• 1 The art of assessing aortic stenosis. 复制标题 收藏 收藏

    【评估主动脉瓣狭窄的艺术。】 复制标题 收藏 收藏
    DOI:10.1136/heartjnl-2012-302392 复制DOI
    作者列表:Rajani R,Hancock J,Chambers JB
    BACKGROUND & AIMS: :This review describes the assessment of the aortic valve by echocardiography and also the roles that multidetector CT (MDCT) and cardiac magnetic resonance have to play as complimentary imaging modalities. It describes how to resolve apparent discrepancies in grading aortic stenosis and discusses the management of apparently moderate stenosis associated with cardiac symptoms or left ventricular dysfunction. The role of cardiac imaging including three-dimensional (3D) echocardiography and MDCT scanning in the preparation for transcatheter aortic valve implantation and during and after the procedure are described. While echocardiography remains the mainstay of imaging, 3D modalities, notably MDCT, are increasingly useful and a multimodality approach is likely to become established as routine clinical practice.
    背景与目标: : 这篇综述描述了超声心动图对主动脉瓣的评估,以及多探测器CT (MDCT) 和心脏磁共振作为互补成像方式所发挥的作用。它描述了如何解决主动脉狭窄分级中的明显差异,并讨论了与心脏症状或左心室功能障碍相关的明显中度狭窄的管理。描述了包括三维 (3D) 超声心动图和MDCT扫描在内的心脏成像在经导管主动脉瓣植入准备以及手术期间和之后的作用。尽管超声心动图仍然是成像的主要手段,但3D模式 (尤其是MDCT) 越来越有用,并且多模态方法可能会被确立为常规临床实践。
  • 【“PICA交通动脉” 动脉瘤: 病例报告。】 复制标题 收藏 收藏
    DOI:10.1097/00006123-199112000-00024 复制DOI
    作者列表:Hlavin ML,Takaoka Y,Smith AS
    BACKGROUND & AIMS: :We present an unusual case of an aneurysm of the distal posterior inferior cerebellar artery (PICA). The aneurysm was associated with a unilateral PICA that supplied both cerebellar hemispheres and arose from an anastomotic vessel to the contralateral circulation, a branch of the contralateral PICA. Such an aneurysm has not been reported previously. The associated of vascular anomalies with aneurysms of the PICA is discussed.
    背景与目标: : 我们介绍了一个不寻常的小脑后下动脉 (PICA) 动脉瘤病例。动脉瘤与单侧PICA有关,该PICA提供了两个小脑半球,并从吻合血管出现到对侧PICA的分支对侧循环。这种动脉瘤以前没有报道过。讨论了血管异常与PICA动脉瘤的相关性。
  • 【六十四层CT使用主动脉瓣面积的平面测量法评估主动脉瓣狭窄。】 复制标题 收藏 收藏
    DOI:10.2214/AJR.07.2069 复制DOI
    作者列表:Feuchtner GM,Müller S,Bonatti J,Schachner T,Velik-Salchner C,Pachinger O,Dichtl W
    BACKGROUND & AIMS: OBJECTIVE:The purpose of our study was to evaluate planimetry of the aortic valve area with 64-slice CT in comparison with transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in patients with aortic stenosis. MATERIALS AND METHODS:Thirty-six patients with aortic valve disease referred for coronary 64-slice CT angiography were examined. Planimetry of the aortic valve area with 64-slice CT was compared with TTE using the Doppler continuity equation for calculation of the aortic valve area and with planimetric measurement of the aortic valve area using TEE. RESULTS:Planimetry of the aortic valve area with CT (1.11 +/- 0.42 cm2) showed a good correlation with TTE (1.05 +/- 0.42 cm2) (r = 0.88, p < 0.001) in 32 patients and a good correlation with TEE (1.41 +/- 1.61 cm2) (r = 0.99, p < 0.0001) in 10 patients. The mean and maximum transvalvular pressure gradients were correlated with the aortic valve area as measured with CT (r = -0.68, p = 0.0001; and r = -0.67, p = 0.0001, respectively). Beta-blockers were not given (mean heart rate, 62.5 +/- 10.7 beats per minute). CONCLUSION:MDCT allows accurate planimetry of the aortic valve area in patients with aortic stenosis. In patients referred for 64-slice CT coronary angiography, concomitant aortic stenosis can be identified and evaluated.
    背景与目标:
  • 【细胞外镁的升高迅速提高人主动脉内皮细胞的细胞内游离Mg2: 细胞外Mg2是调节阳离子吗?】 复制标题 收藏 收藏
    DOI:10.2741/a157 复制DOI
    作者列表:Zhang A,Altura BT,Altura BM
    BACKGROUND & AIMS: :Extracellular magnesium ions [Mg2+]o are known to regulate functions of endothelial cells, but whether [Mg2+]o can alter intracellular free ionized magnesium [Mg2+]i in these cells remains unknown. The present studies, using digital imaging microscopy and the Mg2+ fluorescent probe, mag-fura-2, determined effects of elevation of [Mg2+]o on [Mg2+]i in cultured human aortic endothelial cells. With normal Mg2+(1.2 mM)-containing incubation media, [Mg2+]i was 0.51+/-0.04 mM with a heterogeneous distribution. The ratio of [Mg2+]i/[Mg2+]o was 0.52+/-0.07. Elevation of [Mg2+]o up to 4.8 mM increased [Mg2+]i to 0.80+/-0.07 mM in 2-10 min and lowered the ratio of [Mg2+]i/[Mg2+]o to 0.16+/-0.02. Irrespective of the observed increments of [Mg2+]i, a subcellular heterogeneous distribution of [Mg2+]i was always evident in all cells tested. Our results suggest that [Mg2+]o can regulate [Mg2+]i more rapidly than heretofore believed, supporting the hypothesis that extracellular Mg2+ can exert regulatory effects on endothelial cell functions and probably act as extracellular regulatory cations
    背景与目标: : 已知细胞外镁离子 [Mg2] o调节内皮细胞的功能,但是 [Mg2] o是否可以改变这些细胞中的细胞内游离电离镁 [Mg2] i仍然未知。本研究使用数字成像显微镜和Mg2荧光探针mag-fura-2确定了 [Mg2] o升高对培养的人主动脉内皮细胞 [Mg2] i的影响。对于含正常Mg2 +(1.2 mM) 的孵育培养基,[Mg2 +]i为0.51 +/-0.04 mM,具有异质分布。[Mg2 +]i/[Mg2 +]o的比率为0.52 +/-0.07。[Mg2 +]o升高至4.8 mM在2-10分钟内使 [Mg2 +]i增加至0.80 +/-0.07 mM,并降低 [Mg2 +]i/[Mg2 +]o与0.16 +/-0.02的比率。不管观察到的 [Mg2] i的增量如何,在所有测试的细胞中,[Mg2] i的亚细胞异质分布总是很明显。我们的结果表明,[Mg2] o可以比以前更快地调节 [Mg2] i,支持以下假设: 细胞外Mg2可以对内皮细胞功能发挥调节作用,并可能充当细胞外调节阳离子
  • 【先天性主动脉瓣狭窄实时三维超声心动图与手术解剖的相关性。】 复制标题 收藏 收藏
    DOI:10.1017/S1047951106000977 复制DOI
    作者列表:Sadagopan SN,Veldtman GR,Sivaprakasam MC,Keeton BR,Gnanapragasam JP,Salmon AP,Haw MP,Vettukattil JJ
    BACKGROUND & AIMS: OBJECTIVE:To define the anatomic characteristics of the congenitally malformed and severely stenotic aortic valve using trans-thoracic real time three-dimensional echocardiography, and to compare and contrast this with the valvar morphology as seen at surgery. DESIGN:Prospective cross-sectional observational study. SETTING:Tertiary centre for paediatric cardiology. METHODS:All patients requiring aortic valvotomy between December 2003 and July 2004 were evaluated prior to surgery with three-dimensional echocardiography. Full volume loop images were acquired using the Phillips Sonos 7500 system. A single observer analysed the images using "Q lab 4.1" software. The details were then compared with operative findings. RESULTS:We identified 8 consecutive patients, with a median age of 16 weeks, ranging from 1 day to 11 years, with median weight of 7.22 kilograms, ranging from 2.78 to 22 kilograms. The measured diameter of the valvar orifice, and the number of leaflets identified, corresponded closely with surgical assessment. The sites of fusion of the leaflets were correctly identified by the echocardiographic imaging in all cases. Fusion between the right and non-coronary leaflets was identified in half the patients. Dysplasia was observed in 3 patients, with 1 patient having nodules and 2 shown to have excrescences. At surgery, nodules were excised, and excrescences were trimmed. The dysplastic changes correlated well with operative findings, though statistically not significant. CONCLUSION:We recommend trans-thoracic real time three-dimensional echocardiography for the assessment of the congenitally malformed aortic valve, particularly to identify sites of fusion between leaflets and to measure the orificial diameter. The definition of nodularity, and the prognosis of nodules based on the mode of intervention, will need a comparative study of patients submitted to balloon dilation as well as those undergoing surgical valvotomy.
    背景与目标:
  • 【[自发性双侧VA夹层动脉瘤伴SAH的病例]。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Nishimu YA,Ikeda A,Sugita R,Maeda K,Nakamua S,Takerroto M,Shibuya M
    BACKGROUND & AIMS: :We report a case of bilateral vertebral artery (VA) dissecting aneurysm presenting subarachnoid hemorrhage (SAH). It was difficult to decide which side was responsible for SAH because the patient's symptom and head CT suggested that the left VA aneurysm had ruptured, but angiography and MRA showed an irregular pearl and string sign on the right side. He was successfully treated by trapping of the right VA dissecting aneurysm and we confirmed by intraoperative evaluation that the right VA dissecting aneurysm had ruptured. The left unruptured aneurysm decreased its size spontaneously. In the treatment of the bilateral VA dissecting aneurysms, angiography needs to be performed over and over again because contralateral unruptured aneurysm may grow or rupture due to increased hemodynamic stress. Various combinations of direct sugery with or without arterial reconstruction and endovascular treatment should be considered when treating bilateral VA dissecting aneurysms.
    背景与目标: : 我们报告一例双侧椎动脉 (VA) 夹层动脉瘤,表现为蛛网膜下腔出血 (SAH)。由于患者的症状和头部CT提示左VA动脉瘤破裂,因此很难确定是哪一侧引起SAH的原因,但是血管造影和MRA在右侧显示不规则的珍珠和弦征。通过捕获右VA夹层动脉瘤成功治疗了他,我们通过术中评估确认右VA夹层动脉瘤破裂。左未破裂的动脉瘤会自发减小其大小。在双侧VA夹层动脉瘤的治疗中,由于血流动力学压力增加,对侧未破裂的动脉瘤可能会生长或破裂,因此需要一遍又一遍地进行血管造影。在治疗双侧VA夹层动脉瘤时,应考虑直接切除有或没有动脉重建以及血管内治疗的各种组合。
  • 【完全常温主动脉弓置换术,无循环阻滞。】 复制标题 收藏 收藏
    DOI:10.1016/j.ejcts.2007.04.035 复制DOI
    作者列表:Touati GD,Marticho P,Farag M,Carmi D,Szymanski C,Barry M,Trojette F,Caus T
    BACKGROUND & AIMS: BACKGROUND:Various techniques have been proposed for cerebral protection during the surgical treatment of complex aortic disease. The authors propose a revisited strategy of normothermic replacement of the aortic arch to avoid limitations and complications of profound hypothermic circulatory arrest. MATERIALS AND METHODS:From April 2000 to May 2006, 19 patients with an aneurysm of the aortic arch and 10 patients with an acute (7) or a chronic (3) aortic dissection underwent a totally normothermic, complete replacement of the aortic arch using three pumps: One pump ensured antegrade cerebral perfusion, at a flow rate adapted to obtain a pressure of 70 mmHg in the right radial artery, and required a selective cannulation of the supra-aortic vessels. A second pump ensured body perfusion at a flow rate adapted to obtain a pressure of 55 mmHg in the left femoral artery and was situated between the right femoral artery and the right atrium. A special balloon aortic occlusion catheter was placed in the descending thoracic aorta. A third pump ensured intermittent normothermic myocardial perfusion via the coronary venous sinus. The arch reconstruction was performed with no time limit. RESULTS:There were two operative, in-hospital (6.8%) mortalities. All others patients were rapidly extubated, except one, with no neurological sequelae, and postoperative course was uneventful, without coagulopathy or hepato-renal impairment. CONCLUSIONS:In the light of these results, a normothermic procedure is possible for arch surgery and may ensure a more physiological autoregulation of cerebral blood flow while maintaining body perfusion without high vascular resistances.
    背景与目标:
  • 【[主动脉壁夹层的组织病理学研究]。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Niitsuya M,Kuwao S,Sato B,Kameya T,Kikawada R
    BACKGROUND & AIMS: :To determine the etiology of aortic wall dissection, a histopathological study of the aorta in 20 cases with dissecting aortic aneurysm (DA), 3 cases with Marfan syndrome and 3 cases with annulo-aortic ectasia (AAE) was performed. Controls consisted of 348 cases of normally-aging aorta. In cases with aortic wall dissection, the histopathological changes in the undissected media were also carefully examined. In Marfan syndrome and AAE, there was a marked accumulation of acid mucopolysaccharide (AMPS) and its distribution in the wall was diffuse in patients under 50 years old, resulting in changes in elastic fibers including fragmentation, elastolysis and reticulation. In contrast, DA was histopathologically characterized by zonal fibrosis and abnormally-dilated vessels in the aortic media. These lesions were found in 8 (40%) of the 20 DA cases. The remaining 12 cases also had increased vascularization and fragmentation of elastic fibers. This medial fibrosis and increased vascularization were particularly marked in older patients. Among the 3 diseased entities responsible for aortic wall dissection, DA differed distinctly from Marfan syndrome or AAE as to the amount and site of AMPS accumulation in the media as well as fibrosis and hypervascularity in the outer half of the aortic media. In conclusion, aortic wall dissection in younger patients may be etiologically associated with the increased AMPS accumulation in the aortic media which may always be accompanied by degeneration of elastic fibers in this study, however, in older patients zonal fibrosis and abnormal vessels developing in the media are responsible for the dissection.
    背景与目标: : 为了确定主动脉壁夹层的病因,对20例夹层主动脉瘤 (DA),3例Marfan综合征和3例环状主动脉扩张 (AAE) 的主动脉进行了组织病理学研究。对照组包括348例正常老化的主动脉。在主动脉壁夹层的情况下,还仔细检查了未解剖介质的组织病理学变化。在Marfan综合征和AAE中,在50岁以下的患者中,酸性粘多糖 (AMPS) 明显积累,并且其在壁中的分布是弥漫性的,导致弹性纤维的变化,包括碎片,弹性分解和网状。相反,DA的组织病理学特征是主动脉介质中的带状纤维化和异常扩张的血管。在20例DA病例中,有8例 (40% 例) 发现了这些病变。其余12例也有血管化和弹性纤维碎裂的增加。这种内侧纤维化和血管化增加在老年患者中尤为明显。在负责主动脉壁夹层的3个患病实体中,DA与Marfan综合征或AAE在培养基中AMPS积累的数量和部位以及主动脉培养基外半部的纤维化和血管增生方面明显不同。总之,年轻患者的主动脉壁夹层可能与主动脉介质中AMPS积累增加在病因学上有关,在本研究中,这可能总是伴随着弹性纤维的变性,但是,在老年患者中,带状纤维化和异常血管在主动脉介质中发展是造成夹层的原因。
  • 【接受胸动脉瘤修复的患者的脑脊液中的热休克蛋白HSP70和HSP27与术后瘫痪的可能性相关。】 复制标题 收藏 收藏
    DOI:10.1007/s12192-008-0039-z 复制DOI
    作者列表:Hecker JG,Sundram H,Zou S,Praestgaard A,Bavaria JE,Ramchandren S,McGarvey M
    BACKGROUND & AIMS: :An understanding of the time course and correlation with injury of heat shock proteins (HSPs) released during brain and/or spinal cord cellular stress (ischemia) is critical in understanding the role of the HSPs in cellular survival, and may provide a clinically useful biomarker of severe cellular stress. We have analyzed the levels of HSPs in the cerebrospinal fluid (CSF) from patients who are undergoing thoracic aneurysm repair. Blood and CSF samples were collected at regular intervals, and CSF was analyzed by enzyme-linked immunosorbent assay for HSP70 and HSP27. These results were correlated with intraoperative somatosensory-evoked potentials measurements and postoperative paralysis. We find that the levels of these proteins in many patients are elevated and that the degree of elevation correlates with the risk of permanent paralysis. We hypothesize that sequential measurement intraoperatively of the levels of the heat shock proteins HSP70 and HSP27 in the CSF can predict those patients who are at greatest risk for paralysis during thoracic aneurysm surgery and will allow us to develop means of preventing or attenuating this severe and often fatal complication.
    背景与目标: : 了解大脑和/或脊髓细胞应激 (缺血) 期间释放的热休克蛋白 (hsp) 的时间过程以及与损伤的相关性对于理解hsp在细胞存活中的作用至关重要,并且可能提供临床上有用的生物标志物严重的细胞应激。我们已经分析了正在接受胸动脉瘤修复的患者的脑脊液 (CSF) 中HSPs的水平。定期收集血液和CSF样本,并通过酶联免疫吸附法分析CSF中的HSP70和hsp27。这些结果与术中体感诱发电位测量和术后瘫痪相关。我们发现许多患者中这些蛋白质的水平升高,并且升高的程度与永久性瘫痪的风险相关。我们假设,术中连续测量CSF中热休克蛋白HSP70和HSP27的水平可以预测那些在胸动脉瘤手术中瘫痪风险最大的患者,并将使我们能够开发预防或减轻这种严重且通常致命的并发症的方法。
  • 【肾下主动脉血栓体积的测量和决定因素。】 复制标题 收藏 收藏
    DOI:10.1007/s00330-008-0956-3 复制DOI
    作者列表:Golledge J,Wolanski P,Parr A,Buttner P
    BACKGROUND & AIMS: :Intra-luminal thrombus has been suggested to play a role in the progression of abdominal aortic aneurysm (AAA). The aims of this study were twofold. Firstly, to assess the reproducibility of a computer tomography (CT)-based technique for measurement of aortic thrombus volume. Secondly, to examine the determinants of infrarenal aortic thrombus volume in a cohort of patients with aortic dilatation. A consecutive series of 75 patients assessed by CT angiography with maximum aortic diameter > or = 25 mm were recruited. Intra-luminal thrombus volume was measured by a semi-automated workstation protocol based on a previously defined technique to quantitate aortic calcification. Intra- and inter-observer reproducibility were assessed using correlation coefficients, coefficient of variation and Bland-Altman plots. Infrarenal aortic thrombus volume percentage was related to clinical, anatomical and blood characteristics of the patients using univariate and multivariate tests. Infrarenal aortic thrombus volume was related to the severity of aortic dilatation assessed by total aortic volume (r = 0.87, P < 0.0001) or maximum aortic diameter (r = 0.74, P < 0.0001). We therefore examined the clinical determinates of aortic thrombus expressed as a percentage of total aortic volume. Aortic thrombus percentage was negatively correlated with serum high density lipoprotein (HDL, r = -0.31). By ordinal multiple logistic regression analysis serum HDL below median (< or = 1.2 mM: ) was associated with aortic thrombus percentage in the upper quartile adjusting for other risk factors (odds ratio 5.3, 95% CI 1.1-25.0). Infrarenal aortic thrombus volume can be measured reproducibly on CT. Serum HDL, which can be therapeutically raised, may play a role in discouraging aortic thrombus accumulation with implications in terms of delaying progression of AAA.
    背景与目标: : 腔内血栓已被认为在腹主动脉瘤 (AAA) 的进展中起作用。这项研究的目的是双重的。首先,评估基于计算机断层扫描 (CT) 的主动脉血栓体积测量技术的可重复性。其次,在一组主动脉扩张患者中检查肾下主动脉血栓体积的决定因素。连续招募了75例通过CT血管造影评估的主动脉最大直径> 或 = 25毫米的患者。腔内血栓体积是通过基于先前定义的定量技术的半自动工作站协议测量的,以定量主动脉钙化。使用相关系数,变异系数和Bland-Altman图评估观察者内和观察者间的可重复性。使用单变量和多变量测试,肾下主动脉血栓体积百分比与患者的临床,解剖和血液特征有关。肾下主动脉血栓体积与主动脉总体积 (r = 0.87,P <0.0001) 或主动脉最大直径 (r = 0.74,P <0.0001) 评估的主动脉扩张严重程度有关。因此,我们检查了以总主动脉体积百分比表示的主动脉血栓的临床决定。主动脉血栓百分比与血清高密度脂蛋白 (HDL,r = -0.31) 呈负相关。通过有序多元逻辑回归分析,血清HDL低于中位数 (<或 = 1.2 mM:) 与调整其他危险因素的上四分位数的主动脉血栓百分比相关 (优势比5.3,95% CI 1.1-25.0)。可以在CT上重复测量肾下主动脉血栓体积。可以在治疗上升高的血清HDL可能在阻止主动脉血栓积聚方面发挥作用,从而延迟AAA的进展。
  • 【计算机断层结肠成像筛查大肠癌,结肠外癌和主动脉瘤: 具有成本效益分析的模型模拟。】 复制标题 收藏 收藏
    DOI:10.1001/archinte.168.7.696 复制DOI
    作者列表:Hassan C,Pickhardt PJ,Laghi A,Kim DH,Zullo A,Iafrate F,Di Giulio L,Morini S
    BACKGROUND & AIMS: BACKGROUND:In addition to detecting colorectal neoplasia, abdominal computed tomography (CT) with colonography technique (CTC) can also detect unsuspected extracolonic cancers and abdominal aortic aneurysms (AAA).The efficacy and cost-effectiveness of this combined abdominal CT screening strategy are unknown. METHODS:A computerized Markov model was constructed to simulate the occurrence of colorectal neoplasia, extracolonic malignant neoplasm, and AAA in a hypothetical cohort of 100,000 subjects from the United States who were 50 years of age. Simulated screening with CTC, using a 6-mm polyp size threshold for reporting, was compared with a competing model of optical colonoscopy (OC), both without and with abdominal ultrasonography for AAA detection (OC-US strategy). RESULTS:In the simulated population, CTC was the dominant screening strategy, gaining an additional 1458 and 462 life-years compared with the OC and OC-US strategies and being less costly, with a savings of $266 and $449 per person, respectively. The additional gains for CTC were largely due to a decrease in AAA-related deaths, whereas the modeled benefit from extracolonic cancer downstaging was a relatively minor factor. At sensitivity analysis, OC-US became more cost-effective only when the CTC sensitivity for large polyps dropped to 61% or when broad variations of costs were simulated, such as an increase in CTC cost from $814 to $1300 or a decrease in OC cost from $1100 to $500. With the OC-US approach, suboptimal compliance had a strong negative influence on efficacy and cost-effectiveness. The estimated mortality from CT-induced cancer was less than estimated colonoscopy-related mortality (8 vs 22 deaths), both of which were minor compared with the positive benefit from screening. CONCLUSION:When detection of extracolonic findings such as AAA and extracolonic cancer are considered in addition to colorectal neoplasia in our model simulation, CT colonography is a dominant screening strategy (ie, more clinically effective and more cost-effective) over both colonoscopy and colonoscopy with 1-time ultrasonography.
    背景与目标:
  • 【3T磁共振血管造影检测颅内动脉瘤。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Tang PH,Hui F,Sitoh YY
    BACKGROUND & AIMS: INTRODUCTION:The new 3 Tesla (T) magnetic resonance (MR) scanners yield improved signal-to-noise ratio and spatial resolution with superior background suppression compared to lower field strength systems. This is advantageous for MR angiograms. The purpose of our study was to compare unenhanced three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) at 3T with catheter digital subtraction angiography (DSA) in detecting unruptured intracranial aneurysms. MATERIALS AND METHODS:Out of 1375 consecutive patients who underwent unenhanced 3D TOF MRA at 3T, 15 patients with unruptured intracranial aneurysms were retrospectively identified. Nine of these 15 patients had DSA as the reference standard for comparison. Aneurysm size, location and morphology were independently assessed on both MRA and DSA by 2 radiologists. RESULTS:Seventeen aneurysms ranging in size from 1 mm to 24 mm were identified in 15 patients on MRA. DSA confirmed the aneurysms in 9 patients with good anatomical correlation compared with the MRA findings. CONCLUSIONS:3D TOF MRA at 3T has good correlation with DSA and aneurysms as small as 1 mm in size can be detected. This can be a promising, non-invasive method for aneurysm surveillance.
    背景与目标:
  • 【[成人瓣膜窦先天性动脉瘤伴右心房瘘的二维和多普勒彩色超声心动图研究]。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Madariaga JA,Lekuona I,Serrano A,Palomar S,Salcedo A,Alcibar J,Castellanos E,Barrenetxea JI
    BACKGROUND & AIMS: :This report describe a 69-year old woman with a congenital aneurysm of the non-coronary sinus of Valsalva ruptured in the right atrium, causing severe hemodynamic derangement of the right ventricle. The site of the communication between the aneurysm and the receiving chamber was accurately diagnosed by two-dimensional color flow Doppler imaging which provided more valuable preoperative information than conventional aortography.
    背景与目标: : 该报告描述了一名69岁的女性,其先天性的Valsalva非冠状窦动脉瘤在右心房破裂,导致右心室严重血流动力学紊乱。通过二维彩色多普勒成像准确诊断了动脉瘤与接收室之间的通讯部位,这比传统的主动脉造影提供了更有价值的术前信息。
  • 【在无法手术的患者中使用经主动脉,经根尖和经颈动脉导管主动脉瓣置换术。】 复制标题 收藏 收藏
    DOI:10.1016/j.athoracsur.2013.05.068 复制DOI
    作者列表:Thourani VH,Gunter RL,Neravetla S,Block P,Guyton RA,Kilgo P,Lerakis S,Devireddy C,Leshnower B,Mavromatis K,Stewart J,Simone A,Keegan P,Nguyen TC,Merlino J,Babaliaros V
    BACKGROUND & AIMS: BACKGROUND:Transcatheter aortic valve replacement (TAVR) is an effective treatment in patients with severe aortic stenosis unsuitable for surgical aortic valve replacement (SAVR). This study evaluated the early experience with the posttrial application of TAVR, with specific focus on non-transfemoral (TF) access. METHODS:All patients who underwent posttrial TAVR at Emory University from November 2011 to April 2012 were reviewed. During this time, 44 posttrial TAVRs were performed: TF in 18, transapical in 11, transaortic in 12, and transcarotid in 3. RESULTS:A total of 40.9% of all patients were candidates for TF implantation. Mean age was 78.2 ± 11.3 years, and 34.1% were women. Mean ejection fraction was 0.463 ± 0.164, and 90.2% had New York Heart Association class III to IV heart failure. Fifty percent were diabetic, 27.3% had moderate to severe chronic obstructive pulmonary disease, and 20.5% had a prior stroke. The mean creatinine was 1.63 ± 1.74 mg/dL, 9.1% required preoperative dialysis, and 61.4% had undergone prior cardiac operations. No patients had postoperative myocardial infarction, stroke, or required new dialysis. Intraoperative vascular complications occurred in 11.4%. No patient had more than mild perivalvular leak by transthoracic echocardiography at discharge. Mean postoperative ventilator time was 17.8 ± 40.1 hours. Intensive care unit length of stay was 58.0 ± 67.0 hours. Postoperative hospital length of stay was 6.1 ± 4.7 days. The 30-day mortality was 6.8% (3 of 44) for all patients, despite a mean The Society of Thoracic Surgeons Predicted Risk of Mortality score of 12.6. CONCLUSIONS:Less than half of patients deemed appropriate for posttrial TAVR were candidates for TF implantation. The use of all available access routes leads to excellent outcomes in patients deemed inoperable.
    背景与目标:
  • 【SA4503刺激血管内皮 σ1-受体可通过Akt/eNOS信号在去势大鼠主动脉束带中挽救主动脉松弛。】 复制标题 收藏 收藏
    DOI:10.1253/circj.cj-13-0256 复制DOI
    作者列表:Tagashira H,Matsumoto T,Taguchi K,Zhang C,Han F,Ishida K,Nemoto S,Kobayashi T,Fukunaga K
    BACKGROUND & AIMS: BACKGROUND:We previously reported that σ1-receptor (σ1R) expression in the thoracic aorta decreased after pressure overload (PO) induced by abdominal aortic banding in ovariectomized (OVX) rats. Here, we asked whether stimulation of σ1R with the selective agonist SA4503 elicits functional recovery of aortic vasodilation and constriction following vascular injury in OVX rats with PO. METHODS AND RESULTS: SA4503 (0.3-1.0mg/kg) and NE-100 (a σ1R antagonist, 1.0mg/kg) were administered orally for 4 weeks (once daily) to OVX-PO rats. Vascular functions of isolated descending aorta were measured following phenylephrine (PE)- or endothelin-1 (ET-1)-induced vasoconstriction and acetylcholine (ACh)- or clonidine-induced vasodilation. SA4503 administration rescued PO-induced σ1R decreases in aortic smooth muscle and endothelial cells. SA4503 treatment also rescued PO-induced impairments in ACh- and clonidine-induced vasodilation without affecting PE- and ET-1-induced vasoconstriction. Ameliorated ACh- and clonidine-induced vasodilation was closely associated with increased Akt activity and in turn endothelial nitric oxide synthase (eNOS) phosphorylation. The SA4503-mediated improvement of vasodilation was blocked by NE-100 treatment. CONCLUSIONS: σ1R is downregulated following PO-induced endothelial injury in OVX rats. The selective σ1R agonist SA4503 rescues impaired endothelium-dependent vasodilation in the aorta from OVX-PO rats through σ1R stimulation, enhancing eNOS-cGMP signaling in vascular endothelial cells. These observations encourage development of novel therapeutics targeting σ1R to prevent vascular endothelial injury in vascular diseases.
    背景与目标:

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