aortic

摘要： Severe valvular aortic stenosis is a commonly encountered disorder in the elderly,and the intervention is indicated when the pa-tient is symptomatic.Transcatheter aortic valve im-plantation(TAVI)is a safer therapeutic option in symptomatic patients who cannot undergo surgery or who have high,intermediate,or even low surgic-al risk.[1]Idiopathic thrombocytopenic purpura(ITP)is acquired thrombocytopenia caused by autoan-tibodies against platelet antigens.[2]Herein,we re-port an 81-year-old patient,who was diagnosed with primary ITP two years ago,was admitted to the hospital for heart failure with acute coronary syndrome and severe aortic stenosis.We describe our experience in the peri-operative management of the case of coronary and structural intervention in a patient with ITP.

摘要： Aortic stenosis(AS)is the most common valvular disorder frequently affecting patients as they get older,and resulting in life-altering symptoms such as dyspnea,angina,pre-syncope,and syncope,which are often made worse with exertion.Often,AS is caused by age-related calcification of the valve;in addition,its pathogenetic mechanism also involves the fact that bicuspid aortic valves tend to narrow rapidly compared to other three-leaflet valve.As the aging population continues to grow,an increasing number of patients are seeking treatment for AS,which makes therapies for AS continuing to evolve and improve.Initially,surgical aortic valve replacement(SAVR),requiring a median sternotomy and an extended post-operative intensive care unit stay,was the predominant therapy for patients with AS.

摘要： OBJECTIVES To assess the impact of prosthesis choice and aortic valve calcifications on the occurrence of conduction disturb-ances after transcatheter aortic valve implantation(TAVI).METHODS We retrospectively analyzed the preoperative clinical characteristics,electrocardiograms,contrast-enhanced mul-tidetector computed tomography scans and procedural strategies of patients who underwent TAVI in our center between January 2012 and June 2017.Quantification of calcium volume was performed for each aortic cusp above(aortic valve)and below(left ventricular outflow tract,LVOT)the basal plane.Multivariate analysis was performed to evaluate risk factors for the onset of new bundle branch block(BBB),transient and permanent atrioventricular block(tAVB,pAVB).RESULTS A total of 569 patients were included in the study.Six different prostheses were implanted(Edwards Sapien XT,n=162;Edwards Sapien 3,n=240;Medtronic CoreValve,n=27;Medtronic CoreValve Evolut R,n=21;Symetis Acurate,n=56;Sy-metis Acurate neo,n=63).The logistic regression analysis for BBB showed association with baseline left anterior hemiblock.The logistic regression for tAVB,found the prior valvuloplasty and the balloon post-dilatation associated with the outcome.Baseline left and right BBB,degree of oversizing,and LVOT calcification beneath the non-coronary cusp were associated with pAVB.Neither the prosthesis model,nor the use of a self-expandable prosthesis showed statistical significance with the above-men-tioned outcomes on univariate analysis.CONCLUSIONS LVOT calcification beneath the non-coronary cusp,baseline left anterior hemiblock,right BBB,balloon post-dilatation,prior valvuloplasty and oversizing are independently associated with postprocedural conduction disturbances after TAVI.Use of a self-expandable prosthesis may show a lower incidence of AVB,if applied in lower calcified aortic valves.

摘要： Since it was first acquainted to us in 2002,tr-anscatheter aortic valve implantation(TAVI)was rapidly applied and earned worldwide approval.TAVI is the standard of care for patients with symptomatic severe aortic stenosis(AS),at in-termediate to high-risk and in some low-risk pa-tients in light of the recent data,principally if it can be performed transfemoral approach.

摘要： 胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR)可用于治疗累及主动脉弓的主动脉夹层[1-4];其中,体外预开窗技术具有简便、快速、经济的优势,但如何能够达到安全、可控,需要术者理解其原理并掌握技巧。本文根据笔者的临床经验,详细介绍TEVAR体外预开窗的技术要领如下。

摘要： Stanford B型主动脉夹层破裂(ruptured type B aortic dissection,rTBAD)是B型主动脉夹层最具破坏性的并发症之一,一直以来均被指南纳入复杂性主动脉夹层的范围[1-4]。本文结合笔者临床经验对rTBAD的处理策略进行介绍如下。

摘要： Our research aims to explore the effect and potential mechanism of HNF1b on macrophage sortilin expression and cholesterol efflux,and aortic atherosclerosis.The mRNA and protein levels of HNF1b and sortilin were detected by Western blot and qRT-PCR respectively.The combination of HNF1b and SORT1 promoter was predicted with online websites Jaspar,Promo and Alibaba,and further tested by the luciferase reporter gene and CHIP assay.

摘要： BACKGROUND Cystatin C(CysC)is a cysteine protease inhibitor involved in proteins catabolism and plays an essential role in human vascular pathophysiology.CysC may also increase the risk of aortic stenosis(AS),but limited studies have reported on this association.This study aimed to investigate if elevated serum CysC levels are associated with hemodynamically significant AS.METHODS Serum CysC levels were estimated in 4,791 participants,samples were collected in 1990−1992.The study popula-tion was divided into quintile groups.Follow-up continued in 2011-2013 when participants returned for echocardiography exam-ination.Incidence of aortic valve disease(AVD)was ascertained by Doppler echocardiography through the end of 2013.AVD defined in hemodynamic progression was assessed and classified as aortic sclerosis,mild stenosis,and moderate-to-severe sten-osis.RESULTS Overall,a total of 4,791 participants(mean age:54.8±5.0 years,females:57.6%,blacks:8.2%)were included in this study.During a follow-up of 21 years,we identified 736 cases(15.4%)of aortic sclerosis,194 cases(4.0%)of mild stenosis,and 42 cases(0.7%)of moderate-to-severe stenosis.Compared with serum CysC levels within individual quintile groups,the odds ratio(OR)was per standard deviation associated with an increased incidence of AVD(OR=1.15,95%CI:1.05−1.26,P=0.002).CONCLUSIONS In this large population-based study,an increased serum CysC levels is independently associated with the incidence of hemodynamically significant AS.However,this association appears not to extend to patients with extremely high serum CysC levels and necessitate further investigation.

摘要： BACKGROUND Cardiovascular disease is the leading cause of death in patients with Turner syndrome(TS),and cardiovascular surgery is frequently required for management of these patients.TS is associated with medical comorbidities than can complicate the care of this patient population.AIM To describe the cardiovascular surgical outcomes of patients with TS.METHODS A retrospective case series was compiled of 51 consecutive TS patients who had at least one cardiovascular surgery at Mayo Clinic Rochester from 1977-2017.The baseline clinical data of these patients were reviewed including demographics,medical comorbidities,congenital heart disease history,and medications.Echocardiographic reports were analyzed in detail.Operative reports and surgical hospital courses were reviewed.Long-term mortality was determined using medical records and the Social Security Death Index.Survival analysis was performed with the Kaplan Meier method.RESULTS The cohort comprised 51 TS patients,average age at the time of surgery at Mayo Clinic was 28(8-41)years,and 23(45%)patients were under the age of 18.At the time of first Mayo Clinic surgery,18(35%)patients had previously undergone cardiac surgery at another institution.The most common procedures were repair of aortic coarctation in 14(28%)patients,aortic valve replacement in 6(12%)patients,and composite aortic root/ascending aorta replacement in 7(14%)patients,with 7 patients undergoing repair of more than one lesion.Aortic dissection required operative intervention in 5 patients.After initial Mayo Clinic surgery,subsequent operations were required in 6(13%)patients.Average hospital length of stay was 6±2 d.There were 4(8%)early surgical deaths.Freedom from death was 97%and 89%at 10 and 20 years,and the freedom from reoperation was 93%and 81%at 10 and 20 years.CONCLUSION Cardiovascular surgery is associated with 8%early mortality given the medical complexity of TS patients.Those who survive to dismissal have good survival.Later cardiovascular reoperations are not rare.

摘要： Except for the standard aortic valve replacement,no effective medical treatment is available to prevent or delay calcific aortic valve disease(CAVD)progression.Recently,macrophages and high-mobility group box 1(HMGB1)are the most intriguing candidates in various inflammatory disorders.However,the association between serum HMGB1,CAVD,and macrophage polarization remains unclear.Therefore,we examined whether the level of serum HMGB1 is clinically associated with aortic valve calcification and whether HMGB1 treatment can promote macrophage differentiation toward M1 or M2 phenotype.This experimental study included 19 CAVD patients and 20 healthy controls whose serum HMGB1 levels were examined by ELISA assay.THP-1 macrophage polarization system was established to test the polarization capability of HMGB1 treatment.The results showed that serum levels of HMGB1 were significantly reduced in patients with CAVD.HMGB1 treatment promoted M2 macrophage polarization but not M1 phenotype with increased IL-10 expression and reduced inducible nitric oxide synthase(iNOS)expression.Our findings suggest that serum HMGB1 is negatively associated with the development of aortic valve calcification,and HMGB1 treatment may facilitate M2 macrophage polarization for reducing aortic valve calcification.