Stanford Type A Aortic Dissection in a Hypertensive Patient with Atherosclerosis of Aorta and Aortitis

Bedeleanu, D; Coman, Corneliu George; Encică, Svetlana; Hagiu, R.; Molnar, AA; Căpâlneanu, R.

doi:10.1111/j.1540-8175.2000.tb01122.x

Cited by 6 publications

(1 citation statement)

References 16 publications

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“…MMP-2 is physiologically expressed by mesenchymal cells in the middle layer of the aortic wall. These two gelatinases, largely expressed in AAA, are considered the primary proteolytic enzymes responsible for the degradation of the ECM [6,7].…”

Section: Introductionmentioning

confidence: 99%

Neutrophil to Lymphocyte Ratio Reflects the Proteolytic Activity of the Abdominal Aortic Aneurysm Wall

Sasarman¹,

Andercou²,

Bruno³

et al. 2021

J Biomed Res Environ Sci

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Background: This study aims to evaluate the local proteolytic activity from the level of Abdominal Aortic Aneurysm (AAA) wall and correlate the obtained values with the preoperative values of NLRs (Neutrophil-Lymphocyte Ratio), evaluating a possible association between the two variables and, implicitly, between the local proteolysis process and the systemic inflammatory response of those patients diagnosed with AAA. Methods: The current study is monocentric, observational, and prospective, taking place at the Department of Cardiovascular Surgery, Cluj-Napoca, Romania. Patients undergoing elective or emergency classical surgery for unruptured AAA or ruptured AAA were included in the study. During classical surgery, samples from the infrarenal aortic aneurysmal wall were collected in a standardized manner, from the central part of the anterior wall from uAAA and rAAA and were analyzed by gel zymography. Results: The concentration of MMP2 was similar in the ruptured/non-ruptured group, without any statistical significance. In the MMP-9 case, we obtained a mean of 821.35 U arb/µg at the level of unruptured aneurysmal wall and 1411.57 U arb/µg at the level of the ruptured aneurysmal wall. According to the ANOVA test, there is a significant difference between the two categories of aneurysms. The same correlation was observed regarding both the zymogen category, pro-MMP-2, as well as pro-MMP-9: they expressed significant higher quantities of inactive enzymes in rAAA. We splitted the study population into two categories: patients who presented preoperative NLR values < 5 and > 5. MMP-2 collagenase levels did not register statistical differences between the two groups, p = 0.3236. High levels of MMP-9 are positively associated with increased values of NLR, the NLR<5 group had an MMP-9 mean of 902.41(473.71) U arb/µg, statistically lower than the MMP-9 mean indicated in the NLR>5 group, 1474(521.21) U arb/µg. Similarly, MMP-2 and MMP-9 zymogens were found in statistically higher quantities (p < 0.05) in the NLR>5 group of patients. Conclusions: This is the first study that analyzes a possible correlation between the local proteolytic activity at the site of the dilated aneurysmal aortic wall and circulating levels of NLR. Following the results obtained, we conclude that the group of patients presenting with NLR>5 preoperatively, as in the rAAA group, significantly greater levels of MMP-9 and inactive proenzymes were identified. Local metalloproteinase MM9 activity is proportional to the systemic inflammatory activity. Concomitantly, we hypothesize that the increased sensitivity of NLR as a prognostic marker in AAA pathology, which is ensured and confirmed by its strong association with local proteolytic activity, directly implied in the evolution of the disease.

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Section: Introductionmentioning

confidence: 99%

Neutrophil to Lymphocyte Ratio Reflects the Proteolytic Activity of the Abdominal Aortic Aneurysm Wall

Sasarman¹,

Andercou²,

Bruno³

et al. 2021

J Biomed Res Environ Sci

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Fatal Aortic Dissection due to a Fulminant Variety of Isolated Aortitis

Ryder

Tafe²,

Burns³

2009

JCR: Journal of Clinical Rheumatology

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Aortitis is typically a chronic, progressive disease manifestation associated with large vessel vasculitidies, most notably giant cell, Takayasu arteritis, and a newly described entity, isolated aortitis. The aortitis may lead to aneurysm formation and symptoms associated with branch vessel occlusion in these diseases, but aortic dissection is rare and usually a late complication of smoldering, incompletely treated disease. We present a case of aortitis in a previously healthy 39-year-old man who succumbed to aortic dissection hours after the onset of symptoms. No aneurysm or fibrosis was found on postmortem examination. The inflammation was characterized by disruption of the media with patchy transmural chronic and focally acute inflammatory infiltrate. We review case reports of other individuals with aortitis, who initially or very early in their course presented with aortic dissection in the absence of known rheumatic disease and most without evidence of aneurysm formation. We believe that this represents a process characterized by an aggressive vasculitis of the aorta with its own clinical features, a fulminant variety of isolated aortitis.

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Particularities of cardiovascular rehabilitation after coronary artery bypass graft: a case report

Molnar¹,

Oprea²,

Moldovan

et al. 2020

BALNEO

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Objectives. This paper assesses the importance and contribution of cardiovascular rehabilitation programs in the short- and long-term outcome following surgical revascularization procedures for patients with coronary artery disease (CAD). Methods. We present the case of a 64-year-old patient who benefited from a coronary artery bypass graft (CABG) procedure for CAD, followed by an individualized cardiac rehabilitation program. The case particularity consisted of the presence of associated peripheral vascular disease that imposed additional challenge in decision-making process regarding surgical therapy. Results and discussion. Immediately after surgery, the patient was included in a phase II residential recovery program, preceded by a ramp effort test. The rehabilitation program consisted of partial toning massage of the lumbosacral spine, and individual physiotherapy. Coronary revascularization procedures often cause lowered exercise capacity and declining physical activity levels. In our case even preoperative assessment showed a limited physical effort capacity, further reduced by the surgical intervention. The physiotherapy plan should be personalized, safe, effective, and must increase the independent mobility of patient soon after open heart surgery. Conclusions. The main contribution of cardiac rehabilitation program should be the improvement of physical and social status of patients undergoing surgical myocardial revascularization. This program should be included in the management of all cardiac heart disease patients who benefit from cardiac surgery procedures. Implementation of CR programs at most hospitals and community centres, as well as awareness about their efficacy, would result in higher participation after coronary revascularization interventions and improvement of functional parameters and quality of life.

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Stanford Type A Aortic Dissection in a Hypertensive Patient with Atherosclerosis of Aorta and Aortitis

Cited by 6 publications

References 16 publications

Neutrophil to Lymphocyte Ratio Reflects the Proteolytic Activity of the Abdominal Aortic Aneurysm Wall

Neutrophil to Lymphocyte Ratio Reflects the Proteolytic Activity of the Abdominal Aortic Aneurysm Wall

Fatal Aortic Dissection due to a Fulminant Variety of Isolated Aortitis

Particularities of cardiovascular rehabilitation after coronary artery bypass graft: a case report

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