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Abstract
The transition from fetal to neonatal life is a dramatic and complex process involving extensive physiologic changes, which are most obvious at the time of birth. Individuals who care for newly born infants must monitor the progress of the transition and be prepared to intervene when necessary. In the majority of births, this transition occurs without a requirement for any significant assistance. If newborns require assistance, the majority of the time respiratory support is all that is required. In some instances, however, there are circulatory emergencies that need to be rapidly identified or there may be dire consequences including death in the delivery room. This chapter will review various pathologies that are circulatory emergencies, and discuss how to assess them. We will also review new technologies which may help providers better understand the circulatory status or hemodynamic changes in the delivery room including heart rate, cardiac output, cerebral oxygenation and echocardiography.
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Affiliation(s)
- Anup C Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, 3003 Health Center Dr., San Diego, CA 92123, USA.
| | - Wade D Rich
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, 3003 Health Center Dr., San Diego, CA 92123, USA.
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2
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Jhaveri S, Komarlu R. Prenatal diagnosis of right-sided cervical aortic arch with aberrant left subclavian artery and absent ductus arteriosus in tetralogy of Fallot. Ultrasound Obstet Gynecol 2019; 54:414-416. [PMID: 30338597 DOI: 10.1002/uog.20151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/03/2018] [Accepted: 10/08/2018] [Indexed: 06/08/2023]
Affiliation(s)
- S Jhaveri
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - R Komarlu
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, USA
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3
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Rizza A, De Caterina AR, Murzi M, Farneti PA, Palmieri C, Berti S. Double Carotid-Subclavian Bypass Followed by Endovascular Exclusion of a Kommerell Diverticulum and Bilateral Subclavian Artery Occlusion in a Right-Sided Aortic Arch. JACC Cardiovasc Interv 2019; 12:e81-e82. [PMID: 30981575 DOI: 10.1016/j.jcin.2019.01.221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/02/2019] [Accepted: 01/08/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Antonio Rizza
- Ospedale del Cuore, Fondazione Toscana "G. Monasterio," Massa, Italy
| | | | - Michele Murzi
- Ospedale del Cuore, Fondazione Toscana "G. Monasterio," Massa, Italy
| | | | - Cataldo Palmieri
- Ospedale del Cuore, Fondazione Toscana "G. Monasterio," Massa, Italy
| | - Sergio Berti
- Ospedale del Cuore, Fondazione Toscana "G. Monasterio," Massa, Italy
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Gil B, Anastasova S, Yang GZ. A Smart Wireless Ear-Worn Device for Cardiovascular and Sweat Parameter Monitoring During Physical Exercise: Design and Performance Results. Sensors (Basel) 2019; 19:s19071616. [PMID: 30987280 PMCID: PMC6480663 DOI: 10.3390/s19071616] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/25/2019] [Accepted: 03/30/2019] [Indexed: 11/27/2022]
Abstract
Wearable biomedical technology has gained much support lately as devices have become more affordable to the general public and they can easily interact with mobile phones and other platforms. The feasibility and accuracy of the data generated by these devices so as to replace the standard medical methods in use today is still under scrutiny. In this paper, we present an ear-worn device to measure cardiovascular and sweat parameters during physical exercise. ECG bipolar recordings capture the electric potential around both ears, whereas sweat rate is estimated by the impedance method over one segment of tissue closer to the left ear, complemented by the measurement of the lactate and pH levels using amperiometric and potentiometric sensors, respectively. Together with head acceleration, the acquired data is sent to a mobile phone via BLE, enabling extended periods of signal recording. Results obtained by the device have shown a SNR level of 18 dB for the ECG signal recorded around the ears, a THD value of −20.46 dB for the excitation signal involved in impedance measurements, sweat conductivity of 0.08 S/m at 1 kHz and sensitivities of 50 mV/pH and 0.8 μA/mM for the pH and lactate acquisition channels, respectively. Testing of the device was performed in human subjects during indoors cycling with characteristic level changes.
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Affiliation(s)
- Bruno Gil
- The Hamlyn Centre, Imperial College London, London SW7 2AZ, UK.
| | | | - Guang Z Yang
- The Hamlyn Centre, Imperial College London, London SW7 2AZ, UK.
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5
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Luiting S, Jansen S, Seppälä LJ, Daams JG, van der Velde N. Effectiveness of Cardiovascular Evaluations and Interventions on Fall Risk: A Scoping Review. J Nutr Health Aging 2019; 23:330-337. [PMID: 30932131 PMCID: PMC6507528 DOI: 10.1007/s12603-019-1165-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/12/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Cardiovascular abnormalities are consistently associated with fall risk in older people. However, little research has been done to assess the effect of cardiovascular interventions on fall risk. The aim of this scoping review is to explore the current literature on the effectiveness of cardiovascular evaluations and interventions in reducing fall risk in older people. DESIGN Scoping review. DATA SOURCES Medline, Cochrane Library, and WHO ICTRP Search Portal were systematically searched. SELECTION CRITERIA Randomized controlled trials (RCTs) and intervention studies of community-dwelling adults aged ≥50 years or with a mean age of >60 years that assessed the effect of a cardiovascular assessment and interventions in reducing fall risk. Key search concepts were "falls" and "aged", and terms for different cardiovascular evaluations and interventions were included. The Cochrane Checklist for risk of bias and the ROBINS-I tool were used to assess the quality of the studies. RESULTS Seven studies were included. The majority showed a reduction in falls after cardiovascular evaluation and intervention. Two out of four studies that focused on carotid sinus hypersensitivity (CSH) as a modifiable cardiovascular risk factor for falls, showed a significant reduction in falls after pacemaker implantation. Two studies that looked at sinus node dysfunction (SND) both showed a significant reduction in falls after pacemaker implantation. One study showed that 33% of the patients experienced a fall after cardiovascular evaluation and intervention, whereas all patients fell before assessment. CONCLUSIONS The majority of the included studies showed a reduction in falls after the intervention. However, the number of published papers regarding the effect of cardiovascular assessment and interventions on falls is small. A standardized assessment of cardiovascular risk factors may be essential in preventing falls in older adults and could consequently reduce injuries, loss of quality of life, deaths, and fall-related expenditures.
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Affiliation(s)
- S Luiting
- Nathalie van der Velde, PhD, Amsterdam University Medical Center, Department of Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam 1105AZ, the Netherlands, Tel. nr: +31 20-5665991, e-mail:
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6
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Dai W, Zhang Z, Zhao S. Baseline levels of serum high sensitivity C reactive protein and lipids in predicting the residual risk of cardiovascular events in Chinese population with stable coronary artery disease: a prospective cohort study. Lipids Health Dis 2018; 17:273. [PMID: 30509306 PMCID: PMC6278046 DOI: 10.1186/s12944-018-0923-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 08/29/2018] [Accepted: 11/21/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The contributions of inflammation, triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) to the residual risk of cardiovascular events have not been determined in a large cohort of Chinese population before. This study was aimed to investigate the association of serum levels of high sensitive C reactive protein (hs-CRP), TG and HDL-C with the residual risk of cardiovascular events in patients with stable coronary artery disease (CAD). METHODS We enrolled 4090 patients with stable CAD from 13 hospitals in China. All participants received optimal medical treatment (OMT) for stable CAD suggested by guidelines and were followed. The endpoint measures were the first occurrence of a major adverse cardiovascular event (MACE), defined as cardiovascular death, non-fatal myocardial infarction, non-fatal stroke or unplanned coronary revascularization. Cox proportional regression analysis was conducted to identify independent predictors of MACE. RESULTS We found that hs-CRP and HDL-C levels were associated with coronary lesion severity at baseline (both p < 0.001). After 3 months OMT, 91.2% (3730/4090) patients achieved the therapeutic goal for low density lipoprotein cholesterol (LDL-C) (< 1.8 mmoL/L). During a mean follow-up period of 39.5 months, 11.5% (471/4090) patients suffered MACE. In multivariate Cox proportional regression analysis, the hazard ratio for MACE was 1.17 (95% confidence interval: 1.07-1.28, p < 0.001) per standardized deviation in the log-transformed hs-CRP levels after adjustment for other traditional cardiovascular risk factors. However, baseline TG and HDL-C levels were not associated with MACE in this study. CONCLUSIONS Baseline hs-CRP level was an independent predictor of residual risk of cardiovascular events in Chinese population with stable CAD. However, TG and HDL-C levels were not associated with MACE.
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Affiliation(s)
- Wen Dai
- Department of Cardiology, The Second Xiangya Hospital, Central South University, No. 139, Middle Renmin Road, Changsha, 410011 China
| | - Ziyu Zhang
- Department of Cardiology, The Second Xiangya Hospital, Central South University, No. 139, Middle Renmin Road, Changsha, 410011 China
| | - Shuiping Zhao
- Department of Cardiology, The Second Xiangya Hospital, Central South University, No. 139, Middle Renmin Road, Changsha, 410011 China
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Liu N, Schoch K, Luo X, Pena LDM, Bhavana VH, Kukolich MK, Stringer S, Powis Z, Radtke K, Mroske C, Deak KL, McDonald MT, McConkie-Rosell A, Markert ML, Kranz PG, Stong N, Need AC, Bick D, Amaral MD, Worthey EA, Levy S, Wangler MF, Bellen HJ, Shashi V, Yamamoto S. Functional variants in TBX2 are associated with a syndromic cardiovascular and skeletal developmental disorder. Hum Mol Genet 2018; 27:2454-2465. [PMID: 29726930 PMCID: PMC6030957 DOI: 10.1093/hmg/ddy146] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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: 03/07/2018] [Revised: 04/07/2018] [Accepted: 04/16/2018] [Indexed: 12/15/2022] Open
Abstract
The 17 genes of the T-box family are transcriptional regulators that are involved in all stages of embryonic development, including craniofacial, brain, heart, skeleton and immune system. Malformation syndromes have been linked to many of the T-box genes. For example, haploinsufficiency of TBX1 is responsible for many structural malformations in DiGeorge syndrome caused by a chromosome 22q11.2 deletion. We report four individuals with an overlapping spectrum of craniofacial dysmorphisms, cardiac anomalies, skeletal malformations, immune deficiency, endocrine abnormalities and developmental impairments, reminiscent of DiGeorge syndrome, who are heterozygotes for TBX2 variants. The p.R20Q variant is shared by three affected family members in an autosomal dominant manner; the fourth unrelated individual has a de novo p.R305H mutation. Bioinformatics analyses indicate that these variants are rare and predict them to be damaging. In vitro transcriptional assays in cultured cells show that both variants result in reduced transcriptional repressor activity of TBX2. We also show that the variants result in reduced protein levels of TBX2. Heterologous over-expression studies in Drosophila demonstrate that both p.R20Q and p.R305H function as partial loss-of-function alleles. Hence, these and other data suggest that TBX2 is a novel candidate gene for a new multisystem malformation disorder.
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Affiliation(s)
- Ning Liu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Kelly Schoch
- Division of Medical Genetics, Department of Pediatrics, Duke Health, Durham, NC, USA
| | - Xi Luo
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Loren D M Pena
- Division of Medical Genetics, Department of Pediatrics, Duke Health, Durham, NC, USA
| | | | - Mary K Kukolich
- Department of Genetics, Cook Children’s Hospital, Fort Worth, TX, USA
| | - Sarah Stringer
- Department of Genetics, Cook Children’s Hospital, Fort Worth, TX, USA
| | - Zöe Powis
- Clinical Genomics, Ambry Genetics, Aliso Viejo, CA, USA
| | - Kelly Radtke
- Clinical Genomics, Ambry Genetics, Aliso Viejo, CA, USA
| | | | - Kristen L Deak
- Department of Pathology, Duke University, Durham, NC, USA
| | - Marie T McDonald
- Division of Medical Genetics, Department of Pediatrics, Duke Health, Durham, NC, USA
| | - Allyn McConkie-Rosell
- Division of Medical Genetics, Department of Pediatrics, Duke Health, Durham, NC, USA
| | - M Louise Markert
- Division of Allergy and Immunology, Department of Pediatrics, Duke Health, Durham, NC, USA
| | - Peter G Kranz
- Division of Neuroradiology, Department of Radiology, Duke Health, Durham, NC, USA
| | - Nicholas Stong
- Institute for Genomic Medicine, Columbia University, New York, NY, USA
| | - Anna C Need
- Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK
| | - David Bick
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
| | | | | | - Shawn Levy
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
| | | | - Michael F Wangler
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX, USA
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX, USA
| | - Hugo J Bellen
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX, USA
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Howard Hughes Medical Institute, Houston, TX, USA
| | - Vandana Shashi
- Division of Medical Genetics, Department of Pediatrics, Duke Health, Durham, NC, USA
| | - Shinya Yamamoto
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX, USA
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
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8
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Hai Z, Maohua W, Guangrui S. Successful endovascular repair of symptomatic aberrant left subclavian artery arising from Kommerell diverticulum with the chimney technique. J Thorac Cardiovasc Surg 2016; 153:806-808. [PMID: 27838007 DOI: 10.1016/j.jtcvs.2016.09.070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/13/2016] [Accepted: 09/26/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Zhong Hai
- Department of Radiology, Second Hospital of Shandong University, Jinan, Shandong, China
| | - Wang Maohua
- Department of Vascular Surgery, Shandong Provincial Hospital, Jinan, Shandong, China
| | - Shao Guangrui
- Department of Radiology, Second Hospital of Shandong University, Jinan, Shandong, China.
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Roy NM, Ochs J, Zambrzycka E, Anderson A. Glyphosate induces cardiovascular toxicity in Danio rerio. Environ Toxicol Pharmacol 2016; 46:292-300. [PMID: 27525560 DOI: 10.1016/j.etap.2016.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/10/2016] [Indexed: 06/06/2023]
Abstract
Glyphosate is a broad spectrum herbicide used aggressively in agricultural practices as well as home garden care. Although labeled "safe" by the chemical industry, doses tested by industry do not mimic chronic exposures to sublethal doses that organisms in the environment are exposed to over long periods of time. Given the widespread uses of and exposure to glyphosate, studies on developmental toxicity are needed. Here we utilize the zebrafish vertebrate model system to study early effects of glyphosate on the developing heart. Treatment by embryo soaking with 50μg/ml glyphosate starting at gastrulation results in structural abnormalities in the atrium and ventricle, irregular heart looping, situs inversus as well as decreased heartbeats by 48h as determined by live imaging and immunohistochemistry. Vasculature in the body was also affected as determined using fli-1 transgenic embryos. To determine if the effects noted at 48h post fertilization are due to early stage alterations in myocardial precursors, we also investigate cardiomyocyte development with a Mef2 antibody and by mef2ca in situ hybridization and find alterations in the Mef2/mef2ca staining patterns during early cardiac patterning stages. We conclude that glyphosate is developmentally toxic to the zebrafish heart.
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Affiliation(s)
- Nicole M Roy
- Department of Biology, Sacred Heart University, Fairfield, CT, United States.
| | - Jeremy Ochs
- Department of Biology, Sacred Heart University, Fairfield, CT, United States
| | - Ewelina Zambrzycka
- Department of Biology, Sacred Heart University, Fairfield, CT, United States
| | - Ariann Anderson
- Department of Biology, Sacred Heart University, Fairfield, CT, United States
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Schelleman H, Bilker WB, Kimmel SE, Daniel GW, Newcomb C, Guevara JP, Cziraky MJ, Strom BL, Hennessy S. Amphetamines, atomoxetine and the risk of serious cardiovascular events in adults. PLoS One 2013; 8:e52991. [PMID: 23382829 PMCID: PMC3559703 DOI: 10.1371/journal.pone.0052991] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [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: 08/05/2012] [Accepted: 11/22/2012] [Indexed: 11/23/2022] Open
Abstract
Main Objective To compare the incidence rates of serious cardiovascular events in adult initiators of amphetamines or atomoxetine to rates in non-users. Methods This was a retrospective cohort study of new amphetamines (n = 38,586) or atomoxetine (n = 20,995) users. Each medication user was matched to up to four non-users on age, gender, data source, and state (n = 238,183). The following events were primary outcomes of interest 1) sudden death or ventricular arrhythmia, 2) stroke, 3) myocardial infarction, 4) a composite endpoint of stroke or myocardial infarction. Cox proportional hazard regression was used to calculate propensity-adjusted hazard ratios for amphetamines versus matched non-users and atomoxetine versus matched non-users, with intracluster dependence within matched sets accounted for using a robust sandwich estimator. Results The propensity-score adjusted hazard ratio for amphetamines use versus non-use was 1.18 (95% CI: 0.55–2.54) for sudden death/ventricular arrhythmia, 0.80 (95% CI: 0.44–1.47) for stroke, 0.75 (95% CI: 0.42–1.35) for myocardial infarction, and 0.78 (95% CI: 0.51–1.19) for stroke/myocardial infarction. The propensity-score adjusted hazard ratio for atomoxetine use versus non-use was 0.41 (95% CI: 0.10–1.75) for sudden death/ventricular arrhythmia, 1.30 (95% CI: 0.52–3.29) for stroke, 0.56 (95% CI: 0.16–2.00) for myocardial infarction, and 0.92 (95% CI: 0.44–1.92) for stroke/myocardial infarction. Conclusions Initiation of amphetamines or atomoxetine was not associated with an elevated risk of serious cardiovascular events. However, some of the confidence intervals do not exclude modest elevated risks, e.g. for sudden death/ventricular arrhythmia.
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Affiliation(s)
- Hedi Schelleman
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics & Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Warren B. Bilker
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics & Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Pharmacoepidemiololgy Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Stephen E. Kimmel
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics & Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Pharmacoepidemiololgy Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Therapeutic Effectiveness Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Gregory W. Daniel
- Engelberg Center for Health Care Reform, The Brookings Institution, Washington, District of Columbia, United States of America
| | - Craig Newcomb
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics & Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - James P. Guevara
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics & Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Pharmacoepidemiololgy Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- PolicyLab: Center to Bridge Research, Practice, and Policy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Mark J. Cziraky
- HealthCore, Inc., Wilmington, Delaware, United States of America
| | - Brian L. Strom
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics & Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Pharmacoepidemiololgy Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Therapeutic Effectiveness Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Sean Hennessy
- Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics & Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Pharmacoepidemiololgy Research and Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Center for Therapeutic Effectiveness Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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11
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Menke A, Muntner P, Fernández-Real JM, Guallar E. The association of biomarkers of iron status with mortality in US adults. Nutr Metab Cardiovasc Dis 2012; 22:734-740. [PMID: 21330119 PMCID: PMC3138865 DOI: 10.1016/j.numecd.2010.11.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [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: 05/31/2010] [Revised: 10/27/2010] [Accepted: 11/25/2010] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Elevated iron biomarkers are associated with diabetes and other cardiometabolic abnormalities in the general population. It is unclear whether they are associated with an increased risk of all-cause or cause-specific mortality. The purpose of the current analysis was to evaluate the association of ferritin and transferrin saturation levels with all-cause, cardiovascular, and cancer mortality in the general US adult population. METHODS AND RESULTS A prospective cohort study was conducted with 12,258 adults participating in the Third National Health and Nutrition Examination Survey (NHANES III), a nationally representative sample of the US population. Study participants were recruited in 1988-1994 and followed through December 31, 2006 for all-cause, cardiovascular disease, and cancer mortality. The multivariable-adjusted hazard ratios (95% confidence interval) for all-cause mortality comparing the fourth versus the second quartiles of ferritin and transferrin saturation were 1.09 (0.82-1.44; p-trend across quartiles = 0.92) and 1.08 (0.82-1.43; p-trend across quartiles = 0.62), respectively, for men, 1.43 (0.63-3.23; p-trend across quartiles = 0.31) and 1.48 (0.70-3.11; p-trend across quartiles = 0.60), respectively, for premenopausal women, and 1.03 (0.79-1.34; p-trend across quartiles = 0.95) and 1.17 (0.92-1.49; p-trend across quartiles = 0.63), respectively, for postmenopausal women. Quartile of ferritin and transferrin saturation also showed no association between biomarkers of iron status and mortality. CONCLUSIONS In a large nationally representative sample of US adults, within the spectrum of normal iron metabolism, ferritin and transferrin saturation were not associated with risk of mortality among people who were not taking iron supplements and did not have a baseline history of cardiovascular disease or cancer.
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Affiliation(s)
- A Menke
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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12
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Radak D, Tanaskovic S, Sagic D, Antonic Z, Kolar J. A case of extrinsic chronic cerebrospinal venous insufficiency in a patient with multiple sclerosis. Ann Vasc Surg 2012; 26:419.e5-6. [PMID: 22321478 DOI: 10.1016/j.avsg.2011.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 09/15/2010] [Revised: 10/16/2010] [Accepted: 08/25/2011] [Indexed: 11/19/2022]
Abstract
We aim to present a very rare case of chronic cerebrospinal venous insufficiency due to both brachiocephalic vein obstruction by aberrant right subclavian artery and internal jugular vein distal compression by first cervical vertebra transverse process, demonstrated by multislice computerized tomography in a patient with multiple sclerosis.
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Affiliation(s)
- Djordje Radak
- Department of Vascular Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia.
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13
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Gupta G, Singh K, Chhabra S, Gupta V, Kayalvizhi I. Bilateral superficial ulnar artery with high origin from the axillary artery: its anatomy and clinical significance. Folia Morphol (Warsz) 2012; 71:48-51. [PMID: 22532186] [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
The superficial ulnar artery (SUA) is a rare anatomical variant that usually arises either in the axilla or the arm and runs a superficial course in the forearm, enters the hand, and participates in the formation of superficial palmar arch. During the routine dissection of cadavers in the department of anatomy, whilst preparing the specimen for medical students, an unusual bilateral branch of the axillary artery was found in one of the cadavers: a rare variant of the artery known as SUA, which originates from the 2nd part of the axillary arteries of both sides. The SUA is a known anatomical variant, but the bilateral high origin from the 2nd part of the axillary artery is extremely unusual. Its occurrence is of great clinical importance to the surgical and radiological departments.
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Affiliation(s)
- G Gupta
- Department of Anatomy, Pt. B.D. Sharma PGIMS, Haryana, India.
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González-Panizo-Tamargo F, Juzgado-Lucas D, Vázquez-Sequeiros E. Endosonographic diagnosis of aberrant right subclavian artery that leads to disphagia lusoria. Rev Esp Enferm Dig 2011; 103:497-498. [PMID: 21951124 DOI: 10.4321/s1130-01082011000900014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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15
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Magalski A, McCoy M, Zabel M, Magee LM, Goeke J, Main ML, Bunten L, Reid KJ, Ramza BM. Cardiovascular screening with electrocardiography and echocardiography in collegiate athletes. Am J Med 2011; 124:511-8. [PMID: 21605728 DOI: 10.1016/j.amjmed.2011.01.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 12/21/2010] [Accepted: 01/11/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Current guidelines for preparticipation screening of competitive athletes in the US include a comprehensive history and physical examination. The objective of this study was to determine the incremental value of electrocardiography and echocardiography added to a screening program consisting of history and physical examination in college athletes. METHODS Competitive collegiate athletes at a single university underwent prospective collection of medical history, physical examination, 12-lead electrocardiography, and 2-dimensional echocardiography. Electrocardiograms (ECGs) were classified as normal, mildly abnormal, or distinctly abnormal according to previously published criteria. Eligibility for competition was determined using criteria from the 36(th) Bethesda Conference on Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities. RESULTS In 964 consecutive athletes, ECGs were classified as abnormal in 334 (35%), of which 95 (10%) were distinctly abnormal. Distinct ECG abnormalities were more common in men than women (15% vs 6%, P<.001) as well as black compared with white athletes (18% vs 8%, P<.001). Echocardiographic and electrocardiographic findings initially resulted in exclusion of 9 athletes from competition, including 1 for long QT syndrome and 1 for aortic root dilatation; 7 athletes with Wolff-Parkinson-White patterns were ultimately cleared for participation. (Four received further evaluation and treatment, and 3 were determined to not need treatment.) After multivariable adjustment, black race was a statistically significant predictor of distinctly abnormal ECGs (relative risk 1.82, 95% confidence interval, 1.22-2.73; P=.01). CONCLUSIONS Distinctly abnormal ECGs were found in 10% of athletes and were most common in black men. Noninvasive screening using both electrocardiography and echocardiography resulted in identification of 9 athletes with important cardiovascular conditions, 2 of whom were excluded from competition. These findings offer a framework for performing preparticipation screening for competitive collegiate athletes.
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Affiliation(s)
- Anthony Magalski
- Saint Luke's Mid America Heart and Vascular Institute, Kansas City, MO 64111, USA.
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16
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Iimura A, Oguchi T, Shibata M, Matsuo M, Takahashi T. Double superior vena cava and anomaly of cardiovascular system with a review of the literature. Okajimas Folia Anat Jpn 2011; 88:37-42. [PMID: 21882595 DOI: 10.2535/ofaj.88.37] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In a student course of gross anatomy dissection at Kanagawa Dental College in 2008, we found an extremely rare case of the double superior vena cava that has a shunt between the right and left atria of a 81-year-old Japanese male cadaver. The left superior vena cava passed through the space between the left cardiac auricle and the left pulmonary vein and entered the coronary sulcus. Then it opened near the opening of the inferior vena cava as the coronary venous sinus to the right atrium. The upper edge of the interatrial septum was located at the site where the right superior vena cava opened to the right atrium. Accordingly, the right atrium connected with left atrium through this site. We discuss the anatomy and etiology of these anomalous structures with a brief review of the literature.
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Affiliation(s)
- Akira Iimura
- Department of Anatomy, Kanagawa Dental College, 82 Inaoka, Yokosuka, Kanagawa 238-8580, Japan.
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17
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Gurgacz AM, Horbaczewska A, Klimek-Piotrowska W, Walocha J. Variations in hepatic vascularisation: lack of a proper hepatic artery. Two case reports. Folia Morphol (Warsz) 2011; 70:130-134. [PMID: 21630235] [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
The blood supply of the liver and other abdominal organs plays a significant role during abdominal surgery. Knowledge of the most common patterns of vascularisation should be broadened and new anomalies of the celiac trunk and its branches dutifully reported. This paper presents two case reports which describe the lack of a proper hepatic artery. Case 1 describes the cadaver of a 64-year-old female in whom the right hepatic artery was observed to arise from the common hepatic artery and run behind the portal vein. The common hepatic artery was observed to be divided into three terminal vessels: the left hepatic artery, the gastroduodenal artery, and the right gastric artery. Case 2 describes the cadaver of a 75-year-old male with a liver that was supplied from 3 different sources: the left hepatic artery from the left gastric artery (which arose directly from the aorta), the right hepatic artery from the superior mesenteric artery, and the middle hepatic artery from the common hepatic artery - (branch of the hepato-splenic trunk). Moreover, the left inferior phrenic artery arose from the left hepatic artery.
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Affiliation(s)
- A M Gurgacz
- Department of Anatomy, Collegium Medicum, Jagiellonian University, Kraków, Poland
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18
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Khaki AA, Shoja MAM, Khaki A. A rare case report of subscapular artery. Ital J Anat Embryol 2011; 116:56-59. [PMID: 21898975] [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: 05/31/2023]
Abstract
Axillary artery is one of the most important arteries of the upper limb, which is a continua- tion of the subclavian artery. It begins at the lateral border of the first rib and ends at the inferior border of the teres major where it becomes the brachial artery. Axillary artery has six important branches included: 1) Superior thoracic artery 2) Thoracoacromial artery 3) Lateral thoracic artery 4) Subscapular artery 5) Posterior circumflex humeral artery 6) Anterior circumflex humeral artery. Subscapular artery arises from the third part of axillary artery normally and then divides into cir- cumflex scapular artery that extremely enters the triangular space. The other branch of subscapular artery, the thoracodorsal artery, accompanies thracodorsal nerve to lateral border of scapula and supplies and innervates that region. In this case the subscapular artery was absent in both sides and instead of that the circumflex scapular artery was directly derived from axillary artery and the thoracodorsal artery is separated from circumflex scapular artery as a thin and short branch, too. It seemed that the lateral thoracic artery, which was thicker than its normal condition, supplied the muscles of the lateral part of scapula and the thoracodorsal muscle. Other branches of the axillary artery demonstrated without any abnormally. Since axillary artery has the highest rate of rapture and damage coming after the popliteal artery, knowing the variations is important and essential for surgeons, radiologist and anatomist.
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Affiliation(s)
- Amir Afshin Khaki
- Department of Anatomy, Tabriz University of Medical Sciences and National Health Management Center [NPMC], Tabriz, Iran.
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Belov YV, Abugov SA, Komarov RN, Puretskiĭ MV, Stepanenko AB, Stogniĭ NY, Magamadov YU. Hybrid surgical management of a patient with an aneurysm of the arch and descending portion of the right-sided aorta combined with type B dissection and decompensated tracheal stenosis. Angiol Sosud Khir 2011; 17:131-141. [PMID: 22616242] [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: 06/01/2023]
Abstract
The right-sided aorta is a rare congenital abnormality of the cardiovascular system encountered in 0.05-0.1% of cases during roentgenological examinations and in 0.04-0.1% of cases of autopsy series. Given utterly low prevalence of this pathology, we considered it wise to present herein our own case report dealing with hybrid surgical management of a patient suffering from an aneurysm of both the arch and descending portion of the right-sided aorta combined with type B dissection thereof and decompensated tracheal stenosis. The first stage of the operation consisted in prosthetic repair of the distal third of the arch and the descending portion of the aorta with the "Vascutek" stent graft 20 mm with type 1 haemodynamical correction (i. e., re-establishing the blood flow into the true channel in the zone of the distal anastomosis) in the conditions of extracorporeal circulation (EC) and bihemispheric antegrade cerebral perfusion ACP, followed by replantation of the left subclavian artery ostium into the left common carotid artery. An aneurysmal growth rate of more than 1 cm a year was considered an absolute indication for the second stage of correction of the aortic pathology concerned. The second stage included stenting of the thoracic portion of the aorta. The TF262C150X Valiant thoracic stent graft was implanted into the area of the distal anastomosis with a conduit, followed by positioning the TF 323C150X Valiant thoracic system inserted into the distal end of the first stent. The use of hybrid techniques (a combination of open and endovascular interventions) predetermined the success of surgical management of the patient presenting with dissection of the right-sided aorta.
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Affiliation(s)
- Yu V Belov
- Department of Surgery of the Aorta and its Branches, of the Municipal Clinical Hospital, SP Botkin, Moscow, Russia
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20
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Choudhry PK, Pandey R, Deshpande SB. 2-Deoxy-D-glucose reverses the Indian red scorpion venom-induced cardiopulmonary abnormalities in anesthetized rats. Indian J Exp Biol 2011; 49:16-23. [PMID: 21365991] [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
Role of 2-Deoxy-D-glucose (2-DG) in reversing the Indian red scorpion (Mesobuthus tamulus concanesis Pocock, MBT) venom-induced toxicity was examined. Femoral arterial pressure, ECG and respiratory movements were recorded in urethane anesthetized rats. Plasma glucose and serum insulin levels were also estimated. Intravenous injection of 5 mg/kg MBT venom produced immediate decrease in mean arterial pressure, heart rate and respiratory frequency followed by an increase and subsequent progressive decrease. ECG pattern exhibited ischaemic changes. There was hyperinsulinemia after venom without corresponding decrease in plasma glucose. The animals died within 37 +/- 9 min and demonstrated significant increase in pulmonary water content. 2-DG pretreatment (0.5 g/kg, iv) improved the cardiopulmonary abnormalities induced by venom and the animals survived for nearly 120 min. There was no hyperinsulinemia and increased pulmonary water content in these animals. In insulin (2 IU/kg) treated rats, the MBT venom-induced cardiopulmonary abnormalities were attenuated and ECG abnormalities were reversed. The pulmonary water content in these animals exhibited a decreasing trend and the animals survived for 120 min. Repaglinide (10 microg/kg, iv) pretreatment failed to reverse the venom-induced cardiopulmonary changes including the increased pulmonary water content. The survival time was similar to venom only group. The present results reveal that 2-DG reverses the venom-induced cardiopulmonary toxicity probably by restoring insulin sensitivity.
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Affiliation(s)
- P K Choudhry
- Department of Physiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221 005, India
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Oguanobi NI, Onwubere BJC, Ike SO, Anisiuba BC, Ejim EC, Ibegbulam OG. Electocardiographic findings in adult Nigerians with sickle cell anaemia. Afr Health Sci 2010; 10:235-241. [PMID: 21327134 PMCID: PMC3035954] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Cardiovascular system abnormalities are common causes of morbidity and mortality in sickle cell anaemia. OBJECTIVES The study aims at determining the pattern of electrocardiographic changes in adult Nigerian sickle cell anaemia patients. METHODS A descriptive cross sectional study was done on sixty sickle cell anaemia patients seen at the adult sickle cell clinic of University of Nigeria Teaching Hospital (UNTH) Enugu, and sixty age and sex matched normal controls. All the subjects had clinical evaluation as well as electrocardiographic examination. RESULTS The mean heart rate, P-wave duration, P-wave dispersion, PR interval, QRS duration, QRS dispersion, QTc interval and QTc dispersion were significantly higher in the patients than in the control group. Electrocardiographic abnormalities identified by this study were: left ventricular hypertrophy (75%; 1.7%), left atrial enlargement (40%; 0%), biventricular hypertrophy (11%; 0), ST-segment elevation (10%; 0%) and increased P-wave and QTc dispersions. ST segment elevation was found more in patients with moderate and severe anaemia (P= 0.02, Spearman correlation r= 0.342; P= 0.007), CONCLUSION Sickle cell anaemia is associated with significant electrocardiographic abnormalities. Further prospective studies are recommended to evaluate the prognostic significance of the electrocardiographic intervals dispersion on the long term disease outcome in sickle cell anaemia.
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Affiliation(s)
- N I Oguanobi
- Department of Medicine, University of Nigeria Teaching Hospital Enugu, Nigeria.
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Nagareddy PR, McNeill JH, MacLeod KM. Chronic inhibition of inducible nitric oxide synthase ameliorates cardiovascular abnormalities in streptozotocin diabetic rats. Eur J Pharmacol 2009; 611:53-9. [PMID: 19344709 DOI: 10.1016/j.ejphar.2009.03.061] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [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: 11/13/2008] [Revised: 03/11/2009] [Accepted: 03/23/2009] [Indexed: 02/05/2023]
Abstract
Previous studies from our lab have demonstrated cardiovascular abnormalities such as depressed mean arterial blood pressure and heart rate, endothelial dysfunction and attenuated pressor responses to vasoactive agents in streptozotocin diabetic rats. We investigated whether these abnormalities are due to diabetes-associated chronic activation of inducible nitric oxide synthase (iNOS). Control and streptozotocin (60 mg/kg, iv) diabetic rats were treated with either vehicle or N6-(1-Iminoethyl)-L-lysine dihydrochloride (L-NIL, 3 mg/kg/day, p.o), a specific inhibitor of iNOS for 8 weeks. At the end of treatment, the mean arterial blood pressure and heart rate were measured in freely moving conscious rats. Further, pressor responses to bolus doses of methoxamine were determined. Endothelial nitric oxide synthase (eNOS) and iNOS expression as well as nitrotyrosine (NT) levels were assessed in the heart and superior mesenteric arteries by western blot and immunohistochemistry. Untreated diabetic rats showed depressed mean arterial blood pressure and heart rate and exhibited vascular hyporeactivity that were significantly improved by treatment with L-NIL. Further, decreased eNOS expression and increased iNOS expression and activity were associated with increased NT levels in the heart and superior mesenteric arteries of untreated diabetic rats. L-NIL treatment of diabetic rats normalized the expression of eNOS and NT levels without any effect on iNOS expression in the heart and superior mesenteric arteries. The results of our study suggest that induction of iNOS in cardiovascular tissues contributes significantly to the depressed mean arterial blood pressure, heart rate and pressor responses to vasoactive agents. Chronic inhibition of iNOS in diabetes may prove beneficial in the treatment of cardiovascular abnormalities.
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Hartley CJ, Reddy AK, Michael LH, Entman ML, Taffet GE. Coronary flow reserve as an index of cardiac function in mice with cardiovascular abnormalities. Annu Int Conf IEEE Eng Med Biol Soc 2009; 2009:1094-1097. [PMID: 19963485 PMCID: PMC3341618 DOI: 10.1109/iembs.2009.5332488] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Mice are now commonly used as models of human cardiovascular diseases and conditions, but it is challenging to measure blood flow velocity in small vessels such as coronary arteries. Accordingly, we have developed a method using a 2 mm diameter 20 MHz pulsed Doppler probe applied to the chest of anesthetized mice to measure left main coronary blood flow velocity noninvasively. We also found that coronary flow velocity could be increased from baseline (B) to hyperemic (H) levels by changing the concentration of isoflurane gas anesthesia from 1% to 2.5% in oxygen. We used the ratio B/H to estimate coronary flow reserve (CFR) in young, adult, and old mice and in mice with obesity, atherosclerosis, pressure overload hypertrophy, and coronary artery occlusion. We found that B/H increases with age from 2.4 (young) to 3.6 (old) and is decreased to as low as 1.1 by all forms of heart and vascular disease studied. We conclude that CFR can be measured noninvasively and serially in mice as their cardiovascular systems adapt and remodel to various imposed or natural conditions, and that coronary flow reserve may be a good index of overall cardiac function in mice and potentially in man.
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Affiliation(s)
- Craig J Hartley
- Department of Medicine, Section of Cardiovascular Sciences, Baylor College of Medicine and The Methodist DeBakey Heart & Vascular Center, Houston, TX 77030, USA.
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Zani A, Morini F, Paolantonio P, Cozzi DA. Not all symptoms disappear after vascular ring division: a pathophysiological interpretation. Pediatr Cardiol 2008; 29:676-8. [PMID: 17851633 DOI: 10.1007/s00246-007-9041-y] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 06/18/2007] [Indexed: 11/28/2022]
Abstract
Vascular rings are a group of cardiovascular lesions due to faulty embryological development derived from an abnormality of neural crest cells (cephalic neurocristopathy). In addition to peculiar symptoms due to compression on the trachea and/or the esophagus, patients with vascular rings might present further features of neural crest-related defects. We report on a case of a child with complete vascular ring, affected both by compressive symptoms and by autonomic disturbances and minor facial anomalies. The autonomic disturbances are clinical features of maturational dysautonomia and tend to disappear with aging, whereas major compressive symptoms are solved by surgery.
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Affiliation(s)
- Augusto Zani
- Pediatric Surgery Unit, University of Rome La Sapienza, Rome, Italy
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Huang MR, Chen SB, Gao W, Li F, Li Y, Yang JP. [Noninvasive preoperative estimation of pulmonary vascular resistance of the patients waiting for two staged Fontan procedure]. Zhonghua Er Ke Za Zhi 2008; 46:267-271. [PMID: 19099728] [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: 05/27/2023]
Abstract
OBJECTIVE Noninvasive method for estimating the pulmonary vascular resistance (PVR) was used in patients waiting for two staged Fontan procedure to observe the relationship between estimated PVR and surgical results. METHODS Thirty-three candidate patients for two staged Fontan procedures were randomly selected for this trial. Preoperative hemoglobin (HGB), hematocrit (HCT) and pulse oxygen saturation (SpO2) were measured. Estimated PVRs were then calculated by the regression equations. The cases were divided into three groups of low risk group with PVR less than 2.4 wood, high risk group with PVR between 2.4 to 3.2 wood, and extremely high risk group with PVR more than 3.2 wood. The incidences of postoperative low cardiac output and multi-organ failure were compared. Simultaneously, the cases without or with postoperative severe low cardiac output and multi-organ failure after operation were divided into two groups. The preoperative HGB, HCT and estimated PVR among the groups were analyzed. RESULTS The rates of postoperative severe low cardiac output and multi-organ failure were 10.0%, 32.4% and 63.6% for the patients of low, high and extremely high risk groups respectively. The difference was significant (P < 0.01). The preoperative HGB, HCT, SpO2 and PVR were all significantly different between the patients without or with postoperative severe low cardiac output and multi-organ failure. The PVR (HGB) were (2.53 +/- 0.56) wood and (3.24 +/- 0.58) wood respectively. The PVR (HCT) were (2.59 +/- 0.58) wood and (3.21 +/- 0.79) wood respectively. The PVR (SpO2) were (2.22 +/- 0.55) wood and (2.93 +/- 0.58) wood, respectively. The differences were all significant (t = 3.25, 2.52 and 3.33 respectively, P < 0.01 or 0.05). CONCLUSIONS Preoperative estimated PVRs calculated by HGB, HCT and SpO2 were comparable with the postoperative results. Thus, the invasive preoperative estimation of pulmonary vascular resistance could be a method in estimating the surgical indication and predicting the surgical result for two stage Fontan procedure.
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Affiliation(s)
- Mei-rong Huang
- Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University, Shanghai 200127, China
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26
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Groenendijk BCW, Stekelenburg-de Vos S, Vennemann P, Wladimiroff JW, Nieuwstadt FTM, Lindken R, Westerweel J, Hierck BP, Ursem NTC, Poelmann RE. The Endothelin-1 Pathway and the Development of Cardiovascular Defects in the Haemodynamically Challenged Chicken Embryo. J Vasc Res 2007; 45:54-68. [PMID: 17901707 DOI: 10.1159/000109077] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [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: 03/24/2007] [Accepted: 06/03/2007] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND/AIMS Ligating the right lateral vitelline vein of chicken embryos (venous clip) results in cardiovascular malformations. These abnormalities are similar to malformations observed in knockout mice studies of components of the endothelin-1 (ET-1)/endothelin-converting enzyme-1/endothelin-A receptor pathway. In previous studies we demonstrated that cardiac ET-1 expression is decreased 3 h after clipping, and ventricular diastolic filling is disturbed after 2 days. Therefore, we hypothesise that ET-1-related processes are involved in the development of functional and morphological cardiovascular defects after venous clip. METHODS In this study, ET-1 and endothelin receptor antagonists (BQ-123, BQ-788 and PD145065) were infused into the HH18 embryonic circulation. Immediate haemodynamic effects on the embryonic heart and extra-embryonic vitelline veins were examined by Doppler and micro-particle image velocimetry. Ventricular diastolic filling characteristics were studied at HH24, followed by cardiovascular morphologic investigation (HH35). RESULTS ET-1 and its receptor antagonists induced haemodynamic effects at HH18. At HH24, a reduced diastolic ventricular passive filling component was demonstrated, which was compensated by an increased active filling component. Thinner ventricular myocardium was shown in 42% of experimental embryos. CONCLUSION We conclude that cardiovascular malformations after venous clipping arise from a combination of haemodynamic changes and altered gene expression patterns and levels, including those of the endothelin pathway.
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Affiliation(s)
- Bianca C W Groenendijk
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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Javois AJ, Patel D, Roberson D, Husayni T. Pre-existing left pulmonary artery stenosis and other anomalies associated with device occlusion of patent ductus arteriosus. Catheter Cardiovasc Interv 2007; 70:83-9. [PMID: 17420999 DOI: 10.1002/ccd.21120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A retrospective analysis was performed on 200 consecutive patients who underwent cardiac catheterization for occlusion of Patent Ductus Arteriosus (PDA) at a single center by a single operator. Four significant anomalies were observed: pre-existing Left Pulmonary Artery (LPA) stenosis, left recurrent laryngeal nerve (LRLN) injury, electrocardiogram (EKG) changes, and aorto-pulmonary (AP) collateral arteries. The observation of pre-existing LPA stenosis, marked EKG changes, and permanent LRLN injury have not been previously reported. Incidence, etiology, and clinical significance of these anomalies are discussed with specific new recommendations for the prevention of LRLN injury and occlusion of AP collaterals.
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Affiliation(s)
- Alexander J Javois
- The Heart Institute for Children, Advocate Hope Children's Hospital, Oak Lawn, IL 60453, USA.
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Abstract
During the implantation of a definitive pacemaker for complete atrioventricular block via the left subclavian vein, a rare and abnormal origin of the superior vena cava was detected. No such finding has ever been reported, leading us to adopt the contralateral approach.
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Affiliation(s)
- Franco Alberto Ferrari
- Division of Cardiology, Hospital of Rho, Azienda Sanitaria G. Salvini, Garbagnate Milanese, MI, Italy.
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Yu WC, Chuang SY, Lin YP, Chen CH. Brachial-ankle vs carotid-femoral pulse wave velocity as a determinant of cardiovascular structure and function. J Hum Hypertens 2007; 22:24-31. [PMID: 17597797 DOI: 10.1038/sj.jhh.1002259] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Carotid-femoral pulse wave velocity (cf-PWV) is a validated marker of arterial stiffening over the central arteries. Brachial-ankle pulse wave velocity (ba-PWV) integrates the mechanical properties from both the central and peripheral arteries and may be more representative than cf-PWV as arterial load for left ventricle (LV). We compared ba-PWV with cf-PWV for the association of cardiovascular structure and function in 320 subjects with various degrees of abnormality in cardiac structure and function. ba-PWV (by oscillometric technique) and cf-PWV (by tonometric technique) were measured simultaneously, and were highly correlated (r=0.79, P<0.001). Both ba-PWV and cf-PWV were significantly correlated with LV mass, but the correlation was better with ba-PWV (r=0.29 vs r=0.22, P=0.0219). While ba-PWV and cf-PWV were similarly significantly correlated with LV end-systolic elastance and mitral E/A ratio, ba-PWV had better correlation with isovolumic relaxation constant (r=0.34 vs r=0.27, P=0.0202) than cf-PWV. In addition, the correlation was also significantly stronger with ba-PWV than with cf-PWV for other indices of arterial stiffness, including carotid incremental modulus (r=0.59 vs 0.50, P=0.0013), effective arterial elastance (r=0.41 vs r=0.33, P=0.0081) and carotid augmentation index (r=0.38 vs r=0.32, P=0.0368). In conclusion, ba-PWV correlates better with LV mass and diastolic function and other indices of arterial function than cf-PWV, probably because ba-PWV encompasses a greater territory of arterial tree than cf-PWV.
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Affiliation(s)
- W-C Yu
- Department of Internal Medicine, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
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Rajagopal SK, Ma Q, Obler D, Shen J, Manichaikul A, Tomita-Mitchell A, Boardman K, Briggs C, Garg V, Srivastava D, Goldmuntz E, Broman KW, Benson DW, Smoot LB, Pu WT. Spectrum of heart disease associated with murine and human GATA4 mutation. J Mol Cell Cardiol 2007; 43:677-85. [PMID: 17643447 PMCID: PMC2573470 DOI: 10.1016/j.yjmcc.2007.06.004] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.2] [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: 05/01/2007] [Revised: 06/11/2007] [Accepted: 06/12/2007] [Indexed: 01/01/2023]
Abstract
The transcription factor GATA4 is essential for heart morphogenesis. Heterozygous mutation of GATA4 causes familial septal defects. However, the phenotypic spectrum of heterozygous GATA4 mutation is not known. In this study, we defined the cardiac phenotypes that result from heterozygous mutation of murine Gata4. We then asked if GATA4 mutation occurs in humans with these forms of congenital heart disease (CHD). In mice, heterozygous Gata4 mutation was associated with atrial and ventricular septal defect (ASD, VSD), endocardial cushion defect (ECD), RV hypoplasia, and cardiomyopathy. Genetic background strongly influenced the expression of ECD and cardiomyopathy, indicating the presence of important genetic modifiers. In humans, non-synonymous GATA4 sequence variants were associated with ECD (2/43), ASD (1/8), and RV hypoplasia in the context of double inlet left ventricle (1/9), forms of CHD that overlapped with abnormalities seen in the mouse model. These variants were not found in at least 500 control chromosomes, and encode proteins with non-conservative amino acid substitutions at phylogenetically conserved positions, suggesting that they are disease-causing mutations. Cardiomyopathy was not associated with GATA4 mutation in humans. These data establish the phenotypic spectrum of heterozygous Gata4 mutation in mice, and suggest that heterozygous GATA4 mutation leads to partially overlapping phenotypes in humans. Additional studies will be required to determine the degree to which GATA4 mutation contributes to human CHD characterized by ECD or RV hypoplasia.
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Affiliation(s)
- Satish K. Rajagopal
- Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115
| | - Qing Ma
- Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115
| | - Dita Obler
- Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115
| | - Jie Shen
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, Ohio 45229
| | - Ani Manichaikul
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, Ohio 45229
| | - Aoy Tomita-Mitchell
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, Ohio 45229
| | - Kari Boardman
- Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115
| | - Christine Briggs
- Department of Genetics, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115
| | - Vidu Garg
- Departments of Pediatrics (Cardiology) and Molecular Biology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, Texas 75390-9063
| | - Deepak Srivastava
- Departments of Pediatrics (Cardiology) and Molecular Biology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, Texas 75390-9063
| | - Elizabeth Goldmuntz
- Division of Cardiology, The Children’s Hospital of Philadelphia, Abramsom Research Center 702A, 3516 Civic Center Blvd, Philadelphia, PA 19104
| | - Karl W. Broman
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205
| | - D. Woodrow Benson
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, Ohio 45229
| | - Leslie B. Smoot
- Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115
| | - William T. Pu
- Department of Cardiology, Children’s Hospital Boston, 300 Longwood Avenue, Boston, MA 02115
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Abstract
AIM This review highlights the relevance of the neural crest (NC) as a developmental control mechanism involved in several pediatric surgical conditions and the investigative interest of following some of its known signaling pathways. METHODS The participation of the NC in facial clefts, ear defects, branchial fistulae and cysts, heart outflow tract and aortic arch anomalies, pigmentary disorders, abnormal enteric innervation, neural tumors, hemangiomas, and vascular anomalies is briefly reviewed. Then, the literature on clinical and experimental esophageal atresia-tracheoesophageal fistula (EA-TEF) and congenital diaphragmatic hernia (CDH) is reviewed for the presence of associated NC defects. Finally, some of the molecular signaling pathways involved in both conditions (sonic hedgehog, Hox genes, and retinoids) are summarized. RESULTS The association of facial, cardiovascular, thymic, parathyroid, and C-cell defects together with anomalies of extrinsic and intrinsic esophageal innervation in babies and/or animals with both EA-TEF and CDH strongly supports the hypothesis that NC is involved in the pathogenesis of these malformative clusters. On the other hand, both EA-TEF and CDH are observed in mice mutant for genes involved in the previously mentioned signaling pathways. CONCLUSIONS The investigation of NC-related molecular pathogenic pathways involved in malformative associations like EA-TEF and CDH that are induced by chromosomal anomalies, chemical teratogens, and engineered mutations is a promising way of clarifying why and how some pediatric surgical conditions occur. Pediatric surgeons should be actively involved in these investigations.
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MESH Headings
- Abnormalities, Multiple/embryology
- Abnormalities, Multiple/physiopathology
- Abnormalities, Multiple/surgery
- Blood Vessels/abnormalities
- Branchial Region/abnormalities
- Cardiovascular Abnormalities/embryology
- Cardiovascular Abnormalities/physiopathology
- Cell Lineage
- Cell Movement
- Child
- Child, Preschool
- Enteric Nervous System/abnormalities
- Esophageal Atresia/embryology
- Esophageal Atresia/physiopathology
- Esophageal Atresia/surgery
- Face/abnormalities
- Genes, Homeobox
- Hedgehog Proteins/physiology
- Hernia, Diaphragmatic/embryology
- Hernia, Diaphragmatic/physiopathology
- Hernia, Diaphragmatic/surgery
- Hernias, Diaphragmatic, Congenital
- Homeodomain Proteins/physiology
- Humans
- Infant
- Infant, Newborn
- Neoplasms/etiology
- Neural Crest/physiopathology
- Patched Receptors
- Pigmentation Disorders/etiology
- Receptors, Cell Surface/physiology
- Receptors, G-Protein-Coupled/physiology
- Receptors, Retinoic Acid/physiology
- Signal Transduction
- Smoothened Receptor
- Syndrome
- Transcription Factors/physiology
- Tretinoin/physiology
- Zinc Finger Protein GLI1
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Affiliation(s)
- Juan A Tovar
- Departamento de Cirugía Pediátrica, Hospital Universitario La Paz, 28046 Madrid, Spain.
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32
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Melek IM, Seyfeli E, Duru M, Duman T, Akgul F, Yalcin F. Autonomic dysfunction and cardiac repolarization abnormalities in patients with migraine attacks. Med Sci Monit 2007; 13:RA47-9. [PMID: 17325646] [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] [Received: 01/03/2006] [Accepted: 03/28/2006] [Indexed: 05/14/2023] Open
Abstract
The clinical symptoms of migraine are widely accepted to be related to the involvement of the autonomic nervous system, and especially to dysfunction in the regulation of the circulatory system and autonomic balance. Disturbance of the autonomic nervous system is a primary characteristic of migraine Therefore, patients with migraine have a variety of symptoms, such as vasodilatation (flushing), pilo-erection, nausea, vomiting, diarrhea, cutaneous vasoconstriction (pallor), and diaphoresis. The electrocardiographic changes seen during a migraine attack compared with the pain-free period could be secondary to reversible disturbances of the state of autonomic innervation of the heart and coronary arteries. Dysfunction of ANS may affect atrial and ventricular repolarization. For instance, increased sympathetic activity causes sinus tachycardia, but increased parasympathetic activity causes sinus bradycardia, atrioventricular block, and ST-segment and T-wave abnormalities. Comprehensive electrocardiographic analyses have been providing more details in terms of the detection of abnormalities in atrial and ventricular repolarization which potentially may result in arrhythmias in patients with migraine. However, there is no information in literature reporting the frequency of cardiac arrhythmias in migraine patients who had cardiac repolarization abnormalities. In this review, detailed electrocardiographic findings and their relation with the autonomic nervous system, including recent observations, have been evaluated. However, further studies are needed to investigate the association between autonomic dysregulation and cardiac repolarization abnormalities in patients with migraine.
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Affiliation(s)
- Ismet M Melek
- Department of Neurology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey.
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33
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Abstract
We report a patient with a snake-shaped, mobile mass in the right atrium. The mass was determined to be an elongated Eustachian valve which was a persistent part of the embryologic valve of the sinus venosus.
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Affiliation(s)
- Okan Gulel
- Department of Cardiology, Faculty of Medicine, 19 Mayis University, Samsun, Turkey
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34
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Abstract
The prevalence of a right-to-left shunt, both cardiac and pulmonary, is high in patients with migraines, especially migraine with aura. Percutaneous closure of a right-to-left shunt seems to be associated with a pronounced decrease in the number of migraine attacks or its prevalence. In this review, the relationship between migraine and right-to-left shunting is described by highlighting the different pathophysiologic hypotheses.
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Affiliation(s)
- Martijn C Post
- Department of Cardiology, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands.
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35
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Beck C, Wessel A, Yelbuz TM, Bertram H. Images in cardiovascular medicine. Unusual case of anomalous pulmonary venous return with left atrial to systemic venous shunt. Circulation 2006; 113:e840-1. [PMID: 16754806 DOI: 10.1161/circulationaha.105.595835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
MESH Headings
- Angiography
- Blood Circulation/physiology
- Bundle-Branch Block/pathology
- Bundle-Branch Block/physiopathology
- Cardiac Catheterization
- Cardiovascular Abnormalities/diagnosis
- Cardiovascular Abnormalities/pathology
- Cardiovascular Abnormalities/physiopathology
- Cardiovascular System/pathology
- Cardiovascular System/physiopathology
- Child, Preschool
- Echocardiography, Transesophageal
- Heart Atria/abnormalities
- Heart Atria/physiopathology
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/pathology
- Heart Defects, Congenital/physiopathology
- Heart Septal Defects, Atrial/diagnosis
- Heart Septal Defects, Atrial/pathology
- Heart Septal Defects, Atrial/physiopathology
- Heart Ventricles/abnormalities
- Heart Ventricles/physiopathology
- Hemodynamics
- Humans
- Male
- Pulmonary Veins/abnormalities
- Pulmonary Veins/physiopathology
- Vena Cava, Superior/abnormalities
- Vena Cava, Superior/physiopathology
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Affiliation(s)
- Carsten Beck
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany.
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36
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Abstract
Anatomic anomalies of the cardiovascular system occur in approximately 50% of individuals with Turner syndrome (TS), with the specific genetic cause(s) for the heart defects still unknown. Because congenital heart disease may be associated with conduction system abnormalities, we compared electrocardiograms (ECGs) in 100 women with TS and 100 age-matched female controls. Women with TS were significantly more likely to demonstrate left posterior fascicular block (p < 0.005), accelerated AV conduction (p < 0.006), and T wave abnormalities (p < 0.006). The PR interval was significantly shorter (137 +/- 17 vs. 158 +/- 18 ms, p < 0.0001) and the rate-corrected QT interval (QTc) significantly longer in women with TS than in controls (423 +/- 19 ms vs. 397 +/- 18 ms; p < 0.0001). Twenty-one women with TS but no controls had a QTc greater than 440 ms. We found no statistically significant relation between body habitus, cardiac dimensions, evidence of congenital heart disease, or metabolic parameters and the incidence of ECG abnormalities or QTc duration in TS. Cardiac conduction and repolarization abnormalities appear to be intrinsic features of TS, suggesting that deletion of the second sex chromosome has more profound effects on the cardiovascular system than previously recognized, and that ECG analysis should be included in evaluating and monitoring patients with Turner syndrome.
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Affiliation(s)
- Carolyn A Bondy
- From Developmental Endocrinology Branch (CAB, PLV, VKB), National Institute of Child Health & Human Development; National Heart, Lung and Blood Institute (VS, CAM, DRR); Diagnostic Radiology Department (VBH), Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland; and Department of Radiology (VBH), Uniformed Services University of the Health Sciences, Bethesda, Maryland
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37
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Longás Valién J, Gonzalo Gonzál ez A, Martínez Ubieto J, Giron Mombiela JA, Pascual Bellosta A, Viu Salmons MD. [Thoracic impedance cardiography in a case of anomalous drainage of the superior vena cava into the coronary sinus]. Rev Esp Anestesiol Reanim 2005; 52:627-30. [PMID: 16435618] [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: 05/06/2023]
Abstract
Thoracic impedance cardiography is a noninvasive hemodynamic monitoring technique based on the physical principal of impedance, which can be defined as resistance to electrical flow. We report the case of a man who underwent orthotopic heart transplantation, during which the superior vena cava was found to drain into the coronary sinus. Impedance cardiography was used because hemodynamics could not be monitored invasively with a Swan-Ganz catheter. We describe the main applications of impedance cardiography and the characteristics of this rare vascular anomaly.
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Affiliation(s)
- J Longás Valién
- Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Universitario Miguel Servet, Zaragoza.
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38
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Affiliation(s)
- Stanley G Rockson
- Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular Medicine, Stanford University School of Medicine, Falk Cardiovascular Research Center, Stanford, CA 94305, USA.
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39
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Demkow M, Ruzyłło W, Chmielak Z. [Use of percutaneous technique for treatment of selected cardiovascular defects in adults]. Kardiol Pol 2005; 63:S559-S570. [PMID: 20527391] [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: 05/29/2023]
Affiliation(s)
- Marcin Demkow
- Pracownia Hemodynamiki, Instytut Kardiologii, Warszawa
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40
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Pascual-Castroviejo I, Pascual-Pascual SI, Velázquez-Fragua R, García L, López-Gutiérrez JC, Viaño-López J, Martínez V, Palencia R. [Cutaneous hemangiomas and vascular malformations and associated pathology (Pascual-Castroviejo type II syndrome). Study of 41 patients]. Rev Neurol 2005; 41:223-36. [PMID: 16075401] [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: 05/03/2023]
Abstract
AIM To describe the clinical, diagnostic and therapeutic features of this angiomatous neurocutaneous syndrome, which is the most frequent one, and to report a personal series of 41 patients. PATIENTS AND METHODS Forty one patients--31 females and 10 males--were studied during childhood and then, several patients were followed during many years, which allowed us to learn about the evolution of the abnormalities. The cutaneous lesions were classified as hemangiomas in 30 patients (73%) and as vascular malformations in 11 patients (27%). RESULTS A cerebellar anomaly (unilateral hemispheric hypoplasia and Dandy-Walker malformation) was seen in 13 patients (31.5%) cerebral cortical dysplasia in 4 patients (10%), aortic arch coarctation in 6 patients (15%), and congenital cardiopathy in 5 patients (12%). The most frequent abnormalities were intracranial and/or extracranial vascular malformations. Persistence of the trigeminal artery was observed in 7 patients (17%), absence or severe hypoplasia of an internal carotid artery in 13 patients (32%), absence of a vertebral artery in 7 patients (17%), hypoplasia of intracranial arteries in 6 patients (15%) and aneurysmal enlargement of carotid or vertebral arteries in 5 patients (12%). Also were observed 4 patients (10%) with intracranial hemangioma, 2 (5%) with hemangioma in mediastinum, and 3 (7.5%) with intestinal hemangioma, all of which disappeared during the first years of life. Aneurysmal enlargement of the carotid and vertebral arteries and intracranial branches also disappeared after a process of progressive narrowing of the arterial lumen that caused complete obstruction of these arteries. At the same time the cutaneous hemangioma regressed. During this process, collateral vascularization through branches of the external carotid artery and of the non-affected branches of the contralateral intracranial arteries developed. CONCLUSION This neurocutaneous syndrome is the most frequent one and it is associated with several types of vascular and non-vascular abnormalities which can involve any organ of the body. Internal and external hemangiomas and hemangiomatous lesions progress and tend to regress concomitantly.
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41
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Abramian MA, Khar'kin AV, Kim AI, Lobacheva GV, Il'in VN. [Emergency sternotomy in complex intensive care of acute heart failure in babies undergone correction of congenital heart disease]. Anesteziol Reanimatol 2005:61-3. [PMID: 16076052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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42
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Dupays L, Jarry-Guichard T, Mazurais D, Calmels T, Izumo S, Gros D, Théveniau-Ruissy M. Dysregulation of connexins and inactivation of NFATc1 in the cardiovascular system of Nkx2-5 null mutants. J Mol Cell Cardiol 2005; 38:787-98. [PMID: 15850572 DOI: 10.1016/j.yjmcc.2005.02.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Revised: 02/08/2005] [Accepted: 02/16/2005] [Indexed: 10/25/2022]
Abstract
In humans, mutations of the gene encoding the transcription factor Nkx2-5 result in the heart in electrical conduction defects and morphological abnormalities. In this organ Nkx2-5 is expressed in both the myocardium and the endocardium. Connexins (Cxs) are gap junction channel proteins that have been shown to be involved in both heart development and cardiac electrical conduction, suggesting a possible correlation between expression of Cxs and Nkx2-5. To evaluate this correlation, the expression of Cxs has been investigated in the cardiovascular system of wild-type and Nkx2-5-/- 9.2 days post-conception (dpc) mouse embryos. The disruption of the Nkx2-5 gene results in the loss of Cx43 in the heart, due in part to the poor development of the ventricular trabecular network, as well as specific downregulation of Cx45 gene expression. In addition, the nuclear translocation of NFATc1 in the endocardial endothelial cells is inhibited in the Nkx2-5-/- embryos. These results indicate for the first time that Nkx2-5 is involved in the transcriptional regulation of the Cx45 gene expression. In the mutant embryos the aorta is collapsed, and the vascular endothelial Cxs, Cx40 and Cx37, are no longer expressed in its posterior region. Poor development of the trabeculae and downregulation of Cx45 may contribute both to failure of the myocardial function and to hemodynamic insufficiency. The latter, in turn, may result in the dysregulation of Cx40 and -37 expressions along the whole length of the aorta. Direct or indirect effects of Nkx2-5 inactivation on the Cx45 gene expression could explain the absence of the endocardial cushions in the heart of Nkx2-5-/- embryos.
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Affiliation(s)
- Laurent Dupays
- Laboratoire de Génétique et Physiologie du Développement (UMR CNRS 6545), Institut de Biologie du Développement de Marseille, Université de la Méditerranée, 13288 Marseille cedex 9, France
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43
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Flynn AC, Jelinek HF, Smith M. Heart rate variability analysis: a useful assessment tool for diabetes associated cardiac dysfunction in rural and remote areas. Aust J Rural Health 2005; 13:77-82. [PMID: 15804330 DOI: 10.1111/j.1440-1854.2005.00658.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Cardiovascular complications are the main cause of death in people with diabetes. Early, asymptomatic changes are due to autonomic nervous system dysfunction, which if identified can lead to improved health. This study used detrended fluctuation analysis to identify changes in heart rate variability (HRV) associated with short-time electrocardiograph (ECG) recordings. The aim of the study was to determine whether heart rate variability analysis on short ECG recordings has the potential to be a useful adjunct to clinical practice. DESIGN Comparative design with three independent simple random samples. SETTING University-based research project. PARTICIPANTS Forty-eight people with no diabetes or cardiovascular complications had a 20 min ECG recorded, which was subsequently analysed using mathematical procedures. All participants also had a lying-to-standing autonomic nervous system test. Data was analysed using a Student t-test. RESULTS Heart rate variability expressed as a numeric value (alpha(1)), is reduced in disease states. We found a significant difference in alpha(1)(P = 0.03) between the ECG recordings of the diabetes and control groups. In addition lower alpha(1)values were obtained from people identified with autonomic dysfunction within the diabetes group. CONCLUSION The importance of our findings is that abnormal HRV identifies people with cardiovascular disease, irrespective of diabetes status, that may have autonomic neuropathy. HRV analysis is easily implemented by primary health care providers and has the potential to lead to improved health care by reducing inequity in rural areas and specifically addressing cardiovascular complications associated with diabetes.
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Affiliation(s)
- Allyson C Flynn
- School of Community Health, Charles Sturt University, Albury, Australia
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44
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Abstract
Physical constraints and metabolic differences in neonates require that special attention is given to performing procedures in this patient group. Neonates have a thinner dermis and a greater surface-to-weight ratio, allowing for easier invasion through the skin barrier. The enzymes for metabolism of agents and defense against organisms inside the body are not fully developed in infants. Very premature neonates also have less circulating albumin, making the effective concentration of circulating agent even greater. The infant is prone to unanticipated movement during procedures, such as rolling on the procedure table. The neonatal period is the most common time period for malformations to become manifest on the skin, and invasion of some of these lesions can produce morbidity. These and other factors affect the choice of the type of procedure used, the timing for intervention, and the approach to intervention in this age group. This article reviews the important considerations for approaching procedures and offers suggestions for safe and effective methods of reliably producing the intended outcome.
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Affiliation(s)
- Valerie B Lyon
- Northwestern University, Medical College of Wisconsin, Evanston, IL, USA.
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45
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Chinoy MR, Miller SA, Myers RL, Cilley RE, Dillon PW. Persistent vascular defects in lung allografts attributed to defective endogenous endothelial progenitors. J Surg Res 2005; 124:14-22. [PMID: 15734474 DOI: 10.1016/j.jss.2004.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [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: 10/03/2003] [Indexed: 11/23/2022]
Abstract
BACKGROUND A major pathological finding in human newborns with pulmonary hypoplasia and congenital diaphragmatic hernia is the presence of vascular abnormalities in lungs. Vasculogenesis/angiogenesis are crucial to lung development. To study lung alveolar development, including microvascular formation in fetal lung implants, Schwarz et al. [1] developed a subcutaneous allograft model. We adopted their model to assess the influence of neovascularization or the "host-graft vascular development" on hypoplastic lung structure and growth. MATERIALS AND METHODS Normal and hypoplastic lungs at pseudoglandular stage were implanted subcutaneously under the dorsolateral fold of immunocompromised nude mice (athymic, nu/nu). Lung allografts were removed and assessed at 2, 4, 6, and 8 weeks postimplantation. RESULTS Neovascularization of implanted lungs from subcutaneous vasculature of nude mice resulted in varying degrees of maturation of implanted normal and hypoplastic lungs. By 4 weeks, implanted normal lungs contained Type 2-like cells and by 7 to 8 weeks, Type 2 and Type 1-like cells, air spaces had enlarged, and surfactant secretion was observed. Despite some differentiation and maturation of hypoplastic lungs, there was more mesenchymal tissue, no secondary septa, and smaller air spaces compared to normal lungs. CONCLUSIONS (a) Neovascularization or host-graft vascular development occurs in both normal and hypoplastic lung allografts. (b) Development and maturation of implanted normal and hypoplastic lungs follow the establishment of the vascular connections between the host and grafts. (c) The host-graft vascular connections do not improve the growth of normal or hypoplastic lungs. (d) Neovascularization failed to overcome the embryonic defects in vascular formation and the pulmonary vasculogenesis remained defective in hypoplastic lung allografts, which may be attributed to the defective endogenous endothelial progenitor cells.
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Affiliation(s)
- Mala R Chinoy
- Lung Development Research Program, Department of Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, USA.
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46
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Korpal-Szczyrska M, Aleszewicz-Baranowska J, Dorant B, Potaz P, Birkholz D, Kamińska H. [Cardiovascular malformations in Turner syndrome]. Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw 2005; 11:211-4. [PMID: 16232358] [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: 05/04/2023]
Abstract
BACKGROUND A literature review indicates that the prevalence of cardiovascular malformations in patients with Turner syndrome ranges from 17 to 47 percent. OBJECTIVES The aim of the study was to evaluate the cardiovascular system in patients with Turner syndrome, controlled by the Pediatric Endocrinology Clinic of the Medical University of Gdansk. MATERIAL AND METHODS The study included 55 females with Turner syndrome aged 3-20 years (mean age 9.6 years). The procedure included an interview, subject examination, chest X-rays and echocardiography. The echocardiography included M-mode measurements, two-dimensional evaluations from all standard planes, pulsed and continuous wave Doppler as well as color flow mapping. In selected cases, cardiologic examination embraced also cardiac catheterization, cineangiography and continuous 24-hour blood pressure measurement. RESULTS Cardiovascular malformations were found in 18 out of 55 females (32.7%). Aortic coarctation was detected in 9 out of 18 patients (50%), bicuspid aortic valve in 33%, and aortic insufficiency in 22% of them. 78% of Turner subjects with cardiovascular malformations had monosomy (45,X). All females, except one, with aortic coarctation, had a 45,X karyotype. One aortic coarctation was diagnosed during prenatal examination. Before the last medical examination, 9 females had undergone a surgical treatment. In one case, the surgical treatment was preceded by a balloon angioplasty. Due to a recoarctation, one female was submitted to an additional balloon angioplasty. One female died during the post surgical period suffering from aortic wall injury. In four cases, despite successful surgeries, there still remains an arterial hypertension requiring pharmacological treatment. In 4 out of 18 cases (22%) isolated aortic valves defects were diagnosed, however, at present time they do not require any surgical treatment. In three cases, echocardiographic examination indicated a persistent left superior vena cava and aneurysm atrial septal defect with an intact septum. CONCLUSIONS Due to a high prevalence of cardiovascular malformations, girls with Turner syndrome should be monitored by a pediatric cardiologist. In each case, female with Turner syndrome should be submitted to echocardiography. Also a careful control of the blood pressure is indicated.
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47
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Abstract
This article reviews the state of the art in prenatal cardiovascular imaging, the elucidation of regional vascular flow patterns in the developing fetus and what can be learned from these flow patterns, the new clinical practice systems being that are being implemented to deal with the fetal patient and its family, and the prospects for fetal surgery.
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Affiliation(s)
- Jack Rychik
- Fetal Heart Program, The Cardiac Center at The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Liao J, Kochilas L, Nowotschin S, Arnold JS, Aggarwal VS, Epstein JA, Brown MC, Adams J, Morrow BE. Full spectrum of malformations in velo-cardio-facial syndrome/DiGeorge syndrome mouse models by altering Tbx1 dosage. Hum Mol Genet 2004; 13:1577-85. [PMID: 15190012 DOI: 10.1093/hmg/ddh176] [Citation(s) in RCA: 173] [Impact Index Per Article: 8.7] [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] [Indexed: 11/13/2022] Open
Abstract
Velo-cardio-facial syndrome/DiGeorge syndrome (VCFS/DGS) is associated with de novo hemizygous 22q11.2 deletions and is characterized by malformations attributed to abnormal development of the pharyngeal arches and pouches. The main physical findings include aortic arch and outflow tract heart defects, thymus gland hypoplasia or aplasia and craniofacial anomalies. The disorder varies greatly in expressivity; while some patients are mildly affected with learning disabilities and subtle craniofacial malformations, others die soon after birth with major cardiovascular defects and thymus gland aplasia. In addition to the main clinical features, many other findings are associated with the disorder such as chronic otitis media and hypocalcemia. Tbx1, a gene encoding a T-box transcription factor, which is hemizygously deleted on chromosome 22q11.2, was found to be a strong candidate for the equivalent of human VCFS/DGS in mice. Mice hemizygous for a null allele of Tbx1 had mild malformations, while homozygotes had severe malformations in the affected structures; neither precisely modeling the syndrome. Interestingly, bacterial artificial chromosome (BAC) transgenic mice overexpressing human TBX1 and three other transgenes, had similar malformations as VCFS/DGS patients. By employing genetic complementation studies, we demonstrate that altered TBX1 dosage and not overexpression of the other transgenes is responsible for most of the defects in the BAC transgenic mice. Furthermore, the full spectrum of VCFS/DGS malformations was elicited in a Tbx1 dose dependent manner, thus providing a molecular basis for the pathogenesis and varied expressivity of the syndrome.
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Affiliation(s)
- Jun Liao
- Department of Molecular Genetics, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Ma XJ, Huang GY. [Progresses in studies on residual cardiovascular problems in children with postoperative tetralogy of Fallot]. Zhonghua Er Ke Za Zhi 2004; 42:311-4. [PMID: 15157400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Abstract
All the components of the kallikrein-kinin system are located in the cardiac muscle, and its deficiency may lead to cardiac dysfunction. In recent years, numerous observations obtained from clinical and experimental models of diabetes, hypertension, cardiac failure, ischemia, myocardial infarction, and left ventricular hypertrophy have suggested that the reduced activity of the local kallikrein-kinin system may be instrumental for the induction of cardiovascular-related diseases. The cardioprotective property of the angiotensin-converting enzyme inhibitors is primarily mediated via the kinin-releasing pathway, which may cause regression of left ventricular hypertrophy in hypertensive situations. The ability of kallikrein gene delivery to produce a wide spectrum of beneficial effects makes it an excellent candidate in treating hypertension and cardiovascular and renal diseases. In addition, stable kinin agonists may also be available in the future as therapeutic agents for cardiovascular and renal disorders.
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Affiliation(s)
- Jagdish N Sharma
- Department of Applied Therapeutics, Faculty of Pharmacy, Health Sciences Center, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait
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