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ULTRASOUND IN DIAGNOSIS OF CONGENITAL HEART-DISEASE

AMERICAN HEART JOURNAL 1975年第5期89卷 638-656页

作者： MURPHY, KF KOTLER, MN REICHEK, N PERLOFF, JK VET ADM HOSP PHILADELPHIAPA UNIV PENN SCH MEDDEPT MEDCARDIOVASC SECTPHILADELPHIAPA UNIV PENN HOSP CARDIOVASC SECT3400 SPRUCE STPHILADELPHIAPA 19104

In addition to recording the motion of the mitral, tricuspid, aortic, and pulmonic valves, echocardiography can identify right and left ventricular cavities and the interventricular septum. Disorders such as atrial-septal defect, valvular and subvalvular aortic stenosis, pulmonic stenosis, Ebstein's anomaly of the tricuspid valve, and the hypoplastic left-heart syndrome can readily be evaluated by echocardiography. In tetralogy of Fallot and truncus arteriosus, discontinuity between the anterior aortic wall and septum with overriding aorta has been demonstrated. Doubleoutlet right ventricle is associated with posterior aortic wall and mitral valve discontinuity. In disorders such as single ventricle, tricuspid atresia, and endocardial cushion defect with common A-V canal, echocardiographic demonstration of the absence of the interventricular septum has provided the clinician with valuable information. Newer techniques such as compound-B ultrasonography, which produces a two-dimensional cross-sectional image of intracardiac structures, and multiscan echocardiography will enhance the use of conventional echocardiography by providing a more accurate anatomic display of cardiac chambers and outflow vessels.

关键词：主动脉/病理生理学主动脉瓣狭窄/先天性主动脉瓣狭窄/病理生理学心肌病肥厚性/诊断心肌病肥厚性/病理生理学超声心动描记术/方法心脏/病理生理学心房/病理生理学心脏缺损先天性/诊断心脏缺损先天性/病理生理学心间隔心室/病理生理学二尖瓣/病理生理学二尖瓣狭窄/先天性二尖瓣狭窄/病理生理学肺动脉/病理生理学法乐四联症/病理生理学换能器三尖瓣/病理生理学三尖瓣狭窄/先天性成年人儿童人类婴儿新生

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Clinical and hemodynamic performance of the freestyle aortic root bioprosthesis

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ANNALS OF THORACIC SURGERY 1999年第2期67卷 345-349页

作者： Cartier, PC Dumesnil, JG Métras, J Desaulniers, D Doyle, DP Lemieux, MD Raymond, G Laval Hosp Dept Cardiac Surg Ste Foy PQ G1V 4G5 Canada

Background. The objective of this study is to assess the clinical and hemodynamic performance of a stentless porcine bioprosthesis, the Freestyle aortic root bioprosthesis. Methods. Consenting patients requiring isolated aortic valve or aortic root replacement received the Freestyle bio-prosthesis. Clinical follow-up and echocardiographic data were obtained at discharge, 3 to 6 months, 1 year, and annually thereafter. Results. Two hundred seventy-six patients received a Freestyle aortic root bioprosthesis between January 1993 and July 1997. The mean age was 67.7 years. Preoperatively, 86.3% were either New York Heart Association class III or IV. Two hundred thirty-eight patients underwent valve (subcoronary) replacement, 36 underwent aortic root replacement, and 2 underwent valve replacement using the root-inclusion technique. The early mortality was 5.4%, with 3.3% mortality for the subcoronary technique and 19.4% mortality for aortic root replacement. The mean gradient decreased significantly between discharge and the 3- to 6-month follow-up and stabilized thereafter. The effective orifice area increased significantly from discharge to 3 to 6 months' follow-up. At 3 years, 84.4% of the patients had either no or trivial regurgitation. Conclusions. The Freestyle bioprosthesis has good clinical performance and good short-term hemodynamic performance. The majority of the regurgitation identified is not clinically significant. (C) 1999 by The Society of Thoracic Surgeons.

关键词：主动脉/病理生理学主动脉/外科学主动脉瓣/病理生理学主动脉瓣/外科学生物假体超声心动描记术心脏瓣膜疾病/死亡率心脏瓣膜疾病/病理生理学心脏瓣膜疾病/外科学心脏瓣膜人工手术后并发症/死亡率手术后并发症/病理生理学手术后并发症/超声检查前瞻性研究假体设计假体失效再手术成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Characteristic cardiovascular manifestation in homozygous and heterozygous familial hypercholesterolemia

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AMERICAN HEART JOURNAL 1999年第3期137卷 410-418页

作者： Kawaguchi, A Miyatake, K Yutani, C Beppu, S Tsushima, M Yamamura, T Yamamoto, A Natl Cardiovasc Ctr Res Inst Dept Etiol & Pathophysiol Suita Osaka 565 Japan Natl Cardiovasc Ctr Res Inst & Hosp Dept Etiol & Pathophysiol Suita Osaka 565 Japan

Background The aortic valve dysfunction of patients with homozygous familial hypercholesterolemia (FH) suggests that hypercholesterolemia affects not only coronary arteries but also the aortic valve. We studied the aortic root of patients with homozygous FH and those of patients with heterozygous FH to characterize the premature atherosclerotic lesions by using histopathologic specimens, Methods and Results The aortic roots of 10 patients with homozygous FH, age 9 to 58 years, were studied by cardiac catheterization with several angiographies. The aortic roofs of 39 patients with heterozygous FH under age 60 years were also examined For aortic and mitral valvular functions by color Doppler echocardiography, and 30 normocholesterolemic patients with coronary artery disease were examined as control subjects. In addition, in 22 patients with FH and 20 control subjects, the internal diameter of the aortic annulus and the aortic ridge in cardiac cycles were measured. Of the 10 homozygotes with FH, 8 patients had aortic regurgitation demonstrated by aortography;3 ct them showed significant transvalvular pressure gradients. Stenotic changes of coronary ostia were observed in 8 of the 10 homozygotes with moderate coronary atherosclerosis. Of the 39 heterozygotes with FH, 10 patients had aortic regurgitation shown by Doppler echocardiography, as did only 1 of the 30 control subjects (P < .05). The average diameter and distensibility of the ascending aorta were significantly reduced in the heterozygotes compared with the control subjects, The surgically resected cusp specimens of aortic valves obtained from 1 homozygous and 1 heterozygous patient showed significant thickening of the cusp with foam cell infiltration. Conclusions :Premature atherosclerosis in FH had a characteristic distribution, affecting the aortic root dominantly. The involvement of the aortic valve indicating "hypercholesterolemic valvulopathy" was a peculiar feature of FH, especially ifs homozygous form, b

关键词：主动脉/病理学主动脉/病理生理学主动脉疾病/病因学主动脉疾病/放射摄影术主动脉疾病/超声检查主动脉瓣/病理学主动脉瓣/病理生理学主动脉瓣关闭不全/病因学主动脉瓣关闭不全/病理生理学主动脉瓣关闭不全/放射摄影术主动脉瓣狭窄/病因学主动脉造影术动脉硬化/病因学动脉硬化/放射摄影术动脉硬化/超声检查血压/生理学冠状血管造影术冠心病/超声检查超声心动描记术多普勒彩色泡沫细胞/病理学心脏导管插入术心脏瓣膜疾病/病因学心脏瓣膜疾病/病理生理学杂合子纯合子高胆固醇血症Ⅱ型/遗传学高胆固醇血症Ⅱ型/放射摄影术高胆固醇血症Ⅱ型/超声检查二尖瓣闭锁不全/病因学二尖瓣闭锁不全/病理生理学青少年成年人儿童女(雌)性人类男(雄)性中年人

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ARTERIAL COMPLIANCE IN HYPERTENSION

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AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1976年第1期6卷 49-59页

作者： RANDALL, OS ESLER, MD CALFEE, RV BULLOCH, GF MAISEL, AS CULP, B OROURKE WIKSTRAND GOW HUNYOR BROD OROURKE UNIV MICHIGAN MED CTRDEPT INTERN MED HYPERTENSIONANN ARBORMI 48109 UNIV MICHIGAN MED CTRDIV CARDIOLANN ARBORMI 48109

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IMMUNOLOGICAL ARTERIAL INJURY IN ATHEROGENESIS

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ANNALS OF THE NEW YORK ACADEMY OF SCIENCES 1976年第AUG27期275卷 210-227页

作者： MINICK, CR NEW YORK HOSP CORNELL MED CTRDEPT PATHOLNEW YORKNY 10021

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The effects of anti-hypertensive therapy on the structural, mechanical and metabolic properties of the rat aorta

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JOURNAL OF MUSCLE RESEARCH AND CELL MOTILITY 2000年第3期21卷 255-267页

作者： Clark, JF Radda, GK Boehm, EA Univ Oxford Dept Biochem Oxford OX1 3QU England

The vascular system exhibits altered growth, calcium responses and metabolism during hypertension. To relate such changes, we compared histological, tension and metabolic responses in the aorta from 32-week-old spontaneously hypertensive rats (SHRs), normotensive Wistar-Kyoto (WKY) rats, and SHRs treated with Verapamil (V) and ACE-inhibitor, Trandolapril (T) as well as a combination of the two treatments (C). Vascular hypertrophy was apparent in the SHRs. Contractile responses induced by 50 mmol/l KCl and 2.5 mmol/l Ca2+ were significantly lower in the SHR (64.4 mN/mm(2) vs. 49.2 mN/mm(2)), but an associated increase in Ca2+-sensitivity (EC50 of extracellular Ca2+ (mu mol/l): SHR, 456 vs. WKY, 616) normalised tension generating ability. All treatments led to significant decreases in blood pressure, although only T and C treated animals became normotensive with concomitant normalisation of vascular hypertrophy. An increase in oxygen consumption was apparent in the SHR aorta, which was associated with significant differences in the activities of key metabolic enzymes. Anti-hypertensive treatment normalised many of the metabolic parameters, with the C therapy being the most efficacious. We conclude that the treatment of hypertension by combined therapy leads to a better normalisation of structural, contractile, and metabolic parameters in the SHR, than either treatment alone and that metabolic changes with the pathology are resolved with appropriate therapy.

关键词：血管紧张素转换酶抑制药/药理学血管紧张素转换酶抑制药/治疗应用抗高血压药/药理学抗高血压药/治疗应用主动脉/药物作用主动脉/代谢主动脉/病理生理学高血压/药物疗法高血压/代谢高血压/病理生理学吲哚类/药理学吲哚类/治疗应用肌收缩/药物作用肌平滑血管/药物作用肌平滑血管/代谢肌平滑血管/病理生理学大鼠近交SHR 大鼠近交WKY 血管舒张药/药理学血管舒张药/治疗应用维拉帕米/药理学维拉帕米/治疗应用动物男(雄)性大鼠

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Aortic stiffness: a predictor of acute coronary events?

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EUROPEAN HEART JOURNAL 2000年第5期21卷 342-344页

作者： Sutton, MS Univ Penn Med Ctr Philadelphia PA 19104 USA

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Effect of long-term β-blockade on aortic root compliance in patients with Marfan syndrome

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AMERICAN HEART JOURNAL 1999年第6期137卷 1057-1061页

作者： Rios, AS Silber, EN Bavishi, N Varga, P Burton, BK Clark, WA Denes, P Michael Reese Hosp & Med Ctr Cardiovasc Inst Chicago IL 60616 USA Michael Reese Hosp & Med Ctr Dept Med Genet Chicago IL 60616 USA

Background This study was undertaken to assess the effect of long-term beta-blockade on the aortic root stiffness index and distensibility in patients with Marfan syndrome. Methods Aortic root stiffness index and distensibility were calculated according to the formulas of Stefanadis and Hirai, respectively, with 2-dimensional guided M-mode echocardiogram before and after an average of 26 months of atenolol administration. Results Twenty-three asymptomatic patients were studied (11 men and 12 women, aged 31 +/- 14.2 years). The follow-up was 4 +/- 2.2 years. The dose of atenolol was individualized (mean 43.5 +/- 21.6 mg/d). Heart rate decreased from 79 +/- 9 beats/min to 64 +/- 9 beats/min (P =.01), and systolic blood pressure decreased from 124 +/- 13 mm Hg to 114 +/- 2 mm Hg (P =.01). Distensibility increased from 1.85 +/- 0.70 x 10(-6) cm(2)/dynes(-1) to 2.21 +/- 0.76 x 10(-6) cm(2)/dynes(-1) (P =.02), and the stiffness index decreased from 9.68 +/- 3.78 to 8.85 +/- 3.15 (P =.2). Two groups of responses to treatment were identified. Compared with baseline values 15 (65%) patients who responded to treatment had increased distensibility and decreased stiffness index of the aortic root (P =.05). Eight patients (35%) who did not respond to treatment had no significant change. Body weight >91 kg and baseline end-diastolic aortic root diameter >40 mm were significantly associated with no response (P =.05). Two patients in the nonresponding group had echocardiographic progression of aortic insufficiency. Conclusions There was a heterogeneous response in the aortic root elastic properties after long-term treatment with atenolol in asymptomatic patients with Marfan syndrome. Stiffness index and distensibility are more likely to respond when the baseline end-diastolic aortic root diameter is <40 mm.

关键词：肾上腺素能β受体拮抗剂/药理学肾上腺素能β受体拮抗剂/治疗应用主动脉/药物作用主动脉/病理生理学主动脉瓣/药物作用主动脉瓣/病理生理学阿替洛尔/药理学阿替洛尔/治疗应用卡方分布顺应性/药物作用超声心动描记术/药物作用心电描记术/药物作用马凡综合征/药物疗法马凡综合征/病理生理学时间因素血管容量/药物作用血管容量/生理学成年人女(雌)性人类男(雄)性中年人

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TISSUE ABLATION WITH EXCIMER LASER AND MULTIPLE FIBER CATHETERS - EFFECTS OF OPTICAL FIBER DENSITY AND FLUENCE

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JOURNAL OF INTERVENTIONAL CARDIOLOGY 1992年第4期5卷 263-273页

作者： KVASNICKA, J NAKAMURA, F LANGE, F GESCHWIND, HJ UNIV PARIS 12 HOSP HENRI MONDORINSERMU2UNITE HEMODYNAM & CARDIOL INTERVENTIONNELLEF-94010 CRETEILFRANCE

This study was performed to assess the ablational properties of 1.4-, 1.7-, and 2.0-mm wire-guided multiple fiber catheters coupled to a XeCl excimer laser. Samples of postmortem human aorta were irradiated in blood at fluences of 40, 50, and 60 mJ/mm2. Our results indicate that: 1) an increase in the active irradiation coverage results in an increase in the ablation efficiency;2) the ablation efficiency is not fluence related using the 1.4- or 1. 7-mm multiple fiber catheter but efficiency is fluence dependent using the 2.0-mm multiple fiber catheter;3) the depth of tissue ablated with a multiple fiber catheter depends primarily upon the proportion of the active irradiation coverage at the catheter tip;4) the 2.0-mm multiple fiber catheter induces craters surrounded by a larger zone of tissue damage than that observed with the 1.4- or 1.7-mm multiple fiber catheter;and 5) the 2.0-mm multiple fiber catheter should be used cautiously for laser angioplasty because of its high penetration and its risk of arterial wall damage.

关键词：血管成形术激光/仪器和设备血管成形术激光/方法主动脉/病理生理学主动脉/外科学设备设计纤维光学显微摄影术人类

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Does dilatation of the sinotubular junction cause aortic regurgitation?

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ANNALS OF THORACIC SURGERY 1999年第3期68卷 949-953页

作者： Furukawa, K Ohteki, H Cao, ZL Doi, K Narita, Y Minato, N Itoh, T Saga Prefectural Hosp Dept Cardiovasc Surg Saga 8408571 Japan Saga Med Sch Dept Thorac & Cardiovasc Surg Saga 84001 Japan

Background. Some patients develop aortic regurgitation (AR) in association with dilatation of the sinotubular junction (STJ), despite having normal aortic valve. However, the relationship between dilatation of the STJ and AR is unclear. Methods. Canine hearts and aortas were isolated. A suture was placed in each commissure and in the sinus of Valsalva at the STJ. These interrupted sutures were drawn horizontally, and strain on the sutures was varied. The sites of the retracted sutures were changed to various positions, and the opening and closing of the aortic valve was observed endoscopically. A beating heart model was used to observe changes in aortic valve function during mechanical retraction of the commissures or sinuses. Results. Opening area of the valve increased when strain on all sutures or commissures was increased. When strain was increased on the sinus alone, coaptation of the valve was not affected. Conclusion. We observed endoscopically that mechanical dilatation of the STJ causes AR. These findings suggest that the principal cause of AR associated with dilatation of the STJ is outward deviation of the commissure. (Ann Thorac Surg 1999;68:949-54) (C) 1999 by The Society of Thoracic Surgeons.

关键词：主动脉/病理学主动脉/病理生理学主动脉瓣/病理学主动脉瓣/病理生理学主动脉瓣关闭不全/病因学主动脉瓣关闭不全/病理学主动脉瓣关闭不全/病理生理学扩张病理性内窥镜检查 Valsalva窦/病理学 Valsalva窦/病理生理学动物狗

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