- 作者列表："Horn B","Lo KB","Sengupta SP","Pressman GS
:Mitral annular calcification (MAC) is increasingly encountered, particularly among the elderly and those with chronic kidney disease, and is often associated with a transvalvular gradient. In contrast to rheumatic mitral stenosis relatively little is known about mitral stenosis due to MAC. We aimed to clarify whether exercise limitation in this group is primarily due to valvular obstruction or ventricular dysfunction resulting from multiple comorbidities. 20 patients with severe MAC (bulky calcium deposits which restricted leaflet motion) were submitted to supine bicycle exercise, measuring Doppler and echocardiographic parameters at baseline and during exercise. They were compared 1:1 to subjects matched for age, sex, and left ventricular wall thickness. At baseline MAC subjects had higher mean mitral valve gradients (MVG) than comparison subjects (7.5 ± 3.8 vs 1.6 ± 0.8 mm Hg, p < 0.0001), along with larger indexed left atrial volumes (54.4 ± 14.9 vs 34.0 ± 11.7 mL, p < 0.0001) and reduced left atrial strains (reservoir, conduit, and booster pump). With exercise MAC subjects reached higher levels of MVG (17.3 ± 8.4 vs 5.5 ± 2.5 mm Hg, p < 0.0001), and pulmonary artery systolic pressure (estimated from tricuspid regurgitant jet [TR] velocity) and displayed a moderate correlation between ΔMVG and ΔTR velocity (r2 = 0.57). MAC subjects whose exercise MVG was ≥ 15 mm Hg all had a peak pulmonary artery systolic pressure > 60 mm Hg. MAC subjects also had relative chronotropic incompetence. Patients with severe MAC and a transvalvular gradient experience large increases in MVG and pulmonary pressure with exercise, similar to what has been described in rheumatic mitral stenosis. MAC may be an under-recognized cause of dyspnea and exercise intolerance in older patients.
: 二尖瓣环钙化 (MAC) 越来越多，特别是在老年人和慢性肾病患者中，并且通常与跨瓣梯度相关。与风湿性二尖瓣狭窄相比，由于MAC引起的二尖瓣狭窄相对鲜为人知。我们旨在阐明该组中运动受限是否主要是由于多种合并症导致的瓣膜梗阻或心室功能障碍。20名患有严重MAC (限制小叶运动的大体积钙沉积物) 的患者接受仰卧自行车运动，在基线和运动期间测量多普勒和超声心动图参数。将他们与年龄、性别和左心室壁厚度匹配的受试者进行1:1比较。在基线MAC时，受试者的平均二尖瓣梯度 (MVG) 高于对照受试者 (7.5 ± 3.8 vs 1.6 ± 0.8毫米mmhg，p <0.0001)，同时有较大的索引左心房容积 (54.4 ± 14.9 vs 34.0 ± 11.7 mL，P <0.0001) 并减少左心房应变 (储库、导管和增压泵)。随着运动MAC受试者达到更高水平的MVG (17.3 ± 8.4 vs 5.5 ± 2.5毫米Hg，p <0.0001) 和肺动脉收缩压 (根据三尖瓣反流射流 [TR] 速度估计) 并显示 Δ mvg与 Δ tr速度之间的中等相关性 (r2 = 0.57)。运动MVG ≥ 15毫米Hg的MAC受试者的肺动脉收缩压峰值> 60毫米Hg。MAC受试者也具有相对变时性机能不全。患有严重MAC和跨瓣梯度的患者在运动时会经历MVG和肺动脉压的大幅增加，类似于风湿性二尖瓣狭窄中描述的情况。MAC可能是老年患者呼吸困难和运动不耐受的一个认识不足的原因。
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.