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A review of aortic disease research in Malaysia

Tan GJS, Khoo PLZ, Sailesh MK, Chan KMJ

Med J Malaysia, 2019 02;74(1):67-78.
PMID: 30846666

INTRODUCTION: Aortic disease includes conditions such as chronic aortic aneurysms, acute aortic syndromes and congenital aortic abnormalities, amongst others. This paper reviews all research on aortic disease performed in Malaysia and published between 2000-2016.
METHODS: A literature search was conducted in PubMed, Scopus, MyJurnal and the UKM Journal Repository. The search process was based on a previously published methodology. The medical subject headings (MeSH) search terms used were "aortic", "aorta" and "Malaysia".
RESULTS: Two-hundred-thirteen papers were identified, of which 60 papers were selected and reviewed on the basis of their relevance. The epidemiology, pathophysiology, clinical presentations, case reports, investigations, treatment and outcomes of aortic disease in Malaysia were reviewed and summarised. The clinical relevance of the studies performed are discussed.
CONCLUSION: The review provided an insight into the pathophysiology, prevalence and epidemiology of aortic diseases in Malaysia, how the condition is managed, and the outcomes of treatment. Limitations of the research performed in Malaysia to date were identified and recommendations for further research and improvement in clinical practice were recommended.

Matched MeSH terms: Aortic Diseases/congenital; Aortic Diseases/diagnosis; Aortic Diseases/epidemiology*; Aortic Diseases/therapy
Fulltext Primary aorto-duodenal fistula

Muhsein KA, Suib I, Hanif H

Med J Malaysia, 2003 Aug;58(3):446-9.
PMID: 14750389

Primary aorto-duodenal fistula is a rare and life-threatening cause of upper gastro-intestinal bleed. In this case report, a patient presented acutely with several episodes of haematochezia and pulseless lower limbs bilaterally. Primary aorto-duodenal fistula with peripheral vascular disease was diagnosed after an urgent CT angiogram was performed. She underwent left axillo-bifemoral bypass, resection of the fistula, Rouxen-Y gastro-jejunostomy, pyloric exclusion and controlled duodenal fistula the following day.

Matched MeSH terms: Aortic Diseases/diagnosis*
Aortic saddle embolectomy via femoral arteries

Nambiar RM

Med J Malaya, 1970 Mar;24(3):212-4.
PMID: 4246804
Matched MeSH terms: Aortic Diseases/surgery
Paediatric middle aortic syndrome with endovascular treatment in East Malaysia

Hong Ong G, Benjamin Leong DK

Med J Malaysia, 2018 02;73(1):57-59.
PMID: 29531207 MyJurnal

Middle-aortic syndrome is a surgically curable cause of childhood hypertension. Open surgery is traditionally offered but with the advance of medical technology, endovascular approached is available in many country. Failure to control BP in open surgery is as low as 4.1% compares to 13% in endovascular approaches. However, mortality is 4% in open surgery almost 2 times higher than 2.3% in endovascular approach. This article presents a case of 10 years old child treated successfully without complication with endovascular balloon dilatation, as a first case of such disease in East Malaysia.

Matched MeSH terms: Aortic Diseases
Acute myelomonocytic leukaemia complicated by an acute aortic thrombosis

Leong KW, Bosco JJ, Shaik IB

Postgrad Med J, 1995 Feb;71(832):112-3.
PMID: 7724422

Acute aortic thrombosis is a rare condition, occurring mainly as a result of trauma or atherosclerosis and occasionally secondary to hypercoagulable states. We report a patient with relapsed acute myeloid leukaemia who developed an unusual complication, acute aortic thrombosis.

Matched MeSH terms: Aortic Diseases/complications*
Fulltext Antihypercholesterolemic and antioxidant efficacies of zerumbone on the formation, development, and establishment of atherosclerosis in cholesterol-fed rabbits

Hemn HO, Noordin MM, Rahman HS, Hazilawati H, Zuki A, Chartrand MS

Drug Des Devel Ther, 2015;9:4173-208.
PMID: 26347047 DOI: 10.2147/DDDT.S76225

Owing to the high incidence of cholesterol-induced cardiovascular disease, particularly atherosclerosis, the current study was designed to investigate the preventive and therapeutic efficacies of dietary zerumbone (ZER) supplementation on the formation and development of atherosclerosis in rabbits fed with a high cholesterol diet. A total of 72 New Zealand white rabbits were divided randomly on two experimental studies carried out 8 weeks apart. The first experiment was designed to investigate the prophylactic efficacy of ZER in preventing early developed atheromatous lesion. The second experimental trial was aimed at investigating the therapeutic effect of ZER in reducing the atherosclerotic lesion progression and establishment. Sudanophilia, histopathological, and ultrastructural changes showed pronounced reduction in the plaque size in ZER-medicated aortas. On the other hand, dietary supplementation of ZER for almost 10 weeks as a prophylactic measure indicated substantially decreasing lipid profile values, and similarly, plaque size in comparison with high-cholesterol non-supplemented rabbits. Furthermore, the results of oxidative stress and antioxidant biomarker evaluation indicated that ZER is a potent antioxidant in suppressing the generation of free radicals in terms of atherosclerosis prevention and treatment. ZER significantly reduced the value of malondialdehyde and augmented the value of superoxide dismutase. In conclusion, our data indicated that dietary supplementation of ZER at doses of 8, 16, and 20 mg/kg alone as a prophylactic measure, and as a supplementary treatment with simvastatin, significantly reduced early plague formation, development, and establishment via significant reduction in serum lipid profile, together with suppression of oxidative damage, and therefore alleviated atherosclerosis lesions.

Matched MeSH terms: Aortic Diseases/blood; Aortic Diseases/drug therapy*; Aortic Diseases/etiology; Aortic Diseases/pathology; Aortic Diseases/prevention & control*
Fulltext Acute aortic occlusion: the need to be aware

Zainal AA, Oommen G, Chew LG, Yusha AW

Med J Malaysia, 2000 Mar;55(1):29-32.
PMID: 11072487 MyJurnal

A prospective study of patients with acute aortic occlusion (AAO) admitted to the Vascular Unit, Hospital Kuala Lumpur was carried out over a 12 month period. There were a total of 11 patients admitted with a clinical diagnosis of AAO. There was a male preponderance with 10 patients. The median age was 58 years (40-70 years). Hypertension was the commonest underlying medical illness (n = 7). All patients had painful lower limb paraparesis or paraplegia with bilateral absent limb pulses from the groin downwards on admission to the vascular unit. The majority of patients (10 patients) were referred from other hospitals, of which 6 patients came from outside the Klang Valley. Only eight (8) patients underwent an operative procedure with seven (7) having an initial bilateral balloon catheter thromboembolectomy. There was one (1) aorta-bifemoral bypass after failed embolectomy. An aneurysectomy with inlay-graft was done as the initial procedure in one (1) patient. Mortality was 82% (9/11). The two survivors were in the group that had vascular reconstructive surgery. Acute aortic occlusion is an uncommon but catastrophic event with a high mortality. Clinicians must have a high index of suspicion in patients who present with painful paresis or paraplegia. Clinical examination of peripheral pulses in these patients is mandatory. Early diagnosis and treatment is important to improve the outcome of this disease.

Matched MeSH terms: Aortic Diseases/complications*; Aortic Diseases/epidemiology
Aortic and coronary atherosclerosis in the Malaysian Orang Asli

Prathap K, Montgomery GL

Pathology, 1974 Jul;6(3):255-61.
PMID: 4412062
Matched MeSH terms: Aortic Diseases/epidemiology*; Aortic Diseases/pathology
Fulltext Primary arteritis of aorta causing renal artery stenosis and hypertension

Danaraj TJ, Wong HO, Thomas MA

Br Heart J, 1963 Mar;25(2):153-65.
PMID: 14024854

The evidence presented by the nine cases described in this paper indicates that primary arteritis of the aorta is a single clinico-pathological entity of which Takayashu's syndrome is a part. Different segments of the aorta may be affected resulting in a variety of symptom complexes. In this series, the mode of presentation was hypertension consequent on renal artery stenosis. Early diagnosis is important and surgical treatment is indicated to relieve the hypertension which carries an immediately serious prognosis.

Matched MeSH terms: Aortic Diseases*
Successful clot lysis using low dose of streptokinase in 22 neonates with aortic thromboses

Cheah FC, Boo NY, Rohana J, Yong SC

J Paediatr Child Health, 2001 Oct;37(5):479-82.
PMID: 11885713

OBJECTIVE: To determine whether intravenous infusion of low dose of streptokinase was effective in lysing umbilical arterial catheter (UAC)-associated aortic thrombi.
METHOD: A prospective cohort study of 31 consecutive newborn infants with UAC-associated aortic thrombi which were detected by abdominal ultrasonography after removal of UAC. Twenty-two infants were treated with intravenous infusion of low dose (1000 U/h) streptokinase, while nine others were not treated due to various contra-indications. Thrombolysis occurred after a mean interval of 2.2 days (standard deviation (SD) = 1.8) in the treated infants. In the untreated infants, spontaneous thrombolysis occurred significantly later, after a mean interval of 16.9 days (SD = 14.7) (95% confidence intervals of difference between mean intervals - 26.0, - 3.4; P = 0.02). Only one treated infant developed mild bleeding directly attributed to streptokinase therapy.
CONCLUSION: Low dose streptokinase infusion was effective and safe in thrombolysing UAC-associated aortic thrombi.

Matched MeSH terms: Aortic Diseases/drug therapy*; Aortic Diseases/etiology
Fulltext Morphology of the human aorta and age-related changes: anatomical facts

Komutrattananont P, Mahakkanukrauh P, Das S

Anat Cell Biol, 2019 Jun;52(2):109-114.
PMID: 31338225 DOI: 10.5115/acb.2019.52.2.109

Aorta is the largest artery in the human body. Its starting point is the aortic orifice of the aortic valve and it terminates at the level of the fourth lumbar vertebra. The main function of the aorta is to transport oxygenated blood to supply all the organs and cells. With advancing age, the structure and hence the function show progressive changes. Various changes in the aortic morphology include the luminal diameter of aorta, whole length of the aorta, thickness, the microstructural components also change, and these include collagen, elastin and smooth muscle cells. In addition, the dimensions of all segments of the aorta increase with age in both sexes. Since age is a major risk factor for degenerative change and diseases affecting the aorta, understanding the detailed anatomy of the aorta may provide essential information concerning the age-associated process of the aorta. Knowledge of the morphological changes in the aorta is also important for future clinical therapies pertaining to aortic disease. Additionally, the information regarding the structural changes with age may be applied for age determination. This review describes the overview of the anatomy of the aorta, age related changes in the morphology of the aorta and aortic diseases.

Matched MeSH terms: Aortic Diseases
Fulltext A challenging case report of acute sinus of Valsalva aneurysm rupture in cardiogenic shock and multi-organ failure with an emphasis on rapid recognition and 'never giving up' in face of futility

Jin QW, Jeswant Dillon J, Tjen Jhung L, Isman Rusani B

Eur Heart J Case Rep, 2020 Dec;4(6):1-5.
PMID: 33442636 DOI: 10.1093/ehjcr/ytaa441

Background : Sinus of Valsalva aneurysm (SoVA) is a rare anomaly and can be divided into acquired and congenital forms, the latter being commonly associated with ventricular septal defects (VSDs). Rupture is a catastrophic complication with high mortality without urgent surgical intervention. We would like to highlight the use of echocardiography in an emergency setting for diagnosis and surgical intervention in a critically ill patient.
Case summary : We report a 27-year-old female with history of conservatively managed VSD known since childhood. She presented with acute decompensated cardiac failure requiring intubation and inotropic support. Bedside echocardiography performed in the emergency department suggested a ruptured SoVA at the right coronary cusp with underlying supracristal VSD. Despite the patient being critically ill with multi-organ failure, surgery was performed as it was the patient's best chance for survival. Intraoperative findings tallied with the early echocardiographic results. She recovered gradually and was eventually discharged despite a stormy post-operative period.
Discussion : This case report highlights the importance of prompt recognition of SoVA rupture by using bedside echocardiography. Surgical intervention needs to be early despite ongoing sepsis in view of acute mechanical failure. This case was unique as it illustrates a successful management of an acutely ill patient with multi-organ failure through early diagnosis, intensive perioperative stabilization, and surgical intervention.

Matched MeSH terms: Aortic Diseases
Fulltext Can Brain Natriuretic Peptides and Osteoprotegerin Serve As Biochemical Markers for the Detection of Aortic Pathology in Children and Adolescents with Turner Syndrome?

Mavinkurve M, O'Gorman CS

Front Endocrinol (Lausanne), 2017;8:142.
PMID: 28725213 DOI: 10.3389/fendo.2017.00142

Turner syndrome (TS) is a chromosomal disorder that affects 1:2,000 females. It results from either the complete or partial loss of the X chromosome as well as other aberrations. Clinical features of TS include short stature, delayed puberty, and congenital cardiac malformations. TS children also have an increased prevalence of cardiometabolic risk factors, which predisposes them to complications like coronary artery disease, cerebrovascular-related deaths, and aortic dissection. Early cardiac imaging, such as echocardiography and cardiac magnetic resonance imaging, are recommended to detect underlying aortic pathology. However, these modalities are limited by cost, accessibility, and are operator dependent. In view of these shortcomings, alternative methods, like vascular biomarkers, are currently being explored. There are only a few studies that have examined the relationship between B-type natriuretic peptide (BNP), N-terminal pro BNP (NT pro-BNP), and osteoprotegerin (OPG) and aortic disease in TS, and thus the data are only in proof-of-concept stages. Further meticulous longitudinal studies are required before BNP, NT pro-BNP, and OPG are used as vascular biomarkers for the detection of aortic disease in childhood and adolescent TS.

Matched MeSH terms: Aortic Diseases