve replacement with aortic reinforcement.
 ...
PMID:A critical review of the American College of Cardiology/American Heart Association practice guidelines on bicuspid aortic valve with dilated ascending aorta. 1857 46

Cardiovascular complications in Turner's syndrome are the most common cause of excess early mortality, with a life expectancy that may be reduced by more than 10 years. Congenital cardiac abnormalities are described in approximately one third of patients. These abnormalities are mostly left heart obstructions, the most common of which are bicuspid aortic valve (16%) and coarctation of the aorta (11%). Dilatations of the ascending aorta are often described and may occur in isolation from any heart disease, suggesting a vasculopathy specific to the syndrome, probably predisposed to by extracardiac risk factors such as oestrogen deficiency, diabetes, dysplidaemia and overweight. The most feared complication is aortic dissection with around a 100 cases, described at average age of approximately 35-years-old. This is believed to complicate 2% of induced pregnancies. Hypertension (HBP) usually essential, affects up to 50% of patients with Turner's syndrome. This is an important risk factor for cardiovascular complications and justifies aggressive treatment. On the other hand, retrospective studies have not demonstrated adverse cardiological effects due to growth hormone treatments. Patients with Turner's syndrome merit regular cardiology follow-up from childhood onwards, particularly if they have treated heart disease. The merits of preventative treatments for aortic dilatation have not been demonstrated in Turner's syndrome and justify prospective trials.
 ...
PMID:Cardiovascular abnormalities in Turner's syndrome: what prevention? 1884 91


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>