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Sample records for great arteries comparison

  1. Facts about Transposition of the Great Arteries

    MedlinePlus

    ... Septal Defect Atrioventricular Septal Defect Coarctation of the Aorta D-Transposition of the Great Arteries Hypoplastic Left ... of the heart—the pulmonary artery and the aorta —are switched in position, or “transposed”. Normally, blood ...

  2. Transposition of the great arteries.

    PubMed

    Martins, Paula; Castela, Eduardo

    2008-01-01

    Transposition of the great arteries (TGA), also referred to as complete transposition, is a congenital cardiac malformation characterised by atrioventricular concordance and ventriculoarterial (VA) discordance. The incidence is estimated at 1 in 3,500-5,000 live births, with a male-to-female ratio 1.5 to 3.2:1. In 50% of cases, the VA discordance is an isolated finding. In 10% of cases, TGA is associated with noncardiac malformations. The association with other cardiac malformations such as ventricular septal defect (VSD) and left ventricular outflow tract obstruction is frequent and dictates timing and clinical presentation, which consists of cyanosis with or without congestive heart failure. The onset and severity depend on anatomical and functional variants that influence the degree of mixing between the two circulations. If no obstructive lesions are present and there is a large VSD, cyanosis may go undetected and only be perceived during episodes of crying or agitation. In these cases, signs of congestive heart failure prevail. The exact aetiology remains unknown. Some associated risk factors (gestational diabetes mellitus, maternal exposure to rodenticides and herbicides, maternal use of antiepileptic drugs) have been postulated. Mutations in growth differentiation factor-1 gene, the thyroid hormone receptor-associated protein-2 gene and the gene encoding the cryptic protein have been shown implicated in discordant VA connections, but they explain only a small minority of TGA cases.The diagnosis is confirmed by echocardiography, which also provides the morphological details required for future surgical management. Prenatal diagnosis by foetal echocardiography is possible and desirable, as it may improve the early neonatal management and reduce morbidity and mortality. Differential diagnosis includes other causes of central neonatal cyanosis. Palliative treatment with prostaglandin E1 and balloon atrial septostomy are usually required soon after birth

  3. Anatomically corrected malposed great arteries misdiagnosed as transposition of great arteries: Diagnosis on fetal echocardiography

    PubMed Central

    Kumar, Vivek; Shah, Sejal

    2016-01-01

    We present a diagnosis of isolated anatomically corrected malposed great arteries on fetal echocardiography at 31 weeks of gestation period. The patient was referred to our institute with a diagnosis of suspected transposition of great arteries.

  4. Anatomically corrected malposed great arteries misdiagnosed as transposition of great arteries: Diagnosis on fetal echocardiography.

    PubMed

    Kumar, Vivek; Shah, Sejal

    2016-01-01

    We present a diagnosis of isolated anatomically corrected malposed great arteries on fetal echocardiography at 31 weeks of gestation period. The patient was referred to our institute with a diagnosis of suspected transposition of great arteries. PMID:27625528

  5. [Comparison of long-term results of arterial switch and Senning procedure in transposition of great vessels with intact ventricular septum].

    PubMed

    Sousa Uva, M; Lacour-Gayet, F; Touchot-Koné, A; Serraf, A; Bruniaux, J; Losay, J; Houyel, L; Petit, J; Binet, J P; Planché, C

    1993-05-01

    One hundred and five survivors after the 30th day of complete cure of transposition of the great arteries with intact ventricular septum between 1980 and 1985 were followed up. Fifty-four had an arterial switch (AS) in a single stage at an average age of 10 +/- 9 days and 51 had Senning's procedure (S) at an average age of 4 +/- 2.5 months. The average follow-up (97% of patients) was 5.8 +/- 1.1 years for the AS group and 9.3 +/- 2.3 years for the S group. The actuarial survival at 5 years was 100% in the AS group and 85.8% in the S group (p < 0.01) (8 late deaths). In the AS group, 3 patients were reoperated for stenosis of the pulmonary artery and, in the S group, 4 patients underwent 6 reoperations. All but 3 patients in the S group and all but 1 patient in the AS group are in functional Class I of the NYHA classification. Doppler echocardiographic studies have shown mild to severe dysfunction of the systemic ventricle in 2% of the AS group and 26% of the S group (p < 0.001). Holter monitoring, performed in 70% of patients in the S group showed sinus node dysfunction in 60% and sinus rhythm in 40% of cases. In conclusion, good functional results were observed at over 5 years in both groups. However, the absence of late mortality and the minimal incidence of systemic ventricular dysfunction in the AS group confirm the authors' choice of indication of arterial switch for the treatment of transposition of the great arteries with intact ventricular septum. PMID:8257269

  6. [Corrected transposition of the great arteries].

    PubMed

    Alva-Espinosa, Carlos

    2016-01-01

    Corrected transposition of the great arteries is one of the most fascinating entities in congenital heart disease. The apparent corrected condition is only temporal. Over time, most patients develop systemic heart failure, even in the absence of associated lesions. With current imaging studies, precise visualization is achieved in each case though the treatment strategy remains unresolved. In asymptomatic patients or cases without associated lesions, focalized follow-up to assess systemic ventricular function and the degree of tricuspid valve regurgitation is important. In cases with normal ventricular function and mild tricuspid failure, it seems unreasonable to intervene surgically. In patients with significant associated lesions, surgery is indicated. In the long term, the traditional approach may not help tricuspid regurgitation and systemic ventricular failure. Anatomical correction is the proposed alternative to ease the right ventricle overload and to restore the systemic left ventricular function. However, this is a prolonged operation and not without risks and long-term complications. In this review the clinical, diagnostic, and therapeutic aspects are overviewed in the light of the most significant and recent literature. PMID:27335197

  7. Congenitally Corrected Transposition of the Great Arteries (CCTGA)

    MedlinePlus

    ... Understanding Your Adult Congenital Heart Disease Quality of Life Birth Control Pregnancy and ... Corrected Transposition of the Great Arteries (CCTGA)* *Please note: This article is directed to those who have not undergone ...

  8. Surgery for transposition of great arteries: A historical perspective

    PubMed Central

    Marathe, Supreet P; Talwar, Sachin

    2015-01-01

    The history of surgery for transposition of great arteries (TGA) has paralleled the history of cardiac surgery. In fact, it began before the birth of open heart surgery when the palliative Blalock–Hanlon septectomy was first performed in 1948. The atrial switch, which was an attempt to correct the physiology of transposition, had significant shortcomings. The arterial switch sought to address them. This has emerged as an anatomically as well as physiologically appropriate solution. Today we continue to pursue technical refinements as well as try to expand the indications of the arterial switch. This review traces the various milestones in this perpetual journey. PMID:26085763

  9. Surgery for malposition of the great arteries: the REV procedure.

    PubMed

    Di Carlo, Duccio; Lecompte, Yves; Tomasco, Biagio; Cohen, Laurence; Vouhé, Pascal

    2009-01-01

    The REV procedure was introduced in 1980 to treat transposition of the great arteries with ventricular septal defect (VSD) and pulmonary stenosis and malpositions similar to transposition of the great arteries (TGA). It aims at overcoming the drawbacks and limitations of the classic Rastelli operation, such as subaortic stenosis, late ventricular deterioration, arrhythmias and sudden death. In particular, the resection of the infundibular septum allows for the placement of a straighter, smaller ventricular patch, bulging much less in the right ventricular cavity. The extensive mobilization of the main pulmonary branches permits a direct connection with the right ventricular incision, thus avoiding the need for an extracardiac conduit. The procedure was performed in 205 patients as of December 2003 with 12% hospital mortality. Patients for whom the Rastelli operation would have been contraindicated, were accepted for REV repair. Late results show a clear improvement over those reported with the Rastelli operation in terms of overall survival (85% at 25-year follow-up interval) and prevalence of reoperation for right ventricular obstruction. Obstruction of the left ventricle-to-aorta tunnel is exceedingly rare. This operation should be considered the gold standard when new surgical options are considered for this complex form of transpositions/malpositions of the great arteries. PMID:24412824

  10. Development of the coronary arteries in a murine model of transposition of great arteries.

    PubMed

    González-Iriarte, M; Carmona, R; Pérez-Pomares, J M; Macías, D; Costell, M; Muñoz-Chápuli, R

    2003-07-01

    Transposition of great arteries in humans is associated with a wide spectrum of coronary artery patterns. However, no information is available about how this pattern diversity develops. We have studied the development of the coronary arteries in mouse embryos with a targeted mutation of perlecan, a mutation that leads to ventriculo-arterial discordance and complete transposition in about 70% of the embryos. The perlecan-deficient embryos bearing complete transposition showed a coronary artery pattern consisting of right and left coronary arteries arising from the morphologically dorsal and ventral sinuses of Valsalva, respectively. The left coronary artery gives rise to a large septal artery and runs along the ventral margin of the pulmonary root. In the earliest embryos where transposition could be confirmed (12.5 d post coitum), a dense subepicardial vascular plexus is located in this ventral margin. In wild-type mice, however, capillaries are very scarce on the ventral surface of the pulmonary root and the left coronary artery runs dorsally to this root. We suggest that the establishment of the diverse coronary artery patterns is determined by the anatomical arrangement and the capillary density of the peritruncal vascular plexus, a plexus that spreads from the atrio-ventricular groove and grows around the aortic or pulmonary roots depending on the degree of the short-axis aortopulmonary rotation. This simple model, based on very few assumptions, might explain all the observed variation of the coronary artery patterns in humans with transposition, as well as our observations on the perlecan-deficient and the normal mice. PMID:12818570

  11. Transposition of great arteries is associated with increased carotid artery stiffness.

    PubMed

    Mersich, Beatrix; Studinger, Peter; Lenard, Zsuzsanna; Kadar, Krisztina; Kollai, Mark

    2006-06-01

    Transposition of great arteries is the consequence of abnormal aorticopulmonary septation. Animal embryonic data indicate that septation and elastogenesis are related events, but human and clinical data are not available. We tested the hypothesis that large artery elastic function was impaired in patients with transposition of great arteries. We studied 34 patients aged 9 to 19 years, 12+/-3 years after atrial switch operation; 14 patients aged 7 to 9 years, 8+/-1 years after arterial switch operation; and 108 healthy control subjects matched for age. Carotid artery diastolic diameter and pulsatile distension were determined by echo wall-tracking; carotid blood pressure was measured by tonometry. Systolic pressure was higher and diastolic pressure was lower in patients than in controls. Patients with atrial and arterial switch repair were compared with their respective controls by 2-factor ANOVA. For patients with atrial switch repair versus control, stiffness index beta was 4.9+/-1.5 versus 3.1+/-1.0 (P<0.001); for patients witch arterial switch versus control, stiffness index beta was 3.8+/-1.1 versus 2.1+/-0.6 (P<0.001). Similar differences were observed for carotid compliance, distensibility, and incremental elastic modulus as well. The interaction term was not significant for any of the elastic variables, indicating that carotid stiffening was a characteristic of the condition and not the consequence of different hemodynamics. Carotid artery is markedly stiffer in patients, suggesting that impaired elastogenesis may constitute part of the congenital abnormality. Since carotid artery stiffness has been established as an independent cardiovascular risk factor, this condition may have consequences in the clinical management of these patients. PMID:16618837

  12. [Arterial switch operation for transposition of the great arteries with situs inversus and mirror image dextrocardia].

    PubMed

    Uchida, Hiroaki; Nemoto, Shintaro; Ozawa, Hideki; Sasaki, Tomoyasu; Motohashi, Yoshikazu; Katsumata, Takahiro; Inoue, Nao; Kishi, Kanta; Okumura, Kenichi; Mori, Yasuhiko

    2012-09-01

    We report a successful arterial switch operation for complete transposition of great arteries with atrial and visceral situs inversus totalis and mirror image dextrocardia in a 12-day-old infant girl. The aorta was located left side-by-side to the pulmonary trunk with a single coronary artery (mirror image of 1RLCx). After French maneuver, the posterior circumference of the neo-aorta was reconstructed. Then the coronary button was transplanted into the neo-aorta with a trap door technique carefully avoiding any twist and over-stretch. The neo-pulmonary trunk was reconstructed with an autologous pericardial patch and sutured to the longitudinal incision made into the left central pulmonary artery. The baby was discharged from hospital and has been doing well without any morbidity relating myocardial ischemia. PMID:22940657

  13. [Anatomic repair of transposition of the great arteries or arterial switch operation. Report of 62 cases].

    PubMed

    Abid, Fekria; Chaker, Lilia; Hakim, Khaouther; Larbi, Chiheb; Ouarda, Fatma; Msaad, Hela; Mechmeche, Rachid

    2004-01-01

    Between January 1990 and September 2003, 62 patients underwent anatomic repair of a transposition of the great arteries. Mean operative age is 40 days. Transposition of the great arteries was simple in 38 cases and associated to a large ventricular septal defect in 24 cases. 44 patients have had an atrial septostomy of Rashkind and 45 an infusion of prostaglandin E 1.5 patients with simple transposition of the great arteries have had left ventricular retraining before arteriel switch. In association to arterial switch, were performed closure of ventricular septal defect in 24 cases, cure of coarctation of the aorta in 4 cases and cure of an abnormal partial pulmonary venous return in 1 case. Early mortality was 6,45%. After a mean follow up of 3 years, one patient died suddenly (late mortality is 1.72%) and one patient had to have 2 reoperations. Results of anatomic repair are now excellent. Late mortality is essentially related to coronary complications so that a careful follow-up is mandatory. PMID:15127697

  14. Prenatal diagnosis of dextrotransposition of the great arteries.

    PubMed

    Hung, Jeng-Hsiu; Huang, Pi-Tao; Weng, Zen-Chung; Chen, Chih-Yao; Chao, Kuan-Chong; Yang, Ming-Jie; Hung, Jamie

    2008-10-01

    Dextrotransposition of the great arteries (DTGA) is a common cardiac cause of cyanosis in newborn infants that can cause acidosis and death within a short period of time unless there is a large atrial-level shunt or a patent ductus arteriosus. Here, we report a case of prenatal diagnosis of DTGA at 24+1 gestational weeks. In a tilted 4-chamber view, the pulmonary trunk branched to the left and the right pulmonary, with its root connected to the left ventricle outflow tract. In the short-axis view, the pulmonary trunk was shown to be parallel with the ascending aortic root. Cesarean section was performed due to the nonreassuring fetal status at 38+5 gestational weeks. The male neonate appeared to have mild cyanotic symptoms and weighed 3,108 g. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. Neonatal echocardiography was performed immediately after birth and the findings confirmed DTGA associated with atrial septal defect secundum. Postnatally, angiography confirmed the echocardiographic diagnosis of DTGA with a large atrial septal defect secundum and a large patent ductus arteriosus. Jatene arterial switch operation and atrial septal defect closure with Gore-Tex patch were performed. The neonate withstood the operation well and was discharged 27 days after birth weighing 2,950 g and in a stable condition. Prenatal diagnosis of DTGA can greatly aid to prepare the patient's family and the surgeon and significantly improve the outcome of complex heart disease in the neonatal period. PMID:18955191

  15. [Embryological and genetic mechanisms of cardiac great arteries malformations].

    PubMed

    Bonnet, Damien; Zaffran, Stéphane; Kelly, Robert; Bajolle, Fanny

    2009-01-01

    Developmental genetics of congenital heart diseases have evolved from analysis of embryonic hearts towards molecular genetics of cardiac morphogenesis with a dynamic view of cardiac development. Ablation techniques, transgenic animal models and clonal analysis of the developing heart led to identification of different cardiac lineages and their respective roles. The mechanistic approach for great arteries anomalies has led to emerging concepts such as common embryological origin of anatomically different cardiac defects, phenotypic continuum of left heart obstructive defects, or developmental algorithms for cardiac isomerisms. Recent experiments that demonstrated the myocardial rotation of the outflow tract in mouse embryos led to a better understanding of the origin of transposition of the large arteries. This has also raised the hypothesis of a new group of congenital heart anomalies defined as laterality defects limited to a segment of the embryonic heart. These results confirm that genetic heterogeneity of congenital heart defects is related to the heterogeneity of the mechanisms that finally produce the same phenotype. PMID:19527629

  16. Modified Shumacker repair of transposition of the great arteries.

    PubMed

    Waldhausen, J A; Pierce, W S; Berman, W; Whitman, V

    1979-08-01

    Seven infants weighing from 6.4 to 10.3 kg underwent correction of transposition of the great arteries by the venous transposition operation as described by Shumacker. In this operation, a new atrial septum is constructed using a bipedicled right atrial flap, and the lateral atrial wall is constructed using a viable pericardial flap. Three of the patients had an associated ventricular septal defect. Six of the seven patients survived and have had an excellent clinical result. Although atrial arrhythmias were common in the early postoperative period, all patients are now in sinus rhythm. Two patients have had postoperative cardiac catheterization and cineangiography, which showed excellent hemodynamic results. The modified Shumacker operation preserves two of the three internodal pathways, provides a compliant, viable atrial septum, and permits fabrication of a generous-size physiological left atrium. This appears to offer advantages not present in the Mustard procedure. PMID:445766

  17. Transposition of Great Arteries: New Insights into the Pathogenesis

    PubMed Central

    Unolt, Marta; Putotto, Carolina; Silvestri, Lucia M.; Marino, Dario; Scarabotti, Alessia; Valerio Massaccesi; Caiaro, Angela; Versacci, Paolo; Marino, Bruno

    2013-01-01

    Transposition of great arteries (TGA) is one of the most common and severe congenital heart diseases (CHD). It is also one of the most mysterious CHD because it has no precedent in phylogenetic and ontogenetic development, it does not represent an alternative physiological model of blood circulation and its etiology and morphogenesis are still largely unknown. However, recent epidemiologic, experimental, and genetic data suggest new insights into the pathogenesis. TGA is very rarely associated with the most frequent genetic syndromes, such as Turner, Noonan, Williams or Marfan syndromes, and in Down syndrome, it is virtually absent. The only genetic syndrome with a strong relation with TGA is Heterotaxy. In lateralization defects TGA is frequently associated with asplenia syndrome. Moreover, TGA is rather frequent in cases of isolated dextrocardia with situs solitus, showing link with defect of visceral situs. Nowadays, the most reliable method to induce TGA consists in treating pregnant mice with retinoic acid or with retinoic acid inhibitors. Following such treatment not only cases of TGA with d-ventricular loop have been registered, but also some cases of congenitally corrected transposition of great arteries (CCTGA). In another experiment, the embryos of mice treated with retinoic acid in day 6.5 presented Heterotaxy, suggesting a relationship among these morphologically different CHD. In humans, some families, beside TGA cases, present first-degree relatives with CCTGA. This data suggest that monogenic inheritance with a variable phenotypic expression could explain the familial aggregation of TGA and CCTGA. In some of these families we previously found multiple mutations in laterality genes including Nodal and ZIC3, confirming a pathogenetic relation between TGA and Heterotaxy. These overall data suggest to include TGA in the pathogenetic group of laterality defects instead of conotruncal abnormalities due to ectomesenchymal tissue migration. PMID:24400257

  18. Radionuclide angiographic evaluation of right and left ventricular function during exercise after repair of transposition of the great arteries. Comparison with normal subjects and patients with congenitally corrected transposition

    SciTech Connect

    Parrish, M.D.; Graham, T.P. Jr.; Bender, H.W.; Jones, J.P.; Patton, J.; Partain, C.L.

    1983-01-01

    We assessed the incidence, clinical significance and etiology of ventricular dysfunction after intraatrial repair of d-transposition of the great arteries in 11 patients, mean age 9 +/- 3 years, who had had Mustard operations. We compared the results to 15 patients who were considered to have normal ventricular function, two patients who had Rastelli operations and five patients with congenitally corrected transposition. Gated equilibrium radionuclide angiography with supine exercise stress testing was used to assess these children. We found no significant difference between our patient groups in exercise capacity, heart rate, or blood pressure response to exercise. However, we found a high incidence of right ventricular dysfunction in the patient groups, manifested by an abnormal right ventricular ejection fraction response to dysfunction in the patient groups, manifested by an abnormal right ventricular ejection fraction response to exercise in six of 11 patients with a Mustard repair, both patients with a Rastelli repair and all five with congenitally corrected transposition. In addition, the left ventricular response to exercise was abnormal in 10 of 11 patients who had undergone a Mustard repair, both patients with a Rastelli repair, and two of five patients with congenitally corrected transposition. We conclude that biventricular dysfunction is frequently present after intraatrial repair of d-transposition of the great arteries. Despite this dysfunction, no significant decrease in exercise tolerance is found in childhood.

  19. Development of advanced pulmonary vascular disease in D-transposition of the great arteries after the neonatal arterial switch operation.

    PubMed Central

    Rivenes, S M; Grifka, R G; Feltes, T F

    1998-01-01

    We report the case of a neonate with D-transposition of the great arteries who, after undergoing an uneventful arterial switch operation at the age of 4 days, was found at the age of 42 months to have developed advanced pulmonary vascular disease. Because the arterial switch operation was performed when our patient was only 4 days old, this case challenges the hypothesis that postnatal hemodynamics alone dictate the development of advanced pulmonary vascular disease in infants and children with transposition of the great arteries. Images PMID:9782561

  20. Midterm results after arterial switch operation for transposition of the great arteries: a single centre experience

    PubMed Central

    2012-01-01

    Background The arterial switch operation (ASO) has become the surgical approach of choice for d-transposition of the great arteries (d-TGA). There is, however an increased incidence of midterm and longterm adverse sequelae in some survivors. In order to evaluate operative risk and midterm outcome in this population, we reviewed patients who underwent ASO for TGA at our centre. Methods In this retrospective study 52 consecutive patients with TGA who underwent ASO between 04/1991 and 12/1999 were included. To analyze the predictors for mortality and adverse events (coronary stenoses, distortion of the pulmonary arteries, dilatation of the neoaortic root, and aortic regurgitation), a multivariate analysis was performed. The follow-up time was ranged from 1–10 years (mean 5 years, cumulative 260 patient-years). Results All over mortality rate was 15.4% and was only observed in the early postoperative period till 1994. The predictors for poor operative survival were low APGAR-score, older age at surgery, and necessity of associated surgical procedures. Late re-operations were necessary in 6 patients (13.6%) and included a pulmonary artery patch enlargement due to supravalvular stenosis (n = 3), coronary revascularisation due to coronary stenosis in a coronary anatomy type E, aortic valve replacement due to neoaortic valve regurgitation (n = 2), and patch-plasty of a pulmonary vein due to obstruction (n = 1). The dilatation of neoaortic root was not observed in the follow up. Conclusions ASO remains the procedure of choice for TGA with acceptable early and late outcome in terms of overall survival and freedom of reoperation. Although ASO is often complex and may be associated with morbidity, most patients survived without major complications even in a small centre. PMID:22958234

  1. Facts about dextro-Transposition of the Great Arteries (d-TGA)

    MedlinePlus

    ... Facts about dextro-Transposition of the Great Arteries (d-TGA) Language: English Español (Spanish) Recommend on Facebook ... What is dextro-Transposition of the Great Arteries (d-TGA)? Dextro-Transposition (pronounced DECKS-tro trans-poh- ...

  2. Continuous inhaled iloprost in a neonate with d-transposition of the great arteries and severe pulmonary arterial hypertension.

    PubMed

    Dykes, John C; Torres, Marilyn; Alexander, Plato J

    2016-03-01

    This report describes the case of a neonate with d-transposition of the great arteries and severe pulmonary arterial hypertension stabilised in the post-operative period with continuous iloprost nebulisation. To our knowledge, this is the first documented method of treating post-operative severe pulmonary arterial hypertension with continuous inhaled iloprost in a patient with complex CHD. We found this method of delivering the drug very effective in stabilising haemodynamic swings in the setting of severe pulmonary arterial hypertension. PMID:26220108

  3. Pregnancy outcomes in women with transposition of the great arteries and arterial switch operation.

    PubMed

    Tobler, Daniel; Fernandes, Susan M; Wald, Rachel M; Landzberg, Michael; Salehian, Omid; Siu, Samuel C; Colman, Jack M; Sermer, Matthew; Silversides, Candice K

    2010-08-01

    There is a growing population of young women of child-bearing age with complete transposition of the great arteries (TGA) who have had an arterial switch operation (ASO). Pregnancy imposes a hemodynamic stress on the heart and, therefore, adverse cardiac events can occur during this period; however, pregnancy outcomes in this population have not been well studied. We sought to describe cardiac outcomes during pregnancy in women with TGA who had undergone an ASO in childhood. Women were identified from 2 large tertiary care hospitals. A retrospective chart review was performed to determine the prevalence of adverse maternal cardiac events during pregnancy. Overall, 74 women of child-bearing age were identified, 9 of whom had 17 pregnancies. There were 4 miscarriages. Six women (67%) had clinically important valve (n = 5) and ventricular (n = 1) lesions before the index pregnancy. Two women developed cardiac complications during pregnancy; 1 woman with impaired left ventricular systolic function had nonsustained ventricular tachycardia and 1 woman with a mechanical systemic atrioventricular valve developed postpartum valve thrombosis. There were no maternal deaths. In conclusion, young women with TGA from this early cohort repaired with ASO are reaching child-bearing age. A significant proportion have residua and/or sequelae that can confer risk for adverse cardiac events in pregnancy. Co-ordinated care between a congenital heart disease specialist and a high-risk obstetrician should be implemented. PMID:20643256

  4. Long-term fate of the coronary arteries after the arterial switch operation in newborns with transposition of the great arteries.

    PubMed Central

    Bonnet, D.; Bonhoeffer, P.; Piéchaud, J. F.; Aggoun, Y.; Sidi, D.; Planché, C.; Kachaner, J.

    1996-01-01

    OBJECTIVE: Concern continues to be expressed about the long-term impact of coronary artery translocation after the arterial switch operation for transposition of the great arteries. This study was conducted to determine the prevalence of obstructions of the translocated coronary arteries by the use of selective coronary artery angiography. METHODS AND RESULTS: 64 children (mean age 7.6 (SD) 1.5 years) who had survived an arterial switch operation underwent evaluation. They had been operated on by one surgeon and they were followed up by a single hospital. Selective coronary artery angiography was possible in 58 patients. Five patients showed occlusion or stenosis of a coronary artery: one occlusion and two stenoses of the left coronary trunk, two occlusions of the circumflex artery. The prevalence of late coronary artery complications was 7.8 (SD) 6.6% (95% CI 1.2 to -14.4%). The three patients with occlusion of one coronary artery had perioperative ischaemic complications, with associated electrocardiogram evidence of ischaemia and left ventricular dysfunction with mitral valve insufficiency. Both patients with stenosis of the left main coronary artery trunk did not have any evidence of an anomaly before catheterisation. CONCLUSIONS: The prevalence of the late coronary artery complications after an arterial switch operation was low in this series. This accords with the view that the arterial switch operation remains the preferred treatment for such patients. Screening for late coronary artery patency should be done by using selective coronary artery angiography, because even patients who remain symptom free can have coronary artery anomalies. Images PMID:8868989

  5. Left main coronary artery stenting in a 3.6 kg infant after arterial switch operation for transposition of the great arteries

    PubMed Central

    El-Said, Howaida G; Ebrahim, Mohammad; Moore, John W

    2015-01-01

    The patient presented with flash pulmonary edema related to severe left ventricular diastolic dysfunction several weeks after arterial switch operation (ASO) for D-transposition of the great arteries. Long segment, critical left main coronary artery stenosis in this 3.6 kilogram infant was successfully stented and resulted in resolution of the clinical findings. At 15-month follow-up, the patient remains asymptomatic and thriving. PMID:26085768

  6. A NEW APPROACH TO CORRECTION OF D-LOOP TRANSPOSITION OF THE GREAT ARTERIES

    PubMed Central

    Subramanian, V. A.; Herman, S. A.; Gay, William A.

    1977-01-01

    An operative procedure is described for repair of transposition of the great arteries in which the left ventricle is the “aortic” ventricle and the right ventricle is the “pulmonic” ventricle. The technical feasibility of this procedure is supported by its successful application in experimental animals. A modified procedure, which may be applicable in certain complex forms of transposition of the great arteries and other perplexing anomalies for which there are no known repairs, is discussed. Images PMID:15216116

  7. Modified Shumacker operation for correction of transposition of the great arteries.

    PubMed

    Alvarado, A

    1977-10-01

    Correction of the transposition of the great arteries can be accomplished with a modified Shumacker operation. This procedure has been demonstrated in cadavers to have many advantages over the techniques used by Mustard and by Angelini and Sandiford. At present these two operations provide the best clinical results in correction of transposition of the great arteries. The details of the modified Shumacker technique are described and the different advantages of this technique are discussed. PMID:904361

  8. Congenitally corrected transposition of the great arteries: surgical repair in adulthood.

    PubMed

    Mitropoulos, Fotios A; Kanakis, Meletios; Vlachos, Antonios P; Lathridou, Paraskevi; Tsaoussis, George; Georgiou, George; Goudevenos, John A

    2007-02-01

    We report a patient with congenitally corrected transposition of the great arteries, dextrocardia in congestive heart failure, with severe tricuspid regurgitation; a large ventricular septal defect, and giant left atrium. The patient underwent a two-ventricle repair with physiologic correction and had an excellent postoperative outcome. PMID:17258011

  9. Transposition of the great arteries: long-term outcome and current management.

    PubMed

    Murphy, Daniel J

    2005-07-01

    There is a large group of young adults who survived atrial baffle repair of transposition of the great arteries. Most survivors are asymptomatic, although nearly all have decreased exercise capacity. Loss of sinus rhythm and atrial arrhythmias are common and increase with age. There is concern about the ability of the right ventricle to function long term as a systemic pump, and recent publications have highlighted right ventricular dysfunction in this patient population. Sudden death and congestive heart failure are the main causes of death, and outcomes beyond 30 years are unknown. Pulmonary artery banding, late arterial switch, and cardiac transplantation are employed when intractable arrhythmias or right ventricular failure threaten survival or quality of life. PMID:15987628

  10. Intra-atrial Reentrant Tachycardia in Complete Transposition of the Great Arteries Without Femoral Venous Access.

    PubMed

    Borne, Ryan T; Kay, Joseph; Fagan, Thomas; Nguyen, Duy Thai

    2016-03-01

    Catheter ablation for patients with transposition of the great arteries (d-TGA) requires multiple considerations and careful preprocedural planning. Knowledge of the patient's anatomy and surgical correction, in addition to electroanatomic mapping and entrainment maneuvers, are important to identify and successfully treat arrhythmias. This case was unique in that the lack of femoral venous access required transhepatic venous access and bidirectional block was attained with ablation lesions along the cavotricuspid isthmus on both sides of the baffle. PMID:26920194

  11. D-TRANSPOSITION OF THE GREAT ARTERIES: Hot Topics in the Current Era of the Arterial Switch Operation

    PubMed Central

    Villafañe, Juan; Lantin-Hermoso, M. Regina; Bhatt, Ami B.; Tweddell, James S.; Geva, Tal; Nathan, Meena; Elliott, Martin J.; Vetter, Victoria L.; Paridon, Stephen M.; Kochilas, Lazaros; Jenkins, Kathy J.; Beekman, Robert H.; Wernovsky, Gil; Towbin, Jeffrey A.

    2015-01-01

    Objectives This paper aims to update clinicians on “Hot Topics” in the management of patients with d-transposition of the great arteries (D-TGA) in the current surgical era. Background The arterial switch operation (ASO) has replaced atrial switch procedures for D-TGA and 90% of patients now reach adulthood. Methods The Adult Congenital and Pediatric Cardiology Council (ACPC) of the American College of Cardiology assembled a team of experts to summarize current knowledge on genetics, prenatal diagnosis, surgical timing, balloon atrial septostomy (BAS), prostaglandin therapy (PGE), intraoperative techniques, imaging, coronary obstruction, arrhythmias, sudden death, aortic dilation and regurgitation (AR), neurodevelopmental (ND) issues and lifelong care of D-TGA patients. Results In simple D-TGA, 1) familial recurrence risk is low; 2) children diagnosed prenatally have improved cognitive skills compared with those diagnosed postnatally; 3) echocardiography helps to identify risk factors; 4) routine use of BAS and PGE may not be beneficial in some cases; 5) early ASO improves outcomes and reduces costs with a low mortality. Single or intramural coronary arteries remain risk factors; 6) post-ASO arrhythmias and cardiac dysfunction should raise suspicion of coronary insufficiency; 7) coronary insufficiency and arrhythmias are rare but associated with sudden death; 8) early and late-onset ND abnormalities are common; 9) AR and aortic root dilation are well tolerated; and 10) the aging ASO patient may benefit from “exercise-prescription” rather than restriction. Conclusions Significant strides have been made in understanding risk factors for cardiac, ND and other important clinical outcomes after ASO. PMID:25082585

  12. Switch operation for transposition of the great arteries in neonates. A study of 120 patients.

    PubMed

    Planché, C; Bruniaux, J; Lacour-Gayet, F; Kachaner, J; Binet, J P; Sidi, D; Villain, E

    1988-09-01

    From March 1984 to January 1987, anatomic surgical correction was performed on 110 newborn infants (2 to 23 days old, mean 7.8 +/- 3.5, standard deviation) with simple transposition of the great arteries and 10 additional neonates (7 to 30 days old, mean 17.9 +/- 8.3, standard deviation) with transposition and a large ventricular septal defect. All had preoperative catheterization. Ninety-six percent of the patients underwent balloon atrial septostomy and 90% received prostaglandin E1 infusion until the time of the operation. The anatomy of the coronary arteries according to the Yacoub classification was as follows: type A, 82 patients; type B, 5 patients; type C, 4 patients; type D, 23 patients; and type E, 6 patients. Continuous hypothermic bypass with no circulatory arrest was used for all patients except two. Myocardial protection was ensured by crystalloid cardioplegia. Coronary artery relocation was performed according to the Yacoub technique with some modifications, and pulmonary artery reconstruction was done according to the Lecompte maneuver in all patients, even when the great vessels had a side-by-side relationship. The proximal pulmonary artery was reconstructed with two circular patches for the first 10 patients and with a single large posterior patch for the last 110 patients. Tanned heterologous pericardium was used for the first 25 patients and autologous native pericardium for the last 95 patients. The perioperative mortality rates were 8.3% for the entire series and 5.4% for the last 110 patients, with no deaths in the group having transposition plus ventricular septal defect. Late death from acute myocardial infarction occurred in two patients in the second month after operation. No patient was lost to follow-up, which ranged from 2 to 46 months (mean 16 +/- 11.2, standard deviation). The follow-up included sequential noninvasive evaluations and 32 catheterizations performed 10 to 18 months postoperatively. Two patients were reoperated on for

  13. Perventricular closure of a large ventricular septal defect in congenitally corrected transposition of the great arteries.

    PubMed

    Aboulhosn, Jamil; Levi, Dan; Sopher, Michael; Johnson, Allen; Child, John S; Laks, Hillel

    2010-01-01

    We report the case of a 30 year-old male with congenitally corrected transposition of the great arteries, atrial, and ventricular septal defects (VSD), and pulmonary stenosis. He previously underwent three palliative surgical procedures before undergoing intracardiac repair at age 20 with a left ventricular to pulmonary artery (LV-PA) conduit, VSD closure, and replacement of the systemic atrioventricular valve. A residual VSD was noted postoperatively. He did well for approximately 10 years when he started becoming more breathless with daily activities and was noted to have a resting room air oxygen saturation of 85%. Despite increased diuretic therapy he continued to deteriorate and was ultimately admitted to the hospital in florid right and left heart failure with recurrent atrial fibrillation. Catheterization revealed pulmonary hypertension (pulmonary artery pressure = 80/17 mm Hg), moderate conduit stenosis, severe pulmonic regurgitation, and oxygen saturation of 75%. Calculated shunt fraction (Qp : Qs) was 1.3:1. He was referred for surgical intervention, specifically, LV-PA conduit replacement, oversewing of the pulmonic valve, VSD closure, and pacemaker placement. Intraoperatively, the VSD could not be closed despite multiple attempts through various approaches. Therefore, perventricular VSD closure using two Amplatzer septal occluders (AGA Medical, Golden Valley, MN) was performed in the operating room with the chest open off cardiopulmonary bypass. Following deployment, the residual shunt was small and the inferior vena cava-to-pulmonary artery saturation step-up was only 4%. The left ventricular systolic pressure decreased to one half systemic. This case highlights the utility and efficacy of a hybrid approach in the treatment of complex congenital heart disease. PMID:20136860

  14. Anesthetic considerations in a child with unrepaired D-transposition of great arteries undergoing noncardiac surgery

    PubMed Central

    Mathur, Pooja; Khare, Arvind; Jain, Neena; Verma, Priya; Mathur, Vivek

    2015-01-01

    D-transposition of great arteries (D-TGA) is the most common cyanotic congenital heart disease diagnosed at birth. There is ventriculoarterial discordance leading to parallel circulation. The postnatal survival depends on intercirculatory mixing of oxygenated and deoxygenated blood at various levels through atrial septal defect, ventricular septal defect or patent ductus arteriosus. The anesthesiologist must have an understanding of concepts of shunting and other long-term consequences of transposition of great arteries (TGA) in order to tailor the anesthetic technique to optimize the hemodynamic variables and oxygenation in the perioperative period. The preoperative evaluation includes echocardiography to delineate the type of TGA, associated lesions and extent and direction of shunts. Oxygen saturation is influenced by the ratio of pulmonary vascular resistance (PVR) to systemic vascular resistance. Thus, care should be taken to avoid an increase in PVR which can lead to decreased pulmonary blood flow leading to hypoxia. We report a case of an 8-year-old child with unrepaired D-TGA, who presented to us for craniotomy for drainage of brain abscess. PMID:26712994

  15. Mechanical circulatory support in patients with heart failure secondary to transposition of the great arteries.

    PubMed

    Joyce, David L; Crow, Sheri S; John, Ranjit; St Louis, James D; Braunlin, Elizabeth A; Pyles, Lee A; Kofflin, Paula; Joyce, Lyle D

    2010-11-01

    Advances in palliation of congenital heart disease have resulted in improved survival to adulthood. Many of these patients ultimately develop end-stage heart failure requiring left ventricular assist device implantation (LVAD). However, morphologic differences in the systemic ventricle of these patients require careful attention to cannula placement. We report on the evolution of our surgical technique for implanting LVADs in 3 patients with transposition of the great arteries and congenitally corrected transposition of the great arteries. Applying standard LV cannulation techniques to the systemic ventricle led us too anteriorly in our first patient, creating obstruction by the moderator band. Subsequent use of epicardial and transesophageal echocardiography allowed for intraoperative localization of the intracardiac muscular structures to identify the optimal cannulation site. The acute angle of the inflow cannula on the DeBakey LVAD (MicroMed Technology, Houston, TX) required flipping the device 180°. The HeartMate II device (Thoratec, Pleasanton, CA) could be shifted towards the midline. One patient underwent successful transplant and 2 are home waiting for a donor organ. We conclude from our experience that LVAD surgery can be safely performed in patients with congenital heart disease when implanted under echocardiographic guidance. PMID:20620085

  16. Metabolic alterations and neurodevelopmental outcome of infants with transposition of the great arteries.

    PubMed

    Park, I Sook; Yoon, S Young; Min, J Yeon; Kim, Y Hwue; Ko, J Kok; Kim, K Soo; Seo, D Man; Lee, J Hee

    2006-01-01

    Abnormal neurodevelopment has been reported for infants who were born with transposition of the great arteries (TGA) and underwent arterial switch operation (ASO). This study evaluates the cerebral metabolism of TGA infants at birth and before ASO and neurodevelopment 1 year after ASO. Proton magnetic resonance spectroscopy (1H-MRS) was performed on 16 full-term TGA brains before ASO within 3-6 days after birth. The brain metabolite ratios of [NAA/Cr], [Cho/Cr], and [mI/Cr] evaluated measured. Ten infants were evaluated at 1 year using the Bayley Scales of Infants Development II (BSED II). Cerebral metabolism of infants with TGA was altered in parietal white matter (PWM) and occipital gray matter (OGM) at birth before ASO. One year after ASO, [Cho/Cr] in PWM remained altered, but all metabolic ratios in OGM were normal. The results of BSID II at 1 year showed delayed mental and psychomotor development. This delayed neurodevelopmental outcome may reflect consequences of the altered cerebral metabolism in PWM measured by 1H-MRS. It is speculated that the abnormal hemodynamics due to TGA in utero may be responsible for the impaired cerebral metabolism and the subsequent neurodevelopmental deficit. PMID:16897317

  17. Acute myocardial infarction with isolated congenitally corrected transposition of the great arteries

    PubMed Central

    Altman, J. Ryan; Gantt, D. Scott

    2016-01-01

    Congenital cardiac abnormalities diagnosed at the time of acute coronary syndrome are rare. A 43-year-old man presented to the emergency department complaining of recurring, severe chest pain. Subsequent emergent coronary angiography demonstrated unusual coronary anatomy: 1) one small caliber bifurcating vessel originating from the right sinus of Valsalva; 2) one very large vessel arising from the posterior sinus; and 3) no coronary artery from the normal left sinus of Valsalva. The large vessel from the posterior sinus was totally occluded in its midportion and was treated with intravascular ultrasound-guided percutaneous coronary intervention. Further diagnostic workup, including two-dimensional transthoracic echocardiogram and computed tomographic coronary angiography, demonstrated isolated corrected transposition of the great arteries with a dilated systemic ventricle and systolic dysfunction with an ejection fraction of 30%. The patient's clinical course was complicated by recurrent nonsustained ventricular tachycardia, treated with medical therapy and a dual-chamber implantable cardioverter defibrillator. This case is an example of a common clinical presentation with a very uncommon congenital heart disorder. Similar cases may become more frequent as the number of adult congenital heart patients increases in the population. PMID:27034557

  18. Coronary Events and Anatomy After Arterial Switch Operation for Transposition of the Great Arteries: Detection by 16-Row Multislice Computed Tomography Angiography in Pediatric Patients

    SciTech Connect

    Oztunc, Funda Baris, Safa; Adaletli, Ibrahim Onol, Nurper Onder Olgun, Deniz Cebi; Guezeltas, Alper Ozyilmaz, Isa Ozdil, Mine; Kurugoglu, Sebuh; Eroglu, Ayse Gueler

    2009-03-15

    The purpose of this study was to evaluate the feasibility of multislice computed tomographic (MSCT) angiography as a noninvasive method for detecting ostial, proximal, and middle segment coronary stenosis or occlusion and anatomy in patients with transposition of the great arteries who had undergone arterial switch operation (ASO). Sixteen-detector-row MSCT angiography was performed in 16 patients treated with ASO for transposition of the great arteries. The median age was 10.3 years (range, 6.2-16.3 years). Sixteen-detector-row MSCT angiography was performed in 16 patients who had undergone ASO. CT imaging was performed in the craniocaudal direction from 2 cm above the carina up to the heart basis. Noninvasive assessment of coronary artery stenosis and anatomy were investigated by MSCT angiography. Two patients were excluded from the study because of artifacts. Of 14 evaluated patients, 1 patient had ostial stenosis (7.1%). A coronary artery anatomy variant was present in six patients: left main artery (LMA) and right coronary artery (RCA) originating from the right sinus as a single orifice (n = 2); left circumflex artery (LCX) originating from the RCA (n = 1); LMA and RCA, after branching to the LCX, originating separately from the right sinus (n = 1); and LMA (n = 1) and left anterior descending artery (LADA; n = 1) originating directly from the right sinus. Intramural bridging in the LAD (n = 2) was detected. Five patients were normal. In conclusion, MSCT angiography, as a noninvasive, feasible technique for assessing coronary stenosis or occlusion and anatomy, can be used in the follow-up of patients who have undergone ASO.

  19. Review: surgery for transposition of the great arteries in the first year of life.

    PubMed Central

    Zavanella, C; Subramanian, S

    1978-01-01

    Elective intracardiac repair by the Mustard operation is recommented in patients with transposition of the great arteries and intact ventricular septum in the first year of life (Fig. 1). In patients with associated ventricular septal defect in the first three months of life, early banding followed by early debanding before the first year of life is recommended. When the left ventricular outflow tract obstruction is discrete at valvular or subvalvular level, Mustard operation, closure of the ventricular septal defect and direct relief of out-flow obstruction is acceptable, but in patients with an unfavorable left ventricular outflow tract anatomy, a preliminary shunt followed by a Rastelli operation after the age of four years will probably result in a greater salvage. The utilization of surface induced profound hypothermia and circulatory arrest allows for more precise and rapid surgery and is shown to be a definite advantage in the very young infant. PMID:75716

  20. Complete transposition of the great arteries with double outlet right ventricle in a dog.

    PubMed

    Koo, S T; LeBlanc, N L; Scollan, K F; Sisson, D D

    2016-06-01

    A 2-year old intact male Collie dog presented to the cardiology service at Oregon State University for evaluation of cyanosis and suspected congenital cardiac disease. Echocardiography revealed a constellation of cardiac abnormalities including a single large vessel exiting the right ventricle with a diminutive left ventricular outflow tract, a ventricular septal defect, and marked concentric right ventricular hypertrophy with moderate right atrial dilation. Cardiac-gated computed tomography confirmed the previous anomalies in addition to supporting a diagnosis of complete transposition of the great arteries, double outlet right ventricle, and pulmonic hypoplasia with a single coronary ostium. Prominent bronchoesophageal collateral vessels were concurrently identified. Clinically, the dog was stable despite mild cyanosis that worsened with exercise; no intervention was elected at the time. This case report describes a rare combination of congenital cardiac defects and the usefulness of cardiac-gated cross-sectional imaging in the anatomic diagnosis. PMID:26936424

  1. Familial recurrence of heart defects in subjects with congenitally corrected transposition of the great arteries.

    PubMed

    Piacentini, Gerardo; Digilio, M Cristina; Capolino, Rossella; Zorzi, Andrea De; Toscano, Alessandra; Sarkozy, Anna; D'Agostino, Rita; Marasini, Maurizio; Russo, M Giovanna; Dallapiccola, Bruno; Marino, Bruno

    2005-08-30

    Familial recurrence of congenitally corrected transposition of the great arteries (CCTGA) is considered uncommon. Most of the previous familial studies involved a small number of patients and referred to all situs and looping anomalies including single ventricle, heterotaxia, and other cardiac defects different from CCTGA. We performed a large, consecutive clinical case series study in order to detect the recurrence of congenital heart defects in families of children with the classic form of CCTGA. From January 1997 through December 2004, 102 consecutive patients with CCTGA were evaluated in four institutions. There were 59 male (57.8%) and 43 female (42.2%). Mean age was 8.6 +/- 7.8 years. Eighty-eight patients (86.3%) had situs solitus of the atria, 14 (13.7%) situs inversus. The cardiac and extracardiac anomalies among relatives and the patterns of familial recurrence were investigated. Relatives with congenital heart defects were found in 16/102 families (15.7%). Transposition of the great arteries (TGA) was the most common recurrent defect (6/102 families). Consanguinity was identified in the parents of three probands. Six probands had an unaffected twin-sib. Recurrence risks for congenital heart defects were calculated at 5.2% (6/116) for siblings. In conclusion, CCTGA is not always sporadic in families. The pattern of inheritance, the presence of consanguinity among parents and the recurrence of situs inversus could suggest, in some families, an autosomal recessive mechanism with similarities with that occurring in some pedigrees with heterotaxia. The recurrence of TGA and CCTGA in the same family suggests a pathogenetic link between these two anatomically different malformations. PMID:16059940

  2. Single primitive ventricle with normally related great arteries and atresia of the left A-V valve.

    PubMed Central

    Coto, E O; Raggio, J M; Malo, P; Sainz, C; Aparisi, R; Gomez-Ullate, J M

    1978-01-01

    A child aged 2 years and 9 months was angiocardiographically diagnosed to have a single ventricle with normally related great arteries and atresia of the left A-V valve. A Blalock-Hanlon procedure and division of a large patent ductus arteriosus were followed by reduction in pulmonary artery pressure, but after operation the patient showed signs of left ventricular failure unresponsive to medical treatment, necessitating pulmonary artery banding. We have found only three similar published cases, and this is the only one with full angiographic documentation. Images PMID:725830

  3. Aortic Root Translocation with Arterial Switch for Transposition of the Great Arteries or Double Outlet Right Ventricle with Ventricular Septal Defect and Pulmonary Stenosis

    PubMed Central

    Lee, Han Pil; Bang, Ji Hyun; Baek, Jae-Suk; Goo, Hyun Woo; Park, Jeong-Jun; Kim, Young Hwee

    2016-01-01

    Double outlet right ventricle (DORV) and transposition of the great arteries (TGA) with ventricular septal defect (VSD) and pulmonary stenosis (PS) are complex heart diseases, the treatment of which remains a surgical challenge. The Rastelli procedure is still the most commonly performed treatment. Aortic root translocation including an arterial switch operation is advantageous anatomically since it has a lower possibility of conduit blockage and the left ventricle outflow tract remains straight. This study reports successful aortic root transpositions in two patients, one with DORV with VSD and PS and one with TGA with VSD and PS. Both patients were discharged without postoperative complications. PMID:27298797

  4. Dynamic outflow tract obstruction in congenitally corrected transposition of the great arteries.

    PubMed

    Zurick, Andrew O; Menon, Venu

    2010-08-01

    Congenitally corrected transposition of the great arteries (CCTGA) is a rare form of congenital heart disease, constituting 0.5% of all congenital heart defects. The incidence of left ventricle (non-systemic ventricle) outflow tract obstruction ranges between 44 and 57%. Herein, we present the case of a 45 year old woman with CCTGA with progressively worsening dyspnea who had been referred for surgical correction of severe systemic ventricle (morphologic right ventricle) atrio-ventricular valve (tricuspid valve) regurgitation. Cardiac magnetic resonance imaging (CMR) and transesophageal imaging (TEE) demonstrated severe systemic ventricle (morphologic right ventricle) contractile dysfunction, as well as dynamic non-systemic ventricle (morphologic left ventricle) outflow tract obstruction due to systolic anterior motion (SAM) of the non-systemic ventricle (morphologic left ventricle) atrio-ventricular valve (mitral valve) with a large membranous ventricular septal aneurysm that protrudes into the outflow tract of the non-systemic ventricle (morphologic left ventricle). Ultimately, our patient was felt to be too high-risk for surgical correction and a course of medical therapy has been pursued. PMID:20191324

  5. Voxelwise atlas rating for computer assisted diagnosis: Application to congenital heart diseases of the great arteries

    PubMed Central

    Zuluaga, Maria A.; Burgos, Ninon; Mendelson, Alex F.; Taylor, Andrew M.; Ourselin, Sébastien

    2015-01-01

    Atlas-based analysis methods rely on the morphological similarity between the atlas and target images, and on the availability of labelled images. Problems can arise when the deformations introduced by pathologies affect the similarity between the atlas and a patient’s image. The aim of this work is to exploit the morphological dissimilarities between atlas databases and pathological images to diagnose the underlying clinical condition, while avoiding the dependence on labelled images. We propose a voxelwise atlas rating approach (VoxAR) relying on multiple atlas databases, each representing a particular condition. Using a local image similarity measure to assess the morphological similarity between the atlas and target images, a rating map displaying for each voxel the condition of the atlases most similar to the target is defined. The final diagnosis is established by assigning the condition of the database the most represented in the rating map. We applied the method to diagnose three different conditions associated with dextro-transposition of the great arteries, a congenital heart disease. The proposed approach outperforms other state-of-the-art methods using annotated images, with an accuracy of 97.3% when evaluated on a set of 60 whole heart MR images containing healthy and pathological subjects using cross validation. PMID:26433929

  6. Modified Shumacker repair of transposition of the great arteries. Surgical and angiocardiographic considerations.

    PubMed

    Tonkin, I L; Allen, R G; Casini, M; Marin-Garcia, J; Anthony, C L; Bell, E D; Paul, R N; Chase, N A

    1983-02-01

    Sixteen patients with transposition of the great arteries, 8 days to 2 1/2 years of age, underwent intra-atrial transposition of venous return by the modified Shumacker technique. A bipedicle flap of right atrial wall was used to direct vena caval return to the mitral valve, and a hinged viable flap of pericardium was used to form the lateral wall of the pulmonary venous pathway. Thirteen patients survived operation and are well to date. Two of the three nonsurvivors were less than 1 month of age at operation, and the third had an associated inlet ventricular septal defect and a straddling tricuspid valve. Early postoperative chest radiographs were compared with preoperative films in each patient. Postoperative findings included minor right pleural effusion in four, minor pneumothorax in two, and paralyzed right hemidiaphragm in one. Two patients required a permanent pacemaker because of the development of sick sinus syndrome 2 and 4 years postoperatively. Each preoperative angiocardiogram was reviewed and compared with postoperative studies in nine patients. The latter demonstrated absence of caval gradients in each, trivial baffle leaks in four, a moderate baffle leak in one, small residual ventricular septal defects in two, and mild tricuspid regurgitation in two patients. PMID:6823149

  7. Aortopulmonary window: a rare mechanism of inter-circulatory mixing and prepared left ventricle in transposition of the great arteries with intact ventricular septum.

    PubMed

    Gopalan Nair, Rajesh; Kalathingathodika, Sajeer; Bastian, Cicy

    2014-08-01

    Transposition of the great arteries with intact ventricular septum and aortopulmonary window is an extremely rare anatomic combination associated with high morbidity and mortality. We report a case of a 3-month-old baby with d-transposition of the great arteries with intact ventricular septum and a large aortopulmonary window as a mechanism of inter-circulatory mixing. PMID:24020981

  8. Sudden cardiac death in adults with congenitally corrected transposition of the great arteries

    PubMed Central

    McCombe, A; Touma, F; Jackson, D; Canniffe, C; Choudhary, P; Pressley, L; Tanous, D; Robinson, Peter J; Celermajer, D

    2016-01-01

    Background Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital heart disease. There have been only few reports of sudden cardiac death (SCD) in patients with ccTGA and reasonable ventricular function. Methods A retrospective review of the medical records of all patients attending our adult congenital heart centre, with known ccTGA. Results From a database of over 3500 adult patients with congenital heart disease, we identified 39 (∼1%) with ccTGA and ‘two-ventricle’ circulations. 65% were male. The mean age at diagnosis was 12.4±11.4 years and the mean age at last time of review was 34.3±11.3 years. 24 patients (56%) had a history of surgical intervention. 8 (19%) had had pacemaker implantation and 2 had had a defibrillator implanted for non-sustained ventricular tachycardia (NSVT). In 544 years of patient follow-up, there had been five cases of SCD in our population; 1 death per 109 patient-years. Two of these patients had had previously documented supraventricular or NSVT. However, they were all classified as New York Heart Association (NYHA) class I or II, and systemic (right) ventricular function had been recorded as normal, mildly or mildly–moderately impaired, at most recent follow-up. Conclusions Our experience suggests the need for improved risk stratification and/or surveillance for malignant arrhythmia in adults with ccTGA, even in those with reasonable functional class on ventricular function. PMID:27493760

  9. Characterizaton of the Vessel Geometry, Flow Mechanics and Wall Shear Stress in the Great Arteries of Wildtype Prenatal Mouse

    PubMed Central

    Yap, Choon Hwai; Liu, Xiaoqin; Pekkan, Kerem

    2014-01-01

    Introduction Abnormal fluid mechanical environment in the pre-natal cardiovascular system is hypothesized to play a significant role in causing structural heart malformations. It is thus important to improve our understanding of the prenatal cardiovascular fluid mechanical environment at multiple developmental time-points and vascular morphologies. We present such a study on fetal great arteries on the wildtype mouse from embryonic day 14.5 (E14.5) to near-term (E18.5). Methods Ultrasound bio-microscopy (UBM) was used to measure blood velocity of the great arteries. Subsequently, specimens were cryo-embedded and sectioned using episcopic fluorescent image capture (EFIC) to obtain high-resolution 2D serial image stacks, which were used for 3D reconstructions and quantitative measurement of great artery and aortic arch dimensions. EFIC and UBM data were input into subject-specific computational fluid dynamics (CFD) for modeling hemodynamics. Results In normal mouse fetuses between E14.5–18.5, ultrasound imaging showed gradual but statistically significant increase in blood velocity in the aorta, pulmonary trunk (with the ductus arteriosus), and descending aorta. Measurement by EFIC imaging displayed a similar increase in cross sectional area of these vessels. However, CFD modeling showed great artery average wall shear stress and wall shear rate remain relatively constant with age and with vessel size, indicating that hemodynamic shear had a relative constancy over gestational period considered here. Conclusion Our EFIC-UBM-CFD method allowed reasonably detailed characterization of fetal mouse vascular geometry and fluid mechanics. Our results suggest that a homeostatic mechanism for restoring vascular wall shear magnitudes may exist during normal embryonic development. We speculate that this mechanism regulates the growth of the great vessels. PMID:24475188

  10. The Concept of the Arch Window in the Spiral Switch of the Great Arteries.

    PubMed

    Chiu, Ing-Sh; Lee, Meng-Luen; Huang, Shu-Chien; Chang, Chung-I; Chen, Yih-Sharng; Wu, Mei-Hwan; Anderson, Robert H

    2016-08-01

    When the arterial switch operation includes the Lecompte maneuver, the arterial trunks are reconnected in parallel, rather than the spiral fashion observed in the normal heart. Thus, although the ventriculo-arterial connections are hemodynamically corrected, the anatomic arrangement cannot be considered normal. We hypothesized that, if feasible, it would be advantageous to restore a spiral configuration for the arterial trunks. In 58 patients, we reconstructed the arterial trunks such that, postoperatively, the pulmonary channel spirals round the aorta, passing to either the right or the left, and branches posteriorly. We compared the outcomes with those in 95 patients undergoing a standard non-spiraling operation over the same period. Average follow-up was 8.2 ± 4.5 years. The estimated 10-year survival was similar in the cohorts, at 94.7 % for those with spiraling trunks, as compared to 90.4 % for those with parallel outflow tracts. Reoperation-free survival at 10 years was not significantly different (87.6 vs. 90.5 %). Supravalvar pulmonary stenosis, aortic neo-coarctation, or left bronchial stenosis, however, was encountered in one-eighth of those undergoing a standard operation. None of these complications occurred in those patients who, postoperatively, had spiraling outflow tracts (P = 0.002). Reconstruction of spiraling trunks after the arterial switch has, thus far, avoided the complications of supravalvar pulmonary stenosis, neo-aortic kinking, or bronchial stenosis. The spiraling arrangement prevents compression of the pulmonary vessels and bronchial tree by the aorta, since it provides a wide window in the new aortic arch. PMID:27272691

  11. Atrial tachyarrhythmias after atrial switch operation for transposition of the great arteries: Treating old surgery with new catheters.

    PubMed

    Houck, Charlotte A; Teuwen, Christophe P; Bogers, Ad J J C; de Groot, Natasja M S

    2016-08-01

    The arterial switch operation has been the procedure of first choice for correction of transposition of the great arteries (TGA) for several decades now. However, a large number of adult patients with TGA nowadays were palliated previously by either a Mustard or a Senning procedure. Atrial tachyarrhythmias (ATs) are frequently observed during long-term follow-up of patients with TGA after these atrial switch corrections and are associated with both morbidity and mortality. Because of the complex postoperative anatomy in these patients, ablative therapy for these tachyarrhythmias can be challenging. The goals of this review are to discuss the most prevalent ATs in patients after the Mustard or Senning procedure and to summarize (long-term) outcomes of ablative therapy. In addition, recent developments in ablative therapy for ATs in this patient population are outlined. PMID:27018378

  12. Is the "I-Sign" in the 3-Vessel and Trachea View a Valid Tool for Prenatal Diagnosis of D-Transposition of the Great Arteries?

    PubMed

    Palatnik, Anna; Gotteiner, Nina L; Grobman, William A; Cohen, Leeber S

    2015-07-01

    Prenatal diagnosis of D-transposition of the great arteries remains less frequent compared to other major congenital heart defects. In this study, we examined how often the 3-vessel and trachea view was abnormal in a large series of prenatally diagnosed cases of D-transposition of the great arteries. We found that an abnormal 3-vessel and trachea view in the shape of an "I" ("I-sign"), which represents an anteriorly displaced aorta, was present in all fetuses with D-transposition of the great arteries when a 3-vessel and trachea view was successfully obtained. Therefore we believe that the 3-vessel and trachea view can be used to reliably detect D-transposition of the great arteries during prenatal sonography. PMID:26112638

  13. Ectopia cordis with a double outlet right ventricle, large ventricular septal defect, malposed great arteries and left ventricular hypoplasia.

    PubMed

    Malik, Rabiya; Zilberman, Mark V; Tang, Liwen; Miller, Susan; Pandian, Natesa G

    2015-03-01

    Ectopia cordis, defined as partial or complete displacement of the heart outside of the thoracic cavity, is a rare congenital malformation. If not surgically corrected during the early years of life, ectopia cordis can prove to be a fatal abnormality. However, due to the presence of multiple intracardiac and extracardiac malformations, a corrective surgery might not always be successful. The pathology of ectopia cordis with a double outlet right ventricle, large ventricular septal defect, malposed great arteries and left ventricular hypoplasia is discussed, highlighting the complexities involved in such a rare disorder. PMID:25409882

  14. Phentolamine as a treatment for poor mixing in transposition of the great arteries with adequate intraatrial communication.

    PubMed

    Galal, M O; El-Naggar, W I; Sharfi, M H

    2005-01-01

    Patients with transposition of the great arteries often show poor mixing for different reasons, even after adequate balloon atrial septostomy. We present a patient with such a lesion whose clinical status improved dramatically after phentolamine was applied. We believe this improvement is due to reduction in afterload caused by the alpha(2) blocker and also possibly as a response to a presumptive effect of the drug on the diastolic function of the right ventricle, allowing more left-to-right shunt across the atrial septal defect. Both phenomena can improve cardiac output in such a situation. PMID:16374695

  15. Diagnostic dilemma with a narrow QRS regular rhythm at normal rates in a patient with corrected transposition of great arteries.

    PubMed

    Shenthar, Jayaprakash; Rai, Maneesh K

    2015-01-01

    A 35 year old male, known case of corrected transposition of great arteries presented with exertional dyspnea and recurrent pre-syncope. 12 lead electrocardiogram revealed a regular rhythm at 75 beats per minute, P waves occurring on the upstroke of T waves and apparent 1:1 P-QRS relationship. The possibilities to be considered - complete AV block with junctional escape, junctional rhythm with 1:1 retrograde conduction, junctional rhythm with isorhythmic AV dissociation and prolonged PR interval have been discussed. PMID:26937115

  16. Diagnostic dilemma with a narrow QRS regular rhythm at normal rates in a patient with corrected transposition of great arteries

    PubMed Central

    Shenthar, Jayaprakash; Rai, Maneesh K.

    2015-01-01

    A 35 year old male, known case of corrected transposition of great arteries presented with exertional dyspnea and recurrent pre-syncope. 12 lead electrocardiogram revealed a regular rhythm at 75 beats per minute, P waves occurring on the upstroke of T waves and apparent 1:1 P-QRS relationship. The possibilities to be considered – complete AV block with junctional escape, junctional rhythm with 1:1 retrograde conduction, junctional rhythm with isorhythmic AV dissociation and prolonged PR interval have been discussed. PMID:26937115

  17. Aneurysm of the Membranous Septum Causing Outflow Obstruction of the Venous Ventricle in Corrected Transposition of the Great Arteries

    PubMed Central

    Gunawan, Antonius; Krajcer, Zvonimir; Leachman, Robert D.

    1982-01-01

    A 58 year-old man with clinical and hemodynamic evidence of subpulmonic stenosis was admitted to our hospital. Angiography revealed corrected transposition of the great arteries and an aneurysm of membranous ventricular septum (AVS) that protruded into the venous outflow tract, causing severe subpulmonic obstruction during systole. The diagnosis was confirmed at surgery, and successful repair of the aneurysm was performed. This was an unusual case because the AVS caused such severe obstruction that the venous ventricular pressure was elevated to a value equal to the systemic level. Images PMID:15226819

  18. Radionuclide measurement of right ventricular function in atrial septal defect, ventricular septal defect and complete transposition of the great arteries

    SciTech Connect

    Baker, E.J.; Shubao, C.; Clarke, S.E.; Fogelman, I.; Maisey, M.N.; Tynan, M.

    1986-05-01

    Right ventricular (RV) function was assessed in 80 patients with congenital heart disease by first-pass and gated equilibrium radionuclide angiography. In 30 patients with a ventricular septal defect (VSD) the mean RV ejection fraction (+/- standard deviation) was 64 +/- 7%. In 30 patients with a secundum atrial septal defect it was 61 +/- 9% and in 20 patients with surgically corrected complete transposition of the great arteries it was 49 +/- 13%. These values are in close agreement with values established with cineangiography for similar groups of patients. The mean ejection fraction in the group with transposition of the great arteries was significantly less than in the group with VSD (p less than 0.001). Phase analysis of the equilibrium studies showed that there was delayed RV contraction in many patients in the absence of conduction abnormalities. This delay was significantly greater in patients with atrial septal defect than in those with VSD (p less than 0.05). There was a strong correlation between size of left-to-right shunt and phase delay in patients with VSD (r = -0.72). Thus, first-pass gated radionuclide angiography provides a valid measurement of RV ejection fraction, and delayed RV contraction on phase analysis may be a sensitive index of early RV dysfunction.

  19. Echocardiographic analysis of regional left ventricular wall motion in children after the arterial switch operation for complete transposition of the great arteries

    SciTech Connect

    Vogel, M.; Smallhorn, J.F.; Trusler, G.A.; Freedom, R.M. )

    1990-05-01

    Regional left ventricular wall motion was assessed by two-dimensional echocardiography in 21 patients with complete transposition of the great arteries at a mean of 2.2 years (range 0.3 to 7) after an arterial switch operation. Fourteen patients had undergone a two-stage and seven patients a primary repair. Twenty patients were found to have echocardiographic images adequate for wall motion analysis. The results of these studies were correlated with thallium-201 myocardial perfusion scans. Left ventricular wall motion was assessed by measuring regional area change in parasternal and apical views. After planimetry of an end-systolic and an end-diastolic frame, the ventricle was divided into eight equal segments and the percent area change was calculated. Both a fixed reference and a floating system correcting for translation and rotation were applied. The measurements in the patient group were compared with normal age-matched values previously obtained in 55 normal infants and children. Wall motion abnormalities, found in seven patients, were located at the apex in three, at the inferior septum and anterolateral wall in one and the inferior, anterolateral and lateral walls in one patient each. All had a myocardial perfusion defect in a corresponding anatomic location. One patient with a small reversible perfusion defect at the basilar septum had normal regional wall motion. The sensitivity of detecting impairment of myocardial perfusion was 0.95. Wall motion abnormalities were found only in patients who had undergone a two-stage repair. Echocardiographic wall motion analysis can be used as a screening method to identify patients with suspected myocardial ischemia after the arterial switch operation.

  20. A comparison of stent‐induced stenosis in coronary and peripheral arteries

    PubMed Central

    Krueger, K D; Mitra, A K; DelCore, M G; Hunter, W J; Agrawal, D K

    2006-01-01

    Background and objectives Restenosis is a complication of interventional procedures such as angioplasty and stenting, often limiting the success of these procedures. Knowledge regarding the relative behaviour of different arteries after these procedures is limited, despite the extensive use of different vascular models. Although the results from studies using different vessels are analysed to predict the behaviour of coronary arteries and other vasculature, direct controlled comparisons between different arteries are necessary for a better understanding of the differential response to restenosis. Methods This study examines the response to stenting in coronary and internal iliac arteries as characterised by intimal hyperplasia and restenosis. In a swine model of in‐stent stenosis, coronary arteries exhibited higher levels of intimal hyperplasia and per cent stenosis than internal iliac arteries. Results After normalisation for injury score, coronary arteries were found to undergo 47% more intimal hyperplasia (p<0.05), whereas per cent stenosis normalised for injury score tended to be higher (p = 0.01). Other measurements reflecting post‐stenting intimal hyperplasia (maximal intimal thickness, medial area) did not exhibit significant differences between the artery groups. Conclusions These results show that coronary vessels are more prone to develop significant intimal hyperplasia and subsequent restenosis than internal iliac vessels. A better insight into how different arteries and arterial components behave is important in understanding and developing newer and better therapeutic measures for restenosis. PMID:16473929

  1. [Value and limitations of coronary artery imaging with the MRI navigator technique. Comparison with coronary angiography results in 37 patients].

    PubMed

    Haffner, C; Germain, Ph; Roul, G; Jahn, Ch; Beaujeux, R; Bareiss, P

    2002-10-01

    The introduction of a non-invasive method of imaging the coronary arteries would be a great advance in daily cardiological practice. The authors report their experience of imaging the coronary arteries with 1 Tesla MRI using the "navigator technique". Twenty-five sections 1.2 mm thick, focused on the proximal left coronary artery, were acquired with a 512 matrix, without injecting contrast during normal respiration with a tolerance on the portion of the right diaphragmatic cupola of 5 mm. Analysis of the coronary segments included in the field of view was performed on native sections after curve reconstruction and on targetedMIP series. A comparison of the results with respect to conventional coronary angiography showed a relatively limited visualisation of the proximal coronary segments because, in addition to the impossibility of carrying out the investigation in 24% of cases (faulty cardiac or respiratory synchronisation, poor signal/noise ratio), only 93% of the left main coronary and 75% of the proximal left anterior descending arteries could be visualised. In the analyzable segments, the diagnostic performances were modest with a global sensitivity of 60.8% and specificity of 91%. With the exception of the left main coronary artery, the sensitivities observed did not make MRI of the coronary arteries a rival to conventional coronary angiography. These limited performances may be explained by the lack of rapidity of the sequences of acquisition compared to the rapid motion of the structures under investigation whose dimensions are 5 to 10 times smaller than their amplitude of excursion. Technical developments are regularly accomplished in this domain, especially 3rd generation sequences in apnoea with injection of contrast media. At present, despite some results reported in the literature, angio-MRI of the coronary arteries cannot be used reliably to guide clinical decisions in coronary artery disease with the exception of some situations like congenital

  2. Trachea-innominate artery fistula: retrospective comparison of treatment methods.

    PubMed

    Yang, F Y; Criado, E; Schwartz, J A; Keagy, B A; Wilcox, B R

    1988-06-01

    A fistula between the trachea and the innominate artery, a potentially fatal complication of tracheostomy, can be managed successfully. We have derived several guidelines from our experience with one such case and from a review of the 36 cases reported in the literature over the last decade. Diagnosis must be established before exsanguination occurs. Bronchoscopy and angiography are often nondiagnostic. Control of hemorrhage and a patent airway are the initial goals of treatment. Interruption of the innominate artery is the definitive treatment, with a low rebleeding rate (7%, 1/14 cases) and good long-term survival (64%, 9/14 cases). Maintenance of continuity of the innominate artery is contraindicated, because of a high rebleeding rate (60%, 6/10 cases) and poor long-term survival (10%, 1/10 cases). There is no convincing evidence that interruption of the innominate artery causes significant neurologic or vascular compromise. PMID:3287639

  3. Measurement of mean arterial pressure: comparison of the Vasotrac monitor with the finger differential oscillometric device.

    PubMed

    Jagomägi, K; Raamat, R; Talts, J; Ragun, U; Tähepõld, P

    2010-01-01

    The Vasotrac monitor provides non-invasive near-continuous blood pressure monitoring and is designed to be an alternative to direct intra-arterial blood pressure (BP) measurement. As compared to radial artery invasive BP and upper arm non-invasive BP, Vasotrac readings have been found to have a good agreement with them. However, discrepancies have been reported when rapid changes in BP exist. In the present study we compared BP measured by the Vasotrac monitor on the radial artery with that recorded on the finger arteries by the differential oscillometric device allowing measurement on the beat-to-beat basis. Comparisons were performed on the mean arterial pressure (MAP) level. Special attention was paid to the signal conditioning before comparison of pressures of different temporal resolution. Altogether 383 paired MAP measurements were made in 14 healthy subjects. Based on all 383 paired measurements, the MAP values measured at the radial artery at rest were 4.8+/-6.0 mm Hg higher than those measured on fingers. The observed difference between the Vasotrac and differential oscillometric device can be explained by different measurement sites. This result is consistent with previous investigations, and the Vasotrac monitor can be considered to adequately track relatively rapid MAP changes on the radial artery. Attention should be paid to a proper signal conditioning before comparison of results obtained by different devices. PMID:20406039

  4. Relationship of white matter network topology and cognitive outcome in adolescents with d-transposition of the great arteries.

    PubMed

    Panigrahy, Ashok; Schmithorst, Vincent J; Wisnowski, Jessica L; Watson, Christopher G; Bellinger, David C; Newburger, Jane W; Rivkin, Michael J

    2015-01-01

    Patients with congenital heart disease (CHD) are at risk for neurocognitive impairments. Little is known about the impact of CHD on the organization of large-scale brain networks. We applied graph analysis techniques to diffusion tensor imaging (DTI) data obtained from 49 adolescents with dextro-transposition of the great arteries (d-TGA) repaired with the arterial switch operation in early infancy and 29 healthy referent adolescents. We examined whether differences in neurocognitive functioning were related to white matter network topology. We developed mediation models revealing the respective contributions of peri-operative variables and network topology on cognitive outcome. Adolescents with d-TGA had reduced global efficiency at a trend level (p = 0.061), increased modularity (p = 0.012), and increased small-worldness (p = 0.026) as compared to controls. Moreover, these network properties mediated neurocognitive differences between the d-TGA and referent adolescents across every domain assessed. Finally, structural network topology mediated the neuroprotective effect of longer duration of core cooling during reparative neonatal cardiac surgery, as well as the detrimental effects of prolonged hospitalization. Taken together, worse neurocognitive function in adolescents with d-TGA is mediated by global differences in white matter network topology, suggesting that disruption of this configuration of large-scale networks drives neurocognitive dysfunction. These data provide new insights into the interplay between perioperative factors, brain organization, and cognition in patients with complex CHD. PMID:25685710

  5. The challenge of staphylococcal pacemaker endocarditis in a patient with transposition of the great arteries endocarditis in congenital heart disease

    SciTech Connect

    Ch'ng, Julie; Chan, William; Lee, Paul; Joshi, Subodh; Grigg, Leanne E.; Ajani, Andrew E

    2003-06-01

    Staphylococcus aureus is a leading cause of septicaemia and infective endocarditis. The overall incidence of staphylococcal bacteraemia is increasing, contributing to 16% of all hospital-acquired bacteraemias. The use of cardiac pacemakers has revolutionized the management of rhythm disturbances, yet this has also resulted in a group of patients at risk of pacemaker lead endocarditis and seeding in the range of 1% to 7%. We describe a 26-year-old man with transposition of the great arteries who had a pacemaker implanted and presented with S. aureus septicaemia 2 years postpacemaker implantation and went on to develop pacemaker lead endocarditis. This report illustrates the risk of endocarditis in the population with congenital heart disease and an intracardiac device.

  6. [Uncorrected transposition of the great arteries and large ventricular septum defect perioperative management of a caesarean section].

    PubMed

    Schummer, W; Schummer, C; Schleussner, E; Fröber, R; Ferrari, M; Fuchs, J

    2005-04-01

    Patients with congenital cyanotic heart disease are a challenge to the anaesthetist due to the individual haemodynamic characteristics. Maintaining a balance between systemic and pulmonary-vascular resistance is crucial. Here we outline the successful perioperative management of a 24-year-old female with uncorrected transposition of the great arteries (D-TGA) and large septal defect of the ventricle (functionally single ventricle). She was transferred to our perinatologic centre in the 32nd week of pregnancy with symptoms of increasing cardial insufficiency. The peripartum management was agreed upon at an interdisciplinary conference and caesarean section was performed in the 35th week of pregnancy with epidural anaesthesia and no significant problems. Due to hypercoagulability and the risk of "paradoxical" embolism, low molecular weight heparin was given for 6 weeks post partum. The infant was underweight and was admitted to the neonatal intensive care unit, where she made a satisfactory progress. PMID:15614542

  7. Exercise Performance in Patients with D-Loop Transposition of the Great Arteries After Arterial Switch Operation: Long-Term Outcomes and Longitudinal Assessment.

    PubMed

    Kuebler, Joseph D; Chen, Ming-Hui; Alexander, Mark E; Rhodes, Jonathan

    2016-02-01

    The first patients to undergo a successful arterial switch operation (ASO) for d-transposition of the great arteries (D-TGA) are now entering their fourth decade of life. Past studies of ASO survivors' exercise function have yielded conflicting results. We therefore undertook this study to describe the current function of ASO survivors, to identify factors related to inferior exercise performance and to determine whether their exercise function tends to deteriorate over time. A retrospective cohort study was designed examining all patients with D-TGA after the ASO who underwent comprehensive cardiopulmonary exercise testing (CPET). Patients with palliative surgery prior to ASO, ventricular hypoplasia or severe valvar dysfunction were excluded from the study. Data from CPETs in which the peak respiratory exchange ratio was <1.09 were also excluded. We identified 113 patients who met entry criteria and had 186 CPX at our institution between 1/2002 and 1/2013; 41 patients had at least 2 qualifying CPX. Mean age at the time of the initial test was 17 ± 1 year. Peak oxygen consumption (VO2) averaged 84 ± 2 % predicted. Peak VO2 was lower among patients with repaired ventricular septal defects (82 ± 4 vs. 86 ± 3 % predicted; p < 0.05) and among patients with ≥ moderate right-sided obstructive lesions (77 ± 5 vs. 87 ± 3 % predicted; p < 0.05). Surgery prior to 1991 was also associated with a lower peak VO2 (81 ± 3 vs. 87 ± 3 % predicted; p < 0.01). The mean % predicted peak heart rate was 92 ± 1 %, with no significant difference between any of the subgroups. Non-diagnostic exercise-induced STT changes developed in 10 patients (12 studies). In the subgroup with at least 2 exercise tests, the annual decline in % predicted peak VO2 was quite slow (-0.3 % points/year; p < 0.01 vs. expected normal age-related decline). The exercise capacity of ASO survivors is well preserved and is only mildly reduced compared to normal subjects. Moreover, there is only a slight

  8. Circulating Annexin A5 Levels after Atrial Switch for Transposition of the Great Arteries: Relationship with Ventricular Deformation and Geometry

    PubMed Central

    Lai, Clare T. M.; Chow, Pak-cheong; Wong, Sophia J.; Chan, Koon-wing; Cheung, Yiu-fai

    2012-01-01

    Background Inflammatory cytokines, cardiomyocyte apoptosis, and altered collagen turnover may contribute to unfavourable ventricular remodeling. This unfavourable ventricular remodelling is well documented in patients after atrial switch operation for complete transposition of the great arteries. We therefore tested if levels of circulating markers of inflammation, apoptosis, collagen synthesis, and extracellular matrix degradation are altered in patients after atrial switch operation for transposition of the great arteries. Methods and Results Circulating tumour necrosis factor (TNF)-α, annexin A5 (AnxA5), carboxy-terminal propeptide of type I procollagen (PICP), amino-terminal propeptide of type III procollagen (PIIINP), matrix metalloproteinase-1 (MMP-1), and tissue inhibitor of metalloproteinase-1 (TIMP-1) levels were determined in 27 patients aged 25.2±3.1 years and 20 controls. Ventricular myocardial deformation and left ventricular eccentricity index (EI) were determined by speckle tracking and two-dimensional echocardiography, respectively. Compared with controls, patients had significantly higher circulating AnxA5 (p<0.001) and TNF-α (p = 0.018) levels, but similar PICP, PIIINP, MMP-1 and TIMP-1 levels. For the whole cohort, plasma AnxA5 correlated with serum TNF-α (p = 0.002), systemic ventricular global longitudinal strain (GLS) and systolic and early diastolic strain rate (all p<0.001), and subpulmonary ventricular GLS and early diastolic strain rate (both p<0.001). In patients, plasma AnxA5 level correlated positively with subpulmonary ventricular EI (p = 0.027). Multiple linear regression analysis identified systemic ventricular GLS (β = −0.50, p<0.001) and serum TNF-α (β = 0.29, p = 0.022) as significant correlates of plasma AnxA5. Conclusions Elevated plasma AnxA5 level in patients after atrial switch operation is associated with impaired systemic myocardial deformation, increased subpulmonary ventricular

  9. Comparison of precipitable water vapor measurements obtained by microwave radiometry and radiosondes at the Southern Great ...

    SciTech Connect

    Lesht, B.M.; Liljegren, J.C.

    1996-12-31

    Comparisons between the precipitable water vapor (PWV) estimated by passive microwave radiometers (MWRs) and that obtained by integrating the vertical profile of water vapor density measured by radiosondes (BBSS) have generally shown good agreement. These comparisons, however, have usually been done over rather short time periods and consequently within limited ranges of total PWV and with limited numbers of radiosondes. We have been making regular comparisons between MWR and BBSS estimates of PWV at the Southern Great Plains Cloud and Radiation Testbed (SGP/CART) site since late 1992 as part of an ongoing quality measurement experiment (QME). This suite of comparisons spans three annual cycles and a relatively wide range of total PWV amounts. Our findings show that although for the most part the agreement is excellent, differences between the two measurements occur. These differences may be related to the MWR retrieval of PWV and to calibration variations between radiosonde batches.

  10. Senning operation for very low birth weight infant with transposition of the great arteries: one of the smallest cases in the world.

    PubMed

    Fujimoto, Yoshifumi; Suehiro, Shoichi; Wada, Hiromi; Oda, Teiji

    2016-07-01

    We report a case of a Senning operation for very low birth weight infant weighing 1,168 g with transposition of the great arteries. The patient underwent a Senning operation on 62 days, 1,700 g after the first palliation. In this case, the orifice of the left anterior descending artery was located in sinus 1 (left posterior facing sinus), but we could not find orifices of both right coronary artery and left circumflex artery before the Senning operation. The surgical procedure of the Senning operation is typical one, but we used flesh autopericardial patch to cover the roof of the new pulmonary vein chamber to get an enough size. The patient recovered with no cardiac events after the repair. PMID:25392255

  11. Dextrocardia and corrected transposition of the great arteries (I,D,D) in a case of Kartagener's syndrome: a unique association.

    PubMed

    Bitar, F F; Shbaro, R; Mroueh, S; Yunis, K; Obeid, M

    1998-04-01

    Kartagener's syndrome (KS) usually includes mirror-image dextrocardia. The incidence of congenital heart disease in KS is comparable with that in the general population. This paper reports on a case of Kartagener's syndrome associated with dextrocardia, corrected transposition of the great arteries (I,D,D), ventricular septal defect, and valvar pulmonary stenosis in an 8-year-old girl. PMID:9562943

  12. [Use of non-fluoroscopic mapping in recurrent atrioventricular nodal reentrant tachycardia in a patient with corrected transposition of the great arteries].

    PubMed

    Aristizábal, Julián; Uribe, William; Duque, Mauricio; Marín, Jorge; Medina, Eduardo; Velásquez, Jorge; Femenía, Francisco; Baranchuk, Adrían

    2013-01-01

    The anatomy in congenital corrected transposition of the great arteries is complex and the conduction system may experience large degrees of variation. Invasive procedures should be done with the use of the highest possible technological sources to warrant success. We describe here, a patient with recurrent atrioventricular node reentry tachycardia where non-fluoroscopic navigation system helped in a complex ablation. PMID:23906743

  13. Isolated congenitally corrected transposition of the great arteries with dextroversion discovered incidentally in a patient with cocaine-induced acute myocardial infarction

    PubMed Central

    Tandon, Anumeha; Bose, Rahul; Yoon, Anthony D.

    2016-01-01

    Complex cardiac congenital anomalies can occasionally be found in adult patients who have no knowledge of their condition. Here we present the case of a 27-year-old man with cocaine-induced acute myocardial infarction in whom an isolated congenitally corrected transposition of the great arteries with dextroversion was discovered incidentally. PMID:27034558

  14. Executive Function and Theory of Mind in School-Aged Children after Neonatal Corrective Cardiac Surgery for Transposition of the Great Arteries

    ERIC Educational Resources Information Center

    Calderon, Johanna; Bonnet, Damien; Courtin, Cyril; Concordet, Susan; Plumet, Marie-Helene; Angeard, Nathalie

    2010-01-01

    Aim: Cardiac malformations resulting in cyanosis, such as transposition of the great arteries (TGA), have been associated with neurodevelopmental dysfunction. The purpose of this study was to assess, for the first time, theory of mind (ToM), which is a key component of social cognition and executive functions in school-aged children with TGA.…

  15. Trajectories of Parasympathetic Nervous System Function before, during, and after Feeding in Infants with Transposition of the Great Arteries

    PubMed Central

    Harrison, Tondi M.

    2011-01-01

    Background Compromised parasympathetic response to stressors may underlie feeding difficulties in infants with complex congenital heart defects, but little is known about the temporal pattern of parasympathetic response across phases of feeding. Objectives To describe initial data exploration of trajectories of parasympathetic response to feeding in 15 infants with surgically corrected transposition of the great arteries and to explore effects of feeding method, feeding skill, and maternal sensitivity on trajectories. Method In this descriptive, exploratory study, parasympathetic function was measured using high frequency heart rate variability (HF HRV), feeding skill was measured using the Early Feeding Skills assessment, and maternal sensitivity was measured using the Parent-Child Early Relational Assessment. Data were collected before, during, and after feeding at 2 weeks and 2 months of age. Trajectories of parasympathetic function and relationships with possible contributing factors were examined graphically. Results Marked between-infant variability in HF HRV across phases of feeding was apparent at both ages, although attenuated at 2 months. Four patterns of HF HRV trajectories across phases of feeding were identified and associated with feeding method, feeding skill, and maternal sensitivity. Developmental increases in HF HRV were apparent in most breastfed, but not bottle-fed, infants. Discussion This exploratory data analysis provided critical information in preparation for a larger study in which varying trajectories and potential contributing factors can be modeled in relationship to infant outcomes. Findings support inclusion of feeding method, feeding skill, and maternal sensitivity in modeling parasympathetic function across feeding. PMID:21543958

  16. Pulmonary arterial hypertension: a comparison between children and adults

    PubMed Central

    Barst, R.J.; Ertel, S.I.; Beghetti, M.; Ivy, D.D.

    2011-01-01

    The characteristics of pulmonary arterial hypertension (PAH), including pathology, symptoms, diagnosis and treatment are reviewed in children and adults. The histopathology seen in adults is also observed in children, although children have more medial hypertrophy at presentation. Both populations have vascular and endothelial dysfunction. Several unique disease states are present in children, as lung growth abnormalities contribute to pulmonary hypertension. Although both children and adults present at diagnosis with elevations in pulmonary vascular resistance and pulmonary artery pressure, children have less heart failure. Dyspnoea on exertion is the most frequent symptom in children and adults with PAH, but heart failure with oedema occurs more frequently in adults. However, in idiopathic PAH, syncope is more common in children. Haemodynamic assessment remains the gold standard for diagnosis, but the definition of vasoreactivity in adults may not apply to young children. Targeted PAH therapies approved for adults are associated with clinically meaningful effects in paediatric observational studies; children now survive as long as adults with current treatment guidelines. In conclusion, there are more similarities than differences in the characteristics of PAH in children and adults, resulting in guidelines recommending similar diagnostic and therapeutic algorithms in children (based on expert opinion) and adults (evidence-based). PMID:21357924

  17. Asymmetric distribution of the pulmonary blood flow between the right and left lungs in d-transposition of the great arteries.

    PubMed

    Muster, A J; Paul, M H; Van Grondelle, A; Conway, J J

    1976-09-01

    Pulmonary angiograms, radionuclide lung images and chest roentgenograms were evaluated regarding the incidence, magnitude and natural evolution of maldistribution of the pulmonary blood flow between the lungs in 63 patients with dextrotransposition of the great arteries. Approximately half of these patients had some degree of greater perfusion of the right relative to the left lung. A significant correlation was demonstrated between the incidence of this maldistribution of blood flow and the angulation between the main and the right pulmonary arteries. For any given angulation between these vessels, additional pulmonary stenosis increased the incidence of disparity in perfusion. Our observations suggest the following developmental mechanisms: The maldistribution in flow results from the abnormal rightward inclination of the main pulmonary artery in the transposition malformation which straightens the flow axis from the main to the right pulmonary artery. Under these circumstances the momentum of the blood in the main pulmonary artery carries the blood preferentially into the right pulmonary artery. This momentum is increased when there is stenosis of the left ventricular outflow tract. Consequent differences in the mechanical properties of the two pulmonary vascular beds can increase this maldistribution. The disparity in perfusion between the lungs is not present in newborns with d-transposition, appears to be progressive in severity and in time may result in almost complete cessation of effective perfusion of the left lung. The effect of the Mustard operation on this abnormality of flow is discussed. PMID:961610

  18. Genetic diversity of Diporeia in the Great Lakes: comparison of Lake Superior to the other Great Lakes

    EPA Science Inventory

    Abundances of Diporeia have dropped drastically in the Great Lakes, except in Lake Superior, where data suggest that population counts actually have risen. Various ecological, environmental, or geographic hypotheses have been proposed to explain the greater abundance of Lake Supe...

  19. Cardiovascular response to exercise training in the systemic right ventricle of adults with transposition of the great arteries

    PubMed Central

    Shafer, K M; Janssen, L; Carrick-Ranson, G; Rahmani, S; Palmer, D; Fujimoto, N; Livingston, S; Matulevicius, S A; Forbess, L W; Brickner, B; Levine, B D

    2015-01-01

    We aimed to assess the haemodynamic effects of exercise training in transposition of the great arteries (TGA) patients with systemic right ventricles (SRVs). TGA patients have limited exercise tolerance and early mortality due to systemic (right) ventricular failure. Whether exercise training enhances or injures the SRV is unclear. Fourteen asymptomatic patients (34 ± 10 years) with TGA and SRV were enrolled in a 12 week exercise training programme (moderate and high-intensity workouts). Controls were matched on age, gender, BMI and physical activity. Exercise testing pre- and post- training included: (a) submaximal and peak; (b) prolonged (60 min) submaximal endurance and (c) high-intensity intervals. Oxygen uptake (; Douglas bag technique), cardiac output (, foreign-gas rebreathing), ventricular function (echocardiography and cardiac MRI) and serum biomarkers were assessed. TGA patients had lower peak , , and stroke volume (SV), a blunted / slope, and diminished SV response to exercise (SV increase from rest: TGA = 15.2%, controls = 68.9%, P < 0.001) compared with controls. After training, TGA patients increased peak by 6 ± 8.5%, similar to controls (interaction P = 0.24). The magnitude of SV reserve on initial testing correlated with training response (r = 0.58, P = 0.047), though overall, no change in peak was observed. High-sensitivity troponin T (hs-TnT) and N-terminal prohormone of brain naturetic peptide (NT pro-BNP) were low and did not change with acute exercise or after training. Our data show that TGA patients with SRVs in this study safely participated in exercise training and improved peak . Neither prolonged submaximal exercise, nor high-intensity intervals, nor short-term exercise training seem to injure the systemic right ventricle. Key Points Patients with transposition of the great arteries (TGA) and systemic right ventricles have premature congestive heart failure; there is also a growing concern that athletes who perform

  20. Myocardial hypoperfusion detected by cardiac computed tomography in an adult patient with heart failure after classic repair for corrected transposition of the great arteries.

    PubMed

    Okayama, Satoshi; Seno, Ayako; Soeda, Tsunenari; Takami, Yasuhiro; Horii, Manabu; Uemura, Shiro; Saito, Yoshihiko

    2011-08-01

    A 69-year-old male with a history of classic repair for corrected transposition of the great arteries (TGA) arrived at our hospital with dyspnoea upon exertion. Echocardiography revealed severe dilation and diffuse hypokinesis of the systemic ventricle without obvious valvular dysfunction. Cardiac computed tomography (CT) revealed no significant stenosis. However, the morphological right coronary artery (CA) on the left side was unequally distributed to the large systemic ventricle and was mostly obscured, especially on the anterior wall. A low attenuation area in the anterior wall of the systemic ventricle and prominent trabeculations suggested ischaemia or infarction. We considered that chronic myocardial hypoperfusion due to an inadequate coronary arterial supply was one cause of the exacerbated heart failure long after the classic repair. Cardiac CT is useful for evaluating the distribution of the CA and to predict blood supply to the myocardium in corrected TGA. PMID:21894815

  1. Quantitative comparison of cerebral artery development in metatherians and monotremes with non-human eutherians.

    PubMed

    Ashwell, Ken W S; Shulruf, Boaz

    2016-03-01

    A quantitative comparison of the internal diameters of cerebral feeder arteries (internal carotid and vertebral) and the aorta in developing non-human eutherians, metatherians and monotremes has been made, with the aim of determining if there are differences in cerebral arterial flow between the three infraclasses of mammals such as might reflect differences in metabolism of the developing brain. There were no significant differences between eutherians and metatherians in the internal radius of the aorta or the thickness of the aortic wall, but aortic internal radius was significantly smaller in developing monotremes than therians at the < 10 mm body length range. Aortic thickness in the developing monotremes also rose at a slower rate relative to body length than in metatherians or eutherians. The sums of the internal calibres of the internal carotid and vertebral arteries were significantly lower in metatherians as a group and monotremes compared with non-human eutherians at body lengths up to 20 mm and in metatherians at > 20 mm body length. The internal calibre of the internal carotids relative to the sum of all cerebral feeder arteries was also significantly lower in monotremes at < 10 mm body length compared with eutherians. It was noted that dasyurids differed from other metatherians in several measures of cerebral arterial calibre and aortic internal calibre. The findings suggest that: (i) both aortic outflow and cerebral arterial inflow may be lower in developing monotremes than in therians, particularly at small body size (< 20 mm); (ii) cerebral inflow may be lower in some developing metatherians than non-human eutherians; and (iii) dasyurids have unusual features of cerebral arteries possibly related to the extreme immaturity and small size at which they are born. The findings have implications for nutritional sourcing of the developing brain in the three infraclasses of mammals. PMID:26644330

  2. Summary of Clinical Experience of Modified Double Root Translocation in the Management of Complete Transposition of Great Arteries With Left Ventricular Outflow Tract Obstruction.

    PubMed

    Yang, Bin; Xu, Jing; Zhou, Zhiming; Wang, Ke; Chen, Jianchao; Chen, Hongling; Wen, Meng; Liang, Qiaoru

    2016-07-27

    To summarize the therapeutic effects of modified double root translocation (MDRT) in the management of congenital heart disease-transposition of great arteries (TGA) with ventricular septum defect (VSD) and left ventricular outflow tract obstruction (LVOTO). From May 2013 to March 2015, we treated 6 patients (4 males, 2 females, aged from 1 year and 8 months old to 5 years old) with complete transposition of great arteries with left ventricular outflow tract obstruction, SaO2 54 ± 7.3%; the outflow velocity of the left ventricular or pulmonary valve measured by Doppler was 4.46 ± 0.15 m/s, and the Nakata index was 217 ± 32 cm(2)/m(2). We carried out a double root translocation operation on these 6 patients.One patient developed low cardiac output syndrome 4 hours after the operation. Extracorporeal membrane oxygenation (ECMO) was performed, but the patient died of multiple organ failure. The other 5 patients all recovered and were discharged from the hospital. During the 3-month to 2-year follow-up period, these 5 patients all demonstrated NYHA Class I or NYHA Class II LVEF (65 ± 2.7) %; 4 had mild pulmonary regurgitation, 1 moderate pulmonary regurgitation; 3 no aortic regurgitation, and 2 micro aortic regurgitation, SaO2 99 ± 0.4%.Modified double root translocation is an effective treatment method in the management of complete transposition of great arteries with left ventricular outflow tract obstruction. PMID:27396558

  3. Noninvasive Assessment of Vascular Function in Postoperative Cardiovascular Disease (Coarctation of the Aorta, Tetralogy of Fallot, and Transposition of the Great Arteries).

    PubMed

    Mivelaz, Yvan; Leung, Mande T; Zadorsky, Mary Terri; De Souza, Astrid M; Potts, James E; Sandor, George G S

    2016-08-15

    Using noninvasive techniques, we sought to assess arterial stiffness, impedance, hydraulic power, and efficiency in children with postoperative tetralogy of Fallot (TOF), coarctation of the aorta (COA), and transposition of the great arteries (TGAs). Results were compared with those of healthy peers. Fifty-five children with repaired congenital heart disease (24 TOFs, 20 COAs, and 11 TGAs) were compared with 55 age-matched control subjects (CTRL). Echocardiographic Doppler imaging and carotid artery applanation tonometry were preformed to measure aortic flow, dimensions, and calculate pulse wave velocity, vascular impedance and arterial stiffness indexes, hydraulic power (mean and total), and hydraulic efficiency (HE) which were calculated using standard fluid dynamics equations. All congenital heart disease subgroups had higher pulse wave velocity than CTRL. Only the COA group had higher characteristic impedance. Mean power was higher in TGA than in CTRL and TOF, and total power was higher in TGA than in CTRL and TOF. Hydraulic efficiency was higher in TOF than in COA and TGA. In conclusion, children with TOF, COA, and TGA have stiffer aortas than CTRL. These changes may be related to intrinsic aortic abnormalities, altered integrity of the aorta due to surgical repair, and/or acquired postsurgery. These patients may be at increased long-term cardiovascular risk, and long-term follow-up is important for monitoring and assessment of efforts to reduce risk. PMID:27401272

  4. Long-Term Follow-Up of the Half-Turned Truncal Switch Operation for Transposition of the Great Arteries with Ventricular Septal Defect and Pulmonary Stenosis

    PubMed Central

    Lee, Jong Uk; Jang, Woo Sung; Lee, Young Ok; Cho, Joon Yong

    2016-01-01

    The half-turned truncal switch (HTTS) operation has been reported as an alternative to the Rastelli or réparation à l’étage ventriculaire procedures. HTTS prevents left ventricular outflow tract (LVOT) obstruction in patients with complete transposition of the great arteries (TGA) with a ventricular septal defect (VSD) and pulmonary stenosis (PS), or in those with a Taussig-Bing anomaly with PS. The advantages of the HTTS procedure are avoidance of late LVOT or right ventricular outflow tract (RVOT) obstruction, and of overstretching of the pulmonary artery. We report the case of a patient who underwent HTTS for TGA with VSD and PS, in whom there was no LVOT obstruction and only mild aortic regurgitation and mild RVOT obstruction, including observations at 12-year follow-up. Our experience with long-term follow-up of HTTS supports a solution for late complications after the Rastelli procedure. PMID:27064891

  5. Presentation and therapy of spontaneous coronary artery dissection and comparisons of postpartum versus nonpostpartum cases.

    PubMed

    Ito, Hiroki; Taylor, Lee; Bowman, Martha; Fry, Edward T A; Hermiller, James B; Van Tassel, James W

    2011-06-01

    Predisposing risk factors, clinical course, and prognosis of spontaneous coronary artery dissection (SCAD) remain poorly understood. We reviewed medical records and coronary angiograms of patients admitted to our institution with the diagnosis of SCAD from 1999 through 2010. A definite diagnosis of SCAD required the agreement of 2 blinded board-certified interventional cardiologists who reviewed all images separately. Baseline characteristics of patients (n = 23) included mean age 45 ± 11 years, female gender in all (100%), history of hypertension in 13 (57%), and postpartum in 7 (30%). Eleven (48%) had ST-segment elevation on initial electrocardiogram. SCAD involved the left main in 5 patients (21.7%), left anterior descending coronary artery in 16 (70%), left circumflex coronary artery in 8 (35%), and right coronary artery in 6 (26%). Four patients (17%) underwent coronary stenting and 6 (26%) required urgent bypass surgery. Comparison between postpartum and nonpostpartum patients revealed significant differences in mean peak troponin levels: 50 ± 34 ng/ml vs 21 ± 23, p = 0.04, mean left ventricular ejection fraction: 34 ± 6% vs 49 ± 9, p <0.01, proximal coronary segment distribution: 6 (86%) vs 3 (19%), p = 0.004, and left anterior descending coronary artery distribution: 7 (100%) vs 9 (56%), p = 0.04, respectively. Repeat coronary angiographies were performed in 11 patients (46%) during a mean follow-up of 39 ± 38 months and 10 (91%) were found to have healed SCAD, including those who had undergone bypass surgery. In conclusion, our patients with SCAD were characterized by female gender, absence of coronary risk factors, and a high rate of vascular healing without residual stenosis. Larger infarct was found in postpartum patients. PMID:21439531

  6. Characterization and comparison of phytoplankton in selected lakes of five Great Lakes area national parks

    USGS Publications Warehouse

    Nevers, Meredith Becker; Whitman, Richard L.

    2004-01-01

    Phytoplankton species have been widely used as indicators of lake conditions, and they may be useful for detecting changes in overall lake condition. In an attempt to inventory and monitor its natural resources, the National Park Service wants to establish a monitoring program for aquatic resources in the Great Lakes Cluster National Parks. This study sought to establish baseline information on the phytoplankton and water chemistry of selected lakes in five national parks in a preliminary effort toward establishing a long-term monitoring program. Phytoplankton and water chemistry samples were collected from ten lakes in five national parks over a two-year period. A total of 176 taxa were identified during the study. Northern lakes generally had higher Shannon-Wiener diversity and clustered together in similarity. Lakes exhibited a south to north gradient of many water chemistry variables, with northern lakes having lower hardness, sulfate, turbidity, and temperature and higher dissolved oxygen. Chloride and sulfate concentrations were the variables that best explained variation among phytoplankton in the ten lakes. A monitoring plan will have to incorporate the differences among lakes, but by coordinating the effort, comparisons within and among parks and other regions will prove useful for determining environmental change.

  7. Functional comparison of endothelin receptors in human and rat pulmonary artery smooth muscle.

    PubMed

    Bialecki, R A; Fisher, C S; Murdoch, W W; Barthlow, H G; Bertelsen, D L

    1997-02-01

    The receptors mediating arterial smooth muscle contraction to endothelins (ET) differ among species and origin of vascular bed. We characterized ET receptors mediating contraction of endothelium-denuded human intralobar pulmonary artery (hIPA) and rat intralobar (rIPA) and extralobar left branch (rLPA) pulmonary artery with ET-1, ET-2, ET-3, sarafotoxin S6c, sarafotoxin S6b, and ET receptor antagonists in vitro. Rat aorta was studied for comparison. Each vascular segment showed concentration-dependent contraction with a rank order sensitivity (pD2) profile of ET-1 > or = ET-2 = sarafotoxin S6b > ET-3. Maximum contraction to ET-1 was greater than to sarafotoxin S6c in all preparations. Responses of rIPA and rLPA to sarafotoxin S6c were conspicuous when compared with hIPA or aorta. The ET(A) receptor blockers BQ-123 and BMS-182874 competitively antagonized ET-1 responses of hIPA and aorta, but not rLPA. The ET(B) receptor antagonist BQ-788 attenuated contractions of rIPA and rLPA to ET-3 and sarafotoxin S6c, respectively. In conclusion, ET(B)-mediated contraction of endothelium-denuded conduit pulmonary arteries varies among species and may contribute more to contraction of rIPA and rLPA than of hIPA and aorta, although maximum ET(B)-mediated contraction is smaller than that mediated by the ET(A) receptor. PMID:9124371

  8. Sex comparisons in muscle sympathetic nerve activity and arterial pressure oscillations during progressive central hypovolemia

    PubMed Central

    Carter III, Robert; Hinojosa-Laborde, Carmen; Convertino, Victor A

    2015-01-01

    Increased tolerance to central hypovolemia is generally associated with greater sympathoexcitation, high-frequency oscillatory patterns of mean arterial pressure (MAP), and tachycardia. On average, women are less tolerant to central hypovolemia than men; however, the autonomic mechanisms governing these comparisons are not fully understood. We tested the hypothesis that women with relatively high tolerance (HT) to central hypovolemia would display similar physiological reserve capacity for sympathoexcitation and oscillations in MAP at presyncope compared to HT men. About 10 men and five women were exposed to progressive lower body negative pressure (LBNP) until the presence of presyncopal symptoms. Based on our previous classification system, all subjects were classified as HT because they completed at least −60 mmHg LBNP. Muscle sympathetic serve activity (MSNA) was measured directly from the peroneal nerve via microneurography and arterial pressure (AP) was measured at the finger by photoplethysmography. LBNP time to presyncope was less (P < 0.01) in women (1727 ± 70 sec) than in men (2022 ± 201 sec). At presyncope, average MSNA in men (50 ± 12 bursts/min) and women (51 ± 7 bursts/min) was similar (P = 0.87). Coincident with similar stroke volume (SV) at presyncope, women had similar MAP and heart rates. However, women had less physiological reserve capacity for SV, AP-MSNA coherence, and oscillations in the high-frequency (HF) components of arterial pressure compared to men. Contrary to our hypothesis, lower tolerance to central hypovolemia in women was not associated with sympathoexcitation, but can be explained, in part by lower physiological reserve to elicit oscillatory patterns in AP, maintenance of AP-MSNA coherence and SV when compared to men. PMID:26109186

  9. Sex comparisons in muscle sympathetic nerve activity and arterial pressure oscillations during progressive central hypovolemia.

    PubMed

    Carter, Robert; Hinojosa-Laborde, Carmen; Convertino, Victor A

    2015-06-01

    Increased tolerance to central hypovolemia is generally associated with greater sympathoexcitation, high-frequency oscillatory patterns of mean arterial pressure (MAP), and tachycardia. On average, women are less tolerant to central hypovolemia than men; however, the autonomic mechanisms governing these comparisons are not fully understood. We tested the hypothesis that women with relatively high tolerance (HT) to central hypovolemia would display similar physiological reserve capacity for sympathoexcitation and oscillations in MAP at presyncope compared to HT men. About 10 men and five women were exposed to progressive lower body negative pressure (LBNP) until the presence of presyncopal symptoms. Based on our previous classification system, all subjects were classified as HT because they completed at least -60 mmHg LBNP. Muscle sympathetic serve activity (MSNA) was measured directly from the peroneal nerve via microneurography and arterial pressure (AP) was measured at the finger by photoplethysmography. LBNP time to presyncope was less (P < 0.01) in women (1727 ± 70 sec) than in men (2022 ± 201 sec). At presyncope, average MSNA in men (50 ± 12 bursts/min) and women (51 ± 7 bursts/min) was similar (P = 0.87). Coincident with similar stroke volume (SV) at presyncope, women had similar MAP and heart rates. However, women had less physiological reserve capacity for SV, AP-MSNA coherence, and oscillations in the high-frequency (HF) components of arterial pressure compared to men. Contrary to our hypothesis, lower tolerance to central hypovolemia in women was not associated with sympathoexcitation, but can be explained, in part by lower physiological reserve to elicit oscillatory patterns in AP, maintenance of AP-MSNA coherence and SV when compared to men. PMID:26109186

  10. Successful biventricular repair of double-outlet right ventricle with transposition of the great arteries, pulmonary stenosis, and straddling mitral valve.

    PubMed

    Koshiyama, Hiroshi; Aoki, Mitsuru; Akiyama, Syou; Nakamura, Yuki; Hagino, Ikuo; Fujiwara, Tadashi

    2014-04-01

    A 9-month-old boy with polysplenia, double-outlet right ventricle (DORV), transposition of the great arteries (TGA), a large ventricular septal defect (VSD), straddling mitral valve, pulmonary stenosis (PS), and a normal-sized pulmonary annulus underwent ventricular septation at the right side of the straddling mitral chord as well as an en bloc truncal switch procedure to minimize reduction of right ventricular (RV) volume from the intraventricular conduit. Echocardiography 5 months postoperatively showed laminar flow without obstruction through both ventricular outflow tracts, normal ventricular function, trivial aortic regurgitation, and mild pulmonary regurgitation (PR). This procedure is a good option for biventricular repair in the presence of a straddling mitral valve. PMID:24694423

  11. Primary Prevention of Sudden Cardiac Death in Adults with Transposition of the Great Arteries: A Review of Implantable Cardioverter-Defibrillator Placement

    PubMed Central

    Cedars, Ari M.

    2015-01-01

    Transposition of the great arteries encompasses a set of structural congenital cardiac lesions that has in common ventriculoarterial discordance. Primarily because of advances in medical and surgical care, an increasing number of children born with this anomaly are surviving into adulthood. Depending upon the subtype of lesion or the particular corrective surgery that the patient might have undergone, this group of adult congenital heart disease patients constitutes a relatively new population with unique medical sequelae. Among the more common and difficult to manage are cardiac arrhythmias and other sequelae that can lead to sudden cardiac death. To date, the question of whether implantable cardioverter-defibrillators should be placed in this cohort as a preventive measure to abort sudden death has largely gone unanswered. Therefore, we review the available literature surrounding this issue. PMID:26413012

  12. Evaluation and comparison of gross primary production estimates for the Northern Great Plains grasslands

    USGS Publications Warehouse

    Zhang, L.; Wylie, B.; Loveland, T.; Fosnight, E.; Tieszen, L.L.; Ji, L.; Gilmanov, T.

    2007-01-01

    Two spatially-explicit estimates of gross primary production (GPP) are available for the Northern Great Plains. An empirical piecewise regression (PWR) GPP model was developed from flux tower measurements to map carbon flux across the region. The Moderate Resolution Imaging Spectrometer (MODIS) GPP model is a process-based model that uses flux tower data to calibrate its parameters. Verification and comparison of the regional PWR GPP and the global MODIS GPP are important for the modeling of grassland carbon flux. This study compared GPP estimates from PWR and MODIS models with five towers in the grasslands. Among them, PWR GPP and MODIS GPP showed a good agreement with tower-based GPP at three towers. The global MODIS GPP, however, did not agree well with tower-based GPP at two other towers, probably because of the insensitivity of MODIS model to regional ecosystem and climate change and extreme soil moisture conditions. Cross-validation indicated that the PWR model is relatively robust for predicting regional grassland GPP. However, the PWR model should include a wide variety of flux tower data as the training data sets to obtain more accurate results. In addition, GPP maps based on the PWR and MODIS models were compared for the entire region. In the northwest and south, PWR GPP was much higher than MODIS GPP. These areas were characterized by the higher water holding capacity with a lower proportion of C4 grasses in the northwest and a higher proportion of C4 grasses in the south. In the central and southeastern regions, PWR GPP was much lower than MODIS GPP under complicated conditions with generally mixed C3/C4 grasses. The analysis indicated that the global MODIS GPP model has some limitations on detecting moisture stress, which may have been caused by the facts that C3 and C4 grasses are not distinguished, water stress is driven by vapor pressure deficit (VPD) from coarse meteorological data, and MODIS land cover data are unable to differentiate the sub

  13. Left ventricular outflow tract obstruction in complete transposition of the great arteries with intact ventricular septum. A cross sectional echocardiography study.

    PubMed Central

    Robinson, P J; Wyse, R K; Macartney, F J

    1985-01-01

    The roles of posterior bulging of the interventricular septum (septal bulge) and of systolic septal mitral apposition in patients with simple transposition of the great arteries are not known. Cross sectional echocardiograms of 40 such patients were reviewed (after exclusion of those with fixed left ventricular outflow tract obstruction) and haemodynamic findings were compared with long and short axis measurements within the left ventricle. There was no significant correlation between the degree of septal bulge and systolic gradient across the left ventricular outflow tract, but septal bulge correlated weakly with systolic right ventricular pressure and inversely with pulmonary arteriolar resistance index. Systolic left ventricular outflow gradient was inversely related to the minimum systolic distance between the anterior mitral leaflet and interventricular septum. No patients without complete systolic apposition of the anterior mitral leaflet and interventricular septum had a left ventricular outflow gradient greater than 20 mm Hg. Conversely, even when cross sectional echocardiography showed apparently total obstruction of the left ventricular outflow tract at some time in systole there was often no significant gradient detected during haemodynamic study. In the short axis cuts closeness of the papillary muscles to the interventricular septum or to each other was unrelated to systolic gradient. This study shows that (a) cross sectional echocardiography can identify fixed obstruction of the left ventricular outflow tract in simple transposition of the great arteries; (b) the degree of septal bulge, unless complicated by fibrous thickening of the anterior mitral leaflet and interventricular septum, is unrelated to the gradient across the left ventricular outflow tract; (c) the absence of systolic septal/mitral apposition excludes a significant gradient at that site across the left ventricular outflow tract; and (d) papillary muscle geometry is unrelated to dynamic

  14. Mechanisms driving recruitment variability in fish: comparisons between the Laurentian Great Lakes and marine systems

    USGS Publications Warehouse

    Pritt, Jeremy J.; Roseman, Edward F.; O'Brien, Timothy P.

    2014-01-01

    In his seminal work, Hjort (in Fluctuations in the great fisheries of Northern Europe. Conseil Parmanent International Pour L'Exploration De La Mar. Rapports et Proces-Verbaux, 20: 1–228, 1914) observed that fish population levels fluctuated widely, year-class strength was set early in life, and egg production by adults could not alone explain variability in year-class strength. These observations laid the foundation for hypotheses on mechanisms driving recruitment variability in marine systems. More recently, researchers have sought to explain year-class strength of important fish in the Laurentian Great Lakes and some of the hypotheses developed for marine fisheries have been transferred to Great Lakes fish. We conducted a literature review to determine the applicability of marine recruitment hypotheses to Great Lakes fish. We found that temperature, interspecific interactions, and spawner effects (abundance, age, and condition of adults) were the most important factors in explaining recruitment variability in Great Lakes fish, whereas relatively fewer studies identified bottom-up trophodynamic factors or hydrodynamic factors as important. Next, we compared recruitment between Great Lakes and Baltic Sea fish populations and found no statistical difference in factors driving recruitment between the two systems, indicating that recruitment hypotheses may often be transferable between Great Lakes and marine systems. Many recruitment hypotheses developed for marine fish have yet to be applied to Great Lakes fish. We suggest that future research on recruitment in the Great Lakes should focus on forecasting the effects of climate change and invasive species. Further, because the Great Lakes are smaller and more enclosed than marine systems, and have abundant fishery-independent data, they are excellent candidates for future hypothesis testing on recruitment in fish.

  15. Automated segmentation and tracking of coronary arteries in cardiac CT scans: comparison of performance with a clinically used commercial software

    NASA Astrophysics Data System (ADS)

    Zhou, Chuan; Chan, Heang-Ping; Chughtai, Aamer; Patel, Smita; Hadjiiski, Lubomir M.; Sahiner, Berkman; Wei, Jun; Kazerooni, Ella A.

    2010-03-01

    Coronary CT angiography (cCTA) has been reported to be an effective means for diagnosis of coronary artery disease. We are investigating the feasibility of developing a computer-aided detection (CADe) system to assist radiologists in detection of non-calcified plaques in coronary arteries in ECG-gated cCTA scans. In this study, we developed a prototype vessel segmentation and tracking method to extract the coronary arterial trees which will define the search space for plaque detection. Vascular structures are first enhanced by 3D multi-scale filtering and analysis of the eigenvalues of Hessian matrices using a vessel enhancement response function specifically designed for coronary arteries. The enhanced vascular structures are then segmented by an EM estimation method. The segmented coronary arteries are tracked using a 3D dynamic balloon tracking (DBT) method. For this preliminary study, two starting seed points were manually identified at the origins of the left and right coronary artery (LCA and RCA). The DBT method automatically moves a sphere along the vessel whose diameter is adjusted dynamically based on the local vessel size, tracks the vessels, and identifies its branches to generate the left and right coronary arterial trees. The algorithm was applied to 20 cCTA scans that contained various degrees of coronary artery diseases. To evaluate the performance of vessel segmentation and tracking, the rendered volume of coronary arteries tracked by our algorithm was displayed on a PC, placed next to a GE Advantage workstation on which the coronary arterial trees tracked by the GE software and the original cCTA scan were displayed. Two experienced thoracic radiologists visually examined the coronary arteries on the cCTA scan and the segmented vessels to count untracked false-negative (FN) segments and false positives (FPs). The comparison was made by radiologists' visual judgment because the digital files for the segmented vessels were not accessible on the

  16. Comparison of Computed Tomography and Cineangiography in the Demonstration of Central Pulmonary Arteries in Cyanotic Congenital Heart Disease

    SciTech Connect

    Taneja, Karuna; Sharma, Sanjiv; Kumar, Krishan; Rajani, Mira

    1996-03-15

    Purpose: To assess the diagnostic accuracy of contrast-enhanced computed tomography (CT) for central pulmonary artery pathology in patients with cyanotic congenital heart disease (CCHD) and right ventricular outflow obstruction. Methods: We compared contrast-enhanced CT and cine pulmonary arteriography in 24 patients with CCHD to assess central pulmonary arteries including the confluence. Both investigations were interpreted by a cardiac radiologist in a double-blinded manner at an interval of 3 weeks. Angiography was used as the gold standard for comparison. Results: The sensitivity for visualization of main pulmonary artery (MPA), right pulmonary artery (RPA), left pulmonary artery (LPA), and confluence on CT was 94%, 100%, 92.8%, and 92.8%, respectively. Diagnostic specificity for the same entities was 28.5%, 100%, 80%, and 50%, respectively. The positive predictive value for each was 76.2%, 100%, 94.1%, and 72.2%, respectively. The low specificity of CT in the evaluation of the MPA and the confluence is perhaps due to distorted right ventricular outflow anatomy in CCHD. Large aortopulmonary collaterals in this region were mistaken for the MPA in some patients with pulmonary atresia. Conclusion: CT is a useful, relatively noninvasive, imaging technique for the central pulmonary arteries in selected patients. It can supplement diagnostic information from angiography but cannot replace it. LPA demonstration on axial images alone is inadequate.

  17. Comprehensive analysis of myocardial infarction due to left circumflex artery occlusion: comparison with infarction due to right coronary artery and left anterior descending artery occlusion

    SciTech Connect

    Huey, B.L.; Beller, G.A.; Kaiser, D.L.; Gibson, R.S.

    1988-11-01

    Forty consecutive patients with creatine kinase-MB confirmed myocardial infarction due to circumflex artery occlusion (Group 1) were prospectively evaluated and compared with 107 patients with infarction due to right coronary artery occlusion (Group 2) and 94 with left anterior descending artery occlusion (Group 3). All 241 patients underwent exercise thallium-201 scintigraphy, radionuclide ventriculography, 24 h Holter electrocardiographic (ECG) monitoring and coronary arteriography before hospital discharge and were followed up for 39 +/- 18 months. There were no significant differences among the three infarct groups in age, gender, number of risk factors, prevalence and type of prior infarction, Norris index, Killip class and frequency of in-hospital complications. Acute ST segment elevation was present in only 48% of patients in Group 1 versus 71 and 72% in Groups 2 and 3, respectively (p = 0.012), and 38% of patients with a circumflex artery-related infarct had no significant ST changes (that is, elevation or depression) on admission (versus 21 and 20% for patients in Groups 2 and 3, respectively) (p = 0.001). Abnormal R waves in lead V1 were more common in Group 1 than in Group 2 (p less than 0.003) as was ST elevation in leads I, aVL and V4 to V6 (p less than or equal to 0.048). These differences in ECG findings between Group 1 and 2 patients correlated with a significantly higher prevalence of posterior and lateral wall asynergy in the group with a circumflex artery-related infarct. Infarct size based on peak creatine kinase levels and multiple radionuclide variables was intermediate in Group 1 compared with that in Group 2 (smallest) and Group 3 (largest). During long-term follow-up, the probability of recurrent cardiac events was similar in the three infarct groups.

  18. A comparison of the Great Red Spot with temporary spots on Jupiter

    NASA Technical Reports Server (NTRS)

    Browne, G. C.; Meadows, A. J.

    1976-01-01

    The International Planetary Patrol collection of Jupiter photographs is used to examine the development of a temporary spot that was visible in the northern equatorial zone for a total of 211 days. The motion and color of this spot are compared with those of the Great Red Spot. It is shown that the temporary spot was bluer than the Great Red Spot and has a longitudinal oscillation of approximately 4 deg with a period of about 45 days, implying that it may have possessed a significant dynamical property in common with other temporary spots and the Great Red Spot. It is concluded that the present spot is more likely to have been associated with a hole in the cloud deck rather than with an elevated surface feature.

  19. Perceptions of collaboration: A comparison of educators and scientists for COSEE Great Lakes

    NASA Astrophysics Data System (ADS)

    Kim, Chankook

    The Great Lakes region of North America, holding 20% of the world's fresh water and home to ¼ of the U.S. population, can provide its 13 million K-12 learners with a relevant context for science learning, unique opportunities for exploring local environmental issues, and connections to global issues. By linking Great Lakes research scientists with educators, students, and the public, the COSEE (Centers for Ocean Sciences Education Excellence) Great Lakes pursues its goal of enhancing science and environmental literacy of both adults and students. This doctoral research had a three-fold purpose in the COSEE Great Lakes context. First, this study aimed to characterize the population of Great Lakes scientists and K-12 teachers in the Great Lakes region targeted as potential audiences for activities of COSEE Great Lakes. Second, this study aimed to identify factors that may affect educational collaboration between teachers and scientists. Third, this study was conducted as a part of an ongoing process of evaluating overall COSEE program outcomes related to increasing educational collaborations. This dissertation consists of three research reports on professional development and interprofessional collaboration of K-12 teachers and scientists. The first report in Chapter 2 investigates primary and secondary teachers' views of collaboration with scientists and incorporates the findings of teacher surveys into discussions about professional development programs for educators. From 180 schools randomly selected in the eight Great Lakes States, 194 primary and secondary educators responded to a mailed survey. Through the survey responses, the educators reported that while they have positive attitudes toward their collaboration with scientists, their professional preparation has not equipped them with enough understanding of the process of science and the professions of scientists. Regression analysis shows that five predictor variables account for a majority of the variance

  20. Graduate Employability and Educational Context: A Comparison between Great Britain and the Netherlands

    ERIC Educational Resources Information Center

    Tholen, Gerbrand

    2014-01-01

    Within policy circles, graduate employability remains a problem. It is often understood as an individual phenomenon, overlooking the influence of the organisation of higher education on the competition for graduate jobs. This article explores and compares how graduate employability is socially constructed within Great Britain and the Netherlands.…

  1. Motivation to Study in Higher Education: A Comparison between Germany and Great Britain

    ERIC Educational Resources Information Center

    Loeber, Sandra; Higson, Helen E.

    2009-01-01

    This article deals with reasons for the motivation to study in higher education. To find out about motives, around 200 A-level students in Germany and Great Britain were asked about their plans for the time after completion of their A-levels. Through socio-demographic data the authors could deploy facts about social backgrounds and the…

  2. Bringing Educational Fundraising Back to Great Britain: A Comparison with the United States

    ERIC Educational Resources Information Center

    Proper, Eve

    2009-01-01

    As a solution to dwindling government revenue, higher education in Great Britain has recently begun to increase fundraising. While it looks to the United States' higher education sector as a model, there are significant legal, historical and cultural differences between the two nations that could limit the British higher education sector's…

  3. A Comparison between Mechanical Thrombectomy and Intra-arterial Fibrinolysis in Acute Basilar Artery Occlusion: Single Center Experiences

    PubMed Central

    Jung, Seunguk; Jung, Cheolkyu; Bae, Yun Jung; Choi, Byung Se; Kim, Jae Hyoung; Lee, Sang-Hwa; Chang, Jun Young; Kim, Beom Joon; Han, Moon-Ku; Bae, Hee-Joon; Kwon, Bae Ju; Cha, Sang-Hoon

    2016-01-01

    Background and Purpose Recent advances in intra-arterial techniques and thrombectomy devices lead to high rate of recanalization. However, little is known regarding the effect of the evolvement of endovascular revascularization therapy (ERT) in acute basilar artery occlusion (BAO). We compared the outcome of endovascular mechanical thrombectomy (EMT) versus intra-arterial fibrinolysis (IAF)-based ERT in patients with acute BAO. Methods After retrospectively reviewed a registry of consecutive patients with acute ischemic stroke who underwent ERT from September 2003 to February 2015, 57 patients with acute BAO within 12 hours from stroke onset were enrolled. They were categorized as an IAF group (n=24) and EMT group (n=33) according to the primary technical option. We compared the procedural and clinical outcomes between the groups. Results The time from groin puncture to recanalization was significantly shorter in the EMT group than in the IAF group (48.5 [25.3 to 87.8] vs. 92 [44 to 179] minutes; P=0.02) The rate of complete recanalization was significantly higher in the EMT group than in the IAF group (87.9% vs 41.7%; P<0.01). The good outcome of the modified Rankin Scale score≤2 at 3 months was more frequent in the EMT group than in the IAF group, but it was not statistically significant (39.4% vs 16.7%; P=0.06). Conclusions EMT-based ERT in patients with acute BAO is superior to IAF-based ERT in terms of the reduction of time from groin puncture to recanalization and the improvement of the rate of complete recanalization. PMID:27283281

  4. Intra-arterial digital subtraction angiogrpahy: comparison with conventional hepatic arteriography

    SciTech Connect

    Flannigan, B.D.; Gomes, A.S.; Stambuk, E.C.; Lois, J.F.; Pais, S.O.

    1983-07-01

    To evaluate the efficacy of arterial digital subtraction angiography (DSA), 28 patients with a variety of hepatic lesions underwent intra-arterial DSA immediately following conventional celiac or hepatic arteriography. Thirty-one studies were obtained and the results of DSA were compared with the conventional arteriograms. DSA showed good visualization of the arteries in the early arterial phase of the examination. The late arterial phase was better evaluated on conventional arteriograms due to the decreased spatial resolution of DSA. Arterial DSA was most useful in the evaluation of the parenchyma of the liver; the use of remasking techniques allowed improved visualization of hepatic lesions, particularly in the left lobe of the liver. It is concluded that arterial DSA is useful in hepatic imaging and may supplant conventional hepatic arteriography as the technology improves.

  5. Comparison of Cardiovascular Risk Factors for Peripheral Artery Disease and Coronary Artery Disease in the Korean Population

    PubMed Central

    Jang, Shin Yi; Ju, Eun Young; Cho, Sung-Il; Lee, Seung Wook

    2013-01-01

    Background and Objectives The objective of this study was to analyze and compare risk factors for peripheral artery disease (PAD) and coronary artery disease (CAD). Subjects and Methods The sample included 7936 Korean patients aged ≥20 years who were hospitalized from 1994 to 2004. Of the 7936 subjects, PAD (n=415), CAD (n=3686), and normal controls (Control) (n=3835) were examined at the Health Promotion Center, Samsung Medical Center. Results The mean age (years) of PAD subjects was 64.4 (±9.3), while CAD subjects was 61.2 (±9.9), and Control subjects was 59.9 (±9.1) (p<0.01). The proportion of males was 90.6% for PAD, 71.4% for CAD, and 75.5% for Control subjects (p<0.01). The adjusted odds ratios (ORs) for hypertension, diabetes mellitus, hypercholesterolemia, smoking, metabolic syndrome and chronic kidney disease were significantly higher in subjects with PAD or CAD compared to those in Control. However, the ORs for high density lipoprotein, being overweight, and being obese were significantly lower in PAD subjects compared to those in Control. Conclusion We found that cardiovascular risk factors were in fact risk factors for both PAD and CAD. PMID:23755078

  6. Cardiovascular response to physical exercise in adult patients after atrial correction for transposition of the great arteries assessed with magnetic resonance imaging

    PubMed Central

    Roest, A A W; Lamb, H J; van der Wall, E E; Vliegen, H W; van den Aardweg, J G; Kunz, P; de Roos, A; Helbing, W A

    2004-01-01

    Objective: To assess with magnetic resonance imaging (MRI) cardiovascular function in response to exercise in patients after atrial correction of transposition of the great arteries (TGA). Methods: Cardiac function at rest and during submaximal exercise was assessed with MRI in 27 patients with TGA (mean (SD) age 26 (5) years) late (23 (2) years) after atrial correction and in 14 control participants (25 (5) years old). Results: At rest, only right ventricular ejection fraction was significantly lower in patients than in controls (56 (7)% v 65 (7)%, p < 0.05). In response to exercise, increases in right ventricular end diastolic (155 (55) ml to 163 (57) ml, p < 0.05) and right ventricular end systolic volumes (70 (34) ml to 75 (36) ml, p < 0.05) were observed in patients. Furthermore, right and left ventricular stroke volumes and ejection fraction did not increase significantly in patients. Changes in right ventricular ejection fraction with exercise correlated with diminished exercise capacity (r  =  0.43, p < 0.05). Conclusions: In patients with atrially corrected TGA, MRI showed an abnormal response to exercise of both systemic right and left ventricles. Exercise MRI provides a tool for close monitoring of cardiovascular function in these patients, who are at risk for late death. PMID:15145879

  7. HeartWare Ventricular Assist Device Placement in a Patient With Corrected Dextro-Transposition of Great Arteries: A Case Report and Its Clinical Challenges.

    PubMed

    Sehgal, Sankalp; Ramachandran, Sujatha; Leff, Jonathan D

    2015-09-01

    Given the improved survival in patients with corrected dextro-transposition of great arteries (D-TGA), it has evolved into an adult congenital heart defect. It is important to understand the management and complications observed in this population that eventually progresses to systemic ventricular failure requiring cardiac transplantation. Our case focuses on the rapid right ventricle (RV) deterioration of a patient with corrected D-TGA following a surgical procedure requiring systemic support. With such patients awaiting heart transplantation, there are limited assist devices available for RV support and no right ventricular assist device is approved for destination therapy yet. Current indications for implantation of the HeartWare ventricular assist device (HVAD) are limited by the Food and Drug Administration (FDA) to the left ventricle support as a bridge to transplantation. However, its use in the United States for right-sided support has rarely been described for adult congenital defects. In this case, a HeartWare assist device was used to provide systemic support as a bridge to cardiac transplant. The size and implantation design of the HVAD makes it a promising option for patients with this challenging patient population and RV failure as a late complication. PMID:25601596

  8. Discovery and Management of Diaphragmatic Hernia Related to Abandoned Epicardial Pacemaker Wires in a Pregnant Woman with {S,L,L} Transposition of the Great Arteries

    PubMed Central

    Benson, Craig C.; Valente, Anne M.; Economy, Katherine E.; Hoffman-Sage, Yael; Bevilacqua, Laura M.; Podovei, Mihaela; Opotowsky, Alexander R.

    2012-01-01

    Epicardial pacemaker leads placed during childhood are often not removed when transvenous systems are placed later in life. The risk of complications related to retained pacemaker leads and generators is not clear but is generally considered low. We report the case of a 23-year-old pregnant woman who presented with left upper quadrant pain at 20 weeks gestation. The patient was born with {S,L,L} transposition of the great arteries and had high-grade conduction disease in infancy compelling epicardial pacemaker placement. A standard transvenous pacemaker was placed at age 9 years, without removal of the epicardial system. The patient’s abdominal pain was attributed to herniation of abdominal contents through a diaphragmatic defect at the site of the abandoned epicardial pacing wire. Her pain improved spontaneously but worsened later in pregnancy leading to repair of the diaphragmatic hernia via anterolateral thoracotomy at 30 weeks gestation. The procedure was well tolerated by mother and fetus. At 38 3/7 weeks gestation, the patient underwent uneventful delivery by cesarean section for breech presentation. This case illustrates the importance of multidisciplinary collaboration in the care of women with congenital heart disease. PMID:21718459

  9. A comparison of postnatal arterial patterns in a growth series of giraffe (Artiodactyla: Giraffa camelopardalis)

    PubMed Central

    Gignac, Paul M.; Hieronymus, Tobin L.; Witmer, Lawrence M.

    2016-01-01

    Nearly all living artiodactyls (even-toed ungulates) possess a derived cranial arterial pattern that is highly distinctive from most other mammals. Foremost among a suite of atypical arterial configurations is the functional and anatomical replacement of the internal carotid artery with an extensive, subdural arterial meshwork called the carotid rete. This interdigitating network branches from the maxillary artery and is housed within the cavernous venous sinus. As the cavernous sinus receives cooled blood draining from the nasal mucosa, heat rapidly dissipates across the high surface area of the rete to be carried away from the brain by the venous system. This combination yields one of the most effective mechanisms of selective brain cooling. Although arterial development begins from the same embryonic scaffolding typical of mammals, possession of a rete is typically accompanied by obliteration of the internal carotid artery. Among taxa with available ontogenetic data, the point at which the internal carotid obliterates is variable throughout development. In small-bodied artiodactyls, the internal carotid typically obliterates prior to parturition, but in larger species, the vessel may remain patent for several years. In this study, we use digital anatomical data collection methods to describe the cranial arterial patterns for a growth series of giraffe (Giraffa camelopardalis), from parturition to senescence. Giraffes, in particular, have unique cardiovascular demands and adaptations owing to their exceptional body form and may not adhere to previously documented stages of cranial arterial development. We find the carotid arterial system to be conserved between developmental stages and that obliteration of the giraffe internal carotid artery occurs prior to parturition. PMID:26925324

  10. A comparison of postnatal arterial patterns in a growth series of giraffe (Artiodactyla: Giraffa camelopardalis).

    PubMed

    O'Brien, Haley D; Gignac, Paul M; Hieronymus, Tobin L; Witmer, Lawrence M

    2016-01-01

    Nearly all living artiodactyls (even-toed ungulates) possess a derived cranial arterial pattern that is highly distinctive from most other mammals. Foremost among a suite of atypical arterial configurations is the functional and anatomical replacement of the internal carotid artery with an extensive, subdural arterial meshwork called the carotid rete. This interdigitating network branches from the maxillary artery and is housed within the cavernous venous sinus. As the cavernous sinus receives cooled blood draining from the nasal mucosa, heat rapidly dissipates across the high surface area of the rete to be carried away from the brain by the venous system. This combination yields one of the most effective mechanisms of selective brain cooling. Although arterial development begins from the same embryonic scaffolding typical of mammals, possession of a rete is typically accompanied by obliteration of the internal carotid artery. Among taxa with available ontogenetic data, the point at which the internal carotid obliterates is variable throughout development. In small-bodied artiodactyls, the internal carotid typically obliterates prior to parturition, but in larger species, the vessel may remain patent for several years. In this study, we use digital anatomical data collection methods to describe the cranial arterial patterns for a growth series of giraffe (Giraffa camelopardalis), from parturition to senescence. Giraffes, in particular, have unique cardiovascular demands and adaptations owing to their exceptional body form and may not adhere to previously documented stages of cranial arterial development. We find the carotid arterial system to be conserved between developmental stages and that obliteration of the giraffe internal carotid artery occurs prior to parturition. PMID:26925324

  11. Hindlimb muscle architecture in non-human great apes and a comparison of methods for analysing inter-species variation.

    PubMed

    Myatt, Julia P; Crompton, Robin H; Thorpe, Susannah K S

    2011-08-01

    By relating an animal's morphology to its functional role and the behaviours performed, we can further develop our understanding of the selective factors and constraints acting on the adaptations of great apes. Comparison of muscle architecture between different ape species, however, is difficult because only small sample sizes are ever available. Further, such samples are often comprised of different age-sex classes, so studies have to rely on scaling techniques to remove body mass differences. However, the reliability of such scaling techniques has been questioned. As datasets increase in size, more reliable statistical analysis may eventually become possible. Here we employ geometric and allometric scaling techniques, and ancovas (a form of general linear model, GLM) to highlight and explore the different methods available for comparing functional morphology in the non-human great apes. Our results underline the importance of regressing data against a suitable body size variable to ascertain the relationship (geometric or allometric) and of choosing appropriate exponents by which to scale data. ancova models, while likely to be more robust than scaling for species comparisons when sample sizes are high, suffer from reduced power when sample sizes are low. Therefore, until sample sizes are radically increased it is preferable to include scaling analyses along with ancovas in data exploration. Overall, the results obtained from the different methods show little significant variation, whether in muscle belly mass, fascicle length or physiological cross-sectional area between the different species. This may reflect relatively close evolutionary relationships of the non-human great apes; a universal influence on morphology of generalised orthograde locomotor behaviours or, quite likely, both. PMID:21507000

  12. The Phenotypic Spectrum of ZIC3 Mutations Includes Isolated d-Transposition of the Great Arteries and Double Outlet Right Ventricle

    PubMed Central

    D’Alessandro, Lisa C. A.; Latney, Brande C.; Paluru, Prasuna C.; Goldmuntz, Elizabeth

    2013-01-01

    Disease causing mutations for heterotaxy syndrome were first identified in the X-linked laterality gene, ZIC3. Mutations typically result in males with situs ambiguus and complex congenital heart disease; however affected females and one male with isolated d-transposition of the great arteries (d-TGA) have been reported. We hypothesized that a subset of patients with heart defects common to heterotaxy but without laterality defects would have ZIC3 mutations. We also sought to estimate the prevalence of ZIC3 mutations in sporadic heterotaxy. Patients with TGA (n=169), double outlet right ventricle (DORV) (n=89), common atrioventricular canal (CAVC) (n= 41) and heterotaxy (n=54) underwent sequencing of ZIC3 exons. We tested 90 patients with tetralogy of Fallot (TOF) to correlate genotype with phenotype. Three potentially disease-related missense mutations were detected: c.49G>T (Gly17Cys) in a female with isolated DORV, c.98C>T (Ala33Val) in a male with isolated d-TGA, and c.841C>T (His281Tyr) in a female with sporadic heterotaxy. We also identified a novel insertion (CPFP333ins) in a family with heterotaxy. All were absent in 200 control patients and the 1000 Genomes Project (n = 629). No significant mutations were found in patients with TOF. Functional studies demonstrated reduced transcriptional activity of the ZIC3 His281Tyr mutant protein. ZIC3 mutations were rarely identified in isolated DORV and d-TGA suggesting that a subset of DORV and d-TGA may fall within the spectrum of laterality defects. ZIC3 mutations were found in 3.7% of patients with sporadic heterotaxy; therefore testing should be considered in patients with heterotaxy. PMID:23427188

  13. The detection of coronary artery disease: a comparison of exercise thallium imaging and exercise equilibrium radionuclide ventriculography.

    PubMed

    McGhie, I; Martin, W; Tweddel, A; Hutton, I

    1987-01-01

    This study compared the accuracy of rest and exercise gated equilibrium technetium ventriculography with exercise thallium imaging in 50 consecutive male patients undergoing routine coronary angiography for the evaluation of chest pain. No patients were excluded on the basis of prior myocardial infarction, nature of angiographically defined coronary disease or symptoms. Antianginal therapy was continued in all patients. Eight patients had normal coronary arteries, 9 had single vessel, disease, 20 had double vessel disease and 13 had triple vessel disease. Sixteen patients had previously documented myocardial infarction. Using exercise radionuclide ventriculography, 34 patients with coronary disease were detected resulting in a sensitivity of 81%; 6 patients with normal coronary arteries had normal scans, a specificity of 75%, with a predictive accuracy of 80%. In comparison, thallium imaging detected 42 patients with coronary disease resulting in a sensitivity of 100%. Six patients with normal coronary arteries had normal thallium images resulting in a specificity of 75% and a predictive accuracy of 96%. These results suggest that exercise thallium imaging is a more accurate investigation than exercise equilibrium radio-nuclide ventriculography and is the investigation of choice in the noninvasive detection of coronary artery disease. PMID:3036530

  14. Comparison of levosimendan and nitroglycerine in patients undergoing coronary artery bypass graft surgery

    PubMed Central

    Sahu, Manoj K.; Das, Anupam; Malik, Vishwas; Subramanian, Arun; Singh, Sarvesh Pal; Hote, Milind

    2016-01-01

    Background: Levosimendan a calcium ion sensitizer improves both systolic and diastolic functions. This novel lusitropic drug has predictable antiischemic properties which are mediated via the opening of mitochondrial adenosine triphosphate-sensitive potassium channels. This action of levosimendan is beneficial in cardiac surgical patients as it improves myocardial contractility, decreases systemic vascular resistance (SVR), and increases cardiac index (CI) and is thought to be cardioprotective. We decided to study whether levosimendan has any impact on the outcomes such as the duration of ventilation, the length of Intensive Care Unit (ICU) stay, and the hospital stay when compared with the nitroglycerine (NTG), which is the current standard of care at our center. Materials and Methods: Forty-seven patients undergoing elective coronary artery bypass surgery were randomly assigned to two groups receiving either levosimendan or NTG. The medications were started before starting surgery and continued until 24 h in the postoperative period. Baseline hemodynamic parameters were evaluated before beginning of the operation and then postoperatively at 3 different time intervals. N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) levels were also measured in both groups. Results: In comparison to the NTG group, the duration of ventilation and length of ICU stay were significantly less in levosimendan group (P < 0.05, P = 0.02). NT-proBNP level analysis showed a slow rising pattern in both groups and a statistically significant rise in the levels was observed in NTG group (P = 0.03, P = 0.02) in postoperative period when compared to levosimendan group of patients. Conclusion: Levosimendan treatment in patients undergoing surgical revascularization resulted in improved CI, decreased SVR and lower heart rate. And, thereby the duration of ventilation and length of ICU stay were significantly less in this group of patients when compared with NTG group. PMID:26750674

  15. Bayesian comparison of cost-effectiveness of different clinical approaches to diagnose coronary artery disease

    SciTech Connect

    Patterson, R.E.; Eng, C.; Horowitz, S.F.; Gorlin, R.; Goldstein, S.R.

    1984-08-01

    The objective of this study was to compare the cost-effectiveness of four clinical policies (policies I to IV) in the diagnosis of the presence or absence of coronary artery disease. A model based on Bayes theorem and published clinical data was constructed to make these comparisons. Effectiveness was defined as either the number of patients with coronary disease diagnosed or as the number of quality-adjusted life years extended by therapy after the diagnosis of coronary disease. The following conclusions arise strictly from analysis of the model and may not necessarily be applicable to all situations. As prevalence of coronary disease in the population increased, it caused a linear increase in cost per patient tested, but a hyperbolic decrease in cost per effect, that is, increased cost-effectiveness. Thus, cost-effectiveness of all policies (I to IV) was poor in populations with a prevalence of disease below 10%. Analysis of the model also indicates that at prevalences less than 80%, exercise thallium scintigraphy alone as a first test (policy II) is a more cost-effective initial test than is exercise electrocardiography alone as a first test (policy I) or exercise electrocardiography first combined with thallium imaging as a second test (policy IV). Exercise electrocardiography before thallium imaging (policy IV) is more cost-effective than exercise electrocardiography alone (policy I) at prevalences less than 80%. 4) Noninvasive exercise testing before angiography (policies I, II and IV) is more cost-effective than using coronary angiography as the first and only test (policy III) at prevalences less than 80%. 5) Above a threshold value of prevalence of 80% (for example patients with typical angina), proceeding to angiography as the first test (policy III) was more cost-effective than initial noninvasive exercise tests (policies I, II and IV).

  16. Comparison of Radiocarbon Ages for Multiproxy Paleoclimate Reconstruction of the Great Salt Lake, Utah

    NASA Astrophysics Data System (ADS)

    Nielson, K. E.; Bowen, G. J.; Eglinton, T. I.

    2008-12-01

    Multiproxy paleoclimate reconstructions from high sedimentation-rate systems offer promising opportunities to deconvolve multiple aspects climate system response to past forcing. However, the time-equivalence of proxies must be established before such reconstructions can be usefully interpreted. Differences in source ages, transport pathways, and surface residence times for substrates may lead to differences in lag times between proxy formation and deposition, compromising comparative analysis of data from multiple proxies. We used multi-substrate radiocarbon dating to investigate the potential for multi-proxy reconstruction of Holocene changes in the volume of the Great Salt Lake (GSL), Utah, based on the stable isotope composition of organic and inorganic substrates in lake sediment cores. Among potential substrates for this work are normal alkanes of vascular higher plant and algal origin, fossil cysts of lake-dwelling brine shrimp (Artemia), and micritic aragonite. Radiocarbon ages for all organic substrates (alkanes, cysts) sampled at any given core depth are concordant within analytical uncertainty and are similar to ages determined on land-plant debris and filamentous algae isolated from the sediment. Inorganic carbonate, in contrast, is depleted in 14C compare to the organic proxies, giving ages that were apparently 2000 to 3000 years older, likely due to winnowing and re-deposition of carbonate at the core site. These results suggest that the maximum temporal resolution achievable through analysis of mineral substrates is on the order of several millennia. Although the limited precision of the radiocarbon analysis precludes precise determination of the maximum potential resolution of organic-proxy based climate reconstructions, the relatively high sedimentation rates (50--150 cm/kyr) and age-equivalence of the substrates analyzed implies that sub- centennial scale resolution should be achievable throughout much of the Holocene portion of the GSL

  17. Segmental Comparison of Peripheral Arteries by Doppler Ultrasound and CT Angiography

    PubMed Central

    Swaminathan, Ram Kumar; Ganesan, Prakash; Mayavan, Manibharathi

    2016-01-01

    Introduction Diseases of peripheral arterial system are one of the common causes of limb pain, especially in elderly patients. Here we analyse non invasive imaging of peripheral arterial segments. Aim Aim of the study was to compare arterial diseases of extremities using Doppler ultrasound and CT angiography, and to find the better non-invasive modality of choice. Materials and Methods Fifty patients {14 patients with upper limb complaints (15 upper limbs) and 36 patients with lower limb complaints (72 lower limbs)} of peripheral arterial disease underwent Doppler ultrasound (USG) and CT Angiogram (CTA). Arterial systems divided into anatomic segments and luminal narrowing were compared using gray scale Doppler ultrasound and axial images of arterial phase of CT angiogram. Using statistical methods, sensitivity, specificity and accuracy of Doppler ultrasound and CT angiography were determined. Results Six hundred and nineteen arterial segments were studied with CT angiography and Doppler ultrasound. Of which 226 diseased segments were identified in CT angiography. Doppler overestimated narrowing by one grade in 47 segments, by two grade in 11 segments, by three grades in 30 segments and by four grades in 22 segments; underestimated by one grade in 28 segments, by two grades in 9 segments, by three grades in 5 segments and by four grades in 3 segments. Significant statistical difference exists between Doppler USG and CT angiography. Doppler showed good correlation with CT angiography in 74%, but, Doppler overestimated stenosis grade in a significant percentage. The sensitivity, specificity and accuracy of Doppler USG compared with CT angiography was 93.36%, 82.44%, and 86.42%. Conclusion Duplex Doppler can be the first investigation in excluding peripheral arterial disease, especially for evaluation of infra inguinal region of lower limbs and from second part of the subclavian artery in upper limbs. PMID:27042556

  18. Great Minds? Great Lakes!

    ERIC Educational Resources Information Center

    Environmental Protection Agency, Chicago, IL. Great Lakes National Program Office.

    This book contains lesson plans that provide an integrated approach to incorporating Great Lakes environmental issues into elementary subjects. The book is divided into three subject areas: (1) History, which includes the origins of the Great Lakes, Great Lakes people, and shipwrecks; (2) Social Studies, which covers government, acid rain as a…

  19. Comparison between Angiographic Findings of Coronary Artery Disease in STEMI and NSTEMI Patients of Bangladesh.

    PubMed

    Khan, M H; Islam, M N; Ahmed, M U; Shafique, A M; Bari, M S; Islam, M Z; Ahamed, N U; Masud, M R; Bhowmick, K; Begum, M; Akhter, S M; Siddique, S R

    2016-04-01

    Coronary Angiogram (CAG) has been used to detect coronary artery disease in myocardial infarction (both STEMI and NSTEMI) patients. The purpose of this study was to compare the degree of coronary artery disease among STEMI and NSTEMI patients. Among acute coronary syndrome in NSTEMI we found more widespread coronary artery disease other than STEMI. Lack of documentations encouraged us to perform this study in our center. In this retrospective observational study we summarized all myocardial infarction (MI) patients who underwent coronary angiography (CAG) from August 2013 to August 2014 at Enam Medical College Hospital, Dhaka, Bangladesh and data of degree of coronary artery disease were recorded. Data of 100 consecutive MI patients who underwent CAG during that period were recorded. Among them 50 patients having STEMI as Group I (male 45, female 5) & other 50 patients sustained NSTEMI as Group II (male 38, female 12). Among NSTEMI patient group 80% were having multi-vessel disease and in STEMI patient group 80% having single vessel disease and remaining having multi-vessel disease. The degree of coronary artery disease is extensive in NSTEMI patients than in STEMI group. Coronary angiogram can visualize the degree of coronary artery involvement and is a useful screening modality to compare disease extent in MI patients. PMID:27277351

  20. Comparison of the Windkessel model and structured-tree model applied to prescribe outflow boundary conditions for a one-dimensional arterial tree model.

    PubMed

    Guan, Debao; Liang, Fuyou; Gremaud, Pierre A

    2016-06-14

    One-dimensional (1D) modeling is a widely adopted approach for studying wave propagation phenomena in the arterial system. Despite the frequent use of the Windkessel (WK) model to prescribe outflow boundary conditions for 1D arterial tree models, it remains unclear to what extent the inherent limitation of the WK model in describing wave propagation in distal vasculatures affect hemodynamic variables simulated at the arterial level. In the present study, a 1D model of the arterial tree was coupled respectively with a WK boundary model and a structured-tree (ST) boundary model, yielding two types of arterial tree models. The effective resistances, compliances and inductances of the WK and ST boundary models were matched to facilitate quantitative comparisons. Obtained results showed that pressure/flow waves simulated by the two models were comparable in the aorta, whereas, their discrepancies increased towards the periphery. Wave analysis revealed that the differences in reflected waves generated by the boundary models were the major sources of pressure wave discrepancies observed in large arteries. Additional simulations performed under aging conditions demonstrated that arterial stiffening with age enlarged the discrepancies, but with the effects being partly counteracted by physiological aortic dilatation with age. These findings suggest that the method adopted for modeling the outflow boundary conditions has considerable influence on the performance of a 1D arterial tree model, with the extent of influence varying with the properties of the arterial system. PMID:27062594

  1. 30-day mortality after coronary artery bypass grafting and valve surgery has greatly improved over the last decade, but the 1-year mortality remains constant

    PubMed Central

    Hansen, Laura Sommer; Hjortdal, Vibeke Elisabeth; Andreasen, Jan Jesper; Mortensen, Poul Erik; Jakobsen, Carl-Johan

    2015-01-01

    Introduction: European system for cardiac operative risk evaluation (EuroSCORE) is a valuable tool in control of the quality of cardiac surgery. However, the validity of the risk score for the individual patient may be questioned. The present study was carried out to investigate whether the continued fall in short-term mortality reflects an actual improvement in late mortality, and subsequently, to investigate EuroSCORE as predictor of 1-year mortality. Methods: A population-based cohort study of 25,602 patients from a 12-year period from three public university hospitals undergoing coronary artery bypass grafting (CABG) or valve surgery. Analysis was carried out based on EuroSCORE, age and co-morbidity factors (residual EuroSCORE). Results: During the period the average age increased from 65.1 ± 10.0 years to 68.9 ± 10.7 years (P < 0.001, one-way ANOVA), and the number of females increased from 26.0% to 28.2% (P = 0.0012, Chi-square test). The total EuroSCORE increased from 4.67 to 5.68 while the residual EuroSCORE decreased from 2.64 to 1.83. Thirty-day mortality decreased from 4.07% in 1999–2000 to 2.44% in 2011–2012 (P = 0.0056; Chi-square test), while 1-year mortality was unchanged (6.50% in 1999–2000 vs. 6.25% in 2011–2012 [P = 0.8086; Chi-square test]). Discussion: The study demonstrates that both co-morbidity and age has a great impact on 30-day mortality. However, with time the impact of co-morbidity seems less. Thus, age is more important than co-morbidity in late mortality. The various developments in short and long-term mortality are not readily explained. Conclusion: Although 30-day mortality of CABG and valve surgery patients has decreased during the 12-year period, the 1-year mortality remains the same. PMID:25849679

  2. Circulating microRNA expression profile and systemic right ventricular function in adults after atrial switch operation for complete transposition of the great arteries

    PubMed Central

    2013-01-01

    Background Data on the use of circulating microRNAs (miRNAs) as biomarkers of cardiovascular diseases are emerging. Little, however, is known on the expression profile of circulating of microRNAs in congenital heart malformations with a systemic right ventricle that is prone to functional impairment. We aimed to test the hypothesis that circulating miRNA profile is altered in patients late after atrial switch operation for complete transposition of the great arteries (TGA) and further explored possible relationships between alteration of circulating miRNAs and systemic ventricular contractility. Methods Circulating miRNA expression profiling of serum samples from 5 patients and 5 healthy controls was performed. The results were validated in 26 patients and 20 controls using real-time quantitative reverse-transcription polymerase chain reaction for candidate miRNAs with fold changes >3 by expression profiling. Systemic ventricular myocardial acceleration during isovolumic contraction (IVA) was determined by colour tissue Doppler echocardiography. Results Compared with controls, patients had significantly lower systemic ventricular IVA (p = 0.002). Of the 23 upregulated miRNAs identified by profiling, 11 were validated to be increased in patients compared with controls: miR-16, miR-106a, miR-144*, miR-18a, miR-25, miR-451, miR-486-3p, miR-486-5p, miR-505*, let-7e and miR-93. Among the validated 11 miRNAs, miR-18a (r = −0.45, p = 0.002) and miR-486-5p (r = −0.35, p = 0.018) correlated negatively with systemic ventricular IVA for the whole cohort. Conclusions A distinct serum miRNA expression signature exists in adults with complete TGA after atrial switch operation, with serum miR-18a and miR-486-5p being associated with systemic ventricular contractility. PMID:24040857

  3. Bayesian comparison of cost-effectiveness of different clinical approaches to diagnose coronary artery disease.

    PubMed

    Patterson, R E; Eng, C; Horowitz, S F; Gorlin, R; Goldstein, S R

    1984-08-01

    The objective of this study was to compare the cost-effectiveness of four clinical policies (policies I to IV) in the diagnosis of the presence or absence of coronary artery disease. A model based on Bayes' theorem and published clinical data was constructed to make these comparisons. Effectiveness was defined as either the number of patients with coronary disease diagnosed or as the number of quality-adjusted life years extended by therapy after the diagnosis of coronary disease. The following conclusions arise strictly from analysis of the model and may not necessarily be applicable to all situations. As prevalence of coronary disease in the population increased, it caused a linear increase in cost per patient tested, but a hyperbolic decrease in cost per effect, that is, increased cost-effectiveness. Thus, cost-effectiveness of all policies (I to IV) was poor in populations with a prevalence of disease below 10%, for example, asymptomatic people with no risk factors. Analysis of the model also indicates that at prevalences less than 80%, exercise thallium scintigraphy alone as a first test (policy II) is a more cost-effective initial test than is exercise electrocardiography alone as a first test (policy I) or exercise electrocardiography first combined with thallium imaging as a second test (policy IV). Exercise electrocardiography before thallium imaging (policy IV) is more cost-effective than exercise electrocardiography alone (policy I) at prevalences less than 80%. 4) Noninvasive exercise testing before angiography (policies I, II and IV) is more cost-effective than using coronary angiography as the first and only test (policy III) at prevalences less than 80%. 5) Above a threshold value of prevalence of 80% (for example patients with typical angina), proceeding to angiography as the first test (policy III) was more cost-effective than initial noninvasive exercise tests (policies I, II and IV). One advantage of this quantitative model is that it estimates a

  4. Comparison of the Effects of Coronary Artery Bypass Grafting Versus Medical Therapy on Short and Long Term Outcomes in Octogenarian Patients With Multi-Vessel Coronary Artery Disease

    PubMed Central

    Alizadehasl, Azin; Sohrabi, Bahram; Panjavi, Laleh; Sadeghpour, Anita; Azarfarin, Rasoul; Ghadrdoost, Behshid; Zolfaghari, Reza; Habibzadeh, Afshin

    2016-01-01

    Background: Appropriate treatment methods lead to a reduced rate of mortality and morbidity, and an improved quality of life, in patients with multi-vessel coronary artery disease. Objectives: In this study, we compared short and long-term outcomes of coronary artery bypass grafting (CABG) versus medical therapy in patients 80 years of age and older with multi-vessel coronary artery disease (MVCAD). Patients and Methods: In this retrospective study, 50 octogenarian patients with MVCAD who underwent CABG were compared with 50 patients in the same condition who were treated with medical therapy during the same time. The primary objective was to compare mortality and morbidity rates, as well as other factors such as the occurrence of chest pain, deterioration of the NYHA functional class, and re-hospitalization, between the two groups. The comparison was made using medical records from the five years post-treatment. Results: After five years, the overall mortality rate included 11 patients (22%) in the CABG group versus 18 patients (36%) in the medical therapy group; this difference was not significant between the two groups (P = 0.186). Regarding short-term outcomes, in the CABG group, cardiogenic shock occurred in 9 patients (18%), renal failure in 13 patients (26%), pulmonary complications in 9 patients (18%) and neurologic complications in 3 patients (6%); in the medical therapy group, these same complications occurred, respectively, in 6 patients (12%), 7 patients (14%), 10 patients (20%) and 1 patient (2%). In addition to these factors, freedom from chest pain and improvement in the functional class among the CABG group was significantly higher than among the medical therapy group (P = <0.001). Conclusions: CABG may be the superior form of treatment for long-term outcomes in terms of the relief of chest pain, improvement of the functional class, reduced need for re-admission, and later death for octogenarians. However, short-term morbidity may be higher among

  5. Comparisons of planar and tubular biaxial tensile testing protocols of the same porcine coronary arteries.

    PubMed

    Keyes, Joseph T; Lockwood, Danielle R; Utzinger, Urs; Montilla, Leonardo G; Witte, Russell S; Vande Geest, Jonathan P

    2013-07-01

    To identify the orthotropic biomechanical behavior of arteries, researchers typically perform stretch-pressure-inflation tests on tube-form arteries or planar biaxial testing of splayed sections. We examined variations in finite element simulations (FESs) driven from planar or tubular testing of the same coronary arteries to determine what differences exist when picking one testing technique vs. another. Arteries were tested in tube-form first, then tested in planar-form, and fit to a Fung-type strain energy density function. Afterwards, arteries were modeled via finite element analysis looking at stress and displacement behavior in different scenarios (e.g., tube FESs with tube- or planar-driven constitutive models). When performing FESs of tube inflation from a planar-driven constitutive model, pressure-diameter results had an error of 12.3% compared to pressure-inflation data. Circumferential stresses were different between tube- and planar-driven pressure-inflation models by 50.4% with the planar-driven model having higher stresses. This reduced to 3.9% when rolling the sample to a tube first with planar-driven properties, then inflating with tubular-driven properties. Microstructure showed primarily axial orientation in the tubular and opening-angle configurations. There was a shift towards the circumferential direction upon flattening of 8.0°. There was also noticeable collagen uncrimping in the flattened tissue. PMID:23132151

  6. Comparisons of planar and tubular biaxial tensile testing protocols of the same porcine coronary arteries

    PubMed Central

    Keyes, Joseph T; Lockwood, Danielle R; Utzinger, Urs; Montilla, Leonardo G; Witte, Russell S; Vande Geest, Jonathan P

    2013-01-01

    To identify the orthotropic biomechanical behavior of arteries, researchers typically perform stretch-pressure-inflation tests on tube-form arteries or planar biaxial testing of splayed sections. We examined variations in finite element simulations (FESs) driven from planar or tubular testing of the same coronary arteries to determine what differences exist when picking one testing technique versus another. Arteries were tested in tube-form first, then tested in planar-form, and fit to a Fung-type strain energy density function. Afterwards, arteries were modeled via finite element analysis looking at stress and displacement behavior in different scenarios (e.g., tube FESs with tube- or planar-driven constitutive models). When performing FESs of tube inflation from a planar-driven constitutive model, pressure-diameter results had an error of 12.3% compared to pressure-inflation data. Circumferential stresses were different between tube- and planar-driven pressure-inflation models by 50.4% with the planar-driven model having higher stresses. This reduced to 3.9% when rolling the sample to a tube first with planar-driven properties, then inflating with tubular-driven properties. Microstructure showed primarily axial orientation in the tubular and opening-angle configurations. There was a shift towards the circumferential direction upon flattening of 8.0 . There was also noticeable collagen uncrimping in the flattened tissue. PMID:23132151

  7. Impact of Climate Change on extreme flows across Great Britain: a comparison of extreme value distributions and uncertainty assessment.

    NASA Astrophysics Data System (ADS)

    Collet, Lila; Beevers, Lindsay; Prudhomme, Christel

    2016-04-01

    Floods are the most common and widely distributed natural risk to life and property worldwide, causing over £6B worth of damage to the UK since 2000. Climate projections are predicted to result in the increase of UK properties at risk from flooding. It thus becomes urgent to assess the possible impact of these changes on extreme high flows in particular, and evaluate the uncertainties related to these projections. This paper aims to assess the changes in extreme runoff for the 1:100 year return period event across Great Britain as a result of climate change. It is based on the Future Flow database and analyses daily runoff over 1961-2098 for 281 gauging stations. The Generalized Extreme Value (GEV) and Generalized Pareto (GP) distribution functions are automatically fitted for 11 climate-change ensembles over the baseline (1961-1990) and the 2080s (2069-2098) for each gauging station. The analysis evaluates the uncertainty related to the Extreme Value (EV) distributions, and the uncertainty related to the climate model parameterization. Then it assesses return levels with combined uncertainties across Great Britain for both EV distributions. Ultimately, this work gives a national picture of extreme flows assessed by the two methods and allows a direct comparison between them. Results show that the GP distribution computes higher runoff estimates than the GEV distribution. Generally, the uncertainties associated with both distributions are similar, but the GP computes significantly higher uncertainties for stations in the south and southeast of England. From the baseline to the 2080s horizon, the GEV distribution shows variable runoff trends across Great Britain, while the GP distribution shows an increasing trend of return level estimate and uncertainties, especially in the northeast and southeast of England. The lowest climate model and extreme value uncertainty is generally seen across the west coast of Great Britain. In terms of uncertainty, with the GEV

  8. Great Lakes: Great Gardening.

    ERIC Educational Resources Information Center

    New York Sea Grant Inst., Albany, NY.

    This folder contains 12 fact sheets designed to improve the quality of gardens near the Great Lakes. The titles are: (1) "Your Garden and the Great Lakes"; (2) "Organic Gardening"; (3) "Fruit and Vegetable Gardening"; (4) "Composting Yard Wastes"; (5) "Herbicides and Water Quality"; (6) "Watering"; (7) "Soil Erosion by Water"; (8) "Soil…

  9. Evaluation of skin temperature over carotid artery for temperature monitoring in comparison to nasopharyngeal temperature in adults under general anesthesia

    PubMed Central

    Selvaraj, Venkatesh; Gnanaprakasam, Pughal Vendan

    2016-01-01

    Background: Thermoregulation is markedly affected in patients undergoing surgical procedures under anesthesia. Monitoring of temperature is very important during such conditions. Skin temperature is one of the easy and noninvasive ways of temperature monitoring. Common skin temperature monitoring sites are unreliable and did not correlate to the core temperature measurement. Aim: To compare and study the correlation of skin temperature over carotid artery in the neck to that of simultaneously measured nasopharyngeal temperature in adult patients undergoing surgical procedures under general anesthesia. Settings and Design: Prospective double-blinded study in a Tertiary Care Center. Materials and Methods: Ninety-seven consecutive American Society of Anesthesiologists I–II patients of age 18–40 years posted for elective surgical procedures under general anesthesia were included. Two temperature sites are monitored: The skin temperature over the carotid artery in the neck with a skin temperature probe T (skin-carotid) and the nasopharyngeal temperature T (naso) with another nasopharyngeal probe. The temperature readings are taken at 0, 15, 30, 45, and 60 min after induction of general anesthesia. Statistical Analysis: Paired t-test, Pearson correlation and Bland–Altman analysis for the rate of agreement. Results: The skin over the carotid artery in the neck showed statistically significant lower values than simultaneously measured nasopharyngeal temperature. This comparison is done with paired t-test at P< 0.05 significance. Bland–Altman plots showed good agreement between the two sites of temperature measurement. Conclusion: This study has shown that the skin temperature over the carotid artery in the neck was strongly correlated to the nasopharyngeal temperature in adult patients undergoing surgical procedures under general anesthesia. PMID:27212763

  10. Marital Discord and Coronary Artery Disease: A Comparison of Behaviorally Defined Discrete Groups

    ERIC Educational Resources Information Center

    Smith, Timothy W.; Uchino, Bert N.; Berg, Cynthia A.; Florsheim, Paul

    2012-01-01

    Objective: Marital difficulties can confer risk of coronary heart disease, as in a study of outwardly healthy couples (T. W. Smith et al., 2011) where behavioral ratings of low affiliation and high control during marital disagreements were associated with asymptomatic coronary artery disease (CAD). However, taxometric studies suggest that marital…

  11. Comparison of angiography with continuous wave Doppler ultrasound in the assessment of extracranial arterial disease

    PubMed Central

    Hames, T K; Humphries, K N; Powell, T V; McLellan, D L

    1981-01-01

    Extracranial arterial disease was assessed using non-invasive continuous wave Doppler ultrasound. The results of the Doppler study were compared with those of angiography. There was a positive correlation between the results of angiography and the shape of the Doppler waveform, but the correlation was improved by adding a compression manceuvre to the procedure. Images PMID:7299405

  12. A comparison of absorbable suture and argon laser welding for lateral repair of arteries.

    PubMed

    Lawrence, P F; Li, K; Merrell, S W; Goodman, G R

    1991-08-01

    Conventional vascular anastomoses between autogenous vessels are performed with nonabsorbable sutures. Recently, use of absorbable sutures and laser-assisted vascular anastomoses has been advocated because of their improved healing characteristics. This study compared arterial repairs with the argon laser, absorbable suture, and nonabsorbable suture for technical characteristics including additional suture and overall success rates, burst strength, and cost. Absorbable and nonabsorbable suture closures were comparable with respect to technique, but laser-assisted vascular anastomosis was technically more demanding and required almost twice as much time for completion. The argon laser successfully closed only 58.6% of the arteriotomies, and 90% of the closures required additional sutures for complete hemostasis. All sutured arteriotomies were successfully completed by use of either absorbable or nonabsorbable suture. Burst strength was similar for all groups, but was uniformly greater than 300 mm Hg for sutured repairs, whereas two of five laser-assisted closures burst below 300 mm Hg. Finally, costs for purchasing ($35,000) and operating ($300/hr.) an argon laser make laser-assisted vascular anastomosis much more expensive than sutured repair. These data suggest argon laser-assisted vascular anastomoses are more technically demanding, less successful, and more expensive than conventional sutured anastomoses when evaluated in large caliber arteries in a canine model. Absorbable suture, however, is comparable to conventional nonabsorbable sutured arterial repairs in expense, handling characteristics, and success rates with the added advantage of eliminating permanent foreign body in the arterial wall when it is absorbed. PMID:1861329

  13. Feline cerebral veins and arteries: comparison of autonomic innervation and vasomotor responses

    PubMed Central

    Edvinsson, Lars; McCulloch, James; Uddman, Rolf

    1982-01-01

    1. The innervation of feline cerebral (pial) vessels by nerve fibres containing noradrenaline, substance P or vasoactive intestinal polypeptide (VIP) has been examined using the Falck—Hillarp histo-fluorescence method and immunohistochemical techniques. Cerebral veins were shown to be innervated by nerve fibres containing noradrenaline, substance P or VIP. Nerve fibres containing noradrenaline were the most numerous, while fibres containing substance P were observed least frequently in both types of vessel. For each putative neurotransmitter, the density of the innervation of the cerebral veins was less than that of cerebral arteries. 2. The vasomotor responses of individual pial arteries and veins on the convexity of the cerebral cortex to perivascular micro-injection of noradrenaline, substance P and VIP were examined in twenty-five cats anaesthetized with α-chloralose. 3. The perivascular micro-application of noradrenaline resulted in pronounced dose-dependent reductions in the diameter of pial veins (maximum calibre reduction: 32±3% noradrenaline 10-5 M) and arteries (22±3% noradrenaline 10-5 M). Pial veins were more sensitive to noradrenaline than were pial arteries tested under similar conditions. The reductions in the diameter of cerebral veins and arteries resulting from the administration of noradrenaline could be attenuated by the concomitant micro-application of phentolamine (10-6 M). 4. The perivascular micro-application of substance P effected significant dose-dependent increases in the calibre of pial veins (maximum calibre increase: 16±4% substance P 10-7 M) which were of a similar magnitude to those observed in pial arteries in response to this peptide (21±4% substance P 10-6 M). 5. The perivascular micro-application of VIP resulted in small increases in the calibre of pial veins (maximum calibre increase: 9±2% VIP 10-8 M) which were proportionately smaller than those observed in pial arteries in response to this peptide (23±5% VIP 10-7 M

  14. Comparison of noninvasive blood pressure measurement techniques via the coccygeal artery in anesthetized cheetahs (Acinonyx jubatus).

    PubMed

    Sadler, Ryan A; Hall, Natalie H; Kass, Philip H; Citino, Scott B

    2013-12-01

    Two indirect blood pressure measurement techniques, Doppler (DOP) sphygmomanometry and oscillometry, applied at the ventral coccygeal artery were compared with simultaneous direct blood pressure measurements at the dorsal pedal artery in 10 anesthetized, captive cheetahs (Acinonyx jubatus). The DOP method was moderately accurate, with relatively little bias (mean difference 3.8 mmHg) and 88.6% of the DOP systolic arterial pressure measurements being within 10 mmHg of the direct systolic arterial measurement. With the oscillometric (OM) method, 89.2% of the mean arterial pressure measurements were within 10 mmHg of the direct measurement and had the least bias (mean difference 2.3 mmHg), 80.7% of the systolic measurements were within 10 mmHg of the direct measurement and had the second least bias (mean difference 2.3 mmHg), and 59% of the diastolic measurements were within 10 mmHg of the direct measurement and had significant bias (mean difference 7.3 mmHg). However, DOP showed relatively poor precision (SD 11.2 mmHg) compared with OM systolic (SD 8.0 mmHg), diastolic (SD 8.6 mmHg), and mean (SD 5.7 mmHg). Both techniques showed a linear relationship with the direct technique measurements over a wide range of blood pressures. The DOP method tended to underestimate systolic measurements below 160 mmHg and overestimate systolic measurements above 160 mmHg. The OM method tended to underestimate mean pressures below 160 mm Hg, overestimate mean pressures above 160 mmHg, underestimate systolic pressures below 170 mmHg, overestimate systolic pressures above 170 mmHg, and underestimate diastolic pressures throughout the measured blood pressure range. Indirect blood pressure measurement using the ventral coccygeal artery, particularly when using an OM device for mean and systolic arterial pressure, may be useful in the clinical assessment of cheetahs when monitoring trends over time, but caution should be taken when interpreting individual values. PMID:24450051

  15. Digital Photoplethysmography for Assessment of Arterial Stiffness: Repeatability and Comparison with Applanation Tonometry

    PubMed Central

    Östling, Gerd; Nilsson, Peter M.

    2015-01-01

    Introduction Arterial stiffness is an independent risk factor for cardiovascular morbidity and can be assessed by applanation tonometry by measuring pulse wave velocity (PWV) and augmentation index (AIX) by pressure pulse wave analysis (PWA). As an inexpensive and operator independent alternative, photoelectric plethysmography (PPG) has been introduced with analysis of the digital volume pulse wave (DPA) and its second derivatives of wave reflections. Objective The objective was to investigate the repeatability of arterial stiffness parameters measured by digital pulse wave analysis (DPA) and the associations to applanation tonometry parameters. Methods and Results 112 pregnant and non-pregnant individuals of different ages and genders were examined with SphygmoCor arterial wall tonometry and Meridian DPA finger photoplethysmography. Coefficients of repeatability, Bland-Altman plots, intraclass correlation coefficients and correlations to heart rate (HR) and body height were calculated for DPA variables, and the DPA variables were compared to tonometry variables left ventricular ejection time (LVET), PWV and AIX. No DPA variable showed any systematic measurement error or excellent repeatability, but dicrotic index (DI), dicrotic dilatation index (DDI), cardiac ejection elasticity index (EEI), aging index (AI) and second derivatives of the crude pulse wave curve, b/a and e/a, showed good repeatability. Overall, the correlations to AIX were better than to PWV, with correlations coefficients >0.70 for EEI, AI and b/a. Considering the level of repeatability and the correlations to tonometry, the overall best DPA parameters were EEI, AI and b/a. The two pansystolic time parameters, ejection time compensated (ETc) by DPA and LVET by tonometry, showed a significant but weak correlation. Conclusion For estimation of the LV function, ETc, EEI and b/a are suitable, for large artery stiffness EEI, and for small arteries DI and DDI. The only global parameter, AI, showed a high

  16. A comparison of excimer laser, thermal probe, and mechanical devices for recanalizing occluded human arteries.

    PubMed

    Moriuchi, M; Tobis, J M; Mcrae, M; Mallery, J A; Macleay, L; Moussabeck, O; Berns, M; Henry, W L

    1991-06-01

    To evaluate the mechanism of excimer laser recanalization and compare the results with those of laser-assisted thermal probe recanalization and mechanical recanalization, a total of 42 human atherosclerotic totally occluded arterial segments (2-15 cm long) were recanalized by excimer laser with a 400-800 micron quartz fiber pulsed at 20 Hz with 50 mJ/mm2 of energy (n = 21), an Argon heated thermal probe at 10-12 watts (n = 11), a guidewire directed through a 6 Fr multipurpose catheter, or an angioplasty balloon catheter (n = 10). On histologic examination, the excimer laster created a single round lumen or multiple lumens ("Swiss-cheese" like appearance) with no evidence of thermal injury at the perimeter of the lumen. The incidence of perforation in vitro was less with an excimer laser catherter (8/21 or 38%) than with the thermal prove (10/11 or 91%) (p less than 0.01). However, serial histologic cross-sectional examination showed that the pathway of the devices were essentially the same in all recanalization procedures. The pathway of the device was located outside the atheroma but proximal to the internal elastic membrane in 13 arteries with the excimer laser (62%), in 10 arteries with the thermal probe (91%), and 8 arteries with mechanical devices (80%). These results indicate that although the eximer laser could recanalize human atherosclerotic arteries without thermal injury, the fiber frequently deflected around firm atherosclerotic plaque and advanced in a dissection plane between the plaque and media. A similar course was noted for the thermal probe or during mechanical recanalization with a guidewire and catheter. To insure the safety of an excimer fiber or a thermal probe to reopen complete occlusions, better guidance systems must be developed. PMID:1875527

  17. Comparison of Meteorological Measurements from Sparse and Dense Surface Observation Networks in the U.S. Southern Great Plains

    SciTech Connect

    JW Monroe; MT Ritsche; M Franklin; KE Kehoe

    2008-02-28

    The primary objective of this study was to analyze the spatial variability of temperature and relative humidity across Kansas (KS) and Oklahoma (OK) for sparse and dense networks by comparing data from (1) the Surface Meteorological Observing System (SMOS) installations at the Atmospheric Radiation Measurement (ARM; Peppler et al. 2008) Program’s Southern Great Plains site and (2) the Oklahoma Mesonet (OKM; McPherson et al. 2007). Given the wealth of observations available from these networks, this study provided the unique opportunity to determine, within a quantifiable statistical limit, an optimal distance between stations deployed for observation of the climatological values of temperature and relative humidity. Average distances between a given station and its closest neighboring station for the ARM SMOS (~ 70 km) and the OKM (~ 30 km; Brotzge and Richardson 2003) networks provided an excellent framework for comparisons of sparse and dense observations (Figure 1). This study further lays groundwork for a future investigation to determine the necessary spacing between observations for initialization of gridded numerical models.

  18. Comparison of oscillometric and intra-arterial blood pressure and pulse measurement.

    PubMed

    Rithalia, S V; Edwards, D

    1994-01-01

    Non-invasive oscillometric blood pressure and pulse measured by an Omron HEM-703CP monitor were compared with arterial values obtained from direct measurements of the radial artery. An excellent correlation and agreement was found between the two methods (systolic r = 0.99; diastolic r = 0.97; pulse r = 0.99), although there was some variability among individual subjects. The range of difference between them was 0 to 10 mmHg for systolic and -6 to +5 mmHg for diastolic pressures. When tested on the bench using the Metron QA-1280 non-invasive blood pressure analyser the HEM-703CP monitor rarely exhibited errors exceeding 2-3 mmHg over a measurement range of 50-200 mmHg. PMID:7776359

  19. Comparison of Statistical Methods for Assessing Spatial Correlations Between Maps of Different Arterial Properties.

    PubMed

    Rowland, Ethan M; Mohamied, Yumnah; Yean Chooi, K; Bailey, Emma L; Weinberg, Peter D

    2015-10-01

    Assessing the anatomical correlation of atherosclerosis with biomechanical localizing factors is hindered by spatial autocorrelation (SA), wherein neighboring arterial regions tend to have similar properties rather than being independent, and by the use of aggregated data, which artificially inflates correlation coefficients. Resampling data at lower resolution or reducing degrees-of-freedom in significance tests negated effects of SA but only in artificial situations where it occurred at a single length scale. Using Fourier or wavelet transforms to generate autocorrelation-preserving surrogate datasets, and thus to compute the null distribution, avoided this problem. Bootstrap methods additionally circumvented the errors caused by aggregating data. The bootstrap technique showed that wall shear stress (WSS) was significantly correlated with atherosclerotic lesion frequency and endothelial nuclear elongation, but not with the permeability of the arterial wall to albumin, in immature rabbits. PMID:26201866

  20. A comparison of arterial lines and insertion techniques in critically ill patients.

    PubMed

    Beards, S C; Doedens, L; Jackson, A; Lipman, J

    1994-11-01

    We compared three arterial line insertion techniques and two types of arterial catheters in 69 critically ill patients. Use of the direct-puncture technique (method A) was associated with a significantly higher failure rate (23%) than use of a catheter with a separate guide wire (method B, 'classical' Seldinger technique, p < 0.001) or a catheter with an integral guide wire (method C, 'modified' Seldinger technique, p < 0.02). Operators randomly allocated to using method A took significantly longer to perform the procedure than those using method C (p < 0.01), used significantly more catheters (p < 0.0001) and made significantly more punctures in achieving a successful insertion than those using either methods B (p < 0.001) or C (p < 0.001). Both catheter types B and C (polyurethane) were significantly less likely to block, thus requiring less likely to block, thus requiring re-insertion, than catheter type A (Teflon) (p < 0.02, p < 0.01 respectively). We recommend the use of a 'classical' Seldinger technique (method B) for arterial line insertion in critically ill patients and the use of a polyurethane catheter, in preference to Teflon, to maximise catheter life after insertion. PMID:7802244

  1. Searching the perfect ultrasonic classification in assessing carotid artery stenosis: comparison and remarks upon the existing ultrasound criteria.

    PubMed

    Mozzini, Chiara; Roscia, Giuseppe; Casadei, Alder; Cominacini, Luciano

    2016-01-01

    Doppler ultrasound scanning is the first line investigation for quantifying the internal carotid artery stenosis. Nevertheless, the lack of internationally accepted ultrasound criteria for describing the degree of stenosis has contributed to the different and confusing measurements ranges. The use of two different angiographic methods, the North American Symptomatic Carotid Endoarterectomy Study and the European Carotid Surgery Trial was probably the major initial source of confusion in deriving valid and reliable duplex ultrasound criteria worldwide. The consensus proposed in 2003 by the Society of Radiologists in Ultrasound has been a great attempt to create a conformity document, establishing grey scale and Doppler criteria in considering the different degrees of stenosis. According to this attempt, in 2010, the multi-parametric Deutsche Gesellschaft für Ultraschall in der Medizin ultrasound criteria have been proposed with a precise differentiation between main and additional criteria and depicted a different peak systolic velocity (PSV) threshold. In 2012, these criteria have been implemented, focusing on the multi-parametric approach, re-defining the PSV values and clearly introducing the concept of PSV average. Despite these attempts, a wide range of practice patterns still exists, with consistent disparities in patients' care. This paper collects these previous experiences and summarizes their strengths and weaknesses, to give a contribution in the carotid artery stenosis grading standardization using ultrasonic methods. Carotid ultrasound as the only diagnostic tool for the selection of patients for carotid surgery or stenting will be possible only with internationally accepted criteria. PMID:27298648

  2. Elasticity assessment of electrospun nanofibrous vascular grafts: a comparison with femoral ovine arteries.

    PubMed

    Bagnasco, D Suarez; Ballarin, F Montini; Cymberknop, L J; Balay, G; Negreira, C; Abraham, G A; Armentano, R L

    2014-12-01

    Development of successful small-diameter vascular grafts constitutes a real challenge to biomaterial engineering. In most cases these grafts fail in-vivo due to the presence of a mechanical mismatch between the native vessel and the vascular graft. Biomechanical characterization of real native vessels provides significant information for synthetic graft development. Electrospun nanofibrous vascular grafts emerge as a potential tailor made solution to this problem. PLLA-electrospun nanofibrous tubular structures were prepared and selected as model bioresorbable grafts. An experimental setup, using gold standard and high resolution ultrasound techniques, was adapted to characterize in vitro the poly(L-lactic acid) (PLLA) electrospun structures. The grafts were subjected to near physiologic pulsated pressure conditions, following the pressure-diameter loop approach and the criteria stated in the international standard for cardiovascular implants-tubular vascular prostheses. Additionally, ovine femoral arteries were subjected to a similar evaluation. Measurements of pressure and diameter variations allowed the estimation of dynamical compliance (%C, 10(-2) mmHg) and the pressure-strain elastic modulus (E(Pε), 10(6) dyn cm(-2)) of the abovementioned vessels (grafts and arteries). Nanofibrous PLLA showed a decrease in %C (1.38±0.21, 0.93±0.13 and 0.76±0.15) concomitant to an increase in EPε (10.57±0.97, 14.31±1.47 and 17.63±2.61) corresponding to pressure ranges of 50 to 90 mmHg, 80 to 120 mmHg and 100 to 150 mmHg, respectively. Furthermore, femoral arteries exhibited a decrease in %C (8.52±1.15 and 0.79±0.20) and an increase in E(Pε) (1.66±0.30 and 15.76±4.78) corresponding to pressure ranges of 50-90 mmHg (elastin zone) and 100-130 mmHg (collagen zone). Arterial mechanics framework, extensively applied in our previous works, was successfully used to characterize PLLA vascular grafts in vitro, although its application can be directly extended to in vivo

  3. The role of ambulatory ST-segment monitoring in the diagnosis of coronary artery disease: comparison with exercise testing and thallium scintigraphy.

    PubMed

    Quyyumi, A; Crake, T; Wright, C; Mockus, L; Fox, K

    1987-02-01

    The value of ambulatory ST-segment monitoring in the detection of underlying coronary artery disease was investigated in one hundred consecutive patients who underwent exercise testing and coronary arteriography for chest pain. Forty-seven also had thallium-201 radioisotope imaging performed. Six of the 26 patients with normal coronary arteries and 52 of the 74 patients with significant coronary artery disease had ST-segment changes during 48 h of ambulatory monitoring (sensitivity 77%). In comparison, the sensitivity of conventional exercise testing was 73% and specificity was 81%. Previous myocardial infarction did not influence the results, but patients with poor left ventricular function more often had absence of ambulatory ST-segment changes. Three-vessel coronary artery disease was detected more efficiently (sensitivity 80%), compared with single vessel disease (sensitivity 50%). Thallium scintigraphy demonstrated defects of uptake in nine patients without ambulatory ST-segment changes (sensitivity 82%, specificity 71%). The majority of these patients had small inferior or posterior defects in thallium uptake. Only one patient with ambulatory ST-segment changes had normal coronary arteries and demonstrable spasm. Thus, ambulatory ST-segment monitoring is as valuable as stress testing in the detection of coronary artery disease and in addition helps detect patients with coronary spasm and normal coronary arteries. PMID:3569309

  4. Great Minds? Great Lakes!

    ERIC Educational Resources Information Center

    Environmental Protection Agency, Chicago, IL. Great Lakes National Program Office.

    This booklet introduces an environmental curriculum for use in a variety of elementary subjects. The lesson plans provide an integrated approach to incorporating Great Lakes environmental issues into the subjects of history, social studies, and environmental sciences. Each of these sections contains background information, discussion points, and a…

  5. Comparison of Novel Coronary Artery Disease Risk Factors between Obese and Normal Adolescent

    PubMed Central

    Kouzehgaran, Samaneh; Vakili, Rahim; Nematy, Mohsen; Safarian, Mohamad; Ghayour-Mobarhan, Majid; Khajedaluee, Mohamad

    2015-01-01

    Background Coronary artery disease is considered as the most common cause of death in all societies including Iran. This study seeks to compare the new risk factors of coronary-artery diseases in obese adolescents and control group. Methods In this cross-sectional study, amongst the obese adolescents registered in the nutrition clinic of Ghaem Hospital, 80 individuals were selected. As the control group, additional 80 adolescent students having the same gender and age as the obese group, but with normal weight were selected. These two groups were selected randomly and their serum level of vitamin D, anti-heat shock protein27 (HSP27), balance of oxidants and antioxidants, and homocysteine were determined and compared. Results In this study, 42 (53.2%) and 37 (46.8%) of the obese and normal weight groups were male, respectively. The mean value of triglyceride, cholesterol, and LDL in the obese group was higher than the normal group, but the mean value for HDL, vitamin D, homocysteine, PAB (Preoxidant and Antioxidants Balance), and anti-HSP27 was not significantly different between the groups. In the base of homocysteine >15 µmol/l, 26.6% of the obese group had hyperhomocysteinemia, therefore homocysteine may be a new risk factor for coronary artery disease in obese adolescents (χ2=4.072; P value=0.091). Conclusion The findings of this study showed that despite the presence of obesity in adolescence and adolescents, new risk factors are not present among them more than the control group. This was in contrast to what was seen in adults. PMID:26170518

  6. Comparison of Partial Volume Effects in Arterial and Venous Contrast Curves in CT Brain Perfusion Imaging

    PubMed Central

    Riordan, Alan J.; Bennink, Edwin; Dankbaar, Jan Willem; Viergever, Max A.; Velthuis, Birgitta K.; Smit, Ewoud J.; de Jong, Hugo W. A. M.

    2014-01-01

    Purpose In brain CT perfusion (CTP), the arterial contrast bolus is scaled to have the same area under the curve (AUC) as the venous outflow to correct for partial volume effects (PVE). This scaling is based on the assumption that large veins are unaffected by PVE. Measurement of the internal carotid artery (ICA), usually unaffected by PVE due to its large diameter, may avoid the need for partial volume correction. The aims of this work are to examine i) the assumptions behind PVE correction and ii) the potential of selecting the ICA obviating correction for PVE. Methods The AUC of the ICA and sagittal sinus were measured in CTP datasets from 52 patients. The AUCs were determined by i) using commercial CTP software based on a Gaussian curve-fitting to the time attenuation curve, and ii) by simple integration of the time attenuation curve over a time interval. In addition, frames acquired up to 3 minutes after first bolus passage were used to examine the ratio of arterial and venous enhancement. The impact of selecting the ICA without PVE correction was illustrated by reporting cerebral blood volume (CBV) measurements. Results In 49 of 52 patients, the AUC of the ICA was significantly larger than that of the sagittal sinus (p = 0.017). Measured after the first pass bolus, contrast enhancement remained 50% higher in the ICA just after the first pass bolus, and 30% higher 3 minutes later. CBV measurements were significantly lowered when the ICA was used without PVE correction. Conclusions Contradicting the assumptions underlying PVE correction, contrast in the ICA was significantly higher than in the sagittal sinus, even 3 minutes after the first pass of the contrast bolus. PVE correction might lead to overestimation of CBV if the CBV is calculated using the AUC of the time attenuation curves. PMID:24858308

  7. Biomechanical Comparison of Glutaraldehyde-Crosslinked Gelatin Fibrinogen Electrospun Scaffolds to Porcine Coronary Arteries.

    PubMed

    Tamimi, E; Ardila, D C; Haskett, D G; Doetschman, T; Slepian, M J; Kellar, R S; Vande Geest, J P

    2016-01-01

    Cardiovascular disease (CVD) is the leading cause of death for Americans. As coronary artery bypass graft surgery (CABG) remains a mainstay of therapy for CVD and native vein grafts are limited by issues of supply and lifespan, an effective readily available tissue-engineered vascular graft (TEVG) for use in CABG would provide drastic improvements in patient care. Biomechanical mismatch between vascular grafts and native vasculature has been shown to be the major cause of graft failure, and therefore, there is need for compliance-matched biocompatible TEVGs for clinical implantation. The current study investigates the biaxial mechanical characterization of acellular electrospun glutaraldehyde (GLUT) vapor-crosslinked gelatin/fibrinogen cylindrical constructs, using a custom-made microbiaxial optomechanical device (MOD). Constructs crosslinked for 2, 8, and 24 hrs are compared to mechanically characterized porcine left anterior descending coronary (LADC) artery. The mechanical response data were used for constitutive modeling using a modified Fung strain energy equation. The results showed that constructs crosslinked for 2 and 8 hrs exhibited circumferential and axial tangential moduli (ATM) similar to that of the LADC. Furthermore, the 8-hrs experimental group was the only one to compliance-match the LADC, with compliance values of 0.0006±0.00018 mm Hg-1 and 0.00071±0.00027 mm Hg-1, respectively. The results of this study show the feasibility of meeting mechanical specifications expected of native arteries through manipulating GLUT vapor crosslinking time. The comprehensive mechanical characterization of cylindrical biopolymer constructs in this study is an important first step to successfully develop a biopolymer compliance-matched TEVG. PMID:26501189

  8. Comparison of Risk of Atrial Fibrillation in Black Versus White Patients After Coronary Artery Bypass Grafting.

    PubMed

    Efird, Jimmy T; Gudimella, Preeti; O'Neal, Wesley T; Griffin, William F; Landrine, Hope; Kindell, Linda C; Davies, Stephen W; Sarpong, Daniel F; O'Neal, Jason B; Crane, Patricia; Nelson, Margaret A; Ferguson, Thomas Bruce; Chitwood, Walter Randolph; Kypson, Alan P; Anderson, Ethan J

    2016-04-01

    Obesity has been identified as a risk factor for postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG). However, no studies have addressed the influence of race on this association. A total of 13,594 patients undergoing first-time, isolated CABG without preoperative AF between 1992 and 2011 were included in our study. The association between body mass index and POAF was compared by race. Relative risk and 95% CIs were computed using maximum likelihood log-binomial regression. Increasing levels of body mass index were associated with higher POAF risk after CABG in black but not white patients (pinteraction = 0.0009). PMID:26857161

  9. Comparison of exercise electrocardiography and quantitative thallium imaging for one-vessel coronary artery disease

    SciTech Connect

    Kaul, S.; Kiess, M.; Liu, P.; Guiney, T.E.; Pohost, G.M.; Okada, R.D.; Boucher, C.A.

    1985-08-01

    The relative value of exercise electrocardiography and computer analyzed thallium-201 imaging was compared in 124 patients with 1-vessel coronary artery disease (CAD). Of these, 78 had left anterior descending (LAD), 32 right and 14 left circumflex (LC) CAD. In patients with no previous myocardial infarction (MI), thallium imaging was more sensitive than the electrocardiogram (78% vs 64%, p less than 0.01), but in patients with previous MI, sensitivity was similar. Further, thallium imaging was more sensitive only in LAD and LC disease. Redistribution was compared with ST-segment depression as a marker of ischemia. Only in patients with prior MI (76% vs 44%, p less than 0.01) and only in LC and right CAD did redistribution occur more often than ST depression. Thallium imaging was more accurate in localizing stenoses than the electrocardiogram (p less than 0.001), but did not always correctly predict coronary anatomy. Septal thallium defects were associated with LAD disease in 84%, inferior defects with right CAD in 40% and posterolateral lesion defects with LC CAD in 22%. The results indicate the overall superiority of thallium imaging in 1-vessel CAD compared with exercise electrocardiography; however, there is a wide spectrum of extent and location of perfusion defects associated with each coronary artery. Thallium imaging complements coronary angiography by demonstrating the functional impact of CAD on myocardial perfusion.

  10. Continuous blood pressure measurement using the pulse transit time: Comparison to intra-arterial measurement.

    PubMed

    Patzak, Andreas; Mendoza, Yuri; Gesche, Heiko; Konermann, Martin

    2015-01-01

    Continuous blood pressure (BP) measurement allows the investigation of transient changes in BP and thus may give insights into mechanisms of BP control. We validated a continuous, non-invasive BP measurement based on the pulse transit time (PTT), i.e., BP(PTT), by comparing it with the intra-arterial BP (BP(i.a.)) measurement. Twelve subjects (five females and seven males) were included. BP(i.a.) was obtained from the radial artery using a system from ReCor Medical. Systolic and diastolic BP were calculated using the PTT (BP(PTT), SOMNOscreen). (PTT) was determined from the electrocardiogram and the peripheral pulse wave. The BP was modulated by application of increasing doses of dobutamine (5, 10, 20 μg/kg body mass). Systolic BP(PTT) and systolic BP(i.a.) correlated significantly (R = 0.94). The limits of agreement in the Bland-Altman plot were ± 19 mmHg; the mean values differed by 1 mmHg. The correlation coefficient for the diastolic BP measurements was R = 0.42. The limits of agreement in the Bland-Altman plot were ± 18 mmHg, with a mean difference of 5 mmHg in favour of the BP(PTT). The study demonstrates a significant correlation between the measurement methods for systolic BP. The results encourage the application of PTT-based BP measurement for the evaluation of BP dynamics and pathological BP changes. PMID:25857601

  11. Skeletonization of the internal thoracic artery: a randomized comparison of harvesting methods.

    PubMed

    Urso, Stefano; Alvarez, Luis; Sádaba, Rafael; Greco, Ernesto

    2008-02-01

    We performed a randomized study to compare internal thoracic artery (ITA) flow response to two harvesting methods used in the skeletonization procedure: ultrasonic scalpel and bipolar electrocautery. Sixty patients scheduled for CABG were randomized to receive either ultrasonically (n=30 patients) or electrocautery (n=30 patients) skeletonized ITAs. Intraoperative ITA graft mean flows were obtained with a transit-time flowmeter. ITA flows were evaluated at the beginning (Time 1) and at the end (Time 2) of the harvesting procedure. Post-cardiopulmonary bypass (CPB) flow measurement (Time 3) was obtained in the ITA grafts anastomosed to the left anterior descending artery. Intraoperative mean flow decreased significantly within ultrasonic group (Group U) and electrocautery group (Group E) at the end of the harvesting procedure (P<0.0001 in both cases). Within both groups the final mean flow measured on anastomosed ITAs (Time 3) was significantly higher than the beginning ITA flow value (Time 1). No statistical difference was noted comparing ITA flows between the two groups at any time of evaluation. Skeletonization harvesting of the ITA produces a modification of the mean flow. The quantity and the reversibility of this phenomenon, probably related to vasospasm, are independent from the energy source used in the skeletonization procedure. PMID:17998305

  12. Intra-Arterial Hepatic Chemotherapy: A Comparison of Percutaneous Versus Surgical Implantation of Port-Catheters

    SciTech Connect

    Deschamps, F.; Elias, D. Goere, D.; Malka, D. Ducreux, M. Boige, V.; Auperin, A.; Baere, T. de

    2011-10-15

    Purpose: To compare retrospectively the safety and efficacy of percutaneous and surgical implantations of port-catheters for intra-arterial hepatic chemotherapy (IAHC). Materials and Methods: Between January 2004 and December 2008, 126 consecutive patients (mean age 58 years) suffering from liver colorectal metastases were referred for intra-arterial hepatic chemotherapy (IAHC). Port-catheters were percutaneously implanted (P) through femoral access with the patient under conscious sedation when no other surgery was planned or were surgically implanted (S) when laparotomy was performed for another purpose. We report the implantation success rate, primary functionality, functionality after revision, and complications of IAHC. Results: The success rates of implantation were 97% (n = 65 of 67) for P and 98% (n = 58 of 59) for S. One hundred eleven patients received IAHC in our institution (n = 56P and n = 55S). Primary functionality was the same for P and S (4.80 vs. 4.82 courses), but functionality after revision was significantly higher for P (9.18 vs. 5.95 courses, p = 0.004) than for S. Forty-five complications occurred during 516 courses for P and 28 complications occurred during 331 courses for S. The rates of discontinuation of IAHC linked to complications of the port-catheters were 21% (n = 12 of 56) for P and 34% (n = 19 of 55) for S. Conclusion: Overall, significantly better functionality and similar complication rates occurred after P versus S port-catheters.

  13. Comparison of meteorological measurements from sparse and dense surface observational networks in the U.S. southern Great Plains.

    SciTech Connect

    Monroe, J. W.; Ritsche, M. T.; Franklin, M.; Kehoe, K. E.; Environmental Science Division; Univ.of Oklahoma

    2008-08-13

    The primary objective of this study was to analyze the spatial variability of temperature and relative humidity across Kansas (KS) and Oklahoma (OK) for sparse and dense networks by comparing data from (1) the Surface Meteorological Observing System (SMOS) installations at the Atmospheric Radiation Measurement (ARM; Peppler et al. 2007) Program's Southern Great Plains site and (2) the Oklahoma Mesonet (OKM; McPherson et al. 2007). Given the wealth of observations available from these networks, this study provided the unique opportunity to determine, within a quantifiable statistical limit, an optimal distance between stations deployed for observation of the climatological values of temperature and relative humidity. Average distances between a given station and its closest neighboring station for the ARM SMOS ({approx} 70 km) and the OKM ({approx} 30 km; Brotzge and Richardson 2003) networks provided an excellent framework for comparisons of sparse and dense observations (Figure 1). This study further lays groundwork for a future investigation to determine the necessary spacing between observations for initialization of gridded numerical models. The spatial variability of temperature and relative humidity was examined over KS and OK by comparing observations between station pairs located in three primary domains: (1) a sparse domain in KS, consisting only of ARM SMOS stations; (2) a dense domain centered in northern OK, consisting of both ARM SMOS and OKM stations; and (3) a dense domain centered in central OK, also consisting of both ARM SMOS and OKM stations (Figure 2). In addition, the ARM SMOS stations in OK were utilized to create two secondary sparse domains. Before the observations were compared, quality control (QC) beyond the standard ARM range test was added through implementation of tighter range tests specified by data quality objectives (DQOs). Furthermore, instances of poor-quality data were removed from the data set on the basis of ARM data quality

  14. Comparison of automatic oscillometric arterial pressure measurement with conventional auscultatory measurement in the labour ward.

    PubMed

    Hasan, M A; Thomas, T A; Prys-Roberts, C

    1993-02-01

    We have compared two non-invasive methods of arterial pressure (AP) measurement used in labour wards: an automatic oscillometric measurement obtained by Dinamap 1846, and a conventional auscultatory measurement obtained by midwives. A total of 369 AP measurements were recorded, involving 28 normotensive and hypertensive pregnant women during labour, with or without extradural analgesia. Compared with the midwife group, the Dinamap group had a greater systolic AP, by 2.7 mm Hg (P < 0.01) and smaller diastolic AP, by 9.8 mm Hg (P < 0.01). The correlations between the two methods were highly significant, but the limits of agreement were relatively wide for both systolic and diastolic AP measurements. We conclude that a clinically important difference exists in diastolic AP measurements. Dinamap diastolic AP must be corrected using a regression equation, or simply by adding 10 mm Hg, before being compared with the available normal and hypertensive AP values. PMID:8435255

  15. A comparison of the priming properties of two central venous catheters and one pulmonary artery catheter.

    PubMed

    Sanderson, P M

    1995-01-01

    The time taken to prime the individual lumina of two multilumen central venous catheters (Viggo-Spectramed 14G 20 cm Hydrocath and Vialon 14G 20 cm Deltacath) and one pulmonary artery catheter (Viggo-Spectramed 110 cm 7.5F Pentacath) at flows between 5 ml.h-1 and 99 ml.h-1 is reported. The catheters supplied by different manufacturers but of identical length and gauge have significantly different priming times (p < 0.001). A protocol which may be used to prime the individual lumina of the three catheters studied is described. By means of an in vitro test the accuracy of this protocol is validated. PMID:7702147

  16. Comparison of two progressive treadmill tests in patients with peripheral arterial disease.

    PubMed

    Riebe, D; Patterson, R B; Braun, C M

    2001-11-01

    In a vascular rehabilitation program, 28% of our frail elderly patients are unable to be tested with traditional progressive exercise protocols at program entry due to the high (2.0 miles/h or 3.2 km/h) initial treadmill speeds. The purpose of this investigation was to compare a new progressive treadmill protocol which has a reduced initial speed (1.0 mile/h or 1.6 km/h) to an established protocol performed at 2.0 miles/h (3.2 km/h) to determine the comparability and reproducibility of the new protocol. Eleven patients with arterial claudication performed three symptom-limited exercise tests in random order. Two tests used the new protocol while the remaining trial used the established protocol. Claudication pain was measured using a 5-point scale. Oxygen consumption, heart rate, minute ventilation, respiratory exchange ratio and blood pressure at peak exercise were similar among the three trials. There were strong intraclass correlations for peak oxygen consumption (r = 0.97), onset of claudication (r = 0.96) and maximum walking time (r = 0.98) between the two trials using the new protocol. There was also a significant correlation between the new protocol and the established protocol for peak oxygen consumption (r = 0.90) and maximum walking time (r = 0.89). The new progressive treadmill protocol represents a valid, reliable protocol for patients with arterial claudication. This protocol may be useful for testing patients with a low functional capacity so that clinically appropriate exercise prescriptions can be established and the efficacy of treatments can be determined. PMID:11958386

  17. Comparison of Ultrasound-Guided and Fluoroscopy-Assisted Antegrade Common Femoral Artery Puncture Techniques

    SciTech Connect

    Slattery, Michael M.; Goh, Gerard S.; Power, Sarah; Given, Mark F.; McGrath, Frank P.; Lee, Michael J.

    2015-06-15

    PurposeTo prospectively compare the procedural time and complication rates of ultrasound-guided and fluoroscopy-assisted antegrade common femoral artery (CFA) puncture techniques.Materials and MethodsHundred consecutive patients, undergoing a vascular procedure for which an antegrade approach was deemed necessary/desirable, were randomly assigned to undergo either ultrasound-guided or fluoroscopy-assisted CFA puncture. Time taken from administration of local anaesthetic to vascular sheath insertion in the superficial femoral artery (SFA), patients’ age, body mass index (BMI), fluoroscopy radiation dose, haemostasis method and immediate complications were recorded. Mean and median values were calculated and statistically analysed with unpaired t tests.ResultsSixty-nine male and 31 female patients underwent antegrade puncture (mean age 66.7 years). The mean BMI was 25.7 for the ultrasound-guided (n = 53) and 25.3 for the fluoroscopy-assisted (n = 47) groups. The mean time taken for the ultrasound-guided puncture was 7 min 46 s and for the fluoroscopy-assisted technique was 9 min 41 s (p = 0.021). Mean fluoroscopy dose area product in the fluoroscopy group was 199 cGy cm{sup 2}. Complications included two groin haematomas in the ultrasound-guided group and two retroperitoneal haematomas and one direct SFA puncture in the fluoroscopy-assisted group.ConclusionUltrasound-guided technique is faster and safer for antegrade CFA puncture when compared to the fluoroscopic-assisted technique alone.

  18. Comparison of BMSs with SES for Symptomatic Intracranial Disease of the Middle Cerebral Artery Stenosis

    SciTech Connect

    Yue Xuanye; Yin Qin; Xi Gangming; Zhu Wusheng; Xu Gelin; Zhang Renliang; Zhou Zhiming; Ma Minmin; Jin Guangfu; Liu Xinfeng

    2011-02-15

    This study was designed to compare the clinical and angiographic outcomes of patients with symptomatic atherosclerotic middle cerebral artery stenosis treated with balloon-mounted stents (BMS) and self-expandable Wingspan system (SES). We reviewed the 69 consecutive stent placement procedures for symptomatic atherosclerotic stenosis ({>=}70) in M1 segment of middle cerebral artery in 67 patients in 3 years. According to the stent types, the patients were classed as BMS and SES groups. The demographic characteristics, conventional risk factors of ischemic stroke, degree of stenosis, periprocedural complications, stent types, and clinical and angiographic outcomes were analyzed. There were 39 patients in the BMS group and 28 patients in the SES group. The demographic characteristics, conventional risk factors, and periprocedural complications were similar but different in residual stenosis after stenting in both groups (5.9% {+-} 9.9% vs. 14.4% {+-} 14.6%; P = 0.01). For the overall cohort, the rate of stroke or death and restenosis was 10.9% (7/66) and 24.5% (14/57), respectively. The frequency of restenosis was higher in the SES group than in the BMS group (log-rank, P = 0.04; crude hazard ratio = 3.03; 95% confidence interval (CI), 1.01-9.15; P = 0.049; and adjusted hazard ratio = 3.61; 95% CI, 1.06-12.27; P = 0.04); however, there was no difference in clinical outcomes (log-rank, P = 0.51; crude hazard ratio = 1.66; 95% CI, 0.36-7.61; P = 0.51; and adjusted hazard ratio = 0.59; 95% CI, 0.04-7.89; P = 0.69). The corrected degree of restenosis was higher in the SES than the BMS group. The prevalence of restenosis was higher in the SES than the BMS group, but the perioperative complications and follow-up clinical outcomes had no significant difference.

  19. Comparison of electrocardiography and thallium-201 myocardial scintigraphy for the detection of ergonovine-induced coronary artery spasm: angiographic correlation

    SciTech Connect

    Shanes, J.G.; Pavel, D.; Blend, M.; Olea, E.; Krone, R.; Lacny, K.; Marmulstein, M.; Malik, R.; Meyer, C.; Kondos, G.T.

    1987-03-01

    This study was performed to determine the sensitivity of thallium imaging vs ECG monitoring for detecting coronary artery spasm noninvasively following intravenous ergonovine administration as compared to simultaneous coronary angiography. Thirty-two patients with insignificant coronary artery disease and chest pain underwent 12-lead ECG monitoring, thallium imaging, and coronary arteriography following the administration of 0.05, 0.1, 0.2, and 0.3 mg of ergonovine given 5 minutes apart or until chest pain occurred. One minute following the last dose of ergonovine, 2.5 mCi of thallium-201 was injected intravenously, and a final ECG was recorded and repeat coronary arteriography performed. Within 10 minutes following the injection of thallium, imaging was performed in the 40-degree and 70-degree left anterior oblique and anterior projections. The ECG, thallium study, and coronary arteriogram were read blindly and results were compared. The ECG, angiogram, and thallium study were read as positive if the following occurred, respectively: greater than or equal to 1 mm ST segment elevation, depression, or T wave reversal; greater than 50% vessel narrowing,; and reversible perfusion defect. Five patients were excluded from analysis because of either catheter-induced spasm, suboptimal thallium studies, or protocol violations. Of the 27 patients included for analysis, six had chest pain, five had a positive angiogram, five had a positive thallium study, and one had a positive ECG. The sensitivity of thallium vs ECG monitoring was 80% vs 25%, and the accuracy was 92% vs 80%. We conclude that thallium imaging greatly increases the noninvasive detection of ergonovine-induced coronary spasm as compared with the ECG with no loss of accuracy.

  20. 3D GRASE pulsed arterial spin labeling at multiple inflow times in patients with long arterial transit times: comparison with dynamic susceptibility-weighted contrast-enhanced MRI at 3 Tesla

    PubMed Central

    Martin, Steve Z; Madai, Vince I; von Samson-Himmelstjerna, Federico C; Mutke, Matthias A; Bauer, Miriam; Herzig, Cornelius X; Hetzer, Stefan; Günther, Matthias; Sobesky, Jan

    2015-01-01

    Pulsed arterial spin labeling (PASL) at multiple inflow times (multi-TIs) is advantageous for the measurement of brain perfusion in patients with long arterial transit times (ATTs) as in steno-occlusive disease, because bolus-arrival-time can be measured and blood flow measurements can be corrected accordingly. Owing to its increased signal-to-noise ratio, a combination with a three-dimensional gradient and spin echo (GRASE) readout allows acquiring a sufficient number of multi-TIs within a clinically feasible acquisition time of 5 minutes. We compared this technique with the clinical standard dynamic susceptibility-weighted contrast-enhanced imaging–magnetic resonance imaging in patients with unilateral stenosis >70% of the internal carotid or middle cerebral artery (MCA) at 3 Tesla. We performed qualitative (assessment by three expert raters) and quantitative (region of interest (ROI)/volume of interest (VOI) based) comparisons. In 43 patients, multi-TI PASL-GRASE showed perfusion alterations with moderate accuracy in the qualitative analysis. Quantitatively, moderate correlation coefficients were found for the MCA territory (ROI based: r=0.52, VOI based: r=0.48). In the anterior cerebral artery (ACA) territory, a readout related right-sided susceptibility artifact impaired correlation (ROI based: r=0.29, VOI based: r=0.34). Arterial transit delay artifacts were found only in 12% of patients. In conclusion, multi-TI PASL-GRASE can correct for arterial transit delay in patients with long ATTs. These results are promising for the transfer of ASL to the clinical practice. PMID:25407272

  1. a Comparison of Laser Scanning and Structure from Motion as Applied to the Great Barn at Harmondsworth, UK

    NASA Astrophysics Data System (ADS)

    Andrews, D. P.; Bedford, J.; Bryan, P. G.

    2013-07-01

    The great barn at Harmondsworth near London Heathrow airport, United Kingdom (UK), was built in 1426-7 for the Bishop of Winchester. At 58 metres long and 11.4 metres wide, it is one of the largest ever known to have been built in the UK, and the largest intact medieval timber-framed barn in England. The barn is built almost entirely of oak, although the walls rest on a low masonry sill-wall. Internally the space is divided into a central "nave" with a lower aisle to each side, and is divided along its length into 12 bays. There are three doorways on the east side. For an entirely timber-framed barn, the fabric is exceptionally well preserved. Even the external weatherboarding may be partly original. Following years of neglect, however, there are a number of on-going structural and conservation problems, so in 2011 the barn was bought by English Heritage in order to allow these needs to be addressed. English Heritage is the government agency responsible for the historic sites and buildings in the care of the state of England and is also the UK government's lead advisor on the built heritage. As one of the first steps in the conservation process the English Heritage Geospatial Imaging and Imaging & Visualisation teams undertook a four-day campaign of survey data collection. This took the form of laser scanning of the interior and exterior of the barn plus the acquisition of photography of the exterior elevations to be used with structure from motion (SFM) software. A comparison of the results of these complimentary yet potentially competing technologies will be given, as well as an evaluation of when they can be successfully used together. This paper will describe the procedures and problems involved with collecting the survey data and its subsequent analysis. The laser scanning was undertaken using a FARO Focus 3D phase based instrument. Approximately 60 scans were acquired in order to provide as comprehensive as possible coverage given the site circumstances. A

  2. Utility of the Amplatzer Vascular Plug in Splenic Artery Embolization: A Comparison Study with Conventional Coil Technique

    SciTech Connect

    Zhu Xiaoli; Tam, Matthew D. B. S.; Pierce, Gregory; McLennan, Gordon; Sands, Mark J.; Lieber, Michael S.; Wang Weiping

    2011-06-15

    Purpose: To retrospectively evaluate the role of the Amplatzer Vascular Plug (AVP) in proximal splenic artery embolization (SAE) compared with coils. Materials and Methods: Forty patients had proximal SAE performed with AVP(s) or coils as the primary embolic agent for splenic artery steal syndrome (n = 23), trauma (n = 5), portal hypertension (n = 5), bleeding due to pancreatic pathology (n = 4), and pre-splenectomy (n = 3). Comparisons were made of occlusion and procedure time, cost, and radiation dose. Results: Eighteen proximal SAE procedures were successfully performed with AVP. Twenty-two procedures were performed with coils, including one failed AVP attempt, which was completed with coils. Precise deployment without migration was achieved in all 18 AVP cases. Seven of 22 (31.8%) coil procedures had distal migration without consequence. There was no statistically significant difference in mean occlusion time (24.4 min for AVP vs. 31.5 min for coils, P = 0.13), procedure time (43.7 min for AVP vs. 53.8 min for coils, P = 0.16), or cost ($1474.13 for AVP vs. $1722.51 for coils, P = 0.69). There was significant difference in radiation dose (842 mGy for AVP vs. 1,309 mGy for coils, P = 0.04). Fourteen of the 18 (78%) AVP devices required additional embolic material. Conclusions: AVP with additional embolic agents is a useful alternative for proximal SAE because of precise deployment, resistance to migration, and radiation reduction. AVP use may be limited by vessel tortuosity. The occlusion time, procedure time, and cost were reduced but this was not statistically significant due to the need for additional embolic material.

  3. Constitutive modeling of coronary arterial media--comparison of three model classes.

    PubMed

    Hollander, Yaniv; Durban, David; Lu, Xiao; Kassab, Ghassan S; Lanir, Yoram

    2011-06-01

    Accurate modeling of arterial elasticity is imperative for predicting pulsatile blood flow and transport to the periphery, and for evaluating the mechanical microenvironment of the vessel wall. The goal of the present study is to compare a recently developed structural model of porcine left anterior descending artery media to two commonly used typical representatives of phenomenological and structure-motivated invariant-based models, in terms of the number of model parameters, model descriptive and predictive powers, and requisite different test protocols for reliable parameter estimation. The three models were compared against 3D data of radial inflation, axial extension, and twist tests. Also checked are the models predictive capabilities to response data not used for estimation, including both tests outside the range of estimation database, as well as protocols of a different nature. The results show that the descriptive estimation error (model fit to estimation database), measured by the sum of squared residuals (SSE) between full 3D data and model predictions, was about twice as low for the structural (4.58%) model compared to the other two (9.71 and 8.99% for the phenomenological and structure-motivated models, respectively). Similar SSE ratios were obtained for the predictive capabilities. Prediction SSE at high stretch based on estimation of two low stretches yielded an SSE value of 2.81% for the structural model, and 10.54% and 7.87% for the phenomenological and structure-motivated models, respectively. For the prediction of twist from inflation-extension data, SSE values for the torsional stiffness was 1.76% for the structural model and 39.62 and 2.77% for the phenomenological and structure-motivated models. The required number of model parameters for the structural model is four, whereas the phenomenological model requires six to nine and the structure-motivated has four parameters. These results suggest that modeling based on the tissue structural

  4. Spatial comparison between wall shear stress measures and porcine arterial endothelial permeability.

    PubMed

    Himburg, Heather A; Grzybowski, Deborah M; Hazel, Andrew L; LaMack, Jeffrey A; Li, Xue-Mei; Friedman, Morton H

    2004-05-01

    A better understanding of how hemodynamic factors affect the integrity and function of the vascular endothelium is necessary to appreciate more fully how atherosclerosis is initiated and promoted. A novel technique is presented to assess the relation between fluid dynamic variables and the permeability of the endothelium to macromolecules. Fully anesthetized, domestic swine were intravenously injected with the albumin marker Evans blue dye, which was allowed to circulate for 90 min. After the animals were euthanized, silicone casts were made of the abdominal aorta and its iliac branches. Pulsatile flow calculations were subsequently made in computational regions derived from the casts. The distribution of the calculated time-dependent wall shear stress in the external iliac branches was directly compared on a point-by-point basis with the spatially varying in vivo uptake of Evans blue dye in the same arteries. The results indicate that in vivo endothelial permeability to albumin decreases with increasing time-average shear stress over the normal range. Additionally, endothelial permeability increases slightly with oscillatory shear index. PMID:14715506

  5. Comparison of Neurocognitive Outcomes after Carotid Endarterectomy and Carotid Artery Stenting.

    PubMed

    Kim, Jerry J; Schwartz, Samuel; Wen, Johnny; deVirgilio, Christian; Lobue, Abeline; Walot, Irwin; Koopmann, Matthew; Donayre, Carlos; White, Rodney A

    2015-10-01

    Cognitive and emotional outcomes after carotid endarterectomy (CEA) and carotid artery stenting with embolic protection device (CAS + EPD) are not clear. Patients were entered prospectively into a United States Food and Drug Administration-approved single-center physician-sponsored investigational device exemption between 2004 and 2010 and received either CEA or CAS + EPD. Patients underwent cognitive testing preprocedure and at 6, 12, and 60 months postprocedure. Cognitive domains assessed included attention, memory, executive, motor function, visual spatial functioning, language, and processing speed. Beck Depression and anxiety scales were also compared. There were a total of 38 patients that met conventional indications for carotid surgery (symptomatic with ≥50% stenosis or asymptomatic with ≥70% stenosis)-12 patients underwent CEA, whereas 26 patients underwent CAS + EPD. Both CEA and CAS + EPD patients showed postprocedure improvement in memory and executive function. No differences were seen at follow-up in regards to emotional dysfunction (depression and anxiety), attention, visual spatial functioning, language, motor function, and processing speed. Only two patients underwent neuropsychiatric testing at 60 months-these CAS + EPD patients showed sustained improvement in memory, visual spatial, and executive functions. In conclusion, cognitive and emotional outcomes were similar between CEA and CAS + EPD patients. PMID:26463299

  6. Comparison of Angiographic Burden of Coronary Artery Disease in Patients With Versus Without Hepatitis C Infection.

    PubMed

    Pothineni, Naga V; Rochlani, Yogita; Vallurupalli, Srikanth; Kovelamudi, Swathi; Ahmed, Zubair; Hakeem, Abdul; Mehta, Jawahar L

    2015-10-01

    Hepatitis C virus (HCV) infection is thought to be associated with an increased risk of coronary heart disease (CHD) events, perhaps secondary to increased inflammation. We sought to examine the angiographic burden of coronary artery disease (CAD) in patients with HCV compared to HCV-negative patients. All consecutive HCV RNA-positive patients (n = 61) who underwent coronary angiography at the University of Arkansas for Medical Sciences from 2001 to 2013 were identified. A parallel group of HCV-negative controls (n = 61), matched for age, gender, and indication for coronary angiography served as control. Angiographic burden of CAD was assessed by computing Gensini scores. Statistical analysis was performed using SPSS 21.0. Patients with HCV had significantly lower levels of total and low-density lipoprotein cholesterol. Preangiographic use of aspirin and statin was significantly lower in the HCV cohort. Number of patients with obstructive CAD was less in HCV group (23% vs 39%, p <0.05). However, angiographic Gensini score was similar in both groups. There was no correlation between HCV RNA titers and Gensini score (p = 0.9, analysis of variance). In conclusion, patients with active HCV infection have similar angiographic CAD burden as HCV-negative patients. Furthermore, viral load does not appear to correlate with atherosclerosis burden. Patients with HCV have less-obstructive CAD and less-frequent use of aspirin and statins. PMID:26256578

  7. Comparison of multiple exercise radionuclide methods for detection of coronary artery disease

    SciTech Connect

    Ryan, J.; Gordon, J.; Shaffer, P.; Gibson, R.; Watson, D.; Magorien, R.; Baumert, J.; Kolibash, A.; Bashore, T.

    1985-05-01

    Five planar exercise Thallium (Tl) scintigraphy methods and four exercise radionuclide angiographic criteria were compared for the diagnosis of significant (greater than or equal to50%) angiographic coronary artery disease (CAD). The patient population consisted of 95 randomly selected patients referred for coronary angiography (CATH) for the evaluation of chest pain without other known cardiac pathology. Both Tl and RNA studies were performed on the same day within 48 hours of CATH. Medications were continued. Tl images were evaluated by visual interpretation of analog (A), 20% background subtracted (20), and interpolative background subtracted (INT) images. Quantitative analysis of horizontal profiles (Watson's method) and circumferential profiles (Garcia's method) were also performed. RNA results were classified as abnormal Ejection Fraction response (< 4% rise) (EF), abnormal wall motion (WM), either (E), and both (B). The authors conclude that while significant differences were found among the sensitivities and specificities, the overall accuracy of the methods were not different except for B. Tl and RNA remain useful despite intercurrent drug therapy.

  8. Comparison of Vertebral Artery and Middle Cerebral Artery Monitoring for Right-to-left Shunt Detection by Contrast-enhanced Transcranial Doppler

    PubMed Central

    Guo, Yu-Zhu; Gao, Yong-Sheng; Guo, Zhen-Ni; Niu, Peng-Peng; Yang, Yi; Xing, Ying-qi

    2016-01-01

    Contrast-enhanced transcranial Doppler (c-TCD) is a reliable and reproducible method for right-to-left shunt (RLS) detection, with high sensitivity. Monitoring the middle cerebral artery (MCA) is an optimal choice, yet for patients with insufficient temporal bone windows or severe stenosis of carotid arteries, an alternative should be established. The aim of the present study was to further establish whether c-TCD with vertebral artery (VA) monitoring is as effective as MCA monitoring for RLS detection. We evaluated 194 subjects for RLS detection with VA and MCA monitoring simultaneously. There was no significant difference between the positive rates of VA and MCA monitoring for RLS detection. c-TCD with VA monitoring could be an alternative for RLS detection, with high sensitivity and specificity both at rest and during the Valsalva manoeuvre. PMID:27098054

  9. Comparison of Vertebral Artery and Middle Cerebral Artery Monitoring for Right-to-left Shunt Detection by Contrast-enhanced Transcranial Doppler.

    PubMed

    Guo, Yu-Zhu; Gao, Yong-Sheng; Guo, Zhen-Ni; Niu, Peng-Peng; Yang, Yi; Xing, Ying-Qi

    2016-01-01

    Contrast-enhanced transcranial Doppler (c-TCD) is a reliable and reproducible method for right-to-left shunt (RLS) detection, with high sensitivity. Monitoring the middle cerebral artery (MCA) is an optimal choice, yet for patients with insufficient temporal bone windows or severe stenosis of carotid arteries, an alternative should be established. The aim of the present study was to further establish whether c-TCD with vertebral artery (VA) monitoring is as effective as MCA monitoring for RLS detection. We evaluated 194 subjects for RLS detection with VA and MCA monitoring simultaneously. There was no significant difference between the positive rates of VA and MCA monitoring for RLS detection. c-TCD with VA monitoring could be an alternative for RLS detection, with high sensitivity and specificity both at rest and during the Valsalva manoeuvre. PMID:27098054

  10. Comparison of Full Lesion Coverage versus Spot Drug-Eluting Stent Implantation for Coronary Artery Stenoses

    PubMed Central

    Kim, Seunghwan; Yun, Kyeong Ho; Shin, Dong-Ho; Kim, Jung-Sun; Kim, Byeong-Keuk; Ko, Young-Guk; Choi, Donghoon; Jang, Yangsoo

    2014-01-01

    Purpose The aim of this study was to evaluate and compare the long-term clinical outcomes of the spot drug-eluting stent (DES) implantation strategy, which is used to minimize implanted stent length and the number of stents, versus full lesion coverage for treatment of coronary artery stenoses. Materials and Methods We evaluated 1-year clinical outcomes of 1619 patients with stent implantation for a single coronary lesion. They were divided into two groups: those treated by full lesion coverage (n=1200) and those treated with the spot stenting strategy (n=419). The combined occurrence of 1-year target vessel failure (TVF), including cardiac death, target-vessel related myocardial infarction, or ischemia-driven target-vessel revascularization was evaluated. Results The spot DES implantation group had a shorter stent length (23.14±9.70 mm vs. 25.44±13.24 mm, respectively; p<0.001) and a fewer number of stents (1.09±0.30 vs. 1.16±0.41, respectively; p<0.001), even though the average lesion length was similar to the full lesion coverage group (21.36±10.30 mm vs. 20.58±10.97 mm, respectively; p=0.206). Spot DES implantation was superior to full DES coverage with respect to 1-year TVF (1.4% vs. 3.3%, p=0.044). Cox proportional hazard model analysis showed that the risk for 1-year TVF was almost 60% lower among patients who received spot DESs compared to those who received full DES coverage after adjustment for other risk factors (HR=0.40, 95% confidence interval=0.17-0.98; p=0.046). Conclusion Minimizing stent length and the number of stents with overlapping by spot DES implantation may result in reduced rates of 1-year TVF, compared with full DES coverage. PMID:24719123

  11. Successful Bridge to Orthotopic Cardiac Transplantation with Implantation of a HeartWare HVAD in Management of Systemic Right Ventricular Failure in a Patient with Transposition of the Great Arteries and Previous Atrial Switch Procedure.

    PubMed

    Stokes, Michael B; Saxena, Pankaj; McGiffin, David C; Marasco, Silvana; Leet, Angeline S; Bergin, Peter

    2016-05-01

    A clinical case is described of a patient with a history of dextro-transposition of the great arteries (d-TGA) and prior atrial switch procedure who developed significant pulmonary hypertension whilst awaiting orthotopic cardiac transplantation. The increase in his pulmonary pressures necessitated de-listing for cardiac transplantation. A strategy of ventricular assist device (VAD) placement was then employed which provided improvement in his systemic cardiac output with left atrial off-loading to provide pulmonary vascular remodelling and consequently reduction in pulmonary vascular resistance (PVR). He was supported for a period of 408 days prior to successful orthotopic cardiac transplantation. A small number of cases with this abnormality undergoing VAD implantation have been described. Mechanical circulatory support has an important role in some patients with congenital heart disease. PMID:26712611

  12. [Cognitive dysfunction following anterior communicating artery aneurysm rupture. Comparison with alcoholic Korsakoff syndrome on neuropsychological performance].

    PubMed

    Mimura, M; Kato, M; Yoshimasu, H; Kashima, H

    1995-08-01

    The present study aims to compare neuropsychological performance of patients following anterior communicating artery aneurysm rupture (ACoA) with that of patients with alcoholic Korsakoff syndrome (AKS). Fifteen ACoA patients and ten age-and education-matched AKS patients were included in the study. All the patients were tested at least one year post onset of their illness at a stable condition. The WAIS and forward digit span scores of AKS were also matched to ACoA, and simple attention and general intelligence were well preserved both in ACoA and AKS. Frontal function as measured by the Wisconsin card sorting test (Keio version) (KWCST) was equivalently impaired in the two groups. Anterograde memory as measured by Wechsler memory scale subtests, serial seven word learning test, Rey auditory verbal learning test, and logical memorizing test (Luria's paired word-picture association), was more severely impaired in AKS than ACoA in contrast to the comparable attention, intelligence, and frontal function: (1) memory tasks with low correlations to KWCST (serial word learning tasks and paired verbal associates), reflecting primary simple serial memorizing, and (2) memory tasks with high correlations to KWCST (logical memory and logical memorizing), reflecting higher and complicated strategic mnemonic activities. However, the correlations between these anterograde memory subtests and KWCST were substantially equivalent in ACoA and AKS. This suggests that the differences in anterograde amnesia demonstrated in ACoA and AKS may be of quantitative, not of qualitative property. The extent of deficits in semantic encoding as measured by Wickens' release from proactive interference paradigm (PI release) was also milder in ACoA than AKS. Both AKS and ACoA failed to show PI release in contrast to normal PI release demonstrated in age-matched ten healthy subjects. PI release in ACoA, however, was in between AKS and healthy subjects. The results were interpreted in the light of a

  13. Comparison between transesophageal Doppler echocardiography and nuclear cardioangiography for the evaluation of left ventricular filling during coronary artery bypass grafting.

    PubMed

    Samuelsson, S; Brodin, L A; Broman, M; Owall, A; Settergren, G

    1995-01-01

    This study examines the relative contribution of early (E) and atrial (A) filling of the left ventricle. Ten patients were studied under anesthesia before and after coronary artery bypass grafting (CABG) using measurements of the mitral velocity-time integral (VTI) with transesophageal pulsed Doppler echocardiography and nuclear angiocardiography simultaneously. Thermodilution cardiac output measurements were made simultaneously in order to express the E and A filling in quantitative terms. The mean difference between methods in estimating E filling was -1.0 mL and the figures for the mean +/- 2 SD were 5.7 and -7.8 mL, r = 0.98 using regression analysis. The mean difference during A filling was 0.9 mL and the corresponding figures for the mean +/- 2 SD were 7.9 and -6.1 mL, r = 0.88. There was a reduction in the volume entering the left ventricle during the E filling (42-26 mL) and in the A phase (27-22 mL) from before surgery in comparison to after CABG. There was good agreement between transesophageal Doppler echocardiographic and nuclear angiocardiographic methods concerning the volume contribution during E and A phases of left ventricular filling. PMID:7802298

  14. Sexuality and Body Image After Uterine Artery Embolization and Hysterectomy in the Treatment of Uterine Fibroids: A Randomized Comparison

    SciTech Connect

    Hehenkamp, Wouter J. K. Volkers, Nicole A.; Bartholomeus, Wouter; Blok, Sjoerd de; Birnie, Erwin; Reekers, Jim A.; Ankum, Willem M.

    2007-09-15

    In this paper the effect of uterine artery embolization (UAE) on sexual functioning and body image is investigated in a randomized comparison to hysterectomy for symptomatic uterine fibroids. The EMbolization versus hysterectoMY (EMMY) trial is a randomized controlled study, conducted at 28 Dutch hospitals. Patients were allocated hysterectomy (n = 89) or UAE (n 88). Two validated questionnaires (the Sexual Activity Questionnaire [SAQ] and the Body Image Scale [BIS]) were completed by all patients at baseline, 6 weeks, and 6, 12, 18, and 24 months after treatment. Repeated measurements on SAQ scores revealed no differences between the groups. There was a trend toward improved sexual function in both groups at 2 years, although this failed to reach statistical significance except for the dimensions discomfort and habit in the UAE arm. Overall quality of sexual life deteriorated in a minority of cases at all time points, with no significant differences between the groups (at 24 months: UAE, 29.3%, versus hysterectomy, 23.5%; p = 0.32). At 24 months the BIS score had improved in both groups compared to baseline, but the change was only significant in the UAE group (p = 0.009). In conclusion, at 24 months no differences in sexuality and body image were observed between the UAE and the hysterectomy group. On average, both after UAE and hysterectomy sexual functioning and body image scores improved, but significantly so only after UAE.

  15. Randomized Comparison of Intra-Arterial Chemotherapy Versus Intra-Arterial Chemotherapy and Gelfoam Embolization for Treatment of Advanced Cervical Carcinoma

    SciTech Connect

    Ikeda, O. Mizukami, N.; Murata, Y.; Arakawa, A.; Katabuchi, H.; Okamoto, H.; Yasunaga, T.; Tsunawaki, A.; Yamashita, Y.

    2005-12-15

    Purpose:We evaluated the effects of intra-arterial infusion therapy by comparing the results obtained with a combination of intra-arterial anticancer drugs with and without transcatheter arterial embolization (TAE) in patients with cervical cancer.Methods:Between April 1999 and March 2003, intra-arterial therapy was administered to 45 patients (mean age 49 years) with cervical cancer. Of these, 18 had stage IIb , 4 had stage IIIa, 19 had stage IIIb, and 4 had stage IVb cancer; the histopathologic types were squamous cell carcinoma (n = 35), adenocarcinoma (n = 8), and adenosquamous carcinoma (n = 2). A total of 45 patients gave their informed consent and were randomized on a continuous basis into one of three groups according to the therapeutic protocols: group A consisted of 15 patients who received cisplatin, group B consisted of 17 patients who received cisplatin, mitomycin, doxorubicin hydrochloride, and 5-fluorouracil, and group C consisted of 13 patients who received cisplatin and TAE. Each protocol was administered twice with a 3 week interval between treatments. The efficacy of treatment was evaluated on the basis of the tumor reduction ratio (%) using MR imaging and the side effects were analyzed.Results:In groups A, B, and C, the tumor reduction ratio was 54%, 84%, and 86%, respectively; it was significantly greater in groups B and C than in group A (p < 0.01). The difference between groups B and C was not statistically significant. Although all group C patients developed severe pain after TAE, the pain was controlled with analgesics. Thrombocytopenia occurred in 6 of 17 (35%) group B patients.Conclusion:Group B and C patients had better tumor reduction than those in group A. Fewer hematologic complications occurred in group C patients compared with group B.

  16. Diagnosis and management of Transposition of great arteries within a pediatric cardiology network with the aid of telemedicine: A case report from Brazil.

    PubMed

    Galdino, Millena M; Hazin, Sheila Mv; de Araújo, Juliana Ss; Regis, Cláudio T; Rodrigues, Klecida N; Mourato, Felipe A; Mattos, Sandra da Silva

    2016-04-01

    We present a case of a newborn from a remote, underserved area in the inland of Paraíba, a state from Northeast Brazil. She presented with clinical cyanosis at birth. With the aid of telemedicine, a neonatologist under online cardiology supervision performed a screening echocardiogram. The session established the diagnosis of simple transposition of the great vessels in the baby's first few hours of life. During the same telemedicine session, the necessary arrangements for transferal to a larger maternity center took place. The baby was maintained stable on prostaglandins and was subsequently transferred to a tertiary cardiac center in the neighboring State, Pernambuco. She underwent anatomical correction at day 10, presented no surgical or postoperative complications, and was discharged home at the age of 21 days. She is now over three years old and continues her follow-up care mostly at her hometown, with local pediatricians under online supervision by a cardiologist in a virtual outpatient clinic. The establishment of a Pediatric Cardiology Network, with the aid of telemedicine, can produce a major impact on the access to specialized health care for poor regions of developing countries. PMID:26159438

  17. Comparison of transradial and transfemoral artery approach for percutaneous coronary angiography and angioplasty: A retrospective seven-year experience from a north Indian center

    PubMed Central

    Tewari, Satyendra; Sharma, Naveen; Kapoor, Aditya; Syal, Sanjeev Kumar; Kumar, Sudeep; Garg, Naveen; Goel, Pravin K.

    2013-01-01

    Background With the increasing prevalence of coronary artery disease, percutaneous coronary artery procedures have become even more important. Our study has compared transradial to transfemoral artery approach for coronary procedures in Indian population. Aims and objective Comparison of transradial and transfemoral artery approach for percutaneous coronary procedures. Material & methods 26,238 patients, who underwent percutaneous coronary artery procedures, were divided into two groups depending upon transradial and transfemoral artery approach and compared for the various demographic and clinical characteristics, risk factors profile, vascular access and procedural details. Results 26,238 patients underwent percutaneous coronary procedures at our center. 81% were male and 19% were female. 55.65% and 44.35% procedures were done through transfemoral and transradial approach, respectively. 17,417 (66.38%) coronary angiographies were done, out of which 53.92% were transradial and 46.08% were transfemoral procedures. 8821 (33.62%) Percutaneous Transluminal Coronary Angioplasty (PTCA) were done, out of which 25.46% and 74.54% were done through transradial and transfemoral approach, respectively. Mean fluoroscopy time was 4.40 ± 3.55 min for transradial and 3.30 ± 3.66 min for transfemoral CAG (p < 0.001). For PTCA mean fluoroscopy time was 13.53 ± 2.53 min for transradial and 12.61 ± 9.524 min for transfemoral PTCA (p < 0.001). Minor and major procedure related complications and total duration of hospital stay were lower in transradial as compared to transfemoral group. Conclusion The number of percutaneous transradial procedures have increased significantly with reduced complication rates and comparable success rate to transfemoral approach, along with the additional benefits to patient in terms of patient comfort, preference and reduced cost of health delivery. PMID:23992998

  18. Spectral CT in the Demonstration of the Pancreatic Arteries and Their Branches: A Comparison With Conventional CT

    PubMed Central

    Shi, Yan-Jie; Zhang, Xiao-Peng; Sun, Ying-Shi; Qi, Li-Ping; Li, Ying; Zhu, Hai-Bin; Li, Xiao-Ting; Zhang, Xiao-Yan

    2016-01-01

    Abstract The aim of this study was to investigate the performance of monochromatic images of spectral computed tomographic (CT) in the visualization of the pancreatic arteries compared with polychromatic CT images. We conducted a case–control study in a group of 26 consecutive patients with monochromatic CT and contrasted the results against a control group of 26 consecutive patients with polychromatic CT. The CNR (contrast-to-noise ratio), SIR (signal intensity ratio), SNR (signal to noise ratio), and image noise were measured. A 5-score classification system was used to evaluate the branch order of pancreatic arteries. The course of pancreatic arteries was compared. Compared with polychromatic images, the CNR, SIR, and SNR obtained by monochromatic images were increased by 64.74%, 23.99%, and 39.50%. Branch visualization of PSPDA (posterior superior pancreaticoduodenal artery), ASPDA (anterior superior pancreaticoduodenal artery), and DPA (dorsal pancreatic artery) was better at monochromatic images than at polychromatic images. The display rate was significantly better in monochromatic images for the second and third segments of PSPDA, total course of ASPDA, and artery of uncinate process. Compared with polychromatic images, monochromatic images can improve the visualization of pancreatic arteries. PMID:26886636

  19. Arterial embolism

    MedlinePlus

    ... the artery (arterial bypass) to create a second source of blood supply Clot removal through a balloon catheter placed into the affected artery or through open surgery on the artery (embolectomy) Opening of the ...

  20. Preoperative ejection fraction as a predictor of survival after coronary artery bypass grafting: comparison with a matched general population

    PubMed Central

    2010-01-01

    Background Preoperative left ventricular dysfunction is an established risk factor for early and late mortality after revascularization. This retrospective analysis demonstrates the effects of preoperative ejection fraction on the short-term and long-term survival of patients after coronary artery bypass grafting. Methods Early and late mortality were determined retrospectively in 10 626 consecutive patients who underwent isolated coronary bypass between January 1998 and December 2007. The subjects were divided into 3 groups according to their preoperative ejection fraction. Expected survival was estimated by comparison with a general Dutch population group described in the database of the Dutch Central Bureau for Statistics. For each of our groups with a known preoperative ejection fraction, a general Dutch population group was matched for age, sex, and year of operation. Results and Discussion One hundred twenty-two patients were lost to follow-up. In 219 patients, the preoperative ejection fraction could not be retrieved. In the remaining patients (n = 10 285), the results of multivariate logistic regression and Cox regression analysis identified the ejection fraction as a predictor of early and late mortality. When we compared long-term survival and expected survival, we found a relatively poorer outcome in all subjects with an ejection fraction of < 50%. In subjects with a preoperative ejection fraction of > 50%, long-term survival exceeded expected survival. Conclusions The severity of left ventricular dysfunction was associated with poor survival. Compared with the survival of the matched general population, our coronary bypass patients had a worse outcome only if their preoperative ejection fraction was < 50%. PMID:20416050

  1. Cerebral blood flow quantification in the rat: a direct comparison of arterial spin labeling MRI with radioactive microsphere PET

    PubMed Central

    2012-01-01

    Background Arterial spin labeling magnetic resonance imaging (ASL-MRI) has been recognised as a valuable method for non-invasive assessment of cerebral blood flow but validation studies regarding quantification accuracy by comparison against an accepted gold standard are scarce, especially in small animals. We have conducted the present study with the aim of comparing ASL flow-sensitive alternating inversion recovery (FAIR)-derived unidirectional water uptake (K1) and 68Ga/64Cu microsphere (MS)-derived blood flow (f) in the rat brain. Methods In 15 animals, K1and f were determined successively in dedicated small animal positron emission tomography and MR scanners. The Renkin-Crone model modified by a scaling factor was used for the quantification of f and K1. Results Below about 1 mL/min/mL, we obtain an approximately linear relationship between f and K1. At higher flow values, the limited permeability of water at the blood brain barrier becomes apparent. Within the accessed dynamic flow range (0.2 to 1.9 mL/min/mL), the data are adequately described by the Renkin-Crone model yielding a permeability surface area product of (1.53±0.46) mL/min/mL. Conclusion The ASL-FAIR technique is suitable for absolute blood flow quantification in the rat brain when using a one-compartment model including a suitable extraction correction for data evaluation. Trial registration 24-9168.21-4/2004-1 (registered in Freistadt Sachsen, Landesdirektion Dresden) PMID:22978819

  2. Numerical Investigation of Angulation Effects in Stenosed Renal Arteries

    PubMed Central

    Mortazavinia, Z; Arabi, S; Mehdizadeh, A R

    2014-01-01

    Background: Numerical study of angulation effects of renal arteries on blood flow has been of great interest for many researchers. Objective: This paper aims at numerically determining the angulation effects of stenosed renal arteries on blood flow velocity and renal mass flow. Method: An anatomically realistic model of abdominal aorta and renal arteries is reconstructed from CT-scan images and used to conduct numerical simulation of pulsatile non-Newtonian blood flow incorporating fluid-structure interaction. The renal arteries in the realistic model have left and right branch angles of 53˚ and 45˚, respectively. Atrapezium shape stenosis is considered in the entrance of right renal artery. Two other branch angles, i.e. 90 and 135˚, are also considered for right renal artery to study the angulation effects. Results: Comparison between models with right renal branch angles of 45˚, 90˚ and 135˚ reveals that high curvature of streamlines in the entrance of the renal artery with the angle of 135˚ causes the flow velocity and renal mass flow to be less than those of 45˚and 90˚. Conclusion: It is concluded that large renal branch angles cause the arteries to be unable to deliver blood in the requisite amounts to kidney. Kidney responds to counteract low blood flow by activating the renin-angiotension system which leads to severe hypertension. PMID:25505762

  3. Comparison Between Lidar and Nephelometer Measurements of Aerosol Hygroscopicity at the Southern Great Plains Atmospheric Radiation Measurement Site

    NASA Technical Reports Server (NTRS)

    Pahlow, M.; Feingold, G.; Jefferson, A.; Andrews, E.; Ogren, J. A.; Wang, J.; Lee, Y.-N.; Ferrare, R. A.

    2004-01-01

    Aerosol hygroscopicity has a significant effect on radiative properties of aerosols. Here a lidar method, applicable to cloud-capped, well-mixed atmospheric boundary layers, is employed to determine the hygroscopic growth factor f(RH) under unperturbed, ambient atmospheric conditions. The data used for the analysis were collected under a wide range of atmospheric aerosol levels during both routine measurement periods and during the intensive operations period (IOP) in May 2003 at the Southern Great Plains (SGP) Climate Research Facility in Oklahoma, USA, as part of the Atmospheric Radiation Measurement (ARM) program. There is a good correlation (approx. 0.7) between a lidar-derived growth factor (measured over the range 85% RH to 96% RH) with a nephelometer-derived growth factor measured over the RH range 40% to 85%. For these RH ranges, the slope of the lidar-derived growth factor is much steeper than that of the nephelometer-derived growth factor, reflecting the rapid increase in particle size with increasing RH. The results are corroborated by aerosol model calculations of lidar and nephelometer equivalent f(RH) based on in situ aerosol size and composition measurements during the IOP. It is suggested that the lidar method can provide useful measurements of the dependence of aerosol optical properties on relative humidity, and under conditions closer to saturation than can currently be achieved with humidified nephelometers.

  4. Comparison of bias correction methods for the RegCM4-ICTP daily precipitation simulation over the Great Alpine Region

    NASA Astrophysics Data System (ADS)

    Turco, Marco; von Hardenberg, Jost; Provenzale, Antonello

    2015-04-01

    Global Circulation Models (GCMs) are tools of primary importance to obtain future climate projections under different anthropogenic forcing scenarios. However, the GCM coarse resolution (generally few hundred kilometres) it is not suitable to analyse the projections at regional scale (generally few tens kilometres). Usually the gap between the coarse resolution GCMs and the appropriate scale for regional climate studies is bridged by means of dynamical and/or statistical downscaling techniques. The dynamical downscaling approach is based on high-resolution Regional Climate Models (RCM) -- with typical resolutions of tens of kilometres -- driven by GCMs within a limited domain. The RCMs explicitly solve mesoscale atmospheric processes and provide spatially coherent and, to a certain degree, physically consistent output. However, they have in general considerable biases and therefore often cannot directly be used as input for impact models but they must be corrected/calibrated. In this work, of preliminary nature, we focus on precipitation, a key variable for many impact sectors (agriculture, hydrology, etc.) which has a large uncertainty in RCMs and we describe a simple strategy to develop high-resolution precipitation projections over the Great Alpine Region (GAR) combining dynamical downscaling and statistical methods. Specifically, we compare three different bias correction methods to refine the precipitation simulated by the RegCM4 model and we assess the strengths and limitations of this approach in terms of its robust applicability for climate change studies.

  5. Accurate quantitative measurements of brachial artery cross-sectional vascular area and vascular volume elastic modulus using automated oscillometric measurements: comparison with brachial artery ultrasound

    PubMed Central

    Tomiyama, Yuuki; Yoshinaga, Keiichiro; Fujii, Satoshi; Ochi, Noriki; Inoue, Mamiko; Nishida, Mutumi; Aziki, Kumi; Horie, Tatsunori; Katoh, Chietsugu; Tamaki, Nagara

    2015-01-01

    Increasing vascular diameter and attenuated vascular elasticity may be reliable markers for atherosclerotic risk assessment. However, previous measurements have been complex, operator-dependent or invasive. Recently, we developed a new automated oscillometric method to measure a brachial artery's estimated area (eA) and volume elastic modulus (VE). The aim of this study was to investigate the reliability of new automated oscillometric measurement of eA and VE. Rest eA and VE were measured using the recently developed automated detector with the oscillometric method. eA was estimated using pressure/volume curves and VE was defined as follows (VE=Δ pressure/ (100 × Δ area/area) mm Hg/%). Sixteen volunteers (age 35.2±13.1 years) underwent the oscillometric measurements and brachial ultrasound at rest and under nitroglycerin (NTG) administration. Oscillometric measurement was performed twice on different days. The rest eA correlated with ultrasound-measured brachial artery area (r=0.77, P<0.001). Rest eA and VE measurement showed good reproducibility (eA: intraclass correlation coefficient (ICC)=0.88, VE: ICC=0.78). Under NTG stress, eA was significantly increased (12.3±3.0 vs. 17.1±4.6 mm2, P<0.001), and this was similar to the case with ultrasound evaluation (4.46±0.72 vs. 4.73±0.75 mm, P<0.001). VE was also decreased (0.81±0.16 vs. 0.65±0.11 mm Hg/%, P<0.001) after NTG. Cross-sectional vascular area calculated using this automated oscillometric measurement correlated with ultrasound measurement and showed good reproducibility. Therefore, this is a reliable approach and this modality may have practical application to automatically assess muscular artery diameter and elasticity in clinical or epidemiological settings. PMID:25693851

  6. A Side-by-side Comparison of Eddy Covariance and Bowen Ratio Evapotranspiration From a Northern Great Basin Ecosystem

    NASA Astrophysics Data System (ADS)

    Lyles, B. F.; Jasoni, R. L.

    2008-12-01

    Development of new ground water resources in rural lands surrounding urban areas of the arid western United States has been identified as a key to maintaining urban growth. The extent and rate at which ground water can be sustainably extracted, while minimizing environmental impacts, depends to a large degree on how much of the existing resource escapes back to the atmosphere via the process of evapotranspiration (ET). ET is the sum of water that evaporates (E) from soil surfaces and is transpired (T) from plant leaves. This study was conducted in a northeast/southwest trending closed basin, bounded by mountains on all sides, with no surface water outflow. The playa which is located in the center of the basin encompasses 59,600 hectares, while phreatophytic plants bordering the playa encompass 20,000 hectares. ET data was collected from a sagebrush/greasewood plant community from October 2004 to August 2008 by the Bowen Ratio technique. Eddy covariance ET monitoring equipment was installed in April of 2007 and a side-by-side comparison was conducted from April to October, 2007. At the end of the study period a 25% difference in ET was calculated between the eddy covariance and Bowen ratio techniques. The major factors for the differences in ET from the two different methods will be presented.

  7. Comparison of dual protection and distal filter protection as a distal embolic protection method during carotid artery stenting: a single-center carotid artery stenting experience.

    PubMed

    Kajihara, Yosuke; Sakamoto, Shigeyuki; Kiura, Yoshihiro; Mukada, Kazutoshi; Chaki, Takahiro; Kajihara, Shiro; Kurisu, Kaoru

    2015-10-01

    There are several protection methods used to prevent distal embolism during carotid artery stenting (CAS). The aim of this study was to compare the dual protection method (proximal balloon and distal filter protection) with the distal filter protection during CAS performed at a single center. Between April 2008 and November 2013, 78 consecutive patients with internal carotid artery stenosis were treated with CAS at Istukaichi Memorial Hospital. Twenty-four consecutive patients were treated with CAS using distal filter protection (distal filter protection group), and 54 consecutive patients were treated with CAS using dual protection with a proximal balloon and distal filter protection (dual protection group). We examined the hyperintensity lesions on diffusion-weighted imaging (DWI) and perioperative complications after CAS. All stenotic lesions were successfully dilated. DWI showed hyperintensity lesions among 54.2 % (13/24 patients) in the distal filter protection group and in 27.8 % (15/54 patients) in the dual protection group (p = 0.024). The average number of hyperintensity lesions on DWI was 1.75 (range, 0 to 6) in the distal filter protection group and 0.59 (range, 0 to 5) in the dual protection group (p = 0.0087). Postprocedural persistent ischemic complications occurred in 4.2 % (1/24 patients) in the distal filter protection group and 3.7 % (2/54 patients) in the dual protection group (p = 0.67). In this study, the dual protection method reduced the number of hyperintensity lesions seen on DWI when compared with the distal filter protection method when used for distal embolic protection during CAS. PMID:25953614

  8. Comparison of two models for predicting bioaccumulation of hydrophobic organic chemicals in a Great Lakes food web

    SciTech Connect

    Burkhard, L.P.

    1998-03-01

    The steady-state models of Gobas and Thomann for predicting chemical residues in aquatic food webs were compared. Bioaccumulation factors (BAFs) predicted on the basis of freely dissolved chemical in the water were not significantly different for piscivorous fish, based upon the 10th and 90th percentile predictions, except for chemicals with log n-octanol/water partition coefficients (K{sub ow}s) ranging from 6.5 to 6.9, the region of maximum differences for chemicals with log K{sub ow}s less than 8. For chemicals with log K{sub ow}s greater than 8, the BAFs predicted by the models diverged. The BAFs predicted using the Gobas model were in slightly better agreement with measured BAFs than those predicted using the Thomann model. Sensitivities of the input parameters used by both models were very similar. The most sensitive input parameters were lipid contents, K{sub ow}, and sediment-water column chemical concentration quotient ({Pi}{sub socw}) for both models, and the feeding preferences for benthic invertebrates (Diporeia) for the Thomann model. Simulations performed using uncertainties for the input parameters demonstrated that the K{sub ow} and {Pi}{sub socw} were the dominant sources of uncertainties for predicted BAFs by both models for the Great Lakes food web. For piscivorous fish, overall uncertainties in the predicted BAFs ranged from a factor of 3.3 to 5.5 (Gobas model) and from a factor of 3.3 to 8.7 (Thomann model) for chemicals with log K{sub ow}s less than 7.6.

  9. Effects of reservoirs on river nitrogen and phosphorus export in the Mississippi and Great Lakes Basins: A regional comparison

    NASA Astrophysics Data System (ADS)

    Powers, S. M.; Tank, J. L.; Robertson, D.

    2013-12-01

    Reservoirs can influence mass transport of anthropogenic nitrogen (N) and phosphorus (P) through rivers, but comparative studies are needed to better understand how reservoir processes vary among landscapes and regions. We compared influences of reservoirs on N and P delivery to tributaries of the Mississippi and Great Lakes Basins, using river monitoring stations that were positioned immediately downstream of reservoir outlets. For a given agricultural intensity (percent of basin classified as cropland), outlet stations (n=115) had lower mean annual flow-weighted concentration for N and P than other stations (n=1085), as well as lower concentration variability. For instance, in the presence of high agriculture (>50% of basin as cropland), reservoir outflow stations had on average 40% lower N and 35% lower P concentration, while the coefficient of variation for both N and P was 30% lower. These aggregate patterns were examined more closely for individual reservoirs of different regions, which fell into two monitoring categories: 1) those which had monitoring stations positioned at the inflow as well as the outflow (n= 23 for TN, n=34 for TP); 2) those which had outflow monitoring stations, as well as an estimate of the expected inflow (from a spatially-referenced regression model). Again, both outflow nutrient concentration and yield (mass per basin area) were usually lower and more stable than the inflow. However, the difference between outflow and inflow varied substantially among reservoirs and regions, including some cases where reservoirs appeared to be net P sources to rivers at the annual time frame. These effects of reservoirs on river N and P are presumably the consequence of reservoir nutrient burial, microbial denitrification, and internal nutrient recycling. Management intended to improve the water quality of rivers and receiving waters would benefit from an improved understanding of reservoir processes, which not only vary among regions, but also could

  10. COMPARISON OF HIGH-DEFINITION OSCILLOMETRIC AND DIRECT ARTERIAL BLOOD PRESSURE MEASUREMENT IN ANESTHETIZED CHEETAHS (ACINONYX JUBATUS).

    PubMed

    Sant Cassia, Emma V; Boswood, Adrian; Tordiffe, Adrian S W

    2015-09-01

    Blood pressure measurement reveals important insights into the health of conscious and anesthetized individuals. This is of particular interest in cheetahs (Acinonyx jubatus), which in captivity are known to suffer from chronic diseases that may be associated with hypertension and which often require immobilization for transport or veterinary treatment. Invasive testing methods are considered the gold standard but are not practical in many settings. Consequently, it is important to evaluate the use of noninvasive methods in this species. Measurements for systolic, diastolic, and mean arterial pressure obtained using high-definition oscillometry (HDO) at the coccygeal artery were compared to simultaneous direct measurements obtained via catheterization of the femoral or dorsal pedal artery in eight anesthetized captive cheetahs during nine anesthetic events. Overall, HDO and direct measurements agreed most closely for mean arterial pressure, and the poorest agreement was observed for systolic pressure. There was a tendency for low diastolic pressures to be underestimated and for high diastolic pressures to be overestimated. Across all three parameters, HDO measurements from the tail overestimated directly measured pressures in the femoral artery and underestimated those in the dorsal pedal artery. HDO agreed most closely with directly measured dorsal pedal pressures. Mean arterial pressure showed the greatest precision (standard deviation of 10.2 mm Hg) and lowest bias (-1.2 mm Hg), with 75.9% of readings within 10 mm Hg of the direct dorsal pedal pressure. Agreement with systolic pressure was hindered by a high bias (-10.4 mm Hg), but if a correction factor of +10 mm Hg was applied to all systolic measurements, agreement was improved and 65.7% of readings were within 10 mm Hg of the direct pressure. When compared to criteria defined by the American College of Veterinary Internal Medicine for validation of blood pressure devices, results were favorable, but a

  11. Circulating oxidized low-density lipoproteins and arterial elasticity: comparison between men with metabolic syndrome and physically active counterparts

    PubMed Central

    2010-01-01

    Background Accumulation of oxidized low-density lipoproteins in the intimae of arteries and endothelial dysfunction are key events in the development of atherosclerosis. Patients with metabolic syndrome are at high risk for cardiovascular diseases but the linkage between metabolic syndrome and atherosclerosis is incompletely understood. We studied whether the levels of oxidized LDL and arterial elasticity differ between metabolic syndrome patients and physically active controls. Methods 40 men with metabolic syndrome and 40 physically active controls participated in this cross-sectional study. None of the study subjects had been diagnosed with cardiovascular disease. Levels of oxidized LDL were assessed by a two-site ELISA immunoassay. Arterial elasticity was assessed non-invasively by the HDI/PulseWave™ CR-2000 arterial tonometer. Results Levels of oxidized LDL were 89.6 ± 33.1 U/L for metabolic syndrome subjects and 68.5 ± 23.6 U/L for controls (p = 0.007). The difference remained significant after adjustment for LDL cholesterol. Large artery elasticity index (C1) was 16.2 ± 4.1 mL/mmHgx10 for metabolic syndrome subjects and 19.4 ± 3.7 mL/mmHgx10 for controls (p = 0.001), small artery indices (C2) were 7.0 ± 3.2 mL/mmHgx100 and 6.5 ± 2.9 mL/mmHgx100 (NS), respectively. Conclusions Subjects with metabolic syndrome had elevated levels of oxidized LDL and reduced large arterial elasticity compared to controls. This finding may partly explain the increased risk for cardiovascular diseases among metabolic syndrome patients. Trial registration ClinicalTrials.gov NCT01114763 PMID:20727144

  12. Comparison of Standard Catheters Versus Radial Artery-Specific Catheter in Patients Who Underwent Coronary Angiography Through Transradial Access.

    PubMed

    Chen, On; Goel, Sunny; Acholonu, Michael; Kulbak, Guy; Verma, Shivani; Travlos, Efstratios; Casazza, Richard; Borgen, Elliot; Malik, Bilal; Friedman, Michael; Moskovits, Norbert; Frankel, Robert; Shani, Jacob; Ayzenberg, Sergey

    2016-08-01

    In this prospective, randomized controlled study, we aim to compare the performance outcomes of standard catheters with the radial artery-specific catheter. Over the past decade, transradial cardiac catheterization has gained widespread popularity because of its low complication rates compared with transfemoral access. Operators have the choice of using either standard catheters (used for both transfemoral and transradial approach, with need for separate catheter use for either right or left coronary artery engagement) or a dedicated radial artery catheter, which is specifically designed to engage both coronary arteries through radial artery access. A total of 110 consecutive patients who underwent coronary angiography at our institution from March 2015 to April 2015 were prospectively randomized to either radial artery-specific Tiger catheter (5Fr; Terumo Interventional Systems, Somerset, New Jersey) versus standard Judkins left and right catheters (5Fr R4, L4; Cordis Corporation, Miami, Florida). The end points of the study included fluoroscopy time, dose-area product, contrast volume used, and total procedure time for the coronary angiography. A total of 57 patients (52%) were randomized to radial artery-specific catheter and 53 (48%) to the standard catheter. Tiger catheter was associated with significantly lower fluoroscopy time (184 ± 91 vs 238 ± 131 seconds, p = 0.015), which was statistically significant. Other outcome measures such as dose-area product (2,882.4 ± 1,471.2 vs 3,524.6 ± 2,111.7 Gy·cm(2), p = 0.07), total contrast volume (48.1 ± 16.1 vs 53.4 ± 18.5 ml, p = 0.114), and total procedure time (337 ± 382 vs 434 ± 137 seconds, p = 0.085) were also lower in single-catheter group, but it did not reach statistical significance. A total of 8 patients (14%) were crossed over from radial-specific catheter arm to standard catheter arm because of substandard image quality and difficulty in coronary engagement. Six patients had to be

  13. Transposition of the Greater Arteries (TGA)

    MedlinePlus

    ... Heart Disease Diseases of the arteries, valves, and aorta, as well as cardiac rhythm disturbances Aortic Valve ... Transposition of the Great Arteries Coarctation of the Aorta Truncus Arteriosus Single Ventricle Defects Lung, Esophageal, and ...

  14. Acceleration induced depriming and capillary rewetting of external artery heat pipes - Comparison with SHARE-II flight experiment

    NASA Technical Reports Server (NTRS)

    Ochterbeck, J. M.; Peterson, G. P.; Ungar, E. K.

    1993-01-01

    A combined analytical and numerical model for the analysis of the deprime and reprime/rewetting characteristics of two high-capacity external artery heat pipe designs undergoing externally induced accelerations was developed using several previously derived analytical expressions. Three distinct phases of the deprime and reprime/rewetting process were analyzed: (1) the effect of longitudinal accelerations on the depriming, (2) the time required for repriming of the liquid artery once the longitudinal acceleration has been terminated, and (3) the rewetting characteristics of the circumferential wall grooves. Combining the three processes, a technique was developed allowing the prediction of the effect of external acceleration on the characteristics of the external artery heat pipes. The predictions made with this technique agreed well with the microgravity flight results.

  15. Arterial elasticity imaging: comparison of finite-element analysis models with high-resolution ultrasound speckle tracking

    PubMed Central

    2010-01-01

    Background The nonlinear mechanical properties of internal organs and tissues may be measured with unparalleled precision using ultrasound imaging with phase-sensitive speckle tracking. The many potential applications of this important noninvasive diagnostic approach include measurement of arterial stiffness, which is associated with numerous major disease processes. The accuracy of previous ultrasound measurements of arterial stiffness and vascular elasticity has been limited by the relatively low strain of nonlinear structures under normal physiologic pressure and the measurement assumption that the effect of the surrounding tissue modulus might be ignored in both physiologic and pressure equalized conditions. Methods This study performed high-resolution ultrasound imaging of the brachial artery in a healthy adult subject under normal physiologic pressure and the use of external pressure (pressure equalization) to increase strain. These ultrasound results were compared to measurements of arterial strain as determined by finite-element analysis models with and without a surrounding tissue, which was represented by homogenous material with fixed elastic modulus. Results Use of the pressure equalization technique during imaging resulted in average strain values of 26% and 18% at the top and sides, respectively, compared to 5% and 2%, at the top and sides, respectively, under physiologic pressure. In the artery model that included surrounding tissue, strain was 19% and 16% under pressure equalization versus 9% and 13% at the top and sides, respectively, under physiologic pressure. The model without surrounding tissue had slightly higher levels of strain under physiologic pressure compared to the other model, but the resulting strain values under pressure equalization were > 60% and did not correspond to experimental values. Conclusions Since pressure equalization may increase the dynamic range of strain imaging, the effect of the surrounding tissue on strain should

  16. Arterial stick

    MedlinePlus

    ... venous blood) mainly in its content of dissolved gases . Testing arterial blood shows the makeup of the ... arteries. Blood samples are mainly taken to measure gases in the arteries. Abnormal results may point to ...

  17. Great Apes

    USGS Publications Warehouse

    Sleeman, Jonathan M.; Cerveny, Shannon

    2014-01-01

    Anesthesia of great apes is often necessary to conduct diagnostic analysis, provide therapeutics, facilitate surgical procedures, and enable transport and translocation for conservation purposes. Due to the stress of remote delivery injection of anesthetic agents, recent studies have focused on oral delivery and/or transmucosal absorption of preanesthetic and anesthetic agents. Maintenance of the airway and provision of oxygen is an important aspect of anesthesia in great ape species. The provision of analgesia is an important aspect of the anesthesia protocol for any procedure involving painful stimuli. Opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are often administered alone, or in combination to provide multi-modal analgesia. There is increasing conservation management of in situ great ape populations, which has resulted in the development of field anesthesia techniques for free-living great apes for the purposes of translocation, reintroduction into the wild, and clinical interventions.

  18. Technical note: comparison between two tracing methods with ultrasonography to determine lumen area of the caudal artery in beef cattle

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Doppler ultrasonography has potential use in studying the effects of ergot alkaloids on vascular circulation in cattle. Accurate and precise measurement of artery lumen area is critical in quantifying vasoconstriction responses to ergot alkaloids and other toxins. Lumen area can be determined by...

  19. Comparison of the effects of levosimendan, pimobendan, and milrinone on canine left ventricular-arterial coupling and mechanical efficiency.

    PubMed

    Pagel, P S; Hettrick, D A; Warltier, D C

    1996-01-01

    We examined and compared the effects of levosimendan, a new myofilament calcium sensitizer with phosphodiesterase inhibiting activity, pimobendan, and milrinone on left ventricular-arterial coupling and mechanical efficiency in 21 experiments performed in open-chest, barbiturate-anesthetized dogs instrumented for measurement of aortic and left ventricular (LV) pressure (micromanometer-tipped catheter), +dP/dt, and LV volume (conductance catheter). Myocardial contractility was assessed with the end-systolic pressure-volume relation (Ees) and preload recruitable stroke work (Msw) generated from a series of differentially loaded LV pressure-volume diagrams. LV-arterial coupling and mechanical efficiency were determined by the ratio of Ees to effective arterial elastance (Ea; the ratio of end-systolic arterial pressure to stroke volume) and the ratio of stroke work (SW) to pressure-volume area (PVA), respectively. Levosimendan (0.75, 1.5, and 3.0 micrograms.kg-1.min-1) significantly (p < 0.05) increased heart rate, +dP/dt, and ejection fraction (EF) and decreased mean arterial pressure (MAP), pressure-work index (PWI; an estimate of myocardial-oxygen consumption), and LV systolic and end-diastolic pressures (LVSP and LVEDP) and volumes (EDV and ESV). Levosimendan-induced augmentation of myocardial contractility (Ees, Msw and +dP/dt) and reductions in LV afterload (Ea) caused increases in the Ees/Ea ratio (0.61 +/- 0.10 during control to 3.3 +/- 0.7 during the high dose) consistent with enhancement of LV-arterial coupling. Levosimendan increased SW/PVA (0.48 +/- 0.05 during control to 0.84 +/- 0.04 during the high dose), indicating this drug improves the transfer of myocardial potential energy to external work. Levosimendan also increased the ratio of SW to PWI (109 +/- 18 during control to 255 +/- 50 mmHg.min.100g during the high dose), suggesting that myocardial metabolic efficiency was improved as well. Like levosimendan, pimobendan and milrinone (10, 20, and 40 and

  20. Comparison of the effects of semicarbazide and {beta}-aminopropionitrile on the arterial extracellular matrix in the Brown Norway rat

    SciTech Connect

    Mercier, Nathalie; Kakou, Augustine; Challande, Pascal; Lacolley, Patrick; Osborne-Pellegrin, Mary

    2009-09-15

    To investigate a putative role for semicarbazide-sensitive amine oxidase (SSAO) in arterial extracellular matrix (ECM) organization, we compared arteries of growing Brown Norway (BN) rats after chronic administration of semicarbazide (SCZ) and {beta}-aminopropionitrile (BAPN), two inhibitors with different properties and relative specificities for SSAO and lysyl oxidase (LOX). The BN model is particularly well adapted to evaluating effects of toxic compounds on the arterial elastic network. We measured aortic LOX and SSAO activities and quantified several ECM parameters. After a pilot study comparing doses previously studied and testing for additivity, we studied low and high equimolar doses of SCZ and BAPN. Both compounds similarly inhibited LOX, whereas SCZ inhibited SSAO far more effectively than BAPN. Both decreased carotid wall rupture pressure, increased tail tendon collagen solubility, decreased aortic insoluble elastin (% dry weight) and dose-dependently increased defects in the internal elastic lamina of abdominal aorta, iliac and renal arteries. Our results suggest that either these effects are mediated by LOX inhibition, SCZ being slightly more effective than BAPN in our conditions, or SSAO acts similarly to and in synergy with LOX on ECM, the greater SCZ effect reflecting the simultaneous inhibition of both enzymes. However, the high SCZ dose increased aortic collagen and ECM proteins other than insoluble elastin markedly more than did equimolar BAPN, possibly revealing a specific effect of SSAO inhibition. To discriminate between the two above possibilities, and to demonstrate unequivocally a specific effect of SSAO inhibition on ECM formation or organization, we must await availability of more specific inhibitors.

  1. The Inflammatory Response to Femoral Arterial Closure Devices: A Randomized Comparison Among FemoStop, AngioSeal, and Perclose

    SciTech Connect

    Jensen, Jens Saleh, Nawzad; Jensen, Ulf; Svane, Bertil; Joensson, Anders; Tornvall, Per

    2008-07-15

    The objectives of this study were to investigate whether the systemic inflammatory response differs, in patients undergoing coronary angiography, among the arterial closure devices FemoStop, AngioSeal, and Perclose. The study is a prospective and randomized study. We measured pre- and postprocedural C-reactive protein (CRP), fibrinogen, and interleukin-6 (IL-6) plasma levels and collected clinical and procedural data on 77 patients who underwent coronary angiography because of stable angina pectoris. Patients were randomized to the following device: FemoStop (mechanical compression), AngioSeal (anchor and collagen sponge), or Perclose (nonabsorbable suture). No patient group experienced an increased incidence of vascular complications. There were no differences among the three groups regarding CRP, fibrinogen, or IL-6 values before or after coronary angiography. IL-6 levels increased 6 h after the procedure in all groups (p < 0.01), however, the increase did not differ among the groups. After 30 days there were no increased values of CRP or fibrinogen. We conclude that the femoral arterial closure devices AngioSeal and Perclose do not enhance an inflammatory response after a diagnostic coronary angiography, measured by CRP, fibrinogen, and IL-6, compared to femoral arterial closure using a mechanical compression device.

  2. Comparison of the Postprocedural Quality of Life between Coronary Artery Bypass Graft Surgery and Percutaneous Coronary Intervention: A Systematic Review.

    PubMed

    Fatima, Kaneez; Yousuf-Ul-Islam, Mohammad; Ansari, Mehreen; Bawany, Faizan Imran; Khan, Muhammad Shahzeb; Khetpal, Akash; Khetpal, Neelam; Lashari, Muhammad Nawaz; Arshad, Mohammad Hussham; Amir, Raamish Bin; Kakalia, Hoshang Rustom; Zaidi, Qaiser Hasan; Mian, Sharmeen Kamran; Kazani, Bahram

    2016-01-01

    The treatment of choice between coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) has remained unclear. Considering quality of life (QOL) increases life expectancy, we believe QOL should be important in determining the optimum treatment. Thus the objective of this review was to illustrate the comparative effects of CABG and PCI on postprocedural QOL. Methods. We searched PubMed (Medline) and Embase from inception of the databases to May 2014 using "PCI versus CABG quality of life", "Percutaneous Coronary intervention versus Coronary artery bypass graft surgery Quality of life", "PCI versus CABG health status", "Angioplasty versus CABG", "Percutaneous coronary intervention versus coronary artery bypass surgery health status", and different combinations of the above terms. 447 articles were found. After applying strict exclusion criteria, we included 13 studies in this review. Results. From the 9 studies that compared QOL scores at 6 months after procedure, 5 studies reported CABG to be superior. From the 10 studies that compared QOL among patients at 1 year after procedure, 9 reported CABG to be superior. Conclusion. It can be established that CABG is superior to PCI in improving patient's QOL with respect to all scales used to determine quality of life. PMID:26989556

  3. Great Comets

    NASA Astrophysics Data System (ADS)

    Burnham, Robert

    2000-05-01

    Spectacular and mysterious objects that come and go in the night sky, comets have dwelt in our popular culture for untold ages. As remnants from the formation of the Solar system, they are objects of key scientific research and space missions. As one of nature's most potent and dramatic dangers, they pose a threat to our safety--and yet they were the origin of our oceans and perhaps even life itself. This beautifully illustrated book tells the story of the biggest and most awe-inspiring of all comets: those that have earned the title "Great." Robert Burnham focuses on the Great comets Hyakutake in 1996 and Hale-Bopp in 1997, which gripped attention worldwide because, for many, they were the first comets ever seen. He places these two recent comets in the context of their predecessors from past ages, among them the famous Comet Halley. Great Comets explains the exciting new discoveries that have come from these magnificent objects and profiles the spaceprobes to comets due for launch in the next few years. The book even takes a peek behind Hollywood's science-fiction fantasies to assess the real risks humanity faces from potential impacts of both comets and asteroids. For everyone interested in astronomy, this exciting book reveals the secrets of the Great Comets and provides essential tools for keeping up to date with comet discoveries in the future. Robert Burnham has been an amateur astronomer since the mid-1950s. He has been a senior editor of Astronomy magazine (1986-88) and is the author of many books and CD-ROMS, including Comet Hale-Bopp: Find and Enjoy the Great Comet and Comet Explorer.

  4. Triple Arterial Phase MR Imaging with Gadoxetic Acid Using a Combination of Contrast Enhanced Time Robust Angiography, Keyhole, and Viewsharing Techniques and Two-Dimensional Parallel Imaging in Comparison with Conventional Single Arterial Phase

    PubMed Central

    Yoon, Jeong Hee; Yu, Mi Hye; Kim, Eun Ju; Han, Joon Koo

    2016-01-01

    Objective To determine whether triple arterial phase acquisition via a combination of Contrast Enhanced Time Robust Angiography, keyhole, temporal viewsharing and parallel imaging can improve arterial phase acquisition with higher spatial resolution than single arterial phase gadoxetic-acid enhanced magnetic resonance imaging (MRI). Materials and Methods Informed consent was waived for this retrospective study by our Institutional Review Board. In 752 consecutive patients who underwent gadoxetic acid-enhanced liver MRI, either single (n = 587) or triple (n = 165) arterial phases was obtained in a single breath-hold under MR fluoroscopy guidance. Arterial phase timing was assessed, and the degree of motion was rated on a four-point scale. The percentage of patients achieving the late arterial phase without significant motion was compared between the two methods using the χ2 test. Results The late arterial phase was captured at least once in 96.4% (159/165) of the triple arterial phase group and in 84.2% (494/587) of the single arterial phase group (p < 0.001). Significant motion artifacts (score ≤ 2) were observed in 13.3% (22/165), 1.2% (2/165), 4.8% (8/165) on 1st, 2nd, and 3rd scans of triple arterial phase acquisitions and 6.0% (35/587) of single phase acquisitions. Thus, the late arterial phase without significant motion artifacts was captured in 96.4% (159/165) of the triple arterial phase group and in 79.9% (469/587) of the single arterial phase group (p < 0.001). Conclusion Triple arterial phase imaging may reliably provide adequate arterial phase imaging for gadoxetic acid-enhanced liver MRI. PMID:27390543

  5. Comparison of relative cerebral blood flow maps using pseudo-continuous arterial spin labeling and single photon emission computed tomography.

    PubMed

    Liu, Peiying; Uh, Jinsoo; Devous, Michael D; Adinoff, Bryon; Lu, Hanzhang

    2012-05-01

    Pseudo-continuous arterial spin labeling (PCASL) MRI is a relatively new arterial spin labeling technique and has the potential to extend the cerebral blood flow (CBF) measurement to all tissue types, including white matter. However, the arterial transit time (δ(a)) for white matter is not well established and a limited number of reports using multi-delay methods have yielded inconsistent findings. In this study, we used a different approach and measured white matter δ(a) (mean ± standard deviation, 1541 ± 173  ms) by determining the arrival times of exogenous contrast agent in a bolus tracking experiment. The data also confirmed δ(a) of gray matter to be 912 ± 209  ms. In the second part of this study, we used these parameters in PCASL kinetic models and compared relative CBF (rCBF, with respect to the whole brain) maps with those measured using a single photon emission computed tomography (SPECT) technique. It was found that the use of tissue-specific δ(a) in the PCASL model was helpful in improving the correspondence between the two modalities. On a regional level, the gray/white matter CBF ratios were 2.47 ± 0.39 and 2.44 ± 0.18 for PCASL and SPECT, respectively. On a single-voxel level, the variance between the modalities was still considerable, with an average rCBF difference of 0.27. PMID:22139764

  6. A theory for water and macromolecular transport in the pulmonary artery wall with a detailed comparison to the aorta

    PubMed Central

    Zeng, Zhongqing; Jan, Kung-Ming

    2012-01-01

    The pulmonary artery (PA) wall, which has much higher hydraulic conductivity and albumin void space and approximately one-sixth the normal transmural pressure of systemic arteries (e.g, aorta, carotid arteries), is rarely atherosclerotic, except under pulmonary hypertension. This study constructs a detailed, two-dimensional, wall-structure-based filtration and macromolecular transport model for the PA to investigate differences in prelesion transport processes between the disease-susceptible aorta and the relatively resistant PA. The PA and aorta models are similar in wall structure, but very different in parameter values, many of which have been measured (and therefore modified) since the original aorta model of Huang et al. (23). Both PA and aortic model simulations fit experimental data on transwall LDL concentration profiles and on the growth of isolated endothelial (horseradish peroxidase) tracer spots with circulation time very well. They reveal that lipid entering the aorta attains a much higher intima than media concentration but distributes better between these regions in the PA than aorta and that tracer in both regions contributes to observed tracer spots. Solutions show why both the overall transmural water flow and spot growth rates are similar in these vessels despite very different material transport parameters. Since early lipid accumulation occurs in the subendothelial intima and since (matrix binding) reaction kinetics depend on reactant concentrations, the lower intima lipid concentrations in the PA vs. aorta likely lead to slower accumulation of bound lipid in the PA. These findings may be relevant to understanding the different atherosusceptibilities of these vessels. PMID:22198178

  7. A theory for water and macromolecular transport in the pulmonary artery wall with a detailed comparison to the aorta.

    PubMed

    Zeng, Zhongqing; Jan, Kung-Ming; Rumschitzki, David S

    2012-04-15

    The pulmonary artery (PA) wall, which has much higher hydraulic conductivity and albumin void space and approximately one-sixth the normal transmural pressure of systemic arteries (e.g, aorta, carotid arteries), is rarely atherosclerotic, except under pulmonary hypertension. This study constructs a detailed, two-dimensional, wall-structure-based filtration and macromolecular transport model for the PA to investigate differences in prelesion transport processes between the disease-susceptible aorta and the relatively resistant PA. The PA and aorta models are similar in wall structure, but very different in parameter values, many of which have been measured (and therefore modified) since the original aorta model of Huang et al. (23). Both PA and aortic model simulations fit experimental data on transwall LDL concentration profiles and on the growth of isolated endothelial (horseradish peroxidase) tracer spots with circulation time very well. They reveal that lipid entering the aorta attains a much higher intima than media concentration but distributes better between these regions in the PA than aorta and that tracer in both regions contributes to observed tracer spots. Solutions show why both the overall transmural water flow and spot growth rates are similar in these vessels despite very different material transport parameters. Since early lipid accumulation occurs in the subendothelial intima and since (matrix binding) reaction kinetics depend on reactant concentrations, the lower intima lipid concentrations in the PA vs. aorta likely lead to slower accumulation of bound lipid in the PA. These findings may be relevant to understanding the different atherosusceptibilities of these vessels. PMID:22198178

  8. Stent sizing strategies in renal artery stenting: the comparison of conventional invasive renal angiography with renal computed tomographic angiography

    PubMed Central

    Michalowska, Ilona; Pregowski, Jerzy; Janaszek-Sitkowska, Hanna; Lech, Katarzyna; Kabat, Marek; Staruch, Adam; Januszewicz, Andrzej; Witkowski, Adam

    2016-01-01

    Introduction Randomized trials comparing invasive treatment of renal artery stenosis with standard pharmacotherapy did not show substantial benefit from revascularization. One of the potential reasons for that may be suboptimal procedure technique. Aim To compare renal stent sizing using two modalities: three-dimensional renal computed tomography angiography (CTA) versus conventional angiography. Material and methods Forty patients (41 renal arteries), aged 65.1 ±8.5 years, who underwent renal artery stenting with preprocedural CTA performed within 6 months, were retrospectively analyzed. In CTA analysis, reference diameter (CTA-D) and lesion length (CTA_LL) were measured and proposed stent diameter and length were recorded. Similarly, angiographic reference diameter (ANGIO_D) and lesion length (ANGIO_LL) as well as proposed stent dimensions were obtained by visual estimation. Results The median CTA_D was 0.5 mm larger than the median ANGIO_D (p < 0.001). Also, the proposed stent diameter in CTA evaluation was 0.5 mm larger than that in angiography (p < 0.0001). The median CTA_LL was 1 mm longer than the ANGIO_LL (p = NS), with significant correlation of these variables (r = 0.66, p < 0.0001). The median proposed stent length with CTA was equal to that proposed with angiography. The median diameter of the implanted stent was 0.5 mm smaller than that proposed in CTA (p < 0.0005) and identical to that proposed in angiography. The median length of the actual stent was longer than that proposed in angiography (p = 0.0001). Conclusions Renal CTA has potential advantages as a tool adjunctive to angiography in appropriate stent sizing. Careful evaluation of the available CTA scans may be beneficial and should be considered prior to the planned procedure. PMID:27279870

  9. Comparison of adenosine and treadmill exercise thallium-201 stress tests for the detection of coronary artery disease.

    PubMed

    Abe, S; Takeishi, Y; Chiba, J; Ikeda, K; Tomoike, H

    1993-12-01

    To determine the clinical usefulness of adenosine Tl-201 imaging for the evaluation of coronary artery disease, 22 patients with suspected coronary artery disease who underwent adenosine and exercise Tl-201 single photon emission computed tomography (SPECT) were studied. The peak levels of heart rate (83 vs 123 bpm, p < 0.001), systolic blood pressure (124 vs 164 mmHg, p < 0.001), diastolic blood pressure (70 vs 86 mmHg, p < 0.01) and rate pressure products (10220 vs 20410 bpm x mmHg, p < 0.001) were markedly smaller during adenosine infusion than during exercise. Segmental agreements between adenosine and exercise tests were 90% (218 of 242 segments) regarding the presence of perfusion defects and 89% (215 of 242 segments) regarding the presence of redistribution. Regional Tl-201 uptake (r = 0.85, p < 0.001) and the extent (r = 0.75, p < 0.001) and intensity (r = 0.83, p < 0.001) of Tl-201 defects during adenosine testing were closely correlated with those of exercise testing. Adenosine and exercise tests showed similar sensitivities for the identification of individual coronary stenosis (85% vs 78%). However, in patients who were unable to perform adequate exercise (maximal heart rate < 120 bpm), the sensitivity of adenosine imaging tended to be higher than that of exercise imaging (92% vs 69%, p = 0.07). Adenosine Tl-201 imaging is an alternative to the exercise test for assessing the severity and loci of coronary artery disease, especially in patients who are unable to perform adequate physical exercise. PMID:8283603

  10. A comparison of non-invasive continuous finger blood pressure measurement (Finapres) with intra-arterial pressure during prolonged head-up tilt.

    PubMed

    Petersen, M E; Williams, T R; Sutton, R

    1995-11-01

    Simultaneous intra-radial and non-invasive (Finapres, Ohmeda) blood pressures were compared during prolonged head-up tilt, in eight patients (mean age 49 years) with malignant vasovagal syncope. Twelve tilts were performed, of which eight resulted in vasovagal syncope. The mean bias (difference between Finapres and intra-arterial pressures) for systolic pressure was +0.7 mmHg (standard deviation 11.3 mmHg) and for diastolic pressure was +5.4 mmHg (standard deviation 7 mmHg). The within-tilt precision (standard deviation of the bias) of the non-invasive measurements varied between 2.9-12.4 mmHg (median 4.5 mmHg) for systolic comparisons, and 1.6-8.4 mmHg (median 4.4 mmHg) for diastolic comparisons. In all but one tilt highly significant positive increases in both systolic (median 7.1 mmHg) and diastolic bias (median 8.1 mmHg) occurred on tilt with respect to resting pre-tilt levels. Independent of the absolute level of agreement, the non-invasive measurements followed changes in intra-arterial pressure closely, with 89% of beat-to-beat changes in systolic pressure, and 95% of beat-to-beat changes in diastolic pressure followed to within +/- 2 mmHg. This study suggests that the Finapres is well suited for use during diagnostic tilt testing, demonstrating an acceptable within-tilt precision and closely following pressure changes during vasovagal syncope. PMID:8881861

  11. Comparison of Epicardial Adipose Tissue Volume and Coronary Artery Disease Severity in Asymptomatic Adults with versus without Diabetes Mellitus

    PubMed Central

    Groves, Elliott M.; Erande, Ashwini S.; Le, Christine; Salcedo, Jonathan; Hoang, Khiet C.; Kumar, Shivesh; Mohar, Dilbahar S.; Saremi, Farhood; Im, Jiye; Agrawal, Yashwant; Nadeswaran, Pradeep; Naderi, Nassim; Malik, Shaista

    2014-01-01

    Epicardial adipose tissue (EAT) has been shown to have important effects on the development of coronary artery disease (CAD) via local paracrine influences on the vascular bed. We compared a cohort of asymptomatic patients with Type II Diabetes (DM) without known CAD to an age and gender matched group of asymptomatic patients without DM from the CTRAD study in which patients underwent a cardiac computed tomography angiogram (CTA), for early detection of CAD. Mean EAT volumes of 118.6 ± 43.0 and 70.0 ± 44.0 cm3 were found in the DM and non-DM groups respectively. When stratified by presence and severity of CAD, it was found that in the DM (p=0.003) and non-DM groups (p<0.001) there was a statistically significant increase in EAT volume as the patients were found to have increasingly severe CAD. After adjusting for age, race, gender, DM, hypertension, insulin use, BMI, and coronary artery calcium (CAC) score, the presence of >120 cm3 of EAT was found to be highly correlated with the presence of significant CAD (Adjusted Odds Ratio 4.47, 95% CI (1.35–14.82)). We found that not only is EAT volume an independent predictor of CAD, but that an increasing volume of EAT predicted increasing severity of CAD even after adjustment for CAC score. PMID:25037677

  12. Hyperemia-Related Changes in Arterial Stiffness: Comparison between Pulse Wave Velocity and Stiffness Index in the Vascular Reactivity Assessment

    PubMed Central

    Torrado, Juan; Bia, Daniel; Zócalo, Yanina; Farro, Ignacio; Farro, Federico; Armentano, Ricardo L.

    2012-01-01

    Carotid-to-radial pulse wave velocity (PWVcr) has been proposed to evaluate endothelial function. However, the measurement of PWVcr is not without limitations. A new simple approach could have wide application. Stiffness index (SI) is obtained by analysis of the peripheral pulse wave and gives reproducible information about stiffness of large arteries. This study assessed the effects of hyperemia on SI and compared it with PWVcr in 14 healthy subjects. Both were measured at rest and during 8 minutes after ischemia. SI temporal course was determined. At 1 minute, SI and PWVcr decreased (5.58 ± 0.24 to 5.34 ± 0.23 m/s, P < 0.05; 7.8 ± 1.0 to 7.2 ± 0.9 m/s; P < 0.05, resp.). SI was positively related to PWVcr in baseline (r = 0.62 , P < 0.05), at 1 minute (r = 0.79, P < 0.05), and during the whole experimental session (r = 0.52, P < 0.05). Conclusion. Hyperemia significantly decreases SI in healthy subjects. SI was related to PWVcr and could be used to facilitate the evaluation of hyperemia-related changes in arterial stiffness. PMID:22919496

  13. Hyperemia-Related Changes in Arterial Stiffness: Comparison between Pulse Wave Velocity and Stiffness Index in the Vascular Reactivity Assessment.

    PubMed

    Torrado, Juan; Bia, Daniel; Zócalo, Yanina; Farro, Ignacio; Farro, Federico; Armentano, Ricardo L

    2012-01-01

    Carotid-to-radial pulse wave velocity (PWV(cr)) has been proposed to evaluate endothelial function. However, the measurement of PWV(cr) is not without limitations. A new simple approach could have wide application. Stiffness index (SI) is obtained by analysis of the peripheral pulse wave and gives reproducible information about stiffness of large arteries. This study assessed the effects of hyperemia on SI and compared it with PWV(cr) in 14 healthy subjects. Both were measured at rest and during 8 minutes after ischemia. SI temporal course was determined. At 1 minute, SI and PWV(cr) decreased (5.58 ± 0.24 to 5.34 ± 0.23 m/s, P < 0.05; 7.8 ± 1.0 to 7.2 ± 0.9 m/s; P < 0.05, resp.). SI was positively related to PWV(cr) in baseline (r = 0.62 , P < 0.05), at 1 minute (r = 0.79, P < 0.05), and during the whole experimental session (r = 0.52, P < 0.05). Conclusion. Hyperemia significantly decreases SI in healthy subjects. SI was related to PWV(cr) and could be used to facilitate the evaluation of hyperemia-related changes in arterial stiffness. PMID:22919496

  14. Very rapid effect of pitavastatin on microvascular function in comparison to rosuvastatin: reactive hyperemia peripheral arterial tonometric study

    PubMed Central

    Kono, Yasushi; Fukuda, Shota; Shimada, Kenei; Nakanishi, Koki; Otsuka, Kenichiro; Kubo, Tomoichiro; Jissho, Satoshi; Taguchi, Haruyuki; Yoshikawa, Junichi; Yoshiyama, Minoru

    2013-01-01

    Background: It has been reported that pitavastatin improves endothelial function faster than other statins. Recently introduced reactive hyperemia peripheral arterial tonometry (RH-PAT) provides objective and quantitative assessment of peripheral microvascular function. Purpose: This study aimed to investigate whether peripheral microvascular function improved 2 hours after pitavastatin in subjects with coronary artery disease (CAD) using RH-PAT, and the results were compared with those of rosuvastatin. Methods: This study included 94 subjects with CAD, assigned to a group given 2 mg of pitavastatin (n = 36), a group given 2.5 mg of rosuvastatin (n = 38), and a control group (n = 20). RH-PAT examinations were performed before and 2 hours after statin administration. Results: The RH-PAT index increased 2 hours after pitavastatin administration from 1.82 ± 0.45 to 2.16 ± 0.62 (P = 0.02), whereas there were no differences in the RH-PAT index in the rosuvastatin group (1.79 ± 0.71 to 1.91 ± 0.53, P = 0.09) and the control group (1.68 ± 0.36 to 1.84 ± 0.58, P = 0.4). No significant changes were observed at 2 hours in serum cholesterol levels in each group. Conclusion: The present study demonstrated that peripheral microvascular function improved 2 hours after a single clinical dose of pitavastatin, but not after rosuvastatin. PMID:23667308

  15. Comparison of the antiplatelet effect of clopidogrel hydrogenosulfate and clopidogrel besylate in patients with stable coronary artery disease.

    PubMed

    Hamilos, Michalis; Saloustros, Ilias; Skalidis, Emmanuel; Igoumenidis, Nikolaos; Kambouris, Marios; Chlouverakis, Grigorios; Vougia, Despina; Loggakis, Ioannis; Vardas, Panos E; Kochiadakis, George

    2015-10-01

    It is well known that patients with poor response to antiplatelet therapy are most likely to have more thrombotic events. Clopidogrel hydrogensulfate (CHS) is a thienopyridine acting as an important antiplatelet agent alone or in combination with acetylsalicylic acid to prevent cardiovascular complications. A different clopidogrel salt, clopidogrel besylate (CB), was recently approved as a generic drug for the same purpose while data about its antiplatelet effect are very scarce. Our study compared the antiplatelet effect of CHS and CB in patients with stable coronary artery disease. Patients with stable coronary artery disease (n = 101) (coronary lesions defined angiographically 30-70 %) were randomized to either CHS (n = 50) or CB (n = 51). After randomization a 600 mg loading dose of the drug was given and monitoring of antiplatelet effect was done 12-14 h later with VerifyNow assay. Antiplatelet response was measured with P2Y12 reaction units (PRU) and % inhibition P2Y12 from baseline (% inhibition P2Y12). Moreover CYP2C19*2, CYP2C19*3 and CYP3Α5 polymorphisms were studied in all patients. Clinical characteristics were similar between the two study groups. No significant difference was observed for baseline platelet reactivity between CHS and CB patients (258 ± 38 vs. 256 ± 38 respectively, p = 0.79). No difference was found for antiplatelet response between the CHS and the CB group, assessed by PRU (195 ± 74 vs. 204 ± 67 respectively, p = 0.51) and by % inhibition P2Y12 (24 ± 25 vs. 24 ± 22 % respectively, p = 0.95). Number of heterozygotes for CYP2C19*2 polymorphism was comparable and their platelet reactivity was similar between the two study groups. Our results indicate that both CB and CHS had an identical antiplatelet effect in patients with stable coronary artery disease. No difference on platelet reactivity of heterozygotes for CYP2C19*2 polymorphism was found between the two study groups. PMID:25662861

  16. Comparison of the relation between renal impairment, angiographic coronary artery disease, and long-term mortality in women versus men.

    PubMed

    Chen, Ruoling; Kumar, Sanjeev; Timmis, Adam; Feder, Gene; Yaqoob, Muhammed M; Hemingway, Harry

    2006-03-01

    Mild to moderate renal impairment has recently been associated with increased cardiovascular mortality. However, gender differences in the association of mild to moderate renal impairment with the presence of angiographic coronary artery disease and long-term mortality remain unknown. We examined a prospective cohort of consecutive patients who underwent coronary angiography from the ACRE study in the Royal Hospitals Trust (London, United Kingdom) with referral from 5 contiguous health authorities. Among 1,609 patients (465 women) who had angiographic and serum creatinine measurements at baseline, renal impairment at modification of diet in renal disease glomerular filtration rates of 45 to 59, 30 to 44, and <30 ml/min/1.73 m(2) was more common in women than in men and was significantly associated with the presence of angiographic coronary artery disease in women but not in men. At each level of glomerular filtration rate, multivariate adjusted hazard ratios of 7-year all-cause mortality for women compared with men were higher: 2.64 (95% confidence intervals [CI] 1.21 to 5.73) versus 1.34 (95% CI 0.995 to 1.79); 2.62 (95% CI 1.12 to 16.12) versus 2.35 (95% CI 1.60 to 3.43); and 10.42 (95% CI 3.97 to 27.39) versus 4.77 (95% CI 2.95 to 7.70), respectively. Similar patterns were observed in cardiovascular and coronary deaths. In conclusion, mild to moderate renal impairment may be a marker for unmeasured proatherogenic factors for women only, and women may bear a greater mortality burden that is attributable to renal impairment compared with men. Gender may influence the prognostic effect of renal impairment in coronary disease. PMID:16490426

  17. Head to Head Comparison of Stress Echocardiography with Exercise Electrocardiography for the Detection of Coronary Artery Stenosis in Women

    PubMed Central

    Kim, Mi-Na; Kim, Su-A; Kim, Yong-Hyun; Hong, Soon Jun; Park, Seong-Mi; Shin, Mi Seung; Kim, Myung-A; Hong, Kyoung-Soon; Shin, Gil Ja

    2016-01-01

    Background Exercise-stress electrocardiography (ECG) is initially recommended for the diagnosis of coronary artery disease. But its value has been questioned in women because of suboptimal diagnostic accuracy. Stress echocardiography had been reported to have comparable test accuracy in women. But the data comparing the diagnostic accuracy of exercise-stress ECG and stress echocardiography directly are few. The aim of the study was to compare the diagnostic accuracy of exercise-stress ECG and dobutamine stress echocardiography (DSE) in Korean women. Methods 202 consecutive female patients who presented with chest pain in outpatient clinic, and who underwent treadmill exercise test (TET), DSE and coronary angiography were included for the study. The diagnostic accuracy TET and DSE were calculated by the definition of > 50% or > 75% coronary artery stenosis (CAS). Results The sensitivity and specificity were higher with DSE (70.4, 94.6%) than TET (53.7, 73.6%) for detection of > 50% CAS. The higher accuracy of DSE was maintained after exclusion of the patients who could not achieve over 85% age predicted heart rate before ischemia induction. DSE also showed greater diagnostic accuracy than TET by > 75% CAS criteria, and in subsets of patient with intermediate pretest probability. Conclusion In the diagnosis of CAS, DSE showed higher accuracy than TET in female patients who presented with chest pain. As well as the test accuracy, adequate stress was more feasible with DSE than TET. These finding suggests DSE may be used as the first-line diagnostic tool in the detection of CAS in women with chest pain. PMID:27358706

  18. Superior Hypogastric Nerve Block to Reduce Pain After Uterine Artery Embolization: Advanced Technique and Comparison to Epidural Anesthesia

    SciTech Connect

    Binkert, Christoph A.; Hirzel, Florian C.; Gutzeit, Andreas; Zollikofer, Christoph L.; Hess, Thomas

    2015-10-15

    PurposeTo evaluate a modified superior hypogastric nerve block (SHNB) to reduce pain after uterine artery embolization (UAE) compared to epidural anesthesia.Materials and methodsIn this retrospective study, the amount of opiate drugs needed after UAE was compared between SHNB and epidural anesthesia. Eighty one consecutive women (mean age: 43.67 years) were in the SHNB group and 27 consecutive women (mean age: 43.48 years) treated earlier at the same institution in the epidural anesthesia group. UAE was performed from a unilateral femoral artery approach using a 4F catheter. 500–700 or 700–900 μm trisacryl gelatine microspheres were used as embolic agents. The SHNB was performed by advancing a 21G from the abdominal wall below the umbilicus to the anterior portion of the 5th vertebral body. For optimal guidance a cranio-caudal tilt of 5°–15° was used. On a lateral view the correct contrast distribution in front of the vertebral body is confirmed. Then 20 ml local anesthesia (ropivacain 0.75 %) is injected. In case of an asymmetric right–left distribution the needle was repositioned.ResultsAll SHNB were successful without severe complications. The mean time for the SHNB was 4 min 38 s (2 min 38 s–9 min 27 s). The needle was repositioned in average 0.87 times. The opiate dose for the SHNB group was 19.33 ± 22.17 mg which was significantly lower. The average time to receive an opiate drug after SHNB was 4 h 41 min.ConclusionThe SHNB is a safe and minimally time-consuming way to reduce pain after UAE especially within the first 4 h.

  19. A Comparison of Measures of Endothelial Function in Patients with Peripheral Arterial Disease and Age and Gender Matched Controls

    PubMed Central

    Allan, Richard B.; Vun, Simon V.; Spark, J. Ian

    2016-01-01

    This study compared flow-mediated dilatation (FMD), peripheral artery tonometry (PAT), and serum nitric oxide (NO) measures of endothelial function in patients with peripheral artery disease (PAD) against age/gender matched controls. 25 patients (mean age: 72.4 years, M : F 18 : 7) with established PAD and an age/gender matched group of 25 healthy controls (mean age: 72.4 years, M : F 18 : 7) were studied. Endothelial function was measured using the % FMD, reactive hyperemia index (RHI) using PAT and serum NO (μmol). Difference for each method between PAD and control patients and correlation between the methods were investigated. FMD and RHI were lower in patients with PAD (median FMD for PAD = 2.16% versus control = 3.77%, p = 0.034 and median RHI in PAD = 1.64 versus control = 1.92, p = 0.005). NO levels were not significantly different between the groups (PAD median = 7.70 μmol, control median = 13.05 μmol, p = 0.662). These results were obtained in elderly patients and cannot be extrapolated to younger individuals. FMD and PAT both demonstrated a lower hyperaemic response in patients with PAD; however, FMD results in PAD patients were unequivocally reduced whereas half the PAD patients had RHI values above the established threshold for endothelial dysfunction. This suggests that FMD is a more appropriate method for the measurement of NO-mediated endothelial function. PMID:26942010

  20. A comparison of high-dose and low-dose tranexamic acid antifibrinolytic protocols for primary coronary artery bypass surgery

    PubMed Central

    McHugh, Stephen M; Kolarczyk, Lavinia; Lang, Robert S; Wei, Lawrence M; Jose, Marquez; Subramaniam, Kathirvel

    2016-01-01

    Background and Aims: Tranexamic acid (TA) is used for prophylactic antifibrinolysis in coronary artery bypass surgeries to reduce bleeding. We evaluated the efficacy of two different doses of TA for prophylactic antifibrinolysis in patients undergoing primary coronary artery bypass grafting (CABG) surgery in this retrospective cohort study at a tertiary care referral centre. Methods: One-hundred eighty-four patients who underwent primary CABG with cardiopulmonary bypass (CPB) via sternotomy between January 2009 and June 2011 were evaluated. Pre-operative patient characteristics, intraoperative data, post-operative bleeding, transfusions, organ dysfunction and 30-day mortality were compared between high-dose TA (30 mg/kg loading dose followed by infusion of 15 mg/kg/h until the end of surgery along with 2 mg/kg priming dose in the bypass circuit) and low-dose TA (15 mg/kg loading dose followed by infusion of 6 mg/kg/h until the end of surgery along with 1 mg/kg priming dose in the bypass circuit) groups. Univariate comparative analysis of all categorical and continuous variables was performed between the two groups by appropriate statistical tests. Linear and logistic regression analyses were performed to control for the effect of confounding on the outcome variables. Results: Chest tube output, perioperative transfusion of blood products and incidence of re-exploration for bleeding did not differ significantly (P> 0.05) between groups. Post-operative complications and 30-day mortality were comparable between the groups. The presence of cardiogenic shock and increased pre-operative creatinine were found to be associated with increased chest tube output on the post-operative day 2 by multivariable linear regression model. Conclusions: Low-dose TA protocol is as effective as high-dose protocol for antifibrinolysis in patients undergoing primary CABG with CPB. PMID:27013747

  1. A comparison of groundwater dating with 81Kr, 36Cl and 4He in four wells of the Great Artesian Basin, Australia

    NASA Astrophysics Data System (ADS)

    Lehmann, B. E.; Love, A.; Purtschert, R.; Collon, P.; Loosli, H. H.; Kutschera, W.; Beyerle, U.; Aeschbach-Hertig, W.; Kipfer, R.; Frape, S. K.; Herczeg, A.; Moran, J.; Tolstikhin, I. N.; Gröning, M.

    2003-06-01

    The isotopic ratios 81Kr/Kr and 36Cl/Cl and the 4He concentrations measured in groundwater from four artesian wells in the western part of the Great Artesian Basin (GAB) in Australia are discussed. Based on radioactive decay along a water flow path the 81Kr/Kr ratios are directly converted to groundwater residence times. Results are in a range of 225-400 kyr with error bars in the order of 15% primarily due to counting statistics in the cyclotron accelerator mass spectrometer measurement. Additional uncertainties from subsurface production and/or exchange with stagnant porewaters in the confining shales appear to be of the same order of magnitude. These 81Kr ages are then used to calibrate the 36Cl and the 4He dating methods. Based on elemental analyses of rock samples from the sandstone aquifer as well as from the confining Bulldog shale the in situ flux of thermal neutrons and the corresponding 3He/ 4He and 36Cl/Cl ratios are calculated. From a comparison of: (i) the 3He/ 4He ratios measured in the groundwater samples with the calculated in situ ratios in rocks and (ii) the measured δ 37Cl ratios with the 4He concentrations measured in groundwater it is concluded that both helium and chloride are most likely added to the aquifer from sources in the stagnant porewaters of the confining shale by diffusion and/or mixing. Based on this 'working hypothesis' the 36Cl transport equation in groundwater is solved taking into account: (i) radioactive decay, (ii) subsurface production in the sandstone aquifer (with an in situ 36Cl/Cl ratio of 6×10 -15) and (iii) addition of chloride from a source in the confining shale (with a 36Cl/Cl ratio of 13×10 -15). Lacking better information it is assumed that the chloride concentration increased linearly with time from an (unknown) initial value Ci to its measured present value C= Ci+ Ca, where Ca represents the (unknown) amount of chloride added from subsurface sources. Using the 81Kr ages of the four groundwater samples and a

  2. True aneurysm of brachial artery.

    PubMed

    Hudorović, Narcis; Lovričević, Ivo; Franjić, Dario Bjorn; Brkić, Petar; Tomas, Davor

    2010-10-01

    True upper extremity peripheral artery aneurysms are a rarely encountered arterial disorder. Following computer-tomography angiographic (CT-a) imaging examination, true saccular aneurysm, originating from the left brachial artery was diagnosed in the 77-year-old female without history of trauma. The aneurysm was resected by surgical intervention, and primary repair of the brachial artery was performed by interposition of a part of great saphenous vein harvested from the left groin and creation of two end-to-end anastomoses between interposition graft and previously resected part of brachial artery. No complication was observed during the follow-up. Surgical intervention for upper extremity aneurysms should be initiated without delay. Factors combined with minimal morbidity associated with repair suggest that surgical repair should be performed routinely for true upper extremity arterial aneurysms. PMID:20865459

  3. Acute arterial occlusion - kidney

    MedlinePlus

    Acute renal arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... kidneys need a good blood supply. The main artery to the kidney is called the renal artery. ...

  4. Acute arterial occlusion - kidney

    MedlinePlus

    ... arterial thrombosis; Renal artery embolism; Acute renal artery occlusion; Embolism - renal artery ... often result in permanent kidney failure. Acute arterial occlusion of the renal artery can occur after injury ...

  5. Automatic detection of coronary artery disease in myocardial perfusion SPECT using image registration and voxel to voxel statistical comparisons.

    PubMed

    Peace, R A; Staff, R T; Gemmell, H G; McKiddie, F I; Metcalfe, M J

    2002-08-01

    The purpose of this study was to compare the performance of automatic detection of coronary artery disease (CAD) with that of expert observers. A male and female normal image template was constructed from normal stress technetium-99m single photon emission computed tomography (SPECT) studies. Mean and standard deviation images for each sex were created by registering normal studies to a standard shape and position. The test group consisted of 104 patients who had been routinely referred for SPECT and angiography. The gold standard for CAD was defined by angiography. The test group studies were registered to the respective templates and the Z-score was calculated for each voxel. Voxels with a Z-score greater than 5 indicated the presence of CAD. The performance of this method and that of three observers were compared by continuous receiver operating characteristic (CROC) analysis. The overall sensitivity and specificity for automatic detection were 73% and 92%, respectively. The area (Az) under the CROC curve (+/-1 SE) for automatic detection of CAD was 0.88+/-0.06. There was no statistically significant difference between the performances of the three observers in terms of Az and that of automatic detection (P> or =0.25, univariate Z-score test). The use of this automated statistical mapping approach shows a performance comparable with experienced observers, but avoids inter-observer and intra-observer variability. PMID:12124485

  6. Tomographic thallium-201 myocardial perfusion scintigrams after maximal coronary artery vasodilation with intravenous dipyridamole: comparison of qualitative and quantitative approaches

    SciTech Connect

    Francisco, D.A.; Collins, S.M.; Go, R.T.; Ehrhardt, J.C.; Van Kirk, O.C.; Marcus, M.L.

    1982-08-01

    Eighty-six patients had thallium-201 (/sup 201/Tl) myocardial perfusion scintigrams after intense coronary artery dilation with i.v. dipyridamole. Tomographic and planar /sup 201/Tl scintigrams were obtained in each patient. Tomographic scintigrams were interpreted using quantitative or visual criteria; planar scintigrams were assessed using visual criteria only. When visual criteria were used, interobserver variability was 40% for tomographic scintigrams and 44% for planar scintigrams. In the 24 patients with normal or nonsignificant CAD, quantitative analysis of the tomograms (range approach) indicated that one of 24 (4%) had a positive image (specificity 96%%); in contrast, when visual criteria were used to interpret the tomographic or planar /sup 201/Tl scintigrams, eight of 24 (33%) had positive scintigrams (specificity 67%). In the 51 abnormal patients, the sensitivity of detecting CAD was 46 of 51 (90%) for tomographic scintigrams interpreted quantitatively, 39 of 51 (76%) for tomographic scintigrams interpreted visually and 41 of 51 (80%) for planar scintigrams assessed visually. The tomographic imaging procedure (quantitative interpretation) also demonstrated a high sensitivity (89%) and specificity (100%) in 28 patients (10 normal and 18 CAD), with a clinical diagnosis of unstable angina pectoris. Overall, the predictive accuracy of an abnormal scintigram with quantitative tomographic imaging (98%) was significantly better (p<0.05) than either qualitative planar or pinhole imaging. (JMT)

  7. Relationship Between Determinants of Arterial Stiffness Assessed by Diastolic and Suprasystolic Pulse Oscillometry: Comparison of Vicorder and Vascular Explorer.

    PubMed

    Teren, Andrej; Beutner, Frank; Wirkner, Kerstin; Löffler, Markus; Scholz, Markus

    2016-03-01

    Pulse wave velocity (PWV) and augmentation index (AI) are independent predictors of cardiovascular health. However, the comparability of multiple oscillometric modalities currently available for their assessment was not studied in detail. In the present study, we aimed to evaluate the relationship between indices of arterial stiffness assessed by diastolic and suprasystolic oscillometry.In total, 56 volunteers from the general population (23 males; median age 70 years [interquartile range: 65-72 years]) were recruited into observational feasibility study to evaluate the carotid-femoral/aortic PWV (cf/aoPWV), brachial-ankle PWV (baPWV), and AI assessed by 2 devices: Vicorder (VI) applying diastolic, right-sided oscillometry for the determination of all 3 indices, and Vascular explorer (VE) implementing single-point, suprasystolic brachial oscillometry (SSBO) pulse wave analysis for the assessment of cfPWV and AI. Within- and between-device correlations of measured parameters were analyzed. Furthermore, agreement of repeated measurements, intra- and inter-observer concordances were determined and compared for both devices.In VI, both baPWV and cfPWV inter-correlated well and showed good level of agreement with bilateral baPWV measured by VE (baPWV[VI]-baPWV[VE]R: overall concordance correlation coefficient [OCCC] = 0.484, mean difference = 1.94 m/s; cfPWV[VI]-baPWV[VE]R: OCCC = 0.493, mean difference = 1.0 m/s). In contrast, SSBO-derived aortic PWA (cf/aoPWA[VE]) displayed only weak correlation with cfPWV(VI) (r = 0.196; P = 0.04) and ipsilateral baPWV (cf/aoPWV[VE]R-baPWV[VE]R: r = 0.166; P = 0.08). cf/aoPWA(VE) correlated strongly with AI(VE) (right-sided: r = 0.725, P < 0.001). AI exhibited marginal between-device agreement (right-sided: OCCC = 0.298, mean difference: 6.12%). All considered parameters showed good-to-excellent repeatability giving OCCC > 0.9 for 2-point-PWV modes and right-sided AI(VE). Intra- and

  8. Removal of Gross Air Embolization from Cardiopulmonary Bypass Circuits with Integrated Arterial Line Filters: A Comparison of Circuit Designs.

    PubMed

    Reagor, James A; Holt, David W

    2016-03-01

    Advances in technology, the desire to minimize blood product transfusions, and concerns relating to inflammatory mediators have lead many practitioners and manufacturers to minimize cardiopulmonary bypass (CBP) circuit designs. The oxygenator and arterial line filter (ALF) have been integrated into one device as a method of attaining a reduction in prime volume and surface area. The instructions for use of a currently available oxygenator with integrated ALF recommends incorporating a recirculation line distal to the oxygenator. However, according to an unscientific survey, 70% of respondents utilize CPB circuits incorporating integrated ALFs without a path of recirculation distal to the oxygenator outlet. Considering this circuit design, the ability to quickly remove a gross air bolus in the blood path distal to the oxygenator may be compromised. This in vitro study was designed to determine if the time required to remove a gross air bolus from a CPB circuit without a path of recirculation distal to the oxygenator will be significantly longer than that of a circuit with a path of recirculation distal to the oxygenator. A significant difference was found in the mean time required to remove a gross air bolus between the circuit designs (p = .0003). Additionally, There was found to be a statistically significant difference in the mean time required to remove a gross air bolus between Trial 1 and Trials 4 (p = .015) and 5 (p =.014) irrespective of the circuit design. Under the parameters of this study, a recirculation line distal to an oxygenator with an integrated ALF significantly decreases the time it takes to remove an air bolus from the CPB circuit and may be safer for clinical use than the same circuit without a recirculation line. PMID:27134304

  9. Voxel-level comparison of arterial spin-labeled perfusion magnetic resonance imaging in adolescents with internet gaming addiction

    PubMed Central

    2013-01-01

    Background Although recent studies have clearly demonstrated functional and structural abnormalities in adolescents with internet gaming addiction (IGA), less is known about how IGA affects perfusion in the human brain. We used pseudocontinuous arterial spin-labeling (ASL) perfusion functional magnetic resonance imaging (fMRI) to measure the effects of IGA on resting brain functions by comparing resting cerebral blood flow in adolescents with IGA and normal subjects. Methods Fifteen adolescents with IGA and 18 matched normal adolescents underwent structural and perfusion fMRI in the resting state. Direct subtraction, voxel-wise general linear modeling was performed to compare resting cerebral blood flow (CBF) between the 2 groups. Correlations were calculated between the mean CBF value in all clusters that survived AlphaSim correction and the Chen Internet Addiction Scale (CIAS) scores, Barratt Impulsiveness Scale-11 (BIS-11) scores, or hours of Internet use per week (hours) in the 15 subjects with IGA. Results Compared with control subjects, adolescents with IGA showed significantly higher global CBF in the left inferior temporal lobe/fusiform gyrus, left parahippocampal gyrus/amygdala, right medial frontal lobe/anterior cingulate cortex, left insula, right insula, right middle temporal gyrus, right precentral gyrus, left supplementary motor area, left cingulate gyrus, and right inferior parietal lobe. Lower CBF was found in the left middle temporal gyrus, left middle occipital gyrus, and right cingulate gyrus. There were no significant correlations between mean CBF values in all clusters that survived AlphaSim correction and CIAS or BIS-11 scores or hours of Internet use per week. Conclusions In this study, we used ASL perfusion fMRI and noninvasively quantified resting CBF to demonstrate that IGA alters the CBF distribution in the adolescent brain. The results support the hypothesis that IGA is a behavioral addiction that may share similar neurobiological

  10. Comparison of Risk Factor between Lacunar Stroke and Large Artery Atherosclerosis Stroke: A Cross-Sectional Study in China

    PubMed Central

    Lv, Pu; Jin, Haiqiang; Liu, Yuanyuan; Cui, Wei; Peng, Qing; Liu, Ran; Sun, Wei; Fan, Chenghe; Teng, Yuming; Sun, Weiping; Huang, Yining

    2016-01-01

    Background Stroke is the second most common cause of mortality in China. Although most subtypes of ischemic stroke share similar risk factors, they have different etiologies. Our study aimed to evaluate the different risk factor profiles between the stroke subtypes, lacunar infarcts (LI) and large-artery atherosclerosis (LAA), and clarify the characteristics of current acute ischemic stroke in China. Methods In this cross-sectional study, we analyzed the clinical characteristics of 1982 patients with acute ischemic stroke who were admitted to the neurology department at the Peking University First Hospital between 2007 and 2014. Ischemic stroke was further classified into LAA, LI, cardioembolism (CE) and undetermined causes of infarction (UDI) according to TOAST classification. Demographic characteristics, risk factors, as well as the findings of laboratory and imaging tests of 1773 patients with LAA and LI, were analyzed by univariate and multivariate logistic analysis. Results Of the 1982 ischemic stroke patients included in this study, 1207 were diagnosed with LAA, 566 with LI, 173 with cardioembolism (CE) and 36 with undetermined causes of infarction (UDI). By comparing the risk factors in multivariate logistic regression analysis, hypertension [odds ratio (OR) = 1.832] and white matter leukoaraiosis (WML) (OR = 1.865) were found to be more strongly correlated with LI than LAA. Low density lipoprotein- cholesterol (LDL-c) (OR = 0.774) were more strongly related to LAA than LI. Conclusions This study found that hypertension and WML were more strongly correlated with LI than LAA. LDL-c was more strongly related to LAA than LI. PMID:26934734

  11. Comparison of arterial pressure and plasma ANG II responses to three methods of subcutaneous ANG II administration

    PubMed Central

    Kuroki, Marcos T.; Fink, Gregory D.

    2014-01-01

    Angiotensin II (ANG II)-induced hypertension is a commonly studied model of experimental hypertension, particularly in rodents, and is often generated by subcutaneous delivery of ANG II using Alzet osmotic minipumps chronically implanted under the skin. We have observed that, in a subset of animals subjected to this protocol, mean arterial pressure (MAP) begins to decline gradually starting the second week of ANG II infusion, resulting in a blunting of the slow pressor response and reduced final MAP. We hypothesized that this variability in the slow pressor response to ANG II was mainly due to factors unique to Alzet pumps. To test this, we compared the pressure profile and changes in plasma ANG II levels during subcutaneous ANG II administration (150 ng·kg−1·min−1) using either Alzet minipumps, iPrecio implantable pumps, or a Harvard external infusion pump. At the end of 14 days of ANG II, MAP was highest in the iPrecio group (156 ± 3 mmHg) followed by Harvard (140 ± 3 mmHg) and Alzet (122 ± 3 mmHg) groups. The rate of the slow pressor response, measured as daily increases in pressure averaged over days 2–14 of ANG II, was similar between iPrecio and Harvard groups (2.7 ± 0.4 and 2.2 ± 0.4 mmHg/day) but was significantly blunted in the Alzet group (0.4 ± 0.4 mmHg/day) due to a gradual decline in MAP in a subset of rats. We also found differences in the temporal profile of plasma ANG II between infusion groups. We conclude that the gradual decline in MAP observed in a subset of rats during ANG II infusion using Alzet pumps is mainly due to pump-dependent factors when applied in this particular context. PMID:24993045

  12. Comparison of two walk tests in determining the claudication distance in patients suffering from peripheral arterial occlusive disease

    PubMed Central

    Dixit, Snehil; Chakravarthy, Kalyana; Reddy, Ravi Shankar; Tedla, Jaya Shanker

    2015-01-01

    Background: The purpose of this study was to compare the six-minute walk test (6MWT) and the incremental shuttle walk test (ISWT) in terms of the initial onset of pain (IOP), maximal claudicating pain (MCP), maximum walking distance (MWD), initial ankle brachial index (IABI), post ankle brachial index (PABI), and difference in ankle brachial index (DFABI), as well as to correlate changes in IOP and MWD, MCP and MWD, IABI and MWD, PABI and MWD, and DFABI and MWD in the 6MWT and ISWT. Materials and Methods: Participants (n = 19, 17 men and 2 women) were randomly allocated to the 6MWT or ISWT and crossed over to the other test after 24 hours. The baseline ankle brachial index (ABI) measurements were taken using the Doppler, following which the participants performed the tests. Post-test MWD, IOP, MCP, and ABI were measured. The paired t test was used pre- and post the walk test and the Pearson correlation was used to find any relationship between the desired variables. Results: The paired t test at 95% confidence interval for IABI and PABI (P > 0.05) was insignificant for the 6MWT and ISWT. The Pearson correlation of MWD with IOP showed a fair correlation, and the correlation of MWD to MCP showed a strong correlation in ISWT. Conclusion: ISWT can be of vital importance as a tool to assess the functional status of patients suffering from Peripheral Arterial Occlusive Disease (PAOD) in both the clinical and research areas, and reflects a better assessment of the functional limitation when walking with PAOD as compared to the 6MWT. PMID:26261825

  13. Comparison of quality of life in patients with peripheral arterial disease caused by atherosclerosis obliterans or Buerger’s disease

    PubMed Central

    Karakoyun, Rojbin; Köksoy, Cüneyt; Şener, Zeynep; Gündüz, Umut; Karakaş, Barış; Karakoyun, Mustafa

    2014-01-01

    Summary Objective Buerger’s disease and atherosclerosis obliterans (ASO) are two peripheral arterial diseases (PAD) that are frequently encountered. The aim of this study was to compare quality of life (QOL) in patients with Buerger’s disease and ASO. Methods We prospectively followed 86 patients who were admitted to our hospital due to ASO or Buerger’s disease. Their ischaemia was evaluated according to the clinical category chronic limb ischaemia at the time of hospital admission and at six and 12 months. The QOL was measured at the time of hospital admission and at six and 12 months with the Short Form Health Status Survey (SF-36) and Vascular Quality of Life Questionnaire (VASCUQOL). Results A total of 86 patients with ASO or Buerger’s disease (47 and 39, respectively) were included in the study. Pain parameters from both SF-36 and VASCUQOL scores were lower in patients with Buerger’s disease at the time of hospital admission and at six months. The impairment in QOL was found to be proportional to the extent of chronic limb ischaemia. Conversely, when patients with critical limb ischaemia were evaluated, no difference was observed between those with ASO or Buerger’s disease in terms of QOL. Amputations were found to have a negative effect on quality of life. Conclusion Buerger’s disease had a more pronounced negative effect on QOL than ASO, particularly in terms of pain score. When critical limb ischaemia was considered, ASO and Buerger’s disease impaired quality of life at the same rate. PMID:25000442

  14. Comparison of Economic and Patient Outcomes With Minimally Invasive Versus Traditional Off-Pump Coronary Artery Bypass Grafting Techniques

    PubMed Central

    Poston, Robert S.; Tran, Richard; Collins, Michael; Reynolds, Marty; Connerney, Ingrid; Reicher, Barry; Zimrin, David; Griffith, Bartley P.; Bartlett, Stephen T.

    2009-01-01

    Background Minimally invasive coronary artery bypass grafting (miniCABG) decreases in-hospital morbidity versus traditional sternotomy CABG. We performed a prospective cohort study (NCT00481806) to assess the impact of miniCABG on costs and metrics that influence quality of life after hospital discharge. Methods One hundred consecutive miniCABG cases performed using IMA grafting ± coronary stenting were compared with a matched group of 100 sternotomy CABG patients using IMA and saphenous veins, both treating equivalent number of target coronaries (2.7 vs. 2.9), off-pump. We compared perioperative costs, time to return to work/normal activity, and risk of major adverse cardiac/cerebrovascular events (MACCE) at 1 year: myocardial infarction (elevated troponin or EKG changes), target vessel occlusion (CT angiography at 1 year), stroke, or death. Results For miniCABG, robotic instruments and stents increased intraoperative costs; postoperative costs were decreased from significantly less intubation time (4.80 ± 6.35 vs. 12.24 ± 6.24 hours), hospital stay (3.77 ± 1.51 vs. 6.38 ± 2.23 days), and transfusion (0.16 ± 0.37 vs. 1.37 ± 1.35 U) leading to no significant differences in total costs. Undergoing miniCABG independently predicted earlier return to work after adjusting for confounders (t = − 2.15; P = 0.04), whereas sternotomy CABG increased MACCE (HR, 3.9; 95% CI, 1.4 –7.6), largely from lower target-vessel patency. Conclusions MiniCABG shortens patient recovery time, minimizes MACCE risk at 1 year, and showed superior quality and outcome metrics versus standard-of-care CABG. These findings occurred without increasing costs and with superior target vessel graft patency. PMID:18936577

  15. Comparison of effects of cromakalim and pinacidil on mechanical activity and 86Rb efflux in dog coronary arteries

    SciTech Connect

    Masuzawa, K.; Asano, M.; Matsuda, T.; Imaizumi, Y.; Watanabe, M. )

    1990-05-01

    Effects of two K+ channel openers, cromakalim and pinacidil, on mechanical activity and on 86Rb efflux were compared in strips of dog coronary arteries. Cromakalim and pinacidil produced the relaxation in 20.9 mM K(+)-contracted strips with a pD2 of 6.53 and 5.95, respectively. In 65.9 mM K(+)-contracted strips, high concentrations of pinacidil, but not cromakalim, produced relaxation. Ca+(+)-induced contractions in 80 mM K(+)-depolarized strips were also inhibited by pinacidil but not by cromakalim. Glibenclamide, a blocker of ATP-regulated K+ (KATP) channels, competitively antagonized the relaxant responses to cromakalim with a pA2 value of 7.62. However, the antagonism by glibenclamide of the relaxant responses to pinacidil was not a typical competitive type, suggesting the contribution of other effects than the KATP channel opening activity to the relaxant effects of pinacidil. In resting strips preloaded with 86Rb, cromakalim and pinacidil increased the basal 86Rb efflux in a dose-dependent manner. The increase in the 86Rb efflux induced by cromakalim was greater than that by pinacidil. When the effects of cromakalim and pinacidil on the 86Rb efflux were determined in the 20.9 or 65.9 mM K(+)-contracted strips, both drugs increased the 86Rb efflux. Under the same conditions nifedipine, a Ca(+)+ channel blocker, produced the relaxation that is accompanied by the decrease in 86Rb efflux. The increase in the 86Rb efflux induced by cromakalim was much greater than that by pinacidil.

  16. A propensity matched comparison of return to work and quality of life after stenting or coronary artery bypass surgery

    PubMed Central

    Maznyczka, Annette M; Howard, James P; Banning, Amerjeet S; Gershlick, Anthony H

    2016-01-01

    Objectives We sought to determine (1) return to work (RTW) rates, (2) long-term employment (>12 months postprocedure), (3) time taken to RTW, and (4) quality of life (QoL), in patients treated with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Methods Questionnaires regarding RTW were sent to 689 PCI and 169 CABG patients who underwent PCI or CABG at University Hospitals of Leicester Trust, UK, from May 2012 to May 2013. QoL was also measured using the European QoL 5-dimensions questionnaire (EQ-5D). Responses from patients employed preprocedure were analysed using multivariate logistic regression. Propensity score-matching was further used to compare similar patient populations receiving PCI or CABG. Results The response rate was 38% (235 PCI and 88 CABG patients). 241 respondents (75%) were employed preprocedure. Of these 162 (93%) PCI and 51 (77%) CABG patients returned to work, whereas 147 (85%) PCI and 41 (62%) CABG patients were still employed at >12 months postprocedure. After propensity analysis, there was no significant difference between PCI and CABG patients in RTW, long-term employment, nor QoL. The median time taken to RTW was 6 weeks after PCI and 13 weeks after CABG (p=0.001). The effect remained significant after multivariate analysis (p=0.001) and propensity analysis (p=0.001). Conclusions In this first propensity score-matched study comparing RTW and QoL after PCI or CABG strict propensity matching indicates that RTW or QoL, is similar for PCI or CABG, albeit the number of matched pairs was small. There are differences, however, in delay in RTW. PMID:26835141

  17. Arterial stick

    MedlinePlus

    ... limit tissue damage. Alternative Names Blood sample - arterial ... by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, ...

  18. Arterial Catheterization

    MedlinePlus

    ... rial line can provide valuable information to adjust oxygen therapy or mechanical ventilator (respirator; breathing machine) settings. The blood oxygen pres- sure measures from an arterial line give ...

  19. Comparison of Pain After Uterine Artery Embolization Using Tris-Acryl Gelatin Microspheres Versus Polyvinyl Alcohol Particles

    SciTech Connect

    Ryu, Robert K. Omary, Reed A.; Sichlau, Michael J.; Siddiqi, Aheed; Chrisman, Howard B.; Nemcek, Albert A.; Vogelzang, Robert L.

    2003-08-15

    When compared in a uterine artery embolization(UAE) animal model, Embospheres (ES) (Biosphere Medical, Rockland, MA)were found to induce less uterine ischemia than polyvinyl alcohol (PVA)particles. Given this finding, we aimed to test the hypothesis that ESis associated with less pain after UAE than PVA in human patients. We performed retrospective analysis on data from 72 consecutive UAE patients, collected from a prospectively acquired database.Patient-controlled analgesia (PCA) pump-delivered morphine sulfate (MS)dosages were compared between patients who received ES versus PVA.Subjective pain scores (SPS) were also compared between the two groups.Secondary outcome measures, including embolic volume and clinical outcome data, were also collected. Linear regression and t-test statistical analyses were performed. Null hypotheses were rejected at the p < 0.05 level. Mean follow-up period in the PVS population was 178 days (range 28-426), versus 96 days (range 24-197)in the ES population. The mean MS doses used by ES and PVA patients were 37.2 (s.d. 23.5) versus 47.1 (s.d. 26.8), respectively. This difference was not significant (p > 0.15).Utilizing a standard 0-10 pain scale, the mean peak SPS for the ES and PVA groups were 5.58 (s.d. 2.77) and 5.07 (s.d. 2.99), respectively.The difference was not significant. The mean amount of embolic material used in each ES and PVA patient was 4.86 cc (s.d. 3.01) and 3.52 cc(s.d. 1.63), respectively. The difference revealed a strong trend toward statistical significance (p = 0.05). There was one treatment failure in each group of patients. Within both patient samples, no significant correlation was found when comparing the volume of embolic used and subsequent MS dose. Despite a strong trend toward a significantly higher volume of ES used per patient, there is no subjective or objective difference in pain after UAE with ES when compared to PVA.

  20. Clinicopathological comparisons of open vein harvesting and endoscopic vein harvesting in coronary artery bypass grafting patients in Mashhad

    PubMed Central

    Amouzeshi, Ahmad; Teshnisi, Mohamad Abbassi; Zirak, Nahid; Shamloo, Alireza Sepehri; Hoseinikhah, Hamid; Alizadeh, Behzad; Moeinipour, Aliasghar

    2016-01-01

    Introduction Harvesting of the greater saphenous vein is almost an inevitable part of coronary artery bypass grafting (CABG) operations, and it is done by two main techniques, i.e., conventional or open vein harvesting (OVH) and the minimally-invasive endoscopic vein harvesting (EVH). This study aimed to compare these two techniques in off-pump CABG procedures with respect to clinical and pathological outcomes. Methods This cohort study was conducted on CABG candidates during a one-year period from October 2013 through September 2014 in the Department of Cardiac Surgery at Mashhad University of Medical Sciences. Eighty-seven patients voluntarily underwent EVH, and another 86 patients matched for age, gender, and other cardiovascular risk factors were selected for OVH. They were followed up for six weeks, and the main outcome measures were infections of the wound, pain, duration of hospital stay, and the costs of hospitalization. Paired sample t-test, independent t-test, or their non-parametric equivalents and the chi-squared test were used by SPSS version 17.0 for data analysis. Results The mean duration of time for vein harvesting was shorter in the EVH group (p < 0.001), and the pain score was lower (p = 0.04). No infections occurred at the site of the wound. The length of hospital stay was not significantly different for the two groups (OVH versus EVH: 8.5 ± 3.3 versus 8.4 ± 3.2 days; p-value: 0.08). Hospitalization costs were significantly higher in the EVH group (OVH versus EVH: 5.8 ± 4.7 versus 7.3 ± 2.0 million Tomman; p-value: 0.008), yet no difference was diagnosed with respect to endothelial damage in the vein grafts harvested by the EVH and OVH techniques. Conclusion EVH is considered as a minimally invasive and safe vein harvesting technique in our Center, and it can reduce the harvesting time and post-operative pain. In addition, its efficiency was similar to that of OVH. PMID:26955438

  1. Comparison Between Balloon-Assisted and Stent-Assisted Technique for Treatment of Unruptured Internal Carotid Artery Aneurysms

    PubMed Central

    Park, Keun Young; Kim, Dong Joon

    2016-01-01

    Purpose To compare clinical and angiographic outcomes between balloon-assisted (BAC) and stent-assisted coiling for internal carotid artery unruptured aneurysms (ICA-UA). Materials and Methods A total of 227 ICA-UA in 190 patients were treated with BAC (120 patients, 141 ICA-UA) or SAC (70 patients, 86 ICA-UA. We compared characteristics of patients and ICA-UA, and clinical and angiographic outcomes between groups. Results Aneurysm size and neck diameter were greater for SAC than in BAC, but aneurysm volume and coil packing density were not different between groups. Immediate angiographic occlusion grade was better for BAC than for SAC. Periprocedural thromboembolic events were more frequent during SAC (11.6%) than BAC (2.4%) per aneurysm, but hemorrhagic events were the opposite (2.4% for BAC and none for SAC per aneurysm) (p < 0.05). At discharge, treatment-related morbi-mortality rates were 1.6% for BAC and 1.4% per patient for SAC. At clinical follow-up (BAC, 118 patients [98.3%] for a mean of 48.4 months; SAC, 69 patients [98.6%], for a mean of 37.4 months), 1 additional treatment-related infarction occurred during SAC, resulting in a modified Rankin scale score of 4. Thus, overall treatment-related morbi-mortality rates were 1.7% in BAC and 2.9% in SAC. At imaging follow-up (BAC, 135 aneurysms [95.7%] for 28.3 months; SAC, 81 aneurysms [94.1%] for 23.9 months), BAC and SAC showed stable or improved occlusion in 94.1% and 95.0%, minor recurrence in 4.4% and 2.5%, and major recurrence in 1.5% and 2.5%, respectively. Conclusion Both BAC and SAC were safe and effective techniques for ICA-UA. There were no differences in morbi-mortality and recurrence rates between groups. PMID:27621946

  2. Comparison between Exclusive and Selective Drug-Eluting Stent Strategies in Treating Patients with Multivessel Coronary Artery Disease

    PubMed Central

    Tung, Ying-Chang; Hsiao, Ping-Gune; Hsu, Lung-An; Kuo, Chi-Tai; Chang, Chi-Jen

    2014-01-01

    Background The expanded usage of drug-eluting stents (DES) in treating patients with multivessel coronary artery disease (CAD) may sometimes be limited in real-world practice due to cost concerns. We compared the clinical outcomes of exclusive and selective DES use in treating patients with multivessel CAD. Methods From November 2004 to December 2011, 110 patients with multivessel CAD who received four or more stents were enrolled into this study, and divided into two groups according to the DES strategy employed: exclusive DES (n = 52), or selective DES (n = 58). In the selective DES group, DES was reserved for complex lesions only, such that the incidence and predictors of clinical events were assessed. Results At a mean follow-up of 41.4 ± 26.5 months, there were no significant differences between the two strategies in terms of baseline characteristics, all-cause mortality (exclusive vs. selective: 1.9% vs. 6.9%, p = 0.21), cardiac death (1.9% vs. 1.7%, p = 0.94) and nonfatal myocardial infarction (3.8% vs. 5.2%, p = 0.74). Despite the presence of more ostial lesions in the exclusive DES group, there was a trend such that major adverse cardiac events (MACE) and target lesion revascularization (TLR) rates were higher in the selective DES group (MACE: 17.3% vs. 31%, p = 0.16; TLR: 11.5% vs. 24.1%, p = 0.08). The higher MACE rate in the selective DES group was mainly driven by a higher target vessel revascularization (TVR) rate (15.4% vs. 29.3%, p = 0.08). In the exclusive DES group, SYNTAX score was an independent predictor of MACE [Haxard ratio (HR): 1.09, 95% confidence internal (CI): 1.02-1.16, p = 0.01] and TVR (HR 1.08, 95% CI 1.01-1.15, p = 0.04). Conclusions Compared to the exclusive DES strategy, the selective DES strategy with reservation of DES for complex lesions is associated with numerically higher, but not statistically significant, rates of MACE and all-cause mortality in this small group of patients with multivessel CAD receiving four or more

  3. Comparisons between Garcia, Modo, and Longa rodent stroke scales: Optimizing resource allocation in rat models of focal middle cerebral artery occlusion.

    PubMed

    Bachour, Salam P; Hevesi, Mario; Bachour, Ornina; Sweis, Brian M; Mahmoudi, Javad; Brekke, Julia A; Divani, Afshin A

    2016-05-15

    The use of rodent stroke models allow for the understanding of stroke pathophysiology. There is currently no gold standard neurological assessment to measure deficits and recovery from stroke in rodent models. Agreement on a universal preclinical stroke scale allows for comparison of the outcomes among conducted studies. The present study aimed to compare three routinely used neurological assessments in rodent studies (i.e., Garcia, Modo, and Longa) to determine which is most effective for accurately and consistently quantifying neurological deficits in the context of focal middle cerebral artery occlusion (MCAo) in rats. Focal MCAo was induced in 22 male Wistar rats using a novel transfemoral approach. Rodents were assessed for neurological deficit pre-injury as well as 3 and 24h post-injury. Data was analyzed to determine Pearson correlation coefficients in addition to McNemar's χ(2) values between each pair of neurological assessments. All three stroke scales, Garcia, Modo, and Longa, showed statistically significant changes between the baseline and the 3-hour neurological assessments. A trend towards neurological recovery was observed in all three stroke scales between the 3 and 24-hour endpoints. The three scales were highly correlated with each other, with Garcia and Modo having the strongest correlation. Of the three pairwise analyses, the comparison between the Garcia and Longa tests demonstrated the highest McNemar's χ(2) value, indicating least marginal homogeneity between these two tests. The combination of high correlation between Garcia and Modo tests along with greatest marginal heterogeneity observed between the Garcia and Longa test lead us to recommend the use of Garcia and Longa neurological scales when researchers are hoping to capture the broadest range of neurological factors using only two stroke scales. PMID:27084232

  4. CT-Based Evaluation of Tumor Volume After Intra-Arterial Chemotherapy of Locally Advanced Carcinoma of the Oral Cavity: Comparison with Clinical Remission Rates

    SciTech Connect

    Rohde, Stefan Turowski, Bernd; Berkefeld, Joachim; Kovacs, Adorjan F.

    2007-02-15

    Purpose. To assess the volume of locally advanced tumors of the oral cavity and the oropharynx before and after intra-arterial (i.a.) chemotherapy by means of computed tomography and to compare these data with clinically determined treatment response of the same patient population. Methods. Eighty-eight patients with histologically proven, advanced carcinoma of the oral cavity and/or the oropharynx (local tumor stages T3/4) received neoadjuvant i.a. chemotherapy with cisplatin as part of a multimodal therapeutic regimen, comprising (1) local chemotherapy, (2) surgery, and (3) combined radio-chemotherapy. Three weeks after the intervention, residual disease was evaluated radiologically by measurement of the tumor volume and clinically by inspection and palpation of the primary tumor according to WHO criteria. Results. Comparison of treatment response according to radiological and clinical criteria respectively revealed complete remission in 5% vs. 8% (p < 0.05), partial remission in 30% vs. 31%, stable disease in 61% vs. 58%, and tumor progression in 5% vs. 2%. Conclusion. Radiological volumetry and clinical evaluation found comparable response rates after local chemotherapy. However, in patients with good response after local treatment, volumetric measurement with CT may help to distinguish between partial and complete remission. Thus, radiological tumor volumetry provides precise and differentiated information about tumor response and should be used as an additional tool in treatment monitoring after local chemotherapy.

  5. Ankle-Arm Index, Angiography, and Duplex Ultrasonography After Recanalization of Occlusions in Femoropopliteal Arteries: Comparison of Long-Term Results

    SciTech Connect

    Winter-Warnars, Hillegonda A.O.; Graaf, Yolanda van der; Mali, Willem P.T.M.

    1996-04-15

    Purpose: Comparison of the relative values of the ankle-arm index (AAI) at rest and after exercise, angiography, and duplex ultrasonography for the follow-up of percutaneous transluminal angioplasty (PTA) in patients with peripheral vascular disease. Methods: Thirty-two patients were prospectively followed after technically and clinically successful PTA of a femoropopliteal occlusion. The patency of the femoropopliteal artery was assessed for 1 year using AAI measurements at rest and after exercise; duplex ultrasonography at 4, 12, 24, 36, and 52 weeks; and angiography at 3 and 12 months after PTA. Results: Patency was highly dependent on the measurement technique. The cumulative patency after 1 year determined with the AAI at rest and during exercise, by angiography, and by duplex ultrasonography was 74%, 19%, 31%, and 32%, respectively. Seventy-five percent of the restenoses occurred at the site of the treated occlusion. Conclusion: Duplex ultrasonography is most suitable for this assessment, as it causes no patient discomfort and the specificity is better than AAI after exercise because vascular disease in other, proximal segments does not interfere with the results.

  6. Coronary artery fistula connecting the left main coronary artery with the superior vena cava

    PubMed Central

    Nikolaidou, C; Gourassas, J

    2015-01-01

    Background Coronary artery fistulas are rare congenital coronary artery abnormalities, with direct communication between a coronary artery and a cardiac chamber, great vessel or other structure. Description of case We report a case of a large coronary artery fistula connecting the left main coronary artery with the superior vena cava in a 70-year-old patient undergoing diagnostic coronary angiography for a non-ST-segment elevation myocardial infarction. The patient rejected closure of the fistula and remains asymptomatic on follow-up. Conclusion Angiographic recognition of coronary artery fistulas is important for the appropriate diagnosis and management of patients. Hippokratia 2015; 19 (2):186-188.

  7. Supravalvular aortic stenosis after arterial switch operation.

    PubMed

    Maeda, Takuya; Koide, Masaaki; Kunii, Yoshifumi; Watanabe, Kazumasa; Kanzaki, Tomohito; Ohashi, Yuko

    2016-07-01

    Supravalvular aortic stenosis as a late complication of transposition of the great arteries is very rare, and only a few cases have been reported. We describe the case of a 14-year-old girl who developed supravalvular aortic stenosis as a late complication of the arterial switch operation for transposition of the great arteries. The narrowed ascending aorta was replaced with a graft. The right pulmonary artery was transected to approach the ascending aorta which adhered severely to the main pulmonary trunk, and we obtained a good operative field. PMID:25957091

  8. Coronary artery fistulas

    PubMed Central

    Said, S.A.M.; Thiadens, A.A.H.J.; Fieren, M.J.C.H.; Meijboom, E.J.; van der Werf, T.; Bennink, G.B.W.E.

    2002-01-01

    The aetiology of congenital coronary artery fistulas remains a challenging issue. Coronary arteries with an anatomically normal origin may, for obscure reasons, terminate abnormally and communicate with different single or multiple cardiac chambers or great vessels. When this occurs, the angiographic morphological appearance may vary greatly from discrete channels to plexiform network of vessels. Coronary arteriovenous fistulas (CAVFs) have neither specific signs nor pathognomonic symptoms; the spectrum of clinical features varies considerably. The clinical presentation of symptomatic cases can include angina pectoris, myocardial infarction, fatigue, dyspnoea, CHF, SBE, ventricular and supraventricular tachyarrhythmias or even sudden cardiac death. CAVFs may, however, be a coincidental finding during diagnostic coronary angiography (CAG). CAG is considered the gold standard for diagnosing and delineating the morphological anatomy and pathway of CAVFs. There are various tailored therapeutic modalities for the wide spectrum of clinical manifestations of CAVFs, including conservative pharmacological strategy, percutaneous transluminal embolisation and surgical ligation. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:25696067

  9. Relationship between Arterial Inflow Rate and Venous Filling Index of the Lower Extremities Assessed by Air Plethysmography in Subjects with or without Axial Reflux in the Great Saphenous Vein

    PubMed Central

    2014-01-01

    Objective: To evaluate the relationship between arterial inflow rate (AIR) and venous filling index (VFI) in limbs with or without varicose veins, assessed by air plethysmography (APG). Materials and Methods: A total of 142 patients (142 limbs) visiting our clinic with leg complaints, but without arterial and venous disease, were defined as the normal group (NG), and 65 patients (65 limbs) with leg varices were defined as the varicose vein group (VG). Both groups underwent duplex ultrasonography and APG to identify venous reflux and measure hemodynamic parameters, respectively. Examinations were performed at the first visit in the NG and before and one month after treatment in the VG. Results: A strong correlation between resting AIR and VFI was found in the NG (r = 0.72) and postoperative VG (r = 0.71). Twenty-two and three limbs in the NG and postoperative VG, respectively, had a VFI over 2.0 mL/s because of the high AIR. In the VG, AIR tended to decrease after treatment (P >0.01). Conclusions: High leg AIR lead to high VFI measured by APG. AIR and VFI should be measured at the same session to assess venous hemodynamic changes after varicose vein treatment when residual venous reflux cannot be diagnosed with duplex ultrasonography. PMID:25298834

  10. Angioplasty and stent placement -- peripheral arteries

    MedlinePlus

    Percutaneous transluminal angioplasty - peripheral artery; PTA - peripheral artery; Angioplasty - peripheral arteries; Iliac artery -angioplasty; Femoral artery - angioplasty; Popliteal artery - angioplasty; Tibial artery - angioplasty; Peroneal artery - ...