Doppler evaluation of maternal and fetal vessels during normal gestation in rabbits

The aim of this work was to evaluate the hemodynamic changes in the utero-placental arterial vessels in rabbits (Orictolagus cuniculus) throughout pregnancy as well as those in the umbilical cord, aorta, and caudal vena cava of fetuses to establish their normal reference ranges for systolic peak velocity (SPV), end diastolic velocity (EDV), pulsatility index (PI), and resistance index (RI). The blood flow waveforms were monitored every 4 d in 10 rabbits from Day 10 of pregnancy onward by means of color and pulsed wave Doppler ultrasonography using a 5.5-7.5 MHz microconvex transabdominal probe. The utero-placental blood flow was characterized by steep increases and decrease in the SPV with a slow diastolic wave and relatively high EDV, whereas that of the umbilical artery was discontinuous until Day 22 of pregnancy, when a diastolic waveform was also detectable. From Day 10 to 22 of pregnancy, the fetal aorta blood flow was discontinuous, but thereafter a diastolic peak was measurable. The blood flow of the fetal caudal vena cava was characterized by a systolic peak followed by a small diastolic peak. Throughout the gestation, the SPV and the EDV of maternal and fetal vessels increased (α < 0.05), whereas the PI and the RI decreased (α < 0.05), except for the utero-placental vessels. This work confirms that the rabbit could also be a valid experimental animal model to study, by Doppler ultrasonography, functional hemodynamic changes of the fetuses and placenta vessels in both normal and pathophysiologic conditions.     

Doppler evaluation of maternal and foetal vessels during normal gestation in queen

The aim of this work is to evaluate the haemodynamic characteristics of maternal and foetal vessels during normal pregnancy in queens, using colour Doppler and pulsed wave Doppler ultrasonography, in order to obtain information about maternal and foetal circulation. The blood waveforms of the uteroplacental arteries, aorta, caudal cava vein and umbilical cord of the fetuses were recorded weekly in seven healthy pregnant queens. Also, the measurements of peak systolic, end diastolic velocities, resistance and pulsatility indices were carried out. Uteroplacental blood flow was biphasic while the ones of the umbilical artery and aorta were first systolic and then diastolic. The caudal cava vein showed a typical waveform of venous vessels. During gestation the EDV and PSV of foetal vessels increased ( < 0.05) while the PI and RI of all vessels examined decreased ( < 0.05) except for the IP of the aorta. The Doppler ultrasonography, also in queens, can be used to evaluate the characteristics of maternal and foetal vessel flow and their progressive changes during pregnancy. This study can be considered the basis for further contribution in diagnosing and monitoring high-risk pregnancies in Veterinary Medicine.     

Measurement of human fetal blood flow.

Real-time B-mode ultrasonography was combined with a pulsed Doppler ultrasound technique for transcutaneous measurement of human fetal blood flow in the aorta and intra-abdominal part of the umbilical vein. The target vessel was located and its diameter measured in the two-dimensional real-time image. The pulsed Doppler transducer was attached to the real-time transducer at a fixed angle. By processing the Doppler shift signals the instrument estimated the mean and maximum blood velocities and the integral under the velocity curves. This permitted calculation of the blood flow. The method was applied to 26 fetuses in normal late pregnancies. Mean blood flow in the descending part of the fetal aorta based on maximum velocity was 191 ml/kg/min. Mean flow in the intra-abdominal part of the umbilical vein was 110 ml/kg/min. This method of measurement is non-invasive and opens new perspectives in studying fetal haemodynamics.     

Role of Thyroid Doppler in Differential Diagnosis of Thyrotoxicosis

ObjectiveTo evaluate the role of thyroid blood flow assessment by color-flow Doppler ultrasonography in the differential diagnosis of thyrotoxicosis.MethodsConsecutive patients with thyrotoxicosis presenting to our center between June 2007 and March 2008 were included in the study. Clinical data were collected, and thyroid function tests including measurements of thyrotropin, total thyroxine, and total triiodothyronine were performed. Thyroid glands of all patients were evaluated with color-flow Doppler ultrasonography for size, vascularity, and peak systolic velocity of the inferior thyroid artery. Technetium Tc 99m pertechnetate scan was done when the diagnosis was not clear on the basis of clinical findings. Patients were divided into 2 groups for analysis: patients with destructive thyrotoxicosis and patients with Graves disease. Paired t tests and Fisher exact tests were used for statistical analysis.ResultsA total of 65 patients participated in the study; 31 had destructive thyrotoxicosis and 34 had Graves disease. Thyroid blood flow, as assessed by peak systolic velocity of the inferior thyroid artery, was significantly higher in patients with Graves disease than in patients with destructive thyroiditis (57.6 ± 13.1 cm/s vs 22.4 ± 5.4 cm/s; P < .05). All patients with destructive thyroiditis had low peak systolic velocity of the inferior thyroid artery, and 32 of 34 patients with Graves disease had high peak systolic velocity. Color-flow Doppler ultrasonography parameters correlated significantly with pertechnetate scan results, demonstrating a comparable sensitivity of 96% and specificity of 95%.ConclusionsDifferentiating Graves thyrotoxicosis from destructive thyrotoxicosis is essential for proper selection of therapy. Assessment of thyroid blood flow by color-flow Doppler ultrasonography is useful in this differentiation. (Endocr Pract. 2009;15:6-9)     

Measurement of the blood flow velocity in the pericallosal artery of children with hydrocephalus by transcranial Doppler ultrasonography--preliminary results

AIM: The goal of this study was to evaluate selected parameters of the Doppler curve of the pericallosal artery at children with hydrocephalus. METHODS: 12 patients with hydrocephalus were divided into two groups. Group 1 comprised children needing cerebrospinal fluid drainage, and group 2 comprised children without any indication for drainage or with an already inserted well-functioning drainage system. Dilatation of the cerebral ventricles was determined by transcranial ultrasonography. Following parameters of a blood flow of the pericallosal branch of the anterior cerebral artery: peak systolic blood flow velocity (PSFV), end-diastolic blood flow velocity (EDFV) and resistive index (RI) were observed by transcranial Doppler ultrasonography. Parameters of The Doppler curve were measured without pressure (baseline parameters) and during compression of the anterior fontanelle (pressure provocation test). RESULTS: Group 1: baseline parameters: PSFV 68.9 +/- 13.52 cm/s, EDFV 18.26 +/- 10.39 cm/s, RI 0.76 +/- 0.12; parameters during pressure provocation test: PSFV 66.92 +/- 19.75 cm/s, EDFV 10.88 +/- 11.18 cm/s, RI 0.86 +/- 0.14. Group 2: baseline parameters: PSFV 59.95 +/- 19.38 cm/s, EDFV 20.65 +/- 8 cm/s, RI 0.65 +/- 0.04; parameters during the pressure provocation test: PSFV 57.14 +/- 18.91 cm/s, EDFV 17.7 +/- 8.3 cm/s, RI 0.68 +/- 0.05. CONCLUSION: The results show increased baseline and postcompressive values of RI of pericallosal artery in infants with hydrocephalus before drainage procedure and normal values of RI at children without the need for cerebrospinal fluid drainage or with a well-functioning drainage system.     

The effect of regular physical activity on the left ventricle systolic function in patients with chronic coronary artery disease

The purpose of this study was to assess the influence of aerobic training on the left ventricular (LV) systolic function. Thirty patients with stable coronary artery disease, who had participated in the conducted 3-month physical training, were retrospectively divided into 2 cohorts. While patients in the cohort I (n=14) had continued training individually for 12 months, patients in the cohort II (n=16) had stopped training after finishing the conducted program. Rest and stress dobutamine/atropine echocardiography was performed in all patients before the training program and 1 year later. The peak systolic velocities of mitral annulus (Sa) were assessed by tissue Doppler imaging for individual LV walls. In addition, to determine global LV systolic longitudinal function, the four-site mean systolic velocity was calculated (Sa glob). According to the blood supply, left ventricular walls were divided into 5 groups: A- walls supplied by nonstenotic artery; B- walls supplied by coronary artery with stenosis ≤50 %; C- walls supplied by coronary artery with stenosis 51-70 %; D- walls with stenosis of supplying artery 71-99 %; and E- walls with totally occluded supplying artery. In global systolic function, the follow-up values of Sa glob in cohort I were improved by 0.23±0.36 as compared with baseline values at rest, and by 1.26±0.65 cm/s at the maximal load, while the values of Sa glob in cohort II were diminished by 0.53±0.22 (p=NS), and by 1.25±0.45 cm/s (p<0.05), respectively. Concerning the resting regional function, the only significant difference between cohorts in follow-up changes was found in walls E: 0.37±0.60 versus -1.76±0.40 cm/s (p<0.05). At the maximal load, the significant difference was found only in walls A (0.16±0.84 versus -2.67±0.87 cm/s; p<0.05). Patients with regular 12-month physical activity improved their global left ventricle systolic function mainly due to improvement of contractility in walls supplied by a totally occluded coronary artery.     

Evaluation of the cardiovascular function of older adult Rhesus monkeys by ultrasonography

OBJECTIVE: To evaluate the cardiovascular structure and function of older adult Rhesus monkey by utrasonography. METHODS: Sixteen monkeys aged from 17 to 20 years and weighing from 8.2 to 15.3 kg, six adults aged 7-8 years and weighing from 8.1 to 9.2 kg. All monkeys were determined to be free from hypertension, hyperglycaemia and cardiac disease. The normal values of index related to heart and blood vessels including structure, haemodynamics and systolic or diastolic function were detected by 2D, M-mode, pulsed Doppler and tissue Doppler echocardiography respectively under ketamine hydrochloride sedation. Meanwhile, blood pressures were also measured by electronic sphygmomanometer. Each monkey underwent repeated detections in 2 weeks and all data were analysed with statistical methods. RESULTS: Compared with young adult monkeys, the older's heart rate (HR), the left ventricular diastolic function and the compliance of big artery including right and left common carotid artery, bulbus caroticus, internal carotid artery and abdominal aorta were decreased and the associated indexes changed significantly (P < 0.05 or P < 0.01). Meanwhile, older monkeys exhibited significant increase in the aorta diameter (AO), amplitude of aortic wall (AAO), left atrial diameter (LAD), end diastolic volume of left ventricle (EDV), stroke volume (SV), left ventricular mass (LVM) (P < 0.05 vs. young adult monkeys); however, cardiac output (CO) only slightly increased but the difference did not reach the statistical significance (P = 0.418, P = 0.644 respectively). CONCLUSIONS: The present results demonstrated the profiles of cardiovascular function and structure in the older Rhesus monkeys. Older monkey is accompanied by diminished left ventricular diastolic function and big artery compliance. Ultrasonography provides a means to non-invasively evaluate the anatomy and function of the heart and blood vessel, and plays an increasingly important role in the drug evaluation against cardiovascular dysfunction.     

Study of the development of uteroplacental and fetal feline circulation by triplex Doppler

The objective was to evaluate blood flow in fetal and maternal vessels by Triplex Doppler and its association with development of blood vessels during gestation in the domestic cat. Ten queens were examined weekly from 14 to 63 d after mating. Peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI) and pulsatility index (PI) of uteroplacental, aorta and umbilical fetal arteries and caudal vena cava of the fetus were evaluated. Throughout pregnancy, there was an increase in PSV and EDV in the aorta and umbilical arteries. In the caudal vena cava, there was an increase in PSV, whereas the EDV was constant, with a significant increase on Day 63. Peak systolic velocity and EDV of the uteroplacental artery reduced significantly on Day 63. Resistance index of the umbilical artery progressively decreased. In the aorta, this reduction was detected only on Day 42, with no defined pattern in the caudal vena cava and uteroplacental artery. Pulsatility index of the aorta varied. Although pulsatility increased in the caudal vena cava on Day 35 and remained elevated, pulsatility was significantly reduced in the umbilical artery by Day 63. The pulsatility index of the uteroplacental artery was constant (increased only on Day 63). Triplex Doppler evaluation could be a useful adjunct for prenatal care of pregnant queens, including assessment of vascular gestational development and prediction of gestational age.     

甲状腺结节良恶性的彩色多普勒超声特征及其诊断价值分析

目的:研究甲状腺结节良恶性的彩色多普勒超声特征及其诊断价值。方法:选取从2016年3月~2019年2月于我院接受手术治疗的甲状腺疾病患者300例作为研究对象,均予以彩超检查,比较甲状腺良恶性结节的超声特征(主要包括直径、钙化情况、边界、回声、血流状况)。以病理活检结果为金标准,分析彩超诊断甲状腺结节良恶性的敏感性、特异性以及准确度。对比甲状腺良恶性结节的血流分型情况以及各项血流动力学参数。结果:恶性结节超声特征直径≥2 cm、有钙化、边界模糊、无回声/低回声、血流丰富人数占比均高于良性结节(均P<0.05)。以手术病理组织活检结果作为金标准,彩色多普勒超声诊断甲状腺结节的敏感性、特异性以及准确度分别为97.73%、86.11%、96.33%。甲状腺良性结节血流分型为Ⅰ型、Ⅱ型人数占比高于恶性结节,而Ⅲ型、Ⅳ型人数占比低于恶性结节(均P<0.05)。甲状腺良性结节的收缩期峰值血流速度(PSV)、阻力指数(RI)均低于恶性结节,而舒张末期血流速度(EDV)高于恶性结节(均P<0.05)。结论:彩色多普勒超声对甲状腺结节良恶性的鉴别价值较高,且具有较高的敏感性、特异性以及准确度,可为甲状腺良恶性结节的早期诊断、临床治疗提供重要的参考依据。     

Aortic velocity contours at abdominal branches in anesthetized dogs

Pulsed Doppler velocimetry was used to record a grid of velocity waveforms 0.5 cm downstream of the cephalic mesenteric and left renal branches of the aorta in anesthetized dogs. Aortic velocity contours at different phases of the pulse cycle were developed from the grid of waveforms. Transient flow recirculation occurred in the post-systolic phase of the pulse cycle at the aortic wall opposite the branch artery. There was no recirculation at the systolic peak but there was asymmetry of the velocity profile. In contrast, in the in vivo post-stenotic velocity field recirculation persists throughout most of the cycle. These results compare well with similar results from pulsatile model studies. Spectral width of the Doppler signal was not increased in any of the velocity waveforms immediately downstream of the branches, this suggests that flow is relatively undisturbed in these locations.     

Electromechanical and structural alterations in the aging rabbit heart and aorta

Aging increases the risk for arrhythmias and sudden cardiac death (SCD). We aimed at elucidating aging-related electrical, functional, and structural changes in the heart and vasculature that account for this heightened arrhythmogenic risk. Young (5-9 mo) and old (3.5-6 yr) female New Zealand White (NZW) rabbits were subjected to in vivo hemodynamic, electrophysiological, and echocardiographic studies as well as ex vivo optical mapping, high-field magnetic resonance imaging (MRI), and histochemical experiments. Aging increased aortic stiffness (baseline pulse wave velocity: young, 3.54 ± 0.36 vs. old, 4.35 ± 0.28 m/s, P < 0.002) and diastolic (end diastolic pressure-volume relations: 3.28 ± 0.5 vs. 4.95 ± 1.5 mmHg/ml, P < 0.05) and systolic (end systolic pressure-volume relations: 20.56 ± 4.2 vs. 33.14 ± 8.4 mmHg/ml, P < 0.01) myocardial elastances in old rabbits. Electrophysiological and optical mapping studies revealed age-related slowing of ventricular and His-Purkinje conduction (His-to-ventricle interval: 23 ± 2.5 vs. 31.9 ± 2.9 ms, P < 0.0001), altered conduction anisotropy, and a greater inducibility of ventricular fibrillation (VF, 3/12 vs. 7/9, P < 0.05) in old rabbits. Histochemical studies confirmed an aging-related increased fibrosis in the ventricles. MRI showed a deterioration of the free-running Purkinje fiber network in ventricular and septal walls in old hearts as well as aging-related alterations of the myofibrillar orientation and myocardial sheet structure that may account for this slowed conduction velocity. Aging leads to parallel stiffening of the aorta and the heart, including an increase in systolic stiffness and contractility and diastolic stiffness. Increasingly, anisotropic conduction velocity due to fibrosis and altered myofibrillar orientation and myocardial sheet structure may contribute to the pathogenesis of VF in old hearts. The aging rabbit model represents a useful tool for elucidating age-related changes that predispose the aging heart to arrhythmias and SCD.     

Autonomic nervous system regulation of epicardial coronary vein systolic and diastolic blood velocity as measured by a laser Doppler velocimeter

The velocity of blood in a major epicardial coronary vein accompanying the left anterior descending coronary artery of dogs was measured by means of a 140-micron fiber optic probe connected to a laser Doppler velocimeter. Right atrial pressure, left ventricular intramyocardial and cavity pressures, aortic pressure, as well as peripheral and central coronary venous pressures were compared with the velocity of blood measured in the epicardial coronary vein midway between the sites of the catheters measuring proximal and distal coronary vein pressures. During control conditions, coronary vein velocity was 14-18 cm/s during systole and 1.0-2.1 cm/s during diastole. Right stellate ganglion stimulation, norepinephrine or isoproterenol increased diastolic coronary vein velocity significantly, whereas left stellate ganglion stimulation did not. Average peak systolic velocity was not affected by these interventions. During these positive inotropic interventions, the peak coronary vein velocity usually occurred later in the cardiac cycle than during control conditions. Positive inotropic interventions appeared to decrease coronary vein velocity during systole and increase it during diastole. Left vagosympathetic trunk stimulation decreased diastolic but not systolic coronary vein velocity and usually caused peak coronary vein velocity to occur earlier in the cardiac cycle than during control states. Changes induced by vagosympathetic trunk stimulation usually occurred within one cardiac cycle. It is concluded that coronary vein blood velocity can be influenced by the autonomic nervous system.     

The effects of prostacyclin and thromboxane analogue (U46619) on the fetal circulation and umbilical flow velocity waveforms

In placental insufficiency and pre-eclampsia the relative production rates of prostacyclin and thromboxane by the placenta and umbilical vessels are altered and the Doppler umbilical flow velocity waveform shows a high resistance pattern. To investigate the control of umbilical placental blood flow by those eicosanoids either prostacyclin (10 micrograms/min), or the thromboxane analogue U46619 (10 ng/min) was infused into the distal aorta of 12 chronically catheterized fetal lambs at day 125. Thromboxane produced a rise in mean arterial pressure and a rise in the systolic diastolic ratio of the umbilical artery flow waveform (2.6 to 3.1; P less than 0.05). Umbilical blood flow did not change and there was no evidence of altered flow to other organs. Prostacyclin caused a fall in fetal mean arterial pressure and a decrease in the umbilical artery systolic diastolic ratio (2.9 to 2.4; P less than 0.05). Prostacyclin produced a three-fold increase in lung perfusion (and the onset of fetal breathing movements) and this was associated with a 90% reduction in muscle blood flow (hindlimb muscle flow reduced from 12.5 to 1.1 ml.min-1 100g-1; P less than 0.01). We conclude that the local release of thromboxane in the fetal placental vascular bed could account for the rise in systolic diastolic ratio seen in umbilical placental insufficiency.     

高危孕妇胎儿缺氧与彩色多普勒超声结合四维超声检查的相关性研究

摘要 目的：探讨与研究高危孕妇胎儿缺氧与彩色多普勒超声结合四维超声检查的相关性。方法：2018年2月到2020年1月在本院进行建档分娩的高危孕妇108例作为研究对象,都给予彩色多普勒超声结合四维超声检查,记录影像学特征,判定胎儿缺氧发生情况并进行相关性分析。结果：在高危孕妇108例中,发生宫内缺氧28例（宫内缺氧组）,发生率为25.9 %;宫内缺氧组的大脑中动脉、脐动脉的阻力指数（RI）、搏动指数（PI）、收缩期峰值流速舒张期流速比值（S/D）均高于非宫内缺氧组（P<0.05）;宫内缺氧组的上腔静脉血流心室收缩期峰值流速（S波）、心房收缩期速度（A波）、心室舒张期峰值流速（D波）均高于非宫内缺氧组（P<0.05）;高危孕妇108例中,Spearsman分析显示大脑中动脉、脐动脉的RI、PI、S/D以及上腔静脉血流S、D、A均与宫内缺氧都存在相关性（P<0.05）;logistic多因素回归分析显示：大脑中动脉、脐动脉的S/D与上腔静脉血流S、A为导致胎儿缺氧的主要影响因素（P<0.05）。结论：高危孕妇胎儿缺氧与彩色多普勒超声结合四维超声检查特征具有相关性,彩色多普勒超声结合四维超声可作为检查胎儿缺氧的可行、简单无创、方便快捷的方式,具有极高的应用价值。     

Influence of Intraaortic Balloon Pump Counterpulsation on Transesophageal Echocardiography Derived Determinants of Diastolic Function

Introduction

Intraaortic balloon pump counterpulsation (IABP) is often used in patients with acute coronary syndrome for its favourable effects on left ventricular (LV) systolic function and coronary perfusion. However, the effects of IABP on LV diastolic function have not been comprehensively investigated. Acute diastolic dysfunction has been linked to increased morbidity and mortality. The aim of this study was to examine the influence of IABP on LV diastolic dysfunction using standard TEE derived parameters.

Methods

Intraoperative TEE was performed in 10 patients (mean age 65 ± 11 yrs) undergoing urgent coronary artery bypass graft surgery (CABG), who had received an IABP preoperatively. TEE derived measures of diastolic dysfunction included early to late transmitral Doppler inflow velocity ratio (E/A), deceleration time (Dt), pulmonary venous systolic to diastolic Doppler velocity ratio (S/D), transmitral propagation velocity (Vp), and the ratio of early to late mitral annular tissue Doppler velocities (e’/a’). Statistical analyses included the Wilcoxon Sign-Rank test, and a p<0.05 was considered significant.

Results

Transmitral inflow E/A ratios increased significantly from 0.86 to 1.07 (p < 0.05), while Dt decreased significantly from 218 to 180 ms (p < 0.05) with the use of IABP. Significant increases in Vp (34 cm/s to 43 cm/s; p < 0.05), and e’/a’ (0.58 to 0.71; p < 0.05) suggested a favourable influence of intraaortic counterpulsation on diastolic function.

Conclusion

The use of perioperative IABP significantly improves TEE derived parameters of diastolic function consistent with a favourable impact on LV relaxation in cardiac surgery patients undergoing CABG.     

Ultrasound studies in varicocele

Renal function, the anatomic and functional status of the vena cava inferior, renal arteries and veins, and spermatic veins were evaluated in healthy individuals and patients with varicocele before and 12 months after laparoscopic ligation of the left spermatic vein. The renal vessels were assessed by color Doppler ultrasonography and renal function was examined by complex radionuclide study with 99mTc-pentatech. There were no significant changes in the diameter of renal arteries and vena cava inferior and the right arterial blood flow velocities in healthy individuals and patients. No difference were found in the diameter of renal veins and in the blood flow velocity in renal arteries and veins. The enlarged renal veins and decreased mean blood flow velocity in the left renal vein in healthy persons and patients with varicocele and lower blood flow in the left renal artery than in the right one indicate left-sided renal hypertension that is attributable to left renal vein overload due to a great variety of collaterals and to compression at the site of "a forcepts". At the same time 12-month postoperative ultrasonic, Doppler and complex radionuclide studies revealed no significant changes in the diameter and blood flow velocity in the left renal vein.     

戊巴比妥钠和乌拉坦对超声检测兔肾血流动力学变化的影响探讨

目的比较戊巴比妥钠和乌拉坦两麻醉剂在超声监测兔肾血流动力学变化的影响。方法选用日本大耳白兔24只,随机分组,戊巴比妥钠和乌拉坦麻醉两组,每组12只。采用频谱多普勒检测兔肾各级肾动脉血流参数。结果乌拉坦组各级肾动脉收缩期峰值流速（Vmax）,舒张期最低流速（Vmin）均明显高于戊巴比妥钠组（P〈0.05）,动脉搏动指数（PI）和阻力指数（RI）无明显变化（P〉0.05）。结论为保证超声监测兔肾血流动力学实验数据的准确性,戊巴比妥钠麻醉较乌拉坦麻醉更适合。     

CTA联合CEUS在锁骨上皮瓣术前设计中的应用

目的:探讨计算机断层扫描血管造影(CTA)联合对比增强超声(CEUS)在锁骨上皮瓣术前设计中的应用价值。方法:将2016年1月2018年12月本院收治的15例锁骨上皮瓣术前患者作为研究对象。所有患者术前进行CTA和CEUS联合检查以观察锁骨上动脉穿支解剖变异及走行,应用于锁骨上皮瓣术前的辅助设计,评估该方法的成功率和并发症的发生情况。结果:15例患者的锁骨上动脉来源于颈横动脉,其中5例(33.33%)来自甲状颈干,10例(66.67%)来自锁骨下动脉。CTA检查中,10例识别出右锁骨上动脉,血管平均长度为(38.25±11.08)mm,血管平均直径(1.52±0.45)mm;13例确定了左锁骨上动脉,血管平均长度为(38.14±11.05)mm,血管平均直径(1.52±0.51)mm。CEUS检查的15个皮瓣中,发现27个胸锁骨上动脉的胸廓分支(TBSA),平均口径为(0.8±0.2)mm,平均收缩期峰值流速(PSV)为(11.95±2.08)cm/s。所有病例(100%)术中观察皮瓣血管数量、走形等情况与术前影像学相一致的手术结果。与造影剂有关的并发症发生率为6.67%。所有患者均随访1年以上,无进一步并发症,手术效果满意。结论:将CTA和CEUS相结合用于锁骨上皮瓣术前的辅助设计,可互为补充,尤其适用于锁骨上皮瓣(SCF)存在血管解剖变异而且管径细小的皮瓣术前设计。     

Diastolic dysfunction and intraventricular dyssynchrony are restored by low intensity exercise training in obese men

The aim of this study was to evaluate the impact of a low-intensity training program on subclinical cardiac dysfunction and on dyssynchrony in moderately obese middle aged men. Ten obese and 14 age-matched normal-weight men (BMI: 33.6 ± 1.0 and 24.2 ± 0.5 kg/m(2)) were included. Obese men participated in an 8-week low-intensity training program without concomitant diet. Cardiac function and myocardial synchrony were assessed by echocardiography with tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE). At baseline, obese men showed diastolic dysfunction on standard echocardiography, lower strain values (systolic strain: 15.9 ± 0.9 vs. 18.8 ± 0.3%, diastolic strain rate: 0.81 ± 0.09 vs. 1.05 ± 0.06 s(-1)), and significant intraventricular dyssynchrony (systolic: 13.3 ± 2.1 vs. 5.4 ± 2.1 ms, diastolic: 17.4 ± 3.2 vs. 9.1 ± 2.1 ms) (P < 0.05 vs. controls for all variables). Training improved aerobic fitness, decreased systolic blood pressure and heart rate, and reduced fat mass without weight loss. Diastolic function, strain values (systolic strain: 17.4 ± 0.9%, diastolic strain rate: 0.96 ± 0.12 s(-1)) and intraventricular dyssynchrony (systolic: 3.3 ± 1.7 ms, diastolic: 5.5 ± 3.4 ms) improved significantly after training (P < 0.05 vs. baseline values for all variables), reaching levels similar to those of normal-weight men. In conclusion, in obese men, a short and easy-to-perform low intensity training program restored diastolic function and cardiac synchrony and improved body composition without weight loss.     

Diastolic dysfunction is associated with cardiac fibrosis in the senescence-accelerated mouse

Diastolic heart failure is a major cause of mortality in the elderly population. It is often preceded by diastolic dysfunction, which is characterized by impaired active relaxation and increased stiffness. We tested the hypothesis that senescence-prone (SAMP8) mice would develop diastolic dysfunction compared with senescence-resistant controls (SAMR1). Pulsed-wave Doppler imaging of the ratio of blood flow velocity through the mitral valve during early (E) vs. late (A) diastole was reduced from 1.3 ± 0.03 in SAMR1 mice to 1.2 ± 0.03 in SAMP8 mice (P < 0.05). Tissue Doppler imaging of the early (E') and late (A') diastolic mitral annulus velocities found E' reduced from 25.7 ± 0.9 mm/s in SAMR1 to 21.1 ± 0.8 mm/s in SAMP8 mice and E'/A' similarly reduced from 1.1 ± 0.02 to 0.8 ± 0.03 in SAMR1 vs. SAMP8 mice, respectively (P < 0.05). Invasive hemodynamics revealed an increased slope of the end-diastolic pressure-volume relationship (0.5 ± 0.05 vs. 0.8 ± 0.14; P < 0.05), indicating increased left ventricular chamber stiffness. There were no differences in systolic function or mean arterial pressure; however, diastolic dysfunction was accompanied by increased fibrosis in the hearts of SAMP8 mice. In SAMR1 vs. SAMP8 mice, interstitial collagen area increased from 0.3 ± 0.04 to 0.8 ± 0.09% and perivascular collagen area increased from 1.0 ± 0.11 to 1.6 ± 0.14%. Transforming growth factor-β and connective tissue growth factor gene expression were increased in the hearts of SAMP8 mice (P < 0.05 for all data). In summary, SAMP8 mice show increased fibrosis and diastolic dysfunction similar to those seen in humans with aging and may represent a suitable model for future mechanistic studies.