建立基于浸入边界有限元法的三维静脉瓣流固耦合数值模型

目的 探究静脉内血液与瓣膜之间的流固耦合动态过程和保证血液单向回流的生理机制。方法 基于浸入边界有限元法,结合人体下肢静脉医学图像及牛大隐静脉的解剖结构和尺寸,采用超弹性本构模型描述静脉瓣膜在生理条件下不可压缩、非线性和超弹性力学响应,构建静脉血管和静脉瓣膜的三维数值模型。结果 研究结果可视化地展示静脉动态运输血液的过程以及静脉瓣膜防止反流的功能机制,再现静脉内瓣膜运动和血液流动的周期性特点,讨论和量化了整个心动周期内的重要生理数据,包括静脉内血液的压力、流速和流量以及静脉瓣膜的开口面积、静脉瓣膜表面的应力和应变分布等。结论 三维流固耦合模型可数值再现静脉内生理动态过程,为进一步揭示静脉疾病相关机制提供重要的参考和指导意义。     

Analysis of ATS leaflet behavior by in vitro experiment

It has been reported that the normally functional bileaflet valve ATS with open-pivot design does not exhibit a full opening motion either in the mitral or in the aortic position in patients. An in vitro experiment was conducted to investigate the mechanism of the ATS leaflet movement. ATS 29 mm for the mitral position was chosen in our experiment and SJM 29 mm was chosen as a control. Two pulsatile simulators were employed to investigate the factors affecting leaflet movement. Two different conduits to be incorporated downstream (in simulator I) and three different inlet coverings to alter the local flow field around the open pivot (in simulator II) were used. A high-speed video camera was employed to observe leaflet movment. The ATS valve could exhibit a fully open movement in straight conduit but could not fully open when an enlarging shape was incorporated downstream of the ATS valve. The covering of the ATS open pivot could make the leaflets fully open or increase the opening angle with the existene of the enlarging downstream shape. The enlargement downstream of the ATS valve, which induces a divergent transvalvular flow, is the main reason that the leaflets do not fully open. The local flow field around the open pivot, which induces an additional moment M_a, plays an important role in the movement of the ATS leaflets.     

新型抗钙化牛颈静脉管道材料的体外细胞毒性评价

背景：Triton X-100、环氧氯丙烷联合改性处理戊二醛固定的牛颈静脉管道是一种新型抗钙化右心管道材料,其生物相容性方面的研究较少。 目的：评价新型抗钙化牛颈静脉管道的体外细胞毒性。 方法：通过CCK-8法检测新型抗钙化牛颈静脉管道(实验组)及单纯戊二醛处理牛颈静脉管道材料浸提液(对照组)对L-929小鼠成纤维细胞的毒性作用,以第2,4天为检测时间点,计算细胞相对增殖率、对材料毒性进行分级。 结果与结论：CCK-8法细胞毒性试验显示新型抗钙化牛颈静脉管道材料浸提液第2,4天L-929细胞增殖率均在85%以上,毒性分级为1级,无细胞毒性,且显著优于对照组(P < 0.05)。提示经戊二醛、Triton X-100、环氧氯丙烷联合处理制备的新型抗钙化牛颈静脉管道材料无细胞毒性。     

Septum in the external jugular vein

We examined 70 external jugular veins from 35 cadavers. In six veins we observed a septum, 6–25 mm long, which completely divided the lumen of the vein. The septum, which has not been previously described, was located approximately 5 cm superior to the vein's termination into the subclavian vein. Histologically, the septum is composed of tunica intima and tunica media in contrast to venous valves which are composed of tunica intima only.     

Development of a prosthetic venous valve

The pathology of thrombophlebitis primarily results from the obliteration of venous valves in the lower extremities. The objective of this study was to develop a prosthetic venous valve that could be implanted in the human femoral system to ameliorate the deleterious effects of thrombophlebitis. Prosthetic venous valves were produced from two materials: Pellethane valves were fabricated from a dip-casting process; umbilical vein valves were produced by a fixation process. The valves were evaluated as implants within the external jugular veins of 10 research dogs. Each animal was implanted with one Pellethane valve in one external jugular vein and one umbilical vein venous valve in the contralateral jugular vein. Each valve was positioned over a stainless-steel cylinder that had been implanted into the jugular veins in such a manner that there existed no blood-cylinder interaction. Patency of the valves was determined by X-ray venography at 24, 48, and 72 h and at 5 and 8 days postoperatively. All of the umbilical vein venous valves were occluded by the end of 48 h, whereas two of the Pellethane venous valves remained patent for at least 5 days but were occluded at 8 days. The results of this study suggest the possibility of success of Pellethane valve implants in the venous circulation and indicate future directions for study.     

静脉瓣膜修复术治疗深静脉瓣膜功能不全17例

对17例下肢深静脉瓣膜关闭不全的病人,行股静脉纵行切开,检查病变瓣膜下垂情况,将过长的瓣叶以间断缝合法缝于静脉壁上,使下垂的瓣叶缩短,张力增强,以阻挡股静脉血返流。术后17例18条肢体原有的肿胀、色素沉着及溃疡等症状均减轻或愈合。     

Topographic anatomy of the fetal inferior vena cava,coronary sinus,and pulmonary veins: Variations in Chiari's network

To understand anomalies in Chiari's network better, we assessed the topographical anatomy of the fetal inferior vena cava (IVC), coronary sinus, and atria. We examined sagittal serial paraffin sections of 15 human fetuses of crown–rump length 24–36 mm, corresponding to a gestational age of 8 weeks. Although their outflow tract morphologies were similar, these 15 specimens could be classified into two groups. In eight specimens, the left common cardinal vein reached the body wall, whereas in the other seven the vein was obliterated near the left pulmonary vein. Irrespective of the group in which the specimen was included, the anteroposterior arrangement of the coronary sinus, the sinus septum (septum), and the right sinus valve (right valve) could be classified into three types: the right valve–septum–coronary sinus arrangement in seven specimens; the right valve–coronary sinus–septum arrangement in five; and the coronary sinus–right valve–septum arrangement in three. Depending on differences in topographical anatomy, the sinus septum separated the coronary sinus opening from either the right or the left atrium. Likewise, the coronary sinus opening was either adjacent to or distant from the IVC terminal. Rather than the counter‐side position of the right valve being at the IVC terminal, the left sinus valve protruded leftward, forming an incomplete interatrial septum. Fetal variations seemed to be closely connected with individual variations and a high frequency of Chiari's network anomalies in adults. Clin. Anat. 28:627–637, 2015. © 2014 Wiley Periodicals, Inc.     

Clinical anatomy of cardiac veins,Vv. cardiacae

New methods of cardiological examination and treatment, such as catheterization and arterialization of the coronary sinus, venous reperfusion and cardioplegia have made necessary an exact account of the distribution pattern and the mode of opening of the cardiac veins. 350 hearts were prepared for examination with macroscopical techniques. There are three systems of the major cardiac veins: tributaries of the coronary sinus, anterior cardiac veins, atrial cardiac veins. Their openings lie in a circle-like arrangement between the ostia of both caval veins and just above the tricuspid valve. In most cases there are variably sized intramural collecting chambers or sinuses just before the opening of all the cardiac veins. These sinuses are interpreted to favour the return of cardiac venous bloodstream from the myocardium to the right atrial cavity. The tributaries of the coronary sinus and of the anterior cardiac veins are very variable. There is for instance only in 36% of cases a small cardiac vein, which belongs to the coronary sinus system. In 64% a small cardiac vein does not exist, but its origin, the right marginal vein, joins the system of anterior cardiac veins. This behaviour diminishes the function of the coronary sinus and increases the importance of the system of anterior cardiac veins. Intramural courses of the great cardiac vein, crossing coronary arteries, ostial valves of cardiac veins, ostial valve of coronary sinus and of inferior vena cava, ostial occlusion of coronary sinus, and aneurysm like excavation of the posterodorsal wall of the right atrium have been described also. These facts and structures may cause morphological hindrances fo catheterization of the right atrium and coronary sinus and for reperfusion of cardiac venous drainage pathways. This report about a large conus vein, which is a great cardiac vein joining anterior cardiac veins and about intramural courses of great cardiac vein as well as semicircular venous sinuses in the wall of the right atrium is the first in the literature.     

Anatomical data on the intracranial venous drainage of the tufted capuchin,Cebus apella linnaeus, 1758

The venous channels responsible for the intracranial drainage were dissected in a series of 25 male and female adult tufted or brown capuchin monkeys (Cebus apella). It was found that Cebus have a venous arrangements fundamentally the same as in man, differing only in that: 1. the monkey has no inferior sagittal sinus, sphenoparietal sinus, and emissary parietal and condylar veins; 2. the occipital sinus is not in connection with other sinuses; 3. there are a sphenopetrosal sinus, a petrosquamous sinus, and an unpaired inferior cerebellar vein; 4. besides the internal jugular vein, there is additional intracranial drainage through the petrosquamous sinus and the postglenoid vein; 5. the superficial middle cerebral vein opens into the petrosquamous sinus; 6. the lingual and facial veins are not tributaries of the internal jugular vein; 7. there is a bilateral uniform division of the superior sagittal sinus at the confluence of the sinuses to drain equally into both transverse sinuses; 8. the vascular pattern appears to be quite stable; anatomical variations appear to be few and unimportant.     

Venous valves in subclavian and internal jugular veins. Frequency, position, and structure in 100 autopsy cases

Valves in the subclavian and internal jugular veins were studied in 100 autopsy cases (52 men and 48 women; range, 18 to 91 years old; mean, 67 years). In 87 cases, valves were present in all 4 veins, and in 13 cases, valves anatomically were absent from 16 veins, 9 of which were the left internal jugular vein. The average distance from the valve to the junction with the innominate vein was 1.7 cm for the subclavian vein and 0.3 cm for the internal jugular vein. Cuspid height averaged 0.9 cm. Valves were bicuspid in 347 (90%) and unicuspid in 39 (10%); unicuspid valves were more common in the internal jugular vein than in the subclavian vein. Catheter-induced trauma was observed in 4 cases and implied in 4 more. These findings may have important implications concerning the failure, in some cases, of closed-chest cardiac resuscitation to maintain forward blood flow at adequate pressure.     

脑静脉与静脉窦血栓形成累及的结构及其影像学特征研究

目的探讨脑静脉及静脉窦血栓形成(CVST)累及的结构及影像学特征。方法回顾性分析152例经临床及影像检查确诊为CVST患者的临床资料,观察CVST累及的结构,分析其影像学特征。结果152例CVST中,最常受累的静脉结构为横窦(57.2%),其次为上矢状窦(51.9%)、乙状窦(48%)、颈内静脉(12.5%),超过50%的CVST累及多个静脉窦,皮质静脉及深静脉血栓少见;上矢状窦血栓以中段血栓最为常见。39.5%的患者存在脑实质损害,最为常见的是脑水肿或脑肿胀,其次是静脉性脑梗死、颅内出血等;CVST最为常见的CT影像学特征依次是高密度三角征、条带征,而高密度点征、火焰征少见;MRI的特征性表现为静脉血管腔血液流空效应消失;DSA表现为静脉窦腔狭窄、显影变淡或完全不显影,侧支静脉异常扩张。结论CVST主要累及横窦及上矢状窦中段,常同时阻塞多个静脉窦;常见的直接影像学特征有条带征、三角征及血管充盈缺损;间接影像征象有脑水肿、脑出血、静脉性脑梗死等。了解脑静脉及静脉窦的结构及CVST影像学特征对CVST的早期诊断具有重要意义。     

Ultrasound study of the cranial venous system in the human new-born infant and the adult

A pulsed doppler ultrasound technique has been used to measure changes in blood velocities in the superior sagittal sinus, the jugular veins and intracranial and extracranial arteries in 13 neonates, and in the jugular veins and an extracranial artery in 13 adults, during unilateral and bilateral jugular venous compressions. The results have enabled us to determine how the subject under examination functionally uses his cranial venous drainage system in the resting state, and whether or not he can shunt obstructed venous flow through other cranial venous channels. We have found great variability between the subjects. In the resting situation the range of possibilities from total dependence on one jugular vein alone to usage of both jugular veins and the vertebral veins exists. Shunting of blood on jugular compression from either or both jugular veins to the vertebral veins may occur, and contralateral shunting between the jugular veins may be possible in both directions, in one direction or not at all.     

Pulmonary artery catheter insertion in a patient of dextrocardia with anomalous venous connections

In a young adult patient having situs solitus with dextrocardia the attempted pulmonary artery catheter placement for emergency mitral valve replacement required an unduly long length (50cm) of catheter insertion to get into right ventricle and then into pulmonary artery. Although catheter coiling was suspected initially, chest x-ray taken after successfully placement revealed an uncommon congenital anomalous venous connection i.e. right internal jugular opening into left sided superior vena cava then into inferior vena cava after running all along the left border of the heart. With the result, it required to pass 50cm of PA catheter to get into right ventricle in our patient. This emphasizes the need to look for abnormal venous connections during echocardiography and x-ray screening in congenital heart disease. Fluoroscopy is recommended when an unusual length of pulmonary artery catheter insertion is required to enter the pulmonary artery.     

彩超对曲张静脉管径和交通静脉反流与临床分级的相关性研究

目的应用彩色多普勒超声（彩超）对静脉曲张的患肢及正常肢体进行检查，探讨小腿交通静脉反流对临床分级的影响，并对比观察观察组及正常组下肢静脉的管径。方法站立位时通过彩色多普勒超声对观察组25例患者的39条患肢与正常组10例患者（健康下肢）和正常人的12条健康下肢进行检查，对比观察有无小腿交通静脉反流、静脉管径等参数；对小腿交通静脉反流与临床分级作相关分析。结果正常组小腿交通静脉管径均小于3mm．未见交通静脉反流。观察组小腿交通静脉管径大于4mm伴有反流者18条下肢，小腿交通静脉反流与临床分级具有相关性（Fisher＇s exact=0．005），有小腿交通静脉反流者临床分级更高。站立位观察组患者的下肢大隐静脉、股总静脉、股浅静脉、胭静脉管径较正常组健康者的增宽。结论有小腿交通静脉反流者临床分级更高，故应常规检查小腿交通静脉；下肢静脉曲张组静脉管径较正常者的增宽，因此，发现静脉管径明显增粗时，应观察静脉有无反流。     

Micro-venous valves in the superficial veins of the human lower limb

It is commonly believed that venous valves are not present in veins smaller than 2 mm in diameter. Venous valves, however, have been identified recently in small veins in several regions of the body. This study was undertaken to determine the size distribution of venous valves in the human lower limb micro-venous circulation. Vascular casts were made from six adult lower limbs and the sampled areas were viewed by scanning electron microscopy. In total, 2,376 valves were identified from 410 cm(3) of subcutaneous tissue. The vast majority (94%) of the valves were in veins less than 300 microm in luminal diameter, with 65% of the valves present in venous channels less than 100 microm in luminal diameter. The smallest valves identified were present in venous channels 18 microm in diameter. All valves were bicuspid and often associated with a tributary. Endothelial cells on the vein wall not associated with a valve were fusiform and arranged parallel to the long axis of the vessel, however, the endothelial cells on the luminal and valve sinus surfaces of the cusp were more polyhedral in shape and showed no obvious pattern of alignment. This study provides direct evidence to show that small superficial veins of the human lower limb do contain abundant venous valves and, for the first time, shows that the majority of these valves are present within venous channels less than 100 microm in luminal diameter.     

小隐静脉解剖和多普勒超声活体观察在远端蒂皮瓣的意义

目的:探讨小隐静脉与远端蒂皮瓣静脉回流.方法:以腓肠神经营养血管皮瓣为例.(1)解剖观察40侧小隐静脉.(2)用多普勒超声检查60侧人的小隐静脉.结果:解剖观察外踝尖水平上 3～4 cm小隐静脉体表投影与皮瓣轴线基本一致,两者相差(0.5±0.3)cm.40侧中有12侧各有1支与腓静脉的交通支,距外踝尖(3.0±0.7)锄,外径(1.2±0.5)mm;彩超检杳外踝尖水平上3～4cm小隐静脉内径为(2.3±0.7)mm,距体表(3.2±1.0)mm,78.3%正常人的小隐静脉能较显著将远侧的静脉血导入近侧.若足踝部大隐静脉回流障碍,小隐静脉引流将加剧.结论:(1)结扎小隐静脉消除了浅静脉干对远端蒂皮瓣的倒灌,可改善皮瓣静脉回流.(2)经超声定位,在外踝尖水平上3～4cm行0.5～1 cm的纵向小切口能准确结扎小隐静脉,操作简单,不会损伤蒂部穿支血管和血管网.     

0.1 mm ePTFE versus autologous pericardium for hand-sewn trileaflet valved conduit: a comparative study

Journal of Artificial Organs - A hand-sewn trileaflet valved conduit is reportedly better than a bovine jugular graft. However, the comparative efficacy and safety between 0.1&nbsp;mm ePTFE and...     

Variation of anatomical structures related to biventricular pacing procedures and cannulation of the coronary sinus

The success of biventricular pacing procedures is at least partially related to the ability to implant leads into the heart. Lead placement into the coronary sinus can be particularly challenging because of variations in the coronary venous anatomy. We examined the anatomy of the coronary sinus and the Thebesian valve. Forty-three (22 male, 21 female) embalmed adult cadavers were used to determine the internal diameter of the coronary sinus ostium, the presence of a membranous or fenestrated Thebesian valve, and the percent occlusion of the coronary sinus ostium by the Thebesian valve, if present. An 8-French (F) guiding catheter was used to simulate coronary sinus cannulation. The average internal diameter of the coronary sinus ostium was 11.44 ± 3.21 mm. A Thebesian valve was present in 74 % of the cadavers, and the majority (84 %) of those valves were membranous. In the presence of a Thebesian valve, the opening at the ostium was reduced to 7.47 ± 2.69 mm. The percent occlusion of the coronary sinus ostium by the Thebesian valve varied from 8.26 to 100 %. The average cannulation distance (length of catheter travel into the coronary sinus from the coronary sinus ostium) was 69 ± 18 mm. Statistical analyses revealed no gender differences in the measurement data for either the coronary sinus or Thebesian valve. The most common presentation is a membranous Thebesian valve. Most frequently, the percent occlusion ranged between 41 and 50 %. The cannulation distance was greater in males than in females.     

A completely autologous valved conduit prepared in the open form of trileaflets (type VI biovalve): mold design and valve function in vitro

In-body tissue, architecture technology represents a promising approach for the development of living heart valve replacements and preparation of a series of biovalves. To reduce the degree of regurgitation and increase the orifice ratio, we designed a novel mold for a type VI biovalve. The mold had an outer diameter of 14 mm for implantation in beagles, and it was prepared by assembling two silicone rods with a small aperture (1 mm) between them. One rod had three protrusions of the sinus of Valsalva, whereas the other was almost cylindrical. When the molds were embedded in the subcutaneous pouches of beagles for 1 month, the native connective tissues that subsequently developed covered the entire outer surface of the molds and migrated into the aperture between the rods. The mold from both sides of the harvested cylindrical implant was removed, and homogenous well-balanced trileaflets were found to be separately formed in the open form with a small aperture at the three commissure parts inside the developed conduit, which had a thick homogenous wall even in the sinus of Valsalva. Exposure of the obtained biovalves to physiological aortic valve flow in beagles revealed proper opening motion with a wide orifice area. The closure dynamics were suboptimal, probably due to the reduction in the size of the sinus of Valsalva. The mechanical behavior of this biovalve might allow its use as a living aortic valve replacement.