Histological diagnosis of atypical Takayasu arteritis using percutaneous transluminal atherectomy.

PURPOSE: To describe the use of percutaneous directional atherectomy to aid in the diagnosis of atypical Takayasu arteritis in the lower limb vessels. CASE REPORT: In a 24-year-old woman with severe peripheral artery disease (Rutherford-Becker category 5), imaging showed bilateral occlusion of the superficial femoral arteries (SFA), but no lesions of the proximal or supra-aortic vessels. The right SFA was treated first; after guidewire passage through the occlusion, 7 passes of the SilverHawk Peripheral Atherectomy Catheter debulked the lesion, followed by balloon angioplasty. Catheter biopsy showed inflammatory infiltrates consistent with Takayasu arteritis. CONCLUSION: Percutaneous transluminal atherectomy is not only an interventional device but also a diagnostic tool and can be used to distinguish between inflammatory and atherosclerotic lesions.     

Inter-individual variance and cardiac cycle dependency of aortic root dimensions and shape as assessed by ECG-gated multi-slice computed tomography in patients with severe aortic stenosis prior to transcatheter aortic valve implantation: is it crucial for correct sizing?

To evaluate the inter-individual variance and the variability of the aortic root dimensions during the cardiac cycle by computed tomography (CT) in patients with severe aortic stenosis prior to transcatheter aortic valve implantation (TAVI). Fifty-six patients (m/w = 16/40, 81 ± 6.8 years), scheduled for a transapical aortic valve implantation with available preprocedural ECG-gated CT were retrospectively included. The evaluation included sizing of the aortic annulus and the aortic sinus, measurements of the coronary topography, aortic valve planimetry and scoring of calcification. The new defined aortic annulus sphericity ratio revealed a mostly elliptical shape with increasing diastolic deformation. The calculated effective diameter (ED), determined from the annulus’ lumen area, turned out to be the parameter least affected from cardiac cycle changes while systolic and diastolic annulus dimensions and shape (diameter and area) differed significantly (p < 0.001). In about 70 % of the patients with relevant paravalvular leaks the finally implanted prosthesis was too small according to the CT based calculated ED. The ostial height of the coronaries showed a high variability with a critical minimum range <5 mm. The degree of the aortic calcification did not have an influence on the aortic annulus deformation during the cardiac cycle, but on the occurrence of paravalvular leaks. The aortic root anatomy demonstrated a high inter-individual variability and cardiac cycle dependency. These results must be strongly considered during the patient evaluation prior to TAVI to avoid complications. The systolic effective diameter, as measured by ECG-gated CT, represents an appropriate parameter for sizing the aortic annulus.     

Diffuse fibromuscular dysplasia successfully treated with scoring balloon angioplasty in a 3-year-old boy

In children, up to 10% of the cases of arterial hypertension may be caused by a renovascular disease. The etiology of this renovascular disease is most of the time due to a fibromuscular dysplasia (FMD), which causes a noninflammatory intimal-medial fibroplasia leading to luminal compromise. Percutaneous transluminal angioplasty of FMD is a worldwide-accepted treatment modality for this serious arterial disease with, so far, good safety and long-term efficacy data. Once FMD involves several arterial compartments leading to symptoms the outcomes are poor. Herein we report the case of a 3½-year-old boy with severe arterial hypertension and abdominal angina due to a diffuse multivisceral FMD involvement, successfully managed by a percutaneous angioplasty approach using a new balloon catheter for plaque modulation.     

Moderate versus deep hypothermia for arterial switch operation

BACKGROUND: We evaluated the impact of moderate versus deep intraoperative hypothermia on postoperative morbidity in patients receiving a standard arterial switch operation (ASO). METHODS: 71 newborns underwent ASO from 9/98 onwards. Patients were operated using moderate hypothermia (M, 24 degrees C to 30 degrees C, n=21) or deep hypothermia (D, 16-22 degrees C, n=50). Mean patient age was 9.5 (M) versus 10 (D) days, body weight 3.6+/-0.7 (M) versus 3.8+/-0.9 kg (D), P=n. s. Coronary anatomy was complex in 9.5% (M) versus 16% (D) of patients; additional VSD was present in 23.8 (M) versus 38% (D) of the patients, respectively. Mean follow-up is 2.3+/-1.6 years. RESULTS: Intraoperative rectal temperature was 25+/-2 degrees C (M) and 19+/-2 degrees C (D). Cross-clamping time was 95+/-24 (M) versus 108+/-31 min (D), P=n. s. Conventional ultrafiltration was performed at 114+/-46 (M) versus 129+/-69 ml/kg (D), P=n. s. One patient (D) with complex anatomy suffered myocardial ischemia required ECMO support and died. In-hospital mortality was 1.4%. All other patients were safely weaned from extracorporeal circulation with moderate inotropic support. Secondary chest closure was performed in 33% (M) versus 54 % (D) of the patients. Patients were extubated after 7.4 (M) versus 6 (D) days. There was no renal failure and no other serious complications. CONCLUSIONS: ASO can be safely performed using moderate hypothermia, even with complex anatomy, leading to comparatively good results compared to a conventional approach.     

Cultural/interpersonal values and smoking in an ethnically diverse sample of Southern California adolescents

In ethnically diverse school contexts, values from multiple cultures might influence adolescents' attitudes and behaviors. This study developed scales to assess cultural values among Southern California 6'-grade adolescents (N=2281) and evaluated the associations between values and smoking. The scales assessed values salient in many Hispanic and Asian cultures: Respect for Adults (e.g., filial piety, respeto), Interpersonal Harmony (e.g., saving face, simpatia), and Differentiated Gender Roles (e.g., machismo). In cross-sectional and one-year longitudinal models, Respect for Adults and Interpersonal Harmony were associated with a lower risk of lifetime smoking. The associations were significant even after controlling for demographic characteristics, friends' smoking, and parents' smoking, indicating that values influence adolescents' behavior over and above the effects of modeling and peer influence. Increased understanding of adolescents' values could inform the creation of smoking prevention programs for ethnically diverse adolescents.