The elevated expression of osteopontin and NF-κB in human aortic aneurysms and its implication

The expression and significance of osteopontin (OPN) and NF-κB in patients with thoracic aortic aneurysm (TAA) and abdominal aortic aneurysm (AAA) were investigated.Thirteen TAA specimens,20 AAA specim...     

Elastic fiber regeneration in vitro and in vivo for treatment of experimental abdominal aortic aneurysm

Background The pathological characteristics of abdominal aortic aneurysm (AAA) involved the regression of extracellular matrix (ECM) in aortic walls,especially elastic structure in medial layer.As the ...     

主动脉壁内血肿的再认识

正急性主动脉综合征(acute aortic syndrome,AAS)是一种累及主动脉的致死性大血管疾病,以急性的胸背部疼痛为主要临床表现的临床综合征。主动脉综合征分为三类:主动脉夹层(aortic dissection,AD)、穿透性溃疡(penetrating aortic ulcer,PAU)与主动脉壁内血肿(intramural hematoma,IMH)。IMH     

超声心动图在经导管主动脉瓣置换术后随访应用的研究进展

<正>经导管主动脉瓣置换术(transcatheter aortic valve replacement, TAVR)已成为外科主动脉瓣置换术(surgical aortic valve replacement, SAVR)治疗无法手术或高危症状性重度主动脉瓣狭窄(aortic stenosis, AS)患者的一种可行方案，且在中期随访中，TAVR预示着与SAVR相似的结果，并已证实具有良好的瓣膜耐久性^[1]。此外，     

Heart,cardiovascula,vascular disorder

208677 Experience on surgical treatment of severe aortic valve stenosis:a report of 171 cases/Cui Yong(崔勇,Dept Cardiothorac Surg,Changhai Hosp,2rd Mil Med Univ,Shanghai 200433)…Chin J Surg.-2008,46(17).-1322～1324Objective To analyze the experiences on surgical treatment of severe aortic valve stenosis.Methods From December 1990 to December 2006,171 patients with severe aortic valve stenosis underwent aortic valve replacement(AVR).     

Reoperation on aortic disease in patients with previous aortic valve surgery

Background Aortic valve replacement (AVR) is a safe and effective method in the treatment of aortic valve diseases.This study aimed to increase the understanding on re-treatment of aortic diseases afte...     

Transcatheter aortic valve implantation: preliminary experience in West China Hospital

Transcatheter aortic valve implantation (TAVI) is a promising alternative to surgical aortic valve replacement for patients with symptomatic severe aortic stenosis (AS) who were deemed at a high surgical risk.This novel technique has kept evolving rapidly throughout the world in the past decade,but was not introduced to China until recently.Here we report our clinical experience in TAVI based on the largest cohort of Chinese patients in a single center.     

Experimental study on aortic remodeling in sinoaortic denervated rats

Objective: To study the aortic remodeling produced by chronic sinoaortic denervation (SAD) and its time course, and to study the role of humoral factor in the SAD-induced aortic remodeling. Methods: In rats with chronic SAD or sham operation, the aortic structure was measured by computer-assisted image analysis, the aortic function by isolated artery preparation, and angiotensin Ⅱ concentration by radioimmunoassay. Results and Conclusion: The aortic structural remodeling developed progressively at 4, 8, 16 and 32 weeks after SAD. Aortic structural remodeling after SAD expressed mainly as aortic hypertrophy due to SMC growth and collagen accumulation. The aortic contraction elicited by norepinephrine (NE) was progressively increased 8, 16 and 32 weeks after SAD. The aortic relaxation elicited by acetylcholine (ACh) was depressed 8, 16 and 32 weeks after SAD. In addition, in 32-week SAD rats the NE-induced contraction was not increased by endothelial denudation. These indicated that the increased contraction and depressed relaxation after SAD were related to the change of endothelium and/or the change of interaction between endothelium and SMC. In 10-week SAD rats, plasma angiotensin Ⅱ concentration remained unchanged, whereas aortic angiotensin Ⅱ concentration was significantly increased, suggesting that activation of tissue renin-angiotensin system may be involved in SAD-induced aortic remodeling.     

Congenital aortic arch anomalies: diagnosis using contrast enhanced magnetic resonance angiography

Coinn gcehnilitdarle nao·rtTich ea rdcihs eaansoem caalnie bs eo cccluarss mifioesdt cinotmom thorneley types:① obstructive congenital abnormalities, including coarctation of aorta (CoA) and interruption of aortic arch ( IAA); ② non-obstructive congenital abnormalities, including double aortic arch and others; ③ congenital shunt abnormalities, including different types of patent ductus arteriosus (PDA)·Management of patients with congenital aortic arch anomalies relies on imaging· Rou…     

Congenital quadricuspid aortic valve: analysis of 11 surgical cases

Background  Congenital quadricuspid aortic valve is rarely seen during aortic valve replacement (AVR). The diagnosis and treatment of the disease were reported in 11 cases.

Methods  Eleven patients (nine men and two women, mean age 33.4 years) with quadricuspid aortic valve were retrospectively evaluated. Medical records, echocardiograms and surgical treatment were reviewed.

Results  In accordance with the Hurwitz and Roberts classification, the patients were classified as type A (n=2), type B (n=7), type F (n=1) and type G (n=1). Three patients were associated with other heart diseases, including infective endocarditis and mitral prolaps, left superior vena cava, aortic aneurysm. All had aortic regurgitation (AR) except two with aortic stenosis (AS), detected by color-flow Doppler echocardiography. The congenital quadricuspid aortic valve deformity in seven patients was diagnosed by echocardiography. All patients underwent successful aortic valve replacement.

Conclusion  Quadricuspid aortic valve is a rare cause of aortic insufficiency, while echocardiography plays an important role in diagnosing the disease. Aortic valve replacement is the major therapy for the disease.

     

经导管主动脉瓣置换术的现状与发展趋势

目前,尽管严重主动脉狭窄的治疗指南仍以外科手术置换(surgical aortic valve replacement,SAVR)为治疗标 准,但随着大血管外科技术的不断发展,经导管主动脉瓣置换术(transcatheter aortic valve implantation,TAVI)逐渐成为 高危和禁忌SAVR患者的常规治疗措施。近年来各瓣膜厂商,包括国内医药公司,对瓣膜技术极力地推进,使得TAVI 技术取得了显著成效,加上其并发症也得到了有效控制,TAVI有望在治疗主动脉狭窄乃至关闭不全上取代传统术 式,应用前景可观。     

First transcatheter aortic valve implantation for severe pure aortic regurgitation in Asia

Transcatheter aortic valve implantation (TAVI) has become the standard of care for inoperable patients with symptomatic severe aortic stenosis (AS), and an alternative to open aortic valve replacement for patients at high surgical risk. TAVI has also been performed in several groups of patients with off-label indications such as severe bicuspid AS, and as a valve-in-valve therapy for a degenerated surgical bioprosthesis. Although TAVI with CoreValve® prosthesis is technically challenging, and global experience in the procedure is limited, the procedure could be a treatment option for well-selected patients with severe pure aortic regurgitation (AR). Herein, we report Asia''s first case of TAVI for severe pure AR in a patient who was at extreme surgical risk, with good clinical outcome at six months.     

One-year results of transcatheter aortic valve implantation as an alternative treatment for severe aortic stenosis in high-risk patients

BackgroundAortic valve replacement (AVR) remains the gold standard treatment for symptomatic severe aortic stenosis (AS). For the past 10 years, transcatheter aortic valve implantation (TAVI) has been applied in patients with high surgical mortality and morbidity risks. The preliminary results of our TAVI patients are presented in this study.MethodsTen high-risk patients with severe AS, for AVR, were referred and accepted for TAVI in the 6 month period from May 2010 to October 2010. The patient age, logistic EuroSCORE, femoral arterial diameter, aorta annulus size, aorta valve area (AVA), mean aortic pressure gradient (MPG), as well as coronary angiography results were all collected. Six patients were treated via the transapical approach in March 2010, whereas the other four were treated with the transfemoral approach, according to their femoral artery diameter and arterial quality. This study focuses on the immediate, 1 month, 3 month, and 1 year results of TAVI.ResultsThe average age of the 10 patients receiving TAVI was 81.5 years. The mean calculated EuroSCORE was 28.3 ± 7.9%. The mean AVA was 0.61 ± 0.19 cm². The MPG was 48 ± 16 mmHg. The surgical technical success achieved 100%. There was no reported moderate to severe postoperative paravalvular aortic regurgitation, permanent complete atrioventricular block, major access site complication, or embolic stroke. Chronic renal failure, which necessitated permanent hemodialysis, developed in 10% of the patients. One acute myocardial infarction and one case of pneumonia developed postoperatively. The AVA was increased by 251%, whereas the MPG was decreased by 80% at the 3 month follow-up. The 30-day mortality rate was 10%. The all-cause 1-year mortality rate was 20%.ConclusionThis new technique and device requires greater caution and needs more practice to accumulate sufficient experience. The studied patients were very fragile, due to old age and multiple comorbidities. Our results are similar to findings of multicenter trials. With careful patient screening and selection, TAVI can be a promising treatment for high-risk severe AS patients.     

Procedural results and 30-day clinical events analysis following Edwards transcatheter aortic valve implantation in 48 consecutive patients: initial experience

Background  Transcatheter aortic valve implantation (TAVI) is a rapidly evolving strategy for therapy of aortic stenosis. We presented the procedural results and analyzed the death causes of 30-day mortality and clinical events in patients who underwent TAVI with Edwards prosthetic valves in University Hospital of Caen, France.

Methods  The patients with severe aortic stenosis but at high surgical risk or inoperable were considered as candidates for TAVI. Forty-eight patients undergoing TAVI from July 2010 to September 2011 were enrolled in this registry. The Edwards prosthetic valves were solely used in this clinical trial.

Results  Overall 48 patients underwent TAVI, 28 of which accepted TAVI by trans-femoral (TF) approaches, 20 by trans-apical approaches (TA). The aortic valve area (AVA) was (0.70±0.23) cm², left ventricular ejection fraction (LVEF) was (57.4±17.6)%, Log EuroSCORE was (19.2±15.8)%, mean gradient was (47.0±16.6) mmHg. There were no significant differences between TF and TA groups in all these baseline parameters. Device success rate was 95.8%, and procedural success rate was 93.7% in total. Procedural mortality was 6.7% (3/48): two deaths in TA group (10%), and one death in TF group (3.6%). Forty-six Edwards valves were implanted: 10 Edwards Sapien and 36 Edwards XT. Procedure-related complications included cardiac tamponade in 2 cases (4.2%), acute myocardial infarction (AMI) in 1 case (2.1%), permanent pacemaker implantation in 1 case (2.1%), life-threatening and major bleeding in 3 cases; access site related major complication in 1 case, AKI stage 3 in 3 cases (6.3%), minor stroke in 1 case (2.1%). Thirty-day survival rate was 89.6%. There were 5 deaths in total (10.4%): 4 in TA group (20%) and 1 in TF group (3.6%).

Conclusion  The procedural success rate and 30-day mortality were acceptable in these high risk patients with Edwards prosthetic valves in the first 48 TAVI.

     

经导管主动脉瓣膜植入术的可选瓣膜植入途径

经导管主动脉瓣膜植入术（TAVI）是介入方法治疗严重主动脉瓣狭窄的一种新技术,经过十余年的发展,TAVI的效果与中期存活率与外科手术治疗效果相当。随着输送装置、支架瓣膜的改进,TAVI的适应证扩大,安全性、有效性进一步提升。本文将TAVI术中瓣膜植入途径的现状作一介绍。     

Experience of a high-risk aortic valve clinic in Ireland

Background

The advent of transcatheter aortic valve implantation (TAVI) has broadened the management options for severe aortic stenosis. The indications for TAVI are narrow. Selecting those that will benefit most from this intervention warrants careful consideration and input from cardiologists, anaesthetists and cardiac surgeons familiar with TAVI and surgical aortic valve replacement (SAVR).

Aims

The aims of this paper were to assess the feasibility of establishing a high-risk aortic clinic in Ireland, and report stratification of the referred group into those suitable for SAVR, TAVI and conservative management.

Methods

Patient data was prospectively collected by a dedicated clinical nurse specialist. ANOVA was used to assess variance in means between groups. Analyses were performed using IBM SPSS v20 (Armonk, NY: IBM Corp.).

Results

A total of 105 patients were assessed. Eighty-five patients were deemed suitable for TAVI, 9 (10.5 %) died awaiting the procedure and a further 6 (7 %) declined intervention. Eleven (10.5 %) underwent conventional SAVR, 1 (0.9 %) a balloon valvuloplasty, 4 (3.8 %) entered surveillance and 4 (3.8 %) were declined treatment.

Conclusions

Establishment of a high-risk aortic clinic is feasible in the Irish context. The advent of TAVI has reduced the proportion of patients denied intervention to a minority. Despite being considered high risk, a number of patients were suitable candidates for SAVR. Measuring frailty continues to provide a challenge; a TAVI-specific frailty assessment tool would be advantageous to patient stratification.     

Transcatheter aortic valve replacement in the developing world: Lessons learnt and its implications for practice

BackrgroundTranscatheter aortic valve replacement (TAVR) has become an accepted modality of treatment in intermediate and high surgical risk patients of symptomatic severe calcific aortic stenosis (AS). We herein report Indian data of 84 intermediate and high-risk patients who underwent TAVR at two Armed Forces cardiac centres.MethodsMost of the patients underwent TAVR in cardiac catheterization lab by percutaneous transfemoral approach, under conscious sedation. Patients were followed up and echocardiographic parameters were assessed after six months of procedure.ResultsTotal of 84 intermediate and high-risk patients underwent TAVR between Jan 2017 and June 2021. Mean age of population was 71.5 ± 8.4 years; 28.5% of patients had bicuspid aortic valve and Mean STS score was 6.34 ± 2.08. Majority (92.8%) patients underwent the procedure under conscious sedation. Self-expanding valves were used in 72.6% and balloon expandable in 27.4% of patients. Predilatation was done in 64% patients while 13% cases underwent post dilatation. Procedural mortality was 2.3%. Rate of permanent pacemaker implantation was 4.9%. Ischemic stroke occurred in 1.1% of patents. There was no case of severe paravalvular leak. Emergency surgical aortic valve replacement was done in 2.4% patients. Procedural success in this study was 97.6%. All-cause mortality was 9.5% at 6 months.ConclusionsTAVR is an effective treatment modality in intermediate and high-risk Indian patients with severe aortic stenosis. Patients with bicuspid or previous bio prosthetic aortic valves also have a good outcome post TAVR.     

经皮导管内主动脉瓣置入术的麻醉管理

经皮导管内主动脉瓣置入术的迅速发展给麻醉医师带来了巨大的挑战,伴随着人工合成瓣膜技术逐步优化、操作者经验日渐丰富,成为越来越多外科手术高风险的主动脉狭窄患者的新选择。麻醉管理也越来越复杂且精细,需要麻醉医师掌握更多相关新知识、新技术,现就其麻醉方法的选择及其特殊性加以综述。     

经主动脉途径植入主动脉支架瓣膜一例报道

经导管主动脉瓣植入术（TAVI）是治疗主动脉瓣狭窄患者的新技术,适用于无法外科手术和外科高风险的主动脉瓣狭窄患者,其常规植入途径为股动脉和心尖。该文介绍1例92岁高龄患者,经股动脉途径植入主动脉瓣失败后,改由经主动脉途径植入的成功经验。