ObjectiveTo evaluate the CT features of coronary artery aneurysm by coronary artery imaging on 128 slice CT and dual source CT (CTCA).
MethodsA total of 1 108 cases were prospectively examined using CTCA between March 2011 and April 2014. With volume rendering, maximum intensity projection, multiplanar reconstruction and surface reconstruction, we observed the coronary artery morphology and vascular wall condition.
ResultsThree cases of coronary artery aneurysm were found. In case one, the anterior descending branch (LAD) had grape-like prominency segmentally; in case two, LAD and left coronary circumflex branch (LCX) and right coronary artery (RCA) had diffuse dilation with local shuttle expansion; in case three, left main, LAD and LCX and RCA had diffuse expansion.
ConclusionCTCA is a noninvasive, simple and effective method for the diagnosis of coronary artery aneurysm, and it can be the first choice for the high risk population with coronary artery aneurysm.
Objective To explore the diagnostic methods, therapy and the prognostic factors for the ruptured abdominal aortic aneurysm (RAAA). Methods The clinical data of 23 patients (males 15, females 8, age range 35-78, mean age 65) with RAAA below the level of renal arteries, who were treated with surgery, were collected from April 1999 to December 2005 and were analyzed retrospectively. Seven cases had a history of RAAA, 6 cases had pulsating abdominal masses; 15 cases were diagnosed by emergency Doppler ultrasonic examination or CT. All of the patients underwent emergency surgical operation: The ruptures of the abdominal aorta below the level of renal arteries were obstructed by using clamp ring or using transluminal ballon according to conditions of each patient. The aritficial vascular graft was then taken after the control of hemorrhage. Results There were 9 (39%) patients died within 30 d after the emergency operation. The causes of death included acute renal failure because of hemorrhagic shock (4 cases), multiple organ failure (3 cases), and respiratory-circulatory failure (2 cases).Conclusion Surgery may be an effective treatment for RAAA. The critical step of the operation was to control hemorrhage by obstructing the proximal end of the aortic rupture according to the conditions of each patient. The main postoperative complications and causes of death include acute cardiovascular and cerebrovascular diseases, renal failure and pneumonia.
The hemodynamic parameters in arteries are difficult to measure non-invasively, and the analysis and prediction of hemodynamic parameters based on computational fluid dynamics (CFD) has become one of the important research hotspots in biomechanics. This article establishes 15 idealized left coronary artery bifurcation models with concomitant stenosis and aneurysm lesions, and uses CFD method to numerically simulate them, exploring the effects of left anterior descending branch (LAD) stenosis rate and curvature radius on the hemodynamics inside the aneurysm. This study compared models with different stenosis rates and curvature radii and found that as the stenosis rate increased, the oscillatory shear index (OSI) and relative residence time (RRT) showed a trend of increase; In addition, the decrease in curvature radius led to an increase in the degree of vascular curvature and an increased risk of vascular aneurysm rupture. Among them, when the stenosis rate was less than 60%, the impact of stenosis rate on aneurysm rupture was greater, and when the stenosis rate was greater than 60%, the impact of curvature radius was more significant. Based on the research results of this article, it can be concluded that by comprehensively considering the effects of stenosis rate and curvature radius on hemodynamic parameters, the risk of aneurysm rupture can be analyzed and predicted. This article uses CFD methods to deeply explore the effects of stenosis rate and curvature radius on the hemodynamics of aneurysms, providing new theoretical basis and prediction methods for the assessment of aneurysm rupture risk, which has important academic value and practical guidance significance.
ObjectiveTo summarize clinical experience and early to mid-term results of modified aortoplasty with external wrap for aneurysmal dilatation of the ascending aorta with or without heart valve disease.
MethodsClinical data of 27 patients with aneurysmal dilatation of the ascending aorta who underwent modified aortoplasty with external wrap in Department of Cardiovascular Surgery, Fujian Provincial Hospital from January to October 2003 were retrospectively analyzed. There were 19 male and 8 female patients with their age of 35-71 (57±9)years and body weight of 42-90 (59±11)kg.There were 23 patients with aortic valve disease including 3 patients with bicuspid aortic valve. There were 4 patients in New York Heart Association function class Ⅰ, 9 patients in class Ⅱ, 12 patients in class Ⅲ, and 2 patients in class Ⅳ. Preoperative ascending aortic diameter (AAOD)was 40.0-59.1 (46.4±4.8)mm, left ventricular end-diastolic diameter was 42.5-70.7 (56.9±8.3)mm, and left ventricular ejection fraction (LVEF)was 57.7%±8.0%. Patients were followed up with echocardiography to examine changes of AAOD and left ventricle.
ResultsCardiopulmonary bypass (CPB)time was 121.2±52.6 minutes, and aortic cross-clamping time was 70.6±29.7 minutes. Two patients received modified aortoplasty without CPB. There was no in-hospital death.Among the 25 patients who received modified aortoplasty under CPB, 1 patient had cerebral infarction and another patient had hypotension and arrhythmia postoperatively.Postoperative AAOD (36.3±3.4 mm)was significantly smaller than preoperative AAOD (46.4±4.8 mm, t=1.675, P < 0.05). Twenty-four patients were followed up from 1.0 to 120.5 months (average, 35.5 months). During follow-up, no cardiac-related death or reoperation was found. Two patients died of pneumonia, and another 2 patients died of cerebral hemorrhage. One patient had upper gastrointestinal bleeding. Aneurysmal dilatation of the ascending aorta recurred in 1 patient 3 years after discharge with AAOD of 49.9 mm. AAOD at 1 year (40.3±4.3 mm)and 3 years (40.3±5.6 mm)after discharge were significantly smaller than preoperative and postoperative AAOD (P < 0.05).
ConclusionModified aortoplasty with external wrap is a good surgical procedure for aneurysmal dilatation of the ascending aorta with or without valve disease, and early to mid-term results are satisfactory.
Objective To investigate the characteristics of fundus photography and fundus fluorescein angiography (FFA) of IRVAN (idiopathic retinal vasculitis, aneurysms, and neuroretinitis) syndrome and Eales disease. Methods The fundus photography and FFA data of 4 cases (8 eyes) with IRVAN syndrome and 43 cases (68 eyes) with Eales disease were retrospectively analyzed. All patients received ophthalmic routine examinations, including visual acuity, intraocular pressure, slit-lamp microscope and indirect ophthalmoscope. All patients had taken fundus photography and FFA for both eyes, except 4 patients of Eales disease who had vitreous hemorrhage in one eye. All 4 cases(1 male/3 female )with IRVAN syndrome were bilateral and aged 1643 years old( mean age 2700plusmn;1293 years old). 43 cases (32 male/11 female) of Eales disease aged 6-59 years old( mean 30.79plusmn;11.46 years old), 29 cases were bilateral and 14 cases were unilateral. Both diseases had retinal vascular whitesheath or white threadlike changes, exudative retinal hemorrhage and vitreous hemorrhage. Results Both arteries and veins of posterior pole of all eyes with IRVAN syndrome were involved and shown multiple retinal macroaneurysms. Other signs of IRVAN syndrome included capillary occlusion and nonperfusion (7/8 eyes, 87.5%),fluorescein leakage and edema of optic disc (5/8 eyes,62.5%), optic atrophy(2/8 eyes,25%), vitreous hemorrhage(1/8 eyes,12.5%), neovascularization of optic disc(2/8 eyes,25%), retinal neovascularization(4/8 eyes,50%) and macular edema(4/8 eyes,50%). The signs of Eales disease included fluorescein leakage of peripheral retinal vein (68/68 eyes, 100%), fluorescein leakage of posterior retinal vein (32/68 eyes, 47.06%), artery involvement (5/68 eyes, 7.35%), peripheral capillary occlusion and nonperfusion (38/68 eyes, 55.88%), fluorescein leakage of optic disc(29/68 eyes, 42.65%), neovascularization of optic disc(4/68 eyes,5.88%), retinal neovascularization(26/68 eyes,38.2%) and macular edema(15/68 eyes,22.06%). Compared IRVAN syndrome with Eales disease, the difference of artery inflammation, vein inflammation, retinal macroaneurysms in posterior area had statistics significance(all P=000,Plt;005), and that of edema of optic disc, retinal vascular nonperfusion area, neovascularization of optic disc, neovascularization elsewhere, and macular edema had no statistics significance(chi;2=0.479，P＞0.05；P=0.131，P＞0.05；chi;2=1.449，P＞0.05；chi;2=0.068，P＞0.05；chi;2=1.676，P＞0.05). Conclusions Both IRVAN syndrome and Eales disease may have vein and artery inflammation in posterior pole of the eye, and may result in neuroretinitis. IRVAN syndrome has much more vein and artery inflammation in posterior pole than Eales disease. Posterior retinal macroaneurysms is the most important sign for the diagnosis and differential diagnosis of IRVAN syndrome and Eales disease.
Objective To review the strategies on repairing elastic fibers in aorta. Methods Literature concerningelastic fiber as well as its repairment was consulted and summarized from three aspects: enhancement of the expressions ofits components, improvement of the condition of its assembly, and reduction of the destructive effects. Results Elastinis concerned as the main protein to be enhanced with three different methods including gene transfection, stimulationwith ectogenesis factors, and induction of phenotype transition of smooth muscle cell. Fibul in and lysyl oxidases show theabil ity to improve the assembly of the elastic fiber, while the related mechanisms are not clear. Matrix metalloproteinasesare regarded as the main destructive factors, and researches focus on reducing their expression as well as their destructiveeffects. Conclusion To assure a high-qual ity repair of elastic fibers in aorta, their components should be sufficientlyexpressed and effectively assemblyed, and the destructive effects caused by dangerous factors should also be reduced.
Objective To summarize the experiences of surgical treatment for post infarction ventricular aneurysm and mi tral regurgitation， thus to improve surgical curative effect and survival rates . Clinical data of 37 patients with myocardial infarction complicated with ven tricular aneurysm and severer than moderate mitral regurgitation were retrospectively an alyzed between December 2000 and June 2007, all 37 patients underwent coron ary artery bypass grafting and reconstruction of left ventricular after aneurysm resection, mitral valve repair or replacement. Results Three patients died during hospital stay after surgery,mortality rate was 81%, of th em two died in renal failure, one died in brain complications.Thirty patients we re followed up, followup rate was 88.2%(30/34), with 4 patients missed. Follow up time ranged from 1 month to 6 years after surgery, 2 patients died in foll o wup period, of them one died in anticoagulant treatment failure complicated w ith the large cerebral infarction, one died of lung infection and heart failure. The inner diameter of le ft atrium and enddiastolic left ventricle reduced obviously than those before operation （30.1±3.5mm vs.39.3±3.7mm, P=0.004;48.4±4.3mm vs.61.2±5.1mm, P=0.003）by color doppler echocardiography examination at 6th month a fter su rgery.There was no obvious change in size of untouched ventricular aneurysm(diam eterlt;5cm). No regurgitation or slight regurgitation were observed in 12 patient s, mild regurgitation was observed in 2 patients and moderate in 1 patients. Conclusion According to different types of post infarctio n ventricular aneurysm and mitral regurgitation, constitution o f different surgical treatment programs, can result in favorable early and long-term curative effect. There’s marked improvement in most patients’cardiac f unction and survival rate.
One hundred and twenty-eight cases of peripheral aneurysm were reported.Traumatic prsucdoaneursyms(87cases)dominated and aneurysm in lower extremities(68 cases)consisted of most the cases.Rupture of aneurysm and massive kaemomhage is the most serious complications(22 cases in the report).Therefore,operative treatment should be performed soon after the diagnosis is ascertained.Resteration of normal blood flow should be the aim.Intracystic repairation is indicated in pseudoaneurysm with part of the vascular wall invaded.Artificial graft may be indicated for aneurysm of the middle and large artery,and autovenous graft for the smaler arteries.Aneurysm may be resected if the procedure is easy to perform or there is severe inflammation around the aneurysm.Proper postoperative drainage is important.General heparinization during blockade of local circulation is also important in case of vascular grafting. We concluded that proper selection of operative procedure is essential for better prognosis.
【Abstract】ObjectiveTo summarize the study on the feasibility of celiac axis ligation. Methods Literatures about celiac axis ligation were reviewed retrospectively. ResultsCeliac axis branches included common hepatic artery， splenic artery， left gastric artery which had many variation and collateral flow between celiac and mesenteric vessels by gastroduodenal artery and pancreaticoduodenal artery. Celiac axis could be possibly ligated without obvious complications in patients who had celiac axis injuries, celiac artery aneurysms, upper gastrointestinal haemorrhage, excision of carcinoma around the celiac axis and portal hypertension. However, gallbladder necrosis or perforation, focal infarction of the liver even higher mortality had also been reported. ConclusionCeliac axis ligation should not be performed routinely, but it is surgically possible and may be a life saving approach in certain circumstances.
ObjectiveTo investigate the value and clinical significance of multi-slice spiral computed tomography angiography (MSCTA) in diagnosing true splenic artery aneurysm.
MethodsSeven patients with splenic artery aneurysm diagnosed by MSCTA between October 2010 and July 2014 were included in this study. Image post-processing technologies such as multi-planar reformation, curved planar reformation, maximum intensity projection and volume rendering technology were introduced.
ResultsAll the artery aneurysms were found through image post-processing technologies. There were 9 tumors in the 7 patients with splenic artery aneurysm, among which 1 was at the upper segment of pancreas, 2 at the segment of pancreas, 3 at the anterior segment of pancreas, and 1 (multiple) at the anterior segment of pancreas and anterior of hilus of spleen. The maximum volume of tumor was 60 mm×57 mm×54 mm. One tumor wall had calcification and other 6 cases only displayed tumor wall had varying degrees of "egg-shell" calcification, and mural thrombosis was detected in 3 cases.
ConclusionsMSCTA is a reliable method to display splenic artery aneurysm. The combination of multiple image post-processing technologies is more helpful in observing the features of tumor body and the internal and external conditions of tumor cavity, which has guiding significance for further clinical treatment.
