Manejo de pacientes com aneurisma de aorta torácica: uma revisão bibliográfica/Management of patients with thoracic aortic aneurysm: a literature review

Authors

  • Ronan Vieira Mendonça
  • Irwing Franck de Almeida Alves
  • Guilherme de Freitas Braga Borges

DOI:

https://doi.org/10.34119/bjhrv3n6-009

Keywords:

Aneurisma Aórtico, Aneurisma Dissecante, Aneurisma da Aorta Torácica.

Abstract

Introdução: Um aneurisma de aorta é uma dilatação e enfraquecimento de uma área do vaso arterial, o que aumenta o risco de laceração e hemorragia em sua parede causando dissecção, ou tecido circundante causando ruptura. Apesar dos avanços ocorridos nos exames diagnósticos, métodos de monitorização e técnicas cirúrgicas, as doenças da aorta continuam sendo importante causa de mortalidade e morbidade cardiovascular, e um permanente desafio a cardiologistas e cirurgiões. Objetivo: Fazer uma revisão bibliográfica sobre manejo de pacientes com aneurisma de aorta torácica e descrever a fisiopatologia da doença, fatores de risco, principais métodos diagnósticos e paradigmas de tratamento recentes. Método: Trata-se de uma revisão de literatura realizada nas seguintes bases de dados: New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), The Lancet, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) e Scientific Electronic Library Online (SciELO). Utilizou-se na busca dos artigos os seguintes descritores: Aneurisma Aórtico. Aneurisma Dissecante. Aneurisma da Aorta Torácica. Foram selecionados artigos escritos em inglês, português ou espanhol. Após isso, as informações foram ordenadas, analisadas e discutidas. Resultados: Nas bases de dados, os artigos encontrados, desconsiderando a duplicidade de título, foram submetidos aos critérios de inclusão e exclusão. Alguns artigos foram escolhidos quando com grande relevância e cujo tema possuía alguma relação com este trabalho. Ao final, 44 artigos foram utilizados nesta revisão de literatura. O diagnóstico e tratamento de doenças da aorta sempre foi um tema importante, mas frequentemente complexo, da cirurgia cardiovascular. Isso não é apenas devido ao papel da aorta como a maior e mais vital artéria do corpo, mas também porque pode assumir uma variedade de formas com uma ampla gama de consequências, desde doença assintomática lentamente progressiva até morte súbita por ruptura. Conclusão: O aneurisma da aorta é uma condição que leva a dilatação do vaso com enfraquecimento de sua parede. Logo, quantificar a verdadeira incidência de aneurismas de aorta é difícil, e sua letalidade resulta em dados de mortalidade extra-hospitalar que costumam ser imprecisos. Apesar de tais desafios, os esforços e estudos sobre os aneurismas de aorta são essenciais, com uma detecção precoce e tratamento das doenças da aorta, para que haja, assim, um melhor cuidado ao paciente.

References

ALBUQUERQUE, Luciano Cabral et al. Diretrizes para o tratamento cirúrgico das doenças da aorta da Sociedade Brasileira de Cirurgia Cardiovascular: atualização 2009. Brazilian Journal of Cardiovascular Surgery, v. 24, n. 2, p. 7-33, 2009.

BRAVERMAN, Alan C. et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: task force 7: aortic diseases, including Marfan syndrome: a scientific statement from the American Heart Association and American College of Cardiology. Circulation, v. 132, n. 22, p. e303-e309, 2015.

BUFFOLO, Enio et al. Revolutionary treatment of aneurysms and dissections of descending aorta: the endovascular approach. The Annals of thoracic surgery, v. 74, n. 5, p. S1815-S1817, 2002.

CAMBRIA, Richard P. et al. Epidural cooling for spinal cord protection during thoracoabdominal aneurysm repair: a five-year experience. Journal of vascular surgery, v. 31, n. 6, p. 1093-1102, 2000.

CASSIDY, J. T. et al. Granulomatous vasculitis, giant cell arteritis and sarcoidosis. Textbook of pediatric rheumatology. Harcourt Health Science Company, editor: p. 315-343, 2010.

CHAU, Katherine H.; ELEFTERIADES, John A. Natural history of thoracic aortic aneurysms: size matters, plus moving beyond size. Progress in cardiovascular diseases, v. 56, n. 1, p. 74-80, 2013.

COOLEY, Denton A.; DE BAKEY, Michael E. Resection of entire ascending aorta in fusiform aneurysm using cardiac bypass. Journal of the American Medical Association, v. 162, n. 12, p. 1158-1159, 1956.

COOLEY, Denton A.; GOLINO, Alessandro; FRAZIER, O. H. Single-clamp technique for aneurysms of the descending thoracic aorta: report of 132 consecutive cases. European journal of cardio-thoracic surgery, v. 18, n. 2, p. 162-167, 2000.

CRAWFORD, E. Stanley et al. Surgery for acute dissection of ascending aorta: should the arch be included?. The Journal of Thoracic and Cardiovascular Surgery, v. 104, n. 1, p. 46-59, 1992.

DAVID, Tirone E.; FEINDEL, Christopher M. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. The Journal of thoracic and cardiovascular surgery, v. 103, n. 4, p. 617-622, 1992.

DELSART, Pascal et al. Post aortic dissection: Gap between activity recommendation and real life patients aerobic capacities. International journal of cardiology, v. 219, p. 271-276, 2016.

EGGEBRECHT, Holger et al. Endovascular stent–graft placement in aortic dissection: a meta-analysis. European Heart Journal, v. 27, n. 4, p. 489-498, 2006.

ERGIN, M. Arisan et al. Surgical treatment of the dilated ascending aorta: when and how?. The Annals of thoracic surgery, v. 67, n. 6, p. 1834-1839, 1999.

ETZ, Christian D. et al. Aortic root reconstruction with a bioprosthetic valved conduit: a consecutive series of 275 procedures. The Journal of Thoracic and Cardiovascular Surgery, v. 133, n. 6, p. 1455-1463, 2007.

FIHN, Stephan D. et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, v. 130, n. 19, p. 1749-1767, 2014.

GALLOWAY, A. C. et al. Ten-year operative experience with 165 aneurysms of the ascending aorta and aortic arch. Circulation, v. 80, n. 3 Pt 1, p. I249-56, 1989.

GAUDINO, Mario et al. Contemporary outcomes of surgery for aortic root aneurysms: a propensity-matched comparison of valve-sparing and composite valve graft replacement. The Journal of thoracic and cardiovascular surgery, v. 150, n. 5, p. 1120-1129. e1, 2015.

GRIEPP, Randall B. et al. Natural history of descending thoracic and thoracoabdominal aneurysms. The Annals of thoracic surgery, v. 67, n. 6, p. 1927-1930, 1999.

HALAWEISH, Ihab; PATEL, Himanshu; SI, Ming-Sing. Giant aortic aneurysm in a child with Takayasu arteritis. Cardiology in the Young, v. 26, n. 3, p. 593, 2016.

HEINEMANN, M. et al. Surgery extended into the aortic arch in acute type A dissection. Indications, techniques, and results. Circulation, v. 84, n. 5 Suppl, p. III25-30, 1991.

HYSI, Ilir et al. Aortic root surgery improves long-term survival after acute type A aortic dissection. International Journal of Cardiology, v. 184, p. 285-290, 2015.

ISOBE, Mitsuaki. Takayasu arteritis revisited: current diagnosis and treatment. International journal of cardiology, v. 168, n. 1, p. 3-10, 2013.

JOHANSSON, Gunnar; MARKSTRÖM, Ulf; SWEDENBORG, Jesper. Ruptured thoracic aortic aneurysms: a study of incidence and mortality rates. Journal of vascular surgery, v. 21, n. 6, p. 985-988, 1995.

JUVONEN, Tatu et al. Prospective study of the natural history of thoracic aortic aneurysms. The Annals of thoracic surgery, v. 63, n. 6, p. 1533-1545, 1997.

KALANGOS, Afksendiyos et al. Ascending aortic aneurysm associated with aortic insufficiency due to Takayasu’s arteritis. The Annals of thoracic surgery, v. 68, n. 1, p. 248-250, 1999.

KIM, Esther SH; BECKMAN, Joshua. Takayasu arteritis: challenges in diagnosis and management. Heart, v. 104, n. 7, p. 558-565, 2018.

KUMAR, S. et al. Aneurysmal form of aorta arteritis (Takayasu's disease): analysis of thirty cases. Clinical radiology, v. 42, n. 5, p. 342-347, 1990.

LINDSAY, Mark E. Medical management of aortic disease in children with Marfan syndrome. Current opinion in pediatrics, v. 30, n. 5, p. 639-644, 2018.

MCCLURE, R. Scott et al. Epidemiology and management of thoracic aortic dissections and thoracic aortic aneurysms in Ontario, Canada: a population-based study. The Journal of Thoracic and Cardiovascular Surgery, v. 155, n. 6, p. 2254-2264. e4, 2018.

MCKUSICK, VICTOR A. The cardiovascular aspects of Marfan's syndrome: a heritable disorder of connective tissue. Circulation, v. 11, n. 3, p. 321-342, 1955.

MODY, Purav S. et al. Trends in aortic dissection hospitalizations, interventions, and outcomes among medicare beneficiaries in the United States, 2000–2011. Circulation: Cardiovascular Quality and Outcomes, v. 7, n. 6, p. 920-928, 2014.

OLSSON, Christian et al. Thoracic aortic aneurysm and dissection. Circulation, v. 114, n. 24, p. 2611-2618, 2006.

PAN, Emily et al. Early and late outcomes after open ascending aortic surgery: 47-year experience in a single centre. Heart and vessels, v. 33, n. 4, p. 427-433, 2018.

PAPE, Linda A. et al. Presentation, diagnosis, and outcomes of acute aortic dissection: 17-year trends from the International Registry of Acute Aortic Dissection. Journal of the American College of Cardiology, v. 66, n. 4, p. 350-358, 2015.

PRÊTRE, René; VON SEGESSER, Ludwig K. Aortic dissection. The Lancet, v. 349, n. 9063, p. 1461-1464, 1997.

SARSAM, Mazin AI; YACOUB, Magdi. Remodeling of the aortic valve anulus. The Journal of thoracic and cardiovascular surgery, v. 105, n. 3, p. 435-438, 1993.

STANGER, Olaf H.; PEPPER, John R.; SVENSSON, Lars G. (Ed.). Surgical Management of Aortic Pathology: Current Fundamentals for the Clinical Management of Aortic Disease. Springer, 2019.

TRIMARCHI, Santi et al. Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience. The Journal of thoracic and cardiovascular surgery, v. 129, n. 1, p. 112-122, 2005.

TSAI, Thomas T. et al. Long-term survival in patients presenting with type A acute aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD). Circulation, v. 114, n. 1_supplement, p. I-350-I-356, 2006.

TSAI, Thomas T.; TRIMARCHI, Santi; NIENABER, C. A. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD). European Journal of Vascular and Endovascular Surgery, v. 37, n. 2, p. 149-159, 2009.

VANOLI, M. et al. Takayasu's arteritis: a study of 104 Italian patients. Arthritis Care & Research, v. 53, n. 1, p. 100-107, 2005.

WOLFE, W. G.; MORAN, J. F. The evolution of medical and surgical management of acute aortic dissection. Circulation, v. 56, n. 4, p. 503-505, 1977.

ZHU, Wei-Hua; SHEN, Lai-Gen; NEUBAUER, Henning. Clinical characteristics, interdisciplinary treatment and follow-up of 14 children with Takayasu arteritis. World Journal of Pediatrics, v. 6, n. 4, p. 342-347, 2010.

ZIMMERMAN, Kate P. et al. Improving mortality trends for hospitalization of aortic dissection in the National Inpatient Sample. Journal of Vascular Surgery, v. 64, n. 3, p. 606-615. e1, 2016.

Published

2020-11-05

How to Cite

MENDONÇA, R. V.; ALVES, I. F. de A.; BORGES, G. de F. B. Manejo de pacientes com aneurisma de aorta torácica: uma revisão bibliográfica/Management of patients with thoracic aortic aneurysm: a literature review. Brazilian Journal of Health Review, [S. l.], v. 3, n. 6, p. 15726–15737, 2020. DOI: 10.34119/bjhrv3n6-009. Disponível em: https://ojs.brazilianjournals.com.br/ojs/index.php/BJHR/article/view/19340. Acesso em: 28 mar. 2024.

Issue

Section

Original Papers