/pdf/diagnosis-and-management-of-aortic-dissection-ol93ou3jw4.pdf

Diagnosis and management of aortic dissection

Background—Although myocardial ischemia is known to be significantly related to the development of coronary collateral vessels (CCVs), there is considerable variation between patients with ischemic heart disease in the presence of collateral development. The nature of this variability is not well known. Likewise, it remains unclear whether diabetes mellitus (DM) has any effect on CCVs. The aim of this study was to evaluate the effect of DM on CCVs. Methods and Results—Of the patients who underwent coronary angiography during the interval between March 1, 1993, and June 20, 1998, in our institution, 306 were diabetic. Those patients in whom coronary angiography is normal or severity of coronary artery stenosis is thought not to be sufficient for the development of CCVs ( 75...

Effect of diabetes mellitus on formation of coronary collateral vessels.

Endovascular stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patients: A multicenter comparative trial

To evaluate the impact of elimination of the morning peak of cardiovascular events, we performed a meta-analysis of studies of circadian variation of myocardial infarction and sudden cardiac death. The impact would be significant because approximately 1 of every 11 acute myocardial infarctions and 1 of every 15 sudden cardiac deaths are attributable to the morning excess incidence.

Meta-analysis of the morning excess of acute myocardial infarction and sudden cardiac death.

The invention provides an endovascular graft system for repair of aneurysms. The graft system includes a trunk component and first and second leg components. The graft components include graft material supported by a plurality of stents which are spaced apart and affixed to the graft material in a manner that allows articulation of the graft system without excessive wear of the graft material. The stents are formed by intersecting struts which may be tapered to relieve stress. A stabilizing mechanism is provided to stabilize the position of the legs with respect to the trunk when the graft system is deployed.

Endovascular graft system

Background—Recently, thoracic aortic stent grafting has emerged as an alternative therapeutic modality for patients with thoracic aortic aneurysms and aortic dissections. However, its application has been limited to descending thoracic aortic aneurysms distal to the aortic arch. We report our initial clinical experience of endovascular branched stent graft repair for aortic arch aneurysms. Methods and Results—Endovascular grafting with Inoue branched stent grafts was attempted for 15 patients with thoracic aortic aneurysms and aortic dissections under local anesthesia (n=14) or general anesthesia (n=1). Single-branched stent grafts were used in 14 patients, and a triple-branched stent graft in one. The branched stent grafts were delivered through a 22F or a 24F sheath under fluoroscopic guidance and implanted across the aneurysmal aortic arch. In 2 patients, the single-branched stent graft did not pass through the 22F sheath used. Complete thrombosis of the aneurysm was ultimately achieved in 11 patients ...

Aortic Arch Reconstruction by Transluminally Placed Endovascular Branched Stent Graft

Background Collateral growth is induced by chemical signals from the ischemic myocardium. We hypothesized that angiogenic growth factors are produced by cardiac tissue; they are diffusible, more concentrated in pericardial fluids, and are increased by myocardial ischemia.

Methods and Results With the use of an enzyme-linked immunosorbent assay, we measured the concentrations of basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF) in pericardial fluids of 12 patients with unstable angina (group 1) and of 8 patients with nonischemic heart diseases (group 2). The levels of protein in pericardial fluids were quite comparable between the two groups (34±2 versus 32±4 mg/mL). The concentration of bFGF in pericardial fluids in group 1 was 2036±357 pg/mL, significantly ( P <.001) higher than the 289±72 pg/mL in group 2. The amount of bFGF per milligram of protein was also significantly ( P <.05) higher in group 1 than in group 2 (67±15 versus 12±4 pg/mg). The concentration of VEGF in pericardial fluids tended to be higher in group 1, but the difference was statistically insignificant (39±7 versus 22±6 pg/mL). The amount of VEGF per milligram of protein was 1.2±0.3 pg/mg in group 1, similar to the 0.8±0.4 pg/mg in group 2.

Conclusions This finding provides new evidence that bFGF plays an important role in mediating collateral growth in humans.

Elevated Basic Fibroblast Growth Factor in Pericardial Fluid of Patients With Unstable Angina

Clinical endovascular placement of branched graft for type B aortic dissection

Marked Elevation of Brain Natriuretic Peptide Levels in Pericardial Fluid Is Closely Associated With Left Ventricular Dysfunction

http://repository.kulib.kyoto-u.ac.jp/dspace/bitstream/2433/181230/1/yigar01689.pdf

Terumitsu Tanaka

Papers

Aortic Arch Reconstruction by Transluminally Placed Endovascular Branched Stent Graft

Elevated Basic Fibroblast Growth Factor in Pericardial Fluid of Patients With Unstable Angina

Clinical endovascular placement of branched graft for type B aortic dissection

Marked Elevation of Brain Natriuretic Peptide Levels in Pericardial Fluid Is Closely Associated With Left Ventricular Dysfunction

Improvement of exercise capacity by sarpogrelate as a result of augmented collateral circulation in patients with effort angina