主动脉瓣环扩大联合环上瓣置换术治疗成人小瓣环主动脉瓣狭窄近中期疗效分析

目的评价主动脉瓣环扩大联合环上瓣置换术治疗成人小瓣环主动脉瓣狭窄的近中期结果。方法对2007年1月至2011年7月北京安贞医院心外科38例成人小瓣环主动脉瓣狭窄患者行主动脉瓣环扩大后植入环上型人工瓣膜,男12例、女26例,年龄16~58（38.6±21.0）岁,体重48~78（58.5±12.0）kg,身高153~176（162.8±12.0）cm,体表面积（1.67±0.32）m2。风湿性主动脉瓣狭窄19例,先天性主动脉瓣二叶瓣畸形合并狭窄11例,主动脉瓣退行性钙化伴狭窄5例,主动脉瓣狭窄合并感染性心内膜炎3例。入院时心功能分级（NYHA）Ⅱ级8例,Ⅲ级29例,Ⅳ级1例。主动脉瓣环内径15~20（17.6±2.8）mm,平均跨瓣压差53~75（62.8±10.5）mm Hg。结果体外循环时间83~145（112±29）min,升主动脉阻断时间58~116（87±28）min,手术中测瓣器测得主动脉瓣环径15~20（17.3±2.6）mm,扩大瓣环后测瓣器测得瓣环径20~25（22.6±2.3）mm,主动脉瓣环周径增加12~17（14.0±2.6）mm,植入瓣膜增加2~3个标号。无围手术期死亡,无出血等严重并发症。住ICU时间12~41（26±14）h,总住院时间9~15（12.5±3.2）d。37例（97.4%）门诊随访2年以上,所有患者心功能分级（NYHA）Ⅰ级,3例主动脉瓣听诊区存在2/6级收缩期杂音。35例心电图显示左心室肥厚心电图表现显著改善或消失,2例表现为左心室轻度肥厚劳损,无明显心肌缺血表现,无室性心律失常及严重房室传导阻滞。结论主动脉瓣环扩大联合环上瓣置换术治疗成人小瓣环主动脉瓣狭窄近中期效果满意,远期结果有待进一步随访。     

经导管主动脉瓣置换术在二叶式主动脉瓣狭窄中应用的研究进展

二叶式主动脉瓣（bicuspid aortic valve,BAV）的解剖结构不对称，钙化严重，常合并主动脉扩张。相比于三叶式主动脉瓣患者，BAV相关主动脉瓣狭窄（aortic valve stenosis,AS）患者在经导管主动脉瓣置换术（transcatheter aortic valve replacement,TAVR）治疗中，往往会面临更大的手术风险，包括瓣周漏、主动脉瓣环破裂、冠状动脉口堵塞、房室传导阻滞等。然而随着新一代人工瓣膜的出现以及手术策略的优化，目前多项研究均表明TAVR治疗BAV相关AS是安全有效的。本文将对TAVR在BAV相关AS患者中的应用进行综述。     

小主动脉瓣环患者主动脉瓣置换术41例

目的总结主动脉瓣环加宽后的主动脉瓣置换术治疗小主动脉瓣环合并主动脉瓣病变患者的临床经验。方法对41例小主动脉瓣环合并主动脉瓣病变患者(瓣环直径为15~21 mm)行主动脉瓣环加宽后的主动脉瓣置换术,主动脉瓣环加宽采用改良N icks法11例,改良M anougn ian法29例,K onno法1例。结果41例患者主动脉瓣环加宽后都可以植入比测量的主动脉瓣环直径大1#或2#的主动脉瓣,无手术死亡。术后所有患者随访4~36个月(13±2个月),无死亡、瓣周漏、二尖瓣反流和主动脉扩张;超声心动图检查示:人工瓣跨瓣峰值压差为9~25mmHg(17±6mmHg),与术前的70~105mmHg(80±15mmHg)比较差别有统计学意义(P<0.01)。结论小主动脉瓣环合并主动脉瓣病变患者,在置换主动脉瓣时先行主动脉瓣环加宽,能使患者在术后获得良好的血流动力学效果,是一种安全、有效的手术术式。     

三维超声心动图定量评价二尖瓣反流患者的二尖瓣及瓣环几何构型

目的运用MVA软件结合三维成像技术对缺血性二尖瓣反流（IMR）和非缺血性MR患者的二尖瓣瓣环瓣膜进行定量评价,初步探讨MVA的临床应用。方法患者分为3组：IMR组（10例）和非缺血性MR组（7例）,无二尖瓣异常及反流者为对照组（11例）。采用经食管二尖瓣及瓣环的三维图像采集和重建,将三维图像与手术结果进行对比。用SiemensMVA软件进行定量分析,测量参数包括二尖瓣环三维前后径（AP径）、三维交界径（CC径）、三维前外-后内径（AL-PM径）、非平面角度（NPA）、前瓣环长度、后瓣环长度、三维瓣环周长、瓣环面积（MAA）等,并用体表面积校正。计算上述参数在心动周期的变化值（舒张末-收缩末）。结果与对照组相比,IMR组瓣环空间成角NPA增大,瓣环趋于平面化（P〈0．01）;二尖瓣后瓣环较对照组明显扩大（P〈0．05）,收缩期扩张（中位△后瓣环长度：-2．71mm／m^2VS0．52mm／m^2,P〈0．05）。对非缺血性MR组,MVA软件能精确显示二尖瓣病变的部位、范围及机制,与手术结果一致。结论MVA软件可精确地显示二尖瓣的几何形态及关闭不全的部位和范围,可定量评价瓣环的空间构型及其动态变化,有助于指导临床治疗。     

应用J-Valve瓣膜行经心尖导管主动脉瓣置入术治疗主动脉瓣狭窄及主动脉瓣关闭不全各一例

正临床资料病例1:男,74岁,因"活动后气促、乏力10余年,加重伴劳力性胸痛、反复下肢水肿3年余"收入我院。体格检查:轻度紫绀,双肺啰音,胸腔积液及下肢水肿,主动脉瓣区Ⅳ级收缩期杂音伴舒张期杂音。超声心动图:主动脉瓣呈三叶瓣发育,团块状增厚、粘连、不均匀严重钙化,瓣环径2.16～2.25 cm,主动脉瓣口流速5.78 m/s,峰压差133 mm Hg,平均压差75 mm Hg,有效瓣口面积0.37 cm~2;二尖瓣轻-中度反流;三尖瓣轻度关闭不全,估     

肺动脉瓣环占比:法洛四联症根治术跨瓣补片的预测指标

目的评价肺动脉瓣环占比,即肺动脉瓣环直径与主动脉瓣环直径和肺动脉瓣环直径之和的比值,能否较z值更好地指导手术方式的选择。方法回顾性分析广东省人民医院2016年1月至2018年1月行法洛四联症一期根治术254例患者的临床资料,其中男154例、女100例,平均年龄(14.60±18.76)岁。将其分为跨瓣补片组(164例)和非跨瓣补片组(90例),均于心脏CT上测量肺动脉瓣环和主动脉瓣环直径,并通过统计学方法计算出需行跨瓣补片的肺动脉瓣环占比的临界值。结果跨瓣组肺动脉瓣环占比和z值均小于非跨瓣组(肺动脉瓣环占比:0.29±0.06 vs. 0.36±0.06,P0.001;z值:–4.04±2.13 vs.–2.06±1.84,P0.001)。通过受试者工作特征(ROC)曲线分析,肺动脉瓣环占比分界值为0.353(曲线下面积0.781,95%CI 0.725～0.831),z值分界值为–2.13(曲线下面积0.766,95%CI 0.709～0.817),表明肺动脉瓣环占比是有效且简便易行的手术方式评估方法。结论肺动脉瓣环占比是有效评估跨瓣与否的指标,并可简单易行地应用于临床实践。     

小主动脉瓣环患者生物瓣与机械瓣置换术后心功能变化的比较

目的分析比较小主动脉瓣环(直径≤21mm)患者人工生物瓣置换与人工机械瓣置换术后心功能的变化,探讨人工生物瓣置换术后是否存在植入瓣膜与患者不匹配(PPM)现象。方法40例主动脉瓣环直径≤21mm的患者,其中20例置换人工生物瓣(生物瓣组),20例置换人工机械瓣(机械瓣组)。采用彩色多普勒超声心动图于术前和术后6个月～1年期间,检测两组患者的左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、左心室重量指数、瓣膜有效开口面积/体表面积的比值(EOAI)和主动脉瓣跨瓣压差的变化,并进行对比分析。结果术后6个月～1年,两组患者LVEF、LVFS和EOAI均较术前明显升高,左心室重量指数和主动脉瓣跨瓣压差均较术前明显减小或降低。所有患者术后EOAI为0.88～1.32cm2/m2,术后6个月～1年生物瓣组与机械瓣组比较:LVEF79%±8%vs.81%±10%;LVFS43%±9%vs.37%±8%;EOAI1.11±0.14vs.0.92±0.11;左心室重量指数89.10±16.70g/m2vs.95.30±15.10g/m2;主动脉瓣跨瓣压差18.80±12.60mmHgvs.22.30±12.00mmHg,差异无统计学意义(P>0.05)。结论小主动脉瓣环患者(直径≤21mm)置换人工生物瓣术后左心功能指标明显改善,无PPM现象。     

经股动脉经导管主动脉瓣置换术(TAVR)治疗单纯主动脉瓣关闭不全的临床疗效分析及术前评估北大核心CSCD

目的探讨经股动脉经导管主动脉瓣置换术(TAVR)治疗主动脉瓣单纯关闭不全的临床疗效和术前评估要点。方法回顾性分析阜外医院2019年5月至2020年10月行经股动脉TAVR 129例患者的临床资料,其中男83例、女46例,平均年龄(72.26±8.97)岁。根据疾病情况分为单纯主动脉瓣关闭不全组(17例)和主动脉瓣狭窄组(112例)。分析主动脉根部形态学特点、手术有效性及安全性。结果单纯主动脉瓣关闭不全组与主动脉瓣狭窄组比较,3MENSIO测量的瓣环[(25.75±2.21)mm vs.(24.70±2.90)mm,P=0.068]及流出道直径[(25.82±3.75)mm vs.(25.37±3.92)mm,P=0.514]差异无统计学意义。单纯主动脉瓣关闭不全组与主动脉瓣狭窄组相比,瓣中瓣发生率较高(47.0%vs.16.1%,P<0.01)。中转外科手术、术中使用体外循环辅助、术中左室破裂、术后使用体外膜肺氧合辅助、术后外周血管并发症、术后致残性脑卒中、死亡、术后起搏器植入两组差异无统计学意义。结论单纯主动脉瓣关闭不全患者行经股动脉TAVR可行。术前应重点评估瓣环平面直径、流出道直径以及流出道的形态。     

主动脉瓣四叶瓣畸形伴主动脉瓣病变的外科治疗

主动脉瓣四叶瓣畸形伴主动脉瓣功能障碍的病例罕见 ,现对我们外科治疗的 4例主动脉瓣四叶瓣畸形伴主动脉瓣狭窄或 (和 )关闭不全病例报道如下。临床资料　 4例中男 3例 ,女 1例。年龄 2 7～ 39岁。劳累后心悸、气短病程 1～ 5年。 3例主动脉瓣第 2听诊区均闻及舒张期泼水样杂音 ,脉压差 5 0～ 10 0ｍｍＨｇ(1ｍｍＨｇ =0 133ｋＰａ) ,1例主动脉瓣听诊区可闻及收缩期喷射样杂音。心电图显示均为窦性心律 ,3例左室扩大 ,1例左室劳损。Ｘ线胸片显示 3例左室扩大 ,心胸比率 0 5 3～ 0 71。多普勒超声心动图提示 ,3例左室明显扩大 ,1例左室向…     

非原位主动脉瓣置换术治疗主动脉瓣环严重毁损性病变的方法与疗效

目的总结非原位主动脉瓣置换术(AVR)的方法和疗效。方法 2008年3月至2010年12月第二军医大学长海医院收治5例主动脉瓣环严重毁损患者,男4例,女1例;平均年龄46.3(38～53)岁。AVR术后并发严重瓣周漏再次手术4例(白塞氏病2例、大动脉炎2例),严重主动脉瓣感染性心内膜炎1例。术中发现主动脉瓣环严重毁损,无法施行常规AVR,改行非原位AVR,即将人工主动脉瓣环固定的位置提高到毁损的主动脉瓣环以上,固定人工瓣环的缝线从主动脉腔外进针、腔内出针。必要时行冠状动脉旁路移植术(CABG)。结果 5例手术患者均顺利康复出院,无出血再次手术或其它并发症。术后5例患者均获得随访,生存良好,心功能分级(NYHA)Ⅰ～Ⅱ级;分别于术后6个月(4例)、1年(2例)和3年(1例)行主动脉心脏三维CT成像(CTA)检查,均未见有主动脉根部瘤或假性动脉瘤形成,显示左心室流出道延长,左、右冠状动脉形态良好。心脏超声心动图检查均未发现有瓣周漏。结论对主动脉瓣环毁损严重的患者采用非原位AVR,人工瓣膜固定可靠,可以防止术后并发瓣周漏或根部假性动脉瘤。     

功能性与非功能性胰腺神经内分泌肿瘤的MSCT动态增强特征

目的探讨功能性与非功能性胰腺神经内分泌肿瘤(PanNETs)的MSCT动态增强特征。方法回顾分析经手术病理证实的11例功能性PanNETs及10例非功能性PanNETs的MSCT表现。计算肿瘤实性部分的动脉期、门静脉期、延迟期相对强化程度(L_A、L_P、L_D)、瘤体实性区域CT值与胰腺的比值(R_A,R_P,R_D),并进行统计学分析。结果两类瘤体最大径、胰管扩张差异均有统计学意义(P均0.05),而发病部位、边界、囊变、钙化、脾静脉侵犯、淋巴结转移及远处脏器转移差异均无统计学意义(P均0.05)。功能性PanNETs肿瘤实性部分的L_A、L_P、L_D差异有统计学意义(P0.05),R_A,R_P,R_D差异亦有统计学意义(P0.05)。非功能性PanNETs肿瘤实性部分的L_A、L_P、L_D差异无统计学意义(P0.05),R_A,R_P,R_D差异亦无统计学意义(P0.05)。结论功能性PanNETs一般较小,较少合并胰管扩张,动脉期和门静脉期强化程度较延迟期明显,而非功能性PanNETs三期强化程度无明显差别。     

The Cardiac Cycle is a Major Contributor to Variability in Size Measurements of Abdominal Aortic Aneurysms by Ultrasound

Aim

The objective of the study was to evaluate the impact of the cardiac cycle on ultrasound measurements of abdominal aortic aneurysm (AAA) diameters.

Methods

In total, 603 AAAs detected by screening were investigated with respect to the maximal systolic and diastolic anterior-posterior aortic diameters during the cardiac cycle using recorded ultrasound video sequences.

Results

On average, the systolic AAA diameter was 41.60 mm, and the diastolic AAA diameter was 39.63 mm with a paired mean difference at 1.94 mm (p < 0.0001). No association between aneurysmal size and difference in systolic and diastolic size was noted.The mean difference and variability between two observers, one measured during peak-systole and the other measured during end-diastole, was 2.65 and 2.21 mm, respectively, as compared with 0.86 and 1.52 mm, respectively, when both were measured during the peak of systole. The intraobserver variability was 0.94 during systole, 1.18 during diastole and 1.94 mm when systole and diastole measurements were combined.

Conclusion

The lack of a standardised measurement of the AAA diameter during the cardiac cycle is a potential major contributor to the variability in ultrasonography measurements.     

Comparison of dynamic changes in aortic diameter during the cardiac cycle measured by computed tomography angiography and transthoracic echocardiography

ObjectiveThis study aimed to examine the relationship between dynamic changes in aortic diameter and corresponding measurement methods.MethodsConsecutive adult (nonaneurysmal) patients being surgically treated for heart disease (mean age, 51 ± 11 years; range, 29-76 years; N = 25) were included in this study. All patients underwent transthoracic echocardiography (TTE), computed tomography angiography (CTA), and intraoperative ultrasound (IOUS). Anteroposterior diameters were measured at 1 cm above the junction of the aortic sinus, the proximal 1 cm of the innominate artery, and the midpoint of the two.ResultsThe average diameter of the proximal ascending aorta in systole/diastole measured by IOUS was 32.07 ± 2.03/30.27 ± 2.05 mm (paired t-test: difference, 1.80 ± 0.46 mm; P < .001). The average diameters of the proximal ascending aorta measured by nonelectrocardiography-gated CTA and TTE were 31.45 ± 1.97 mm and 29.7 ± 1.84 mm, respectively. The average diameter of the mid and distal ascending aorta in systole/diastole measured by IOUS was 32.35 ± 1.95/30.57 ± 1.94 mm (paired t-test: difference, 1.78 ± 0.44 mm; P < .001) and 32.32 ± 1.92/30.67 ± 1.90 mm (paired t-test: difference, 1.65 ± 0.42 mm; P < .001), respectively. The average diameter of the mid and distal ascending aorta measured by CTA was 31.74 ± 1.92 mm and 31.59 ± 1.96 mm, respectively. At each location, the difference in the aortic diameter between systole and diastole was statistically significant (all P values <.001; paired t-test). The minimum and maximum changes in the diameter between systole and diastole were 0.90 mm and 2.70 mm. In all, 96% (24/25) of the average diameters derived from IOUS and CTA at the three locations were within the concordance limit in systole, and 92% to 100% (23/25 to 25/25) were within the concordance limit in diastole. The average diameters derived from IOUS and TTE images of the proximal ascending aorta were within the bounds of the concordance limit 92% (23/25) of the time in systole and 100% (25/25) of the time in diastole. The average diameters derived from CTA and TTE images of the proximal ascending aorta were within the bounds of the concordance limit 88% (22/25) of the time. Pearson correlation coefficients between these groups ranged from 0.905 to 0.982 (all P values <.01).ConclusionsThe ascending aorta diameters measured by nonelectrocardiography-gated CTA and TTE were consistent with the IOUS measurements.     

Preliminary study on relationship between vertebral fracture and aortic calcification in postmenopausal women

The prevalence of aortic calcification and osteoporosis increases with age. Several studies have postulated a direct relationship between the two disorders, suggesting that aortic calcification results from a redistribution of skeletal calcium in osteoporosis. We have undertaken a case-controlled study to reevaluate the possible relationship between the two age-related processes. Lateral spine radiographs of 122 postmenopausal Turkish women were analyzed to determine the presence or absence of vertebral fracture (n ₁=44 andn ₂=78, respectively). Abdominal aortic calcification was quantified in both groups using a subjective grading system (from no calcification to dense calcification adjacent to three vertebrae) and a semiquantitative method. Using the subjective method, the prevalence of aortic calcification increased from 41% in subjects aged 50–65 years to 78% in those over 75 years of age (И²=10.8;P<.005). The prevalence of aortic calcification was similar in women with and without vertebral fracture (60.0%vs 57.7%;P=.63). Using the semiquantitative method, there was no significant difference in the severity of abdominal aortic calcification between subjects with and without vertebral fractures (P=.74). Using logistic regression, the direction of the odds ratio suggested a greater risk of vertebral fracture in the presence of moderate or severe aortic calcification (1.3; 95% CI 0.5–3.9) and multiple loss of intervertebral disk spaces (2.0; 95% CI 0.6–7.4), but the number of subjects was small and the confidence intervals wide. These results do not support the hypothesis of a direct relationship between calcification and vertebral osteoporosis as a result of calcium redistribution in postmenopausal women. It is likely that factors other than vertebral deformity are of importance in the development of aortic calcification in the elderly.     

心脏CT血管造影三维重建定量左心耳口部周长选择封堵器型号

目的 观察心脏CT血管造影(CTA)三维重建定量左心耳(LAA)口部周长对选择左心耳封堵术(LAAC)治疗房颤(AF)所用封堵器型号的价值。方法 基于术前心脏CTA三维重建、经食管超声心动图(TEE)及术中LAA造影测量94例接受LAAC AF患者LAA口部最大长径,基于心脏CTA三维重建测量LAA口部周长、计算周长衍生直径(PDD)。分析LAA口部参数与植入封堵器型号的相关性及一致性,评估以各种方法所获LAA口部参数预测与实际植入封堵器型号的一致性;以LAA PDD为预测变量、植入封堵器型号为因变量建立线性回归方程。结果 实际植入封堵器型号(真实直径)为(28.95±3.13)mm,周长为(90.90±9.82)mm。心脏CTA、TEE及术中LAA造影所测LAA口部最大长径分别为(24.63±3.17)mm、(24.07±3.19)mm及(23.17±3.25)mm,均与封堵器型号呈正相关(r=0.814、0.691、0.790,P均<0.001);基于心脏CTA所测LAA口部周长为(78.48±10.69)mm, PDD为(24.98±3.40)mm; LAA口部周长与封堵器...     

Effects of hemodynamic conditions and valve sizing on leaflet bending stress in self-expanding transcatheter aortic valve: An in vitro study

Transcatheter aortic valve (TAV) replacement has become a viable alternative to surgery for high and intermediate risk patients with severe aortic stenosis. This technology may extend to the younger and lower risk patients. In this population, long-term durability of the TAV is key. Increased leaflet mechanical stress is one of the main determinants of valve structural deterioration. This in vitro study aims at evaluating leaflet bending stress (LBS) in the self-expanding TAV for different valve sizes, stroke volumes (SV), and degrees of valve oversizing (OS). Three different sizes (23, 26, and 29 mm) of CoreValve (CV) were tested on a pulse duplicator in annulus size ranging from 17 to 26 mm. Leaflet bending stress and bending of the leaflet coaptation line in diastole pinwheeling index (PI) were measured using high-speed camera imaging (1000 images/s). For each given CV and annulus size, geometric orifice area (GOA) increased significantly with OS (P < .001) and SV (P = .001). LBS decreased with increasing prosthesis size and aortic annulus (AA) size while increasing with SV (P < .03). The largest value of peak LBS (3.79 MPa) was obtained with the CV 23 mm in AA of 17 mm (%OS = 35%), SV 90 mL and the smallest value (0.99 MPa) for the CV 29 mm in AA of 26 mm (%OS = 12%), SV 30 mL. On multivariable analysis, LBS increased independently with larger OS, smaller AA size and higher SV. The PI increased with decreasing AA size and increasing OS. Moderate valve OS, such as generally used for transcatheter aortic valve implantation, is associated with increased LBS during valve opening and closing, especially in small annuli. Hence, TAV OS may negatively impact long-term valve durability.     

Aortic stiffness in families with inherited non-syndromic thoracic aortic disease

Abstract

Background. In families with an inherited form of non-syndromic thoracic aortic disease (TAAD), aortic diameter alone is not a reliable marker for disease occurrence or progression. To identify other parameters of aortic function, we studied aortic stiffness in families with TAAD. We also compared diameter measurements obtained by transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI). Methods. Seven families, including 116 individuals, with non-syndromic TAAD, were studied. The aortic diameter was measured by TTE and MRI. Aortic stiffness was assessed as local distensibility in the ascending aorta and as regional and global pulse wave velocity (PWV). Individuals with a dilated thoracic aorta (n?=?21) were compared with those without aortic dilatation (n?=?95). Results. Ascending aortic diameter measured by TTE strongly correlated with the diameter measured by MRI (r² = 0.93). The individuals with dilated aortas were older than those without dilatation (49 vs 37 years old). Ascending aortic diameter increased and distensibility decreased with increasing age; while, PWV increased with age and diameter. Some young subjects without aortic dilatation showed increased aortic stiffness. Individuals with a dilated thoracic aorta had significantly higher PWV and lower distensibility, measured by MRI than individuals without dilatation. Conclusions. Diameters measured with TTE agree with those measured by MRI. Aortic stiffness might be a complementary marker for aortic disease and progression when used with aortic diameter, especially in young individuals.     

No association between glucose at age 30 and aortic diameter at age 65 in men: a population-based study

Objectives Impaired glucose metabolism and diabetes mellitus has been linked to a decreased risk for abdominal aortic aneurysm development in men. We evaluated potential relationships between blood glucose levels in 1722 men with mean age 34 years and their aortic diameter measured by ultrasound at age 65 years. Design Prospective cohort study. Results Mean follow-up between baseline glucose investigation and aortic ultrasound was 32.8?±?1.8 years. There was no correlation between baseline blood glucose and later aortic diameter (r?=?0.035, p?=?0.146), whereas a weak correlation between body mass index (BMI) and aortic diameter was observed (r?=?0.097 p?<?0.001). In a partial correlation between aortic diameter and glucose levels adjusted for BMI, the correlation did not change (r?=?0.011, p?=?0.66). Neither were there any significant differences in mean aortic diameter between men belonging to different quartiles of baseline blood glucose levels (19.5, 19.1, 19.6 and 19.7?mm, p?=?0.18). Conclusion Fasting blood glucose in 33-year-old men was not associated with their aortic diameter at age 65 years. Potential pathophysiological processes linking disturbed glucose metabolism to a decreased risk for development of abdominal aortic aneurysm in men are therefore probably not relevant until later in life.     

The Surgical Treatment of Abdominal Aortic Aneurysms in Patients with Light to Moderate Renal Dysfunction

Objective : The incremental surgical risk caused by mild or moderate renal dysfunction in patients undergoing surgery for an abdominal aortic aneurysm is not well defined. The aim of this study is to analyze the prognostic significance of mild or moderate renal dysfunction in 79 patients who have undergone repair of an infrarenal abdominal aortic aneurysm at our institution.

Methods : The postoperative results of 35 non-dialysis-dependent patients (Group I) with renal dysfunction were included and compared with a group of 44 patients (Group II) with similar characteristics of age, gender and pre-operative risk factors. All operations were performed through a standard transperitoneal median laparotomy. Results : The mean operation and aortic cross-clamp times did not differ significantly between the two groups (234 ± 15 min vs. 189 ± 17min; p = 0.25 and 57 ± 12 min. vs. 52 ±9 min.; p = 0.52). Early operative mortality was 5.71% in patients with renal dysfunction and did not differ significantly when compared with the other group of patients 4.5%; p = 0.083). Blood requirement was higher (p < 0.01) and the hospital stay was longer (p < 0.001) in group I. There were 18 patients in group I (51.4%) and three patients in group II (6.8%) in whom the pre-operative serum creatinine level increased above 2.5 mg/dl during the postoperative period. The postoperative increase of creatinine level differed significantly in patients with pre-operative renal dysfunction (p < 0.001). There were nine patients (25.7%) in group I and four patients (9.1%) in group II who required mechanical ventilation for more than 24 hours (p = 0.025). There was no significant difference between the two groups in terms of cardiac morbidity p = 0.234).

Conclusion : Patients with even a mild or moderate degree of renal dysfunction require close monitoring and prolonged hospital care during the postoperative period. Although satisfactory early surgical outcomes may be expected in this particular group of patients, pulmonary and renal morbidity rates are higher than in patients with normal renal function.     

The influence of cardiac valvular calcification on all-cause and cardiovascular mortality in maintenance hemodialysis patients

Objective

To investigate the effect of cardiac valve calcification (CVC) on all-cause and cardiovascular mortality in maintenance hemodialysis (MHD) patients.

Methods

A retrospective cohort study was conducted in 183 long-term hemodialysis patients with complete follow-up data from January 1, 2012, to December 30, 2015. The baseline data between CVC and non-CVC groups were compared. Kaplan–Meier method was used to analyze all-cause and cardiovascular mortality. The effect of CVC on prognosis was analyzed using the Cox proportional hazard regression model and subgroup analysis.

Results

Among 183 patients under hemodialysis, 104 (56.8%) were males, with an average age of 56.1?±?17.0 years and 68 (37.2%) were complicated with valvular calcification. The median follow-up period was 30.8 months. All-cause and cardiovascular mortality were 50% vs. 14.8% and 25% vs. 7.0% in the CVC and non-CVC groups, respectively (P?<?0.05). Kaplan–Meier indicated that differences in all-cause and cardiovascular mortality were statistically significant between the two groups (P?<?0.001). Cox regression analysis showed that CVC significantly increased all-cause (hazards ratio [HR] 2.161 [1.083–4.315]) and cardiovascular mortality (3.435 [1.222–9.651]) after adjusting for multiple factors. Meanwhile, CVC also increases the incidence of new-onset cardiovascular events. Subgroup analysis revealed that all-cause and cardiovascular mortality were significantly higher in patients with aortic valve calcification (AVC) than in patients with mitral valve calcification (MVC). Multivariate calibration showed that AVC increased the risk of cardiovascular death (HR 5.486 [1.802–16.702]) (P?<?0.05), whereas MVC did not. By further comparing the echocardiographic data of the two groups, the incidence of LVH and pulmonary hypertension in the AVC group was significantly higher than that in the MVC group.

Conclusion

Valve calcification increases the risk of all-cause and cardiovascular mortality in MHD patients, also new-onset cardiovascular events, and aortic valve calcification contributes more to the risk of cardiovascular mortality.