• 【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:
  • 【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:
  • 【对不可逆过程的新见解: 根治性前列腺切除术后膀胱尿道吻合口狭窄组织的mRNA和miRNA组合分析。】 复制标题 收藏 收藏
    DOI:10.1007/s00345-017-2060-2 复制DOI
    作者列表:Worst TS,Daskalova K,Steidler A,Berner-Leischner K,Röth R,Niesler B,Weis CA,Kriegmair MC,Erben P,Pfalzgraf D
    BACKGROUND & AIMS: PURPOSE:Until recently, tissue fibrosis-ultimately leading to permanent scaring-has been considered an irreversible process. However, recent findings indicate that it may be reversible after all. Vesicourethral anastomotic stenosis (VUAS) as fibrous narrowing is a frequent complication after radical prostatectomy with high recurrence rates and requires invasive treatment. The pathophysiology is poorly understood. Therefore, a combined mRNA and miRNA transcription profiling in tissue from VUAS was performed using nCounter technology. METHODS:To assess tissue morphology and fiber composition, histochemical staining was performed. RNA expression of healthy and fibrotic tissue of twelve patients was analyzed using the human miRNA panel v3 and mRNA PanCancer pathway panel on the nCounter gene1 system and qRT-PCR. Differential expression data analysis was performed using the nSolver software implementing the R-based advanced pathway analysis tool. miRWalk2.0 was used for miRNA target prediction. RESULTS:More linearized tissue architecture, increased collagens, and decreased elastic fibers were observed in VUAS samples. 23 miRNAs and 118 protein coding genes were differentially expressed (p < 0.01) in fibrotic tissue. miRNA target prediction and overlap analysis indicated an interaction of the strongest deregulated miRNAs with 29 deregulated mRNAs. Pathway analysis revealed alterations in DNA repair, cell cycle regulation, and TGF-beta signaling. qRT-PCR confirmed differential expression of top deregulated miRNAs and mRNAs. CONCLUSIONS:In VUAS tissue, severe alterations on mRNA and miRNA level are found. These consistent changes give insights into the pathogenesis of VUAS after radical prostatectomy and point to future options for transcriptomics-based risk stratification and targeted therapies.
    背景与目标:
  • 【通过在猪中局部施用紫杉醇,支架支持外周动脉血管成形术后,由于内膜增生而减少狭窄。】 复制标题 收藏 收藏
    DOI:10.1097/RLI.0b013e31804f5a60 复制DOI
    作者列表:Albrecht T,Speck U,Baier C,Wolf KJ,Böhm M,Scheller B
    BACKGROUND & AIMS: PURPOSE:To assess if local intra-arterial administration of paclitaxel using drug-coated balloons or an admixture of paclitaxel to contrast medium inhibits stenosis after percutanous transluminal angioplasty (PTA) of peripheral arteries in a porcine overstretch model. METHODS:Neointimal proliferation and stenosis were induced by overstretch and stenting of 40 peripheral arteries in 20 pigs. Paclitaxel was administered locally during PTA using coated balloons (n = 20) or dissolved in contrast medium (n = 10). Conventional balloons and contrast medium were used in a control group (n = 10). Reangiography with quantitative analysis was performed after 5 weeks. RESULTS:On reangiography diameter stenosis and late lumen loss were significantly reduced by both methods of local drug delivery compared with control group; minimal luminal diameter was significantly larger in the treatment groups. CONCLUSIONS:Local short-term administration of paclitaxel during PTA of peripheral arteries using balloons or contrast medium as drug carriers reduced stenosis due to intimal hyperplasia.
    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。
  • 【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:
  • 【解剖性和功能性冠状动脉狭窄严重程度之间的不一致。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Wijpkema JS,Dorgelo J,Willems TP,Tio RA,Jessurun GA,Oudkerk M,Zijlstra F
    BACKGROUND & AIMS: :BACKGROUND.: New developments have made 16-slice multidetector computed tomography (MDCT) a promising technique for detecting significant coronary stenoses. At present, there is a paucity of data on the relation between fractional flow reserve (FFR) measurement and MDCT stenosis detection. OBJECTIVE.: The aim of this study was to investigate the relation between the anatomical severity of coronary artery disease detected by MDCT and functional severity measured by fractional flow reserve (FFR). METHODS.: We studied 53 patients (39 men and 14 women, age 62.5+/-8.1 years) with single-vessel disease scheduled for percutaneous coronary intervention (PCI). All patients underwent MDCT scanning one day prior to PCI and FFR was measured before PCI in the target vessel. RESULTS.: MDCT analysis could be performed in 52 of 53 patients (98.1%) and all patients had adequate FFR and quantitative coronary angiography (QCA) measurements. The mean stenosis diameters calculated by MDCT and QCA were 67.0+/-11.6% and 60.8+/-11.6% respectively. No significant relation was found between MDCT and QCA (r=0.22, p=0.12) The mean FFR in all patients was 0.67+/-0.18. A relation of r=-0.46 (p=0.0006) between QCA and FFR was found. In contrast, no relation between MDCT and FFR could be demonstrated (r=-0.09, p=0.50). Furthermore, a high incidence of false-positive and false-negative findings was present in both diagnostic modalities. CONCLUSION.: There is no clear relation between the anatomical and functional severity of coronary artery disease as defined by MDCT and FFR. Therefore, functional assessment of coronary artery disease remains mandatory for clinical decisionmaking. (Neth Heart J 2007;15:5-11.).
    背景与目标: 背景: 新的发展使16层多探测器计算机断层扫描 (MDCT) 成为检测明显冠状动脉狭窄的有前途的技术。目前,关于血流储备分数 (FFR) 测量与MDCT狭窄检测之间关系的数据很少。目的: 本研究的目的是探讨MDCT检测的冠状动脉疾病的解剖严重程度与血流储备分数 (FFR) 测量的功能严重程度之间的关系。方法: 我们研究了53例 (39例男性和14例女性,年龄62.5 +/-8.1岁) 的单支疾病患者,这些患者计划进行经皮冠状动脉介入治疗 (PCI)。所有患者在PCI前一天接受了MDCT扫描,并在PCI前在目标血管中测量了FFR。结果: 53例患者中的52例 (98.1% 例) 可以进行MDCT分析,所有患者都有足够的FFR和定量冠状动脉造影 (QCA) 测量。通过MDCT和QCA计算的平均狭窄直径分别为67.0 +/-11.6% 和60.8 +/-11.6%。MDCT与QCA之间未发现显着关系 (r = 0.22,p = 0.12)。所有患者的平均FFR为0.67/-0.18。发现QCA和FFR之间的r =-0.46 (p = 0.0006) 关系。相反,MDCT和FFR之间没有关系 (r =-0.09,p = 0.50)。此外,在两种诊断方式中,假阳性和假阴性发现的发生率都很高。结论: MDCT和FFR定义的冠状动脉疾病的解剖和功能严重程度之间没有明确的关系。因此,冠状动脉疾病的功能评估对于临床决策仍然是强制性的。(Neth Heart J 2007;15:5-11。)。
  • 【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:
  • 【低梯度重度主动脉瓣狭窄伴射血分数保留的系统性高血压。】 复制标题 收藏 收藏
    DOI:10.1161/CIRCULATIONAHA.113.003071 复制DOI
    作者列表:Eleid MF,Nishimura RA,Sorajja P,Borlaug BA
    BACKGROUND & AIMS: BACKGROUND:Low-gradient severe aortic stenosis with preserved ejection fraction is an increasingly recognized entity, and symptomatic patients may benefit from aortic valve replacement. However, systemic hypertension frequently coexists with low-gradient severe aortic stenosis, which itself may cause elevated left ventricular (LV) filling pressures with resultant symptoms of dyspnea. METHODS AND RESULTS:Symptomatic patients with hypertension (aortic systolic pressure >140 mm Hg) and low-gradient (mean gradient <40 mm Hg) severe aortic stenosis (aortic valve area <1 cm(2)) with preserved ejection fraction (ejection fraction >50%) who underwent invasive hemodynamic catheterization of the left and right sides of the heart received infusion of intravenous sodium nitroprusside to reduce blood pressure and arterial afterload. At baseline, patients had severe hypertension (aortic systolic pressure, 176±26 mm Hg), pulmonary hypertension (mean pressure, 39±12 mm Hg), elevated LV end-diastolic pressure (19±5 mm Hg), and reduced stroke volume (33±8 mL/m(2)). All measures of afterload were reduced with nitroprusside (P<0.001 for all). Nitroprusside reduced mean pulmonary artery pressure (25±10 mm Hg) and LV end-diastolic pressure (11±5 mm Hg; P<0.001 for both compared with baseline). Aortic valve area (0.86±0.11 to 1.02±0.16 cm(2); P=0.001) and mean gradient (27±5 to 29±6 mm Hg; P=0.02) increased with nitroprusside. CONCLUSIONS:Systemic hypertension in low-gradient severe aortic stenosis with preserved ejection fraction is associated with elevated LV filling pressures and pulmonary hypertension. Treatment of hypertension with vasodilator therapy results in a lowering of the total LV afterload, with a decrease in LV filling pressures and pulmonary artery pressures. These findings have important implications for the management of patients with low-gradient severe aortic stenosis with preserved ejection fraction and hypertension.
    背景与目标:
  • 【[机械心肌支持系统1997: inta-主动脉球囊反搏到可植入左心室支持系统的概述]。】 复制标题 收藏 收藏
    DOI:10.1007/s001010050418 复制DOI
    作者列表:Hammel D,Möllhoff T,Soepawata R,van Aken H,Scheld HH
    BACKGROUND & AIMS: The development of cardiopulmonary bypass (CPB) to support the systemic circulation during cardiac surgical procedures became a clinical reality in 1953. Although the use of CPB for the treatment of post-infarction cardiogenic shock met with little success, intra-aortic balloon counterpulsation was used successfully in 1968 to reduce ischaemic injury in a patient with cardiogenic shock. Today, a broad spectrum of circulatory assist devices for short- and long-term application is available. Three major indication groups for the use of support devices are established. In low-cardiac-output syndrome after cardiac surgical procedures, short-term devices are utilised to enable myocardial recovery. In transplantation candidates suffering from drug-resistant pump failure, the implantation of long-term devices as a bridge to heart transplantation is indicated, and in NYHA class IV patients with contraindications to heart transplantation, the implantation of long-term devices as an alternative to transplantation is under discussion. In the literature, post-cardiotomy support survival is less than 30% on average. About 70% of mechanically bridged patients have survived to undergo heart transplantation and were transplanted with over 90% survival. Major problems during mechanical support are infection, bleeding, and thromboembolism. In view of patients' natural course without support, these clinical results are favourable.

    背景与目标: 体外循环 (CPB) 的发展以支持心脏外科手术过程中的全身循环成为临床现实1953年。尽管使用CPB治疗梗塞后心源休克收效甚微,但主动脉内球囊反搏1968年成功用于减少心源休克患者的缺血性损伤。如今,可以使用广泛的短期和长期应用循环辅助设备。建立了使用支持设备的三个主要指示组。在心脏外科手术后的低心输出量综合征中,使用短期设备来恢复心肌。在患有抗药性泵衰竭的移植候选者中,建议植入长期装置作为心脏移植的桥梁,而在NYHA IV级有心脏移植禁忌症的患者中,植入长期装置作为替代移植正在讨论中。在文献中,心脏切开术后支持生存率平均低于30%。大约70% 的机械桥接的患者存活下来接受心脏移植,并以超过90% 的存活率移植。机械支持期间的主要问题是感染,出血和血栓栓塞。鉴于患者的自然病程没有支持,这些临床结果是有利的。
  • 【Marfan综合征患者的进行性肺动脉扩张与b型主动脉夹层相关。】 复制标题 收藏 收藏
    DOI:10.3390/jcm8111848 复制DOI
    作者列表:Brouwer C,Bulut H,van Gemert W,Staal AH,Cortenbach K,Snoeren M,Nijveldt R,Duijnhouwer A,Loeys BL,van Royen N,Timmermans J,van Kimmenade RR
    BACKGROUND & AIMS: OBJECTIVE:Marfan syndrome (MFS) is a connective tissue disorder associated with severe cardiovascular morbidity and mortality. It is unknown if aorta complications in MFS are associated with progressive pulmonary artery (PA) dilatation. METHODS:We measured the PA diameter on routine magnetic resonance imaging in a population of MFS patients seen in our specialised centre with follow up of diameters as well as the outcome. RESULTS:PA dilatation was defined as an increase in diameter of 2 mm or more, and 71 patients (44%) of our total cohort (n = 162) met this criterion; mean follow up between two scans was 8.6 years (standard deviation (SD) ± 2.7 years). Furthermore, 28 patients suffered from dissections, of which 14 had a type A dissection, 10 had a type B dissection, and 4 patients suffered from both. Of those who suffered from dissection, 64% (18 out of 28) had a dilatation of the PA, versus 39% (53 out of 134) in the patient group without a dissection (p < 0.05). There was a significant association between type B dissection and descending aorta diameter (OR 1.14; 95% CI 1.05-1.24 p < 0.01) and PA dilatation (OR 1.69; 95% CI 1.03-2.77 p = 0.04). In the multivariable analysis the final model for type B dissection, only systolic blood pressure (OR 1.06; 95% CI 1.01-1.11 p = 0.02) and PA dilatation were statistically significant (OR 1.85; 95% CI 1.10-3.12 p = 0.02) while descending aorta diameter was not. CONCLUSIONS:We report an association between progressive PA dilatation and type B dissection. Our findings encourage a renewed interest in PA dimensions in MFS.
    背景与目标:

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