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简介：BackgroundTheconventionalextra-anatomicbypassisoriginatedfromtheaxillary'sarteryandthegraftsizeisoftenlimitedduetothesmalldiameterofaxillary'sartery.Extra-anatomicbypassgraftoriginatingfromascendingaortacanimprovethegraftsizeanddistalperfusion,butneedsternotomywhichmighthavehigheroperativeriskscomparedwithaxillo-femeralbypass.Wesummarizeourexperiencesofextra-anatomicbypassfromascendingaortaforatypicalaorticcoarctation.MethodsBetweenJanuary2005andFebruary2008,5womenagedfrom18to64yearsunderwentextra-anatomicbypassfromascendingaortatoabdominalaortaoriliacarterybypassfortreatmentofatypicalaorticcoarctation.Preoperatively,allpatientshadhypertensionandneededanti-hypertensivemedications.Systolicbloodpressurewas151±9mmHg.Anklepressureindex(API)were0.60±0.23inleftand0.56±0.23inright.Averagesystolicpressuregradientofaorticstenosiswas76±18mmHg.Threepatientsunderwentconcomitantcardiacoperation,includingcoronaryarterybypassgrafting,Bentallprocedureandatrialseptaldefectrepair.ResultsTherewasnohospitalandlatemortalityduring58±15monthsfollow-up(rangefrom44to81months).Postoperativesystolicbloodpressurewasreducedto126±11mmHgatthetimeofdischarge.Allpatientsmaintainednormalbloodpressurewithoutmedicationduringfollow-up.APIwasimprovedto1.12±0.24inleftand1.17±0.25inright(comparedwithpreoperativedata,P<0.05).Follow-upcomputertomographyshowedpatencyinallgrafts.ConclusionsSurgicaltreatmentofatypicalaorticcoarctationwithextra-anatomicbypassoriginatingfromascendingaortaalleviateshypertensionandlowlimbischemia.

简介：Transcatheteraorticvalvereplacement(TAVR)isincreasinglyusedforthetreatmentofhighorveryhighsurgicalriskpatientswithsevereaorticstenosis(AS)orfailingsurgicalbioprosthesis(valve-in-valve,VIV-TAVR).InTAVR,thecollapsedtranscatheterheartvalve(THV)isintroducedusingthedeliverysysteminsertedfromthefemoralartery(preferred)orotheralternativeaccesses(transapical,transaortic,transcarotid,subclavian/transinnominateortranscaval).Thedeliverysystemisthenadvanceduntilcoaxiallyalignedwiththeaorticannulus,wheretheTHVisdeployed.Thisprocedurecanbeassociatedwithcomplicationssuchasaccesssiteinjury(vascularcomplication),paravalvarleak,cerebrovasculareventsandconductiondisturbances.However,therapidacceptanceandsuccessesobservedwithTAVRhavebeenmadepossiblethroughcarefulpatientselection,preproceduralplanning(i.e.MDCTannularsizing),THVtechnology(i.e.newgenerationvalves),andproceduraltechniques(i.e.minimalistTF-TAVRandalternativepercutaneousaccessoptions),aswellasadecreaseincomplicationsasTAVRexperiencegrows.ThoughtheresultsorongoingclinicaltrialsevaluatingTAVRinintermediatesurgicalriskpatientsarepending,itislikelythatTAVRwillsoonbeapprovedforlowerriskpatientsaswell.

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简介：Thecasepresentedhereoffersusanopportunitytodiscussanincreasinglycommonlyconfrontedclinicalchallenge.Twoissuesareraised:howbesttomanagethepatient’svalvularheartdisease,includingboththeindicationsforsurgicalinterventionandtheprostheticoptions,andhowbesttomanagehisaorticdilatation.Letustakethemoneatatime.Thepatienthassevereaorticregurgitationbutanormalejectionfraction.Althoughwedonothavehisventriculardimensions,hehasaclassIindicationforinterventiongivenhissymptoms.

简介：Acuteaorticsyndromeincludesclassicaorticdissection,aorticintramuralhematoma,andpenetratingatheroscleroticulcer–agroupofconditionsthataredefinedbytheirdynamicevolutionandsimilarclinicalmanifestation.Accuratediagnosisandprompttreatmentareessentialasalltheaforementionedconditionsareasignificantthreattoapatient’slife.However,acuteaorticsyndromeandespeciallyaorticintramuralhematomamaybechallengingdiagnosticproblems.Intravascularultrasoundimagingisadiagnosticmethodthatcanbeusefulformorethoroughevaluationoftheaorticlesionandcanparticularlyaidindiscerningthedifferentformsofacuteaorticsyndrome.Wepresentacaseofapatientwithaorticintramuralhematomathatwasmissedbyconventionalimagingstudiesbutwassuccessfullyvisualizedwithintravascularultrasoundimaging.

简介：AbstractPurpose:To analyze the efficacy and outcome of percutaneous thoracic endovascular aortic repair (TEVAR) in patients with traumatic blunt aortic injury in our single-center.Methods:From January 2014 to December 2018, a total of 89 patients with traumatic blunt aortic injuries were treated with emergency TEVAR in our center. Their clinical data such as demographics, operative details and postprocedure outcomes were analyzed retrospectively in this study using SPSS 20 software. Continuous variables were expressed as mean and standard deviation or median and interquartile range. Categorical variables are expressed as the numbers and percentages of patients.Results:The median age of the patients was 37 years, and 76 (85.4%) were males. All the patients were involved in violent accidents and combined with associated injuries. Two patients died while awaiting the operations and 87 patients underwent emergency percutaneous TEVAR, with a 100% technique success. The mean time interval from admission to operating room was (90.1 ± 18.7) min, and the mean procedure time was (54.6 ± 11.9) min. Eighty (92.0%) patients were operated on under local anesthesia, while other 7 (8.0%) patients were under general anesthesia. Two cases underwent open repair of the femoral arteries because of the pseudoaneurysm formation of the access vessels. A total of 98 aortic covered stent grafts were deployed, of which 11 patients used two stent grafts (all in dissection cases). The length of the stent was (177.5 ± 24.6) mm. The horizontal diameter of aorta arch at the proximal left subclavian artery ostium was (24.9 ± 2.4) mm, the proximal diameter of the covered stent was (30.5 ± 2.6) mm, and the oversize rate of proximal site was (22.7 ± 4.0)%. The proximal landing zone length was (14.1 ± 5.5) mm. The left subclavian artery ostium was completely covered in 5 patients and partially covered in 32 patients. No blood flow reconstruction was performed. The overall aortic-related mortality was 2.25% (2/89). Among 87 patients, the median follow-up time was 24 months. Postoperative computed tomography angiography scans demonstrated no residual pseudoaneurysm, hematoma or endoleak. One patient complained of mild left upper limb weakness during follow-up due to left subclavian artery occlusion. Neither late death, nor neurological or other complications occurred.Conclusion:Emergency percutaneous endovascular repair is a less invasive and effective approach for the treatment of traumatic blunt aortic injuries. Long-term results remain to be further followed.

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简介：AbstractBackground:The past decade has witnessed an ever-increasing momentum of transcatheter aortic valve replacement (TAVR) and a subsequent paradigm shift in the contemporary management of severe aortic stenosis (AS). We conducted a multi-centric TAVR registry based on Chinese patients (the China Aortic valve tRanscatheter Replacement registrY [CARRY]) to delineate the clinical characteristics and outcomes of Chinese patients who underwent TAVR and compare the results between different valve types in different Chinese regions.Methods:CARRY is an all-comer registry of aortic valve disease patients undergoing TAVR across China and was designed as an observational study that retrospectively included all TAVR patients at each participating site. Seven hospitals in China participated in the CARRY, and 1204 patients from April 2012 to November 2020 were included. Categorical variables were compared using the chi-squared test, and continuous variables were analyzed using a t test or analysis of variance (ANOVA) test. The Kaplan-Meier curve was used to estimate the risk of adverse events during follow-up.Results:The mean age of the patients was 73.8 ± 6.5 years and 57.2% were male. The median Society of Thoracic Surgeon-Predicted Risk of Mortality score was 6.0 (3.7-8.9). Regarding the aortic valve, the proportion of bicuspid aortic valve (BAV) was 48.5%. During the hospital stay, the stroke rate was 0.7%, and the incidence of high-degree atrioventricular block indicating permanent pacemaker implantation was 11.0%. The in-hospital all-cause mortality rate was 2.2%. After 1 year, the overall mortality rate was 4.5%. Compared to patients with tricuspid aortic valve (TAV), those with BAV had similar in-hospital complication rates, but a lower incidence of in-hospital mortality (1.4% vs. 3.3%) and 1 year mortality (2.3% vs. 5.8%).Conclusions:TAVR candidates in China were younger, higher proportion of BAV, and had lower rates of post-procedural complications and mortality than other international all-comer registries. Given the use of early generation valves in the majority of the population, patients with BAV had similar rates of complications, but lower mortality than those with TAV. These findings further propel the extension of TAVR in low-risk patients.Trial Registration:https://www.chictr.org.cn/(No. ChiCTR2000038526).

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简介：A70-year-oldmanisseenforevaluationofaheartmurmurheardbyhisprimarycareprovider.Thepatientplaysdoublestennistwiceperweekandclaimstobeasymptomatic.–Medication:amlodipineforhypertension.–Physicalexamination(PE):pulse82bpm;bloodpressure140/90mmHg.–Neck:neckveinsflat.Carotidsdelayed.–Chest:clear.–Cardiovascular:grade2/6latepeakingsystolicejectionmurmur.–Extremities:normalpulses.–Echocardiogram:heavilycalcifiedaorticvalve.Peakjetvelocity4.6m/s.Aorticvalvearea0.7cm2.Rightventricularsystolicpressurenotobtainable.

简介：AbstractBackground:Acute type A aortic dissection (ATAAD) and acute type A intramural hematoma (ATAIMH) are life-threatening diseases with high mortality. To better understand their clinical features in the Chinese population, we analyzed the data from the first Registry of Aortic Dissection in China (Sino-RAD) to promote the understanding and management of the diseases.Methods:All patients with ATAAD and ATAIMH enrolled in Sino-RAD from January 1, 2012 to December 31, 2016 were involved. The data of patients’ selection, history, symptoms, management, outcomes, and postoperation complications were analyzed in the study. The continuous variables were compared using the Student’s t test for normal distributions and the Mann-Whitney U test for non-normal distributions. Categorical variables were compared using the Chi-square test or Fisher exact test.Results:A total of 1582 patients with ATAAD and 130 patients with ATAIMH were included. The mean age of all patients was 48.4 years. Patients with ATAAD were significantly younger than patients with ATAIMH (48.9 years vs. 55.6 years, P < 0.001). For the total cohort, males were dominant, but the male ratio of patients with ATAAD was significantly higher compared to those with ATAIMH (P = 0.01). The time range from the onset of symptom to hospitalization was 2.0 days. More patients of ATAIMH had hypertension than that of ATAAD (82.3% vs. 67.6%, P < 0.05). Chest and back pain were the most common clinical symptoms. Computerized tomography (CT) was the most common initial diagnostic imaging modality. 84.7% received surgical treatment and in-hospital mortality was 5.3%. Patients with ATAAD mainly received surgical treatment (89.6%), while most patients with ATAIMH received medical treatment (39.2%) or endovascular repair (35.4%).Conclusions:Our study suggests that doctors should comprehensively use clinical examination and genetic background screening for patients with ATAAD and ATAIMH and further shorten the time range from symptoms onset to intervention, achieving early diagnosis and treatment, thereby reducing the mortality rate of patients with aortic dissection in China. We should standardize the procedures of aortic dissection treatment and improve people’s understanding. Meanwhile, the curing and transferring efficiency should also be improved.

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简介：根据文学，仅仅关于渗透胸的主动脉的损伤的出现的一个小比例能成功地被对待。此处，我们报导我们缺乏的一所农村医院里的如此的一个病人的最近的营救的经验推进了仪器为心肺绕过操作。20岁的男性在在无名的动脉和左普通颈动脉动脉之间的大动脉的拱门上和1.5厘米的撕裂与破坏无名的静脉和恰好普通的颈动脉动脉为渗透的损害被招收。没有实现，病人成功地被救心肺绕过。在这种情况中的表示和管理被讨论。

简介：Theobjectiveofthisstudyistoinvestigatethehemodynamicsinpatient-specificthoracicaorticaneurysmanddiscussthereasonforformationofaorticplaque.A3-Dimensionalpulsatilebloodflowinthoracicaortawithafusiformaneurysmand3mainbranchedvesselswasstudiednumericallywiththeaverageReynoldsnumberof1399andtheWomersleynumberof19.2.Basedontheclinical2-DimensionalCTslicedata,thepatient-specificgeometrymodelwasconstructedusingmedicalimageprocesssoftware.Un...

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