Rugby Player's Aorta: Alarming Prevalence of Ascending Aortic Dilatation and Effacement in Elite Rugby Players.
- 作者列表："Kay S","Moore BM","Moore L","Seco M","Barnes C","Marshman D","Grieve SM","Celermajer DS
BACKGROUND:Prompted by a cluster of observations concerning ascending aortic pathology in elite rugby players, we assessed over 150 asymptomatic predominantly retired players with echocardiography, aiming to document the prevalence and severity of ascending aortic dilatation and/or anterior aortic effacement, both 'risk factors' for potentially catastrophic aortic complications. METHODS:Rugby players (at least 5 years of high level competitive rugby) were classified as elite (national, state or first grade representatives) or non-elite. A total of 152 asymptomatic players with a mean age of 45 ± 13 years (range 21-65) underwent transthoracic echocardiography. Z-scores (number of standard deviations from a population mean) were calculated for aortic root and ascending aortic size. RESULTS:Regarding the aortic root, a Z-score of >2 was seen in 24% (expected prevalence 2.3%, p < 0.001) and a Z-score >3 was seen in 4% (expected prevalence 0..1%, p < 0.001). Sixty-two (62) players (41%) had an aortic root greater than 40 mm diameter. Ascending aortic Z-scores were >2 in 53% of players and >3 in 22% (p < 0.001). Abnormal anterior aortic effacement at the sinotubular junction (STJ) was seen in 88 players (58%). Abnormal aortic dilatation and effacement were associated with a longer duration of competitive rugby participation and elite status, respectively. CONCLUSIONS:Ascending aortic dilatation with abnormal anterior effacement is exceedingly common in asymptomatic retired elite rugby players. This warrants increased surveillance in retired players until the clinical significance of these findings can be further investigated.
背景: 在一系列关于优秀橄榄球运动员升主动脉病变的观察结果的推动下，我们用超声心动图评估了超过150名无症状的主要退休运动员，旨在记录升主动脉扩张症和/或前主动脉扩张症的患病率和严重程度，这两个因素都是潜在灾难性主动脉并发症的 “风险因素”。 方法: 橄榄球运动员 (至少5年的高水平竞技橄榄球) 被归类为精英 (国家，州或一级代表) 或非精英。共有152名平均年龄为45岁 ± 13岁 (范围21-65岁) 的无症状运动员接受了经胸超声心动图检查。计算主动脉根部和升主动脉大小的Z评分 (与总体平均值的标准偏差数)。 结果: 关于主动脉根部，在24% 中观察到Z评分> 2 (预期患病率2.3%，p <0.001)，在4% 中观察到Z评分> 3 (预期患病率0..1%，p <0.001)。62名运动员 (41%) 的主动脉根部直径大于40 mm。53% 的运动员升主动脉Z评分> 2分，22% 的运动员升主动脉Z评分> 3分 (p <0.001)。在88名运动员 (58%) 中观察到窦管结 (STJ) 处的异常前主动脉排空。异常主动脉扩张和消失分别与较长时间的竞技橄榄球参与和精英状态相关。 结论: 在无症状的退役优秀橄榄球运动员中，升主动脉扩张伴异常前叶消失是非常常见的。这使得对退役球员的监测增加，直到这些发现的临床意义可以进一步研究。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.