BACKGROUND & AIMS: :Blood vessels and neurons grow often side by side. However, the molecular and cellular mechanisms underlying their parallel development remain unclear. Here, we report that a subpopulation of secondary motoneurons extends axons ventrally outside of the neural tubes and rostrocaudally as a fascicle beneath the dorsal aorta (DA) in zebrafish. We tried to clarify the mechanism by which these motoneuron axons grow beneath the DA and found that Vegfc in the DA and Vegfr3 in the motoneurons were essential for the axon growth. Forced expression of either Vegfc in arteries or Vegfr3 in motoneurons resulted in enhanced axon growth of motoneurons over the DA. Both vegfr3 morphants and vegfc morphants lost the alignment of motoneuron axons with DA. In addition, forced expression of two mutant forms of Vegfr3 in motoneurons, potentially trapping endogenous Vegfc, resulted in failure of growth of motoneuron axons beneath the DA. Finally, a vegfr3 mutant fish lacked the motoneuron axons beneath the DA. Collectively, Vegfc from the preformed DA guides the axon growth of secondary motoneurons.

背景与目标： : 血管和神经元经常并排生长。然而，它们平行发展的分子和细胞机制仍不清楚。在这里，我们报告了次级运动神经元的亚群在斑马鱼的背主动脉 (DA) 下方的束中向神经管的腹侧和尾部延伸轴突。我们试图阐明这些运动神经元轴突在DA下生长的机制，并发现DA中的Vegfc和运动神经元中的Vegfr3对于轴突生长至关重要。动脉中Vegfc或运动神经元中Vegfr3的强制表达导致DA上运动神经元的轴突生长增强。vegfr3形变和vegfc形变都失去了运动神经元轴突与DA的排列。此外，在运动神经元中强迫表达两种突变形式的Vegfr3，可能捕获内源性Vegfc，导致DA下方的运动神经元轴突生长失败。最后，vegfr3突变鱼在DA下方缺少运动神经元轴突。总的来说，来自预先形成的DA的Vegfc引导次级运动神经元的轴突生长。

BACKGROUND & AIMS: :Tinnitus is a challenging condition to manage with no effective treatment. We report a case of lifelong tinnitus present in a patient who was cured with the surgical repair of his coarctation of aorta. The patient was a fit 37-year-old with coarctation of aorta, senserineural deafness and intractable tinnitus. He underwent a thoracotomy and tube by-pass of his coarctation of aorta. A complete relief of his tinnitus and improvement in his hearing was noted postoperatively and confirmed on audiograms. This is the first reported case of tinnitus due to coarctation of aorta relieved by surgical correction of the coarctation.

背景与目标： : 耳鸣是一种具有挑战性的疾病，没有有效的治疗方法。我们报告了一例因手术修复主动脉缩窄而治愈的患者终身耳鸣。该患者为37岁，患有主动脉缩窄，神经性耳聋和顽固性耳鸣。他接受了开胸手术，并对主动脉缩窄进行了管旁路。术后发现他的耳鸣完全缓解，听力得到改善，并在听力图上得到证实。这是首例因主动脉缩窄而通过手术矫正缩窄而缓解的耳鸣病例。

BACKGROUND & AIMS: BACKGROUND:Transesophageal echocardiography (TEE) is a key diagnostic modality in patients with acute aortic dissection, yet its sensitivity is limited by a "blind-spot" caused by air in the trachea. After placement of a fluid-filled balloon in the trachea visualization of the thoracic aorta becomes possible. This method, modified TEE, has been shown to be an accurate test for the diagnosis of upper aortic atherosclerosis. In this study we discuss how we use modified TEE for the diagnosis and management of patients with (suspected) acute aortic dissection. NOVEL DIAGNOSTIC APPROACH OF THE DISSECTED AORTA:Modified TEE provides the possibility to obtain a complete echocardiographic overview of the thoracic aorta and its branching vessels with anatomical and functional information. It is a bedside test, and can thus be applied in hemodynamic instable patients who cannot undergo computed tomography. Visualization of the aortic arch allows differentiation between Stanford type A and B dissections and visualization of the proximal cerebral vessels enables a timely identification of impaired cerebral perfusion. During surgery modified TEE can be applied to identify the true lumen for cannulation, and to assure that the true lumen is perfused. Also, the innominate- and carotid arteries can be assessed for structural integrity and adequate perfusion during multiple phases of the surgical repair. CONCLUSIONS:Modified TEE can reveal the "blind-spot" of conventional TEE. In patients with (suspected) aortic dissection it is thus possible to obtain a complete echocardiographic overview of the thoracic aorta and its branches. This is of specific merit in hemodynamically unstable patients who cannot undergo CT. Modified TEE can guide also guide the surgical management and monitor perfusion of the cerebral arteries.

背景与目标：

BACKGROUND & AIMS: BACKGROUNDS:Hemolysis related to a kinked prosthetic graft or inner felt strip is a very rare complication after aortic surgery. We describe herein a case of hemolytic anemia that developed due to aortic flap of the dissection and inversion of an inner felt strip that was applied at the proximal anastomosis of a replaced ascending aorta 10 years previously. CASE PRESENTATION:A 74-year-old woman presented with consistent hemolytic anemia 10 years after replacement of the ascending aorta to treat Stanford type A acute aortic dissection. The cause of hemolysis was attributed to mechanical injury of red blood cells at a site of stenosis caused by aortic flap of the dissection and inversion of the felt strip used for the proximal anastomosis. Repeated resection of the strip and graft replacement of the ascending aorta resolved this problem. CONCLUSIONS:We considered that blood flow disrupted by a jet of blood at the site of the proximal inner felt strip was the cause of severe hemolysis, we describe rare hemolytic anemia at the site of aortic flap and inverted felt strip after replacement of the ascending aorta.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Postcardiac injury syndrome (PCIS) is an inflammatory response syndrome characterized by pericardial effusion with or without pleural effusion; however, serious PCIS with peripheral hematoma of the ascending aorta and acute cerebral infarction after percutaneous coronary intervention (PCI) have not been reported. CASE PRESENTATION:This article reports a very rare case of a 40-year-old patient who developed acute pericardial and pleural effusions (both bloody), acute respiratory distress, peripheral hematoma of the ascending aorta, and acute cerebral infarction after PCI. The patient's ECG showed bow-back downward ST elevation in leads I, II, III, and V4-V6. A blood test showed significant increases in eukaryotic-cell count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). Echocardiography and pulmonary artery computed tomography angiography (CTA) showed a large amount of pericardial effusion and pleural effusion. CTA of the thoracic and abdominal aorta showed a peripheral hematoma of the ascending aorta. A cranial computed tomography (CT) showed cerebral infarction anterior to the anterior horn of the right ventricle. After tracheal intubation, ventilator breathing support, pericardial and pleural drainage, and adrenocortical steroid (prednisone) treatment, he gradually recovered and was discharged 20 days later. CONCLUSION:We report the management of a case of serious PCIS with peripheral hematoma of the ascending aorta and acute cerebral infarction after PCI. Early diagnosis, early differential diagnosis, and early use of steroid therapy are the key in treating PCIS.

背景与目标：

BACKGROUND & AIMS: :Traumatic injury of the abdominal aorta with total interruption of blood flow is uncommon. When there is total obstruction of the artery, the clinical picture is dramatic. The most frequent mechanism is compression due to the safety belt during a car accident. The patients have absent femoral and distal pulses, associated to neuropathy in the lower limbs. We present a case of abdominal aorta injury secondary to closed trauma and review the causes, presentation forms and management of the injury.

背景与目标： : 完全中断血流的腹主动脉外伤并不常见。当动脉完全阻塞时，临床表现是戏剧性的。最常见的机制是在车祸中由于安全带的压缩。患者的股骨和远端脉搏缺失，与下肢神经病变有关。我们介绍了一例继发于闭合性创伤的腹主动脉损伤，并回顾了损伤的原因，表现形式和处理方法。

BACKGROUND & AIMS: BACKGROUND:The long-term sequelae of Kawasaki disease (KD) are based on the coronary complications. Because KD causes generalized vasculitis, with documented aneurysms in the femoral, iliac, renal, axillary, and brachial arteries, the aim of this study was to assess the biophysical properties of the aorta (BPA) after KD. The BPA are biometric measurements representing vascular structural and dynamic changes in response to cardiac work. METHODS:Anthropometric and echocardiographic measurements of the aorta in a series of patients with KD were compared with those of healthy subjects. The BPA were calculated noninvasively by extrapolating previously validated equations that were conceived for invasive measurements. Because BPA vary with body habitus, control subjects were used to normalize BPA parameters for height to compute BPA Z-score equations. RESULTS:Between June 2007 and February 2010, BPA were recorded in 57 patients with KD >1 year after the onset of the disease, 45 without and 12 with coronary artery sequelae. The mean intervals between the acute onset of KD and enrollment were 10.0 ± 5.0 and 5.8 ± 4.5 years for patients with and without coronary artery sequelae, respectively (P = .008). Patients with KD with coronary artery sequelae had significantly altered Z scores of aortic diameter modulation, Peterson's elastic modulus, and β stiffness index (P = .001-.016). Patients with KD without coronary artery sequelae also exhibited altered elasticity, stiffness, and pulse-wave velocity (P = .001-.026). CONCLUSIONS:Altered BPA after KD are detectible despite apparent resolution of acute vasculitis. Future directions toward determining multilevel and multilayer vascular impact, including vascular autonomous homeostasis, require thorough investigation.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:For a moderately dilated ascending aorta (diameter 35-54 mm), current guidelines recommend continuous annual or semi-annual examinations with computed tomography or magnetic resonance imaging. However, few data have shown the yield and benefit of such a protocol. This study aimed to investigate the fate of a moderately dilated ascending aorta and thereby determine the adequate imaging interval. METHODS:In our institutional database, we identified adult patients having an ascending aortic diameter ≥40 mm in contrast-enhanced computed tomography and follow-up imaging(s) after ≥1 year. Of the 509 patients (mean age 67.2 ± 10.4 years) enrolled in the study, the maximal diameter of the ascending aorta was compared between the first and last images. Also, their medical records were reviewed to investigate the associated illness and clinical events. RESULTS:The mean growth rate of the patients with a 40-44 mm ( n  = 321), 45-49 mm ( n  = 142) and ≥50 mm ( n  = 46) ascending aorta was 0.3 ± 0.5, 0.3 ± 0.5 and 0.7 ± 0.9 mm/year, respectively. During the mean interval of 4.3 ± 2.4 years, significant progression (diameter increase by ≥5 mm) occurred in 3.4, 5.6 and 21.7%, respectively. The 3- to 5-year rates of freedom from significant progression were 99.1%-96.5% (40-44 mm) and 97.8%-96.4% (45-49 mm). In multivariate analysis, initial ascending aortic diameter ≥45 mm and aortic valve regurgitation were significantly associated with significant progression. Acute type A aortic dissection occurred in 5 patients (1%), before the maximal diameter of the ascending aorta reached 55 mm or significant progression was observed. CONCLUSIONS:For a moderately dilated ascending aorta not exceeding 45 mm in maximal diameter and stable in the first annual follow-up image, a 3- to 4-year interval would be reasonable before subsequent imaging. More frequent imaging may be warranted in patients with aortic valve insufficiency or with an aortic diameter ≥45 mm.

背景与目标：

BACKGROUND & AIMS: :The aim of this study was to assess the influence of the endogenous status of ovarian hormones on the relaxation induced by the beta-adrenoceptor agonists isoprenaline (isoproterenol) and dobutamine in thoracic aorta segments, precontracted with noradrenaline, from age-matched (13-week-old) virgin (oestrus) and ovariectomized (OVX) prepubertal female Wistar rats. Isoprenaline-induced relaxation was decreased in intact aortic segments from OVX rats compared with that in segments from oestrus rats. Relaxation was significantly reduced by endothelium removal, 1 micromol/l propranolol or 100 micromol/l N(G)-nitro-L-arginine methyl ester (L-NAME). The beta(1)-adrenoceptor agonist dobutamine induced less relaxation in intact arteries from oestrus rats than did isoprenaline, and dobutamine-induced relaxation was markedly less in intact segments from OVX compared with oestrus rats. This dobutamine-induced relaxation was abolished by endothelium removal, and reduced by 1 micromol/l propranolol, 100 micromol/l L-NAME or 1 micromol/l yohimbine. Cholera toxin (an activator of the stimulatory G-protein G(s)) caused relaxation in intact arteries from oestrus rats; this relaxation was decreased by both deprivation of ovarian hormones and endothelium removal. Forskolin (a direct activator of the catalytic subunit of adenylate cyclase) and sodium nitroprusside (a nitric oxide donor and cGMP-dependent vasodilator agonist) induced similar endothelium-independent relaxation in arteries from both oestrus and OVX rats. These results suggest that the relaxation elicited by endothelial beta-adrenoceptor activation in the rat thoracic aorta is impaired by deprivation of female ovarian hormones; this impairment is caused, at least in part, by decreases in both the endothelial release of NO and G(s) function.

背景与目标： : 这项研究的目的是评估卵巢激素的内源性状态对 β-肾上腺素受体激动剂异丙肾上腺素 (异丙肾上腺素) 和多巴酚丁胺在胸主动脉段中诱导的松弛的影响，来自年龄匹配的 (13周大) 处女 (发情期) 和去卵巢 (OVX) 青春期前雌性Wistar大鼠。与发情大鼠相比，OVX大鼠完整主动脉段异丙肾上腺素诱导的松弛减少。通过内皮去除，1微mol/l普萘洛尔或100微mol/l N(G)-硝基-L-精氨酸甲酯 (l-name) 显着降低松弛。与异丙肾上腺素相比，β (1)-肾上腺素受体激动剂多巴酚丁胺在发情期大鼠的完整动脉中引起的松弛较少，而多巴酚丁胺在OVX的完整节段中引起的松弛明显较少。这种多巴酚丁胺诱导的松弛通过内皮去除消除，并被1微摩尔/升普萘洛尔、100微摩尔/升l-name或1微摩尔/升育亨宾还原。霍乱毒素 (刺激性g蛋白G(s) 的激活剂) 引起发情大鼠完整动脉的松弛; 卵巢激素的剥夺和内皮的去除均降低了这种松弛。Forskolin (腺苷酸环化酶催化亚基的直接激活剂) 和硝普钠 (一氧化氮供体和cGMP依赖性血管扩张激动剂) 在发情和OVX大鼠的动脉中诱导了类似的非内皮依赖性舒张。这些结果表明，剥夺女性卵巢激素会损害大鼠胸主动脉中内皮 β-肾上腺素受体激活引起的松弛; 这种损害至少部分是由NO和G(s) 功能的内皮释放减少引起的。

BACKGROUND & AIMS: :The purpose of the present study was to determine if our recently introduced novel working rat heart preparation could be used to study wall stress-induced dysrhythmias. A double cannula, which consisted of an outer cannula that, was inserted in the aorta and an inner cannula that was advanced into the left ventricle was used. The perfusion flowed through the inner cannula into the left ventricle and was ejected from there into the aorta. Afterload was changed suddenly from 60 to 160 Hg of pressure by turning a valve so that the fluid was diverted to a column set at a different height. A sudden increase of aortic pressure that lasted for 10 sec caused cardiac ectopic beats. Wall stress-induced dysrhythmias were more sustained during perfusion with low potassium and low magnesium Krebs-Henseleit solution. Bradykinin (1 microg) or epinephrine (10 microg) was injected as a bolus via an in-line injection port placed at the inner cannula. Bradykinin significantly reduced the incidence of ectopic beats and epinephrine increased the incidence of nonsustained runs of VT. This "working" heart preparation is a convenient tool to study wall stress-induced dysrhythmias.

背景与目标： : 本研究的目的是确定我们最近引入的新型工作大鼠心脏制剂是否可用于研究壁应力引起的节律障碍。使用了一个双套管，该套管由插入主动脉的外部套管和进入左心室的内部套管组成。灌注通过内套管流入左心室，并从那里喷射到主动脉。通过转动阀使后负荷从60至160 Hg的压力突然改变，使得流体被转移到设置在不同高度的塔中。持续10秒的主动脉压力突然升高导致心脏异位搏动。在使用低钾和低镁Krebs-Henseleit溶液灌注期间，壁应力引起的心律不齐更加持续。缓激肽 (1 microg) 或肾上腺素 (10 microg) 通过放置在内部套管上的在线注射端口作为推注注射。缓激肽显着降低了异位搏动的发生率，肾上腺素增加了非持续性VT运行的发生率。这种 “有效” 的心脏准备是研究壁应力引起的心律不齐的便捷工具。

BACKGROUND & AIMS: :Performing the proximal anastomosis of a free arterial graft to the ascending aorta is problematic, especially if the wall of the aorta is calcified or thickened. We describe a method, which makes it possible to avoid this procedure.

背景与目标： : 对升主动脉进行游离动脉移植物的近端吻合是有问题的，尤其是在主动脉壁钙化或增厚的情况下。我们描述了一种方法，可以避免此过程。

BACKGROUND & AIMS: :Between June 1996 and September 2000, nine angioplasties of the infra-renal aorta were performed in two Surgical Vascular Centers (Hospital Saint-Joseph, Paris, Polyclinic La Baule), in 6 men and three women age ranged from 36 to 72 years (middle age 48 years and 2 months). Eight of these patients presented important stenoses of the middle infra-renal aorta, or in the aortic bifurcation, one of them presented an occlusion, leading to severe intermittent claudication, and rest pain. After endoluminal kissing balloon angioplasty, five aortic stents (five patients), and six iliac primitive arteries stents (in three patients), extended beyond the aorta, were placed. One isolated angioplasty was also performed. All the procedures were performed in the operative room, with good results, except for one patient requiring emergency aorto-bi-femoral by-pass, because of acute leg ischemia, immediately following the procedure. Follow-up was clinical, with Us-Doppler scan, and angiogram in all cases. After 36 months follow-up (4-52), all patients are asymptomatic, with permeable stents. This technique is well-known since 1980, without excessive morbidity. Aortic angioplasty represents the right technique, with good long-term results, for middle or terminal aorta atheromatous stenosis, according to classical aorto-bi-femoral by-passes. Final result depends on associated iliac arteries stenoses.

背景与目标： : 在1996年6月和2000年9月之间，在两个外科血管中心 (巴黎圣约瑟夫医院，拉波勒综合诊所) 进行了9次肾下主动脉血管成形术，其中6名男性和3名女性的年龄在36至72岁之间 (中年48岁和2个月)。这些患者中有8例出现肾下主动脉中部或主动脉分叉处的重要狭窄，其中一例出现闭塞，导致严重的间歇性跛行和静息疼痛。腔内接吻球囊血管成形术后，放置了五个主动脉支架 (五个患者) 和六个原始动脉支架 (三个患者)，延伸到主动脉之外。还进行了一次孤立的血管成形术。所有程序均在手术室中进行，效果良好，除了一名患者因急性腿部缺血而需要紧急主动脉双股骨旁路外，在手术后立即进行。随访均为临床，所有病例均采用Us多普勒扫描和血管造影。经过36个月的随访 (4-52)，所有患者均无症状，均采用可渗透支架。这种技术是众所周知的1980年，没有过度的发病率。根据经典的主动脉-双股骨旁通道，主动脉血管成形术代表了正确的技术，具有良好的长期效果，可治疗中或终末主动脉粥样狭窄。最终结果取决于相关的动脉狭窄。

BACKGROUND & AIMS: OBJECTIVE:Our purpose was to compare the performance of risk stratification model between Parsonnet and European System for Cardiac Operative Risk Evaluation (EuroSCORE) in our patient database. METHODS:From August 1994 to December 2000, 803 consecutive patients have undergone heart and thoracic aorta surgery using cardiopulmonary bypass and scored according to Parsonnet and EuroSCORE algorithm. The population was divided into five clinically relevant risk categories. We compared correlation of predicted mortality and observed mortality between these two models. Score validity was assessed by calculating the area under the receiver operating characteristic (ROC) curve. RESULTS:Overall hospital mortality was 4.5%. In Parsonnet model, predicted mortality was 2.4% for 0-4% risk, 6.7% for 5-9% risk, 12% for 10-14% risk, 17% for 15-19% risk, 25% for 20% plus risk, and 10.4% for overall patients. Observed mortality was 2.4, 0.4, 5.9, 8.7, 11, and 4.5%, respectively. The thoracic aorta and valve cohort indicated poor correlation between predicted and observed mortality compared to coronary cohort. In the EuroSCORE model, predicted mortality was 1.4% for 0-2% risk, 4.0% for 3-5% risk, 6.7% for 6-8% risk, 9.7% for 9-11% risk, 13% for 12% plus risk, and 5.3% for overall patients. Actual mortality was 0, 1.5, 6.8, 11, 21, and 4.5%, respectively. Each of the thoracic aorta, valve, and coronary cohort indicated good correlation between predicted and observed mortality. Areas under the ROC curves were 0.72 in Parsonnet and 0.82 in EuroSCORE. CONCLUSIONS:The EuroSCORE additive model yielded good predictive value for hospital mortality of Japanese patients undergoing not only cardiac but also thoracic aortic surgery.

背景与目标：

BACKGROUND & AIMS: PURPOSE:To develop an automated technique to trace the contours of the lumen and outer boundary of the aortic wall, and measure aortic wall thickness in axial MR images. MATERIALS AND METHODS:The algorithm uses prior knowledge of vessel wall morphology. A geometrical model (ellipse) is deformed, translated and rotated to obtain a rough approximation of the contours. Model-matching is based on image gradient measurements. To enhance edges, the images were preprocessed using gray-level stretching. Refinement is performed by means of dynamic programming. Wall thickness is computed by measuring the distance between inner and outer contour of the aortic wall. RESULTS:The algorithm has been tested on high-resolution axial MR images from 28 human subjects of the descending thoracic aorta. The results demonstrate: High correspondence between automatic and manual area measurements: lumen (r = 0.99), outer (r = 0.96), and wall thickness (r = 0.85). CONCLUSION:Though further optimization is required, our algorithm is a powerful tool to automatically draw the boundaries of the aortic wall and measure aortic wall thickness in aortic wall devoid of major lesions. J. Magn. Reson. Imaging 2006. (c) 2006 Wiley-Liss, Inc.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:Blunt thoracic aortic injury can be treated with thoracic endovascular aortic repair (TEVAR) with excellent short and mid-term outcomes. However, few data are available about the long-term results. Our goal was to report our single-centre, 20-year experience using TEVAR to treat blunt thoracic aortic injury. METHODS:We retrospectively reviewed our institutional database to identify all patients treated with TEVAR for traumatic lesions of the aortic isthmus. We identified 35 patients since 1998. Patients' charts were analysed for preoperative characteristics, intraoperative variables and short-term outcomes. Information about the long-term follow-up was collected by analysing cross-sectional images and via phone calls. Follow-up was 100% complete. Rates of survival and of freedom from aortic redo were estimated using Kaplan-Meier methods. RESULTS:Twenty-nine patients were men (82%). The median age was 42 years (range 22-79 years) and the mean injury severity score was 38 (±13). The endovascular procedure was successfully carried out in all patients. The left subclavian artery was intentionally overstented in 11 patients (31%). Two patients died perioperatively (5.7%). The estimated survival was 92% and 87% at 5 and 10 years, respectively, with no aorta-related deaths. The estimated freedom from aortic redo was 96% and 91% at 5 and 10 years, respectively. CONCLUSIONS:Our data corroborate the excellent results of the endovascular treatment of blunt thoracic aortic injury when follow-up is extended to 20 years. New-generation devices, which are more comfortable and have smaller diameters, may further improve the results of TEVAR in treating traumatic aortic injury. Surveillance with cross-sectional imaging remains mandatory.

背景与目标：