OPERATIONS ON LARGE ARTERIES—Application of Recent Advances

With the use of anticoagulants to prevent recurrence of thrombosis it is now possible to open a major artery which has been occluded by a thrombus, remove the thickened lining with the clot and restore the continuity of the vessel. Free vein grafts have been used successfully to replace arterial segments in the extremities. Vein inlay grafts are preferred in dealing with aneurysms of the abdominal aorta. The aneurysmal wall can be used to support the venous segments.It has been possible to by-pass aneurysms of the abdominal aorta by anastomosing the splenic artery to the left iliac artery. The use of the left superficial femoral artery as a by-pass to supply blood to the right leg is described.     

Biomechanical and morphometric properties of the arterial wall referenced to the zero-stress state in experimental diabetes

Morphometric and passive biomechanical properties were studied in isolated segments of the thoracic and abdominal aorta, left common carotid artery, left femoral artery and the left pulmonary artery in 20 non-diabetic and 28 streptozotocin (STZ)-induced diabetic rats. The diabetic and non-diabetic rats were divided into groups living 1, 4, 8, and 12 weeks after the induction of diabetes (n = 7 for each diabetic group) or sham injection (n = 5 for each group). The mechanical test was performed as a distension experiment where the proximal end of the arterial segment was connected via a tube to the container used for applying pressures to the segment and the distal end was left free. The vessel diameter and length were obtained from digitized images of the arterial segments at pre-selected pressures and at no-load and zero-stress states. Circumferential and longitudinal stresses (force per area) and strains (deformation) were computed from the length, diameter and pressure data and from the zero-stress state data. The zero-stress state was obtained by cutting vessel rings radially causing the rings to open up into a sector. Diabetes was associated with pronounced morphometric changes, e.g., wall thickness. With respect to the biomechanical data, the opening angle increased and reached a plateau in 4 weeks after which it decreased again (p < 0.05). The opening angle was smallest in the thoracic aorta and largest in the pulmonary artery. Furthermore, it was found that the circumferential stiffness of the arteries studied increased with the duration of diabetes. In the longitudinal direction significant differences were found 8 weeks after injection of STZ in all arteries except the pulmonary artery. In the 12 weeks group, the femoral artery was stiffest in the circumferential direction whereas the thoracic aorta was stiffest in the longitudinal direction. The accumulated serum glucose level correlated with the arterial wall thickness and elastic modulus (correlation coefficient between 0.56 and 0.81).     

Use of simultaneous pressure and velocity measurements to estimate arterial wave speed at a single site in humans

It has not been possible to measure wave speed in the human coronary artery, because the vessel is too short for the conventional two-point measurement technique used in the aorta. We present a new method derived from wave intensity analysis, which allows derivation of wave speed at a single point. We apply this method in the aorta and then use it to derive wave speed in the human coronary artery for the first time. We measured simultaneous pressure and Doppler velocity with intracoronary wires at the left main stem, left anterior descending and circumflex arteries, and aorta in 14 subjects after a normal coronary arteriogram. Then, in 10 subjects, serial measurements were made along the aorta before and after intracoronary isosorbide dinitrate. Wave speed was derived by two methods in the aorta: 1) the two-site distance/time method (foot-to-foot delay of pressure waveforms) and 2) a new single-point method using simultaneous pressure and velocity measurements. Coronary wave speed was derived by the single-point method. Wave speed derived by the two methods correlated well (r = 0.72, P < 0.05). Coronary wave speed correlated with aortic wave speed (r = 0.72, P = 0.002). After nitrate administration, coronary wave speed fell by 43%: from 16.4 m/s (95% confidence interval 12.6-20.1) to 9.3 m/s (95% confidence interval 6.5-12.0, P < 0.001). This single-point method allows determination of wave speed in the human coronary artery. Aortic wave speed is correlated to coronary wave speed. Finally, this technique detects the prompt fall in coronary artery wave speed with isosorbide dinitrate.     

Differential patterns of relaxation by synthetic atrial peptide (APII) in the pulmonary artery, ascending and distal abdominal aorta

The vasodilatory effects of the synthetic rat atriopeptin (APII) have been studied in vitro in agonist-contracted, endothelium-denuded segments of the rat pulmonary artery, the ascending, and the distal abdominal aorta. In the pulmonary artery the contractures to methoxamine were inhibited more potently by APII (pD2 = 9.10 +/- 0.40, n = 6) than by the vasodilatory neuropeptide VIP (pD2 = 7.37 +/- 0.66, n = 6). The intrinsic activity of APII was 0.46 +/- 0.16 (n = 6). In segments previously exposed to either VIP or the beta 2-agonist salbutamol, APII was a near complete agonist (alpha = 0.82 +/- 0.17, n = 7 and 0.84 +/- 0.14, n = 6, respectively) without significant changes in the potencies. APII was a complete agonist also for the inhibition of the alpha-agonist-contracted segments of the aorta, however, with potencies 10-fold lower than in the pulmonary artery. VIP was without functionally significant effects in the aorta. The tachykinins (CGRP, SP, Neurokinins A and B) were without effects in all segments tested. In the ascending aorta, APII induced a long-lasting tachyphylaxis to the alpha-agonists, nearly completely abolishing the subsequent responsiveness to NA and methoxamine for more than 4 h.     

两种早期心衰大鼠模型的建立和心功能的比较

目的比较两种不同方法建立大鼠心衰模型心功能的特点,寻找大鼠模型早期心衰阶段。方法用冠脉结扎法及腹主动脉结扎法建立不同的心衰模型,用血流动力学及心脏称重的方法比较其心功能的各项指标。结果冠脉结扎组术后2周没有心功能的改变,2周后收缩和舒张功能均下降,4周达最低。腹主动脉结扎组术后14周没有心功能的下降,16周出现了舒张功能的衰竭。结论冠脉结扎法及腹主动脉结扎法均可以造成早期心衰,冠脉结扎法术后2周为早期心衰阶段,2周后同时出现收缩和舒张功能衰竭,腹主动脉结扎法术后14周为早期心衰阶段,14周后出现了舒张功能衰竭。     

Heterotopic heart transplantation in mice

The mouse heterotopic heart transplantation has been used widely since it was introduced by Drs. Corry and Russell in 1973. It is particularly valuable for studying rejection and immune response now that newer transgenic and gene knockout mice are available, and a large number of immunologic reagents have been developed. The heart transplant model is less stringent than the skin transplant models, although technically more challenging. We have developed a modified technique and have completed over 1000 successful cases of heterotopic heart transplantation in mice. When making anastomosis of the ascending aorta and abdominal aorta, two stay sutures are placed at the proximal and distal apexes of recipient abdominal aorta with the donor s ascending aorta, then using 11-0 suture for anastomosis on both side of aorta with continuing sutures. The stay sutures make the anastomosis easier and 11-0 is an ideal suture size to avoid bleeding and thrombosis.When making anastomosis of pulmonary artery and inferior vena cava, two stay sutures are made at the proximal apex and distal apex of the recipient s inferior vena cava with the donor s pulmonary artery. The left wall of the inferior vena cava and donor s pulmonary artery is closed with continuing sutures in the inside of the inferior vena cava after, one knot with the proximal apex stay suture the right wall of the inferior vena cava and the donor s pulmonary artery are closed with continuing sutures outside the inferior vena cave with 10-0 sutures. This method is easier to perform because anastomosis is made just on the one side of the inferior vena cava and 10-0 sutures is the right size to avoid bleeding and thrombosis. In this article, we provide details of the technique to supplement the video.     

Numerical simulation of fluid–structure interaction in bypassed DeBakey III aortic dissection

It was found that bypass graft alone could achieve great effects in treating aortic dissection. In order to investigate the mechanical mechanism and the haemodynamic validity of the bypassing treatment for DeBakey III aortic dissection, patient-specific models of DeBakey III aortic dissection treated with different bypassing strategies were constructed. One of the bypassing strategies is bypassing between ascending aorta and abdominal aorta, and the other is bypassing between left subclavian artery and abdominal aorta. Numerical simulations under physiological flow conditions based on fluid–structure interaction were performed using finite element method. The results show that blood flow velocity, pressure and vessel wall displacement of false lumen are all reduced after bypassing. This phenomenon indicates that bypassing is an effective surgery for the treatment of DeBakey III aortic dissection. The effectiveness to cure through lumen is better when bypassing between left subclavian artery and abdominal aorta, while the effectiveness to cure blind lumen is better when bypassing between ascending aorta and abdominal aorta.     

压力负荷型心肌肥厚大鼠心肌组织相关基因的分离

心肌肥厚是心血管疾病常见的临床并发症 ,与冠心病、心衰、脑卒中等心血管疾病密切相关[1] ,其发生机制目前仍不清楚 .探讨其机制将为心肌肥厚及相关疾病的研究和治疗提供有益的线索 .本研究选用腹主动脉绑扎的左心室肥厚大鼠模型 ,运用差减杂交法 ,研究其中相关基因的表达变化 .1　材料和方法1 .1　压力负荷型左心室肥厚大鼠模型采用腹主动脉缩窄法[2 ] :雄性健康 Wistar大鼠 ( 2 0 0 g左右 )用速眠新 846合剂麻醉 ,将直径 0 .7mm的小圆棒以3/0丝线绕腹主动脉一起绑紧 ,抽出小圆棒 .对照组行假手术 .大鼠血压测量采用颈动脉插管 (术后 2 8…     

Peripheral arteriosclerosis; arterial grafting procedures; indications and results. I. Arteriosclerotic aneurysms

In 32 cases aneurysms of the aorta and peripheral arteries were resected and replaced by grafts. The results from the use of homografts in 18 cases were more satisfactory than with the use of Ivalon in 14 cases. The abdominal aorta was the most frequent location of aneurysms. The current mortality rate of 5.5 per cent for resection of unruptured abdominal aneurysms indicates that resection and grafting are an effective means of reducing the high mortality of untreated aneurysms. Five ruptured aneurysms were excised, with a mortality rate of 40 per cent. The uniformly fatal outcome of untreated ruptured abdominal aneurysms makes it obligatory for the surgeon to operate immediately after the diagnosis is first made.     

PERIPHERAL ARTERIOSCLEROSIS—Arterial Grafting Procedures—Indications and Results—Part I: Arteriosclerotic Aneurysms

In 32 cases aneurysms of the aorta and peripheral arteries were resected and replaced by grafts. The results from the use of homografts in 18 cases were more satisfactory than with the use of Ivalon in 14 cases. The abdominal aorta was the most frequent location of aneurysms.The current mortality rate of 5.5 per cent for resection of unruptured abdominal aneurysms indicates that resection and grafting are an effective means of reducing the high mortality of untreated aneurysms. Five ruptured aneurysms were excised, with a mortality rate of 40 per cent. The uniformly fatal outcome of untreated ruptured abdominal aneurysms makes it obligatory for the surgeon to operate immediately after the diagnosis is first made.     

SURGICAL MANAGEMENT OF DISSECTING ANEURYSM—The Use of a Simplified Bypass

The alarming mortality in cases of dissecting aneurysm of the aorta has stimulated the development of a surgical technique which results in re-entry of the dissecting channel. During the operative procedure prolonged cross-clamping of the aorta is necessary. While hypothermia will provide protection to the spinal cord and kidneys during reasonable periods of aortic occlusion it will not relieve back pressure on the left ventricle.By the use of a simple bypass blood is drained from the left atrium into a reservoir and then pumped into the lower aorta via the femoral artery. Thus an adequate supply of oxygenated blood is delivered to the spinal cord and kidneys distal to the occlusion while the left ventricular pressure is decompressed to normal levels. The volume of the shunted blood is simply controlled by monitoring the brachial artery pressure with a cuff sphygmomanometer. This simplified bypass has permitted successful repair of a dissecting aneurysm with complete occlusion of the thoracic aorta for a period of two hours.     

Day-night variation in the in vitro contractility of aorta and mesenteric and renal arteries in transgenic hypertensive rats

TGR(mREN2)27 (TGR) rats develop severe hypertension and an inverted circadian blood pressure profile with peak blood pressure in the daytime rest phase. The present study investigated the in vitro responsiveness of different arteries of TGR rats during day and night. Twelve-week-old TGR rats and normotensive Sprague-Dawley (SPRD) controls, synchronized to 12h light, 12h dark (LD 12:12) (light 07:00 19:00), were killed at 09:00 (during rest) and 21:00 (during activity), and endothelium-dependent relaxation by acetylcholine and vascular contraction by angiotensin II were studied by measuring isometric force in ring segments of abdominal aorta and mesenteric and renal arteries. In SPRD rats, consistent day-night variation was found, with greater responses to angiotensin II during the daytime rest span. In TGR rats, biological time-dependent differences were found in the renal vasculature, but not in the aorta and mesenteric artery. Relaxation of SPRD rat aorta and mesenteric artery by acetylcholine was greater at 09:00, whereas in TGR rats, day-night variation was absent (mesenteric artery) or inverted (aorta). In conclusion, based on the study of two time points, daynight variation in vascular contractility of aorta and mesenteric artery is blunted in TGR rats, whereas renal artery segments showed an unchanged daynight pattern compared to SPRD controls. (Chronobiology International, 18(4), 665 681, 2001)     

Differential vasoconstrictions induced by angiotensin II: role of AT1 and AT2 receptors in isolated C57BL/6J mouse blood vessels

Genetically altered mice are increasingly used as experimental models. However, ANG II responses in mouse blood vessels have not been well defined. Therefore, the aim of this study was to determine the role of ANG II in regulating major blood vessels in C57/BL6J mice with isometric force measurements. Our results showed that in mouse abdominal aorta ANG II induced a concentration-dependent contraction (EC50 4.6 nM) with a maximum contraction of 75.1 +/- 4.9% at 100 nM compared with that of 60 mM K+. Similarly, femoral artery also exhibited a contractile response of 76.0 +/- 3.4% to the maximum concentration of ANG II (100 nM). In contrast, ANG II (100 nM)-induced contraction was significantly less in carotid artery (24.5 +/- 6.6%) and only minimal (3.5 +/- 0.31%) in thoracic aorta. The nitric oxide synthase inhibitor N omega-nitro-L-arginine methyl ester and the AT2 antagonist PD-123319 failed to enhance ANG II-induced contractions. However, an AT1 antagonist, losartan (10 microM), completely inhibited ANG II (100 nM) response in abdominal aorta and carotid artery. An AT1 agonist, [Sar1]-ANG II (100 nM), behaved similarly to ANG II (100 nM) in abdominal aorta and carotid artery. RT-PCR analyses showed that mouse thoracic aorta has a significantly lower AT1 mRNA level than abdominal aorta. These results demonstrate that major mouse vessels exhibit differential contractions to ANG II, possibly because of varied AT1 receptor levels.     

DAY-NIGHT VARIATION IN THE IN VITRO CONTRACTILITY OF AORTA AND MESENTERIC AND RENAL ARTERIES IN TRANSGENIC HYPERTENSIVE RATS*

TGR(mREN2)27 (TGR) rats develop severe hypertension and an inverted circadian blood pressure profile with peak blood pressure in the daytime rest phase. The present study investigated the in vitro responsiveness of different arteries of TGR rats during day and night. Twelve-week-old TGR rats and normotensive Sprague-Dawley (SPRD) controls, synchronized to 12h light, 12h dark (LD 12:12) (light 07:00 19:00), were killed at 09:00 (during rest) and 21:00 (during activity), and endothelium-dependent relaxation by acetylcholine and vascular contraction by angiotensin II were studied by measuring isometric force in ring segments of abdominal aorta and mesenteric and renal arteries. In SPRD rats, consistent day-night variation was found, with greater responses to angiotensin II during the daytime rest span. In TGR rats, biological time-dependent differences were found in the renal vasculature, but not in the aorta and mesenteric artery. Relaxation of SPRD rat aorta and mesenteric artery by acetylcholine was greater at 09:00, whereas in TGR rats, day-night variation was absent (mesenteric artery) or inverted (aorta). In conclusion, based on the study of two time points, daynight variation in vascular contractility of aorta and mesenteric artery is blunted in TGR rats, whereas renal artery segments showed an unchanged daynight pattern compared to SPRD controls. (Chronobiology International, 18(4), 665 681, 2001)     

CT增强对比剂的不同浓度和流速对肾脏增强图像质量的影响

目的：探讨128排螺旋CT扫描增强对比剂的不同浓度和流速对肾脏增强图像质量的影响。方法：回顾性分析2011年7月~2013年5月间于我院影像科行腹部增强CT扫描检查的患者136例,对采用不同浓度（300 mgI/mL、350 mgI/mL）和不同流速（3 mL/s、5 mL/s）的图像质量,选取选取左肾动脉开口处腹主动脉（D）、左/右肾脏动脉（E）、左/右肾脏静脉（F）、左/右肾皮质（G）、左/右肾实质（H）作为感兴区进行分析,评估碘海醇浓度及流速增强剂对图像质量的影响。结果：不同浓度相同流速增强剂对图像质量的影响比较：左肾动脉开口处腹主动脉、肾脏动脉、肾脏静脉血管显影质量比较差异无统计学意义,P〉0.05;肾皮质、肾实质差异有统计学意义,P〈0.05;相同浓度不同流速增强剂对图像质量的影响差异各部位均有统计学意义,均P〈0.05。结论：较高碘海醇使用浓度和较快的注射流速对肾脏血流显影有帮助,因此,在安全剂量范围内,适当增加碘海醇使用浓度及增加对比剂的注射速度会提高肾脏增强扫描的图像质量。     

A computational method for calculating distensibility of the blood vessel in vivo.

A computational method for calculating the dynamic distensibility of the vessel wall in vivo, developed on the basis of the pressure pulse transmission, is proposed. Distensibilities of descending thoracic aorta, abdominal aorta, and femoral artery in normal dogs, and of femoral artery of a typical dog under the action of vasoactive drugs, have been calculated. In femoral artery it is compared with the values of the diameter change/pressure change. Comparison of the results clearly indicate the feasibility of the proposed method. The order of distensibility found is: descending thoracic aorta greater than abdominal aorta greater than femoral artery.     

Long-lasting improvement of myocardial perfusion and chronic refractory angina after autologous intramyocardial PBSC transplantation

We report the case of a 60-year-old man with patent coronary by-pass grafts on the left anterior descending and circumflex coronary arteries, who experienced recurrent Canadian class IV angina refractory to medical and interventional treatments for a dominant right coronary artery occlusion. He underwent autologous PBSC transplant into the inferior ventricular wall through a minimally invasive approach as a stand-alone therapy, in an attempt to induce therapeutic angiogenesis. Six months after the operation, angina significantly ameliorated; scintigraphy and coronary angiography showed a marked improvement in perfusion of the target injection area. These benefits had persisted at 25 months after stem cell transplant.     

Comparative study of major lipid constituents in human and monkey aorta

The contents of total lipids, phospholipids, cholesterol, triglyceride and free fatty acid in intima and media of thoracic and abdominal segments of aorta from normal human subjects and rhesus monkeys were determined. An increase in total lipids in intima as compared to that of media was noted in both species. A comparison of lipid contents of thoracic and abdominal segments from both species revealed that abdominal segment contained significantly greater lipid. Further, human thoracic and abdominal aortic intima and media had higher content of cholesterol as compared to that of monkey aorta. The differences in lipid profile in aorta of these two species have been highlighted to provide a clue with respect to the differences in the prevalence and morphology of atherosclerosis as seen in monkey and man.     

Indoleamine 2,3-diooxygenase in periaortic fat: mechanisms of inhibition of contraction

Indoleamine 2,3-dioxygenase (IDO) metabolizes L-tryptophan to L-kynurenine, promotes immunosuppression, and has been described as a consumer of superoxide. We discovered IDO expression in periaortic fat and tested the hypothesis that periarterial IDO functionally reduces agonist-induced contraction. Our model was the thoracic aorta, abdominal aorta, and superior mesenteric artery of the male Sprague-Dawley rat. Periaortic fat from the thoracic aorta stained intensely for IDO, the brown fat marker uncoupling protein-1, and oil red O as a general lipid marker. White fat around the mesenteric artery and abdominal aorta stained less for IDO; brown fat was less abundant. IDO activity (kynurenine-to-tryptophan ratio via HPLC) was detected in visceral and mesenteric artery fat (ratio: ～4) but was highest in perithoracic aortic fat (ratio: 10 ± 1.1). In isometric contractile experiments, periadventitial fat reduced ANG II-induced thoracic aortic (with fat: 34% of without fat) and mesenteric artery (with fat: 63% of without fat) maximal contraction. In contrast, periadventitial fat did not reduce agonist-induced contraction in the abdominal aorta. The IDO inhibitor 1-L-methyltryptophan (1-MT) reversed the fat-induced reduction of ANG II-induced contraction in the thoracic aorta but not in the mesenteric artery. The IDO metabolite kynurenine relaxed the thoracic aorta only at high (9 mM) concentrations, whereas the downstream metabolite quinolinic acid (1 mM) relaxed the contracted thoracic aorta (～80%). 1-MT did not correct the reduction in basal superoxide levels observed in the presence of perithoracic aortic fat. We conclude that IDO is an enzyme active primarily in brown fat surrounding the thoracic aorta and depresses aortic contractility.     

The Treatment of Multiple Coronary Occlusions by Internal Mammary Artery Implantation and Omental Graft: Report on Two Human Cases

The importance of triple coronary artery disease was evident in 125 patients undergoing internal mammary artery implantation, when some patients died from right coronary artery occlusion. This occurred even when the internal mammary artery was patent and revascularizing the left ventricle.In 1961 the free omental graft operation was developed to revascularize both right and left ventricles. In animals this operation has proved most effective in preventing death after application of Ameroid constrictors to all three coronary arteries. Arteriolar or larger-sized vessels rapidly formed between the aorta and omentum and the pericardium and omentum and the heart and omentum.Two patients with triple coronary artery disease underwent internal mammary artery implantation and free omental graft early in December 1962. Postoperative convalescence was uneventful. They have returned home and appear to be improved. Wrapping the entire heart with the free omental graft has produced little reaction, suggesting that, as in the animal, the grafts are surviving.