1. Place animal in induction chamber and anesthetize the mouse and ensure sedation. 2. Once the animal is sedated, move it to a nose cone for hair removal using cream. Only apply cream to the area of the chest that will be utilized for imaging. Once the hair is removed, wipe area with wet gauze to ensure all hair is removed. 3. Move the animal to the imaging platform and tape its paws to the ECG lead plates and insert rectal probe. Body temperature should be maintained at 36-37°C. During imaging, reduce anesthesia to maintain proper heart rate. If the animal shows signs of being awake, use a higher concentration of anesthetic.

人唾液天疱疮抗原的纯化

Aortic Valve Repair of a Stenotic Unicuspid Aortic Valve in Young Patients

Aortic dissection continues to be responsible for significant morbidity and mortality, although recent advances in medical data assimilation and in experimental and in silico models have improved our understanding of the initiation and progression of the accumulation of blood within the aortic wall. Hence, there remains a pressing necessity for innovative and enhanced models to more accurately characterize the associated pathological changes. Early on, experimental models were employed to uncover mechanisms in aortic dissection, such as hemodynamic changes and alterations in wall microstructure, and to assess the efficacy of medical implants. While experimental models were once the only option available, more recently they are also being used to validate in silico models. Based on an improved understanding of the deteriorated microstructure of the aortic wall, numerous multiscale material models have been proposed in recent decades to study the state of stress in dissected aortas, including the changes associated with damage and failure. Furthermore, when integrated with accessible patient-derived medical data, in silico models prove to be an invaluable tool for identifying correlations between hemodynamics, wall stresses, or thrombus formation in the deteriorated aortic wall. They are also advantageous for model-guided design of medical implants with the aim of evaluating the deployment and migration of implants in patients. Nonetheless, the utility of in silico models depends largely on patient-derived medical data, such as chosen boundary conditions or tissue properties. In this review article, our objective is to provide a thorough summary of medical data elucidating the pathological alterations associated with this disease. Concurrently, we aim to assess experimental models, as well as multiscale material and patient data-informed in silico models, that investigate various aspects of aortic dissection. In conclusion, we present a discourse on future perspectives, encompassing aspects of disease modeling, numerical challenges, and clinical applications, with a particular focus on aortic dissection. The aspiration is to inspire future studies, deepen our comprehension of the disease, and ultimately shape clinical care and treatment decisions.

Mechanisms of Aortic Dissection: From Pathological Changes to Experimental and In Silico Models

Neural crest cells (NCCs) are multipotent and are attributed to the combination of complex multimodal gene regulatory mechanisms. Cardiac neural crest (CNC) cells, originating from the dorsal neural tube, are pivotal architects of the cardio-neuro-vascular domain, which orchestrates the embryogenesis of critical cardiac and vascular structures. Remarkably, while the scientific community compiled a comprehensive inventory of neural crest derivatives by the early 1980s, our understanding of the CNC's role in various cardiovascular disease processes still needs to be explored. This review delves into the differentiation of NCC, specifically the CNC cells, and explores the diverse facets of non-syndromic cardiovascular neurocristopathies.A systematic review was conducted as per the PRISMA Statement. Three prominent databases, PubMed, Scopus, and Embase, were searched, which yielded 1,840 studies. We excluded 1,796 studies, and the final selection of 44 studies formed the basis of this comprehensive review.Neurocristopathies are a group of genetic disorders that affect the development of cells derived from the NC. Cardiovascular neurocristopathy, i.e., cardiopathy and vasculopathy, associated with the NCC could occur in the form of (1) cardiac septation disorders, mainly the aortico-pulmonary septum; (2) great vessels and vascular disorders; (3) myocardial dysfunction; and (4) a combination of all three phenotypes. This could result from abnormalities in NCC migration, differentiation, or proliferation leading to structural abnormalities and are attributed to genetic, familial, sporadic or acquired causes.Phenotypic characteristics of cardiovascular neurocristopathies, such as bicuspid aortic valve and thoracic aortic aneurysm, share a common embryonic origin and are surprisingly prevalent in the general population, necessitating further research to identify the underlying pathogenic and genetic factors responsible for these cardiac anomalies. Such discoveries are essential for enhancing diagnostic screening and refining therapeutic interventions, ultimately improving the lives of individuals affected by these conditions.

Systematic review of cardiovascular neurocristopathy—contemporary insights and future perspectives

The total arch replacement with frozen elephant trunk (TARFET) technique has emerged as a leading treatment for extensive aortic pathologies that span from the aortic arch to the proximal descending thoracic aorta. By enabling a single-stage repair that combines complete arch reconstruction and antegrade stent graft deployment under hypothermic circulatory arrest with selective cerebral perfusion, TARFET surgery presents unique and significant challenges to anesthesiologists and surgeons. Anesthesiologists must possess a comprehensive understanding of the surgical procedure and related physiological shifts, and they are vital in preoperative preparation, neurologic monitoring for neuroprotection, and hemodynamic management to support organ perfusion. In addition, anesthesiologists contribute to procedural success by actively evaluating stent graft placement and true lumen perfusion and by approximating the distal stent landing position with intraoperative transesophageal echocardiography. This narrative review highlights key perioperative anesthetic considerations and the role of anesthesiologists in TARFET surgery, focusing on the use of intraoperative transesophageal echocardiography and anesthetic management related to strategies for cerebral and spinal cord protection. Consistent, real-time collaboration within a multidisciplinary heart team and vigilant intraoperative monitoring may help support improved patient outcomes of this technically demanding and increasingly adopted procedure.

Anesthetic perspective on total arch replacement with frozen elephant trunk surgery

Unicuspid aortic valve (UAV) is a rare congenital anomaly typically affecting patients in their fourth and fifth decades and presenting with signs of heart failure. Our case is one of a previously asymptomatic teenage girl with a UAV, who presented with cardiac arrest and was successfully treated. Only two other similar cases have been reported in the literature, both were of slightly older male patients. Our case highlights the morbidity associated with the anomaly supporting the need for careful assessment of the valve in cases where UAV is suspected.

/pdf/unicuspid-aortic-valve-presenting-with-cardiac-arrest-in-an-47ezrig2wu.pdf

Unicuspid aortic valve presenting with cardiac arrest in an adolescent.


 
 
 Thoracoabdominal acute aortic syndrome is associated with high morbidity and mortality. We aim to scrutinize our evolving strategies for acute aortic syndromes (AAS) management using minimally invasive and adaptive surgical techniques.
 
 
 
 This is a longitudinal observational study at our tertiary vascular centre from 2002 to 2021. Amongst 96 with symptomatic aortic thoracic pathologies, 71 had AAS. Our primary endpoint was combined aneurysm and cardiovascular-related mortality.
 
 
 
 There were 43 males and 28 females (5 Traumatic Aortic Transection (TAT), 8 Intramural Hematoma (IMH), 27 Symptomatic Aortic Dissection (SAD) and 31 Thoracic Aortic Aneurysm (TAA)) with a mean age of 69. All AAH received optimal medical therapy (OMT) and TAT underwent emergency thoracic endovascular aortic repair (TEVAR). Fifty-eight patients had aortic dissection, of which 31 developed TAA. These 58 received OMT initially and interval surgical intervention with TEVAR or sTaged hybrId sinGle lumEn Reconstruction (TIGER). To increase our landing area, we performed left subclavian chimney graft with TEVAR in 12 patients. Average follow-up was 78.2 months, and 11 patients (15.5%) had combined aneurysm and cardiovascular-related mortality. None had stroke or bowel ischaemia. 26% developed endoleaks, and 15% required re-intervention (type II & III). Four patients had paraplegia (5.7%) and succumbed to death from renal failure. Eight IMH patients on OMT died within 30 days.
 
 
 
 Acute aortic hematoma necessitates close monitoring and early intervention. TIGER technique with interval TEVAR has salvaged complex situations in young patients. Our experience shows that minimally invasive techniques could be a viable option for AAS.


/pdf/o064-management-of-acute-aortic-syndrome-with-evolving-13fduifr.pdf

O064 Management of acute aortic syndrome with evolving individualized precision medicine solutions: lesson learned over two decades and literature review

Background Thoracoabdominal acute aortic syndrome is associated with high morbidity and mortality. We aim to scrutinize our evolving strategies for acute aortic syndrome (AAS) management using minimally invasive and adaptive surgical techniques over two decades. Methods This is a longitudinal observational study at our tertiary vascular centre from 2002 to 2021. Out of 22,349 aortic referrals, we performed 1,555 aortic interventions over twenty years. Amongst 96 presented with symptomatic aortic thoracic pathology, 71 patients had AAS. Our primary endpoint is combined aneurysm-related and cardiovascular-related mortality. Results There were 43 males and 28 females (5 Traumatic Aortic Transection (TAT), 8 Acute Aortic Intramural Hematoma (IMH), 27 Symptomatic Aortic Dissection (SAD) and 31 Thoracic Aortic Aneurysm (TAA) post-SAD) with a mean age of 69. All the patients with AAS received optimal medical therapy (OMT), but TAT patients underwent emergency thoracic endovascular aortic repair (TEVAR). Fifty-eight patients had an aortic dissection, of which 31 developed TAA. These 31 patients with SAD and TAA received OMT initially and interval surgical intervention with TEVAR or sTaged hybrId sinGle lumEn Reconstruction (TIGER). To increase our landing area, we performed a left subclavian chimney graft with TEVAR in twelve patients. The average follow-up duration was 78.2 months, and eleven patients (15.5%) had combined aneurysm and cardiovascular-related mortality. Twenty-six percentage of the patients developed endoleaks (EL), of which 15% required re-intervention for type II and III. Four patients who had paraplegia (5.7%) and developed renal failure died. None of our patients had a stroke or bowel ischaemia. Twenty patients had OMT, eight of these were patients with acute aortic hematoma, and all eight died within 30 days of presentation. Conclusion Acute aortic hematoma is a sinister finding, which must be closely monitored, and consideration is given to early intervention. Paraplegia and renal failure result in an increased mortality rate. TIGER technique with interval TEVAR has salvaged complex situations in young patients. Left subclavian chimney increases our landing area and abolishes SINE. Our experience shows that minimally invasive techniques could be a viable option for AAS.

/pdf/management-of-acute-aortic-syndrome-with-evolving-1gvn5zog.pdf

Management of acute aortic syndrome with evolving individualized precision medicine solutions: Lessons learned over two decades and literature review

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Unicuspid aortic valve presenting with cardiac arrest in an adolescent.

O064 Management of acute aortic syndrome with evolving individualized precision medicine solutions: lesson learned over two decades and literature review

Management of acute aortic syndrome with evolving individualized precision medicine solutions: Lessons learned over two decades and literature review