Effect of hypertension and risk factors on diameters of abdominal aorta and common iliac and femoral arteries in middle-aged hypertensive and control subjects: a cross-sectional systematic study with duplex ultrasound

There is a general tendency towards atherosclerosis and arterial dilatation in older age, and high blood pressure also tends to increase arterial diameters. The purpose of this study was to examine the effect of hypertension and other cardiovascular risk factors on aortic, common iliac and common femoral artery diameters. The diameters of the abdominal aorta and the iliac and femoral arteries and the extent of echogenic plaques in the aorta and the iliac arteries down to groin level were evaluated with ultrasound in 1007 middle-aged (40-60 years) men (505) and women (502), 496 with arterial hypertension and 511 controls. Twenty-eight subjects were excluded because of poor visualization. Men had significantly larger diameters of the abdominal aorta (mean 21.3+/-2.8 vs. 17.8+/-1.3 mm) and the common iliac (13.4+/-2.0 vs. 12.2+/-1.2) and common femoral arteries (11.0+/-1.4 vs. 9.7+/-0.9) than women (P for all <0.001), but arterial diameter was also related to the subject's size. Atherosclerotic plaques, age and height were associated with the diameter of the abdominal aorta in men, while high body mass index (BMI) had less significance. The diameter of the aorta was larger in hypertensive men aged 56-60 than in controls of the same age. In women, height, BMI and diastolic blood pressure (DBP) were associated with the diameter of the aorta, while systolic blood pressure (SBP) had less and age no effect. Age, plaques, height, BMI, DBP and SBP were associated with the diameters of the common iliac arteries in both genders, while smoking had an inverse correlation. The results on lipid values were inconsistent and an abnormal glucose tolerance test proved nonsignificant. In conclusion, arterial size measured as a diameter related to the subject's size was larger in men. Age, arterial plaques and blood pressure increased arterial diameter significantly. However, the hypertensive disease itself had only a minimal effect. The changes were smaller in women than in men.     

Selective coronary arteriography in infants and children

The recent increase in incidence of Kawasaki disease with attendant coronary artery aneurysms spurred our interest in developing a technique for selective coronary arteriographic examination of infants and children. Right and left coronary artery catheters were shaped according to the aortic root diameters and ascending aorta lengths predicted from the patient's heights. Thirty-eight studies were done in 34 patients who were 7 months to 18 years of age (median 3.2 years) and no permanent sequelae resulted. Advantages of the use of selective coronary arteriography include the ability to visualize stenoses, important branches, and intercoronary anastomoses. The technique is also useful in evaluation of anomalous coronary arteries, myocardial ischemia, and coronary artery distribution before right ventricular outflow tract reconstruction.     

The diameters of the aorta and its major branches in patients with isolated coronary artery ectasia

We designed this study to evaluate the diameters of the aorta and its major branches in patients who had coronary ectasia. We assigned 80 patients (mean age, 57 +/- 11 yr) with isolated coronary artery ectasia to the study group and 25 patients (mean age, 54 +/- 10 yr) without structural or coronary arterial disease to the control group. All patients underwent coronary angiography and angiography of the aorta and its branches. We used computed quantitative angiography to measure the diameters of the coronary arteries, the aorta, and the major aortic branches. Within the study group, the diameter indices of the proximal portions of the right common iliac artery (P=0.041) and the left common iliac artery (P=0.035) were significantly larger than the diameter indices within the control group. The diameter indices of all other evaluated arteries were similar in both groups (all P >0.05).     

Measurements of central blood vessels in infants and children: normal values.

In order to provide physicians interpreting vascular radiographic studies with normal data regarding central blood vessel size in children and to facilitate the design and adaptation of intravascular devices for pediatric use, we measured lengths and diameters of central blood vessels in 141 radiographic studies in 136 children. The diameters of the following vessels were determined: right and left internal jugular veins and common carotid arteries; the inferior vena cava and the descending thoracic aorta; right and left iliac veins; and right and left femoral veins and arteries. In addition, the lengths of the inferior vena cava and the descending aorta were also determined. Blood vessel dimensions were highly correlated with age, height, weight, and body surface area. The linear regression equations for each measured dimension against age, weight, height, and surface area are provided, along with a table of predicted vessel size as a function of age.     

Measurements of central blood vessels in infants and children: Normal values

In order to provide physicians interpreting vascular radiographic studies with normal data regarding central blood vessel size in children and to facilitate the design and adaptation of intravascular devices for pediatric use, we measured lengths and diameters of central blood vessels in 141 radiographic studies in 136 children. The diameters of the following vessels were determined: right and left internal jugular veins and common carotid arteries; the inferior vena cava and the descending thoracic aorta; right and left iliac veins; and right and left femoral veins and arteries. In addition, the lengths of the inferior vena cava and the descending aorta were also determined. Blood vessel dimensions were highly correlated with age, height, weight, and body surface area. The linear regression equations for each measured dimension against age, weight, height, and surface area are provided, along with a table of predicted vessel size as a function of age.     

Criteria for and against primary correction of Fallot's tetralogy

The operability of tetralogy of Fallot (TOF) depends on the development of the pulmonary arteries which must be large enough to accomodate the post-repair blood flow. In contrast to later in life, this is not always true during the first 2 years. In the presence of an urgent surgical indication, therefore, the decision must be made whether to opt for primary correction or palliation. While palliation is unavoidable in patients with hypoplastic pulmonary arteries, the surgeon may choose this operation even in the presence of favorable anatomical conditions, as a result of personal experience. From 1978 through December, 1983 primary intracardiac correction of TOF was performed in 46 children, aged 4 months to 2 years (mean 13.1 months) in our clinic. Twenty-two (48%) were infants under the age of one year. Indications for operation were clinically derived from hypoxic spells or severe persistent hypoxemia. Amongst the diagnostic measures, angiographic delineation of both pulmonary arteries and the descending aorta was most important. A relationship of the diameter of the aorta (at diaphragmatic level) to the sum of the right and left pulmonary arteries: Ao.desc./(R + LPA) less than or equal to 0.6 indicated pulmonary arteries of sufficient size for primary correction, while higher values commanded palliative surgery.(ABSTRACT TRUNCATED AT 250 WORDS)     

Quantitative assessment of coronary arterial diameter before and after coronary artery bypass grafting

Because coronary artery bypass graft patency is related to the size of the artery, a preoperative assessment of arterial diameter is important. However, the relation between coronary arterial diameter (assessed by angiography) and true luminal size of arteries that are occluded and filled by collaterals has not been completely characterized. This study was done to measure the luminal diameter of coronary arteries before and after bypass grafting. Twenty-six patients (20 men and 6 women, aged 34 to 72 years) had coronary angiography before and from 1 to 35 months after bypass surgery. Coronary arterial luminal diameter was similar before and after operation for the 18 insignificantly narrowed arteries and the 24 arteries with narrowings that filled by anterograde flow before operation and were bypassed. In contrast, in the 21 arteries that were occluded and filled by collateral flow, coronary arterial diameter was significantly larger (p less than 0.001) after operation. Thus, when a coronary artery is occluded and filled by collaterals, its true luminal size is consistently underestimated by the angiogram.     

Morphologic determinants of coronary blood flow in the hypoplastic left heart syndrome

The diameters of the ascending aorta, coronary ostia, and proximal coronary arteries were measured in autopsy specimens from 51 infants with hypoplastic left heart syndrome and 18 normal infant heart specimens. Standard cross sections were prepared from 35 of the hypoplastic left heart syndrome hearts, and histologic indices of myocardial viability and fibrosis were determined. The diameters of the coronary arteries and ostia in hypoplastic left heart syndrome were not different from the values in control specimens. Little fibrosis was found but extensive myocardial necrosis was present. The degree of fibrosis and necrosis did not correlate significantly with any of the arterial or ostial diameters. The extent of myocardial preservation in the hypoplastic left heart syndrome, which may substantially limit the success of surgical palliation, cannot be predicted from these morphologic measurements. The observed myocardial damage appeared to be acquired postnatally, implying that early vigorous treatment of these infants may be necessary to preserve myocardial function.     

Normal internal calibres of ostia of great arteries and of aortic isthmus in infants and children.

In order to obtain reference data, useful in paediatric cardiology and paediatric cardiovascular surgery, internal diameters of the ostia of the great arteries, of the aortic isthmus, and of the descending aorta were determined with the aid of calibrated probes in 46 necropsy specimens of normal hearts with great vessels. Age range was from 25 weeks of gestational age up to 9 years post partum. The method used proved to be as accurate as echocardiography in vivo. The data revealed linear correlations between body length and calibres of aortic and pulmonary ostia. The correlation between the calibres of the pulmonary and the aortic ostia was also a linear one with the pulmonary ostium being slightly larger than the aortic ostium. From the cross-sectional areas of the aortic isthmus and of the descending aorta an isthmus index was calculated which indicates the presence (and degree) or absence of a narrowing (tubular hypoplasia) of the aortic isthmus. Results show that narrowing of the aortic isthmus is inconstantly present in infants younger than 10 weeks, whereas it is always absent in infants and children older than 10 weeks. No dependence of narrowing of the aortic isthmus on developmental age attained at birth has been found.     

Changes in the diameter of the coronary arteries in heart transplant recipients with angiographically normal vessels during five years]

INTRODUCTION: Diffuse or focal coronary artery narrowing is a frequent complication of cardiac transplantation. Coronary enlargement has also been described although it is less known. To study the changes of the coronary arteries in transplant recipients, we have performed a quantitative study throughout 5 years. METHODS: Serial coronary angiography was performed annually in all survivors of heart transplant. Forty four patients with visually normal coronary arteries and at least 5 years of evolution were selected for this study. Quantitative measurements of the diameter of the coronary arteries were performed in each angiogram at different levels: proximal, medium and distal left anterior descending coronary artery; proximal and distal left circumflex; proximal, medium and distal right coronary artery. Changes in diameter were compared throughout the 5 years. RESULTS: In the entire group of patients there was a small increase in the diameter of each segment. Taking each patient separately, an enlargement of the diameter of the proximal descending coronary artery was seen in 17 cases; medium descending coronary artery in 13; distal descending coronary artery in 8; proximal left circumflex in 11; distal left circumflex in 14; proximal right coronary artery in 18; medium right coronary artery in 18 and distal right coronary artery in 15. In total, 114 of 352 coronary segments (32%) underwent dilatation. Only 6 patients failed to have dilatation of any segment. CONCLUSIONS: Enlargement of the coronary arterial diameter was seen in 32% of segments of the main coronary arteries in heart transplant recipients with angiographically normal coronary arteries during 5 years of evolution. This could be due to intimal thickening with overcompensation by an additional vessel enlargement with net lumen gain.     

Calcitonin gene-related peptide: a potent dilator of human epicardial coronary arteries

To investigate the action of calcitonin gene-related peptide (CGRP) on human epicardial coronary arteries, six patients received intracoronary CGRP at doses of 50,100, and 200 ng/min. The effect of CGRP was measured angiographically with a computerized analysis system. A dose-dependent increase in coronary arterial diameter was observed. At the highest dose there were 34%, 7%, 38%, and 40% mean increases in the diameters of the circumflex, proximal, mid, and distal left anterior descending arteries, respectively. No further increase in diameter was found after a subsequent dose of 1 mg intracoronary isosorbide dinitrate. Prior infusion of CGRP did not prevent coronary arterial spasm induced by ergonovine in two patients with variant angina, but a subsequent bolus of CGRP partially relieved the spasm. We propose that CGRP has a role in the regulation of coronary vascular smooth muscle tone.     

Distinguishing between anomalous origin of the left coronary artery from the pulmonary trunk and dilated cardiomyopathy: role of echocardiographic measurement of the right coronary artery diameter

Patients with anomalous origin of the left coronary artery from the pulmonary trunk usually have a large right coronary artery. This study examines the diagnostic value of measuring the diameter of the right coronary artery by echocardiography in distinguishing between this lesion and other causes of dilated cardiomyopathy. The diameter of the right coronary artery and the right coronary artery/aorta ratio were measured in the parasternal short axis view in 40 controls, 11 patients with dilated cardiomyopathy, and 10 with anomalous origin of the left coronary artery from the pulmonary trunk. In the controls, the diameter of the right coronary artery increased with age, but the right coronary artery/aorta ratio remained constant. In the control group the 95% upper limits of prediction for right coronary artery diameter were 1.6 mm for one month of age, 1.8 mm for three months, 2.0 mm for one year, 2.2 mm for two years, 2.4 mm for three years, 2.6 mm for four years, 2.7 mm for six years, 3.0 mm for eight years, and 3.2 mm for 10 years; and for right coronary/aorta ratios the limits were 0.17 for one month to one year, 0.18 for one to six years, 0.19 for six to 10 years, and 0.20 for more than 10 years. All patients with dilated cardiomyopathy had normal right coronary artery diameters and right coronary artery/aorta ratios (0.10-0.13). Those patients with anomalous origin of the left coronary artery from the pulmonary trunk had larger than normal right coronary artery diameter and a significant increase in the right coronary artery/aorta ratio (0.21-0.29). The presence of an anomalous left coronary artery was likely if the diameter of the right coronary artery or the right coronary artery/aorta ratio was larger than the normal 95% limits of prediction.     

Distinguishing between anomalous origin of the left coronary artery from the pulmonary trunk and dilated cardiomyopathy: role of echocardiographic measurement of the right coronary artery diameter.

Patients with anomalous origin of the left coronary artery from the pulmonary trunk usually have a large right coronary artery. This study examines the diagnostic value of measuring the diameter of the right coronary artery by echocardiography in distinguishing between this lesion and other causes of dilated cardiomyopathy. The diameter of the right coronary artery and the right coronary artery/aorta ratio were measured in the parasternal short axis view in 40 controls, 11 patients with dilated cardiomyopathy, and 10 with anomalous origin of the left coronary artery from the pulmonary trunk. In the controls, the diameter of the right coronary artery increased with age, but the right coronary artery/aorta ratio remained constant. In the control group the 95% upper limits of prediction for right coronary artery diameter were 1.6 mm for one month of age, 1.8 mm for three months, 2.0 mm for one year, 2.2 mm for two years, 2.4 mm for three years, 2.6 mm for four years, 2.7 mm for six years, 3.0 mm for eight years, and 3.2 mm for 10 years; and for right coronary/aorta ratios the limits were 0.17 for one month to one year, 0.18 for one to six years, 0.19 for six to 10 years, and 0.20 for more than 10 years. All patients with dilated cardiomyopathy had normal right coronary artery diameters and right coronary artery/aorta ratios (0.10-0.13). Those patients with anomalous origin of the left coronary artery from the pulmonary trunk had larger than normal right coronary artery diameter and a significant increase in the right coronary artery/aorta ratio (0.21-0.29). The presence of an anomalous left coronary artery was likely if the diameter of the right coronary artery or the right coronary artery/aorta ratio was larger than the normal 95% limits of prediction.     

Echocardiographic features of arterial tortuosity: A new syndrome?

Twenty-one consecutive children belonging to one extended family, nine girls and twelve boys, with a median age of 3 years (1 day to 16 years), with similar clinical features of velvety, hyperextensible skin, hypermobility of joints, and characteristic facial features, were studied prospectively with echocardiography. Cross-sectional measurements included the aortic annulus, sinus of Valsalva, and the ascending aorta in the parasternal long axis view. In the short axis parasternal view, the pulmonary trunk was measured midway between the pulmonary valve and bifurcation. The right and left pulmonary arteries were measured at their bifurcation points. The appearance of a bifid pulmonary artery, an elongation of the aortic arch and tortuosity and elongation of the brachiocephalic arteries, using high parasternal short axis view and short and long axis suprasternal views, were assessed qualitatively. The descending aorta was visualized in its long axis in a sagittal subcostal view. The control group consisted of 21 normal age and weight matched children who were evaluated with echocardiography for possible heart disease. No statistically significant difference was found in the echocardiographic measurements between the two groups. However, all children in the study group had a bifid pulmonary artery, an elongation of the aortic arch and tortuosity and elongation of the brachiocephalic arteries. Seven of these children also had tortuosity of the descending aorta, three had dilatation of the aortic annulus, sinus of Valsalva and ascending aorta, and five had multiple peripheral pulmonary stenoses. The consistent findings of a bifid pulmonary artery, an elongation of the aortic arch and tortuosity and elongation of the brachiocephalic arteries, can be reliably evaluated with echocardiography, thus identifying children with arterial tortuosity even early in life when characteristic facial features may not be present.     

Percutaneous stent implantation into coronary arteries in infants

Objectives: To investigate the feasibility, procedural techniques, safety, and overall potential of percutaneous coronary angioplasty and stent implantation in infants with coronary artery disease and acute coronary syndrome. Background: Despite extensive experience in adult patients, percutaneous coronary intervention remains uncommon in children and extremely rare in infants. Methods: Retrospective review including all children who underwent percutaneous coronary angioplasty in Rady Children's Hospital—San Diego during a period of 4 years. Results: Seven children including four children less than 15 months of age underwent percutaneous coronary intervention with coronary stent implantation in the proximal portion of the left or right coronary arteries. Successful stent placement with excellent revascularization was achieved in all cases. Mean coronary artery diameter was 0.65 mm prior to stent placement. Balloon angioplasty resulted in suboptimal resolution of coronary stenosis, thus bare metal stents were implanted in all cases, dilated to a mean of 2.5‐mm internal diameter. Average intervention‐free period was 434 days after stent implantation. In‐stent re‐stenosis and stent thrombosis did not occur if the implanted stent diameter was greater than 2.5 mm and the patient received dual anti‐platelet therapy. Conclusions: Our experience suggests that coronary artery stent implantation is a feasible and relatively safe palliative option in infants and toddlers with coronary stenosis. It is a viable strategy for bridging patients with acute ischemia or poor ventricular function to elective surgical revascularization or transplantation. © 2011 Wiley Periodicals, Inc.     

New method of measuring coronary diameter by electron-beam computed tomographic angiography using adjusted thresholds determined by calibration with aortic opacity.

BACKGROUND: In a previous study the adjusted thresholds at which the diameters of coronary arteries determined by enhanced electron-beam computed tomography (CT) scans are equal to the corresponding quantitative coronary angiography measurements were analyzed, and their correlation with maximum CT values for the vessel short axes was determined. A rapid accurate method for such measurements was sought by substituting maximum CT values for the descending aorta in the corresponding axial images for those for the short axes. METHODS AND RESULTS: In 8 patients, 179 sites were measured. Means (+/- SD) of adjusted thresholds and the maximum CT values for vessel short axes and the descending aorta in the corresponding axial images for all vessels were 108 +/-66, 227+/-80, and 363+/-75 Hounsfield Unit (HU), respectively. Adjusted thresholds correlated with the maximum CT values for the corresponding vessel short axes and the descending aorta in the corresponding axial images, with R2=0.55, 0.33, p<0.01, respectively. An abbreviated formula for use of maximum CT values for the descending aorta in the corresponding axial images was y=0.5x-75 (HU) (y= adjusted threshold, x= maximum CT value for the descending aorta in the corresponding axial image). CONCLUSIONS: The abbreviated formula provided a rapid, accurate method for measurements independent of arterial enhancement.     

Natural course of supravalvar aortic stenosis and peripheral pulmonary arterial stenosis in Williams' syndrome.

We investigated the catheterization and angiographic findings of 26 patients with Williams' syndrome to evaluate the natural course of supravalvar aortic stenosis and peripheral pulmonary arterial stenosis. The severity of the stenosis was correlated with age and body surface area in terms of the pulmonary arterial index, right ventricular systolic pressure, sinutubular ratio (ratio of measured to mean normal diameter of sinutubular junction), and systolic pressure gradient across the sinutubular junction. In patients with pulmonary arterial stenosis (n=20), right ventricular systolic pressure tended to decrease, and pulmonary arterial index increased, with increase in age and body surface area. Between the groups with and without pulmonary arterial stenosis, there was significant difference in age (mean 4.70 vs. 9.87, p=0.019), body surface area (0.62 vs. 1.16, p=0.002), pulmonary arterial index (152 vs. 317, p=0.002) and right ventricular systolic pressure (73.9 vs. 33.0, p=0.006). As all patients showed similar diameters at the sinutubular junction regardless of age and body size, sinutubular ratio decreased with increases in age and body surface area. The group with abnormal coronary arteries (n=7) had smaller sinutubular ratio (0.46 vs. 0.61, p=0.021) and higher pressure gradients between the left ventricle and the aorta (67.6 vs. 42.2, p=0.023) than did the group with normal coronary arteries. Stenosis of a coronary artery, or a branch of the aortic arch, was observed only in three patients with diffuse aortic stenosis. Our results suggest that, with time, peripheral pulmonary arterial stenosis tends to improve, and supravalvar aortic stenosis to progress. Failure of growth of the sinutubular junction might be responsible for the progression of the aortic lesion. Progression of the aortic lesion may be associated with involvement of the coronary arteries.     

Coronary artery caliber in normal children and patients with Kawasaki disease but without aneurysms: an echocardiographic and angiographic study

A total of 110 children aged 3 months to 16 years underwent two-dimensional echocardiography of the coronary arteries. Forty-two normal subjects and 68 patients with Kawasaki disease were evaluated. All 68 patients with Kawasaki disease underwent selective coronary arteriography. The objectives of this study were to 1) develop a normal profile of the proximal left and right coronary arteries as to caliber and shape in infants, toddlers and children using echocardiography; 2) compare the dimensions and shape of the coronary arteries of patients with Kawasaki disease but no obvious aneurysms with those of the coronary arteries of normal children; and 3) develop criteria that would permit distinguishing a large but normal coronary artery from a true aneurysm in patients with Kawasaki disease. In the normal subjects and patients with Kawasaki disease, the caliber of the coronary arteries showed little variability from the ostium to 10 mm distally, and ranged in size from 2 mm in infants to 5 mm in teenagers. There was no significant difference between male and female subjects. The feature that distinguished the large but normal coronary artery without aneurysm from that with an aneurysm was its uniformity of caliber. Also, the caliber of the opposite coronary artery was generally at the lower limits of normal. It appears that the proximal coronary arteries of infants and children can be accurately assessed using high resolution two-dimensional echocardiography, and that sequential evaluation of subtle changes over time may be performed.     

The diameter of coronary artery is enlarged in patients with dilated cardiomyopathy

Background Dilated cardiomyopathy(DCM) is a primary cardiomyopathy characterized by the enlargement of left ventricle or biventricular and left ventricular systolic dysfunction, without any obvious stenosis of coronary arteries. However, it remains unclear that whether the diameter of coronary artery is different from those of normal population, because few studies directly assessed the diameter of the coronary artery in patients with DCM. The study aimed to evaluate the diameter of coronary arteries in DCM patients and its influence on prognosis for DCM patients. Methods Fifty-seven DCM patients and fifty-nine patients presenting with atypical chest pain and normal coronary angiography were enrolled in the study. A coronary angiography image analysis system was used to measure the diameters at 5 mm from the opening of the left main coronary artery(LM), left anterior descending(LAD) and left circumflex coronary(LCX) arteries, and the right coronary artery(RCA) of both groups. Follow-up study through telephone over a period of 2 years was performed. Spearman rank correlation and logistic regression were used to evaluate the correlations of the diameter of coronary arteries with the risk of nonfatal heart failure event. Results Diameters of the LM, LAD, LCX, and RCA in DCM group were significantly larger than those of the control group(P 0.001). During a follow-up of 2 years, the nonfatal heart failure event occurred in 9 patients of DCM group, but not in control group. Spearman rank correlation analysis showed diameters of the LM, LAD, and LCX were correlated with the risk of nonfatal heart failure event, respectively(P 0.05). While the diameter of RCA showed no correlation with the risk of nonfatal heart failure event(P =0.583). Whereas logistic regression analysis showed there were no correlation between diameters of the LM,LAD, LCX, and RCA and the risk of nonfatal heart failure event(P 0.05). Conclusions The coronary arteries of DCM patients show a larger diameter without any obvious stenosis, which may not correlate with the risk of heart failure event.