Impact of Cardiac Cycle on Thoracic Aortic Geometry-Morphometric Analysis of Ecg Gated Computed Tomography.
- 作者列表："Zubair MM","de Beaufort HWL","Belvroy VM","Schwein A","Irshad A","Mohamed A","Gomez LF","Chinnadurai P","Nabi F","Yang EY","Trimarchi S","Reardon MJ","Bismuth J
BACKGROUND:Understanding morphological changes of ascending aorta, aortic arch and descending aorta with cardiac and respiratory motion is critical for planning of endovascular repair of thoracic aorta. The aim of this study was to determine the impact of the cardiac cycle on thoracic aortic geometry. METHODS:In this retrospective study, electrocardiogram-gated cardiac computed tomography from 116 patients who were evaluated for transcatheter aortic valve replacement were reviewed. A protocol for measurements of maximal diameters and lengths of the thoracic aorta and supra-aortic vessels was established. Measurements were made in multiplanar views perpendicular to the semiautomatically created centerline on both systolic and diastolic phases. RESULTS:Mean age was 77 ± 11 years of our study cohort. Mean systolic and diastolic diameter were 31.6 ± 0.42 and 30.1 ± 4.4 mm at the sinotubular junction (STJ), 35.6 ± 4.8 and 34.8 ± 4.7 mm in the ascending aorta, 29.1 ± 3.3 and 28.5 ± 3.3 mm in the aortic arch (distal left common carotid artery), and 26.7 ± 5.4 and 25.8 ± 5.4 mm in the descending aorta. Mean diameter change was 1.5 ± 0.9 mm at the STJ, 0.8 ± 0.9 mm in the ascending aorta, 0.6 ± 0.8 mm in the aortic arch, and 0.9 ± 1.2 mm in the descending aorta. Mean arterial strain was 5.0 ± 3.2% at the level of the STJ, 2.4 ± 2.7% in the ascending aorta, 2.0 ± 2.9% in the aortic arch, and 3.9 ± 5.7% in the descending aorta. CONCLUSIONS:Our results demonstrated that small but significant circumferential and longitudinal strain was present at every aortic level. These findings may have implications for endovascular thoracic aortic repair and may provide reference values for future comparison.
背景: 了解升主动脉、主动脉弓和降主动脉随心脏和呼吸运动的形态学变化对胸主动脉腔内修复的规划至关重要。本研究的目的是确定心动周期对胸主动脉几何形状的影响。 方法: 在这项回顾性研究中，我们回顾了116例经导管主动脉瓣置换术患者的心电门控心脏计算机断层扫描。建立了测量胸主动脉和主动脉上血管最大直径和长度的方案。在与收缩期和舒张期的半自动创建的中心线垂直的多平面视图中进行测量。 结果: 我们研究队列的平均年龄为77 ± 11岁。平均收缩期和舒张期内径分别为31.6 ± 0.42mm和30.1 ± 4.4毫米mm，升主动脉为35.6 ± 4.8mm和34.8 ± 4.7毫米mm，主动脉弓 (左颈总动脉远端) 为29.1 ± 3.3mm和28.5 ± 3.3毫米mm，和26.7 ± 5.4和25.8 ± 5.4毫米的降主动脉。STJ时平均直径变化为1.5 ± 0.9毫米mm，升主动脉为0.8 ± 0.9毫米mm，主动脉弓为0.6 ± 0.8毫米mm，降主动脉为0.9 ± 1.2毫米mm.STJ水平的平均动脉应变为5.0 ± 3.2%，升主动脉为2.4 ± 2.7%，主动脉弓为2.0 ± 2.9%，降主动脉为3.9 ± 5.7%。 结论: 我们的结果表明，在每个主动脉水平存在小但显著的圆周和纵向应变。这些发现可能对胸主动脉腔内修复术有影响，并可能为将来的比较提供参考价值。
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.