Category: Aortic Dissection Page 1 of 22

Devin Ryan DeVore was ‘tenderhearted, willing to take in the whole world’

Please read this story.. It’s a travesty!

Ten days after her son’s passing, Jennyne Trani traveled from her home in Nevada to Sacramento to pick up her son’s ashes and meet with Sacramento State President Robert Nelsen. They walked over to the spot where he collapsed. She said that it was the closure she needed.

Devin Ryan DeVore collapsed outside of Sequoia Hall at Sac State on Sept. 18, dying of an aortic dissection, according to Trani.

DeVore, originally from Corona, California, was a 20-year-old transfer student. He transferred from Cal State East Bay to Sacramento State in the fall of 2019. Sac State’s kinesiology program is what brought DeVore to Sac State, according to Trani.

Despite doing her best to move on, Trani is left with feelings of frustration over her son’s death and why it was not prevented.

According to Trani, DeVore had been suffering severe chest pains the week before his death.

“What’s frustrating is that he did go to the campus clinic about 5-7 days before he passed, they diagnosed him as having a respiratory cough,” Trani said. “They did an electrocardiogram and a chest X-ray, but those two things do not show an aortic dissection. They sent him home to rest and told him to return to class when he felt well enough. He stayed home for a couple of days, and when he went back, that’s when he collapsed.”

DeVore continued to suffer chest pains after his visit to the clinic and told his mother about the discomfort he was experiencing.

“He had called me three days before he passed and he explained that his heart was hurting every time it would beat and it kept him up,” Trani said. “He hadn’t slept (in) days.”

DeVore is survived by Trani as well as his two sisters, Ashlee DeVore and Maggie Trani. DeVore was the middle child, often stepping up to play the role of the “man of the house” following his mother’s divorce. His mother described him as being independent, tender-hearted, and willing to take in the whole world.

“He was really close to his siblings, especially his older sister Ashlee, they were like best friends,” Trani said. “She even said at the funeral (that when Ryan was born) before she even knew it, she had a best friend.”

According to Trani, DeVore loved all things nature.

“We would call him the cricket whisperer because in Nevada where I lived, certain times of the years there’s just a ton of crickets,” Trani said. “They would come into the house, he’d grab a cup and set it free.”

DeVore liked hiking and mountain biking and had an interest in surfing, which he had yet to attempt.

According to Trani, DeVore wanted to enter a medical career after college, with a focus on injury rehabilitation. In middle school, he was diagnosed with spondylolisthesis, a congenital back disorder requiring major back surgery when he was 15 years old.

This influenced his decision to focus on rehabilitation, after originally wanting to be a police officer to follow in his uncle’s footsteps.

DeVore volunteered at a shooting range called Firearms Training Associates in Yorba Linda, California for four years.

“We would go to the shooting range together, we’d help volunteer, stay late and shoot together,” Trani said.

Brianna Sims, a Sac State junior majoring in history, was DeVore’s girlfriend of five years. They were high school sweethearts and started dating their junior year of high school. To cope with the loss, Sims took the rest of the semester off and said she plans to return in the Spring of 2020.

When asked what special talents DeVore had, Sims recalled that following his surgery, DeVore had to learn to pick things up with his feet rather than his hands.

“He can probably cook a four-course meal with his feet, me and his family called them monkey feet,” Sims said.

Following the surgery, DeVore was left with two metal rods in his back, something he joked about.

“He would always be like, ‘they’re gonna stop me at the airport,’” Sims said.

Sims said DeVore was a huge “Star Wars” fan. He owned a “Star Wars” robe, keychain and pair of socks and was planning to get a “Star Wars” tattoo.

“Ask him about ‘Star Wars’ and he can write a book for you,” Sims said. “’Star Wars’ was the thing that he geeked out on.”

Sims said she and DeVore were foodies and that they believed in spending quality time together over a good meal was important.

“Food was a big part of our relationship, so what we ate mattered,” Sims said. “We always made sure we ate at least one meal together every day.”

Sims also reflected on how far they had come as a couple.

“We both got cars, we got an apartment together, he got into Sac State,” Sims said. “I guess living (as adults) was our biggest accomplishment together.”

The day DeVore collapsed, many fellow Sac State students witnessed what they thought was a seizure and rushed to help.

“His mom and I want the people that helped when he did collapse to know that there wasn’t anything they could do… there was no way to fix it,” Sims said.

Mac Mauzy, a high school friend of DeVore’s, described him as a kind soul who was “always there.”

“We used to sit together and we’d talk about cars,” Mauzy said. “From the day I met him, until the day we lost touch, he was always so nice and funny. He was always asking how you were and how things were at home.”

Trani said following her son’s death, she wants to spread awareness to the condition that he died from.

“That makes me angry, something needs to change, they need to take it seriously when someone says their heart hurts,” Trani said. “Because it’s such a rare thing, I think it’s important that people are made aware of it.”

DeVore’s memorial service was held Oct. 26. Trani described it as upbeat and full of laughter and said that’s what DeVore would have wanted.

“A piece of me is gone, but we all have to keep on going and keep on living,” Trani said.

12/18/2019 Meeting with other surgeon Dr. Christopher Burke

I met with Dr. Burke and he’s a very talented individual. I am now at peace with my surgery plans to have the Bio Bental (root/valve and old dacron replaced with new dacron). As well as the

considering debranching the innominate artery to facilitate future endovascular interventions if his arch or ascending aorta dilate over time.

I have also decided from now on, I am going to have peace and TRUST IN THE TEAM as Dr. Gabe Aldea said to do. He’s a very talented surgeon and I believe 1000% I will make it out the other side and have a new look at life and will be ready to reach new goals like running a marathon again someday.

Now the next task is my Angiogram to look at my right coronary artery..


It’s time for my aortic valve and aortic root replacement and perhaps other things

Well, I am set to meet with Dr. Gabriel Aldea and will have my wife and parents with me. This is 11/12/19. I just hope that my left ventricle will be able to recover and that I have not waited too long. After watching this video below:

I am not going to put this off any longer. I have really slowed down and noticing my couch time has increased. I have continued to play tennis – mostly doubles and even my doubles, I am just not as sharp of a player or confident in my game. What I am really hoping is that this new valve/root combination will perhaps allow me to start jogging again. Based on my dissection, it goes from both carotid arteries (half way) all the way down to my left illiac artery. So, I used to run quite a bit in my younger days and even ran 6 marathons. There is nothing more rewarding that going for a great run – I really miss the inability to not run. My calf muscles feel like they are starving for blood and get achy.

I feel lucky to be in the hands of the experts at the University of Washington and under Gabe’s leadership and with the assistance of Dr. Christopher Burke.

I just am hoping that over the last 16.5 years the technology and recovery will be a bit easier and that I can get back on my feet and be independent soon. My surgery is scheduled for 12/19/19. I will definitely be messing with our family tradition of Christmas Eve at my folks house and Christmas morning here and my sister in law coming over with her 2 kids for breakfast. But…. I simply can’t push it any longer -especially after watching that video from the Cleveland Clinic.

Aortic Dissection Awareness Day U of W Event Sept 19th, 1-4pm

Come join in meeting and discussing the latest topics on Aortic Diseases. 



Brian Tinsley



Kurt Zivelonghi -57

Type: Descending

It all started when I was watching TV. I bent over to look at my computer, and this pain felt like someone was taking a knife slicing me up the middle and up into my chest. At first, I thought that I may have strained a muscle because I was into working-out with weights but after a few minutes of this pain I knew something was terribly wrong.

I had this instinctive feeling that I couldn’t wait for a ambulance so I took myself to the hospital which was only a few miles away and I knew exactly where it was, because it was right next to my bank. When I got there they asked me all these questions about my pain, how severe it was and told them it was the worst pain that I ever felt, and if I felt nauseous.

After some tests, they told me that my aorta was splitting apart and I knew that having an aorta splitting apart is a serious situation. They gave me some morphine and prepared me to be transferred to another hospital which had a heart specialty facility. When I arrived at the hospital I was immediately put in cardiac Intensive care unit where I spent a few days talking to the nurses and family members.

After about the second day I fell into a coma and all I remember are these weird dreams . After 3 weeks I finally woke up by prodding by the nurses. Evidently, they wanted to come out of the coma, because what I heard was “Kurt time to get up” and them pulling at me to get me on my feet. They didn’t pull in a hard way, they were gentle with me.

I remember in my dreams was them making me stand up and sitting me in this chair. After six weeks I finally was released from Cardiac ICU and sent to physical rehabilitation for a week where I learned to walk and swallow again.

And finally released to my brothers care where nurse came for two weeks.
the effects were that my left hand is paralyzed, depression and sundry other problems and when I left rehabilitation they gave me about 15 prescriptions yo take for my blood pressure and various other problems.

Monday… Meeting with Dr. Brevig

Ok…. Here we go! Monday, I am scheduled to meet with Dr. James Brevig, it’s been over 15 years since my original ER surgery to save my life. I will be interested to hear what he has to say. I also have an echo of my aorta. I have never had this done and I think the reasoning was that I had a CT/Angio last year and they wanted to hold off on the radiation. I also am scheduled to see Gabe at the U of W later in December.

My main cardiologist, Dr. David Liang says that I don’t need surgery just quite yet and I trust him so very much!

More to come……..Brian 🙂

OK.. 12/3… I met with Dr. Brevig for almost an hour, he was great and said that he could do my surgery and I had a 5-6% risk factor. I would have my aortic root and valve replaced. The one really thing I like about Dr. Brevig, he’s calm and cool and very confident! The plan is surgery in Late June and an echo in May as well as a procedure to check my coronary arteries.

Another Emergency Room Visit

Yikes……………. I was at the ER last night for my wife. Just after my son has been complaining of chest pain, my wife woke up yesterday complaining of chest pain in the middle of her chest. So, off to the Providence Everett ER room. I have to say, they were great! She had a couple of EKG tests that did come back with a slight abnormality, as well as a d-dimer test and a few other blood tests plus a chest X-Ray.

We left after about 3 hours there and my wife is going to get stress test done early this week. She is still sleeping and I am hoping that her pain has gone away. However, I am concerned it could be something else like a clogged artery to the heart? Or high cholesterol, but hopefully the stress test and possible echo cardiogram will shed some light.

I have my first of 2 appointments with the doctor at Virginia Mason tomorrow about my value and aortic root issue as well as on 12/3 my appointment with Dr. James Brevig who did my original emergency open heart surgery at Providence Everett.

GOD…. Please help our family to get through this and have the hope to be strong in our faith.

Brian 🙂

Emergency Room Visit last night

My son was complaining about having a chest pains and he’d been off at college. He went to the WSU hospital and they said he had Mono. He wore a monitor for a few days and all tests came back clear. Then yesterday, he said he was still feeling pains and at dinner we ended up leaving and getting it to go.

Well, I took him to the ER at Providence Everett (where I had my surgery) and I told the ER doctor about my condition and that I wanted him to have a CT/Angio, D-dimer test and a partial echo. So, my wish was granted and he got all 3 and all the tests turned out clear. I was so scared that he might have some aortic condition or valve issue.

God IS GOOD! Jesus Christ is in charge!
Brian 🙂

Bicuspid aortic valve: Prevalence, genetics and natural history.

Dr. Otto, my cardiologist the U of W.


Blood Pressure Meds….. Decisions to make

I just have been doing more research and trying to find out where/when I would get my aortic valve, aortic root and possibly my aortic arch replaced. I think I have found, in fact, I know that I found the guy. Dr. Luis Castro The Sequoia Hospital Heart & Vascular Institute in Redding CA. It’s not in my state of Washington, but, this guys got the reviews and reputation as an expert w/proven results. Here’s a video he did. Here’s another one too! “Understanding Heart Valve Replacement Choices: What you need to know.”

I am going to see about sending my latest echo to him and getting his advice. As well as sending it to Dr. Liang at Stanford. However, Dr. Castro has my vote.

I am trying to figure out why I am feeling kind of nauseous lately. I started my BP meds (100mgs of Metroprolol and Mycardias/HCTZ 80/25) and I swear I felt light headed the day of my echo as my BP got up to 200/77. I don’t know if an aortic valve (leaky biscuspid) has this light headiness feeling.

I know the stress of making a decision affects all of my family and my wife being a school teacher, she will need some time off. But… I also don’t know how soon I will need the surgery either. I need to get a “firm” answer from Dr. Castro and take it from there.

God Bless,
Brian 🙂

Emergency Medicine & Acute Care Series – Aortic Dissection Diagnosis

Granted, it’s a bit old, still worth viewing.
Brian 🙂

Management of Aortic Dissection (Jean Bismuth, MD) Saturday, August 20, 2016

Very interesting..

Aortic Dissection | Rodney’s Story

Great success story!

My Aortic Valve is in need of replacement as well as my Aortic Root

I just found out this week that my aortic valve(bicuspid valve) is now leaking at the moderate/severe level and that my left ventricle is enlarged due to the overloading. Also, I was informed that my aortic root was at 5cm and my cardiologist, Dr. Otto at the University of Washington said it was time to start looking.

What was interesting is that they scheduled me to get another echo in 6 months, but said they would schedule me with the surgeon Dr. Ed Verrier.
So, I am waiting to see what that appointment will be. I also have another surgeon there Dr.Gabriel Aldea, that I want to see. As well as I have appointments with Dr. Paul Ryan at Swedish and also with my original surgeon Dr. James Brevig at Providence.

My decision to where to have my surgery is going to be based on who is the most qualified and which surgery institution has the best success rate. I am a bit leary of going to a teaching hospital such as the U of W, but my logic is simply I don’t want students assisting my surgery. I want the well run team that works well together. I am holding a bias only because I personally don’t know if my statement is actually true. My research has led me to wanting to do it at Swedish with Dr. Paul Ryan whom actually assisted Dr. James Brevig 15 years ago in Everett.

My existing Dacron tube will be removed and from what I gather, a longer piece will be required to cover the aortic root and in harmony, my leaking aortic valve replaced at the same time. Dr. Otto seems to think Ed Verrier is the most qualified. But, she’s biased for wanting her institution to do it. I am sure it would be a great learning experience as I doubt they have this many of my type of surgery requirements. I actually emailed Gabe at the U of W last night about my situation and will be interested to get his response. Gabe got back to me and he said both him and Ed could do the surgery.

I also reached out to Mr. Starnes at USC who is considered on of the top surgeons in the world regarding heart stuff. I hope to hear from him too.

God Bless, Jesus is coming soon!
Brian 🙂

Emergency doctors urged to ‘Think Aorta’

article source:

Emergency doctors are being urged to collaborate with a patient-led campaign, which aims to reduce the number of patients dying in Irish Emergency Departments (EDs) from aortic dissection.

An aortic dissection refers to a tear in the body’s largest artery that carries blood away from the heart. Unless the condition is diagnosed rapidly and the patient undergoes surgery, it can prove fatal.

However, symptoms can be similar to other heart problems, such as a heart attack, which can lead to a misdiagnosis or a delay in diagnosis.

A patient support association, Aortic Dissection Awareness (UK and Ireland), is challenging the number of unnecessary deaths that occur due to the misdiagnosis of this condition in Irish hospitals.

It is calling on the Irish Association for Emergency Medicine (IAEM) to collaborate with it and introduce changes in relation to education, awareness and policy around the condition.

The chairperson, vice-chairperson and medical advisor of this patient association are attending the IAEM’s annual scientific meeting and conference in Dublin this week to urge doctors to get involved with the ‘Think Aorta’ campaign.

This campaign was inspired by the death of Tim Fleming, who was sent home from Dublin’s Tallaght Hospital in 2015 with an incorrect diagnosis of gastritis. Mr Fleming’s daughter, Catherine Fowler, who is vice-chairperson of Aortic Dissection Awareness, is a guest speaker at the conference.

“We had no idea when dad died of how common it is for aortic dissection to be missed in the ED. Over the last three years, the picture has become very clear. Sadly, I know of many other families in Ireland who have lost their relatives to missed aortic dissection in hospitals during that time. We must do something to change the future for others,” she said.

She pointed out that as a result of the ‘Think Aorta’ campaign in the UK, the Royal College of Emergency Medicine there has accepted that this is a real issue and it is working with the association to address this.

“I will be asking the IAEM to do the same,” Ms Fowler added.

Statistics show that aortic dissection is only considered in half of the patients who present with it, and one-third of patients are actively treated for something else, such as a heart attack.

The only definitive diagnostic tool for diagnosing the condition is a CT scan, however these are often not ordered until it is too late.

“Aortic dissection is not a difficult condition to diagnose. A doctor just has to be aware enough to ‘Think Aorta’ in the first place, then once their suspicion is raised, they must request an immediate CT scan to confirm.

“Experience in the UK shows that if EDs educate staff about aortic dissection and lower the barriers to CT scanning, lives will be saved,” Ms Fowler noted.

The IAEM annual scientific meeting and conference takes place in Castleknock Hotel from October 17-19. For more information on the ‘Think Aorta’ campaign, click here

Aortic Disease Proves No Match for a Mother’s Love

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After learning she had an aortic aneurysm and dissection, a mother-to-be faced big risks. Michigan Medicine doctors worked together to keep mom and baby safe.

Last November was the start of a happy time after Monique Lowes learned she was pregnant with her first child. She had struggled for years to conceive and was thrilled at the thought of being a mother.

But her excitement soon turned to fear.

In February, the 37-year-old was advised by her primary obstetrician to undergo an echocardiogram. That screening was due to Lowes’ high blood pressure as well as her age, which put the patient in a high-risk pregnancy category.

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The test revealed a devastating and unexpected diagnosis: a thoracic aortic aneurysm and aortic dissection.

A thoracic aortic aneurysm, also referred to as a TAA, is an enlargement of the first portion of the aorta — the body’s major artery.

An aortic dissection happens when layers of the aorta pull apart and blood becomes trapped between the layers. This weakens the aorta and may cause it to rupture. People who have aortic aneurysms are at higher risk of dissection.

A difficult choice
As in Lowes’ case, the cause of aortic aneurysms isn’t always clear. Risk factors include genetic disorders such as Marfan, Loeys-Dietz or Ehlers-Danlos syndromes, arteriosclerosis (plaque buildup in artery walls) and high blood pressure.

Doctors advised Lowes of the risks that aorta repair surgery could have on her unborn child — as well as the risk she herself might face if the necessary surgery was delayed.

In the end, Lowes chose to delay the surgery.

“As a woman who has struggled with infertility, I wanted to do my best for me and my daughter,” Lowes says, noting that her pregnancy is what revealed the underlying heart condition.

“If it weren’t for her, the aneurysm would never have been discovered in time. It was a miracle that I was pregnant and that I found out about my heart condition.”

Handling with care
Lowes was admitted to Michigan Medicine, where she would spend two months on the fourth floor of the Frankel Cardiovascular Center being observed by a team of specialized providers, including cardiac surgeon Himanshu Patel, M.D., and high-risk obstetrics doctors such as Elizabeth Langen, M.D., of Von Voightlander Women’s Hospital.

“This was a very collaborative effort,” says Patel, noting that Lowes’ doctors worked hand-in-hand to monitor her condition as well as the health of her unborn baby.

SEE ALSO: Lifesaving Facts About Aortic Dissection

The goal: to get Lowes as far along in her pregnancy as possible without compromising her condition.

“The cardiac surgery and OB teams did a great job co-managing her care,” says Langen.

An incubator sat near Lowes’ hospital bed, a constant reminder that the baby might need to be delivered prematurely if the patient’s condition worsened.

But at 28 weeks pregnant, she was finally able to go home before giving birth at 32 weeks to her beautiful daughter, Graysen Faith.

The team’s detailed delivery plan included a cesarean delivery performed at the Frankel Cardiovascular Center, just in case Lowes’ aortic condition required immediate surgery.

“She was born with not a hair on her head out of place,” the proud mother says. “She’s a beautiful baby.”

“Within 24 hours, she was up and able to hold her baby and spend time with her during recovery. It was a successful outcome for her and the baby.”
Himanshu Patel, M.D.
Repair and reflection
Lowes was able to spend time with her newborn at home before returning to the Frankel Cardiovascular Center for surgery in August.

Her open-heart procedure included an incision that enabled access to the weakened area of Lowes’ aorta and dissection. The surgery required her to be put on a heart-lung machine to stop the flow of blood during repair of her aorta.

It didn’t take long, though, for mother-daughter bonding to resume.

“Within 24 hours, she was up and able to hold her baby and spend time with her during recovery,” says Patel. “It was a successful outcome for her and the baby.”

SEE ALSO: Genetic Defect Makes Cardiac Care a Family Affair

“Everyone worked so well with me,” Lowes says of her heart and obstetrics team, including the cardiac and neonatal intensive care nurses. “I fell apart a few times but then found strength to go on.”

She credits her care team as well as her sister, nephew and two nieces for keeping her strong through it all.

It was a risky choice, Lowes now admits, but she’s thankful for the outcome. “I had faith that God had a plan for me and my baby.”

As she recuperates from surgery and cares for her infant daughter, Lowes wants to spread a message of hope to moms faced with similar challenges: “Miracles do happen.”

Irbesartan slows aortic root dilatation in Marfan syndrome

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MUNICH — Irbesartan in standard doses is linked to a significant decrease in the rate of aortic dilatation in patients with Marfan syndrome, according to data from the AIMS study presented at the European Society of Cardiology Congress.

In the AIMS trial, Michael Mullen, MBBS, MD, FRCP, from St. Bartholomew’s Hospital in London, and colleagues randomly assigned patients aged 6 to 40 years with Marfan syndrome at 22 centers in the United Kingdom to irbesartan or placebo. The researchers aimed to recruit 490 patients but only enrolled 192 patients.

After an initial run-in period during which all patients received irbesartan 75 mg, 104 patients were up-titrated to targets of 300 mg for patients weighing more than 50 kg and 150 mg for patients weighing less than 50 kg or placebo. Treatment with beta-blockers was not mandated but was encouraged because it is standard treatment, Mullen said.

Patients were followed for up to 5 years and underwent yearly echocardiograms, for which a core lab was used. The primary endpoint was annual change in aortic root diameter and secondary endpoints included annual change in z score and clinical events and requirement for surgery, including aortic dissection.

At baseline, there was a reasonable spread across various age groups, with approximately half of patients younger than 18 years and a good balance between male and female patients. Fifty-seven percent were also taking beta-blockers.

The overall study population was normotensive, and aortic root diameter was similar for the placebo (35.3 mm) and irbesartan groups (34.8 mm). The aortic z score was approximately 3 in both groups, “meaning that, compared with other trials, these patients were fairly early in pathogenesis of their disease,” Mullen said.

Key findings

The rate of aortic dilatation was slower in patients taking irbesartan vs. placebo, with a mean annual rate of change in aortic root diameter of 0.53 mm in the treatment group vs. 0.74 mm in the placebo group (difference, –0.22 mm; 95% CI, –0.41 to –0.02). Significant differences in the change in aortic root diameter were apparent at 1 year and continued out to 5 years, according to Mullen.

In terms of safety, irbesartan was well-tolerated, with four patients in both the placebo and irbesartan groups failing to tolerate medication. There was also no difference in the rate of adverse events between groups. Four patients in both groups underwent cardiac surgery, but the study was again not powered to detect differences in clinical outcomes, according to Mullen. No deaths occurred during the study.

Aortic z score, which adjusted the aortic diameter for patients’ body surface area and particularly any changes in body surface area, appeared to be fairly stable in the irbesartan group (annual rate of change, 0.05; 95% CI, –0.2 to 0.11) when compared with the placebo group (annual rate of change, 0.15; 95% CI, 0.08-0.22). The difference of –0.1 (95% CI, –0.19 to –0.01) was statistically significant, Mullen noted.

The researchers also evaluated the effect of treatment on BP, as irbesartan is a well-recognized antihypertensive treatment, he said. Results showed a significant reduction in systolic BP in patients taking irbesartan vs. placebo (–0.42 mm Hg vs. 1.27; mean difference, –1.69 mm Hg), which was maintained out to 5 years.

There was no difference in treatment effect of irbesartan in patients taking beta-blockers vs. those who were not, suggesting that there was no interaction or synergy between the two drugs. The annual rate of change in aortic diameter between study groups was also not significantly different when analyzed according to aortic z score. Additionally, no statistically significant difference was noted based on patient age, although the effect size appeared to be numerically larger in younger patients.

However, Mullen noted that the study was significantly underpowered to analyze subgroups and suggested interpreting the results with caution.

Interpretations, implications

The results of this study, according to Mullen, suggest that irbesartan may have potential benefits for patients with Marfan syndrome.

“The current treatment strategy is based around beta-blockade, based on small trials conducted many years ago, and monitoring aortic dimensions with timely surgical intervention. However, some patients will still experience aortic dissection prior to presentation or before reaching those thresholds for surgical intervention,” Mullen said. “If translated into clinical practice, long-term irbesartan treatment may impact favorably on clinical outcomes in patients with Marfan syndrome.”

During a discussion of the results, Artur Evangelista Masip, MD, PhD, from Hospital Universitari Vall d’Hebron in Barcelona, Spain, highlighted several issues that may affect these findings, including the study’s sample size.

Evangelista Masip also noted that the inclusion of children and adults in the same series complicates the ability to perform an accurate analysis of this study as well as other trials. The measurement of changes in aortic diameter in systole may also be affected by the reduction in systolic BP.

“It would be interesting to know their results measuring at end-diastole,” he said.

Additionally, Evangelista Masip said the difference in the rate of change in aortic root diameter between the irbesartan and placebo groups occurred mainly during the first year and was similar thereafter.

“This is an important study and I agree that long-term irbesartan treatment may impact favorably in the evolution of patients with Marfan syndrome,” he said. “However, we have to clarify some of the previous doubts and elucidate in future studies if the reduction or aortic enlargement is secondary to biological effect or related to the decrease of BP.” – by Melissa Foster


Mullen M. Hot Line Session 5. Presented at: European Society of Cardiology Congress; Aug. 25-29, 2018; Munich.

Disclosures: Mullen and Evangelista Masip report no relevant financial disclosures.

Virginia native Darius Minor dies during college football workout

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ORONO, Maine — Orange County High School football standout Darius Minor died July 24 after he collapsed during a preseason football workout at the University of Maine, according to a university spokesperson. Minor, 18, was a first-year student at the university and was set to play defensive back on the school’s football team.

“The Athletics Department, our student-athletes and the entire campus mourn the loss of this bright and promising member of our community,” UMaine President Joan Ferrini-Mundy said. “We ask all to keep him, his family and his friends in your thoughts.”

Minor collapsed on the football field during a “supervised light workout” Tuesday at about 1:15 p.m., according to the university. The team’s training staff and first responders were not able to resuscitate him.

“Words cannot express the grief we have following this tragic loss,” UMaine head coach Joe Harasymiak said. “Our thoughts and prayers go out to Darius’ family and friends during this terrible time.”

In high school, Minor led his Orange County High School to three-consecutive post season appearances. He was named All-Central Virginia first-team wide receiver and second-team defensive back in 2017.

The Locust Grove teen was to be a political science major at the University of Maine.

Common antibiotics linked to increased risk of aortic dissection

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Exposure to fluoroquinolones—one of the most popular classes of antibiotics in the world—is associated with more than double the risk of aortic aneurysm (AA) or aortic dissection (AD), according to a study published online in the Journal of the American College of Cardiology.

Using national databases from Taiwan, researchers analyzed fluoroquinolone prescriptions among 1,213 patients hospitalized for AA or AD from 2001 to 2011. They compared exposure to the drug in the 60 days leading up to the AA/AD event to a randomly selected 60-day interval between 60 and 180 days before the event.

Lead author Chien-Chang Lee, MD, ScD, and colleagues found 1.6 percent of patients had been exposed to fluoroquinolone in the two months leading up to their event, versus only 0.6 percent in a preceding 60-day period. That translated to a 2.71-fold risk of AA/AD related to more recent fluoroquinolone use.

In addition, Lee et al. found that prolonged exposure to the antibiotics further increased risk. Those who were prescribed the drugs for between three and 14 days showed a 2.41-fold increased risk versus no prescription at all, while those prescribed fluoroquinolones for more than 14 days demonstrated a 2.83-fold risk.

“Typically, AA/AD develop slowly in patients, but our data suggest that use of fluoroquinolone can contribute in the short term to aneurysm progression or rupture that may require emergency department visits and hospitalization,” wrote Lee, with the department of emergency medicine at National Taiwan University Hospital, and coauthors.

Population-based studies support that AA and AD are rare diseases, occurring in between three and 20 people per 100,000 population each year. However, annual incidence among elderly individuals rises to as much as 130 per 100,000 people, the researchers noted.

Despite the relative rarity of the conditions, Lee et al. suggested the rising prescriptions of fluoroquinolones may be cause for concern, particularly since AA and especially AD are life-threatening without timely treatment.

The authors estimated 25.2 million U.S. outpatients were prescribed fluoroquinolones in 2012, which they calculated would result in an additional 2,591 cases of AA/AD.

“In the United States alone, fluoroquinolone prescriptions have more than tripled, from 7 million in 1995 to 22 million in 2002. With an estimated 25 million people prescribed with fluoroquinolones in the United States annually, which is expected to increase even more, it is clear that fluoroquinolones may contribute substantially to the current and future burdens of AA/AD.”

In a related editorial, Sonal Singh, MD, MPH, and Amit Nautiyal, MD, noted fluoroquinolones “have been known to cause tendon rupture mediated by their adverse effects on collagenous structures”—and the aorta is rich in type I and type III collagen.

“Although the exact biological mechanism remains unknown, several plausible mechanisms have been proposed to explain how fluoroquinolones might affect the synthesis or structural integrity of collagen in the aortic wall,” Lee and colleagues wrote. “First, fluoroquinolones have chelating properties against several metal ions (e.g., calcium, magnesium, aluminum), which are essential for type 1 collagen synthesis. Second, fluoroquinolones can decrease collagen synthesis by increasing the expression of matrix metalloproteinases, which lead to extracellular matrix degradation and medial layer degeneration.”

Based on the biological plausibility of those experimental studies—as well as the consistently increased risk found in epidemiological research—Lee et al. believe there is strong evidence to support that fluoroquinolone contributes to the incidence of AA and AD.

“Although the rare incidence of AA/AD attenuates the public health impact, the rapid increase of fluoroquinolone consumption still poses a large burden of AA/AD in the general population,” they wrote. “Clinicians are advised to consider alternative antibiotic regimens in patients with pre-existing collagen-related disorder or aortic aneurysm.”

Singh and Nautiyal agreed, saying the “cumulative strength” of multiple studies, with different designs and different patient populations, makes it unlikely an unknown confounding factor is biasing all of the studies.

“It would be prudent to entertain the possibly of aortic aneurysms/aortic dissection associated with fluoroquinolones use in patients presenting with chest pain, shortness of breath, or syncope after recent exposure to the fluoroquinolones,” they wrote. “Although one should be careful in extrapolating from mechanistic studies, judicious use of fluoroquinolones may be particularly warranted among patients with risk factors for aortic aneurysms such as increasing age, the presence of smoking, hypertension, and Marfan’s syndrome.”

Sherene Shalhub, MD MPH FACS-New Studies

Hi Brian,

Hope this finds you well, I am working on the grant application for PCORI as I mentioned to you earlier. So more information will be coming in the next week.

“Also, I recently published these manuscripts recently that you may find to be of interest to your readership’

Association of variant arch anatomy with type B aortic dissection and hemodynamic mechanisms

· Type of Research: Retrospective cohort study

· Take Home Message: Compared with 367 controls, variant arch anatomy was observed on computed tomography scans of 40.5% of 185 patients with type B aortic dissection. On four-dimensional flow magnetic resonance imaging, patients with bovine arch had higher systolic wall shear stress compared with those with normal arch anatomy.

· Recommendation: This study suggests that aortic arch anatomy variants are more common in patients with type B aortic dissections, which might be explained by higher wall sheer shear stress.

Endovascular thoracic aortic repair in confirmed or suspected genetically triggered thoracic aortic dissection

· Type of Research: Retrospective analysis of prospectively collected National Registry of Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions (GenTAC) data

· Take Home Message: In 31 patients with descending thoracic aorta dissection treated with thoracic endovascular aortic repair, 13 (42%) required reintervention at a median of 7 months, 3 for retrograde ascending aorta dissection and 7 for thoracoabdominal aortic aneurysm repairs with stent graft explantation.

· Recommendation: This study suggests that patients with genetically triggered descending thoracic aorta dissection, treated with thoracic endovascular aortic repair, have a high risk of retrograde aortic dissection and reintervention.

Testing patterns for genetically triggered aortic and arterial aneurysms and dissections at an academic center

· Type of Research: Retrospective cohort study

· Take Home Message: In 36% of 75 patients suspected of having heritable mutations related to aortic or arterial aneurysms or dissections, genetic testing results were positive. Pathogenic mutation was confirmed in 57% of patients with a family history of diagnosed mutation and in 42% of those with a personal history of ascending aortic disease.

· Recommendation: The authors suggest appropriate genetic consultation and selective testing in patients suspected of having genetically triggered vascular disease and suggest the need for novel gene discovery.

Warm regards,

Sherene Shalhub, MD MPH FACS

Associate Professor of Surgery

Division of Vascular Surgery

University of Washington

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