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Lee E, Jang YJ, Kim IS, Tae HJ, Sim J, Ahn D. Morphology of the aortic arch branching pattern in raccoon dogs ( Nyctereutes procyonoides, Gray, 1834). J Vet Sci 2024; 25:e32. [PMID: 38568833 PMCID: PMC10990908 DOI: 10.4142/jvs.23305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/21/2024] [Accepted: 02/12/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Aortic arch (AA) branching patterns vary among different mammalian species. Most previous studies have focused on dogs, whereas those on raccoon dogs remain unexplored. OBJECTIVES The objective of this study was to describe the AA branching pattern in raccoon dogs and compare their morphological features with those of other carnivores. METHODS We prepared silicone cast specimens from a total of 36 raccoon dog carcasses via retrograde injection through the abdominal aorta. The brachiocephalic trunk (BCT) branching patterns were classified based on the relationship between the left and right common carotid arteries. The subclavian artery (SB) branching pattern was examined based on the order of the four major branches: the vertebral artery (VT), costocervical trunk (CCT), superficial cervical artery (SC), and internal thoracic artery (IT). RESULTS In most cases (88.6%), the BCT branched off from the left common carotid artery and terminated in the right common carotid and right subclavian arteries. In the remaining cases (11.4%), the BCT formed a bicarotid trunk. The SB exhibited various branching patterns, with 26 observed types. Based on the branching order of the four major branches, we identified the main branching pattern, in which the VT branched first (98.6%), the CCT branched second (81.9%), the SC branched third (62.5%), and the IT branched fourth (52.8%). CONCLUSIONS The AA branching pattern in raccoon dogs exhibited various branching patterns with both similarities and differences compared to other carnivores.
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Affiliation(s)
- Euiyong Lee
- Department of Veterinary Medicine, College of Veterinary Medicine and Institute of Animal Transplantation, Jeonbuk National University, Iksan 54596, Korea
| | - Young-Jin Jang
- Department of Veterinary Medicine, College of Veterinary Medicine and Institute of Animal Transplantation, Jeonbuk National University, Iksan 54596, Korea
| | - In-Shik Kim
- Department of Veterinary Medicine, College of Veterinary Medicine and Institute of Animal Transplantation, Jeonbuk National University, Iksan 54596, Korea
| | - Hyun-Jin Tae
- Department of Veterinary Medicine, College of Veterinary Medicine and Institute of Animal Transplantation, Jeonbuk National University, Iksan 54596, Korea
| | - Jeoungha Sim
- Department of Nursing, College of Medical Science, Jeonju University, Jeonju 55069, Korea.
| | - Dongchoon Ahn
- Department of Veterinary Medicine, College of Veterinary Medicine and Institute of Animal Transplantation, Jeonbuk National University, Iksan 54596, Korea.
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Kazim M, Razian SA, Zamani E, Varandani D, Shahbad R, Desyatova A, Jadidi M. Variability in structure, morphology, and mechanical properties of the descending thoracic and infrarenal aorta around their circumference. J Mech Behav Biomed Mater 2024; 150:106332. [PMID: 38160644 DOI: 10.1016/j.jmbbm.2023.106332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/04/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
Aortic diseases, such as aneurysms, atherosclerosis, and dissections, demonstrate a preferential development and progression around the aortic circumference, resulting in a highly heterogeneous disease state around the circumference. Differences in the aorta's structural composition and mechanical properties may be partly responsible for this phenomenon. Our goal in this study was to analyze the mechanical and structural properties of the human aorta at its lateral, anterior, posterior, and medial quadrants in two regions prone to circumferentially inhomogeneous diseases, descending Thoracic Aorta (TA) and Infrarenal Aorta (IFR). Human aortas were obtained from 10 donors (64 ± 11 years) and dissected from their loose surrounding tissue. Mechanical properties were determined in all four quadrants of TA and IFR using planar biaxial testing and fitted to three common constitutive models. The structure of tissues was assessed using Movat Pentachrome stained histology slides. We observed that the anterior quadrant exhibited the greatest thickness, followed by the lateral region, in both the TA and IFR. In TA, the posterior wall appeared as the stiffest location in most samples, while in IFR, the anterior wall was the stiffest. We observed a higher glycosaminoglycans content in the lateral and posterior regions of the IFR. We found elastin density to be similar in TA lateral, anterior, and posterior quadrants, while in IFR, the anterior region demonstrated the highest elastin density. Despite significant variations between subjects, this study highlights the distinct morphometrical, mechanical, and structural properties between the quadrants of both TA and IFR.
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Affiliation(s)
- Madihah Kazim
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA
| | | | - Elham Zamani
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA
| | - Dheeraj Varandani
- Department of Computer Science, University of Nebraska Omaha, Omaha, NE, USA
| | - Ramin Shahbad
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA
| | | | - Majid Jadidi
- Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, USA.
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Ryu B, Mochizuki T, Kushi K, Ishikawa T, Shima S, Sato S, Inoue T, Kawamata T, Niimi Y. Optimal guiding catheter position during advancement of the guiding catheter into the carotid artery from the aortic arch via transfemoral approach. Neuroradiol J 2023; 36:470-478. [PMID: 36661360 PMCID: PMC10588598 DOI: 10.1177/19714009221150858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Guiding catheter (GC) advancement into the target carotid artery is a crucial step in neuroendovascular therapy. In difficult anatomies, alternative methods have been reported to overcome difficult carotid access for swift GC advancement. However, studies focusing on the positional relationship between the GC and inner catheter (IC) at the aortic arch are lacking. METHODS We evaluated the impact of the positional relationship between the GC and IC on whether the GC position affects catheter support or system straightening. We retrospectively reviewed 89 patients who underwent neuroendovascular therapy. We assessed the time to carotid access across difficult arch anatomies. The GC position was divided into Position 1, descending aorta level; Position 2, aortic arch level; and Position 3, origin of the left common carotid artery or innominate artery. We also evaluated the GC support and straightening effects in an in vitro vascular model study. RESULTS The coaxial catheter flexion angle at the aortic arch was significantly larger when the GC was set to Position 3 (p < 0.0001). A significantly shorter time to carotid access was observed with Positions 2 and 3 than with Position 1 in the difficult arch anatomy group. In the in vitro vascular model evaluation, the catheter support effect significantly increased as the GC position became closer to the IC tip (p < 0.0001) and straightening effect significantly increased as the GC moved to Position 2 from Position 1 (p < 0.0001). CONCLUSION During GC advancement, the GC positional relationship changed the support of the coaxial system with system straightening. The optimal GC position, Position 3, facilitated swift GC advancement.
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Affiliation(s)
- Bikei Ryu
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Chuo-ku, Japan
- Department of Neurosurgery, St Luke’s International Hospital, Chuo-ku, Japan
- Department of Neurosurgery, Tokyo Women’s Medical University, Shinjuku-ku, Japan
| | - Tatsuki Mochizuki
- Department of Neurosurgery, St Luke’s International Hospital, Chuo-ku, Japan
| | - Kazuki Kushi
- Department of Neurosurgery, St Luke’s International Hospital, Chuo-ku, Japan
| | - Tomomi Ishikawa
- Department of Neurosurgery, St Luke’s International Hospital, Chuo-ku, Japan
- Department of Neurosurgery, Tokyo Women’s Medical University, Shinjuku-ku, Japan
| | - Shogo Shima
- Department of Neurosurgery, St Luke’s International Hospital, Chuo-ku, Japan
| | - Shinske Sato
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Chuo-ku, Japan
- Department of Neurosurgery, St Luke’s International Hospital, Chuo-ku, Japan
- Department of Neurosurgery, Tokyo Women’s Medical University, Shinjuku-ku, Japan
| | - Tatsuya Inoue
- Department of Neurosurgery, St Luke’s International Hospital, Chuo-ku, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women’s Medical University, Shinjuku-ku, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St Luke’s International Hospital, Chuo-ku, Japan
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Wang R, Mattson JM, Zhang Y. Effect of aging on the biaxial mechanical behavior of human descending thoracic aorta: Experiments and constitutive modeling considering collagen crosslinking. J Mech Behav Biomed Mater 2023; 140:105705. [PMID: 36758423 PMCID: PMC10023391 DOI: 10.1016/j.jmbbm.2023.105705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/20/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023]
Abstract
Collagen crosslinking, an important contributor to the stiffness of soft tissues, was found to increase with aging in the aortic wall. Here we investigated the mechanical properties of human descending thoracic aorta with aging and the role of collagen crosslinking through a combined experimental and modeling approach. A total of 32 samples from 17 donors were collected and divided into three age groups: <40, 40-60 and > 60 years. Planar biaxial tensile tests were performed to characterize the anisotropic mechanical behavior of the aortic samples. A recently developed constitutive model incorporating collagen crosslinking into the two-fiber family model (Holzapfel and Ogden, 2020) was modified to accommodate biaxial deformation of the aorta, in which the extension and rotation kinematics of bonded fibers and crosslinks were decoupled. The mechanical testing results show that the aorta stiffens with aging with a more drastic change in the longitudinal direction, which results in altered aortic anisotropy. Our results demonstrate a good fitting capability of the constitutive model considering crosslinking for the biaxial aortic mechanics of all age groups. Furthermore, constitutive modeling results suggest an increased contribution of crosslinking and strain energy density to the biaxial stress-stretch behaviors with aging and point to excessive crosslinking as a prominent contributor to aortic stiffening.
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Affiliation(s)
- Ruizhi Wang
- Department of Mechanical Engineering, Boston University, Boston, MA, 02215, USA
| | - Jeffrey M Mattson
- Department of Mechanical Engineering, Boston University, Boston, MA, 02215, USA
| | - Yanhang Zhang
- Department of Mechanical Engineering, Boston University, Boston, MA, 02215, USA; Department of Biomedical Engineering, Boston University, Boston, MA, 02215, USA; Divison of Materials Science & Engineering, Boston University, Boston, MA, 02215, USA.
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Nourinezhad J, Ranjbar R, Rostamizadeh V, Tabrizinejad MN, Hallak A, Janeczek M. Morphology of the pattern of branching of the aortic arch (Arcus aortae) in Syrian hamsters (Mesocricetus auratus). Vet Res Commun 2023; 47:51-60. [PMID: 35435569 DOI: 10.1007/s11259-022-09927-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/12/2022] [Indexed: 01/27/2023]
Abstract
The branching patterns of the aortic arches of 28 adult male and female Syrian hamsters (SH) were thoroughly examined under a stereomicroscope for the first time by using latex injection and corrosion casting to determine their general arrangements and morphological variations as well as their differences and similarities to other rodents and rabbits. Three major arteries, namely, the brachiocephalic trunk (BC), left common carotid artery (CC) and left subclavian artery (SA), originating from the aortic arch (AR), were uniformly noted in SH. The BC was consistently divided into the right SA and the right CA. SA in SH normally releases the internal thoracic, deep cervical, dorsal scapular, vertebral, superficial cervical and supreme intercostal arteries. The costocervical trunk typically consisted of supreme intercostal and internal thoracic arteries and a common trunk for dorsal scapular and deep cervical arteries. To comprehend the comparative morphology of the pattern of branching of AR more completely, our results were compared with previous studies in rodents and rabbits. (1) The general morphology of the great arteries from AR in SH was similar to that in mole rats, rats, mice, porcupines, and gerbils but was essentially different from that in rabbits, guinea pigs, red squirrels, ground squirrels, pacas and chinchillas. (2) The typical pattern of the branching of the subclavian arteries in SH was similar to that in guinea pigs, rats, and rabbits but was different from that of the reported rodents regardless of the origins of the bronchoesophageal and internal thoracic arteries and the composition of the costocervical trunk.
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Affiliation(s)
- Jamal Nourinezhad
- Division of Anatomy and Embryology, Department of Basic Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran, B.O.X: 61355-145.
| | - Raza Ranjbar
- Division of Anatomy and Embryology, Department of Basic Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran, B.O.X: 61355-145
| | - Vahid Rostamizadeh
- Ph.D. Student of Comparative Anatomy and Embryology, Division of Anatomy and Embryology, Department of Basic Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Marzieh Norouzi Tabrizinejad
- Ph.D. Student of Comparative Anatomy and Embryology, Division of Anatomy and Embryology, Department of Basic Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Abdulaziz Hallak
- Ph.D. Student of Comparative Anatomy and Embryology, Division of Anatomy and Embryology, Department of Basic Sciences, Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Maciej Janeczek
- Division of Animal Anatomy, Department of Biostructure and Animal Physiology, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wrocław, Poland
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Pirruccello JP, Chaffin MD, Chou EL, Fleming SJ, Lin H, Nekoui M, Khurshid S, Friedman SF, Bick AG, Arduini A, Weng LC, Choi SH, Akkad AD, Batra P, Tucker NR, Hall AW, Roselli C, Benjamin EJ, Vellarikkal SK, Gupta RM, Stegmann CM, Juric D, Stone JR, Vasan RS, Ho JE, Hoffmann U, Lubitz SA, Philippakis AA, Lindsay ME, Ellinor PT. Deep learning enables genetic analysis of the human thoracic aorta. Nat Genet 2022; 54:40-51. [PMID: 34837083 PMCID: PMC8758523 DOI: 10.1038/s41588-021-00962-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/30/2021] [Indexed: 11/16/2022]
Abstract
Enlargement or aneurysm of the aorta predisposes to dissection, an important cause of sudden death. We trained a deep learning model to evaluate the dimensions of the ascending and descending thoracic aorta in 4.6 million cardiac magnetic resonance images from the UK Biobank. We then conducted genome-wide association studies in 39,688 individuals, identifying 82 loci associated with ascending and 47 with descending thoracic aortic diameter, of which 14 loci overlapped. Transcriptome-wide analyses, rare-variant burden tests and human aortic single nucleus RNA sequencing prioritized genes including SVIL, which was strongly associated with descending aortic diameter. A polygenic score for ascending aortic diameter was associated with thoracic aortic aneurysm in 385,621 UK Biobank participants (hazard ratio = 1.43 per s.d., confidence interval 1.32-1.54, P = 3.3 × 10-20). Our results illustrate the potential for rapidly defining quantitative traits with deep learning, an approach that can be broadly applied to biomedical images.
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Affiliation(s)
- James P Pirruccello
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
- Precision Cardiology Laboratory, The Broad Institute & Bayer US LLC, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mark D Chaffin
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
- Precision Cardiology Laboratory, The Broad Institute & Bayer US LLC, Cambridge, MA, USA
| | - Elizabeth L Chou
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Stephen J Fleming
- Precision Cardiology Laboratory, The Broad Institute & Bayer US LLC, Cambridge, MA, USA
- Data Sciences Platform, Broad Institute, Cambridge, MA, USA
| | - Honghuang Lin
- Framingham Heart Study, Boston University and National Heart, Lung, and Blood Institute, Framingham, MA, USA
- Department of Medicine, Section of Computational Biomedicine, Boston University School of Medicine, Boston, MA, USA
| | - Mahan Nekoui
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Shaan Khurshid
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
| | | | - Alexander G Bick
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
- Department of Medicine, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Alessandro Arduini
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
- Precision Cardiology Laboratory, The Broad Institute & Bayer US LLC, Cambridge, MA, USA
| | - Lu-Chen Weng
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
| | - Seung Hoan Choi
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
| | - Amer-Denis Akkad
- Precision Cardiology Laboratory, The Broad Institute & Bayer US LLC, Cambridge, MA, USA
| | - Puneet Batra
- Data Sciences Platform, Broad Institute, Cambridge, MA, USA
| | | | - Amelia W Hall
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
| | - Carolina Roselli
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Emelia J Benjamin
- Framingham Heart Study, Boston University and National Heart, Lung, and Blood Institute, Framingham, MA, USA
- Department of Medicine, Cardiology and Preventive Medicine Sections, Boston University School of Medicine, Boston, MA, USA
- Epidemiology Department, Boston University School of Public Health, Boston, MA, USA
| | | | - Rajat M Gupta
- Department of Medicine, Divisions of Cardiovascular Medicine and Genetics, Brigham and Women's Hospital, Boston, MA, USA
| | - Christian M Stegmann
- Precision Cardiology Laboratory, The Broad Institute & Bayer US LLC, Cambridge, MA, USA
| | - Dejan Juric
- Harvard Medical School, Boston, MA, USA
- Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - James R Stone
- Harvard Medical School, Boston, MA, USA
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Ramachandran S Vasan
- Framingham Heart Study, Boston University and National Heart, Lung, and Blood Institute, Framingham, MA, USA
- Department of Medicine, Cardiology and Preventive Medicine Sections, Boston University School of Medicine, Boston, MA, USA
- Epidemiology Department, Boston University School of Public Health, Boston, MA, USA
| | - Jennifer E Ho
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Udo Hoffmann
- Department of Radiology, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Steven A Lubitz
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anthony A Philippakis
- Data Sciences Platform, Broad Institute, Cambridge, MA, USA
- GV, Mountain View, CA, USA
| | - Mark E Lindsay
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick T Ellinor
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA.
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.
- Cardiovascular Disease Initiative, Broad Institute, Cambridge, MA, USA.
- Precision Cardiology Laboratory, The Broad Institute & Bayer US LLC, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Ojha V, Ganga KP, Goyal A, Reddy PR, Kumar S, Sharma S. Greater Curvature, Centerline or Straightened Centerline Length - Which length is Most Accurate for Preprocedural Planning in Thoracic Endovascular Aortic Repair? Ann Vasc Surg 2021; 78:123-131. [PMID: 34437962 DOI: 10.1016/j.avsg.2021.05.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/09/2021] [Accepted: 05/13/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Automated centerline (CL) measurements have been conventionally used for stent-graft length estimation during thoracic endovascular aortic repair (TEVAR). The purpose of this study was to assess the accuracy of greater curvature length (GL), semiautomated CL and straightened centerline length (SCL) for preprocedural planning in TEVAR. METHODS Immediate postprocedural CT Angiographies of 30 patients (22 males, age-49.2 ± 10.1years) who underwent TEVAR between 2015 and 2017 were retrospectively analyzed. CL, GL, SCL and the straightline length(SL) were measured between proximal and distal ends of the stent-graft and results were compared with the true length of the stent-graft (TL). Tortuosity index (TI = CL/SL) was calculated. RESULTS GL (17.92 ± 4.78 cm) was the closest in predicting the TL (17.75 ± 4.29 cm) (P = 0.414) overall, as well as in both dissection and aneurysm subgroups (P= 0.9). There was a significant difference between CL (16.67 ± 4.07 cm) and TL (P< 0.0001) as well as between SCL (16.86 ± 4.16 cm) and TL (P= 0.001). These differences were greater in dissection subgroup than in the aneurysm group (P< 0.0001 and P= 0.03 for TL-CL and TL-SCL, respectively). The extent of mismatch between GL or CL and TL did not correlate with tortuosity, but the difference between TL and SCL had a significant positive correlation with tortuosity (r = 0.375, P= 0.04). TL-GL had a negative linear correlation with the stent-graft length (TL) in the dissection group (r = 0.50, P= 0.03). CONCLUSIONS The greater curvature length predicts the actual total length of the deployed stent-graft more accurately than centerline or straightened centerline lengths. Hence, it should be used in planning for the length of stent-graft required for TEVAR.
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Affiliation(s)
- Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Kartik P Ganga
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Aayush Goyal
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep Ramakrishnan Reddy
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.
| | - Sanjiv Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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8
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Sodagar H, Sodagar-Abardeh J, Shakiba A, Niazmand H. Numerical study of drug delivery through the 3D modeling of aortic arch in presence of a magnetic field. Biomech Model Mechanobiol 2021; 20:787-802. [PMID: 33449275 DOI: 10.1007/s10237-020-01416-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/21/2020] [Indexed: 12/25/2022]
Abstract
Magnetic drug delivery known as smart technique in medicine is basically according to combining the drug inside capsules with the magnetic property or attaching the drug with magnetic surfaces at the micro- and nanoscale. In the present study, magnetic drug delivery in the aortic artery has been investigated. To approach the more realistic problem conditions of blood flow rheology, the effect of parameters such as non-Newtonian viscosity and oscillating input has been put into consideration. Also, the investigated geometrical parameters of arteries of the aortic arch have been chosen similar to the real size. The results indicate that an increase in the diameter of microparticles rises the efficiency of particles absorption. In addition, the influence of changing the direction of the wire carrying electricity and thus changing the direction of magnetic field on magnetic drug delivery has been examined in the geometry of the aortic arc and it is found that the highest particle absorption efficiency takes place in the case that the wire is parallel to the direction of y-axis. As an example, the results show that the rate of absorption efficiency for particles with 3 µm dia is 26.83% and 19.39% when the wire generating magnetic field is parallel to the direction of y-axis and z-axis, respectively, and this value is 10.91% for the case without a magnetic field. The number of particles released from different part of the aortic arch also is affected by the direction of magnetic field. This value illustrates that the percentage of particles released from different states, is equal when the magnetic field is absent and the wire carrying electricity is parallel to y-axis and z-axis. However, the number of particles released from the 2 outputs of the left carotid and left subclavian is less than the other 2 states (i.e., the state when there is not a magnetic field, and the state when the electric current direction is parallel to the y-axis direction) for the state when the wire carrying current is parallel to the z-axis.
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Affiliation(s)
- Hamid Sodagar
- Department of Mechanical Engineering, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Javad Sodagar-Abardeh
- Department of Mechanical Engineering, Shahrood University of Technology, Shahrood, Iran
| | - Ali Shakiba
- Department of Mechanical Engineering, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Hamid Niazmand
- Department of Mechanical Engineering, Ferdowsi University of Mashhad, Mashhad, Iran
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9
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Furukawa T, Otsuki N, Tomotsu M, Tatehara S, Morita N, Kojima Y, Teshima M, Shinomiya H, Nibu KI. Left non-recurrent inferior laryngeal nerve in a patient with right-sided aortic arch and aberrant left subclavian artery. Auris Nasus Larynx 2020; 48:317-321. [PMID: 32178945 DOI: 10.1016/j.anl.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/08/2020] [Accepted: 02/18/2020] [Indexed: 11/19/2022]
Abstract
Non-recurrent inferior laryngeal nerve (NRILN) is rare but one of the important anatomical variations in thyroid and parathyroid surgery. Almost all cases were observed on the right side with aberrant right subclavian artery and left NRILN have been reported in only five cases so far. Here, we reported a 38 year-old Japanese male with left NRILN accompanying adenomatous goiter. He was referred to our hospital for the surgical treatment of left thyroid goiter. Preoperative computed tomography revealed right-sided aortic arch and aberrant left subclavian artery with no signs of complete situs inversus viscerum, suggesting possible left NRLN. Left hemithyroidectomy was performed using nerve monitoring system. Intraoperatively, left recurrent laryngeal nerve was not identified along tracheoesophageal groove, but directly originated from vagal nerve and was running horizontally to larynx. Mobility of vocal cords were not impaired and postoperative course was uneventful. During thyroid surgery for the patients with right-sided aortic arch, meticulous care should be taken using nerve monitoring system to avoid nerve injury.
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Affiliation(s)
- Tatsuya Furukawa
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe,7-5-2 Kusunoki-Cho, Chuo-ku, Kobe 650-0017, Japan
| | - Naoki Otsuki
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe,7-5-2 Kusunoki-Cho, Chuo-ku, Kobe 650-0017, Japan.
| | - Masahiro Tomotsu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe,7-5-2 Kusunoki-Cho, Chuo-ku, Kobe 650-0017, Japan
| | - Shun Tatehara
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe,7-5-2 Kusunoki-Cho, Chuo-ku, Kobe 650-0017, Japan
| | - Naruhiko Morita
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe,7-5-2 Kusunoki-Cho, Chuo-ku, Kobe 650-0017, Japan
| | - Yasutaka Kojima
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe,7-5-2 Kusunoki-Cho, Chuo-ku, Kobe 650-0017, Japan
| | - Masanori Teshima
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe,7-5-2 Kusunoki-Cho, Chuo-ku, Kobe 650-0017, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe,7-5-2 Kusunoki-Cho, Chuo-ku, Kobe 650-0017, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe,7-5-2 Kusunoki-Cho, Chuo-ku, Kobe 650-0017, Japan
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10
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Jadidi M, Habibnezhad M, Anttila E, Maleckis K, Desyatova A, MacTaggart J, Kamenskiy A. Mechanical and structural changes in human thoracic aortas with age. Acta Biomater 2020; 103:172-188. [PMID: 31877371 DOI: 10.1016/j.actbio.2019.12.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/12/2019] [Accepted: 12/18/2019] [Indexed: 12/22/2022]
Abstract
Aortic mechanical and structural characteristics have profound effects on pathophysiology, but many aspects of physiologic stress-stretch state and intramural changes due to aging remain poorly understood in human tissues. While difficult to assess in vivo due to residual stresses and pre-stretch, physiologic stress-stretch characteristics can be calculated using experimentally-measured mechanical properties and constitutive modeling. Mechanical properties of 76 human descending thoracic aortas (TA) from 13 to 78-year-old donors (mean age 51±18 years) were measured using multi-ratio planar biaxial extension. Constitutive parameters were derived for aortas in 7 age groups, and the physiologic stress-stretch state was calculated. Intramural characteristics were quantified from histological images and related to aortic morphometry and mechanics. TA stiffness increased with age, and aortas became more nonlinear and anisotropic. Systolic and diastolic elastic energy available for pulsation decreased with age from 30 to 8 kPa and from 18 to 5 kPa, respectively. Cardiac cycle circumferential stretch dropped from 1.14 to 1.04, and circumferential and longitudinal physiologic stresses decreased with age from 90 to 72 kPa and from 90 to 17 kPa, respectively. Aortic wall thickness and radii increased with age, while the density of elastin in the tunica media decreased. The number of elastic lamellae and circumferential physiologic stress per lamellae unit remained constant with age at 102±10 and 0.85±0.04 kPa, respectively. Characterization of mechanical, physiological, and structural features in human aortas of different ages can help understand aortic pathology, inform the development of animal models that simulate human aging, and assist with designing devices for open and endovascular aortic repairs. STATEMENT OF SIGNIFICANCE: This manuscript describes mechanical and structural changes occurring in human thoracic aortas with age, and presents material parameters for 4 commonly used constitutive models. Presented data can help better understand aortic pathology, inform the development of animal models that simulate human aging, and assist with designing devices for open and endovascular aortic repairs.
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Affiliation(s)
- Majid Jadidi
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Mahmoud Habibnezhad
- Department of Computer Science, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Eric Anttila
- Department of Mechanical and Materials Engineering, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Kaspars Maleckis
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States; Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, United States
| | - Anastasia Desyatova
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States; Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, United States
| | - Jason MacTaggart
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States
| | - Alexey Kamenskiy
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, United States; Department of Biomechanics, University of Nebraska Omaha, Omaha, NE, United States.
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11
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Tawfik AM, Sobh DM, Ashamallah GA, Batouty NM. Prevalence and Types of Aortic Arch Variants and Anomalies in Congenital Heart Diseases. Acad Radiol 2019; 26:930-936. [PMID: 30266547 DOI: 10.1016/j.acra.2018.08.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/06/2018] [Accepted: 08/12/2018] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES Aortic arch (AA) variants and anomalies are important to recognize in patients with congenital heart disease (CHD) before surgery or intervention. The aim was to study the prevalence of AA anomalies and variants in patients with CHD compared to a control group. The secondary outcome was to report the associations between common variations of AA and specific types of CHD. MATERIALS AND METHODS After institutional review board approval, computed tomography studies of 352 CHD patients and control group of 400 consecutive computed tomography scans of the thorax were evaluated. The AA was assigned to one of seven common types, and their distribution was compared between CHD and control. The distribution of the AA anomalies and variants was evaluated as regard specific types of CHD and the visceroatrial situs. RESULTS Normal three-vessel branching pattern was the commonest in both groups, but was present in only 50.5% in the CHD compared to 68.5% in the control group, p < 0.00001. Right AA and aberrant right subclavian artery were significantly more common in CHD than control group (18.1% versus 0.25%, p < 0.00001) and (4.5% versus 0.25%, p = 0.0001), respectively. Direct aortic origin of left vertebral artery was insignificantly more common in CHD group (4.2% versus 2.7%, p = 0.258). Brachiobicephalic trunk was significantly more common in control than CHD group (27.7% versus 19.3%, p = 0.007). CONCLUSION Normal three-vessel AA was significantly less common in CHD. AA anomalies (right arch and aberrant right subclavian) were more common in CHD than control, while AA variants (brachiobicephalic trunk and direct aortic origin of left vertebral artery) were not.
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Affiliation(s)
- Ahmed M Tawfik
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, 12 El-Gomhoreya Street, Mansoura 35112, Egypt.
| | - Donia M Sobh
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, 12 El-Gomhoreya Street, Mansoura 35112, Egypt.
| | - Germeen A Ashamallah
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, 12 El-Gomhoreya Street, Mansoura 35112, Egypt.
| | - Nihal M Batouty
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, 12 El-Gomhoreya Street, Mansoura 35112, Egypt.
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12
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Belvroy VM, de Beaufort HW, van Herwaarden JA, Bismuth J, Moll FL, Trimarchi S. Tortuosity of the descending thoracic aorta: Normal values by age. PLoS One 2019; 14:e0215549. [PMID: 31013307 PMCID: PMC6478292 DOI: 10.1371/journal.pone.0215549] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/03/2019] [Indexed: 11/19/2022] Open
Abstract
Background Aging changes the aorta in length, tortuosity and diameter. This is relevant in thoracic endovascular aortic repair (TEVAR) and in the long term follow up. Methods and results Two groups of hundred patients < 65 years and hundred patients ≥ 65 years, with no vascular diseases were made. Thin cut CT scans were analyzed with 3Mensio Vascular software and the following measurements were collected; tortuosity index, curvature ratio, maximum tortuosity in degrees and the level of vertebrae of the maximum tortuosity. The descending thoracic aorta (DTA) was analyzed and was divided into four zones of equal length. Subjects were divided into three groups based on their maximum tortuosity value: low (< 30°), moderate (30° – 60°) and high (> 60°). A linear regression model was built to test the effect of age and gender on tortuosity. Tortuosity was more pronounced in the ≥ 65 compared to the < 65 group (tortuosity index: 1.05 vs. 1.14, respectively; p < 0.001), curvature ratio (1.00 vs. 1.01; p < 0.001), maximum tortuosity (22.24 vs. 27.26; p < 0.001), and group of angulation (low vs. low; p < 0.001). Additionally, the location of maximum tortuosity was further distal for the ≥ 65 group (level of vertebrae; 5.00 vs. 5.00; p < 0.001), and zone of maximum tortuosity (4A vs. 4A; p < 0.001). There was no significant difference between male and female subjects. Conclusion Normal DTA tortuosity increases with age. This is important to understand natural aging and for TEVAR planning and follow-up.
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Affiliation(s)
- Viony M. Belvroy
- Thoracic Aortic Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, United States of America
- * E-mail:
| | - Hector W.L. de Beaufort
- Thoracic Aortic Research Center, IRCCS Policlinico San Donato, San Donato Milanese, Italy
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Jean Bismuth
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, United States of America
| | - Frans L. Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Santi Trimarchi
- Department of Health and Community Sciences, University of Milan, Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
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13
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Kolumam Parameswaran P, Dai D, Ding YH, Urban MW, Manlove L, Sathish V, Cebral JR, Kallmes DF, Kadirvel R. Downstream vascular changes after flow-diverting device deployment in a rabbit model. J Neurointerv Surg 2018; 11:523-527. [PMID: 30415228 DOI: 10.1136/neurintsurg-2018-014123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/05/2018] [Accepted: 10/20/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Flow diverters (FDs) are increasingly used in the treatment of intracranial aneurysms, and carry the risk of thromboembolic complications, even in patients treated with dual antiplatelet therapy. The effect of FDs on the downstream vascular is unknown. The aim of the study was to investigate vascular wall pulse wave velocity (PWV) and contractility changes following FD treatment in a rabbit model. METHODS FDs (Pipeline Embolic Device, Medtronic Inc., Irvine, California, USA) were implanted in the aorta of normal rabbits and sham-operated aorta were used as controls (n=6 per group). Pulse wave imaging with ultra-fast ultrasound at 1600 frames per second (Vantage, Verasonics, Inc., Kirkland, WA) was performed in the vessel wall distal to FD prior to device implantation and at 8- week follow-up to measure the PWV. Force contraction vascular reactivity studies were conducted in the aortic rings using an organ bath. RESULTS The difference in mean PWV in the follow-up compared with pre-implantation was significantly higher in the distal vessels compared with sham controls (1.18 m/s [SD=0.54] vs. 0.37 m/s [SD=1.09], P=0.03). Conversely, the aortic segments distal to the FD exhibited a 55% increase in vascular contractility compared with proximal segments (P=0.002). We observed a significant positive correlation between mean PWV and mean vascular contractility. CONCLUSION Implantation of FD was associated with increased PWV and vascular contractility, suggesting that FD implantation causes changes to the vascular wall. Further studies are needed to understand the clinical implication of changes in vascular PWV and contractility.
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Affiliation(s)
| | - Daying Dai
- Applied Neuroradiology Research Laboratory, Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong-Hong Ding
- Applied Neuroradiology Research Laboratory, Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew W Urban
- Division of Radiology Research, Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Logan Manlove
- Pulmonary Cell Biology Laboratory, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Venkatachalem Sathish
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, North Dakota, USA
| | - Juan R Cebral
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - David F Kallmes
- Applied Neuroradiology Research Laboratory, Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ramanathan Kadirvel
- Applied Neuroradiology Research Laboratory, Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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14
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Yang F, Wang D, Liu H, Zhu X, Zou D, Wang X, Hu Z, Ji M, Cui S, Zhu YX, Wen J. Analysis of elasticity characteristics of ascending aorta, descending aorta and pulmonary artery using 640 slice-volume CT. Medicine (Baltimore) 2018; 97:e11125. [PMID: 29952955 PMCID: PMC6039643 DOI: 10.1097/md.0000000000011125] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
As the prevalence of coronary computed tomographic angiography (CCTA), it is meaningful that CCTA can provide not only the structural details of artery, but also functional information of vessel elasticity. Our aim was to explore the elasticity characteristics of ascending aorta (AA), descending aorta (DA), main pulmonary artery (MPA), left pulmonary artery (LPA), right pulmonary artery (RPA), and their relationship between each other using 640 slice-volume computed tomography (CT). Furthermore, this study will also observe their relations with age.A total of 42 subjects that were free of cardiovascular disease, high blood pressure, diabetes, and hyperlipidemia underwent CCTA on 640 slice-volume CT and were enrolled in this study. The subjects were divided into 2 groups: Group 1, age <46; Group 2, age ≥46. The aortic distensibility (AD) and aortic compliance (AC) of aorta and pulmonary artery (PA) of each group were compared.The AD and AC of PA decreased in the following order: MPA, RPA, and LPA. The correlation coefficients of different elastic parameters between different vessels were found to be different. The correlation coefficient of AD between AA and DA, AA and MPA, DA and MPA, RPA and MPA, LPA and MPA, and RPA and LPA were 0.689 (P = .000), 0.520 (P = .000), 0.393 (P = .010), 0.329 (P = .033), 0.579 (P = .000), and 0.534 (P = .000), respectively. The correlation coefficients of AC for the 6 groups mentioned above were 0.351 (P = .023), 0.470 (P = .002), 0.249 (P = .112), 0.190 (P = .228), 0.441 (P = .005), and 0.409 (P = .010), respectively. There was an age-dependent decrease of AD and AC in AA, DA, MPA, LPA (P < .05), but no difference in RPA (P > .05).The elasticity characteristics of AA, DA, MPA, LPA, and RPA could be well shown by 640 slice-volume CT. The elasticity relativity was observed and was different between AA and DA, AA and MPA, LPA and MPA, LPA and RPA. An obvious age-related decrease in vascular elasticity was found in AA, DA, MPA, and LPA, which should be taken into consideration in clinical trials and treatments for the elasticity-related cardiovascular diseases.
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Affiliation(s)
- Fei Yang
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang
| | - Dawei Wang
- Department of Cardiac Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou
| | - Huaijun Liu
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang
| | | | | | | | | | | | | | | | - Jing Wen
- Department of CT, Toshiba Medical Systems (China) Co. Ltd., Beijing, China
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15
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Abstract
The normal aortic arch branching pattern is of a three-vessel arch with the vertebral arteries arising from the subclavian arteries. There are a variety of well-known symptomatic and asymptomatic aortic branching patterns widely reported in the literature. An anomalous right vertebral artery with a diverticulum of Kommerell is an extremely rare variant, with few other cases reported in the literature. Herein, we review the embryology of the aortic arch and vertebral artery, the various types of Kommerell's diverticula and the clinical significance of this anomaly.
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Affiliation(s)
- Alyssa Goldbach
- Department of Radiology, Temple University Health System, Philadelphia, PA, USA
| | - Chandra Dass
- Department of Radiology, Temple University Health System, Philadelphia, PA, USA
| | - Krishna Surapaneni
- Department of Radiology, Temple University Health System, Philadelphia, PA, USA
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16
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Thunes JR, Phillippi JA, Gleason TG, Vorp DA, Maiti S. Structural modeling reveals microstructure-strength relationship for human ascending thoracic aorta. J Biomech 2018; 71:84-93. [PMID: 29544877 DOI: 10.1016/j.jbiomech.2018.01.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 01/11/2018] [Accepted: 01/28/2018] [Indexed: 11/17/2022]
Abstract
High lethality of aortic dissection necessitates accurate predictive metrics for dissection risk assessment. The not infrequent incidence of dissection at aortic diameters <5.5 cm, the current threshold guideline for surgical intervention (Nishimura et al., 2014), indicates an unmet need for improved evidence-based risk stratification metrics. Meeting this need requires a fundamental understanding of the structural mechanisms responsible for dissection evolution within the vessel wall. We present a structural model of the repeating lamellar structure of the aortic media comprised of elastic lamellae and collagen fiber networks, the primary load-bearing components of the vessel wall. This model was used to assess the role of these structural features in determining in-plane tissue strength, which governs dissection initiation from an intimal tear. Ascending aortic tissue specimens from three clinically-relevant patient populations were considered: non-aneurysmal aorta from patients with morphologically normal tricuspid aortic valve (CTRL), aneurysmal aorta from patients with tricuspid aortic valve (TAV), and aneurysmal aorta from patients with bicuspid aortic valve (BAV). Multiphoton imaging derived collagen fiber organization for each patient cohort was explicitly incorporated in our model. Model parameters were calibrated using experimentally-measured uniaxial tensile strength data in the circumferential direction for each cohort, while the model was validated by contrasting simulated tissue strength against experimentally-measured strength in the longitudinal direction. Orientation distribution, controlling the fraction of loaded collagen fibers at a given stretch, was identified as a key feature governing anisotropic tissue strength for all patient cohorts.
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Affiliation(s)
- James R Thunes
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Julie A Phillippi
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States; Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States; Surgery, University of Pittsburgh, Pittsburgh, PA, United States; Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, PA, United States; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Thomas G Gleason
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States; Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States; Surgery, University of Pittsburgh, Pittsburgh, PA, United States; Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, PA, United States; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - David A Vorp
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States; Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA, United States; Surgery, University of Pittsburgh, Pittsburgh, PA, United States; Center for Vascular Remodeling and Regeneration, University of Pittsburgh, Pittsburgh, PA, United States; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Spandan Maiti
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States.
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Braig M, Leupold J, Menza M, Russe M, Ko CW, Hennig J, von Elverfeldt D. Preclinical 4D-flow magnetic resonance phase contrast imaging of the murine aortic arch. PLoS One 2017; 12:e0187596. [PMID: 29117252 PMCID: PMC5678712 DOI: 10.1371/journal.pone.0187596] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 10/23/2017] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Cardiovascular diseases remain the number one death cause worldwide. Preclinical 4D flow phase contrast magnetic resonance imaging can provide substantial insights in the analysis of aortic pathophysiologies in various animal models. These insights may allow a better understanding of pathophysiologies, therapy monitoring, and can possibly be translated to humans. This study provides a framework to acquire the velocity field within the aortic arch. It analyses important flow values at different locations within the aortic arch. Imaging parameters with high temporal and spatial resolution are provided, that still allow combining this time-consuming method with other necessary imaging-protocols. METHODS A new setup was established where a prospectively gated 4D phase contrast sequence is combined with a highly sensitive cryogenic coil on a preclinical magnetic resonance scanner. The sequence was redesigned to maintain a close to steady state condition of the longitudinal magnetization and hence to overcome steady state artifacts. Imaging parameters were optimized to provide high spatial and temporal resolution. Pathline visualizations were generated from the acquired velocity data in order to display complex flow patterns. RESULTS Our setup allows data acquisition with at least two times the rate than that of previous publications based on Cartesian encoding, at an improved image quality. The "steady state" sequence reduces observed artifacts and provides uniform image intensity over the heart cycle. This made possible quantification of blood speed and wall shear stress (WSS) within the aorta and its branches. The highest velocities were observed in the ascending aorta with 137.5 ± 8 cm/s. Peak velocity values in the Brachiocephalic trunk were 57 ± 12 cm/s. Quantification showed that the peak flow occurs around 20 ms post R-wave in the ascending aorta. The highest mean axial wall shear stress was observed in the analysis plane between the left common carotid artery (LCCA) and the left subclavian artery. A stable image quality allows visualizing complex flow patterns by means of streamlines and for the first time, to the best of our knowledge, pathline visualizations from 4D flow MRI in mice. CONCLUSION The described setup allows analyzing pathophysiologies in mouse models of cardiovascular diseases in the aorta and its branches with better image quality and higher spatial and temporal resolution than previous Cartesian publications. Pathlines provide an advanced analysis of complex flow patterns in the murine aorta. An imaging protocol is provided that offers the possibility to acquire the aortic arch at sufficiently high resolution in less than one hour. This allows the combination of the flow assessment with other multifunctional imaging protocols.
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Affiliation(s)
- Moritz Braig
- Department of Radiology, Medical Physics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- * E-mail:
| | - Jochen Leupold
- Department of Radiology, Medical Physics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marius Menza
- Department of Radiology, Medical Physics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maximilian Russe
- Department of Radiology, Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cheng-Wen Ko
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Juergen Hennig
- Department of Radiology, Medical Physics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominik von Elverfeldt
- Department of Radiology, Medical Physics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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18
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Simanovsky N, Hiller N, Timofeev M, Eisenshtein EM, Perles Z, Tal S. Postmortem Computer Tomography Appearance of the Aortic Arch in Children: What Is Considered Normal? Isr Med Assoc J 2017; 19:640-643. [PMID: 29103243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Virtual autopsies by computer tomography (CT) or magnetic resonance imaging can be valuable in cases of unexplained infant death. The radiologist must be familiar with the normal appearance of all the segments of the thoracic aorta in normal and deceased children. A thorough review of the literature revealed no prior articles describing CT changes in the ascending aorta or the aortic arch in pediatric virtual autopsies. OBJECTIVES To compare the CT appearance of the thoracic aorta in deceased children and in those younger than 3 years of age. METHODS Hospital registries were searched for cases of unexpected deaths in children younger than 3 years old, with a postmortem CT available, as well as for clinically indicated chest CT in children of the same age during a 5 year period. The ascending aorta (AA), aortic arch (arch), and the descending aorta (DA) diameters were measured. Student's t-tests and Mann-Whitney U-tests were used to compare the two groups. RESULTS A total of 64 scans were reviewed: 35 postmortem and 29 performed on living patients. The differences in the diameter and the ratios of the diameter between the AA and the arch, as well as between the arch and the DA in the postmortem and living groups were statistically significant (P < 0.05). CONCLUSIONS On postmortem CT scans, we found focal tapering of the aortic caliber at the level of the arch between the origin of the brachiocephalic artery and left subclavian artery. This finding should not be misinterpreted as a hypoplastic aortic arch.
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Affiliation(s)
- Natalia Simanovsky
- Department of Medical Imaging, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nurith Hiller
- Department of Medical Imaging, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Maxim Timofeev
- Department of Medical Imaging, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eli M Eisenshtein
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Zeev Perles
- Department of Pediatric Cardiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sigal Tal
- Department of Radiology, Assaf Harofeh Medical Center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mohammadi H, Cartier R, Mongrain R. Fiber-reinforced computational model of the aortic root incorporating thoracic aorta and coronary structures. Biomech Model Mechanobiol 2017; 17:263-283. [PMID: 28929388 DOI: 10.1007/s10237-017-0959-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 08/31/2017] [Indexed: 01/03/2023]
Abstract
Cardiovascular diseases are still the leading causes of death in the developed world. The decline in the mortality associated with circulatory system diseases is accredited to development of new diagnostic and prognostic tools. It is well known that there is an inter relationship between the aortic valve impairment and pathologies of the aorta and coronary vessels. However, due to the limitations of the current tools, the possible link is not fully elucidated. Following our previous model of the aortic root including the coronaries, in this study, we have further developed the global aspect of the model by incorporating the anatomical structure of the thoracic aorta. This model is different from all the previous studies in the sense that inclusion of the coronary structures and thoracic aorta into the natural aortic valve introduces the notion of globality into the model enabling us to explore the possible link between the regional pathologies. The developed model was first validated using the available data in the literature under physiological conditions. Then, to provide a support for the possible association between the localized cardiovascular pathologies and global variations in hemodynamic conditions, we simulated the model for two pathological conditions including moderate and severe aortic valve stenoses. The findings revealed that malformations of the aortic valve are associated with development of low wall shear stress regions and helical blood flow in thoracic aorta that are considered major contributors to aortic pathologies.
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Affiliation(s)
- Hossein Mohammadi
- Mechanical Engineering Department, McGill University, Montreal, QC, H3A 0C3, Canada
| | - Raymond Cartier
- Department of Cardiovascular Surgery, Montreal Heart Institute, Montreal, QC, H1T 1C8, Canada
| | - Rosaire Mongrain
- Mechanical Engineering Department, McGill University, Montreal, QC, H3A 0C3, Canada.
- Department of Cardiovascular Surgery, Montreal Heart Institute, Montreal, QC, H1T 1C8, Canada.
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Parikh JD, Kakarla J, Keavney B, O’Sullivan JJ, Ford GA, Blamire AM, Hollingsworth KG, Coats L. 4D flow MRI assessment of right atrial flow patterns in the normal heart - influence of caval vein arrangement and implications for the patent foramen ovale. PLoS One 2017; 12:e0173046. [PMID: 28282389 PMCID: PMC5345792 DOI: 10.1371/journal.pone.0173046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 02/14/2017] [Indexed: 11/19/2022] Open
Abstract
AIM To investigate atrial flow patterns in the normal adult heart, to explore whether caval vein arrangement and patency of the foramen ovale (PFO) may be associated with flow pattern. MATERIALS AND METHODS Time-resolved, three-dimensional velocity encoded magnetic resonance imaging (4D flow) was employed to assess atrial flow patterns in thirteen healthy subjects (6 male, 40 years, range 25-50) and thirteen subjects (6 male, 40 years, range 21-50) with cryptogenic stroke and patent foramen ovale (CS-PFO). Right atrial flow was defined as vortical, helico-vortical, helical and multiple vortices. Time-averaged and peak systolic and diastolic flows in the caval and pulmonary veins and their anatomical arrangement were compared. RESULTS A spectrum of right atrial flow was observed across the four defined categories. The right atrial flow patterns were strongly associated with the relative position of the caval veins. Right atrial flow patterns other than vortical were more common (p = 0.015) and the separation between the superior and inferior vena cava greater (10±5mm versus 3±3mm, p = 0.002) in the CS-PFO group. In the left atrium all subjects except one had counter-clockwise vortical flow. Vortex size varied and was associated with left lower pulmonary vein flow (systolic r = 0.61, p = 0.001, diastolic r = 0.63 p = 0.002). A diastolic vortex was less common and time-averaged left atrial velocity was greater in the CS-PFO group (17±2cm/sec versus 15±1, p = 0.048). One CS-PFO subject demonstrated vortical retrograde flow in the descending aortic arch; all other subjects had laminar descending aortic flow. CONCLUSION Right atrial flow patterns in the normal heart are heterogeneous and are associated with the relative position of the caval veins. Patterns, other than 'typical' vortical flow, are more prevalent in the right atrium of those with cryptogenic stroke in the context of PFO. Left atrial flow patterns are more homogenous in normal hearts and show a relationship with flow arising from the left pulmonary veins.
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Affiliation(s)
- Jehill D. Parikh
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jayant Kakarla
- Department of Congenital Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Bernard Keavney
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - John J. O’Sullivan
- Department of Congenital Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gary A. Ford
- Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Andrew M. Blamire
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Louise Coats
- Department of Congenital Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
- Medical Sciences Division, University of Oxford, Oxford, United Kingdom
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21
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Saura D, Dulgheru R, Caballero L, Bernard A, Kou S, Gonjilashvili N, Athanassopoulos GD, Barone D, Baroni M, Cardim N, Hagendorff A, Hristova K, Lopez T, de la Morena G, Popescu BA, Penicka M, Ozyigit T, Rodrigo Carbonero JD, Van De Veire N, Von Bardeleben RS, Vinereanu D, Zamorano JL, Gori AS, Cosyns B, Donal E, Habib G, Addetia K, Lang RM, Badano LP, Lancellotti P. Two-dimensional transthoracic echocardiographic normal reference ranges for proximal aorta dimensions: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 2017; 18:167-179. [PMID: 27044913 DOI: 10.1093/ehjci/jew053] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 02/24/2016] [Indexed: 10/16/2023] Open
Abstract
AIMS To report normal reference ranges for echocardiographic dimensions of the proximal aorta obtained in a large group of healthy volunteers recruited using state-of-the-art cardiac ultrasound equipment, considering different measurement conventions, and taking into account gender, age, and body size of individuals. METHODS AND RESULTS A total of 704 (mean age: 46.0 ± 13.5 years) healthy volunteers (310 men and 394 women) were prospectively recruited from the collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study. A comprehensive echocardiographic examination was obtained in all subjects following pre-defined protocols. Aortic dimensions were obtained in systole and diastole, following both the leading-edge to leading-edge and the inner-edge to inner-edge conventions. Diameters were measured at four levels: ventricular-arterial junction, sinuses of Valsalva, sino-tubular junction, and proximal tubular ascending aorta. Measures of aortic root in the short-axis view following the orientation of each of the three sinuses were also performed. Men had significantly larger body sizes when compared with women, and showed larger aortic dimensions independently of the measurement method used. Dimensions indexed by height and body surface area are provided, and stratification by age ranges is also displayed. In multivariable analysis, the independent predictors of aortic dimensions were age, gender, and height or body surface area. CONCLUSION The NORRE study provides normal values of proximal aorta dimensions as assessed by echocardiography. Reference ranges for different anatomical levels using different (i) measurement conventions and (ii) at different times of the cardiac cycle (i.e. mid-systole and end-diastole) are provided. Age, gender, and body size were significant determinants of aortic dimensions.
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Affiliation(s)
- Daniel Saura
- Unidad de Imagen Cardiaca, Servicio de Cardiologia, Hospital Clinico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - Raluca Dulgheru
- University of Liège hospital, GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, Liège, Belgium
| | - Luis Caballero
- Unidad de Imagen Cardiaca, Servicio de Cardiologia, Hospital Clinico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - Anne Bernard
- University of Liège hospital, GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, Liège, Belgium
- CHU Tours, France et Université de Tours, Tours, France
| | - Seisyou Kou
- Department of Cardiology, St Marianna University, School of Medicine, Kawasaki, Japan
| | - Natalia Gonjilashvili
- Echocardiography Laboratory of Adult Cardiology Department of the JO ANN Medical Center, Tbilisi, Georgia
| | | | - Daniele Barone
- Laboratory of Cardiovascular Ecography-Cardiology Dpt, S. Andrea Hospital, La Spezia, Italy
| | - Monica Baroni
- Laboratorio Di Ecocardiografia Adulti, Fondazione Toscana 'G.Monasterio', Ospedale Del Cuore, Massa, Italy
| | - Nuno Cardim
- Hospital da Luz - Echocardiography laboratory, Lisbon, Portugal
| | - Andreas Hagendorff
- Echokardiographie-Labore des Universitätsklinikums AöR, Department of Cardiology-Angiology, University of Leipzig, Leipzig, Germany
| | - Krasimira Hristova
- Department of Noninvasive Functional Diagnostic and Imaging, University National Heart Hospital, Sofia, Bulgaria
| | - Teresa Lopez
- Cardiology Department, La Paz hospital, Madrid, Spain
| | - Gonzalo de la Morena
- Unidad de Imagen Cardiaca, Servicio de Cardiologia, Hospital Clinico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - Bogdan A Popescu
- 'Carol Davila' University of Medicine and Pharmacy - Euroecolab, Institute of Cardiovascular Diseases, Bucharest, Romania
| | | | - Tolga Ozyigit
- VKV Amerikan Hastanesi, Kardiyoloji Bölümü, Istanbul, Turkey
| | | | | | | | - Dragos Vinereanu
- Cardiovascular Research Unit, University and Emergency Hospital, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | | | - Ann-Stephan Gori
- University of Liège hospital, GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, Liège, Belgium
| | - Bernard Cosyns
- CHVZ (Centrum voor Hart en Vaatziekten) - Universitair ziekenhuis Brussel, Brussel, Belgium
- ICMI (In Vivo Cellular and Molecular Imaging) Laboratory, Brussels, Belgium
| | - Erwan Donal
- CIC-IT U 804, CHU Rennes, Université Rennes 1, Service de Cardiologie, CHU RENNES, France
| | - Gilbert Habib
- Aix-Marseille Université, Marseille 13005, France
- Department of Cardiology, APHM, La Timone Hospital, Marseille 13005, France
| | - Karima Addetia
- Department of Medicine, University of Chicago Medical Center, IL, USA
| | - Roberto M Lang
- Department of Medicine, University of Chicago Medical Center, IL, USA
| | - Luigi P Badano
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, School of Medicine, Padova, Italy
| | - Patrizio Lancellotti
- University of Liège hospital, GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, Liège, Belgium
- Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
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Abstract
Arterial occlusive disease involving the supra-aortic trunks (SATs) is relatively frequent. Its mere presence does not dictate the need for intervention. Revascularization options include intra and extrathoracic surgical bypasses and transpositions, and percutaneous endovascular approaches with angioplasty and stenting. This paper focuses on a description of the fundamental endovascular techniques and equipment that have proved useful in the senior author's (FJC) 15-year experience with catheter-based intervention for treatment of SAT disease. These procedures have gained in popularity over the years and become the preferred modality for management of most patients today.
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Affiliation(s)
- Frank J Criado
- Division of Vascular Surgery and Center for Vascular Intervention, Union Memorial Hospital-MedStar Health, Baltimore, MD, USA.
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Eikendal ALM, Blomberg BA, Haaring C, Saam T, van der Geest RJ, Visser F, Bots ML, den Ruijter HM, Hoefer IE, Leiner T. 3D black blood VISTA vessel wall cardiovascular magnetic resonance of the thoracic aorta wall in young, healthy adults: reproducibility and implications for efficacy trial sample sizes: a cross-sectional study. J Cardiovasc Magn Reson 2016; 18:20. [PMID: 27075677 PMCID: PMC4831203 DOI: 10.1186/s12968-016-0237-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/22/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Pre-clinical detection of atherosclerosis enables personalized preventive strategies in asymptomatic individuals. Cardiovascular magnetic resonance (CMR) has evolved as an attractive imaging modality for studying atherosclerosis in vivo. Yet, the majority of aortic CMR studies and proposed sequences to date have been performed at 1.5 tesla using 2D BB techniques and a slice thickness of 4-5 mm. Here, we evaluate for the first time the reproducibility of an isotropic, T1-weighted, three-dimensional, black-blood, CMR VISTA sequence (3D-T1-BB-VISTA) for quantification of aortic wall characteristics in healthy, young adults. METHODS In 20 healthy, young adults (10 males, mean age 31.3 years) of the AMBITYON cohort study the descending thoracic aorta was imaged with a 3.0 T MR system using the 3D-T1-BB-VISTA sequence. The inter-scan, inter-rater and intra-rater reproducibility of aortic lumen, total vessel and wall area and mean and maximum wall thickness was evaluated using Bland-Altman analyses and Intraclass Correlation Coefficients (ICC). Based on these findings, sample sizes for detecting differences in aortic wall characteristics between groups were calculated. RESULTS For each studied parameter, the inter-scan, inter-rater and intra-rater reproducibility was excellent as indicated by narrow limits of agreement and high ICCs (ranging from 0.76 to 0.99). Sample sizes required to detect a 5% difference in aortic wall characteristics between two groups were 203, 126, 136, 68 and 153 per group for lumen area, total vessel area and vessel wall area and for mean and maximum vessel wall thickness, respectively. CONCLUSION The 3D-T1-BB-VISTA sequence provides excellent reproducibility for quantification of aortic wall characteristics and can detect small differences between groups with reasonable sample sizes. Hence, it may be a valuable tool for assessment of the subtle vascular wall changes of early atherosclerosis in asymptomatic populations.
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Affiliation(s)
- Anouk L. M. Eikendal
- />Department of Radiology (E01.132), University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Björn A. Blomberg
- />Department of Radiology (E01.132), University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Cees Haaring
- />Department of Radiology (E01.132), University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Tobias Saam
- />Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistrasse 15, 81377 Munich, Germany
| | - Rob J. van der Geest
- />Division of Image Processing, Department of Radiology, 1-C2S Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - Fredy Visser
- />Department of Radiology (E01.132), University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- />Philips Healthcare, Veenpluis 4-6, 5684PC Best, The Netherlands
| | - Michiel L. Bots
- />Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Hester M. den Ruijter
- />Laboratory of Experimental Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Imo E. Hoefer
- />Laboratory of Clinical Chemistry and Hematology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Tim Leiner
- />Department of Radiology (E01.132), University Medical Center, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Liu X, Zhang X. The rate of aortic arch branching variation in Chinese patients using multislice spiral computed tomography angiography. INT ANGIOL 2015; 34:514-519. [PMID: 25394953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM The aim of this study was to study the frequency of aortic arch branching variation in Chinese patients using multislice spiral computed tomography (MSCT) angiography. METHODS Retrospectively analysis of MSCT images from 750 consecutively enrolled patients to study the frequency of aortic arch branching variation. RESULTS Among 750 patients enrolled, 21 cases were excluded due to poor image quality, and a total of 729 cases were included for the analysis. Nine types of aortic arch branching pattern were identified. The aortic arch branch has absented of any variation (type I) in 559 patients (76.68%). The most frequent anatomical variant was the common origin to the right brachiocephalic trunk and left common carotid artery (type II), which occurred in 97 patients (13.31%). From type III to type IX, the incidence rate of variation was 2.61%, 5.76%, 0.14%, 0.82%, 0.27%, 0.27% and 0.14%, respectively. CONCLUSION This is the largest study to date that investigated the frequency of aortic arch branching variation in Chinese patients using MSCT. The study showed that the rate of type V aortic arch variation is different between Chinese patienst and Westerners ones. Also, this study identified one case of aortic arch branching variant (type IX) that has not been reported before. MSCT can depict the blood vessel variation from multilayer and multi-angle, reveal its structural relationship with surrounding tissue, and guide the clinical diagnosis and treatment.
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Affiliation(s)
- X Liu
- Department of Radiology, The First Affiliated Hospital of Liaoning Medical College, Jinzhou, China -
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25
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Chiang CH, Yeh ML, Chen WL, Kan CD. Apparatus for Comparison of Pullout Forces for Various Thoracic Stent Grafts at Varying Neck Angulations and Oversizes. Ann Vasc Surg 2015; 31:196-204. [PMID: 26597245 DOI: 10.1016/j.avsg.2015.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 10/07/2015] [Accepted: 10/11/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND The purpose of this study is to provide an apparatus for comparison of pullout forces for various thoracic stent grafts at varying neck angulations and oversizes. METHODS An in vitro platform capable of performing pullout tests was used on stent grafts in angulated silicone tubes designed for this study (0°, 45°, 90°, and 135° with a 32-mm inner diameter) in a temperature-controlled chamber (37 ± 2°C). Three commercial stent grafts with sizes commonly used in Taiwan (Valiant: 34, 36, 38, and 40 mm; Zenith TX2: 34, 36, 38, and 40 mm; and TAG: 34, 37, and 40 mm) were used, and each size was tested 8 times for each angulation condition. RESULTS The mean dislodgement forces (DFs) at 0° angulation within 10-20% oversize were approximately 22.7, 9.6, and 9.0 N for the Valiant, Zenith TX2, and TAG devices, respectively, whereas the mean DFs decreased by 46%, 38%, and 50% to 12.3, 5.9, and 4.5 N when the angulation reached 135°. Regression analysis shows that neck angulation was a significant factor for the Valiant and Zenith TX2 devices (P < 0.0001 and P < 0.0001, respectively) but not for the TAG device (P = 0.483). In addition, oversize and interactions between variables (angulation × oversize) exhibited significant effects on the DFs for all devices (P < 0.0001). CONCLUSIONS We successfully built up an apparatus for comparison of pullout forces for various thoracic stent grafts at varying neck angulations and oversizes. With the empirical comparative data of different brand stent grafts under various conditions shown and compared, our findings suggest that aortic neck angulation has a negative correlation with stent-graft fixation. To have better stent-graft fixation and seal in the aortic arch for thoracic endovascular aortic repair, a longer landing zone with cautiously selected oversize is a more suitable selection.
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Affiliation(s)
- Cheng-Hsien Chiang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ling Chen
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Dann Kan
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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26
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van Ooij P, Semaan E, Schnell S, Giri S, Stankovic Z, Carr J, Barker AJ, Markl M. Improved respiratory navigator gating for thoracic 4D flow MRI. Magn Reson Imaging 2015; 33:992-9. [PMID: 25940391 DOI: 10.1016/j.mri.2015.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 04/25/2015] [Accepted: 04/27/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Thoracic and abdominal 4D flow MRI is typically acquired in combination with navigator respiration control which can result in highly variable scan efficiency (Seff) and thus total scan time due to inter-individual variability in breathing patterns. The aim of this study was to test the feasibility of an improved respiratory control strategy based on diaphragm navigator gating with fixed Seff, respiratory driven phase encoding, and a navigator training phase. METHODS 4D flow MRI of the thoracic aorta was performed in 10 healthy subjects at 1.5T and 3T systems for the in-vivo assessment of aortic time-resolved 3D blood flow velocities. For each subject, four 4D flow scans (1: conventional navigator gating, 2-4: new implementation with fixed Seff =60%, 80% and 100%) were acquired. Data analysis included semi-quantitative evaluation of image quality of the 4D flow magnitude images (image quality grading on a four point scale), 3D segmentation of the thoracic aorta, and voxel-by-voxel comparisons of systolic 3D flow velocity vector fields between scans. RESULTS Conventional navigator gating resulted in variable Seff=74±13% (range=56%-100%) due to inter-individual variability of respiration patterns. For scans 2-4, the new navigator implementation was able to achieve predictable total scan times with stable Seff, only depending on heart rate. Semi- and fully quantitative analysis of image quality in 4D flow magnitude images was similar for the new navigator scheme compared to conventional navigator gating. For aortic systolic 3D velocities, good agreement was found between all new navigator settings (scan 2-4) with the conventional navigator gating (scan 1) with best performance for Seff=80% (mean difference=-0.01 m/s; limits of agreement=0.23 m/s, Pearson's ρ=0.89, p<0.001). No significant differences for image quality or 3D systolic velocities were found for 1.5T compared to 3T. CONCLUSIONS The findings of this study demonstrate the feasibility of the new navigator scheme to acquire 4D flow data with more predictable scan time while maintaining image quality and 3D velocity information, which may prove beneficial for clinical applications.
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Affiliation(s)
- Pim van Ooij
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Edouard Semaan
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Susanne Schnell
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Zoran Stankovic
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James Carr
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Alex J Barker
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, USA.
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Genovese K, Humphrey JD. Multimodal optical measurement in vitro of surface deformations and wall thickness of the pressurized aortic arch. J Biomed Opt 2015; 20:046005. [PMID: 25867620 DOI: 10.1117/1.jbo.20.4.046005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/18/2015] [Indexed: 06/04/2023]
Abstract
Computational modeling of arterial mechanics continues to progress, even to the point of allowing the study of complex regions such as the aortic arch. Nevertheless, most prior studies assign homogeneous and isotropic material properties and constant wall thickness even when implementing patient-specific luminal geometries obtained from medical imaging. These assumptions are not due to computational limitations, but rather to the lack of spatially dense sets of experimental data that describe regional variations in mechanical properties and wall thickness in such complex arterial regions. In this work, we addressed technical challenges associated with in vitro measurement of overall geometry, full-field surface deformations, and regional wall thickness of the porcine aortic arch in its native anatomical configuration. Specifically, we combined two digital image correlation-based approaches, standard and panoramic, to track surface geometry and finite deformations during pressurization, with a 360-deg fringe projection system to contour the outer and inner geometry. The latter provided, for the first time, information on heterogeneous distributions of wall thickness of the arch and associated branches in the unloaded state. Results showed that mechanical responses vary significantly with orientation and location (e.g., less extensible in the circumferential direction and with increasing distance from the heart) and that the arch exhibits a nearly linear increase in pressure-induced strain up to 40%, consistent with other findings on proximal porcine aortas. Thickness measurements revealed strong regional differences, thus emphasizing the need to include nonuniform thicknesses in theoretical and computational studies of complex arterial geometries.
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Affiliation(s)
- Katia Genovese
- University of Basilicata, School of Engineering, Potenza 85100, Italy
| | - Jay D Humphrey
- Yale University, Department of Biomedical Engineering, New Haven, Connecticut 06520, United States
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Shah SB, Witzenburg C, Hadi MF, Wagner HP, Goodrich JM, Alford PW, Barocas VH. Prefailure and failure mechanics of the porcine ascending thoracic aorta: experiments and a multiscale model. J Biomech Eng 2014; 136:021028. [PMID: 24402447 DOI: 10.1115/1.4026443] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 01/08/2014] [Indexed: 11/08/2022]
Abstract
Ascending thoracic aortic aneurysms (ATAA) have a high propensity for dissection, which occurs when the hemodynamic load exceeds the mechanical strength of the aortic media. Despite our recognition of this essential fact, the complex architecture of the media has made a predictive model of medial failure-even in the relatively simple case of the healthy vessel-difficult to achieve. As a first step towards a general model of ATAA failure, we characterized the mechanical behavior of healthy ascending thoracic aorta (ATA) media using uniaxial stretch-to-failure in both circumferential (n = 11) and axial (n = 11) orientations and equibiaxial extensions (n = 9). Both experiments demonstrated anisotropy, with higher tensile strength in the circumferential direction (2510 ± 439.3 kPa) compared to the axial direction (750 ± 102.6 kPa) for the uniaxial tests, and a ratio of 1.44 between the peak circumferential and axial loads in equibiaxial extension. Uniaxial tests for both orientations showed macroscopic tissue failure at a stretch of 1.9. A multiscale computational model, consisting of a realistically aligned interconnected fiber network in parallel with a neo-Hookean solid, was used to describe the data; failure was modeled at the fiber level, with an individual fiber failing when stretched beyond a critical threshold. The best-fit model results were within the 95% confidence intervals for uniaxial and biaxial experiments, including both prefailure and failure, and were consistent with properties of the components of the ATA media.
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Kuan YH, Nguyen VT, Kabinejadian F, Su B, Kim S, Yoganathan AP, Leo HL. Numerical analysis of the hemodynamic performance of bileaflet mechanical heart valves at different implantation angles. J Heart Valve Dis 2014; 23:642-650. [PMID: 25799715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The effects of the implantation angle of bileaflet mechanical heart valves (BMHVs) on the sinus region and downstream flow profiles were investigated. Three-dimensional numerical simulations of BMHVs were performed under physiologic pulsatile flow conditions. The study aim was to examine how the flow fields of different aortic sinus shapes and the downstream aortic arch geometry would be affected by implantation angle. METHODS Two geometric models of sinus were investigated: a simplified axisymmetric sinus; and a three-sinus aortic root model, with two different downstream geometries, namely a straight pipe and a simplified curved aortic arch. A 29 mm St. Jude Medical BMHV geometric model was used and positioned at four different angles (0 degrees, 30 degrees, 60 degrees and 90 degrees). RESULTS The simulation results showed variation in downstream flow profiles at different implantation angles. Generally, at position Z = 1D along the centerline (where Z refers to the axis normal to the x-y plane and D is the inlet diameter), the triple-jet structures were observed with a slight shift of the center jet for three-sinus aortic cases. Apparent differences were observed at position Z = 2D and 4D, such as higher velocity profiles at the inner arch wall. The flow field downstream of the valve implanted at 0 degrees (anatomic position) showed the smallest overall asymmetry at peak systole, while the flow field downstream of the valve implanted at 90 degrees (anti-anatomic position) exhibited high regions of recirculation. CONCLUSION Valve orientation was found not to affect the shear stress distribution significantly in the downstream aorta, and this was in agreement with the findings of earlier studies.
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Abstract
We report a case of a 40-year-old woman with congenital dual arterial supply to an otherwise normal left lower lobe, causing hyperperfusion lung injury. In addition to near normal pulmonary arterial supply, the lower lobe of the left lung received a systemic arterial supply from the descending thoracic aorta. The patient was successfully managed by surgical ligation of the systemic arterial supply without lobectomy. We discuss when to defer lobectomy in Pryce type I sequestration.
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Affiliation(s)
- Ramachandra Barik
- Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
| | - Amar Narayan Patnaik
- Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
| | - Amaresh Rao Malempati
- Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India Department of Cardiothoracic Surgery, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
| | - Lalita Nemani
- Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
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Rea G, Valente T, Iaselli F, Urraro F, Izzo A, Sica G, Muto M, Scaglione M, Muto M, Cappabianca S, Rotondo A. Multi-detector computed tomography in the evaluation of variants and anomalies of aortic arch and its branching pattern. Ital J Anat Embryol 2014; 119:180-192. [PMID: 26749678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Evaluate the prevalence of aortic arch anatomy and branching pattern variants and anomalies in 1359 patients by Multi-Detector Computed Tomography Angiography. METHODS Retrospective multi-centric study including exams performed for various clinical issues with the same acquisition and injection protocols on 64-slices scanners. Multi-Planar reformations and Volume Rendering Images were available in all cases. RESULTS A total of 965 patients (71%) had normal aortic arch anatomy and branching pattern. Anatomical variations and anomalies were present in the remaining 394 patients (29%). The most common variation was the common origin of the brachiocephalic and the left common carotid arteries (302/1359 cases, about 22%). The most common anomaly were aberrant right subclavian artery (4/1359, about 0.5%) and right aortic arch (4/1359 cases, about 0.5%). CONCLUSIONS Our multicentric series is, as far as we know, the largest reported to date for the definition of the prevalence of variation and anomalies of aortic arch anatomy and branching pattern. Knowledge of such findings may avoid both in the immediate and in the long term an injury to the patient, decreasing the rate of complications during surgery and interventional radiology procedures in the head and neck district.
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Porpora A, Zunino P, Vergara C, Piccinelli M. Numerical treatment of boundary conditions to replace lateral branches in hemodynamics. Int J Numer Method Biomed Eng 2012; 28:1165-1183. [PMID: 23212795 DOI: 10.1002/cnm.2488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 03/28/2012] [Accepted: 03/29/2012] [Indexed: 06/01/2023]
Abstract
In this paper, we discuss a technique for weakly enforcing flow rate conditions in computational hemodynamics. In particular, we study the effectiveness of cutting lateral branches from the computational domain and replacing them with non-perturbing boundary conditions to simplify the geometrical reconstruction and the numerical simulation. All these features are investigated both in the case of rigid and compliant walls. Several numerical results are presented to discuss the reliability of the proposed method.
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Affiliation(s)
- A Porpora
- MOX, Dipartimento di Matematica "Francesco Brioschi", Politecnico di Milano, Italy
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Voges I, Jerosch-Herold M, Hedderich J, Pardun E, Hart C, Gabbert DD, Hansen JH, Petko C, Kramer HH, Rickers C. Normal values of aortic dimensions, distensibility, and pulse wave velocity in children and young adults: a cross-sectional study. J Cardiovasc Magn Reson 2012; 14:77. [PMID: 23151055 PMCID: PMC3514112 DOI: 10.1186/1532-429x-14-77] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 10/16/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Aortic enlargement and impaired bioelasticity are of interest in several cardiac and non-cardiac diseases as they can lead to cardiovascular complications. Cardiovascular magnetic resonance (CMR) is increasingly accepted as a noninvasive tool in cardiovascular evaluation. Assessment of aortic anatomy and bioelasticity, namely aortic distensibility and pulse wave velocity (PWV), by CMR is accurate and reproducible and could help to identify anatomical and bioelastic abnormalities of the aorta. However, normal CMR values for healthy children and young adults are lacking. METHODS Seventy-one heart-healthy subjects (age 16.4 ± 7.6 years, range 2.3-28.3 years) were examined using a 3.0 Tesla CMR scanner. Aortic cross-sectional areas and aortic distensibility were measured at four positions of the ascending and descending thoracic aorta. PWV was assessed from aortic blood flow velocity measurements in a aortic segment between the ascending aorta and the proximal descending aorta. The Lambda-Mu-Sigma (LMS) method was used to obtain percentile curves for aortic cross-sectional areas, aortic distensibility and PWV according to age. RESULTS Aortic areas, PWV and aortic distensibility (aortic cross-sectional areas: r = 0.8 to 0.9, p < 0.001; PWV: r = 0.25 to 0.32, p = 0.047 to 0.009; aortic distensibility r = -0.43 to -0.62, p < 0.001) correlated with height, weight, body surface area, and age. There were no significant sex differences. CONCLUSIONS This study provides percentile curves for cross-sectional areas, distensibility and pulse wave velocity of the thoracic aorta in children and young adolescents between their 3rd and 29th year of life. These data may serve as a reference for the detection of pathological changes of the aorta in cardiovascular disease.
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Affiliation(s)
- Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Michael Jerosch-Herold
- Department of Radiology, Brigham & Women's Hospital, Harvard University, 75 Francis Street, Boston, MA, 02115, USA
| | - Jürgen Hedderich
- Department for Medical Informatics and Statistics, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Eileen Pardun
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Christopher Hart
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Dominik Daniel Gabbert
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Jan Hinnerk Hansen
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Colin Petko
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Hans-Heiner Kramer
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
| | - Carsten Rickers
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Germany
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Devereux RB, de Simone G, Arnett DK, Best LG, Boerwinkle E, Howard BV, Kitzman D, Lee ET, Mosley TH, Weder A, Roman MJ. Normal limits in relation to age, body size and gender of two-dimensional echocardiographic aortic root dimensions in persons ≥15 years of age. Am J Cardiol 2012; 110:1189-94. [PMID: 22770936 PMCID: PMC3462295 DOI: 10.1016/j.amjcard.2012.05.063] [Citation(s) in RCA: 247] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 05/24/2012] [Accepted: 05/24/2012] [Indexed: 12/01/2022]
Abstract
Nomograms to predict normal aortic root diameter for body surface area (BSA) in broad ranges of age have been widely used but are limited by lack of consideration of gender effects, jumps in upper limits of aortic diameter among age strata, and data from older teenagers. Sinus of Valsalva diameter was measured by American Society of Echocardiography convention in normal-weight, nonhypertensive, nondiabetic subjects ≥15 years old without aortic valve disease from clinical or population-based samples. Analyses of covariance and linear regression with assessment of residuals identified determinants and developed predictive models for normal aortic root diameter. In 1,207 apparently normal subjects ≥15 years old (54% women), aortic root diameter was 2.1 to 4.3 cm. Aortic root diameter was strongly related to BSA and height (r = 0.48 for the 2 comparisons), age (r = 0.36), and male gender (+2.7 mm adjusted for BSA and age, p <0.001 for all comparisons). Multivariable equations using age, gender, and BSA or height predicted aortic diameter strongly (R = 0.674 for the 2 comparisons, p <0.001) with minimal relation of residuals to age or body size: for BSA 2.423 + (age [years] × 0.009) + (BSA [square meters] × 0.461) - (gender [1 = man, 2 = woman] × 0.267), SEE 0.261 cm; for height 1.519 + (age [years] × 0.010) + (height [centimeters] × 0.010) - (gender [1 = man, 2 = woman] × 0.247), SEE 0.215 cm. In conclusion, aortic root diameter is larger in men and increases with body size and age. Regression models incorporating body size, age, and gender are applicable to adolescents and adults without limitations of previous nomograms.
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Affiliation(s)
- Richard B Devereux
- Greenberg Division of Cardiology, Weill Cornell Medical College, New York, New York, USA.
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Mazzaccaro D, Nano G. The use of virtual reality for carotid artery stenting (CAS) training in type I and type III aortic arches. Ann Ital Chir 2012; 83:81-85. [PMID: 22462324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM Simulation has been proposed to improve learning curves in carotid artery stenting (CAS), but previous studies have only evaluated CAS simulation in a single type of arch usually either type I or type II. The aim of our study is to define the use of virtual reality for CAS training in type I and type III aortic arches for novice operators. MATERIALS AND METHODS Fifty experienced interventionalists and fifty novice trainees with no prior experience with endovascular procedures performed a virtual CAS in a type I aortic arch case and one in a type III arch case. They trained on simulator for two hours and then repeated the procedures. Data of the procedures were collected and analysed. RESULTS Among novice operators, 38 out of 50 ended the first procedure on type I arch (76%) and 32% (16 out of 50) concluded the first procedure on type III arch (p < .05). After training, 100% of novice ended the easy case and 56% (28 out of 50) concluded the difficult case (p < .05). All experienced operators successfully carried out the simulations. The simulator induced greater improvement among novice in type I arch rather than in type III arch. Performances of experienced didn't improve significantly. Among novice, virtual performances of "difficult" cases were significantly worse than those of "easy" cases, both before and after training. CONCLUSIONS Simulator is an effective tool for training of novice operators in type I aortic arch; on the contrary its role has yet to be established in type III aortic arch.
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Affiliation(s)
- Daniela Mazzaccaro
- Ist Unit of Vascular Surgery, University of Milan, IRCCS Policlinico S. Donato, San Donato Milanese, Milan, Italy.
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Tartaglia F, Blasi S, Tromba L, Sgueglia M, Russo G, Di Matteo FM, Carbotta G, Campana FP, Berni A. Duplex ultrasound and magnetic resonance imaging of the supra-aortic arches in patients with non recurrent inferior laryngeal nerve: a comparative study. G Chir 2011; 32:245-250. [PMID: 21619775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Non-recurrent inferior laryngeal nerve (NRILN) is usually discovered during thyroid surgery. It is often associated with vascular abnormalities that can be detected with magnetic resonance imaging (MRI) or duplex ultrasound scan. The aim of this study was to compare the diagnostic sensitivity of ultrasonography with MRI to identify the vascular abnormalities associated to NRILN. PATIENTS AND METHODS We revised 2713 total thyroidectomies to select patients with NRILN. The NRILN was identified in 17 patients (0,6%). A postoperative ultrasonic duplex scanning and a MRI was performed in 15 cases as 2 patients refused to submit to the exams. RESULTS At MRI an unique origin of common carotid trunk and a concomitant aberrant retroesophageal subclavian right artery was showed in 11 patients. In 2 cases vascular abnormality consisted in separated origin of supra-aortic arteries. At duplex ultrasound scan only in 2 patients was impossible to identify vascular abnormalities detected at MRI. Tthe diagnostic sensitivity of duplex ultrasound was 84,6%. CONCLUSIONS Preoperative duplex ultrasound is a non invasive method with high diagnostic sensitivity that can easily complete the preoperative thyroid ultrasonography.
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Affiliation(s)
- F Tartaglia
- Surgical Sciences Department, Sapienza University of Rome, Italy
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Doi T, Harimaya K, Matsumoto Y, Iwamoto Y. Aortic location and flat chest in scoliosis: a prospective study. Fukuoka Igaku Zasshi 2011; 102:14-19. [PMID: 21516987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Adolescent Idiopathic Scoliosis tends to be complicated with spine and ribcage deformities. In addition to the coronal curvature, among the features of right thoracic scoliosis, flat chest, ribcage rotation, cardiac compression and an aortic left shift are also observed. Aorta is known to shift in a leftward direction, especially at the mid-thoracic level. The cause of aortic left shift in scoliosis is not known. To clarify the features of a scoliosis deformity, especially the relationship of the aortic left shift and the flat chest in scoliosis, we investigated the CT scan images of scoliosis patients. METHODS For the measurement of scoliosis patients, the pre-operative CT scans of 22 patients with non-congenital right thoracic scoliosis were recruited. For controls, 25 age-matched non-scoliosis patients were recruited. The aortic location, the ribcage rotation angle and chest depth were measured by CT scan. The chest depth was defined as the smallest inner chest cavity depth between the anterior vertebral body and the anterior inner chest wall. RESULTS Chest depth in scoliosis patients was found to be significantly narrower than the control group at every thoracic level, from T6 to T11. The aortic left shift was significantly larger in scoliosis patients at all measured levels. The chest depth correlated with an aortic leftward shift (r = 0.49). The aortic location was found to be correlated with the ribcage rotation angle (r = -0.52), and the ribcage rotation angle correlated with the thoracic side curvature (r = 0.61) CONCLUSIONS In right thoracic scoliosis, an aortic left shift correlated with both flat chest and the ribcage rotation.
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Affiliation(s)
- Toshio Doi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Ogeng'o JA, Malek AKA, Kiama SG. Regional differences in aorta of goat (capra hircus). Folia Morphol (Warsz) 2010; 69:253-257. [PMID: 21120813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Regional differences in the aortic wall are important in explaining the physicomechanical properties and disease distribution in this artery. The goat is a suitable model for studying cardiovascular disease, but the regional features of its aorta are scarcely reported. The purpose of the study was therefore to describe the regional differences in the wall of its aorta. Sixteen healthy adult male domestic goats (capra hircus) were euthanised with intravenous sodium pentabarbitone and specimens obtained from the ascending, arch, each vertebral level of descending thoracic, and various segments of abdominal aorta. The specimens were fixed in 10% formaldehyde solution and routinely processed for paraffin embedding. Seven micron thick sections were stained with Mason's Trichrome and Weigert Resorcin Fuchsin stains. Light microscopic examination revealed that the aortic wall consists of tunica intima comprising endothelium, subendothelial zone and internal elastic lamina, media, and adventitia. Endothelium comprises flat and round endotheliocytes. The population of round cells declines as the internal elastic lamina increases in prominence caudally. Tunica media in ascending, arch, and proximal thoracic aorta comprises two zones: namely a luminal elastic and adventitial musculo-elastic zone, in which muscle islands interrupt some elastic lamellae. These islands progressively diminish caudally until by the eleventh thoracic vertebra they are only patchy. Beyond this point and in the abdominal aorta they are absent and tunica media consists of regular concentric elastic lamellae. Tunica adventitia, on the other hand, increases in thickness and elastic fibre content caudally. Regional variations exist in all three layers of goat aorta. The nature of these differences suggests that they are related to haemodynamic factors. Furthermore, the variations may form the basis for regional differences in physicomechanical strength and disease distribution along the aorta.
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Affiliation(s)
- J A Ogeng'o
- Department of Human Anatomy, University of Nairobi, Kenya.
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Bhattarai C, Poudel PP. Study on the variation of branching pattern of arch of aorta in Nepalese. Nepal Med Coll J 2010; 12:84-86. [PMID: 21222403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The variations of vessels arising from the aortic arch are numerous. The purpose of this study is the description of the variations on the branching pattern of arch of aorta, in order to offer useful data to anatomists, radiologists, vascular surgeons, neck and thorax surgeons in Nepalese subjects, and relating it with embryological basis. In this investigation, branching patterns of arch of aorta were studied in 85 cases of Nepali origin. Variations in the anatomical arrangements of the branches of arch of aorta in the Nepali population were as par with other populations of the world. Variations on the branching pattern of the arch of aorta were found in 17 cadavers (20.0%) of elderly Nepalese. The accurate information on this is vital for vascular surgery in the thorax, head and neck regions. Although, the variations are usually asymptomatic, they may cause dyspnea, dysphagia, intermittent claudication, misinterpretation ofradiological examinations and complications during neck and thorax surgery. These observations are precious while invading the arch of aorta and its branches by instruments, as all areas are susceptible to surgical attack.
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Affiliation(s)
- C Bhattarai
- Department of Anatomy, Manipal College of Medical Sciences, Pokhara, Nepal.
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Gupta S. Tips and tricks for radial interventions. Indian Heart J 2010; 62:275-276. [PMID: 21275311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Affiliation(s)
- Satya Gupta
- The Heart Care Clinic, Bodakdev, Ahmedabad, Gujarat, India.
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Burzotta F, De Vita M, Trani C. How to manage difficult anatomic conditions affecting transradial approach coronary procedures? Indian Heart J 2010; 62:238-244. [PMID: 21275301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
The adoption of transradial approach for percutaneous coronary diagnostic and interventional procedures is known to reduce access-site complications. However, anatomic variants of brachial-radial axis, axillary-subclavian-anonymous axis and aortic arch may obstacle successful completion of transradial procedures. In the present paper, we discuss how to diagnose and manage the possible obstacles occurring at the different steps of transradial diagnostic and interventional procedures.
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Affiliation(s)
- Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
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Du X, Guo W, Liu XP, Yin T, Jia X, Zhang MH. [CT-research about how to design the diameter and length of the modular branched stent-graft]. Zhonghua Wai Ke Za Zhi 2010; 48:573-576. [PMID: 20646471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To study the anatomical characteristics about ascending aortic and aortic arch in Chinese population by CT. METHODS From September 2006 to September 2007, 388 patients free of current known aortic pathology undergone thoracic aorta CTA. The diameter of ascending aorta, aortic arch, and branch vessels of aortic arch were measured respectively by AW4.2 work station. The data base about all the measurements was set up. The CHISS statistical software was used to analysis data. RESULTS The aortic diameter above coronary artery (CA), the level at origin of and brachiocephalic trunk (BCT), the halfway of the ascending aorta, the level at origin of left common carotid artery (LCCA), the level at origin of left subclavian artery (LSA) and the level at distal of origin of LSA respectively were (34 +/- 5) mm, (34 +/- 5) mm, (33 +/- 4) mm, (30 +/- 4) mm, (28 +/- 3) mm and (26 +/- 3) mm. The diameters of two level between the origin of BCT and right subclavian artery (RSA) were (13.1 +/- 1.9) mm and (12.8 +/- 2.3) mm. Diameters of two level at LCCA were (8.7 +/- 1.5) mm and (7.9 +/- 1.0) mm. The diameters of two level between the origin of LSA and left vertebral artery were (10.7 +/- 1.7) mm and (9.3 +/- 1.3) mm. The aortic lumina length between the origin of CA and BCT was (5.3 +/- 1.2) cm, the aortic lumina length between the origin of BCT and LCCA was (1.3 +/- 0.4) cm, the lumen length between origin of BCT and RSA was (4.1 +/- 0.8) cm, the lumen length between origin of LSA and left vertebral artery was (3.8 +/- 0.8) cm. The distance between the wall of BCT and LCCA was (0.4 +/- 0.2) cm, the distance between the wall of LCCA and LSA was (0.7 +/- 0.6) cm. CONCLUSIONS Modular branched stent-graft system is fit for most part of the Chinese. The size fit for human could be got on this basic.
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Affiliation(s)
- Xin Du
- Department of Vascular Surgery, People's Liberation Army General Hospital, Beijing, China
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Johnson RK, Premraj S, Patel SS, Walker N, Wahle A, Sonka M, Scholz TD. Automated analysis of four-dimensional magnetic resonance images of the human aorta. Int J Cardiovasc Imaging 2010; 26:571-8. [PMID: 20146003 DOI: 10.1007/s10554-010-9592-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 01/07/2010] [Indexed: 11/30/2022]
Abstract
The purpose of the study was to demonstrate the accuracy and clinical utility of an automated method of image analysis of 4D (3D + time) magnetic resonance (MR) imaging of the human aorta. Serial MR images of the entire thoracic aorta were acquired on 32 healthy individuals. Graph theory based segmentation was applied to the images and cross sectional area (CSA) was determined for the entire length of thoracic aorta. Mean CSA was compared between the 3 years. CSA values at the level of sinuses of Valsalva and sino-tubular junction were used to calculate average diameters for comparison to Roman-Devereux norms. A robust automated segmentation method was developed that accurately reproduced CSA measurements for the entire length of thoracic aorta in serially acquired scans with a 1% error compared to expert tracing. Calculated aortic root diameters based on CSA correlated with Roman-Devereux norms. Mean CSA for the aortic root agreed well with previously published manually derived values. Automated analysis of 4D MR images of the thoracic aorta provides accurate and reproducible results for CSA in healthy human subjects. The ability to simultaneously analyze the entire length of thoracic aorta throughout the cardiac cycle opens the door to the calculation of novel indices of aortic biophysical properties. These novel indices may lead to earlier detection of patients at risk for adverse events.
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Affiliation(s)
- Ryan K Johnson
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Karmonik C, Bismuth J, Davies MG, Younes HK, Lumsden AB. An image processing algorithm for the in-vivo quantification and visualization of septum motion in type III B - aortic dissections with cine magnetic resonance imaging. Annu Int Conf IEEE Eng Med Biol Soc 2009; 2009:4391-4. [PMID: 19964359 DOI: 10.1109/iembs.2009.5333811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Currently, there is no method to predict outcome of endovascular treatment (EVAR) of type III B aortic dissections (TB-AD). A new image processing algorithm is presented for quantifying IS displacement from cine 2D phase contrast magnetic resonance images (2D pcMRI) towards a new classification of TB-AD based on IS mobility. Bulk motion of the true aortic lumen (tAB) center (ALC), maximum, minimum and average displacement of the boundary points composing the IS and tAB excluding the IS were quantified at two locations in one patient. Correlations of the ALC motion and the averaged temporal displacement AD(t) of IS and tAB excluding IS with the aortic flow waveform were calculated. Range of ALC motion was similar in both locations (average 0.56 mm, max 1.37 mm) and correlated with the aortic flow waveform in the abdominal aorta but not the thoracic aorta. Range of displacement of the IS was from 1.27 mm to -1.64 mm (average 0.09 + or - 0.07 mm) in the thoracic aorta, and from 0.38 mm to -3.38 mm (average 0.42 + or - 0.23 mm) in the abdominal aorta. tAB motion excluding the IS was 1.21 mm to 0.84 mm (thoracic, average 0.13 + or - 0.07 mm) and 0.52 mm to -1.88 mm (abdominal, average 0.37 + or - 0.11 mm). AD(t) for IS and tAB excluding the IS both correlated with aortic flow in the abdominal aorta only.
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Affiliation(s)
- Christof Karmonik
- Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, TX 77030, USA.
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Anyanwu GE, Agwuna KK. Aortic arch diameter and its significance in the clinical evaluation of cardiac and aortic enlargements. Niger J Clin Pract 2009; 12:453-456. [PMID: 20329691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE OF THE STUDY To determine the relevance of the transverse aortic arch diameter in the evaluation of early aortic and cardiac enlargements. SUBJECT AND METHOD A total of 1818 chest radiographs of male and female normotensive and hypertensive Nigerians of age range 4-80 and 10-80 years respectively were used for this study. Ages of subjects were obtained and transverse aortic arch, chest and heart diameters were determined. RESULTS Mean aortic arch diameter for the normotensive groups were noted to be 5.0 +/- 0.5cm, 4.5 +/- 0.4cm and 4.7 +/- 0.5cm for males, females and both sexes respectively while 5.9 +/- 0.9cm, 5.4 +/- 0.6cm and 5.6 +/- 0.8cm for males, females and both sexes respectively were noted in the hypertensive group. Mean values were also generated for the chest and heart diameters. The study reports a mean difference in the aortic arch, heart and cardiothoracic ratio of 15% between the two groups. CONCLUSION Relationship between aortic arch and heart diameter was established and aortic arch diameter was noted to be significant (p< 0.05) in evaluating aortic and cardiac enlargements.
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Affiliation(s)
- G E Anyanwu
- Department of Anatomy, Enugu State University of Science and Technology, College of Medicine, Enugu, Nigeria.
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Karadeli E, Ulu E. CT of double descending thoracic aorta in an adult female. Diagn Interv Radiol 2009; 15:179-181. [PMID: 19728263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Persistent double dorsal aorta is a rare congenital anomaly of the descending aorta. It is an anomaly with two variants. The first type is characterized by complete separation of two dorsal aortae. The second type is a double-lumen descending aorta with a central dividing septum from the level just below the ductal ligament to the aortic bifurcation. We present a completely separated double dorsal aorta with a narrower right segment and the main left segment between the 6th and 10th thoracic vertebrae.
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Affiliation(s)
- Elif Karadeli
- Department of Radiology, Başkent University School of Medicine, Ankara, Turkey.
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Abstract
OBJECTIVES Knowledge of normal aortic diameters is important in the assessment of aortic disease. The aim of this study was to determine normal thoracic aortic diameters. DESIGN 77 patients undergoing computed tomography of the thorax were studied. The diameter of the thoracic aorta was measured at three levels in the ascending aorta and at three levels in the descending aorta. The diameter was studied in relation to age, sex, weight and height. RESULTS We found that aortic diameter is increasing with increasing age. Even sex and BMI influence the aortic diameter but to a lesser extent than age. The upper normal limit for ascending aorta can be calculated with the formula D(mm) = 31 + 0.16*age and for descending aorta with the formula D(mm) = 21 + 0.16*age. Thus a 20-year-old person has an upper normal limit for ascending aorta of 34 mm and an 80-year-old person has a limit of 44 m. CONCLUSIONS The thoracic aortic diameter varies with age, sex and body weight and height. The strongest correlation can be seen with age. Age should therefore be taken into consideration when determining whether the thoracic aorta is dilated or not.
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Affiliation(s)
- Matias Hannuksela
- Department of Surgical and Perioperative Sciences, Heart Center, Umeå University Hospital, Umeå, Sweden.
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Kristek F, Cacanyiova S, Gerova M. Hypotrophic effect of long-term neuronal NO-synthase inhibition on heart and conduit arteries of the Wistar rats. J Physiol Pharmacol 2009; 60:21-27. [PMID: 19617641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 04/30/2009] [Indexed: 05/28/2023]
Abstract
We demonstrate the effect of long-term nNOS inhibition with 7-nitroindazole (7NI) on the heart and conduit arteries. Ten weeks old Wistar rats were used: two groups of controls and rats receiving 7-NI (10 mg/kg b.w./day) for 6 weeks in drinking water. Blood pressure (BP) was measured by the plethysmographic method. In first group mesenteric, carotid and coronary arteries were excised after perfusion fixation (120 mmHg) for morphological study, in second group mesenteric artery was taken for functional investigation. 7NI did not affect BP, heart/body weight was decreased. In all arteries inner diameter (ID) did not changed, wall thickness (WT) (intima+media), cross sectional area (CSA) (intima+media), and WT/ID decreased. In carotid artery volume density (VD) (percentual proportion) of intima and media did not change; VD and CSAs of endothelial and smooth muscle cells decreased, CSAs of extracellular matrix in intima and media did not change. No difference was found in relaxation of mesenteric artery to acetylcholine (10(-9)-10(-5) mol/L). Contraction induced by transmural nerve stimulation (8 Hz) augmented and contraction to exogennous noradrenaline (10(-9)-10(-5) mol/L) attenuated. Long-term 7NI administration evoked pressure independent cardiac hypotrophy and due to decrease of endothelial and smooth muscle cell mass arterial wall hypotrophy associated with decreased contractile efficiency.
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MESH Headings
- Animals
- Aorta, Thoracic/anatomy & histology
- Aorta, Thoracic/drug effects
- Aorta, Thoracic/physiology
- Blood Pressure/drug effects
- Body Weight/drug effects
- Carotid Arteries/anatomy & histology
- Carotid Arteries/drug effects
- Carotid Arteries/physiology
- Coronary Vessels/anatomy & histology
- Coronary Vessels/drug effects
- Coronary Vessels/physiology
- Dose-Response Relationship, Drug
- In Vitro Techniques
- Indazoles/administration & dosage
- Indazoles/pharmacology
- Muscle Contraction
- Muscle, Smooth, Vascular/anatomy & histology
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/physiology
- Nitric Oxide Synthase Type I/antagonists & inhibitors
- Organ Size/drug effects
- Rats
- Rats, Wistar
- Time Factors
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Affiliation(s)
- F Kristek
- Institute of Normal and Pathological Physiology and Centre of Excellence for Cardiovascular Research, Slovak Academy of Sciences, Bratislava, Slovak Republic.
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Kaiser T, Kellenberger CJ, Albisetti M, Bergsträsser E, Valsangiacomo Buechel ER. Normal values for aortic diameters in children and adolescents--assessment in vivo by contrast-enhanced CMR-angiography. J Cardiovasc Magn Reson 2008; 10:56. [PMID: 19061495 PMCID: PMC2615773 DOI: 10.1186/1532-429x-10-56] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 12/05/2008] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Contrast-enhanced CMR angiography (CE-CMRA) is being increasingly used for diagnosing aortic arch anomalies, planning interventions and follow-up assessment. We sought to establish normal values for the diameters of the thoracic aorta and reference curves related to body growth in children using CE-CMRA. RESULTS CE-CMRA was performed in 53 children without cardiovascular disease. The median age was 9 years (range 2 - 20 years), weight 30 kg (range 12 - 75 kg), height 131 cm (range 81 - 184 cm), body surface area (BSA) 1.05 m2 (range 0.52-1.9 m2). Aortic diameters were measured at nine standardized sites on oblique maximum-intensity projection (MIP) images. Regression analysis of diameters in relation to BSA demonstrated linear relationship between the cross-sectional aortic diameters and the square root of BSA (BSA0.5). Normative diameters were (0.57 + 19.37*BSA0.5) mm for the aortic sinus, (-3.52 + 18.66*BSA0.5) mm for the first segment of the aortic arch, (-3.37 + 16.52*BSA0.5) mm for the isthmic region and (-1.27 + 9.89*BSA0.5) mm for the descending aorta at the level of the diaphragm. Normative curves are presented. CONCLUSION This study provides normative values for aortic diameters in children measured by CE-CMRA. These data may serve for making the diagnosis of pediatric arch anomalies, assessing the need for treatment and planning interventions.
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Affiliation(s)
- Thomas Kaiser
- Division of Pediatric Cardiology, University Children's Hospital, Zurich, Switzerland
| | | | - Manuela Albisetti
- Division of Pediatrics, University Children's Hospital, Zurich, Switzerland
| | - Eva Bergsträsser
- Division of Pediatric Oncology, University Children's Hospital, Zurich, Switzerland
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