Orientador: Wilson Nadruz Júnior / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-22T22:15:29Z (GMT). No. of bitstreams: 1 Cipolli_JoseAlexandreAddeo_D.pdf: 1894085 bytes, checksum: feaa70799935fe151af270ee9d8ad0af (MD5) Previous issue date: 2013 / Resumo: A dilatação da raiz da aorta é observada mais frequentemente em indivíduos hipertensos e está associada de modo independente à hipertrofia do ventrículo esquerdo. Embora a estrutura do ventrículo esquerdo tenha determinantes gênero-específicos, ainda se desconhece a existência de diferenças ligadas ao sexo nos preditores do diâmetro da raiz da aorta em indivíduos portadores de hipertensão arterial. Nós avaliamos 438 pacientes hipertensos com hipertrofia do ventrículo esquerdo (266 mulheres e 172 homens) através de exame clínico, antropometria, parâmetros laboratoriais, hemodinâmicos e inflamatórios, exame de fundo de olho e ecocardiograma. Mulheres com dilatação da raiz da aorta tiveram maior débito cardíaco (p=0,0004), menor resistência vascular periférica (p=0,009), maior prevalência de regurgitação aórtica leve (p=0,02) e maior circunferência abdominal (p=0,04), enquanto homens com dilatação da raiz da aorta apresentaram maior prevalência de hipertrofia concêntrica do ventrículo esquerdo (p=0,0008), de regurgitação aórtica leve (p=0,005) e maiores níveis de Proteína C-reativa (p=0,02), quando comparados com sujeitos do mesmo sexo e sem dilatação da raiz da aorta. Entre as mulheres, a dilatação da raiz da aorta associou-se ao débito cardíaco, circunferência abdominal e regurgitação aórtica moderada, em um modelo de análise multivariada que incluía como variáveis independentes: idade, superfície corpórea, altura, índice de massa ventricular, HOMA (homeostasis model assessment), pressão arterial diastólica, menopausa e uso de anti-hipertensivos. Por outro lado, a dilatação da raiz da aorta associou-se a espessura relativa da parede do ventrículo esquerdo, Proteína C-reativa e regurgitação aórtica leve, sem contribuição de pressão arterial diastólica, altura, superfície corpórea, índice de massa ventricular, resistência vascular periférica e uso de anti-hipertensivos em homens. Em conjunto, esses resultados sugerem que a sobrecarga de volume e a obesidade central podem desempenhar um papel significativo na fisiopatogênese da dilatação da raiz da aorta nas mulheres hipertensas com hipertrofia de ventrículo esquerdo, enquanto o aumento da raiz da aorta nos homens hipertensos com hipertrofia de ventrículo esquerdo está mais associado a parâmetros inflamatórios e ao crescimento das células miocárdicas / Abstract: Aortic root (AoR) dilatation is more frequently observed in hypertensive individuals and is independently associated with left ventricular (LV) hypertrophy. Although the LV structure has sex-specific predictors, it remains unknown whether there are gender-related differences in the determinants of AoR size. We carried out a cross-sectional analysis of clinical, laboratory, anthropometric, funduscopic and echocardiographic features of 438 hypertensive patients with LV hypertrophy (266 women and 172 men). Women with enlarged AoR had higher cardiac output (P=0.0004), decreased peripheral vascular resistance (P=0.009), higher prevalence of mild aortic regurgitation (P=0.02) and increased waist circumference (P=0.04), whereas AoR-dilated men presented with a higher prevalence of concentric LV hypertrophy (P=0.0008) and mild aortic regurgitation (P=0.005) and increased log C-reactive protein levels (P=0.02), compared with sex-matched normal AoR subjects. In women, AoR dilatation associated with cardiac output, mild aortic regurgitation and waist circumference in a multivariate model including age, body surface area, height, homeostasis model assessment index, LV mass index, diastolic blood pressure, menopause status and use of antihypertensive medications as independent variables. Conversely, AoR dilatation associated with LV relative wall thickness, log C-reactive protein and mild aortic regurgitation without contributions from diastolic blood pressure, height, body surface area, LV mass index, peripheral vascular resistance and antihypertensive medications in men. Taken together, these results suggest that both volume overload and abdominal obesity are related to AoR dilatation in hypertensive women, whereas AoR enlargement is associated more with inflammatory and myocardial growth-related parameters in hypertensive men with LV hypertrophy / Doutorado / Clinica Medica / Doutor em Clínica Médica

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Aortic valve-sparing procedures treating patients with aortic root aneurysm with or without aortic insufficiency and patients with ascending aortic aneurysm and aortic insufficiency are no longer experimental and unproven procedures. A successful aortic valve-sparing or repair operation aims not only to correct the failing part of the aortic root but also to restore the intro- and the inter-component relationship of the aortic root elements to optimal dimensions and relations. The avoidance of anticoagulation therapy and prosthesis-related complications makes aortic valve repair a tempting procedure. Considering the increasing rate of cusp repair reported in scientific literature, conservative aortic valve surgery seems to be developing into aortic valve repair surgery. This Dissertation Theses are devoted to the study of some specific technical aspects of aortic root sparing surgery, namely to the study of structural changes occurring in cryopreserved human aortic root allografts and the reproducibility of Coroneo ring implantation procedure. The Introduction of these Dissertation Theses deals with the general review of aortic valve- sparing operations in the light of the historical aspects of used surgical technique, dynamic anatomy and the current situation. One part of the Introduction is...

Treatment of infective endocarditis can often prove challenging due to its wide range of anatomical presentations. When complicated by an aortic root abscess, patients may require extensive root surgery, which on its own leads to a worse outcome. We present our experience with a surgical technique for reinforcing the aortic annulus with a ring from a Dacron aortic prosthesis placed in the left ventricular outflow tract to avoid the need for root replacement procedures or patch closures of the defect. The technique described in this paper provides a viable alternative to the standard techniques used for the treatment of annular abscesses in aortic valve endocarditis. Due to the relative simplicity and ease of use, this approach may present a means of reducing operation time and possibly postoperative complications of this severe condition.