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Nikki. Uh we will uh discuss today uh aortic Disease. Uh Please feel free to interrupt me if you want uh to ask anything. Otherwise I might ask you some questions um to try and make it interactive. Uh If you want to turn on your cameras, it would be good. Yes. And if you wanna start seeing your screen most of the key and yes, please, everyone who is in the chat. Uh feel free, please to turn your cams and mics on. If there's any questions, you can just turn your mic on and shoot um shoot at us and I'll see if you can turn your um CS on would be great. That'll be more engaging um uh for both of us. Um So, OK. Right. OK. I think now it's better. So, uh with this point to presentation, we will discuss a bit about uh treatment for chronic and acute aortic disease. Um The aim of the presentation is to provide an overview of the indications for the management for both acute and chronic aortic disease. Um understand the importance of concomitant indication during aortic surgery. And I'll explain to you later on what we mean with that uh discuss basic principles for the management of patients with aortic disease. Uh And at the end, just a brief overview of the complications after the aortic surgery. Um so, aortic disease, uh aortic diseases, we are referring to diseases that they're affecting the aorta. And we know that they are the most common cardiovascular disease. Um depending on the area of the aorta, there is different in the incidence uh as well as the presentation. Uh So sometimes these diseases are presenting as aneurys, uh meaning that the diameter of the aorta becomes 1.5 times bigger than the normal or stenosis. Uh and these are usually chronic uh pathologies. Um they might present as dissection, uh an intimal tear o of the um oo in on the wall of the aorta that splits. Uh And there is a hematoma uh built uh throughout the wall or penetrating ulcers that these are chronic disease. Uh But they um uh they can initiate a dissection. Um This is a graph from the latest guidelines um reviewing the management of patients with aortic disease. And as you can see, um there are different pathologies um depending on the area of the aorta, starting from the aortic root, uh extending to the ascending aorta and then all the way down to the uh abdominal aorta. Um And on this table, you can also see uh the imaging uh that is treatable to identify and assess uh the disease. So, that we can provide treatment as well as uh the last column shows uh the treatment for each part of the aorta. Now, do you know any causes of aortic disease? What is the cause of aortic disease? So, um we have our acquired causes of aortic disease uh such as uh typically hypertension diabetes and smoking. Um We cocaine use can cause acute aortic dissections. There is uh there, there are iatrogenic injuries uh of the aorta as well as traumatic injuries of the aorta. Uh Some pathologies are related with congenital uh causes uh such as uh besic aortic valve or cord of the aorta or other more complex uh congenital heart disease. Uh And of course, we have genetic causes that we distinguish to syndromic and non syndromic. And I will explain it in a bit what it means. Uh inflammatory arthritis. Uh You may have heard about giant cell arteritis or Taka Takayasu syndrome uh and infectious arthritis. Uh as we said earlier on, uh there are genetic causes uh of aortic disease. So there are families uh that they have higher incidence of um uh of aortic disease. Uh And we separate those to syndromic and non syndromic syndromic. It means that the related genes uh cause a number of clinical presentations of symptoms. And uh this uh uh uh an example is Marfan syndrome loss and Dangler's or Turner Syndrome, uh non syndromic or uh genes that they cause opathy, but they don't cause any other kind of presentation. Um There are 67 genes associated with the aortic disease. And I would say uh one of the mo most uh known uh and sometimes aggressive is to um a gene. Um Now, 80% of the pathology of the aorta uh happens below the diaphragm, uh the abdominal aorta, uh 60% presents in the uh thoracic aorta and 40% in the descending aorta. Um And here you can see a summary of um of the modalities we use to um establish diagnosis and um uh retrieve informations that help us to uh identify what is the best treatment uh option for the patient. Um in general, uh Y often, the first diagnosis happens with an echocardiogram um that helps us to understand the aortic valve, the aortic root and other pathologies of the of the heart and uh similar information and, and as well the as the contractility of the heart uh and similar information we get from the transit of I echocardiogram and the MRI um CT aorta um are essential when we, when we assess patients because they provide information about the details of the pathology and the extent of the disease. And these are very important to uh plan for our uh for the treatment for the surgical treatment. Um And of course, all patients uh that they are having uh thoracic aorta surgical treatment. They need to have a coronary angiogram because if there is coronary artery disease, then we need to treat at the same time. And this is what we said uh earlier on concomitant uh procedures. No. Uh is that clear, is there anything anything you would like to ask? Sorry. So if we start from the aortic root, um uh the aortic root is uh uh can be dilated. And uh that means that the diameter needs to be at least 1.5 times bigger than the normal diameter. We know that 2 to 3 patients every 100,000 of population um have aortic root and ascending aorta aneurys. Uh These are often uh related with uh bicuspid aortic valve, uh connective tissue disease like a left so, or Marfan uh atherosclerosis or sometimes um uh uh we have erogenic pathologies. It's very important to notice that uh the aneurysm of the um aneurysm of the aortic root and the ascending aorta sometimes may be asymptomatic. The patient have no symptoms uh for any reason they have an echo or a CT. Uh And uh diagnosis is incidental. Um sometimes uh they may complain for pain, uh deep pain, um like an ache and this might be the most common symptom, uh back pain, uh cough, uh or shortness of breath when uh when we have Pury that actually um affect the airways, uh pressurize the airways uh very often. And this is very characteristic uh patients especially with arch aneurys present with coarse voice. Uh because uh of pressure on the retrograde laryngeal nerve. You might remember that. Uh.