Surgical Treatment of Aortic Aneurysm and Aortic Dissection： A Retrospective Analysis of 122 Cases

The study summarizes the clinical experience of surgical treatments of various types of thoracic aneurysm and aortic dissection. Clinical data of 122 patients with thoracic aneurysm and aortic dissection during July 2005 to July 2008 were retrospectively analyzed. The elective operations were performed in 107 patients while emergency surgery was done in 15 cases. Different surgical strategies were employed on the basis of diseased region, including simple ascending aortic replacement （n=3）, aortic root replacement （n=43）, hemi-arch replacement/total arch replacement ＋ elephant trunk technique （n=32）, thoracic/thoracoabdominal aortic replacement （n=8） and endovascular repair （n=36）. In this series, there is 4 cases of perioperative death due to massive cerebral hemorrhage （n=1）, respiratory failure （n=1） and multiple organ dysfunction syndrome （MODS） （n=2）. Three cases developed post-operative massive cerebral infarction and the relatives of the patients abandoned treatment. Instant success rate of endovascular repair was 100%. The intimal rupture was sealed. Blood flow was unobstructed in true lumen and no false lumen was visualized. It was concluded that aggressive surgery should be considered in the patients with thoracic aneurysm and aortic dissection. Surgical procedures should vary with the location and the nature of the lesions.     

Does This Patient Have Aortic Regurgitation?

Niteesh K. Choudhry, MD; Edward E. Etchells, MD, MSc

JAMA. 1999;281:2231-2238.

Objective  To review evidence as to the precision and accuracy of clinical examination for aortic regurgitation (AR).

Methods  We conducted a structured MEDLINE search of English-language articles (January 1966-July 1997), manually reviewed all reference lists of potentially relevant articles, and contacted authors of relevant studies for additional information. Each study (n = 16) was independently reviewed by both authors and graded for methodological quality.

Results  Most studies assessed cardiologists as examiners. Cardiologists' precision for detecting diastolic murmurs was moderate using audiotapes (=0.51) and was good in the clinical setting (simple agreement, 94%). The most useful finding for ruling in AR is the presence of an early diastolic murmur (positive likelihood ratio [LR], 8.8-32.0 [95% confidence interval {CI}, 2.8-32 to 16-63] for detecting mild or greater AR and 4.0-8.3 [95% CI, 2.5-6.9 to 6.2-11] for detecting moderate or greater AR) (2 grade A studies). The most useful finding for ruling out AR is the absence of early diastolic murmur (negative LR, 0.2-0.3 [95% CI, 0.1-0.3 to 0.2-0.4) for mild or greater AR and 0.1 [95% CI, 0.0-0.3] for moderate or greater AR) (2 grade A studies). Except for a test evaluating the response to transient arterial occlusion (positive LR, 8.4 [95% CI, 1.3-81.0]; negative LR, 0.3 [95% CI, 0.1-0.8]), most signs display poor sensitivity and specificity for AR.

Conclusion  Clinical examination by cardiologists is accurate for detecting AR, but not enough is known about the examinations of less-expert clinicians.

     

A Clinicopathological Study on Aortic Valves in Children

In order to investigate the clinicopathological characteristics of aortic valve disease in children, all the native surgically excised aortic valves obtained between January 2003 and December 2005 were studied macroscopically and microscopically. The patients’ medical records were reviewed and the clinical information was extracted. According to preoperative echocardiography, intraopera- tive assessment, and postoperative pathology, combined with clinical symptoms and signs, aortic valve diseases were divided into three categories: aortic stenosis (AS), aortic insufficiency (AI), and aortic stenosis with insufficiency (AS-AI). The etiology was determined according to the macro- scopic, microscopic and clinical findings. The results showed that among 70 aortic valves, patient age ranged from 6 to 18 years, with a mean of 15.4 years, and there were 56 boys and 14 girls (male: fe- male=4:1). Forty-four children only had pure aortic valve disease, and the other 26 children had aor- tic valve disease associated with other heart valve diseases. There were 5 cases of AS (7.14%), 60 cases of AI (85.71%) and 5 cases of AS-AI (7.14%). The causes were congenital aortic valve mal- formation (32 cases, 45.71%), rheumatic disease (28 cases, 40%), infective endocarditis (7 cases, 10%), Marfan syndrome (2 cases, 2.86%), and undetermined (1 case, 1.43%). It was concluded that the common causes of aortic valve disease in order of frequency in children were congenital aortic valve malformation, rheumatic disease, infective endocarditis, and Marfan syndrome. AI was more common in children with aortic valve disease. Compared with adult patients, congenital bicuspid aor- tic valve in children was often AI. Histologically, the leaflets of congenital bicuspid aortic valve were mainly myxomatous, fibrosis and calcification less seen. AI was frequently found in rheumatic dis- ease, mostly associated with other heart valve diseases. Macroscopic and microscopic examinations together with clinical information, echocardiographic findings and operative details were important in evaluating the etiology of aortic valve disease.     

Aortic Plaque as a Potential Cause for Cerebral Ischemia

Inrecentyears,useoftransesophagealechographyhaschangedourunderstandingofaorticatherosclerosis[IJ.Aorticplaqueasapotentialsourceofembolistrokehasnowdrawntheattentionsofclinicians[21.Recentstudiesputemphasisonthestrokeofunknownorigin['].Somestudiesshowedthatthepatientswithseverecarotidarteryorheatdiseasefrequentlyhadsevereaorticplaque['],indicatingthataorticplaquemightberesponsiblenotonlyforsomeunexplainedembolicevents,butalsoforsomeoftheembolicstrokeinpatientwhohavecarotidarteryorheartdisease[…     

Mechanism and Correlated Factors of SAM Phenomenon after Aortic Valve Replacement

To investigate the mechanism and correlated factors of systolic anterior motion (SAM) phenomenon after aortic valve replacement, 48 patients with severe aortic valvular stenosis were studied. Tested by echo-Doppler one week after aortic valve replacement, the patients were divided into two groups: SAM group and non-SAM group. The data of the left ventricular end-diastolic di-ameters, the left ventricular end-systolic diameters, the left ventricular outflow diameters, the thick-ness of the interventricular septum, the posterior wall of left ventricle, the blood velocities of left ventricular outflow and intra-cavitary gradients were recorded and compared. The results showed that no patients died during or after the operation. The blood velocities of left ventricular outflow was in-creased significantly in 9 patients (>2.5 m/s), and 6 of them developed SAM phenomenon. There was significant difference in all indexes (P<0.05 or P<0.01) except the posterior wall of left ventricle (P>0.05) between two groups. These indicated that the present of SAM phenomenon after aortic valve replacement may be directly related to the increase of blood velocities of left ventricular out-flow and intra-cavitary gradients. It is also suggested that smaller left ventricular diastolic diameters, left ventricular systolic diameters, left ventricular outflow diameters and hypertrophy of interven-tricular septum may be the anatomy basis of SAM phenomenon.     

Study on Platelet-Derived Growth Factor mRNA and Copper-Zinc Superoxide Dismutase mRNA Expression Changes of Aortic Artery Endothelium with Restenosis after Aortic Artery Dilatation Treated with Buyang Huanwu Decoction

Ｓｔｕｄｙ　ｏｎ　Ｐｌａｔｅｌｅｔ－Ｄｅｒｉｖｅｄ　Ｇｒｏｗｔｈ　Ｆａｃｔｏｒ　ｍＲＮＡ　ａｎｄ　Ｃｏｐｐｅｒ－Ｚｉｎｃ　Ｓｕｐｅｒｏｘｉｄｅ　Ｄｉｓｍｕｔａｓｅ　ｍＲＮＡ　Ｅｘｐｒｅｓｓｉｏｎ　Ｃｈａｎｇｅｓ　ｏｆ　Ａｏｒｔｉｃ　Ａｒｔｅｒｙ　Ｅｎ...     

Noninfectious Fever Following Aortic Surgery： Incidence, Risk Factors, and Outcomes

Objective To determine the incidence, course, potential risk factors, and outcomes of noninfectious fever developed in patients after aortic surgery. Methods Patients who received operation for aortic aneurysm or dissection in our center from January 2006 to January 2008 were reviewed. Patients who met one of the following criteria were excluded： having a known source of infection during hospitalization; having a preoperative oral temperature greater than or equal to 38.0℃; undertaking emergency surgery; having incomplete data. Univariate analysis was performed in patients with noninfectious postoperative fever and those without, with respect to demographics, intraoperative data, etc. Risk factors for postoperative fever were considered for the muhivariate logistic regression model if they had a P value less than 0.10 in the univariate analysis. Results Totally 463 patients undergoing aortic surgery were enrolled for full review. Among them, 345 （74.5%） patients had noninfectious postoperative fever, the other 118 （25.5%） patients didn＇t develop postoperative fever. Univariate analysis demonstrated that several risk factors were associated with the development of noninfectious postoperative fever, including weight, surgical procedure, minimum intraoperative bladder temperature, temperature upon intensive care unit （ICU） admission, discharge, and during ICU stay, as well as blood transfusion. In a further multivariate analysis, surgical site of thoracic and thoracoabdominal aorta （odds ratio： 4.861; 95% confidence interval： 3.029-5.801; P=0.004）, lower minimum intraoperative bladder temperature （odds ratio： 1.117; 95% confidence interval： 1.01-1.24; P=0.04）, and higher temperature on admission to the ICU （odds ratio： 2.57; 95% confidence interval： 1.28-5.18; P=0.008） were found to be significant predictors for noninfectious postoperative fever. No difference was found between the febrile and afebrile patients with regard to postoperative hospitalization duration （P=0.558） or total medical costs （P=0.896）. Conclusion Noninfectious postoperative fever following aortic surgery is very common and closely related with perioperative interventions.     

Effects of Atorvastatin on Warfarin-induced Aortic Medial Calcification and Systolic Blood Pressure in Rats

The effect of atorvastatin on warfarin-induced aortic medial calcification and systolic blood pressure （SBP） of rats induced by warfarin was studied. Thirty healthy and adult rats were randomly divided into Warfarin group （n=10）, Atorvastatin group （n=10） and normal control group （n=10）. Caudal arterial pressure of rats was measured once a week, and 4 weeks later, aorta was obtained. Elastic fiber, collagen fiber and calcium accumulation in tunica media of cells were measured by Von Kossa staining. The results showed that warfarin treatment led to elevation of systolic blood pressure and aortic medial calcification. The chronic treatment also increased collagen, but decreased elastin in the aorta. However, the atorvastatin treatment had adverse effects. It was concluded that treatment with atorvastatin presented evidence of blood pressure lowing and calcification reducing. These data demonstrate that atorvastatin protected aortic media from warfarin-induced calcification and elevation of systolic blood pressure.     

Surgical Treatment of Ascending Aortic Dissecting Aneurysm－Clinical Application of Modified Cabrol＇s Operation

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Real-time Three-Dimensional Color Doppler Flow Imaging： An Improved Technique for Quantitative Analysis of Aortic Regurgitation

The recently introduced real-time three-dimensional color Doppler flow imaging （RT-3D CDFI） technique provides a quick and accurate calculation of regurgitant jet volume （RJV） and fraction. In order to evaluate RT-3D CDFI in the noninvasive assessment of aortic RJV and regurgitant jet fraction （RJF） in patients with isolated aortic regurgitation, real-time three-dimensional echocardiographic studies were performed on 23 patients with isolated aortic regurgitation to obtain LV end-diastolic volumes （LVEDV）, end-systolic volumes （LVESV） and RJV, and then RJF could be calculated. The regurgitant volume （RV） and regurgitant fraction （RF） calculated by two-dimensional pulsed Doppler （2D-PD） method served as reference values. The results showed that aortic RJV measured by the RT-3D CDFI method showed a good correlation with the 2D-PD measurements （r= 0.93, Y=0.89X＋ 3.9, SEE= 8.6 mL, P〈0.001 ）; the mean （SD） difference between the two methods was - 1.5 （9.8） mL. % RJF estimated by the RT-3D CDFI method was also correlated well with the values obtained by the 2D-PD method （r=0.88, Y=0.71X＋ 14.8, SEE= 6.4 %, P〈0. 001）; the mean （SD） difference between the two methods was -1.2 （7.9） %. It was suggested that the newly developed RT-3D CDFI technique was feasible in the majority of patients. In patients with eccentric aortic regurgitation, this new modality provides additional information to that obtained from the two-dimensional examination, which overcomes the inherent limitations of two-dimensional echocardiography by depicting the full extent of the jet trajectory. In addition, the RT-3D CDFI method is quick and accurate in calculating RJV and RJF.     

OxLDL－induced Cytotoxicity and Its Inhibition by API_（0134） in Cultured Porcine Aortic Endothelial Cells

ＯｘＬＤＬ－ｉｎｄｕｃｅｄＣｙｔｏｔｏｘｉｃｉｔｙａｎｄＩｔｓＩｎｈｉｂｉｔｉｏｎｂｙＡＰＩ_（０１３４）ｉｎＣｕｌｔｕｒｅｄＰｏｒｃｉｎｅＡｏｒｔｉｃＥｎｄｏｔｈｅｌｉａｌＣｅｌｌｓＷＡＮＧＨｏｎｇｗｅｉ（王宏伟）；ＺＨＡＯＨｕａｙｕｅ（赵华月）；?..     

The Origin of Neointimal Smooth Muscle Cells in Transplant Arteriosclerosis from Recipient Bone-marrow Cells in Rat Aortic Allograft

In order to investigate the origin of neointimal smooth muscle cells in transplant arterio- sclerosis in rat aortic allograft, sex-mismatched bone marrow transplantation was performed from male Wistar rats to female Wistar rats. Four weeks after transplantation, the aortic transplant model was established by means of micro-surgery in rats. The recipients were divided into 4 groups: female Wistar-female Wistar aortic isografts, female SD-female Wistar aortic allografts, male SD-male Wis- tar aortic allografts, female SD-chimera Wistar aortic allografts. Eight weeks after transplantation, aortic grafts were removed at autopsy and processed for histological evaluation and immunohisto- chemistry. The results indicated that excessive accumulation of α-SMA-positive smooth muscle cells resulted in significant neointima formation and vascular lumen stricture in rat aortic allografts. Neointima assay revealed that the neointimal area and NIA/MA ratio of transplanted artery were sig- nificantly increased in all of aortic allograft groups as compared with those in aortic isograft group (P<0.01). Neointimal smooth muscle cells were harvested from cryostat sections of aortic allograft by microdissection method. The Sry gene-specific PCR was performed, and the result showed that a dis- tinct DNA band of 225 bp emerged in the male-male aortic allograft group and chimera aortic al- lograft group respectively, but not in the female-female aortic allograft group. It was suggested that recipient bone-marrow cells, as the origin of neointimal smooth muscle cells, contributed to the pathological neointimal hyperplasia of aortic allograft and transplant arteriosclerosis.     

Assessment of Effect of Angiotensin Ⅱ Receptor Antagonist Losartan on Aortic Distensibility in Patients With Essential Hypertension by Echocardiography

It is well- known that aorta plays an importantrole in the function of the cardiovascular system.Oneof the mostimportantphysiological roles of aorta is abuffering Windkessel function,which is its capabilityto store part of the stroke volume during systole byaortic distention and to transfer this storage volumeinto peripheral circulation during diastole[1] . De-creased aortic distensibility has long been recognizedas a marker for early atherosclerosis[2 ] and may con-tribute to hypertension[3 ]…     

Function of Serotonin 2C Receptor in Rats＇ Aortic and Pulmonary Arterial Smooth Muscle Cells Exposed to Hypoxia

Objective In the study we explored the expression of 5-HT2c receptor （5-HT2cR） in rats aortic smooth muscle cells （ASMCs） and pulmonary arterial smooth muscle cells （PASMCs） under normoxic and hypoxic condition, as well as examined its role in vascular smooth muscle cells proliferation and contraction induced by 5-HT. Methods The expression of 5-HT2cR in vascular smooth muscle cells were used qRT-PCR and flow cytometry. We also used 5-HTEcR antagonist SB206553 to determine the role of this receptor in vascular smooth muscle cells proliferation and contraction induced by 5-HT. Results The results showed the 5-HT2cR expressed in ASMCs and PASMCs. However, 5-HTEcR expression in hypoxic ASMCs and PASMCs differed from that of normoxic ones. Administrated of SB206553, proliferation and contraction of vascular smooth muscle cells induced by 5-HT were obviously reduced. Conclusion The different expression of 5-HTEcR protein in ASMCs and PASMCs suggests this 5-HT receptor may be involved at least partly in modulating different responses of systemic vessels and pulmonary vasculature in hypoxic pulmonary hypertension.     

Aortic aneurysm replacement with Dacron graft in a 34 year old man. How long will the graft last?

A unique case of an abdominal aortic aneurysm replacement in a young man of Caribbean descent is presented. The initial working diagnosis was of a mycotic aneurysm, which has recently shown resurgence with intravenous drug abuse. Blood tests and subsequent biopsy ruled that out. There was also a clinical suspicion of a connective tissue abnormality. Histological examination of the aneurysm, skin biopsy, and blood tests also ruled out this possibility. The graft used in this patient was from a new generation of grafts. In the absence of any studies on such grafts, there is the question of long term durability of the graft.     

Interleukin-1β,Tumor Necrosis Factor-α and Lipopolysaccharide Induce Expression of Monocyte Chemoattractant Protein-1 in Calf Aortic Smooth Muscle Cells

The focal influx and accumulation of lipoprotein at arterial lesion--prone sites and the recruitment of blood monocytes to those sites are two early key events in atherogenesis. After entering thesubendothelial space of the arterial wall, monocytes undergo activation--differentiation to becomemacrophages which subsequently internallze oxidatively modified lipoproteins through scavenger receptors and become foam cells. Therefore, tostudy the mechanism of the recruitment of bloodmonocytes to the…     

Role of Wnt/β-catenin Signaling Pathway in the Mechanism of Calcification of Aortic Valve简

Aortic valve calcification is a common disease in the elderly, but its cellular and molecular mechanisms are not clear. In order to verify the hypothesis that Wnt/β-catenin signaling pathway is involved in the process of calcification of aortic valve, porcine aortic valve interstitial cells（VICs） were isolated, cultured and stimulated with oxidized low density lipoprotein（ox-LDL） for 48 h to induce the differentiation of VICs into osteoblast-like cells. The key proteins and genes of Wnt/β-catenin signaling pathway, such as glycogen synthase kinase 3β（GSK-3β） and β-catenin, were detected by using Western blotting and real-time polymerase chain reaction（PCR）. The results showed that the VICs managed to differentiate into osteoblast-like cells after the stimulation with ox-LDL and the levels of proteins and genes of GSK-3β and β-catenin were increased significantly in VICs after stimulation for 48 h（P0.05）. It is suggested that Wnt/β-catenin signaling pathway may play a key role in the differentiation of VICs into osteoblast-like cells and make great contribution to aortic valve calcification.