With the serious aging population and lifestyle changes,chronic venous insufficiency accounts for approximately 25.95%of the population,which may lead to lower limb edema and leg heaviness,as well as severe infections...With the serious aging population and lifestyle changes,chronic venous insufficiency accounts for approximately 25.95%of the population,which may lead to lower limb edema and leg heaviness,as well as severe infections of skin ulcers that can result in sepsis and necessitate amputation.Conservative treatment and other supportive measures can only slow the disease's progression but are unable to drastically reverse it;surgical interventions are rarely used due to the high risk of catastrophic postoperative consequences.As one of the most promising minimally invasive therapies,percutaneous prosthetic valve replacement has emerged in light of this situation,providing novel alternatives for patients with deep venous valve insufficiency.We reviewed the historical prosthetic venous valve designs,including their structure and materials,animal evaluation models,and assessment criteria.On the basis of the findings from in vitro tests,animal studies,and clinical trials,we summarized the major challenges and potential solutions for the development of advanced prosthetic venous valves.展开更多
The role of the coronary venous system was underestimated for many years.In the last 20 years,a few percutaneous cardiology techniques in which the anatomy of the coronary venous system was significant were developed ...The role of the coronary venous system was underestimated for many years.In the last 20 years,a few percutaneous cardiology techniques in which the anatomy of the coronary venous system was significant were developed and are in use.The most important seems to be cardiac resynchronization therapy,which is an invasive method for the treatment of heart failure.Unfortunately,one of the major problems is the significant anatomical variability of the coronary venous system.The description of the selected anatomical structures is only useful in selected cases such as,for example,the obstruction of selected vessels,a huge Thebesian valve,etc.The 3D images can add significant value;however,their usefulness is limited due to the different points of view that are obtained during intra-operational fluoroscopy.After summarizing all of the articles andguidelines,it can be recommended that the visualization of the coronary venous system be performed in certain patients before cardiac resynchronization.The best option is to use tomography with retrospective gating with the optimal reconstruction of cardiac veins that occurs during the diastolic phases.展开更多
Purpose: Patients scheduled to undergo the transcatheter aortic valve replacement (TAVR) are usually octogenarians with severe co-morbidities and an increased risk of surgery-associated complications. The aim of this ...Purpose: Patients scheduled to undergo the transcatheter aortic valve replacement (TAVR) are usually octogenarians with severe co-morbidities and an increased risk of surgery-associated complications. The aim of this study was to determine the incidence of insufficient oxygen delivery as measured by mixed venous oxygen saturation (SvO2) via invasive continuous cardiopulmonary monitoring and the low cardiac output syndrome (LCOS) in patients undergoing the TAVR procedure. The second objective was to examine how these hemodynamic measurements would change during critical events, such as rapid ventricular pacing (RVP) during this procedure. Methods: This prospective, observational study, examined twenty patients undergoing TAVR under general anesthesia. Hemodynamic variables, SvO2 and the continuous cardiac output (CO) were assessed using pulmonary artery catheter (PAC) and a Vigilance? monitor. Insufficient oxygen delivery was defined as a SvO2 value under 58% and LCOS as a cardiac index (CI) under 2 L/min/m2. Total intravenous anesthesia and hemodynamic management protocol were standardized. RVP was induced twice during the procedure at a frequency of 180 - 200/min. Predefined clinical endpoints were assessed during the procedure and hemodynamic values were analyzed before and after twelve critical events. Results: The data of twenty patients with a mean age of 80 ± 4 years and EuroSCORE 18 ± 10 were analyzed. Fourteen (70%) of the TAVR procedures were performed transapically, the other six (30%) transfemorally. The SvO2 value under 58% (mean 54 ± 6) and the CI under 2 L/min/m2 (mean 1.6 ± 0.2) were detected in 60% of patients (n = 12) before the use of RVP. All of these patients received perioperative inotropic medication and required norepinephrine infusion for maintenance of adequate blood pressure. The SvO2, CO and CI were significantly decreased after the use of RVP (P 2 reverted rapidly to the same level as before the application of RVP (1 min), CO, and CI 10 min later. At the end of the operation SvO2 values were at same level as before RVP and CO and CI were higher than before RVP. Conclusion: A high incidence of insufficient oxygen delivery and low cardiac output syndrome were detected in patients undergoing TAVR procedures. Nonetheless, all hemodynamic values returned rather rapidly to the same level as before the use of the RVP and were at the optimal level at the end of the procedure. According to the current study, the most hemodynamically hazardous steps during TAVR are the use of RVP sequences, the induction of anesthesia and the initiation of surgery.展开更多
Background: Tricuspid valve thrombus with concomitant bilateral pulmonary embolism (PE) and right heart strain poses a significant risk of hemodynamic instability and increased mortality. Case Report: We report the un...Background: Tricuspid valve thrombus with concomitant bilateral pulmonary embolism (PE) and right heart strain poses a significant risk of hemodynamic instability and increased mortality. Case Report: We report the unique case of a female who presented with dyspnea and tachycardia, and was subsequently found to have a structure attached to the tricuspid valve. Concomitantly, she also had bilateral upper extremity deep venous thrombosis (UEDVT) and bilateral sub-massive PE. Thorough clinical assessment, and diagnostic and risk stratification tools were applied to guide the management and disposition. Tricuspid valve thrombus resolved after unfractionated heparin therapy followed by oral anticoagulation as seen on repeat transthoracic echocardiography. We think the readership will benefit from our experience of managing an uncommon and critical clinical presentation of tricuspid valve thrombus in the setting of extensive venous thromboembolism. Conclusion: Careful clinical assessment, risk stratification tools, and close monitoring are needed to guide the management of tricuspid valve thrombus with concomitant bilateral PE and UEDVT.展开更多
基金CAMS Innovation Fund for Medical Sciences(no.2022-I2M-1-023)Natural Science Fund for Distinguished Young Scholars of Tianjin(no.22JCJQJC00110)+3 种基金Natural Science Foundation of China(no.32071356,no.82272158,no.82100518)Science&Technology Projects of Tianjin of China(22JCYBJC00050,21JCQNJC01530)Fundamental Research Funds for the Central Universities(no.3332022069)Science&Technology Projects of Hubei Province(2023EHA057).
文摘With the serious aging population and lifestyle changes,chronic venous insufficiency accounts for approximately 25.95%of the population,which may lead to lower limb edema and leg heaviness,as well as severe infections of skin ulcers that can result in sepsis and necessitate amputation.Conservative treatment and other supportive measures can only slow the disease's progression but are unable to drastically reverse it;surgical interventions are rarely used due to the high risk of catastrophic postoperative consequences.As one of the most promising minimally invasive therapies,percutaneous prosthetic valve replacement has emerged in light of this situation,providing novel alternatives for patients with deep venous valve insufficiency.We reviewed the historical prosthetic venous valve designs,including their structure and materials,animal evaluation models,and assessment criteria.On the basis of the findings from in vitro tests,animal studies,and clinical trials,we summarized the major challenges and potential solutions for the development of advanced prosthetic venous valves.
文摘The role of the coronary venous system was underestimated for many years.In the last 20 years,a few percutaneous cardiology techniques in which the anatomy of the coronary venous system was significant were developed and are in use.The most important seems to be cardiac resynchronization therapy,which is an invasive method for the treatment of heart failure.Unfortunately,one of the major problems is the significant anatomical variability of the coronary venous system.The description of the selected anatomical structures is only useful in selected cases such as,for example,the obstruction of selected vessels,a huge Thebesian valve,etc.The 3D images can add significant value;however,their usefulness is limited due to the different points of view that are obtained during intra-operational fluoroscopy.After summarizing all of the articles andguidelines,it can be recommended that the visualization of the coronary venous system be performed in certain patients before cardiac resynchronization.The best option is to use tomography with retrospective gating with the optimal reconstruction of cardiac veins that occurs during the diastolic phases.
文摘Purpose: Patients scheduled to undergo the transcatheter aortic valve replacement (TAVR) are usually octogenarians with severe co-morbidities and an increased risk of surgery-associated complications. The aim of this study was to determine the incidence of insufficient oxygen delivery as measured by mixed venous oxygen saturation (SvO2) via invasive continuous cardiopulmonary monitoring and the low cardiac output syndrome (LCOS) in patients undergoing the TAVR procedure. The second objective was to examine how these hemodynamic measurements would change during critical events, such as rapid ventricular pacing (RVP) during this procedure. Methods: This prospective, observational study, examined twenty patients undergoing TAVR under general anesthesia. Hemodynamic variables, SvO2 and the continuous cardiac output (CO) were assessed using pulmonary artery catheter (PAC) and a Vigilance? monitor. Insufficient oxygen delivery was defined as a SvO2 value under 58% and LCOS as a cardiac index (CI) under 2 L/min/m2. Total intravenous anesthesia and hemodynamic management protocol were standardized. RVP was induced twice during the procedure at a frequency of 180 - 200/min. Predefined clinical endpoints were assessed during the procedure and hemodynamic values were analyzed before and after twelve critical events. Results: The data of twenty patients with a mean age of 80 ± 4 years and EuroSCORE 18 ± 10 were analyzed. Fourteen (70%) of the TAVR procedures were performed transapically, the other six (30%) transfemorally. The SvO2 value under 58% (mean 54 ± 6) and the CI under 2 L/min/m2 (mean 1.6 ± 0.2) were detected in 60% of patients (n = 12) before the use of RVP. All of these patients received perioperative inotropic medication and required norepinephrine infusion for maintenance of adequate blood pressure. The SvO2, CO and CI were significantly decreased after the use of RVP (P 2 reverted rapidly to the same level as before the application of RVP (1 min), CO, and CI 10 min later. At the end of the operation SvO2 values were at same level as before RVP and CO and CI were higher than before RVP. Conclusion: A high incidence of insufficient oxygen delivery and low cardiac output syndrome were detected in patients undergoing TAVR procedures. Nonetheless, all hemodynamic values returned rather rapidly to the same level as before the use of the RVP and were at the optimal level at the end of the procedure. According to the current study, the most hemodynamically hazardous steps during TAVR are the use of RVP sequences, the induction of anesthesia and the initiation of surgery.
文摘Background: Tricuspid valve thrombus with concomitant bilateral pulmonary embolism (PE) and right heart strain poses a significant risk of hemodynamic instability and increased mortality. Case Report: We report the unique case of a female who presented with dyspnea and tachycardia, and was subsequently found to have a structure attached to the tricuspid valve. Concomitantly, she also had bilateral upper extremity deep venous thrombosis (UEDVT) and bilateral sub-massive PE. Thorough clinical assessment, and diagnostic and risk stratification tools were applied to guide the management and disposition. Tricuspid valve thrombus resolved after unfractionated heparin therapy followed by oral anticoagulation as seen on repeat transthoracic echocardiography. We think the readership will benefit from our experience of managing an uncommon and critical clinical presentation of tricuspid valve thrombus in the setting of extensive venous thromboembolism. Conclusion: Careful clinical assessment, risk stratification tools, and close monitoring are needed to guide the management of tricuspid valve thrombus with concomitant bilateral PE and UEDVT.
