Extent of Degenerative Changes in Ascending Aorta of Patients with Bicuspid Aortic Valve (BAV)—A Histopathological Study

Objective: To find out, whether the degenerative process of ascending aorta is limited to the aortic sinuses only or is extending to mid and distal ascending aorta of Bicuspid Aortic Valve patients. Method: A prospective consecutive study on 25 patients of BAV (undergoing aortic valve with ± ascending aortic surgeries) was conducted from 1st Jan 2010 to 30th Dec 2011. Morphological and anatomical data of root and ascending aorta were recorded from echocardiography and computed tomography angiography. Intra-operatively, aortic tissue biopsy taken from three sites: sinus, mid, and distal ascending aorta. Histological evaluation of the aortic wall was based on criteria adapted from Schlatmann and Becker and from de Sa et al. The presence and degree of the 5 variables of degeneration were studied: Linear regression and correlation were used to get relationship between histopathological scoring (HPE-T) and aortic diameter for each site of ascending aorta. Results: Significant linear relation was found between aortic sinus diameter and HPE T score with R value = 0.590 (p value 0.001) and variance of 37.5%. Analysis suggests that HPE T Score = -5.139 + (0.188 x Ao. Sinus Diameter in mm). No significant linear relation could be established between mid and distal ascending aorta diameter and HPE T scoring. Conclusion: In BAV patient’s, a definite relationship between degenerative changes of aortic media and aortic diameter was found and was limited up to the sinus level only. Thus, the study reinforces the thought of replacing aortic sinus too while dealing with aortic valve, even without significant dilatation. By this aggressive management of aortic root, progression of aortic dilatation or dissection can be prevented in bicuspid aortic valve patients.

Optimal C-arm angulation during transcatheter aortic valve replacement: Accuracy of a rotational C-arm computed tomography based three dimensional heart model

AIM To investigate the accuracy of a rotational C-arm CTbased 3D heart model to predict an optimal C-arm configuration during transcatheter aortic valve replacement(TAVR). METHODS Rotational C-arm CT(RCT) under rapid ventricular pacing was performed in 57 consecutive patients with severe aortic stenosis as part of the pre-procedural cardiac catheterization. With prototype software each RCT data set was segmented using a 3D heart model. From that the line of perpendicularity curve was obtained that generates a perpendicular view of the aortic annulus according to the right-cusp rule. To evaluate the accuracy of a model-based overlay we compared model- and expert-derived aortic root diameters. RESULTS For all 57 patients in the RCT cohort diameter measurements were obtained from two independent operators and were compared to the model-based measurements. The inter-observer variability was measured to be in the range of 0°-12.96° of angular C-arm displacement for two independent operators. The model-to-operator agreement was 0°-13.82°. The model-based and expert measurements of aortic root diameters evaluated at the aortic annulus(r = 0.79, P < 0.01), the aortic sinus(r = 0.93, P < 0.01) and the sino-tubular junction(r = 0.92, P < 0.01) correlated on a high level and the Bland-Altman analysis showed good agreement. The interobserver measurements did not show a significant bias. CONCLUSION Automatic segmentation of the aortic root using an anatomical model can accurately predict an optimal C-arm configuration, potentially simplifying current clinical workflows before and during TAVR.

老年退行性心脏瓣膜病的超声心动图分析

目的观察老年退行性心脏瓣膜病(Senile Degenerated Heart Valvular Disease,SDHVD)的超声心动图的表现。方法收集我院2014年3月~2015年10月期间收治的年龄大于60岁患者进行超声心动图检查,选取其中89例确诊为SDHVD的超声心动图进行分析。结果 SDHVD主要集中发病于左心系统,以主动脉瓣为最常见。结论超声心动图对于SDHVD的检出具有方便、快捷。

超声评价老年退行性心脏瓣膜病与颈动脉粥样硬化的关系

目的探讨老年退行性心脏瓣膜病(Senile Degenerative Heart Valve Disease,SDHVD)与颈动脉粥样硬化(Carotid Atherosclerosis,CAS)之间的关系。方法选择93例SDHVD患者作为研究组,50例无SDHVD患者作为对照组,超声检测并对比两组患者不同级别心脏瓣膜病钙化程度和颈动脉内膜中层厚度(IMT)、斑块检出率、颈动脉斑块积分及管腔狭窄程度,进行对比分析。结果研究组患者的IMT、斑块检出率、颈动脉斑块积分均高于对照组,且随着心脏瓣膜钙化级别的升高,IMT、斑块检出率及斑块积分也显著升高;研究组颈动脉管腔闭塞率及管腔狭窄率均显著高于对照组。结论 SDHVD与CAS二者之间具有显著密切关系。

超声心电图在老年主动脉瓣退行性变伴狭窄诊断中的应用观察

目的探讨超声心电图在老年主动脉瓣退行性病变伴狭窄诊断中的应用价值。方法回顾性分析本院2017年4月至2019年3月收治的老年主动脉瓣退行性病变伴狭窄患者60例临床资料作为实验组,收集同一时期到本院行体检的健康者60名临床资料作为对照组。对两组入选者行超声心电图检查,记录两组超声心电图相关参数,分析主动脉瓣病变特征。结果经超声心电图检查,实验组患者多为单纯主动脉瓣受累,且主动脉瓣轻度狭窄者占66.67%(40/60),室间隔基底段增厚、左房增大等是主动脉瓣退行性变伴狭窄患者常见心脏结构改变;实验组左室射血分数(LVEF)、左室舒张末内径(LVEDD)、升主动脉内径、左房内径与对照组相比,差异无统计学意义;实验组室间隔基底厚度、跨瓣平均压差、主动脉瓣上流速较对照组高,差异具有统计学意义(P<0.05)。结论主动脉瓣退行性病变伴狭窄采用超声心电图可清晰的显示心脏结构参数及瓣膜结构特征,为临床诊断及治疗老年主动脉瓣退行性病变伴狭窄提供重要指导意义。

基于炎症微环境探讨化痰祛瘀类中药防治主动脉瓣钙化

主动脉瓣钙化性疾病(CAVD)是由炎症、氧化应激、脂质沉积等原因导致钙盐沉积引起瓣叶硬化,进而导致心脏功能障碍的疾病。目前我国CAVD主要为老年退行性瓣膜改变,免疫炎症反应及炎症微环境转化在瓣叶钙化中的作用贯穿全程。瓣叶微环境组成和转化包括细胞及炎症因子变化和继发瓣叶钙化性病变,其发病机制与中医痰瘀互结理论相互印证。该文从瓣叶免疫微环境入手,详细总结了瓣叶微环境成分及改变过程,以及在此过程中的中医学认识和化痰祛瘀类药物疗效,有利于化痰祛瘀类中药在CAVD治疗中的进一步推广应用,为中医药防治CAVD提供新的思路。

丹蒌片治疗老年性主动脉瓣狭窄的临床疗效分析

目的:探讨丹蒌片对老年性主动脉瓣狭窄患者临床疗效及血清炎症因子水平的影响。方法:选取老年性主动脉瓣钙化患者共34例,将其随机分为丹蒌片治疗组(22例)及对照组(12例)。根据西雅图心绞痛问卷中文版、SF-36生活质量量表、中医临床证候评分比较两组的治疗效果,ELISA检测治疗前后患者血清肿瘤坏死因子α(TNF-α)、白介素6(IL-6)及同型半胱氨酸(HCY)的水平。结果:丹蒌片治疗组患者心绞痛程度及治疗满意度较常规治疗组均有明显统计学差异,丹蒌片可提高病人生活质量,改善中医部分证候,减轻血清炎症因子表达。结论:丹蒌片或可减缓主动脉瓣钙化进展,其原因可能和炎症反应减轻有关。

骨膜素在主动脉瓣退行性变中的表达及其意义

目的检验骨膜素在退行性变主动脉瓣中的表达以及其病理作用。方法连续收集接受瓣膜置换术患者的退行性主动脉瓣标本24例（男13例，女11例），取同期Bentall手术切除的正常主动脉瓣膜标本5例作为对照。组织切片常规苏木素-伊红（HE）染色观察瓣膜结构。采用免疫组织化学分析方法对瓣膜中骨膜素及血管内皮生长因子（VEGF）的表达进行比较分析。同时对冰冻标本进行Western blot检测，进一步验证相应分子表达水平组间差异。结果退行性主动脉瓣出现结构破坏、微血管增生、钙化等表现。与正常瓣膜比较，骨膜素在退行性主动瓣膜中表达增高（0.009±0.006比0.041±0.024，P＝0.001），集中表达钙化坏死区域、血管形成区域。VEGF在病变瓣膜中表达增高（0.007±0.011比0.021±0.005，P＝0.002），两者呈线性相关（r＝0.458，P＝0.012）。结论骨膜素参与瓣膜细胞外基质增生，组织重构及新生血管形成，促进了主动脉瓣退行性变。

老年瓣膜性心脏病的诊治进展

瓣膜性心脏病的发生发展与年龄密切相关,随着年龄增长,瓣膜病发生率也随之增加。在老年人群中,退行性主动脉瓣狭窄和二尖瓣反流是最常见的瓣膜性心脏病。严重的瓣膜性心脏病可导致心力衰竭、心律失常甚至死亡等后果,然而对于有症状的重度瓣膜病患者来说,常规药物治疗疗效甚微,且因合并多种并发症常被认为是不适宜外科手术的高危群体。随着外科手术技术的不断创新和经导管介入技术的发展,老年瓣膜病患者的治疗方式也有了更多的选择。