Long-term alteration in maternal blood pressure and renal function after pregnancy in normal and growth-restricted rats

Intrauterine growth restriction is associated with increased risk of adult cardiorenal diseases. Small birth weight females are more likely to experience complications during their own pregnancy, including pregnancy-induced hypertension, preeclampsia, and gestational diabetes. We determined whether the physiological demand of pregnancy predisposes growth-restricted females to cardiovascular and renal dysfunction later in life. Late gestation bilateral uterine vessel ligation was performed in Wistar-Kyoto rats. At 4 months, restricted and control female offspring were mated with normal males and delivered naturally (ex-pregnant). Regardless of maternal birth weight, at 13 months, ex-pregnant females developed elevated mean arterial pressure (indwelling tail-artery catheter; +6 mm Hg), reduced effective renal blood flow ((14)C-PAH clearance; -23%), and increased renal vascular resistance (+27%) compared with age-matched virgins. Glomerular filtration rate ((3)H-inulin clearance) was not different across groups. This adverse cardiorenal phenotype in ex-pregnant females was associated with elevated systemic (+57%) and altered intrarenal components of the renin-angiotensin system. After pregnancy at 13 months, coronary flow (Langendorff preparation) was halved in restricted females compared with controls, and together with reduced NO excretion, this may increase susceptibility to additional lifestyle challenges. Our results have implications for aging females who have been pregnant, suggesting long-term cardiovascular and renal alterations, with additional consequences for females who were small at birth.     

Mitralklappenchirurgie bei schwer verkalktem Mitralklappenanulus

Objective

The aim of this study was the analysis of long-term results in patients with hemodynamically significant mitral valve disease due to extensively calcified mitral annulus who underwent decalcification and patch reconstruction.

Patients and Methods

Between 1996 and 2008 a total of 109?patients underwent surgery for extensive calcification and severe mitral insufficiency and mitral stenosis. The mean age of the patients (65?women and 44?men) was 66.4±13.8?years. In 53?patients (49%) mitral valve repair was performed and the remaining 56?patients (51%) received a mitral valve replacement. Of the patients 64 (59%) required concomitant surgery. The mean follow up time was 96±48?months.

Results

The in-hospital and late mortality was 8.3% (9?patients) and 25.6% (28?patients), respectively. The actuarial survival rates at 5, 8 and 12?years were 88.1%, 76.2% and 66.1%, respectively. Echocardiographic follow-up presented a mitral insufficiency grade III in 4?patients (6%). None of the patients had a mitral insufficiency grade IV. A significant reduction of left atrium diameter, of the LVEDD as well as the mean transvalvular gradient was observed. Freedom from reoperation at 5 and 8?years was 96.4% and 91.8%, respectively. Systemic hypertension, diabetes mellitus, age older than 65?years, concomitant aortic valve replacement, concomitant procedures, chronic renal insufficiency and cardiac decompensation in the medical history were found to be predictors for significantly increased early or late mortality.

Conclusion

The long-term results strongly suggest that en bloc decalcification and patch reconstruction of the mitral annulus can be safely undertaken in high risk patients.     

Echokardiographische und klinische Evaluation nach Mitralklappenchirurgie bei schwer verkalktem Mitralklappenanulus im Langzeitverlauf

Objective

The aim of this study is the analysis of long-term results in patients with hemodynamically significant mitral valve disease due to extensive calcified mitral annulus who underwent decalcification and patch reconstruction.

Patients and Methods

Between 1996 and 2008 a total of 109?patients underwent surgery in the presence of extensive calcification, severe mitral insufficiency and mitral stenosis. The mean age of patients (65?women, 44?men) was 66.4±13.8?years. Mitral valve repair was performed in 53?patients (49%), while the remaining 56?patients (51%) received a mitral valve replacement. In all, 64?patients (59%) required concomitant surgery. The mean follow-up time was 96±48?months.

Results

Inpatient and late mortality rates were 8.3% (nine patients) and 25.6% (28?patients), respectively. The actuarial survival rates at 5, 8 and 12?years were 88.1%, 76.2% and 66.1%. Echocardiographic follow-up demonstrated mitral insufficiency?III in four patients (6%). No patients had mitral insufficiency?IV. We observed a significant reduction in left atrium diameter, LVEDD as well as mean transvalvular gradient. Freedom from reoperation at 5 and 8?years was 96.4% and 91.8%, respectively. We found systemic hypertension, diabetes mellitus, age above 65?years, concomitant aortic valve replacement, concomitant procedures, chronic renal insufficiency and cardiac decompensation in the medical history as predictors for significantly increased early or late mortality.

Conclusion

The long-term results strongly suggest that en bloc decalcification and patch reconstruction of the mitral annulus can be safely undertaken in high-risk patients.     

Periodontal Probing of Dental Furcations Compared With Diagnosis by Low‐Dose Computed Tomography: A Case Series

Background: Therapeutic decisions in periodontal surgery are based on the accurate diagnosis of the furcation. Clinical probing is the basic diagnostic tool; however, the accuracy of clinical probing to distinguish Class II and Class III furcation defects is unknown. Therefore, this study compares clinical probing diagnoses to those of computed tomography (CT). Methods: Seventy‐five patients with severe periodontal disease were enrolled in this case series study. A total of 582 furcation sites in molars were assigned for the diagnosis of Class II and Class III furcation defects by clinical probing. Diagnosis based on CT served as a reference. Results: The degree of furcation involvement on clinical findings was confirmed in 57% of the sites, whereas 20% were overestimated and 23% were underestimated compared with the radiologic analysis. Only 32% of Class III furcations in the CT scan were detected clinically. The best correlation of CT scan and clinical probing was found at buccal furcation sites in the mandible, with a κ‐coefficient of 0.52, and buccal furcation sites in the maxilla, κ = 0.38. The κ‐coefficient was 0.35 for lingual furcations, 0.29 for mesial furcations, and 0.27 for distal furcations, showing weaker correlations. Conclusions: CT scans offer more detailed information on furcation involvement than clinical probing. Especially before surgical treatment, three‐dimensional radiographic imaging can be a useful tool to assess the degree of furcation involvement and optimize treatment decisions.     

Experimentally induced cam impingement in the sheep hip

Sheep hips have a natural non‐spherical femoral head similar to a cam‐type deformity in human beings. By performing an intertrochanteric varus osteotomy, cam‐type femoro‐acetabular impingement (FAI) during flexion can be created. We tested the hypotheses that macroscopic lesions of the articular cartilage and an increased Mankin score (MS) can be reproduced by an experimentally induced cam‐type FAI in this ovine in vivo model. Furthermore, we hypothesized that the MS increases with longer ambulatory periods. Sixteen sheep underwent unilateral intertrochanteric varus osteotomy of the hip with the non‐operated hip as a control. Four sheep were sacrificed after 14, 22, 30, and 38‐weeks postoperatively. We evaluated macroscopic chondrolabral alterations, and recorded the MS, based on histochemical staining, for each ambulatory period. A significantly higher prevalence of macroscopic chondrolabral lesions was found in the impingement zone of the operated hips. The MS was significantly higher in the acetabular/femoral cartilage of the operated hips. Furthermore, these scores increased as the length of the ambulatory period increased. Cam‐type FAI can be induced in an ovine in vivo model. Localized chondrolabral degeneration of the hip, similar to that seen in humans (Tannast et al., Clin Orthop Relat Res 2008; 466: 273–280; Beck et al., J Bone Joint Surg Br 2005; 87: 1012–1018), can be reproduced. This experimental sheep model can be used to study cam‐type FAI. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 580–587, 2013