Immunoglobulin G4–positive ascending thoracic aortitis may be prone to dissection

Kajander, Henri; Paavonen, Timo; Valo, Timo; Tarkka, Matti; Mennander, Ari

doi:10.1016/j.jtcvs.2012.09.039

Cited by 20 publications

(15 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Inflammatory conditions of the aorta, including aortitis and vasculitis, may be associated with degeneration of the medial and adventitial layers of the aortic wall [43]. Both immunoglobulin G4 and complement 4d have been reported to be involved in the pathogenesis of aortic dissection [44,45], whereas giant-cell and Takayasu arteritis are associated with a T-cell-mediated inflammation of the vasa vasori, potentially leading to aneurysm formation and fibrotic stenosis of the aorta [46].…”

Section: Risk Factorsmentioning

confidence: 99%

Acute type A aortic dissection – a review

Guðbjartsson

Ahlsson

Geirsson

et al. 2019

Scandinavian Cardiovascular Journal

107

View full text Add to dashboard Cite

Acute type A aortic dissection (ATAAD) is still one of the most challenging diseases that cardiac surgeons encounter. This review is based on the current literature and includes the results from the Nordic Consortium for Acute Type-A Aortic Dissection (NORCAAD) database. It covers different aspects of ATAAD and concentrates on the outcome of surgical repair. The diagnosis is occasionally delayed, and ATAAD is usually lethal if prompt repair is not performed. The dynamic nature of the disease, the variation in presentation and clinical course, and the urgency of treatment require significant attentiveness. Many surgical techniques and perfusion strategies of varying complexity have been described, ranging from simple interposition graft to total arch replacement with frozen elephant trunk and valve-sparing root reconstruction. Although more complex techniques may provide long-term benefit in selected patients, they require significant surgical expertise and experience. Short-term survival is first priority so an expedited operation that fits in with the surgeon's level of expertise is in most cases appropriate. ARTICLE HISTORY Definitions and classification systemsDissection of the aorta occurs when the aortic media is separated, usually by pulsatile flow that penetrates the intimal layer of the aortic wall [14] (Figure 1(b)). This allows blood to flow between the layers of the aortic wall, forcing the layers apart, creating a false lumen parallel to the native (i.e. true) aortic lumen (Figure 1(b)). Consequently, the false lumen can propagate in both directions from the tear of intima and affect most of its distal branches, including the coronary, cerebral, and mesenteric arteries [15]. Another-but less common-CONTACT Tomas Gudbjartsson

show abstract

Section: Risk Factorsmentioning

confidence: 99%

Acute type A aortic dissection – a review

Guðbjartsson

Ahlsson

Geirsson

et al. 2019

Scandinavian Cardiovascular Journal

107

View full text Add to dashboard Cite

show abstract

“…Headache, cranial nerve palsies, vision disturbance, motor weakness, limb numbness, sensorineural hearing loss, seizures Cardiovascular system Heart and pericardium [41] IgG4-related cardiac disease Acute chest pain (coronary syndrome), dyspnoea, pericardial rub Aorta [30,40] IgG4-related periaortitis (chronic periaortitis/ inflammatory aortic aneurism)…”

Section: Pathologymentioning

confidence: 99%

“…In particular, renal involvement might present with variable degrees of proteinuria, haematuria, renal failure or hypocomplementaemia [37][38][39]. Finally, life-threatening presentations such as rupture of inflammatory aneurysms, coronary syndromes, pachymeningitis and acute neurological events have also been described occasionally [30,[40][41][42]. A comprehensive review of the organs involved by IgG4-RD, common clinical presentation and differential diagnoses is detailed in Table 1 [43][44][45][46][47][48][49][50].…”

Section: Overview Of Clinical Manifestationsmentioning

confidence: 99%

Immunology of IgG4-related disease

Della‐Torre

Lanzillotta

Doglioni

2015

Clinical and Experimental Immunology

188

215

View full text Add to dashboard Cite

SummaryImmunoglobulin G4-related disease (IgG4-RD) is a fibroinflammatory condition that derives its name from the characteristic finding of abundant IgG4 1 plasma cells in affected tissues, as well as the presence of elevated serum IgG4 concentrations in many patients. In contrast to fibrotic disorders, such as systemic sclerosis or idiopathic pulmonary fibrosis in which the tissues fibrosis has remained largely intractable to treatment, many IgG4-RD patients appear to have a condition in which the collagen deposition is reversible. The mechanisms underlying this peculiar feature remain unknown, but the remarkable efficacy of B cell depletion in these patients supports an important pathogenic role of B cell/T cell collaboration. In particular, aberrant T helper type 2 (Th2)/ regulatory T cells sustained by putative autoreactive B cells have been proposed to drive collagen deposition through the production of profibrotic cytokines, but definitive demonstrations of this hypothesis are lacking. Indeed, a number of unsolved questions need to be addressed in order to fully understand the pathogenesis of IgG4-RD. These include the identification of an antigenic trigger(s), the implications (if any) of IgG4 antibodies for pathophysiology and the precise immunological mechanisms leading to fibrosis. Recent investigations have also raised the possibility that innate immunity might precede adaptive immunity, thus further complicating the pathological scenario. Here, we aim to review the most recent insights on the immunology of IgG4-RD, focusing on the relative contribution of innate and adaptive immune responses to the full pathological phenotype of this fibrotic condition. Clinical, histological and therapeutic features are also addressed.

show abstract

“…En effet, l'aortite associée aux IgG4 peut se compliquer de dissection aortique [8] ou de rupture d'anévrysme [9]. L'atteinte artérielle peut aussi être sténosante [10].…”

Section: Quels Patients Faut-il Traiter ?unclassified