2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC).

Autores/Miembros del Grupo de Trabajo: Raimund Erbel (Coordinador) (Alemania), Victor Aboyans (Coordinador) (Francia), Catherine Boileau (Francia), Eduardo Bossone (Italia), Roberto Di Bartolomeo (Italia), Holger Eggebrecht (Alemania), Arturo Evangelista (Espana), Volkmar Falk (Suiza), Herbert Frank (Austria), Oliver Gaemperli (Suiza), Martin Grabenwoger (Austria), Axel Haverich (Alemania), Bernard Iung (Francia), Athanasios John Manolis (Grecia), Folkert Meijboom (Paises Bajos), Christoph A. Nienaber (Alemania), Marco Roffi (Suiza), Herve Rousseau (Francia), Udo Sechtem (Alemania), Per Anton Sirnes (Noruega), Regula S. von Allmen (Suiza) y Christiaan J.M. Vrints (Belgica)

2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases

3D
: three-dimensional
AAA
: abdominal aortic aneurysm
AAS
: acute aortic syndrome
ACC
: American College of Cardiology
ACE
: angiotensin-converting enzyme
AD
: Aortic dissection
ADAM
: Aneurysm Detection and Management
AHA
: American Heart Association
AJAX
: Amsterdam Acute Aneurysm
AO
: aorta
AOS
: aneurysms-osteoarthritis syndrome
ARCH
: Aortic Arch Related Cerebral Hazard
ATS
: arterial tortuosity syndrome
BAV
: bicuspid aortic valve
BSA
: body surface area
CI
: confidence interval
CoA
: coarctation of the aorta
CPG
: Committee for Practice Guidelines
CSF
: cerebrospinal fluid
CT
: computed tomography
DREAM
: Dutch Randomized Aneurysm Management
DUS
: Doppler ultrasound
EBCT
: electron beam computed tomography
ECG
: electrocardiogram
EDS
: Ehlers-Danlos syndrome
EDSIV
: Ehlers-Danlos syndrome type IV
ESC
: European Society of Cardiology
ESH
: European Society of Hypertension
EVAR
: endovascular aortic repair
FDG
: 18F-fluorodeoxyglucose
FL
: false lumen
GCA
: giant cell arteritis
GERAADA
: German Registry for Acute Aortic Dissection Type A
IAD
: iatrogenic aortic dissection
IMH
: intramural haematoma
INSTEAD
: Investigation of Stent Grafts in Patients with type B Aortic Dissection
IRAD
: International Registry of Aortic Dissection
IVUS
: intravascular ultrasound
LCC
: left coronary cusp
LDS
: Loeys-Dietz syndrome
MASS
: Multicentre Aneurysm Screening Study
MESA
: Multi-Ethnic Study of Atherosclerosis
MPR
: multiplanar reconstruction
MRA
: magnetic resonance angiography
MRI
: magnetic resonance imaging
MSCT
: multislice computed tomography
NA
: not applicable
NCC
: non-coronary cusp
ns-TAAD
: non-syndromic thoracic aortic aneurysms and dissection
OR
: odds ratio
OVER
: Open Versus Endovascular Repair
OxVasc
: Oxford Vascular study
PARTNER
: Placement of AoRtic TraNscathetER Valves
PAU
: penetrating aortic ulcer
PICSS
: Patent Foramen Ovale in Cryptogenic Stroke study
PET
: positron emission tomography
RCCA
: right common carotid artery
RCC
: right coronary cusp
RCT
: randomized, clinical trial
RR
: relative risk
SIRS
: systemic inflammatory response
SMC
: smooth muscle cell
TAA
: thoracic aortic aneurysm
TAAD
: thoracic aortic aneurysms and dissection
TAI
: traumatic aortic injury
TEVAR
: thoracic endovascular aortic repair
TGF
: transforming growth factor
TI
: separate thyroid artery (A. thyroidea)
TL
: true lumen
TOE
: transoesophageal echocardiography
TS
: Turner Syndrome
TTE
: transthoracic echocardiography
UKSAT
: UK Small Aneurysm Trial
ULP
: ulcer-like projection
WARSS
: Warfarin-Aspirin Recurrent Stroke Study

Guidelines summarize and evaluate all available evidence at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk-benefit-ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help the health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

A great number of Guidelines have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organisations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions …

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2014 ESC Guidelines on the diagnosis and treatment of aortic diseases

Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: A systematic review

The clinical expert consensus statement on takotsubo syndrome (TTS) part II focuses on the diagnostic workup, outcome, and management. The recommendations are based on interpretation of the limited clinical trial data currently available and experience of international TTS experts. It summarizes the diagnostic approach, which may facilitate correct and timely diagnosis. Furthermore, the document covers areas where controversies still exist in risk stratification and management of TTS. Based on available data the document provides recommendations on optimal care of such patients for practising physicians.

https://www.zora.uzh.ch/id/eprint/162489/1/ehy077.pdf

International Expert Consensus Document on Takotsubo Syndrome (Part II): Diagnostic Workup, Outcome, and Management

Prevalence and characteristics of left ventricular outflow tract obstruction in Tako-Tsubo syndrome.

Resume Buts de l’etude Les dissections coronaires extensives sont une complication grave de l’angioplastie. Nous rapportons une serie retrospective de 19 patients recrutes dans un hopital general, sans chirurgie cardiaque. Patients et methodes La base de donnees de coronographie et d’angioplastie a ete interrogee. Les dissections extensives de type D, E et F ont ete incluses dans cette etude. Les dossiers des patients selectionnes ont ete analyses. Resultats Entre janvier 2003 et mars 2010, 19 angioplasties coronaires sur 2542 ont ete compliquees de dissection extensive (incidence 0,75 %). Dans 63,2 % des cas, il s’agissait d’une dissection liee au catheter guide. Onze patients avaient des lesions de type A ou B1. Les dissections touchaient la coronaire droite dans 16 cas, l’IVA dans deux cas et le tronc commun dans un cas. Apres angioplastie, un flux final thrombolysis in myocardial infraction (TIMI) 3 n’a ete obtenu que chez 11 patients. Dans neuf cas, il existait une extension limitee au sinus de Valsalva qui n’etait pas un element de mauvais pronostic et n’avait pas necessite d’intervention chirurgicale. Les complications ont ete frequentes : deces ( n  = 1), pontage ( n  = 2), infarctus ( n  = 8), choc cardiogenique ( n  = 2) et assistance circulatoire ( n  = 2). Conclusion La dissection coronaire extensive est une complication rare mais non exceptionnelle de l’angioplastie. Elle touche plus souvent la coronaire droite et l’extension au sinus de Valsalva est frequente. Le traitement repose sur l’angioplastie mais les echecs et les complications hospitalieres sont frequents. Nous n’avons pas trouve de facteurs favorisants a ces dissections etendues dont la survenue reste imprevisible.

Dissection coronaire extensive compliquant une angioplastie : à propos d’une série de 19 cas consécutifs

Resume Le syndrome de Tako-tsubo est une entite clinique recemment individualisee mimant un infarctus et associant une douleur thoracique de type infarctoide, des modifications electrocardiographiques et une elevation moderee des marqueurs biologiques de necrose. L'exploration coronarographique chez ces patients ne retrouve pas de stenose angiographiquement significative et la ventriculographie gauche met en evidence une akinesie voire une dyskinesie de l'apex du ventricule gauche avec un aspect de ballonisation apicale. Entre mars 2003 et mars 2005, 11 patientes chez qui a ete evoque ce syndrome ont ete suivies. L'âge moyen etait de 70,3 ans. L'ECG etait pathologique dans tous les cas. Le dosage des marqueurs a montre chez toutes les patientes une elevation de la troponine. L'exploration angiographique a ete systematique et le reseau coronaire a ete juge angiographiquement normal. L'angiographie du ventricule gauche a mis en evidence dans tous les cas une akinesie voire une dyskinesie de l'apex avec un aspect typique de ballonisation. Un facteur declenchant d'ordre psychologique ou physique a ete retrouve dans 8 cas. L'evolution clinique a ete simple sans complications ni recidive avec une duree moyenne de suivi de 15 mois. Le syndrome de Tako-Tsubo ou de ballonisation apicale transitoire du ventricule gauche est lie a un bon pronostic a moyen et long terme meme si des complications graves peuvent survenir. L'etiologie de ce syndrome est inconnue, mais il doit etre integre comme un diagnostic differentiel du syndrome coronaire aigu avec arteres angiographiquement normales.

Ballonisation apicale transitoire du ventricule gauche ou syndrome de tako-tsubo: À propos de 11 cas et revue de la littérature

Takotsubo cardiomyopathy is a clinical entity mimicking an ST elevation myocardial infarction recently identified. Are associated a chest pain, electrocardiographics abnormalities, minor elevation of enzyme biomarkers in patients who don't have any significant angiographic stenosis on the coronary angiography and where left ventricle angiography shows apical regional wallmotion abnormalities with a characteristic apical ballooning aspect. Between march 2003 and march 2005, we included 11 patients for whom this syndrom was suspected. Mean age was 70, 3 years old. Electrocardiogram was abnormal in all cases. Biological markers show for all patients an elevation of troponin I. All patients had a coronary angiography and coronary arteries were normal. Left ventricle angiography showed in all cases wall-motion abnormalities in the apex with a ballooning aspect. A psychological or physical inducing factor has been found for 8 patients. The evolution was simple for all patients with no complications noted and no recurrence with a mean follow up of 15 months. Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrom have a good long-term prognosis even if serious complications sometimes deathly can be seen. The cause of this syndrom is unknown but it must be considered as a possible diagnosis of ST elevation myocardial infarction with normal coronary arteries.

P. Michaud

Papers

Prevalence and characteristics of left ventricular outflow tract obstruction in Tako-Tsubo syndrome.

Dissection coronaire extensive compliquant une angioplastie : à propos d’une série de 19 cas consécutifs

Ballonisation apicale transitoire du ventricule gauche ou syndrome de tako-tsubo: À propos de 11 cas et revue de la littérature

Transient left ventricular apical ballooning syndrome or Takotsubo cardiomyopathy. About 11 cases

Ballonisation apicale transitoire du ventricule gauche ou syndrome de tako-tsubo