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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

Nearly Missed: Painless Aortic Dissection Masquerading as Infective Endocarditis

Bhogal, Sukhdeep, Khalid, Muhammad, Murtaza, Ghulam, Bhandari, Tarun, Summers, Jeffrey A. 07 May 2018 (has links)
Aortic dissection is a life-threatening emergency associated with significant mortality rate. Early diagnosis is essential to improve the survival. Although the most common presentation is severe chest pain, it can be variable leading to delay in the diagnosis especially if it is painless. Painless aortic dissection is a rare entity with sparse data available based on case reports. We present a case of a young male with an atypical presentation where the presumptive diagnosis of infective endocarditis was made based on initial presentation but was eventually diagnosed as painless aortic dissection.
2

A clinical study of Marfan syndrome

Lipscomb, Karen Jane January 2000 (has links)
No description available.
3

Design, development and evaluation of a novel percutaneous Ascending Thoracic Aortic Graft (ATAG)

Keeble, Thomas Roger January 2013 (has links)
There is a huge unmet clinical need for a new, safe and effective minimally invasive treatment for Acute Ascending Aortic Dissection (AAAD) (1). In 2012 AAAD has a mortality rate of 1-2% per hour within the first 24 hours, and even with contemporary surgical techniques, advanced intensive and post operative care, the mortality from AAAD following surgery in most series remains in the unacceptable range of 10-30% at 30 days (2;3). 28% of patients presenting with AAAD are denied life saving surgery often because of age or co-morbidity - medical therapy alone associated with an in hospital mortality rate in excess of 50% (2;4-6). Currently available endovascular stent grafts used in the descending thoracic and abdominal aorta are not adequately designed to be utilised within the ascending aorta. They have a large stowed diameter 22-25 French (F), with a rigid covering of either Dacron or ePTFE, and a stiff inflexible delivery system unlikely to traverse the aortic arch without complication. While the contemporary results of elective surgery for ascending thoracic aortic aneurysm (ATAA) are good, with an elective mortality of <5%, surgical results for AAAD have improved little over the last 20 years, with a 30 day mortality rate between 10-30% (3;7). With the emerging role of endovascular stent grafts in the treatment of thoracic aneurysm and dissection, with shorter hospital stays and improved outcomes I believe now is the time for the development of a percutaneous solution for AAAD. Potential ascending thoracic aortic graft (ATAG) designs must take into account the very close proximity of intimal tear to both the coronary arteries and aortic valve, allowing a 4 good proximal graft seal without compromising coronary flow or aortic valve competence. ATAG should have a low profile, with a thin non porous covering and a flexible delivery sheath with accurate and precise deployment characteristics. Following a literature review and novel anatomical data collection from computerised tomography (CT) and magnetic resonance imaging (MRI) scans of AAAD and ATAA patient cohorts, it seems that 3 embodiments of ATAG should be designed and developed, all sharing advanced core technologies including a laser-cut nitinol stent frame, thin polyurethane (PU) material covering and accurate and precise deployment mechanisms: 1) The “supra-coronary tubular ATAG”, for treating AAAD with an intimal tear in the ascending aorta, no coronary or aortic valve involvement and adequate landing zones above the coronary arteries and before the right brachiocephalic trunk (RBCT). It is likely that this graft will be capable of treating at least a third of all patients with AAAD (8). 2) The “inverted t-shirt ATAG” to proactively protect coronary artery flow and achieve proximal seal within the sinuses in patients with an intimal tear in close association or involving the coronary arteries. 3) The “valved ATAG” to treat patients who have significant aortic regurgitation (AR), to achieve a proximal seal at the annulus when anatomy suggests it would be difficult to achieve with embodiment 1) or 2), and in those patients who have a hugely dilated aortic root, so that the ATAG can seal proximally at a relatively normal annulus size, and seal distally at a normal ascending aorta diameter 5 proximal to the RBCT. This could be the treatment option for the 25-35% of AAAD patients who currently require aortic valve repair or replacement (9). The most complex of the 3 devices above is embodiment 2), the “inverted t-shirt ATAG”, as it must ensure proximal aortic seal within an often dilated sinus, without compromise to aortic valve and proactively protect both coronary arteries with 2 coronary sleeves. Basic proof of concept (PoC) of this embodiment has been demonstrated in vitro within a normal sized aortic glass model, with some important study limitations, nevertheless it does demonstrate that tracking an ATAG branched graft with 2 coronary sleeves is possible over 3 guidewires and deploying accurately within the aortic root under both direct vision and fluoroscopy. Following successful PoC deployment I then specified and had manufactured a 2nd Generation ATAG (2G ATAG), with a laser-cut nitinol frame, longitudinal tie bars, and a novel thin PU graft covering material. The 2G ATAG has been shown to have adequate radial strength when compared to competitor devices, and can be stowed to 28 F for deployment. During ATAG development 2 patents have been filed, and I wrote with Professor Rothman a successful NIHR I4I grant for £743,000 to take ATAG from the current 28 F 2G device, towards the goal of an 18 F device with bench testing, in vitro flow rig and deployment analysis, and in collaboration with the Royal Veterinary College (RVC) into an animal model over the next 3 years (beyond the scope of this thesis). I hope that within this next development cycle ATAG can be iterated into a device that might be ready to embark on a first in man (FIM) trial to offer the AAAD population an effective and less invasive treatment strategy.
4

A Learning Curve in Aortic Dissection Surgery with the Use of Cumulative Sum Analysis

SONG, MIN-HO 02 1900 (has links)
No description available.
5

Anatomy determines etiology in thoracic aortic aneurysm

Vapnik, Joshua 08 April 2016 (has links)
BACKGROUND: It is well established that thoracic aortic aneurysms (TAA) and abdominal aortic aneurysms (AAA) have different risk factors, clinical features, and genetic influences. Differences between and amongst subtypes of TAAs have received less attention. Despite observations of divergent clinical outcomes between ascending thoracic aortic aneurysms (ATAAs) and descending thoracic aortic aneurysms (DTAAs), etiologic factors determining the anatomic distribution of these aneurysms are not well understood. METHODS: From 3,247 patients registered in an institutional Thoracic Aortic Center Database from July 1992 through August 2013, we identified 921 patients with full aortic dimensional imaging by CT or MRI scan with TAA > 3.5 cm and without evidence of aortic dissection (AoD). Patients were analyzed in three groups: isolated ATAA (n=677), isolated DTAA (n=97), and combined ATAA and DTAA (n=146). RESULTS: Patients with a DTAA, alone or with coexistent ATAA, had significantly more hypertension (80.6% vs. 61.8%, p<.001) and a higher burden of atherosclerotic disease ( 86.7% vs. 7.5%, p<.001) ) and were more likely to be female (59.3% vs. 29.5%, P<.001). Conversely, patients with isolated ATAA were significantly younger (average age 59.5 vs. 71, p<.001), and contained almost every case of overt genetically-triggered TAA. Patients with isolated DTAA were demographically indistinguishable from patients with combined ATAA and DTAA. In follow up, patients with isolated DTAA, or with ATAA and DTAA, experienced significantly more aortic events (aortic dissection/rupture) and had higher mortality than patients with isolated ATAA. CONCLUSIONS: Based on patient characteristics and outcomes, subtypes of TAA emerge. DTAA with or without associated ATAA or AAA appears to be a disease more highly associated with atherosclerosis, hypertension, and advanced age. In contrast, isolated ATAA appears to be a clinically distinct entity with a higher burden of genetically triggered disease. These data have important implications for familial screening recommendations for TAA.
6

Evaluation des innovations endovasculaires pour le traitement des dissections aortiques de type B / Assessment of endovascular innovations for the treatment of type B aortic dissections.

Faure, Elsa 22 November 2018 (has links)
Le traitement endovasculaire est devenu en deux décennies le traitement de première intention pour les DAB aiguës compliquées. Cependant, le traitement endovasculaire des DAB aiguës n’est pas optimal et comporte des limitations, tant au niveau proximal que distal, sources de complications précoces et tardives.Notre travail proposait d’évaluer des techniques endovasculaires novatrices permettant d’optimiser le traitement au niveau de la crosse et en distalité au niveau de l’aorte thoraco-abdominale.Nous avons créé un modèle de dissection de type B sur aorte humaine cadavérique extensif et reproductible, se rapprochant au plus près des conditions cliniques et permettant l’évaluation in vitro des dispositifs prothétiques conçus pour aorte humaine.Nous avons évalué sur ce modèle in vitro de DAB aiguë le stenting nu extensif de l’aorte disséquée qui permettait de réaccoler le flap intimal de dissection de manière expérimentale mais entrainait une sténose dans 54% des cas sur les artères viscérales naissant de l’aorte lorsque celles-ci naissaient du faux chenal. Ces artères pouvaient être cathétérisées à travers les mailles du stent.Nous avons ensuite évalué les résultats cliniques de cette technique, associé à un ballonnement du stent, dans le traitement des DAB aiguës compliquées avec un remodelage complet immédiat de l’aorte thoraco-abdominale stentée, persistant à moyen terme et permettant de limiter l’évolution anévrysmale à moyen terme.Enfin nous avons montré sur modèle in vitro la faisabilité et la précision au largage d’une endoprothèse avec échancrure proximale créée par le chirurgien pour avancer la zone d’ancrage dans la crosse, permettant un traitement endovasculaire exclusif en urgence des DAB aiguë compliquée avec un collet court ou une atteinte de la crosse aortique.Ces résultats offrent des perspectives d’évolutions du traitement des dissections aortique de type B au stade aigu, mais aussi plus largement des perspectives d’évolution pour le traitement des dissections de type A, des dissections chroniques, et plus généralement des pathologies de la crosse. / Thoracic endovascular aortic repair (TEVAR) is considered as the first line therapy for complicated acute type B aortic dissection (cABAD). However, current endovascular treatment has limitation regarding the proximal anchoring when aortic arch is involved and regarding the dissected aorta distally to the stent graft leading to early and late complication.The aim of this work was to assess new endovascular techniques to optimise endovascular treatment of ABAD in the aortic arch and in the thoraco-abdominal aorta.We reported the first model of ABAD in human cadaveric aorta, which was reproducible, extended to the infra-renal aorta and close to clinical pattern, allowing for human aortic devices assessment.We assess on this model extensive bare metal stenting of the dissected aorta, which was effective in true lumen reexpansion but induced a drop in pressure in the visceral arteries in 54% when they were supplied by the false lumen.Then, we assessed the results of this technique, associated with balloon inflation of the bare stent in clinical practice, which allowed an immediate and mid-term persisting complete remodelling of the stented thoraco-abdominal aorta, with a low dissecting aneurysmal evolution at one year of follow-up.Finally we reported a model of physician modified scalloped stent graft on currently available thoracic aortic device to extend the proximal landing zone in the arch while preserving the supra aortic trunks.These finding allow for potential improvement of endovascular treatment of ABAD but also of acute type A dissection, chronic dissection and some other acute aortic arch diseases.
7

Exacerbation of Intracranial Aneurysm and Aortic Dissection in Hypertensive Rat Treated With the Prostaglandin F-Receptor Antagonist AS604872 / プロスタグランジンF受容体選択的阻害薬AS604872は高血圧ラットにおいて脳動脈瘤と大動脈解離を増悪させる

Fukuda, Miyuki 25 January 2016 (has links)
京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第19397号 / 医博第4048号 / 新制||医||1012(附属図書館) / 32422 / 京都大学大学院医学研究科医学専攻 / (主査)教授 渡邊 直樹, 教授 小泉 昭夫, 教授 木村 剛 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM
8

Analysis of Acute Type A Aortic Dissection in Japan Registry of Aortic Dissection (JRAD) / JRAD データベースを用いたStanford A型急性大動脈解離の解析

Inoue, Yosuke 25 July 2022 (has links)
京都大学 / 新制・論文博士 / 博士(医学) / 乙第13494号 / 論医博第2259号 / 新制||医||1060(附属図書館) / (主査)教授 石見 拓, 教授 大鶴 繁, 教授 近藤 尚己 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM
9

The role of endothelial cells in the regulation of the vascular response to Angiotensin II

Fan, Lampson Min January 2013 (has links)
Aortic dissection is a detrimental disease with a high mortality. However, the mechanisms regulating the susceptibility to aortic dissection remain unknown. We hypothesize that endothelial oxidative stress due to the activation of the reactive oxygen species (ROS)-generating Nox2 enzyme may play an important role in the development of aortic dissection. To investigate this, we generated transgenic mice (C57BL/6J background) with endothelial specific over-expression of Nox2 (Nox2 Tg) under the control of a tie-2 promoter. Expression of the human Nox2 transgene was confirmed by qRT-PCR to be found only in endothelial cells (EC) isolated from transgenic mice, and not in Wt EC or vascular smooth muscle cells (VSMC) and macrophages isolated from either genotype. Wild-type (Wt) littermates and Nox2 Tg male mice (22-24 weeks old, n=11) were treated with saline or Ang II (1mg/kg/day) via subcutaneous mini-pump for 28 days. There was no significant difference in the pressor responses to Ang II between Wt and Nox2 Tg mice (Wt 121±7mmHg vs. Nox2-Tg 122±6mmHg). However, 5/11 Nox2 Tg mice developed aortic dissections compared to 0/11 Wt mice (P<0.05). Immunohistochemistry revealed significant increases in endothelial VCAM-1 expression, MMP activity and CD45+ inflammatory cell recruitment in the aortas of Nox2 Tg mice after 5 days of Ang II infusion. Inflammatory cell recruitment was confirmed by FACS analysis of cells from digested aortas (P<0.05). Explanted aortas from Nox2-Tg mice had significantly greater secreted pro-inflammatory cytokine, Cyclophilin A (CypA) both at baseline and after 5 days of Ang II infusion compared to Wt littermates. Compared to primary Wt EC and VSMC, Nox2-Tg primary EC, but not primary VSMC, had increased ROS production which was accompanied by increased endothelial CypA secretion and ERK1/2 activation. Furthermore, conditioned media from Nox2-Tg EC induced greater ERK1/2 phosphorylation compared to conditioned media from Wt controls. Knockdown of CypA from sEND.1 endothelial conditioned media by siRNA knockdown abolished VSMC Erk1/2 phosphorylation. In conclusion, we demonstrate for the first time that a specific increase in endothelial ROS through the over-expression of Nox2 was sufficient to induce aortic dissection in response to Ang II stimulation. Endothelial secreted CypA could be the signalling mechanism by which increased endothelial ROS regulates the inflammatory response and the susceptibility to aortic dissection.
10

Determining the effect of congenital bicuspid aortic valves on aortic dissection using computational fluid dynamics

Burken, Jennifer Ann 01 July 2012 (has links)
A normal aortic valve has three leaflets; however, 1- 2% of children are born with an aortic valve with two leaflets, referred to as congenital bicuspid aortic valves (BAV). Recent in vivo studies have shown that flow development past the bicuspid valves into the ascending aorta is markedly different from that past the normal tri-leaflet aortic valve. This difference may lead to the bicuspid valve having a higher rate of ascending aortic root dissection, a pathology that can potentially result in fatality. Using computational fluid dynamics we aim to evaluate the alterations in flow development in the ascending aorta with BAV compared to healthy tri-leaflet valves (TAV) and relate the alterations in flow-induced stresses with higher incidences of aortic dissection in patients with BAV. Simplified models based on the geometry and dimensions from published literature were developed. The preliminary results show that there is a difference in flow development between the BAV and the tri-leaflet valve. This is visible by the differences in wall shear stress and dynamic pressure distribution in the ascending aorta. The conclusion drawn from this is that there are marked differences in the ascending aortic flow development with BAV compared to that with TAV which may lead to dissection of the aortic arch.

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