Bicuspid stenotic aortic valves: clinical characteristics and morphological assessment using MRI and echocardiography

Background

Bicuspid aortic valve (BAV) is one of the most common congenital heart defects with a population prevalence of 0.5% to 1.3%. Identifying patients with BAV is clinically relevant because BAV is associated with aortic stenosis, endocarditis and ascending aorta pathology.

Methods and Results

Patients with severe aortic stenosis necessitating aortic valve replacement surgery were included in this study. All dissected aortic valves were stored in the biobank of the University Medical Centre Utrecht. Additionally to the morphological assessment of the aortic valve by the surgeon and pathologist, echocardiographic and magnetic resonance imaging (MRI) images were evaluated. A total of 80 patients were included of whom 32 (40%) were diagnosed with BAV by the surgeon (gold standard). Patients with BAV were significantly younger (55 vs 71 years) and were more frequently male. Notably, a significant difference was found between the surgeon and pathologist in determining valve morphology. MRI was performed in 33% of patients. MRI could assess valve morphology in 96% vs 73% with echocardiography. The sensitivity of MRI for BAV in a population of patients with severe aortic stenosis was higher than echocardiography (75% vs 55%), whereas specificity was better with the latter (91% vs 79%). Typically, the ascending aorta was larger in patients with BAV.

Conclusion

Among unselected patients with severe aortic valve stenosis, a high percentage of patients with BAV were found. Imaging and assessment of the aortic valve morphology when stenotic is challenging.     

二尖瓣置换术后左心室破裂2例并文献复习

目的：总结二尖瓣置换术后左心室破裂2例临床经验教训,方法：回顾性分析我院2006,1．2009,12二尖瓣置换术后左心室破裂2例的临床资料,两例均在监护室里发生突然大出血,紧急输血,输液,机械呼吸,抗休克治疗,并行开胸手术。结果：一例心外修补抢救成功,术后2周顺利出院,一例CPB下心内外修补,因低心排综合症死亡。结论：左心室破裂是二尖瓣置换术最严重的并发症,一旦发生死亡率极高,因此预防,避免其相关因素更关键：     

Age-related changes of elements in renal arteries of Thai and Japanese and the relationships among elements

To examine whether there were differences between reces in regard to age-related changes of elements and the relationships among elements in the arteries, the authors investigated both the renal arteries of Thai and Japanese. The Thai subjects consisted of 27 men and 11 women, ranging in age from 27 to 88 yr, whereas the Japanese subjects consisted of 19 men and 26 women, ranging in age from 61 to 99 yr. After the ordinary dissections at Chiang Mai University and Nara Medical University were completed, the bilateral renal arteries were resected and the element contents were determined by inductively coupled plasma-atomic emission spectrometry. In the Thai, a slight accumulation of calcium and phosphorus occurred in the fifties, but thereafter headly increased. In contrast, in the Japanese, an accumulation of calcium and phosphorus began to occur in the seventies and increased markedly in the eighties. The result reveraled that a higher accumulation of calcium and phosphorus occurred in the renal arteries of the Japanese in old age compared with those of the Thai. Regarding the relationships among elements, extremely or very significant direct correlations were found among the contents of calcium, phosphorus, magnesium, and sodium in both the renal arteries of the Thai and Japanese, except for magnesium and sodium contents in the renal arteries of the Thai.     

Blocked stomodeal valve of the insect vector: similar mechanism of transmission in two trypanosomatid models

The regurgitation of metacyclic stages from the sand fly cardia is thought to be the prevailing mechanism of Leishmania transmission. This regurgitation may result through damage of the stomodeal valve and its mechanical block by the parasites. We found this phenomenon in three sand fly-Leishmania models and also in avian trypanosomes transmitted by Culex mosquitoes. Phlebotomus duboscqi, Phlebotomus papatasi, Lutzomyia longipalpis, and Culex pipiens were membrane-fed on blood containing Leishmania major, Leishmania chagasi (syn. infantum) and an unidentified avian Trypanosoma from Trypanosoma corvi clade, respectively. Females with the late-stage infections were processed for the optical and transmission electron microscopy. Localization of the parasites and changes to the stomodeal valve were in some aspects similar in all vector-parasite pairs studied: (i) a large plug of flagellates was observed in cardia region, (ii) parasites were attached to the chitin lining of the stomodeal valve by the formation of zonal hemidesmosome-like plaques. Leishmania promastigotes were found both attached to the valve as well as unattached in the lumen of midgut. The stomodeal valve of infected sand flies was opened, its chitin lining was destroyed and the unique filamentous structures on the apical end of cylindrical cells were degraded. In the Culex-Trypanosoma model, the whole population of epimastigotes was found in close contact with the chitin lining, and degenerative changes of the valve were less pronounced. We suggest that the phenomenon involving a blocked valve facilitating the regurgitation of parasites into the vertebrate host may occur generally in heteroxenous trypanosomatids transmitted by the bite of nematoceran Diptera.     

Carbonic Anhydrase of the Alkaliphilic Cyanobacterium Microcoleus chthonoplastes

The activity of carbonic anhydrase (CA) was studied in different cell fractions of the alkaliphilic cyanobacterium Microcoleus chthonoplastes. The activity of this enzyme was found in the soluble and membrane protein fractions, as well as in intact cells and in a thick glycocalyx layer enclosing the cyanobacterium cells. The localization of CA in glycocalyx of M. chthonoplastes was shown by western blot analysis and by immunoelectron microscopy studies with antibodies to the thylakoid CA from Chlamydomonas reinhardtii (Cah3). At least one of the CA forms occurring in M. chthonoplastes CA was shown to be an -type enzyme. A possible mechanism of the involvement of the glycocalyx CA in calcification of cyanobacteria is discussed.     

钙化胎盘中纳米细菌的分离培养与鉴定

目的分离、培养与鉴定钙化胎盘中的纳米细菌,为进一步探讨纳米细菌致胎盘钙化的机制奠定基础。方法剖腹产手术收集25份钙化胎盘组织标本,通过脱矿、过滤、离心处理,用细胞培养的方法进行纳米细菌培养,观察其生长情况。运用透射电镜、扫描电镜观察培养物形态。结果 (1)培养3~4周后,对钙化组织培养标本进行观察,发现部分培养管底部出现紧贴管壁生长的白色沉淀物。(2)扫描电镜见纳米细菌为大颗粒成簇分布。(3)透射电镜可见纳米细菌为针状物的聚集体,大小不一。结论首次从钙化胎盘组织中分离培养鉴定出纳米细菌,表明其感染与胎盘钙化有关,需进一步研究其矿化机制以及所致钙化对后代的影响。     

Structure and formation of the adventitious tube of the Japanese watering-pot shell Stirpulina ramosa (Bivalvia, Anomalodesmata, Clavagellidae) and a comparison with that of the Penicillidae

Abstract. Stirpulina ramosa is the only extant endobenthic representative of the Clavagellidae and is restricted to the waters of Japan. A single intact adventitious tube of this species has been obtained and its structure is described. The right valve is 16 mm long and located within the adventitious tube. It has an opisthodetic ligament located on resilifers. There are anterior and posterior adductor muscle scars, a thick pallial line, and pallial and pedal gape (right valve only) sinuses. The left shell valve is but 9 mm long and is united into the fabric of the adventitious tube via the intermediary of a shelly saddle. Internally, only the anterior adductor muscle scar and a small element of the pallial line scar are identifiable on the left valve. The posterior adductor and the rest of the pallial line scar (including a pallial sinus) are, remarkably, located on the adventitious tube beyond the shell valve margin. The adventitious tube of S. ramosa is formed in a manner wholly dissimilar from that of Brechites vaginiferus (Penicillidae). In B. vaginiferus, the tube is secreted as a single entity from the general outer mantle surface, including the siphons, covering the body. As a consequence, both shell valves are incorporated into the structure of the tube and the watering pot is bilaterally symmetrical. In S. ramosa, the tube and watering pot are secreted from the mantle margin and surface surrounding and extending from the left shell valve, so that only the left valve is incorporated into its structure. A dorsally derived mantle element is progressively extended over to the right side of the body, meeting a ventrally derived counterpart that passes beneath it, forming a pleat in the calcareous structure of the right side of the tube that they secrete. This pleat extends into the complex of watering‐pot tubules and forms the pedal gape. The watering pot is thus Ω shaped. The ventrally derived mantle element forms a sinusoidal crest on the right‐hand base of the watering pot, creating a pedal gape sinus scar on the right valve. The Clavagellidae radiated widely in the Mesozoic, leaving behind a rich fossil record for Stirpulina. Only S. ramosa, however, has survived until the present. In contrast, the Cenozoic Penicillidae has a poor fossil record, but there is a rich variety of extant endobenthic watering‐pot shells. It has been argued hitherto that the two families represent a remarkable example of convergent evolution. In view of the success of the Penicillidae and thus the endobenthic, tube‐dwelling lifestyle, however, it is hard to understand why Stirpulina has largely died out—even S. ramosa being known by but one or two specimens. A study of the anatomy of S. ramosa might one day answer this question.     

Transcatheter aortic valve replacement: design, clinical application, and future challenges

Transcatheter aortic valve replacement (TAVR) is a new technology that recently has been shown to improve survival and quality of life in patients with severe symptomatic aortic stenosis who are not surgical candidates. The development and design of transcatheter valves has been ongoing for the past 20 years, and TAVR has now been approved by the FDA as a treatment for aortic stenosis in patients who are not surgical candidates. In the United States, there are currently two transcatheter valves available: the Edwards Sapien Valve and the Medtronic CoreValve. While similar in some design elements, they also have characteristic differences that affect both the mechanism of delivery as well as performance in patients. This review aims to take a closer look at the development of this new technology, review the published clinical results, and look toward the future of transcatheter valve therapeutics and the challenges therein.