主动脉瓣退行性变发病机制的研究进展

主动脉瓣退行性变导致的主动脉瓣狭窄已成为西方国家主动脉瓣置换的最常见原因,该病早期的表现为主动脉瓣硬化。即使在血流动力学没有显著阻塞的情况下,主动脉瓣退行性变造成的心血管原因死亡的风险也增加到50%。我国渐入老龄社会,可以预见将会有更多的人患主动脉瓣退行性变。主动脉瓣退行性变的发病是一个主动的过程,在其发病中有多机制的参与:血流动力学的影响、炎症、脂质沉积、细胞外的基质重构、骨化和遗传学均参与了这一过程,对此做一综述。     

老年主动脉瓣退行性疾病的发病机制及诊疗研究进展

综述老年退行性主动脉瓣疾病(DAVD)的发病机制、诊断与治疗等研究进展。心血管疾病是目前威胁我国老年人生命健康的主要疾病之一,通常以冠状动脉粥样硬化性心脏病最多见,而近年来发现瓣膜性心脏病的发病率逐年升高,其中DAVD是一种常见的老年退行性心脏瓣膜病,严重威胁我国老年人的生命健康。     

主动脉瓣钙化发病机制的研究进展

主动脉瓣钙化是复杂的多因素参与的异位钙化的过程,可引起主动脉瓣狭窄,严重时导致血流动力学改变,甚至猝死,换瓣手术治疗是目前唯一有效的方法。主动脉瓣钙化的发病机制包括瓣膜内皮细胞的转变、瓣膜间质细胞的转变、细胞外基质重塑、新生微血管、血流动力学影响以及其他相关因素。     

退行性主动脉瓣疾病相关分子学机制的研究进展

<正>近年来,随着人口老龄化程度的加剧和饮食结构中高热量和高胆固醇食物比例的大幅度增加,在世界范围内,作为老年退行性心脏瓣膜病的最常见类型,退行性主动瓣疾病(degenerative aortic valve disease,DAVD)的发病率呈现增长的趋势,已成为老年人心力衰竭、心律失常、晕厥及猝死的主要原因之一。     

神经退行性疾病发病机制研究进展

<正>神经退行性疾病是由神经元和(或)其髓鞘的丧失所致〔1,2〕,随着时间的推移而恶化,出现功能障碍。其可分为急性神经退行性疾病和慢性神经退行性疾病,前者主要包括脑缺血(CI)、脑损伤(BI)、癫痫;后者包括阿尔茨海默病(AD)、帕金森病(PD)、亨廷顿病(HD)、肌萎缩性侧索硬化(ALS)、不同类型脊髓小脑共济失调(SCA)、Pick病等〔3,4〕。这类疾病的脑病     

钙化性主动脉瓣狭窄发病机制的研究进展

钙化性主动脉瓣狭窄是老年人最常见的心脏瓣膜疾病,其病理特征主要是瓣叶的局灶性钙化和广泛纤维性增厚,发病机制过去一直被认为是退行性不可修复的劳损过程,近年来多项研究表明钙化性主动脉瓣狭窄是积极主动调控过程。目前发现主要有炎性细胞浸润、脂质沉积、凋亡结节形成、骨形成、细胞外基质的重塑、血管形成及肾素血管紧张素系统等机制参与。本文就钙化性主动脉瓣狭窄发病机制的研究进展及相应的治疗研究做简单的阐述。     

老年退行性主动脉瓣病误诊分析

老年主动脉瓣退行性变所致狭窄(AS)和/或关闭不全(AI),临床上并非少见,然而人们却往往习惯于把病因归咎于一些一向更为熟悉和重视的病变,诸如风湿性瓣膜病、梅毒性主动脉炎、心肌病等。实应     

Binswanger病发病机制研究进展

Ｂｉｎｓｗａｎｇｅｒ病的病因很复杂，发病机制众说不一。文章介绍近年来该病病理解剖，病理生理、神经电生理、生物化学、血液流变学、遗传因素等方面的研究新进展。     

Binswanger病发病机制研究进展

Binswanger病的病因很复杂,发病机制众说不一。文章介绍近年来该病病理解剖、病理生理、神经电生理、生物化学、血液流变学、遗传因素等方面的研究新进展。     

烟雾病发病机制研究进展

烟雾病是一种进行性脑血管闭塞性疾病,以脑底异常血管网形成为特征,是引起儿童和成人卒中的一个重要原因。烟雾病的病因目前尚不明确,本文将从遗传、血管生成以及免疫炎症3个方面对其发病机制进行综述。     

Insights into degenerative aortic valve disease

Despite the dramatic decline of rheumatic heart disease over the past 5 decades, there has not been a concordant decline in the prevalence of valvular heart disease. Degenerative aortic valve disease (DAVD) has become the most common cause of valvular heart disease in the Western world, causing significant morbidity and mortality. No longer considered a benign consequence of aging, valve calcification is the result of an active process that, much like atherosclerotic vascular disease, is preceded by basement membrane disruption, inflammatory cell infiltration, and lipid deposition and is associated with diabetes, hypercholesterolemia, hypertension, and tobacco use. These realizations, in addition to pathological insights gained from emerging imaging modalities, have lead to the exploration of a variety of therapeutic interventions to delay or prevent the progression of DAVD. Inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, angiotensin-converting enzyme, and matrix metalloproteinase have all been studied as potential disease modifiers. Moreover, tissue engineering, aided by emerging stem cell technology, holds immense potential for the treatment of valvular heart disease as adjuncts to surgical interventions. Here we review the epidemiology and pathophysiology of DAVD, in addition to highlighting emerging therapeutic interventions for this growing problem.     

Insights into degenerative aortic valve disease.

Despite the dramatic decline of rheumatic heart disease over the past 5 decades, there has not been a concordant decline in the prevalence of valvular heart disease. Degenerative aortic valve disease (DAVD) has become the most common cause of valvular heart disease in the Western world, causing significant morbidity and mortality. No longer considered a benign consequence of aging, valve calcification is the result of an active process that, much like atherosclerotic vascular disease, is preceded by basement membrane disruption, inflammatory cell infiltration, and lipid deposition and is associated with diabetes, hypercholesterolemia, hypertension, and tobacco use. These realizations, in addition to pathological insights gained from emerging imaging modalities, have lead to the exploration of a variety of therapeutic interventions to delay or prevent the progression of DAVD. Inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, angiotensin-converting enzyme, and matrix metalloproteinase have all been studied as potential disease modifiers. Moreover, tissue engineering, aided by emerging stem cell technology, holds immense potential for the treatment of valvular heart disease as adjuncts to surgical interventions. Here we review the epidemiology and pathophysiology of DAVD, in addition to highlighting emerging therapeutic interventions for this growing problem.     

Management of elderly patients with aortic valve disease

Increased life expectancy has resulted in a growing population of elderly people, among whom aortic stenosis is increasingly prevalent. For the majority of patients, the treatment of aortic stenosis is surgical, and every symptomatic patient should be considered for aortic valve replacement. Although operative mortality seems to be declining over time, a substantial number of patients do not undergo surgery because of excessive risk, advanced age, or treatment preference of either the patient or the physician. The challenge in the near future will be the enhancement of tools for proper clinical decision-making, so that patients can be stratified to appropriate treatment alternatives. Reports on the treatment of aortic valve stenosis should, therefore, include all patients presenting with the disease and not only those who receive surgery.     

脂蛋白(a)与钙化性主动脉瓣疾病的研究进展

钙化性主动脉瓣疾病是常见的心血管疾病,随着人口老龄化的日益加剧其逐渐成为主要的医疗负担.瓣膜置换术是该病的主要治疗方法,但高龄群体手术风险较大,并发症发生率高.且目前仍缺少预防或减缓疾病进展的有效药物.研究发现,脂蛋白(a)在瓣膜钙化的病理过程中起关键作用,脂蛋白(a)水平升高是钙化性主动脉瓣疾病的重要危险因素,显著增...     

经导管主动脉瓣置换术后瓣膜血栓的研究进展

随着经导管主动脉瓣置换术适应证向外科手术中、低危人群拓展,经导管主动脉瓣置换术后瓣膜血栓逐渐引起人们的关注。瓣膜血栓形成的机制尚不明确。瓣膜血栓的预防、检测及治疗仍在探索阶段。本文将对瓣膜血栓的发生率及潜在机制、检测手段、临床表现、不良结局、预防及治疗等进行综述。     

Transcatheter aortic valve implantation in degenerative sutureless perceval aortic bioprosthesis

Sutureless aortic bioprostheses (SAB) are increasingly being used to provide shorter cross‐clamp time. Valve‐in‐valve transcatheter aortic valve replacement (VIV‐A) is shown to be effective and safe in the vast majority of patients with degenerated bioprosthetics, yet its' use in SAB failure is infrequent. We present a case of balloon‐expandable VIV‐A in an 80‐year‐old woman who suffered severe symptomatic aortic regurgitation in a failed Perceval S 21‐mm valve. Computed tomography scan demonstrated a deformed valve. Our heart team favored a percutaneous VIV‐A over reoperation due to the patients' high surgical risk. An Edwards‐Sapien XT 23 mm was successfully deployed with excellent results. The patient remained asymptomatic following 6 months. As other bioprosthesis, some sutureless valves are condemned to structural valve degeneration. Because VIV‐A is being established for managing degenerative bioprosthesis in high risk patients, it is cardinal to identify its role in novel degenerative sutureless valves. SAB were introduced to the clinical market only 5–7 years ago. The absence of sutures may theoretically impose risk for valve instability when adding a transcatheter sutureless valve inside the first one. Our successful experience was very reassuring. We report its feasibility because we believe it should provide support for further investigation on VIV‐A within novel SAV. © 2016 Wiley Periodicals, Inc.     

Research progress on the pathogenesis of aortic dissection

Aortic dissection(AD) is a cardiovascular emergency with a high mortality rate, and the risk of death is estimated to increase by 1%-2% per hour. AD is complicated by variable clinical manifestations, and early detection and treatment can give more time for the treatment of patients.Hypertension is the most common cause of AD. In China, 65%-75% of patients with AD have poor blood pressure control. Patients with AD who are less than40 years of age are more likely to suffer from genetic diseases. ...     

Determinants of survival after aortic valve replacement as treatment for symptomatic aortic valve disease in the elderly

BACKGROUND AND AIM OF THE STUDY: The effect of concurrent disease and cardiac comorbidity on survival after bioprosthetic valve replacement in elderly patients was assessed retrospectively. Risk factors were categorized as general, non-cardiac (age, diabetes, previously treated carcinoma) and cardiac (LVEF, three-vessel disease, previous CABG or valve replacement, and endocarditis). METHODS: A total of 400 elderly patients (median age 73 years; range: 71-76 years) was studied. Medical history included diabetes, previous CABG or aortic valve replacement (AVR), endocarditis and treatment of previous carcinoma. A left ventricular ejection fraction (LVEF) of <0.66 and presence of three-vessel disease were also investigated. Hospital deaths (and cause) were recorded; survival or date and cause of death after discharge were obtained by questionnaire. Kaplan-Meier univariate and Cox proportional hazards multivariate regression analyses were carried out. RESULTS: Mortality during follow up was 28.3%; hospital mortality was 3.8%. Univariate analysis showed five factors significantly to affect survival: LVEF, history of endocarditis, carcinoma, age and three-vessel disease. Fifteen of 38 patients with history of carcinoma died, 10 due to a malignancy. Of 76 patients with three-vessel disease, 26 died. A history of diabetes and previous CABG did not influence survival significantly. Four of eight patients with preoperative endocarditis died, all in hospital. Six of 11 patients died after redo-AVR, none before 36 months follow up. By Cox regression analysis, LVEF and histories of carcinoma and endocarditis remained significant. CONCLUSION: AVR should be performed before ventricular deterioration occurs. Previous CABG is not a contraindication for AVR. Endocarditis impaired survival. Long-term mortality after redo-AVR in this population was relatively high, but acceptable. AVR should also be performed in elderly patients with aortic valve disease. Since prognosis of symptomatic aortic valve disease is poor in the short term, AVR is indicated in patients treated for carcinoma.