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      Los aneurismas de la aorta torácica y su enfoque terapéutico Translated title: The aortic aneurysms and therapeutic management

      research-article
      1
      Archivos de cardiología de México
      Elsevier
      Aorta, Aneurysms, Dissection, Aorta, Disección, Aneurismas

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          Abstract

          La aorta ha dejado de considerarse como sólo un tubo por el cual se transporta sangre del corazón a toda la economía del cuerpo humano; a convertirse conceptualmente en un órgano, el cual no sólo está diseñado para transportar los elementos sanguíneos que el corazón expulsa, sino que también, en ella reside producción de hormonas, la regulación de la presión y homeostasis del organismo, así como las respuestas metabólicas y de receptores que se traducen en reacciones locales y sistémicas; al ser un órgano específico también presenta su patología especial. En todo el mundo la patología de la aorta es relativamente común, con la aparición de muchos nuevos casos cada año y ocupando un lugar importante en la morbimortalidad general en países como los Estados Unidos, Japón, Brasil, etc. Esta enfermedad también repercute en la utilización de grandes cantidades de recursos económicos, humanos y de infraestructura para su manejo. En México no contamos con estadísticas adecuadas de la enfermedad de la aorta, ya que ésta es poco diagnosticada y cuando provoca la muerte, la defunción se atribuye a otros problemas (infarto al miocardio, arritmias, etc.). Actualmente con los nuevos métodos de diagnóstico menos invasivos que se encuentran más al alcance de la población en general, esta patología se diagnostica cada vez más, observándose que en muchos de los pacientes que se encuentran en servicios de urgencia o con cuadros compatibles con alguna otra enfermedad torácica o abdominal, pueden presentar enfermedad de la aorta. Es por esto que es necesario crear un grupo multidisciplinario especializado para hacer su diagnóstico, y su manejo integral expedito para poder disminuir así la gran morbimortalidad que se asocia a esta enfermedad.

          Translated abstract

          The aorta was saw has a tube who transport blood from the heart to all the human economy, today we see the aorta like an specific organ who not only is design to transport the blood and it is elements, the aorta also produce hormones and elements of the inflammatory responds and control the systemic pressure. That's why the aorta has it specific illness. In the entire world the pathology of the aorta is quite frequent with the appearance of a lot of new cases and occupies a predominant place in the general mortality of countries like United States of America, Japan or Brazil. This pathology needs the utilization of large amounts of economics, human and structural resources. In Mexico do not have the statistical information of the aortic illness because it is few diagnosed, and when induce death it confusing to another diseases. In the present time with the new no invasive diagnostic methods more approachable to the general population this disease is easier to diagnose. That is why he need to develop a multidisciplinary specialize group who can make the diagnosed and do the specific treatment for these disease.

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          Most cited references51

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          What is the appropriate size criterion for resection of thoracic aortic aneurysms?

          Although many articles have described techniques for resection of thoracic aortic aneurysms, limited information on the natural history of this disorder is available to aid in defining criteria for surgical intervention. Data on 230 patients with thoracic aortic aneurysms treated at Yale University School of Medicine from 1985 to 1996 were analyzed. This computerized database included 714 imaging studies (magnetic resonance imaging, computed tomography, echocardiography). Mean size of the thoracic aorta in these patients at initial presentation was 5.2 cm (range 3.5 to 10 cm). The mean growth rate was 0.12 cm/yr. Overall survivals at 1 and 5 years were 85% and 64%, respectively. Patients having aortic dissection had lower survival (83% 1 year; 46% 5 year) than the cohort without dissection (89% 1 year; 71% 5 year). One hundred thirty-six patients underwent surgery for their thoracic aortic aneurysms. For elective operations, the mortality was 9.0%; for emergency operations, 21.7%. Median size at time of rupture or dissection was 6.0 cm for ascending aneurysms and 7.2 cm for descending aneurysms. The incidence of dissection or rupture increased with aneurysm size. Multivariable regression analysis to isolate risk factors for acute dissection or rupture revealed that size larger than 6.0 cm increased the probability by 32.1 percentage points for ascending aneurysms (p = 0.005). For descending aneurysms, this probability increased by 43.0 percentage points at a size greater than 7.0 cm (p = 0.006). If the median size at the time of dissection or rupture were used as the intervention criterion, half of the patients would suffer a devastating complication before the operation. Accordingly, a criterion lower than the median is appropriate. We recommend 5.5 cm as an acceptable size for elective resection of ascending aortic aneurysms, because resection can be performed with relatively low mortality. For aneurysms of the descending aorta, in which perioperative complications are greater and the median size at the time of complications is larger, we recommend intervention at 6.5 cm.
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            Thoracic aortic aneurysms: a population-based study.

            Thoracic aortic aneurysms were detected in 72 residents (44 women and 28 men) in a stable midwestern community over a 30-year period, for an age- and sex-adjusted incidence of 5.9 new aneurysms per 100,000 person-years. The incidence was equal in both sexes and decreased slightly over the 30 years. Ages ranged from 47 to 93 years (median 65 years for men and 77 years for women). The ascending aorta was involved in 37 patients, the aortic arch in 8, and the descending aorta in 27. Pathologic examination was performed in 51 patients. The cause was aortic dissection in 27 patients (53%), atherosclerosis in 15 (29%), aortitis in 4 (8%), cystic medial necrosis in 3 (6%), and syphilis in 2 (4%). All autopsied patients had pathologic evidence of significant hypertension. Eleven patients (25%) had concomitant abdominal aortic aneurysms. Rupture occurred in 53 patients (74%) and 50 died. Thirty-seven of these patients had no prior diagnosis of aneurysm. The median interval between diagnosis and rupture in the 16 remaining patients was 2 years (range 1 month to 16 years). Ninety-five percent of aortic dissections ruptured and 51% of nondissecting aneurysms ruptured. The actuarial 5-year survival for all 72 patients was 13%; for patients with aortic dissection, 7% and for patients without dissection, 19.2%.
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              Natural history, pathogenesis, and etiology of thoracic aortic aneurysms and dissections.

              The natural history of thoracic aortic aneurysms and dissections is diverse, reflecting a broad spectrum of etiologies which include increasing aortic size, hypertension, and genetic factors. The pathogenesis is related to defects or degeneration in structural integrity of the adventitia, not the media, which is required for aneurysm formation. The ascending and descending aorta appear to have separate underlying disease processor that lead to a weakened vessel wall and an increased susceptibility for dissection. Etiologic factors for aortic aneurysms and dissections are multifactorial, reflecting genetic, environmental, and physiologic influences.
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                Author and article information

                Contributors
                Role: ND
                Journal
                acm
                Archivos de cardiología de México
                Arch. Cardiol. Méx.
                Elsevier (México )
                1405-9940
                June 2006
                : 76
                : suppl 2
                : 124-133
                Affiliations
                [1 ] Instituto Nacional de Cardiología Mexico
                Article
                S1405-99402006000600015
                da534fc0-01ad-4705-a8c2-05f14667ae69

                http://creativecommons.org/licenses/by/4.0/

                History
                Categories
                Cardiac & Cardiovascular Systems

                Cardiovascular Medicine
                Aorta,Aneurysms,Dissection,Disección,Aneurismas
                Cardiovascular Medicine
                Aorta, Aneurysms, Dissection, Disección, Aneurismas

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