Right axillary arterial perfusion for a ruptured type B aortic dissection: Report of a case

The results of surgical treatment for a ruptured type B aortic dissection remain far from satisfactory. It is believed that additional perfusion from the right axillary artery might be more beneficial than perfusion from only the femoral artery during surgery for a ruptured thoracic aneurysm. The right axillary perfusion is more likely to perfuse the vital organs proximal to the ruptured area, and thus avoid retrograde emboli. In addition, if the open proximal method is performed, then the right axillary perfusion is able to facilitate the evacuation of air from the aortic lumen. We present herein the case of a patient in whom a ruptured type B acute aortic dissection was successfully treated by applying right axillary perfusion through a left thoracotomy.     

Thoracic Aortic Aneurysms: Role of Echocardiography

This article describes the evolving role of echocardiography for the detection and evaluation of thoracic aortic aneurysms. A brief summary of the clinical, anatomical, and pathological features of the etiologic categories of thoracic aneurysms is presented. The advantages and limitations of echocardiography and its comparison with other techniques (computed tomographic scanning, magnetic resonance imaging, and aortography) are discussed.     

Repair of a ruptured aortic arch aneurysm complicated by postoperative paraplegia: Report of a case

We report herein the rare case of a 79-year-old man who suffered permanent paraplegia after undergoing an otherwise successful total arch replacement for a ruptured aortic arch aneurysm. During cardiopulmonary bypass, perfusion to the distal aorta was maintained from the femoral artery, and postoperative aortography showed intact tributaries from the aorta including the intercostal arteries. Postoperative paraplegia is an extremely rare complication of operations on the aortic arch; however, we speculate that the paraplegia in this patient could be attributed either to a steal phenomenon involving the radicular artery, or to the anatomical particularity of the spinal cord artery described by Cole and Gutelius as the segmental system.     

Experimental approach to the pathogenesis of the anomalies of amniotic disease

By intra-adnexal injection of glucose in the rabbit embryo, we were able to stimulate all the anomalies associated with "Amniotic Disease". Since we were even able to obtain amniotic bands, this study provides an excellent experimental model of this disease. Resulting lesions occur early in development, corresponding to the first trimester of human gestation. All of the anomalies can ultimately be explained by the destruction of the most superficial cells: epiblastic cells of the embryo and the amnion, subjacent mesenchyme, and endothelial cells. The subsequent lack of interaction between these cells and the importance of the anatomical localizations of resulting hematomas can lead to the pathogenetic approach to this disease. In light of the present study, the disease appears to be caused by an external factor within the amniotic fluid. The exact nature of the destructive agent(s) remains a mystery in man.     

红花水煎剂对家兔离体主动脉血管的舒张作用

目的　观察红花Carthamustinctorius (DFCT)水煎剂对血管肌条的舒张作用及机制。方法　将家兔离体主动脉肌条放置于灌流肌槽中 ,记录其等长收缩。结果　DFCT对血管肌条静息张力无明显影响 ,但 2 0mg/mLDFCT水煎剂与 10 -5mol/L乙酰胆碱相似 ,可使 10 -6mol/L去甲肾上腺素预收缩血管肌条产生明显的舒张作用。去除内皮细胞、10 -4mol/LL NNA或 10 -5mol/L甲烯蓝可减弱DFCT的舒张血管作用 ,但前列腺素合成抑制剂和 β肾上腺素能受体阻断无明显影响。另外 ,4 0mg/mLDFCT水煎剂可明显抑制去内皮血管肌条去甲肾上腺和KCl的量效收缩反应 ,使其PD2 值分别由对照组 6 0 6± 0 0 9和 1 71± 0 33变为 5 0 7± 0 0 8和 1 35± 0 2 0。结论DFCT水煎剂可通过受体操纵Ca2 + 通道和电压依赖性Ca2 + 通道抑制外Ca2 + 内流 ,使血管肌条舒张 ,其作用与内皮释放的NO有关。     

金粉蕨素抑制大鼠主动脉平滑肌增殖作用及机制

目的 :观察金粉蕨素对牛血清刺激的大鼠主动脉平滑肌细胞增殖的抑制作用 ,并对其作用机制进行初步探讨。方法 :体外培养大鼠主动脉平滑肌细胞 ,以终浓度为 10 %的新生牛血清 (NCS)作为刺激因素 ,用噻唑蓝 (MTT)比色法和细胞计数法观察细胞增殖状况 ,用流式细胞仪分析细胞周期 ,用Westernblot实验测定蛋白表达。结果 :与 10 %牛血清组相比 ,不同浓度金粉蕨素组的MTT测定值与细胞数目均明显下降 (P <0 .0 5 ) ,其下降幅度呈浓度依赖性 ;10 μmol·L-1时达峰值 (P <0 .0 1) ;细胞周期分析显示 ,金粉蕨素组G1期百分比 (85 .1% )高于10 %牛血清组 (70 .0 % ) ,而S期比例 (4 .3% )低于10 %牛血清组 (16.4 % ) ;Westernblot结果显示给药组P ERK1 2蛋白表达明显低于同时间点牛血清组。结论 :金粉蕨素能阻止细胞周期由G0 G1期向S期推进 ,抑制血管平滑肌细胞增殖 ,此作用与其抑制ERK1 2磷酸化、影响MAPK ERK通路激活有关。     

Flow characteristics past jellyfish and St. Vincent valves in the aortic position under physiological pulsatile flow conditions

Thrombus formation and hemolysis have been linked to the dynamic flow characteristics of heart valve prostheses. To enhance our understanding of the flow characteristics past the aortic position of a Jellyfish (JF) valve in the left ventricle, in vitro laser Doppler anemometry (LDA) measurements were carried out under physiological pulsatile flow conditions. The hemodynamic performance of the JF valve was then compared with that of the St. Vincent (SV) valve. The comparison was given in terms of mean systolic pressure drop, back flow energy losses, flow velocity, and shear stresses at various locations downstream of both valves and at cardiac outputs of 3.5 L/min, 4.5 L/min, and 6.5 L/min respectively. The results indicated that both valves created disturbed flow fields with elevated levels of turbulent shear stress as well as higher levels of turbulence in the immediate vicinity of the valve and up to 1 diameter of the pipe (D) downstream of the valve. At a location further downstream, the JF valve showed better flow characteristics than the SV in terms of velocity profiles and turbulent shear stresses. The closure volume of the SV valve was found to be 2.5 times higher than that of the JF valve. Moreover, the total back flow losses and mean systolic pressure drop also were found to be higher in the SV than the JF valve.     

Aortic aneurysm and dissection are not associated with an increased risk for giant cell arteritis/ polymyalgia rheumatica

It has recently been claimed that giant cell arteritis (GCA) is associated with a markedly increased risk of aortic aneurysm formation or rupture. In the present study, the opposite approach was taken, by looking for the incidence of GCA and polymyalgia rheumatica (PMR) in patients with aortic aneurysm, aortic dissection, or both (AA/D). The records of 315 consecutive patients admitted with the diagnosis of AA/D were reviewed. In addition, follow up information was obtained in 82 patients by examination in the outpatient clinic. After careful examination and assessment of clinical and laboratory data, it was found that none of the 82 patients who survived hospitalisation and were available for examination had GCA or PMR. Moreover, review of the retrospective data available from hospital records of the total consecutive 315 patients with AA/D failed to find any patient with a diagnosis of GCA/PMR. In conclusion, the present study did not find an increased prevalence of GCA/PMR among a cohort of Israeli patients with AA/D. Therefore, it is suggested that a thorough investigation aiming to diagnose GCA/PMR is not cost effective in most of the elderly patients presenting with AA/D.     

Effects of exogenous sphinganine, sphingosine, and sphingosine-1-phosphate on relaxation and contraction of porcine thoracic aortic and pulmonary arterial rings.

Fumonisin mycotoxicosis in pigs causes a decrease in mean aortic pressure, an increase in mean pulmonary arterial pressure, and increases in serum concentrations of sphinganine (3.2 microM) and sphingosine (1.4 microM). To determine a causal relationship between the hemodynamic changes and sphingolipid alterations, we examined the in vitro effects of sphinganine, sphingosine, and sphingosine-1-phosphate on porcine aortic and pulmonary arterial rings. Both sphinganine and sphingosine relaxed un-contracted and phenylephrine-contracted aortic rings at > or = 10 microM and > or = 1 microM, respectively. Sphingosine (> or = 10 microM) relaxed un-contracted and phenylephrine-contracted pulmonary arterial rings, whereas sphingosine-1-phosphate (10 microM) contracted pulmonary arterial rings. Sphingosine (3 microM) also impaired the contractile response of pulmonary artery rings to 60 mM KCl. The results suggested that the systemic hypotension caused by fumonisin is mediated, in part, by increases in serum sphinganine and sphingosine concentrations, and the pulmonary hypertension is mediated, in part, by increased sphingosine-1-phosphate concentrations.     

The effect of two low-dose propofol infusions on the relationship between six-pulse transcranial electrical stimulation and the evoked lower extremity muscle response

BACKGROUND: Transcranial stimulation of the motor cortex using high-voltage electrical stimuli given in train is a method of monitoring the integrity of the motor pathways during thoracoabdominal aortic aneurysm surgery. The purpose of this study was to assess the relationship between the stimulus intensity and the corresponding amplitude of the myogenic motor evoked potential (tcMEP) in response to six-pulse transcranial electrical stimulation during two levels of low-dose propofol infusion and stable fentanyl/nitrous oxide anaesthesia. METHODS: Nine patients (37-78 yr) scheduled to undergo surgery on the thoracoabdominal aorta were studied. After achieving a stable anaesthetic state the output voltage was decreased with 50 V intervals from 350 V to 200 V during a target propofol infusion aimed at a plasma steady-state concentration of 0.7 microg x ml(-1) and increased with 50 V intervals from 200 V to 450 V during a target propofol infusion aimed at a plasma steady-state concentration of 1.4 microg x ml(-1). TcMEPs were recorded from the right tibialis anterior muscle. RESULTS: Doubling the target propofol infusion to 1.4 microg x ml(-1) resulted in a 30-50% decrease in tcMEP amplitude. The largest tcMEP amplitude using the six-pulse paradigm was found during a propofol infusion aimed at a plasma concentration of 0.7 microg x ml(-1) and demanded a stimulus output of 350 V, corresponding to a charge density of 7.5 microC x cm(-2) per phase. CONCLUSION: Doubling the target propofol infusion to 1.4 microg x ml(-1) provides less robust, but still recordable tcMEPs in response to six-pulse electrical stimulation. Safety guidelines are discussed.